doi: 10.1002/cncr.30412. You feel healthy, you arent in pain, you One of the bits of advice the group regularly dispenses is for men to get a second and even a third opinion if you have doubts about the first opinions rendered by your urologist, or your pathologist, or your radiologist, its always okay to seek out a second opinion. So, I believe I made the right choice. Reinterpretation of imaging scans and lab tests. Surgery seems like overkill for me with too many risks for incontinence and permanent ED, am I overlooking something? As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. How much is the fee for an opinion of my recent MRI? Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. Is it done through my doctor or do I do it myself with sending CDs of the MRI? restricted diffusion. PSA had increased to 5.4. Men were asked if they obtained a second opinion from a urologist, and the reasons why. Reasons for getting a second opinion include: You want to be sure you have explored all options. Find more COVID-19 testing locations on Maryland.gov. 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. Are considering a treatment that involves significant risks, such as surgery. The presence of any G4 has been my trigger to seek treatment. MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): I have had a CT of the pelvic area - negative and a whole body bone scan - negative. PREVIOUS MRI RESULTS (LOTS of them) Ask us questions on this webpage. Dont Miss: Can Prostate Problems Cause Burning Urination, Why Prostate Cancer Survivor John Shearron Thinks Its Important To Do Your Research | PCRI, Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference, Johns Hopkins Prostate Cancer Second Opinion, treat rare and complex conditions through breakthrough fetal procedures, Function Of The Prostate Gland And Seminal Vesicles, Best Treatment For Intermediate Prostate Cancer, How Old Can You Be To Get Prostate Cancer, New Treatments For Stage 4 Prostate Cancer, Prostate Radiation Treatment Side Effects, Can Prostate Problems Cause Burning Urination, Prostate Cancer Spread To Skull Prognosis, Life Expectancy Stage 4 Prostate Cancer No Treatment, Diagnostic Procedures For Prostate Cancer. 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. This site needs JavaScript to work properly. * Adjacent organ invasion: None. Then about a month later I started 28 fractions of Proton Radiation.It was painless. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. Little is known about men with localized prostate cancer who seek second opinions, the reasons why, and the association with treatment and quality of care. 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. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. Know Your Stage. 3. 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion If they do not cover this cost and you must pay out of pocket, keep in mind that a second opinion could save you from having to pay (financially and physically) for additional treatment down the line. 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. I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. Johns Hopkins Medicine A commercially available genomic test may help oncologists better determine which patients with recurrent prostate cancer may benefit from hormone therapy, according to new research from the Johns Hopkins Kimmel Cancer Centerand 15 other medical centers. Doctors are skilled at pitching the treatment they specialize in. My long-term prognosis appears to be good with minimal side effects. It works. 5. Assessment categories for this lesion: Read Also: What Are The Signs Of Prostate Infection. I was confident I was making the right decision. You think another treatment might be available. Confused about Pathology report and course of action, Phone Number for John's Hopkins Radioogy Second Opinion. Has anyone sent Radiology (mpMRI) reports and images to Hopkins for Second Opinion Review? Can it be salvaged or are the risks of cancer too high? DIAGNOSIS: It hasn't let me down. We have sought a second opinion and all tests are being reviewed by that second team.My question has to do with the symphysis pubis. Same with the amount of how much pattern 4. If I am rested, I find that I am more ready than if I am not. MM, Much to my dismay my 4th targeted biopsy Oct 12 revealed 5% G4 (upgraded from Grade Group 1 to 2 (Gleason 3+4 intermediate/favorable). Finally, things are set and I know what is going to happen. His second opinion just came back. 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. 2: Prostate, right lateral base * 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! Which Patients Report That Their Urologists Advised Them to Forgo Initial Treatment for Prostate Cancer? AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. The average age at the time of prostate cancer diagnosis is about 66. How important is Oncotype DX test for Gleason 7? If anyone has used him, please let me know what your experience was like. __________________________________________________________________________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. * Prostate size: 3.9 x 2.8 x 3. cm Prostate cancer is an When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. Medical record collection from doctors and hospitals. Epub 2018 Mar 28. One of the problems with second opinions is that insurers may not cover the expense. P60 MD006900/MD/NIMHD NIH HHS/United States, T32 HL007180/HL/NHLBI NIH HHS/United States, K07 CA151910/CA/NCI NIH HHS/United States, P30 CA016520/CA/NCI NIH HHS/United States, K07 CA163616/CA/NCI NIH HHS/United States. There are also some cases of the test showing no depletion but being wrong. 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. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Include Your Primary Care Physician as Member of Your Treatment Team. According to the doctor it is around 3 mm. )As for side effectsI occasionally have some urgency/hesitancy having to pee. Greenfield G, Shmueli L, Harvey A, Quezada-Yamamoto H, Davidovitch N, Pliskin JS, Rawaf S, Majeed A, Hayhoe B. BMJ Open. 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. I have had a second opinion from Johns Hopkins that confirmed the initial pathology of gleason 3+4. - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length 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. 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. With that alone, I would likely be a candidate for continued Active Surveillance. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . He also stated that he would ONLY recommend FLA if done within a trial. You He recommended waiting and watching at that time due to the lower PSA reading. 7: Prostate, left lateral apex Based on the results, our experts can provide you with an individualized treatment plan before you leave. Anyone with insight into this and advice? A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. 3. have no symptoms, and yet you have cancer? They won't be offended, and they may even be able to recommend a specialist for you to see. 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. If pain is present, a digital rectal examination will reveal hard areas. 5. Benign Processes: The lesion also shows focal increased permeability. 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. Dr. Nour is 100% sure that nothing has spread. Greetings gentlemen! What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! It is OK to be scared. - Johns Hopkins Medicine -- Get a Second Opinion - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. 4. Just took time off and then life happened.Thanks in advance for the insights. Had a little complication a day after release, excessive blood/clots in urine. Question anemia. Accessibility * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. fibromuscular stroma, anterior prostatic contour is smooth. The people were great. Maybe lycopene and pomegranate have helped. Lesions are all small or very small. I choose surgery over radiation because you can do surgery and then radiation, but it is almost impossible to do it the other way around. We are vaccinating all eligible patients. doi: 10.1002/cncr.30412. If the enlarged prostate is not completely removed, it will shrink. Thanks for Everyone's Help, * Gleason Score: 4+5, Slide 4 (vs. Sloan's 3+4) Even if I go the radiation route, should I try for Proton radiation or some other type? 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. Further, the two tumors in question have not really changed much in size for more than 2 years. 1. * Both Sloan and Johns Hopkins admit that large discrepancies are unusual, yet both stand by their opinions. Masks are required inside all of our care facilities. * Location: Left, anterior, base to apex, transition zone By basing a treatment Prostate, left medial base: About this time, I started reading this forum and my ignorance starts going away. It hasn't let me down. We have a consult on Friday with the 1st opinion doc to review all tests. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Based on this forum, Im very lucky for this outcome. FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. Therefore, the value of these second opinions remains unknown. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, The Sidney Kimmel Comprehensive Cancer Center. prostate volume). My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. That's the good news. undefined will no longer be visible to you including posts, replies, and photos. 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. The site is secure. I assume it is not free. The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. You're at greater risk if you're Black or of African ancestry. (I think that it was easier to see because Mayo's MRI technology and procedures are better than SMIL's.) Conclusions: It is OK to be overwhelmed with info. We are vaccinating all eligible patients. Getting a second opinion can sometimes lead to a complete change in diagnosis (such as cancerous to benign or vice versa) in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. I had my first of those 2 PSA tests last week and it dropped to 4.77. Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. Im also wondering why no one has scheduled me for MRI to see what biopsy missed. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. Some pathologists have more experience than others. 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. They did 9 patients in Phase I and there have been 12 so far in Phase II. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Move ahead to Dec 2020. It took me awhile but minutes ago received my second opinion from Johns Hopkins. I am 58 and in very good health otherwise. Without the genomic test I have I lesion 3+3=6 and another, 3+4=7, with less than 5% pattern 4, and an MRI that shows no ECE, no other suspicious lesions and questionable cellular EPE based upon disagreement of pathologists. Secondary Gleason grade: 4 If a targeted biopsy is planned, this lesion can be sampled at the same time. Primary Gleason grade: 3 J Am Board Fam Med. Treatment Advice: Sloans radiation oncologist says radiation treatment will likely be the same whichever pathologist report prevails, but may add hormone therapy for about 2 months. 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. All wanted to do what they do, schedule treatment which at this time is only Gleason 6 which I now know is not life threating. Dr. Erick Walser at University of Texas Medical Center. More medical freakouts. Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results. I just received a second opinion report from Johns Hopkins. Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. Keywords: 2.Tammy Jiang, Christian H. Stillson, Craig Evan Pollack, Linda Crossette, Miupdachelle Ross, Archana Radhakrishnan, and David Grande, How Men with Prostate Cancer Choose Specialists: A Qualitative Study, Journal of the American Board of Family Medicine: JABFM, 30(2), (2017): 220229. No one at Hopkins has ever died of prostate cancer if he had Gleason 3 + 3 cancer." Nov 7, 2016. In fact, additional biopsies revealed no additional cancer. I've been on AS since April 2016. My experience at Johns Hopkins was awesome. My diagnosis is T2c, Gleason 7 (3+4).
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