But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). No two cases of prostate cancer are alike and an accurate diagnosisis critical to developing the best treatment plan. When people recommend going to a Center of Excellence, believe them. Dr. Erick Walser at University of Texas Medical Center. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. Grade Group: 2 Emotional outlook is fragile at times and straight clinical approach of doctors does not help. However, older men 75 years were the least likely to report obtaining a second opinion due to dissatisfaction with their initial urologist. The more accurate the information we have, the better our treatment decisions. A new study by researchers at the Johns Hopkins University has found that . We specialize in minimally invasive treatments for prostate cancer such as: We place a high priority on sparing the nerves and tissue around the prostate whenever possible. My diagnosis is T2c, Gleason 7 (3+4). This kills both birds with a single stone. )As for side effectsI occasionally have some urgency/hesitancy having to pee. LESION 2 However, there were no other suspicious areas on MRI. Every year I got a PSA and DRE during my annual physical. He spent an hour on the phone reassuring me that I didn't need to rush into anything, and they he'd love to scan me 6-8 weeks after my TRUS Biopsyhave to let the trauma and all the blood leave the prostate for a good image. We will give that a shot and see how it turns out. The only prescriptions I take are for GERD (Protonix), cholesterol (Atvorstatin), and allopurinol for an episode of gout that I got while doing physical rehab for a bad tibia break (I shattered my tibia plateau 2/2020 and have pretty much recovered). In the mean time my PSA was movingno longer static, but never back up to 6. What have your doctors told you? * Extracapsular extension: None. For all other cancer appointments, please call: 1-855-702-8222. Be sure to confirm your diagnosis at a center of excellence. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. Can it be salvaged or are the risks of cancer too high? Prostate, left lateral base: Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. 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. I just received a second opinion report from Johns Hopkins. Younger men were more likely to cite wanting more information about their cancer and to see the best doctor as the reason to seek a second opinion . very activerun/cycle 6 days a week * Adjacent organ invasion: None. And it is OK to have paralysis by over-analysis. Unlike pathology labs in most hospitals, Jonathan Epstein's lab at Johns Hopkins has pathologists who specialize in reading prostate tissue samples. Read books and realize as soon as they are published, they are outdated. Because physicians may differ in their approach to treating breast cancer, its very important to check with a breast cancer expert to know youre receiving the best treatment for you. In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? Im currently 67 years old. The Johns Hopkins Brady Urological Institute is known around the world for its expertise in diagnosing and treating urologic conditions. Thanks! Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. IMPRESSION: In circumstances where there may not be a single established standard of care, we can ensure the treatment plan integrates the most current, up-to-date data, Dr. Matasar says. OTHER: None. Their opinions are widely held to be definitive. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . Getting a second opinion can sometimes lead to a complete change in diagnosis in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. doi: 10.1002/cncr.30412. It is OK to be scared. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. Who Should Request a Second Opinion? In the United States, prostate cancer is among the most common cancers found in men. A report with the diagnosis will be faxed to your doctor. I tried to send the samples out for genetic testing to Prolaris and Decipher, but there was an ordering error and they never went thru. Suspicion for malignancy left anterior base-to-apex transition zone; Obviously the Covid 19 issue is playing a part in all of our decisions. Three lesions: 1) GS 6 involving 30% of one core; 2) GS 6 involving less than 5% in one core; and 3) GS 6 involving less than 5% in another core. Cancer 2017;123:1027-34. 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). He never sought treatment for the injury. I had my first of those 2 PSA tests last week and it dropped to 4.77. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. 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. Consultation with your nurse care manager. It works. My question is--what importance do volume levels play in determining when to move from AS to treatment? Benign prostatic tissue Then about a month later I started 28 fractions of Proton Radiation.It was painless. Transurethral microwave thermotherapy : In selected patients, microwave energy helps to restructure prostate tissue and alleviate symptoms such as incontinence and voiding dysfunction, Laparoscopic prostatectomy: The prostate is removed with a miniature telescopic instrument, which allows for a quicker recovery, Robotic surgery: This breakthrough technology, which often is used for prostatectomy surgery, requires only a few small incisions. In some situations, insurers will even insist on a second opinion. There is no one-size-fits-all treatment for prostate cancer. desired outcome. ZERO - The End of Prostate Cancer Support Community. It is OK to be scared. 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. If its a common cancer with a well-established standard of care, they can offer insight into clinical trials or novel treatments that may be better than the standard. Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. In the United States, studies estimate 72 new cases of PN for every 100,000 people between the ages of 18 and 64 years old. Good Luck and God Bless everyone. Instead, I did my homework. 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. Prostate cancer is an Two 1cc tumors, gleason score 3+4 each, one in each lobe. - T2 = 3/5 When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. Your email address will not be published. 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. Brachytherapy Experience with Dr. Albert Chang at UCLA? This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Call us with any questions: 410-955-2405, ext. Have you heard of PRECISE follow up score for an MRI? 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. Asking for your comments: I was disappointed that only TRUS was being used, but I did find out that this was for screening only and IF you pass screeningthey use MRI guided biopsy for post-ablation follow up. This site needs JavaScript to work properly. There is no extraprostatic extension. Best practices dictate that you obtain a second confirmatory pathology evaluation. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. Thanks, BigD. 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. 7: Prostate, left lateral apex 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. Thank you, After more than three years on active surveillance, I've pretty much decided to have focal brachytherapy for my prostate cancer. Because physicians may differ in their approach to treating breast cancer, its very important to check with a breast cancer expert to know youre receiving the best treatment for you. Secondary Gleason grade: 3 Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. Based on the results, our experts can provide you with an individualized treatment plan before you leave. * Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project Bethesda, MD 20894, Web Policies Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. 5/10 PSA 4.2/fPSA 9% taken at MSKCC (lab #3) He spent an hour on the phone reassuring me that I didn't need to rush into anything, and they he'd love to scan me 6-8 weeks after my TRUS Biopsyhave to let the trauma and all the blood leave the prostate for a good image. However, just to be safe she schedules me for TRUS biopsy with the Urologist in another 6 weeks. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. EDI am now 52 and not quite functioning like I did 4+ years ago. Other: There is trace ascites in the mesosigmoid. Ask your PCP to refer you to several different types of treating doctors before making a treatment decision. Note respondents were able to choose more than one reason. Good Day Everyone. I suggest for all that hear, "you have cancer" that you seek more opinions! We are vaccinating all eligible patients. The reasons for opting for treatment: the single lesion - previously Gleason 3+4, with a small percentage of pattern 4 - has grown, and according to a biopsy performed March 25, my Gleason 3+4 is now a Gleason 4+3. Someone advised to always get my PSA checked at the same facility in order to make sure the same protocol and lab is used, is that critical? I would really love to hear from you. 2. Surabhi Dangi-Garimella, PhD. All views would be appreciated. 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. Asking about other experience with conflicting Prostate Biopsy Opinions. After sending off all of our records, CD of MRI and path reports, my husband is booked for screening in December. Dr also stated he was able to totally spare one of my nerves, but to get margin may have damaged one. Below is the link with instructions and the authorization form for you to use with your doctor. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. * Extracapsular extension: Possible involvement of the anterior - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 1 of 2 cores (lateral core: 4 mm, 35%), 0.1 mm to the blue inked tissue edge I worked out every day. I am doing my own research, but I am curious as to thoughts of the best possible MRI to obtain to give me the best chance at finding something the needle biopsy didnt find. I understand that patient privacy is a priority (I'm actually a privacy lawyer), but surely there are patients who would give consent and be happy to talk with a prospective patient about their experiences? Of course that was before I found this webpage and I really didn't know what 1 core of 18 samples showing 3+4=7 Gleason meant. My prior Prolaris study (2018) before the FLA was very low risk. Im also wondering why no one has scheduled me for MRI to see what biopsy missed. However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. 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. not hear all the viable treatment options or receive the most up to date How long do you have left? Netto points to prostate cancer as an example: If your diagnosis changes from a higher grade to a lower grade cancer, it could mean having the option to avoid radical treatment.Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. He has had a nagging "groin injury" for may years (he played pick up basket ball until he got injured) and we are now wondering if this could be the source of that recurring ache. __________________________________________________________________________July 2022I've neglected to make journal entries for a couple years, so I will recap below and continue with what I have done and what I have learned.In 2018, at the age of 48, after a routine physical that showed a PSA of (4.X) and after a TRUS biopsy, I was diagnosed with PCa. I am also talking with Dr Nour and Dr. Walser and possibly others to see if I am a good candidate for Focal Laser Ablation. J Am Board Fam Med. Epub 2018 Mar 28. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, The Sidney Kimmel Comprehensive Cancer Center. poorly defined margins and intermediate to low T2. Receiving a second opinion was not associated with perceived quality of prostate cancer care. H. Prostate, lesion #2, core biopsy: You feel healthy, you arent in pain, you Allow yourself the time to seek multiple opinions. PI-RADS v2 score: 5. Get directions, important phone numbers, locations and more. 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. It is OK to not understand all the terminology. Now the oncologist wants to perform a PSMA Pet Scan. In addition to providing a better understanding of your diagnosis, a second opinion can also shed new light on treatment options and give you confidence in how to proceed with your care. Patients may experience a fever or chills as a result of the infection. JHs just said it was minimal less than 5%. In some situations, insurers will even insist on a second opinion. 2nd opinionBone Scan:"Mild increased activity is seen in the right symphysis corresponding to the abnormalities on the prior PET/CT examination. 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. Adenocarcinoma: Six weeks later I have the biopsy in his office and a week later I get the results. DRE is always normal. Reasons for getting a second opinion include: You want to be sure you have explored all options. doi: 10.1001/jamanetworkopen.2020.28320. Details are here: Methods: Dr. Nour - Emory in Atlanta. I am also doing a vegan diet with additional complementary substances. Pathology reports are subjective. Dont Miss: Bladder Control After Prostate Surgery. He said that it will improve in the future due to future improvements in the treatments. But you have to do both. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. My urologist has decided we'll go ahead with the MRI due to the continued elevated PSA scores, in addition to the overall PHI score. BJU Int. But I refuse to sit still, I continue to research and to plan, as best I can. The review process normally takes several days, after which we will send your slides and other materials are returned. Over 80,000 specimen cases are seen at Johns Hopkins each year. I'd like to talk with former patients who have gone through the procedure. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. HHS Vulnerability Disclosure, Help peripheral zone signal intensity on T2-weighted images. When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. Lymph nodes: There is no suspicious lymphadenopathy in the pelvis. I assume it is not free. They won't be offended, and they may even be able to recommend a specialist for you to see.