1. Our team approach brings together highly experienced prostate cancer experts from across disciplines to collaborate on each patients total care, from diagnosis through treatment and recovery. This doctor or team of doctors will review the following: The doctor then communicate their opinion regarding treatment to both the patient and the primary physician. Metastatic disease considered less likely for this pattern. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. It is very rare (<3% of all prostrate cancers) and potentially very lethal (one study showed that 59% of men in the study with Gleason scores of 5 had died within 3 years and it had metastasized in 13% of the remaining men). The results seemed fairly benign and my urologist and I decided to continue to monitor with 2 more PSA tests and then consider an MRI in April 2021. Does 3+4 at some point typically evolve into 4+3 and also serve as a trigger point for moving from AS to treatment? Im currently 67 years old. Targeted MR/Fusion biopsy of one 4x8 mm lesion on Right side showed 3+3 in 2 of 5 cores (20% of total volume), and random Right side: 1 core 3+4 (10%, 20% on second opinion from Johns Hopkins) and 1 core 3+3 (10% volume) ; Left Side 1 core 3+3 (10%, no PCa on second opinion from Johns Hopkins). I'm currently in the process of getting an appointment set up with a Dr. Wang at UCLA. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Recovery from Prostate Cancer | Bills Story. I still have some urgency and frequency issues, but I am not complaining too bad. I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. The peripheral zone has a patchy signal pattern. 2. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. * IF ANYONE reading this doesn't believe in the value of MRI first and targeted biopsy next then take note that my systematic biopsy cores showed 0 positive in 8 cores and my MRI guided core samples were 6 for 6 being positive! Whats right for you will depend on the stage of the cancer, your level of risk and your general overall health. Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. :) Prostate, right lateral base: Covid turned the 1 year into 16 months and PSA tested at 7.44 in August 2020, followed by another referral back to the urologist. I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. Which Patients Report That Their Urologists Advised Them to Forgo Initial Treatment for Prostate Cancer? FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. That's the good news. 6: Prostate, left medial base Some men may have an enlarged prostate but not notice it. Benign Processes: Bethesda, MD 20894, Web Policies restricted diffusion. The people were great. Cancer vaccines.For a long time, the promise of cancer vaccines that would protect healthy people at high risk of cancer has only dangled in front of researchers. Oncologist. The TRUS biopsy is behind me, the second opinion from Johns Hopkins is behind me, and its time for next steps. I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. I have developed an "abscess" on my prostate. I would love to hear from anyone who has been involved in the Chicago study. Last checkup (July 2022) my PSA was .46 and it is currently at .32.I am still eating primarily a plant based diet (only lean meats/cheeses/eggs about 10% of my diet) and maintaining steady weight and I am still quite active physically.As for symptomswith 5mg Daily Cialis the occasional ED symptoms have pretty much gone away. JAMA Netw Open. Treatment must be chosen based on stage and your Study after study confirms that doctors favor the treatment they are trained to do urologists typically recommend surgery and radiation oncologists recommend radiation. Prostate, right anterior MRI lesion: 3. I was on active surveillance after a FLA procedure done in 2018. Left mid-base transition zone (PIRADS 5). You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? That being said, they can be a beneficial member of the treatment team. Methods: Benign Processes: My Oncotype rating was GPS 54, with a 26% chance of metastisis within 10 years. We are vaccinating all eligible patients. You're at greater risk if you're Black or of African ancestry. T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive have no symptoms, and yet you have cancer? The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. EVERY DAY, they'd take a low dose X-RAY and low dose CT to align the fiducials and ensure my bladder was full and the bowel was empty. Thank you for your understanding and cooperation. PROSTATE ADDITIONAL FINDINGS: Benign prostatic lesion. And just this week, 1 YEAR post treatment, it is .46. Based on the results, our experts can provide you with an individualized treatment plan before you leave. I have requested a second pathologist's opinion from Johns Hopkins based on feedback from this forum. Some specialists have more expertise and more experience than others. Good Luck and God Bless everyone. Six weeks later I have the biopsy in his office and a week later I get the results. Associated fees may be incurred up to $1,800 in a minority of more complicated cases requiring special studies. 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. For these reasons, it is a good idea for HMO members to get a second opinion and make sure they are informed about clinical trials or other promising new treatments. A enlarged prostate can also cause blockages in the urethra. I am also not comfortable making a decision based upon 1 genomics test, when my other prior test(s) disagrees and the gleason score disagrees. If you are diagnosed with a urologic cancer, including but not limited to the prostate, bladder, kidney, and testicular or urinary tract, its important to consider a second opinion. Dont Miss: Screening For Prostate Cancer Icd 10. 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. In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could . Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. It hasn't let me down. 4. I was to follow up with my new Urologist (another surgeon) for 3 months PSA checks and annual 3T-MPMRI.My PSA checks were static and the next year's MRI looked just like the first. Grade Group: 2 Other: There is trace ascites in the mesosigmoid. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. As I said, I am 58, so I would really like to preserve my quality of life for as long as possible, but the genomics report has me concerned. 4: Prostate, right medial base The problem is that all 3 pathologies noted an intraductal component. Extracapsular extension: The prostatic capsule is preserved. Ramsey SD, Zeliadt SB, Fedorenko CR, Blough DK, Moinpour CM, Hall IJ, Smith JL, Ekwueme DU, Fairweather ME, Thompson IM, Keane TE, Penson DF. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. 2. Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. When I was diagnosed I really thought that I will live only 2 years. I also had my PTEN test by META-MARK ( I don't have much to say about how I was treated by MM, but I won't be using their services again). Video consultation and written report from your expert. Also, their protocol would be another biopsy, but he was comfortable with the image and velocity of PSA that he didn't have to have one to start treatmentand I was pretty hesitant (given the image and PSA) to take ADT, and didn't see a biopsy changing my mind regarding treatment and/or ADT.Oh. The survey asked the men if they had opted for a second opinion from a urologist following their diagnosis of prostate cancer, and the reasons for the second opinion. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. Have been told a health condition is not treatable. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. When to move from Active Surveillance to Treatment for Prostate Cancer? !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. It has been 2.5 years and the PSA has still not doubled as well. the transition zone. The percentage of tissue with carcinoma is 70% Below is the link with instructions and the authorization form for you to use with your doctor. So, Radiation Oncologist prescribed Cialis 5mg, daily. doi: 10.1002/cncr.30412. This has only low-level nonspecific activity with SUV max of 2.05 and may be due to degenerative changes at the symphysis pubis." By Dec 2019, my PSA reached 4.13. 53 years old Abstract Context: In men who develop an elevated serum prostate-specific antigen level (PSA) after having undergone a radical prostatectomy, the natural history of progression to distant metastases and death due to prostate cancer is unknown. If the enlarged prostate is not completely removed, it will shrink. Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. 9: Prostate, left anterior MRI lesion I assume it is not free. Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. The Journal of the American Board of Family Medicine published a study in 2017 that found that many patients do not get a second opinion outside of their PCPs original referral2. Dr. Jonathan Epstein of Johns Hopkins University Hospital. Im immediately referred to Urologist. H. Prostate, lesion #2, core biopsy: Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. -------------------------------------------------------- With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. An official website of the United States government. Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. Surabhi Dangi-Garimella, PhD. (PZ) - normal BJU Int. 8600 Rockville Pike Surgery took about 3 hrs. I didn't study for the test and it's possible some morning activities might have affected my test score :) 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." After applying exclusion criteria, the final analytic cohort included 2365 respondents. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 2 of 2 cores (medial core: 3.5 mm, 30%; lateral core: 2.5 mm, 20%), 0.5 mm to the blue inked tissue edge (the closer) Thanks for Everyone's Help, And in some cases, the information you gain during a second opinion consultation can even change your diagnosis. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. There are lots of lessons learned on the forum. Unfortunately, the 12/20/20 PSA reading was higher and that led to an MRI on 2/2/21 when two lesions were discovered. PI-RADS v2 score: 5. very activerun/cycle 6 days a week First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. We will give that a shot and see how it turns out. John, I was diagnosed on 11 December, 2013. poorly defined margins and intermediate to low T2. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. My experience at Johns Hopkins was awesome. 7 in 10 PATIENTS WHO GET A SECOND OPINION AT CTCA CHOOSE TO TREAT WITH US Call now to find out why: 800.888.8888 Rosie P. Colorectal Cancer BASE DATA: 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. His second opinion just came back. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night. So my question for you is have you ever heard of PRECISE and if so what should I make of it? 4, Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion. Blessings. EDI am now 52 and not quite functioning like I did 4+ years ago. Thank you! With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3500 specialists. Reason was large volume of cancer (even though most of mine was Gleason 6), presence of Gleason 7 in biopsy and the rapidly increasing PSA. Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. 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. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Urologists are trained as surgeons, radiation oncologists administer radiation, and medical oncologists provide cognitive oversight and general management of the cancer. Us Too Prostate is a great club and many of you have helped me a lot already. What are you doing about it? 2020 Jul 21;19(1):112. doi: 10.1186/s12904-020-00619-9. Cancer 2017;123:1027-34. In 2006 my PSA was .6. We have a consult on Friday with the 1st opinion doc to review all tests. The study was published online Nov. 7 in the journal Cancer. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Low post-void residual volume is You May Like: Prostate Radiation Treatment Side Effects. The prostates function is to create some of the fluid that insulates sperm cells found in semen. Further, the two tumors in question have not really changed much in size for more than 2 years. Compared to younger men, men 70-74 years old and men 75 years were less likely to obtain a second opinion whereas men with college graduate level education or beyond were more likely compared to men with less than high school level education. The best protection for cancer patients who are Health Maintenance Organization members is to seek a second opinion even if she or he has to pay for it. The more accurate the information we have, the better our treatment decisions. Low volume post-void residual urine is present in the bladder. It may be a new cancer, but it is more likely a recurrence since it is really near the ablation zone. Are considering a treatment that involves significant risks, such as surgery. A new study by researchers at the Johns Hopkins University has found that . (I must say that those low numbers concern me a bit.) Obtaining a second opinion in Pathology can in a small percent of cases lead to a complete change in diagnosis in a wide range of conditions including non-cancerous growths, inflammatory disorders, infections, and cancer. Hi All, After a second opinion from both Johns Hopkins and Stanford, the two 4+3's were downgraded. We can help with your case. - High grade prostatic intraepithelial neoplasia (HGPIN) Hillen MA, Medendorp NM, Daams JG, Smets EMA. Dr. Albert Chang at UCLA appears to be the best in the biz for high dose rate (HDR) focal brachytherapy. My understanding is that brachy is great for efficacy with less risk to the bowel and the same risk for incontinence and ED as other forms of radiation. Thank you, After more than three years on active surveillance, I've pretty much decided to have focal brachytherapy for my prostate cancer. This urologist can get you in for surgery next week. Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated. However, that information will still be included in details such as numbers of replies. Day 7 after surgery I took my last pain pill. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. Details are here: Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. With that alone, I would likely be a candidate for continued Active Surveillance. We will then prepare a written recommendation regarding your treatment plans or options. The percentage of tissue with carcinoma is 45% - PI-RADS for this lesion = 4/5 transition zone. Prostate Cancer Grading: A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. Shore ND, Karsh L, Gomella LG, Keane TE, Concepcion RS, Crawford ED. Find more COVID-19 testing locations on Maryland.gov. Brachytherapy Experience with Dr. Albert Chang at UCLA? The out-of-pocket cost may be in the $300 range (insurance may not cover it), and it is a simple matter to call your urologist to forward the slides to them. Fear motivates you to want to treat this as soon as possible. National Library of Medicine Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. The issues in my prostate from the first procedure onward have all been in the same area and the rest of my prostate from the first biopsy and subsequent MRIs onward have never shown any indications of cancer in other areas. Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. Benign Processes: 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. Using an Ellipsoid Volume the dimensions would give you a volume of 20.44. prostate volume). Benign fibromuscular stroma; no prostatic glands are identified Fear, confusion and uncertainty set in. I sent a message to my urologist requesting my slides be sent to Dr. Epstein at Johns Hopkins for a second opinion and I also requested an Oncotype DX test to get an idea of risk for my low teal or basic teal cancer. Note respondents were able to choose more than one reason. I am 62 years old. Benign Processes: When first diagnosed with prostate cancer, your PCP will generally refer you to a urologist for a biopsy. Using the Bullet Volume gives you gland of 25.55. The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. -------------------------------------------------------- Johns Hopkins second opinion - nothing found. Greatest dimension 0.7cm . My first PSA was 8.03. Possible additional organ confined malignant lesion in right apex Should You Exercise When Youre Expecting? Many thanks for that. I was on disability from work the entire time (not that I was disabled, but as a pilot, I couldn't very well work and get treatment at the same time. Time moves fast when dealing with cancer, but Doctors dont. In the mean time my PSA was movingno longer static, but never back up to 6. government site. Prostate, right lateral apex: Conflicting Prostate Biopsy OpinionsWhat to Do? I find that when I'm trapped in the cockpit not able to use the bathroom for a long time is when I experience that most. I appreciate all the input because I am a little overwhelmed and confused as to the best course of treatment. Obtaining a second opinion in Pathology can in a small percent of cases lead to a complete change in diagnosis in a wide range of conditions including non-cancerous growths, inflammatory disorders, infections, and cancer. * Location: Right, anterior, apex, peripheral zone Prostate cancer is the second-most diagnosed cancer in American men. Getting a Second Opinion The best time to seek a second opinion is before you start treatment. 8. The .gov means its official. Every year I got a PSA and DRE during my annual physical. After all, it seems like good idea to deal with your cancer sooner rather than later. It didnt look at changes of grading of the cancer.The chances for some type of modification based on a second opinion are even greater than the study indicated.Asking for a second opinion could lead to a significant change in surgical or medical intervention, Netto says.Even if the diagnosis error isnt catastrophic, such as advising a patient that he has cancer when he really doesnt, an error in grading can be consequential. I retested in January 2019 and scored 4.20. official website and that any information you provide is encrypted Video consultation and written report from your expert. EDI am now 52 and not quite functioning like I did 4+ years ago. And it is OK to have paralysis by over-analysis. Getting a second opinion from us is easy, convenient, and all done remotely. It will be interesting to see, I think. The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. 4. We experienced information overload and decision/analysis paralysis. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. Cancer. During your visit, our specialists will review your medical records, diagnostic tests and other information provided by you or your current physician. They told me to expect a spike in my PSA sometime in the future, and they told me that studies are showing that a slow, steady decline in PSA is often indicative of superior results (whatever that means. 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. fibromuscular stroma, anterior prostatic contour is smooth. They did another 3T-MPMRI (Siemens machine) and it showed a faint area, near the margin, and very close to the down stream sphincter of prostate. An increase of 1.1 in 3 months is not good news. You think another treatment might be available. In order to give treatment for each patient with utmost security we would like to announce that currently there will be no visitors allowed.Please note that only one attendant per in-patients is permitted. All views would be appreciated. For all other cancer appointments, please call: 1-855-702-8222. Benign prostatic tissue Notice of Privacy Practices(Patients & Health Plan Members). They basically said it didn't matter. A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. Keep in mind that not all PCPs are knowledgeable about prostate cancer or know the skill levels of all the specialists in the field. 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.

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