Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. I did genetic testing and there were no mutations of concern, and everyone agreed that there probably wasn't "enough meat on the bone" to get a good genomic test from the biopsy.After seeing Dr Joe Busch, he said he didn't see any target lesions (PIRADS2), nor did he think I was in any danger. Symptoms include leaking and discomfort. Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: The more often a doctor diagnoses and treats prostate cancer the more proficient they become. -------------------------------------------------------- )As for side effectsI occasionally have some urgency/hesitancy having to pee. Prostate, right medial apex: lesion. There is no bony or bulky nodal disease in the pelvis I'm 58 yrs old and had a TRUS random biopsy October 2020 after my PSA continually stayed between 4.4 and 8, and PHI score was 126. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. As a result, patients struggle to differentiate bias from fact. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. Anyway, would appreciate knowing how to contact Johns Hopkins. Johns Hopkins second opinion - nothing found. 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm Seeking a Second Opinion - American Cancer Society - Benign prostatic tissue Federal government websites often end in .gov or .mil. 3. Unfortunately, monetary incentives create biases that can work against patients best interests. My questions are: I am 58 and in very good health otherwise. Johns Hopkins Health - Second Opinions, Second Chances - Hopkins Medicine I had a 3T mp MRI with coil bed, without and with contrast, at Emory on March 3. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. My Oncotype rating was GPS 54, with a 26% chance of metastisis within 10 years. * Size: 1.1 cm Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results. Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancer, Schaufeld Program for Prostate Cancer in Black Men, Read about the latest prostate cancer discoveries by our world-renowned researchers, Learn more about prostate cancer in our health library, Watch: What to expect during your post-surgery hospital stay. Fear, confusion and uncertainty set in. Family history of prostate cancer. This approach helps to decrease side effects that can affect a patients quality of life, such as erectile dysfunction, incontinence or other urinary-tract symptoms. Accessibility Atrophy not hear all the viable treatment options or receive the most up to date A second opinion can help you make an informed, confident decision about your medical care. This may include imaging, blood tests, prior treatment, and pathology reports. Get a Urology Second Opinion | Johns Hopkins Brady - Hopkins Medicine Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions. Dr. Albert Chang at UCLA appears to be the best in the biz for high dose rate (HDR) focal brachytherapy. I still have some urgency and frequency issues, but I am not complaining too bad. My strong preference would be to do FLA again and monitor. Prostate cancer is the second-most diagnosed cancer in American men. Would you like email updates of new search results? I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. 1. Whether you want expert confirmation, lack understanding or confidence in your treatment plan, have a rare or unusual type of cancer, your cancer isnt responding to current treatment its reassuring to know that you have options through a second opinion. The Radiation Oncologist said he would be comfortable waiting a little more, but he wasn't confident that I'd grow a target lesion, nor would I be able to wait years before having to do "something." And luckily I lived in Chattanooga and had mutual friends with Dr. Joe Busch (my Urologist never mentioned him, yet we could almost see his facility from the exam room in which he broke the news. I appreciate any comments or insight that anyone wants to share. Jonathan Epstein, M.D. "We were surprised by the relatively large percentage of men who obtain second opinions for their prostate cancer," said lead author Dr. Archana Radhakrishnan of Johns Hopkins University in . doi: 10.1002/cncr.30412. My experience at Johns Hopkins was awesome. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. Getting A Second Opinion On Your Pathology Report - Cancer ABCs Bladder: Normal. Grade Group: 2 Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? If they have an enlarged colon, their physician can perform a TURP procedure. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Bethesda, MD 20894, Web Policies No extraprostatic extension. Two from one lesion were positive as was one of the two from the other. A doctor may prescribe surgery or perform an endoscopic procedure. The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Precision Medicine Center of Excellence for Prostate Cancer, robotic-assisted radical laparoscopic prostatectomies, The Brady Urological Institute and the Johns Hopkins Kimmel Cancer Center take a, Our urologic surgeons have extensive experience performing, Our surgeons, oncologists and radiologists are also world leaders in prostate cancer research, giving patients access to the latest discoveries and. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. An acute bacterial infection can cause a burning sensation. Same with the amount of how much pattern 4. !I've pasted a previous update below for background.I just got my PSA results and the numbers are still trending in the right direction. I applaud Dr Scholz for his dedication and explanation of such a complex cancer, that has not had his common sense help available for men with prostate cancer. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. My goals are to control PCa, to minimize side effects, and to keep options open in the future. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. official website and that any information you provide is encrypted Cleveland Clinics Virtual Second Opinions program connects you to an expert physician who specializes in your specific health needs. * Perineural Invasion detected Conclusions: I also sent my biopsy slides to Johns Hopkins for a second opinion (Epstein's read was 3+4, but with lower pattern 4 involvement than the local pathologist.). For this study, published in the journal Cancer, 2386 men in the greater Philadelphia area, who were diagnosed with prostate cancer between 2012 and 2014, responded to survey questions. For all other cancer appointments, please call: 1-855-702-8222. Here are some recent updates: Uterine cancer.Women who use chemical hair straighteners frequently could have a higher risk of developing uterine cancer than women who have never used the products, according to new findings from a national study that has followed nearly 34,000 U.S. women for more than a decade. Nov 7, 2016. I'll post the whole thing, my doc and my own comments, and then cut/paste all my MRI results in case anyone REALLY liked data. Remember if you ship them include the following information: You May Like: Blood In Urine After Prostate Biopsy. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. Got my physical and normal DRE with new Dr. No issues identified. Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. I did ask some questions about the study, if anyone is interested. Johns Hopkins said I have options of adjuvant radiation approach up to 3-4months or wait to see if there are two successive rises in PSA and then do "salvage" approach. 2. I assume it is not free. 2: Prostate, right lateral base Hope to hear from a bunch of people. In My Opinion? Get A Second Opinion | ZERO Prostate Cancer I did genetic testing and there were no mutations of concern, and everyone agreed that there probably wasn't "enough meat on the bone" to get a good genomic test from the biopsy.After seeing Dr Joe Busch, he said he didn't see any target lesions (PIRADS2), nor did he think I was in any danger. A. Prostate, right base, core biopsy: The purpose of starting this discussion is to gather peoples thoughts and opinions and actual experiences with Prostate Focal Laser Ablation. Make an appointment: 410-955-5222 Coordinating with your Treating Physician At the Breast Cancer Program at the Johns Hopkins Kimmel Cancer Center in Baltimore, MD, a second opinion requires only that you or your doctor send us your pathology slides, key medical records and signed paperwork requesting the opinion. It is OK to be scared. I have requested a second pathologist's opinion from Johns Hopkins based on feedback from this forum. If you are considering undergoing a specialized treatment, such as cancer surgery, within your HMO, it is important to inquire about the number of such procedures performed each year by the HMO and the results. A second opinion is a review of the cancer diagnosis and the treatment recommendations of the physician who is treating the cancer by another, independent physician. My only concerned was heavy metal poisoning and didn't know how long AS would be beneficial since I was starting at a young age. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. Patient-Driven Second Opinions in Oncology: A Systematic Review. By basing a treatment PSA had increased to 5.4. information. P/ 310-827-7707 | F/ 310-574-4002 | MAIL@PROSTATEONCOLOGY.COM. Note respondents were able to choose more than one reason. A second opinion is part of the education process that is critical for many cancer patients. PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Considering Prostate Cancer Clinical Trials? government site. 2015 Feb;115(2):188-97. doi: 10.1111/bju.12665. Secondary Gleason grade: 4 We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. I then had the PHI test which showed PSA 8.70 and overall PHI 125.9. peripheral zone signal intensity on T2-weighted images. The total number of cores identified is 3 Benign Processes: ORIGINAL MRI REPORT (local radiology group): Those readings were reported on a second opinion by Dr. Epstein. By choosing the first doctor you speak with to be your treating physician, you may be putting your health in the hands of someone who lacks the expertise to accurately and safely treat your prostate cancer. desired outcome. I opted to waive the biopsy, wait 1 year and test again. 1st opinion"Nonspecific sclerotic change of the right pubic bone with low-level radiotracer activity, favor degenerative change rather than osseous metastasis." -------------------------------------------------------- Which Patients Report That Their Urologists Advised Them to Forgo Initial Treatment for Prostate Cancer? This shows very high signal intensity on the diffusion-weighted Secondary Gleason grade: 3 Steve, Groucho was wrong when he said "i don't want to belong to any club that would have me as a member." Receiving a second opinion was not associated with perceived quality of prostate cancer care. See this image and copyright information in PMC. restricted diffusion. Prostate, left lateral apex: 3. Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. Netto says patients should be proactive in requesting that doctors take another look. This puts PCPs in a unique position to impact the treatment decisionif they only refer to urologists and not to radiation oncologists or medical oncologistssurgery is a likely treatment outcome. * Gleason Score: 3+3 (2 of 6 specimens) You may choose to consider a second opinion if you: A new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice among men diagnosed with low-risk prostate cancer. 6. Epub 2017 Jun 12. Read Also: What Are The Signs Of Prostate Infection. And when I attempt to ask questions about intradcutal, I get responses about how little is known about it because it's so rare or that it is controversial or that they're not familiar with the study I'm referencing. I made the appointments. My diagnosis is T2c, Gleason 7 (3+4). Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. Benign Processes: 5. Just had my appointment today and they are pleased with the results, so far. 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion Seminal vesicles are normal. At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). It hasn't let me down. Prostate Cancer | Johns Hopkins Brady Urological Institute When first diagnosed with prostate cancer, your PCP will generally refer you to a urologist for a biopsy. Are you sure you want to block this member? I had the slides reviewed at Johns Hopkins and 1 of the HG PIN cores was changed to suspicious for adenocarcinoma while another HG PIN core was changed to benign. (Scores above 55 have a greater than 50% chance of finding clinically significant cancer on a biopsy) The biopsy showed 2 or 3 cores containing HG PIN but no cancer. Let me know what everyone thinks if you see anything interesting or of note here or just have some advice. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? Usually, patients obtain a second opinion after being referred to a second physician or to a special team of experts in a cancer center, called a multidisciplinary team. Who Should Request a Second Opinion? -------------------------------------------------------- Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. They may defer to the recommendation of the specialist, or refer you to a doctor with limited prostate cancer experience. 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. !I'll try editing a previous post and see if it reads like a journal instead of creating a new thread every update.I just got my PSA results and the numbers are still trending in the right direction. A newly published paper by Fischer et al. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. Am I wrong? The total number of cores identified is 3