Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. An accurate diagnosis is essential to ensure the most effective treatment. Secondary Gleason grade: 3 PSA: 4.7 ng/ml/PSA density: 0.27 ng/ml2 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. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. Value of Second Opinion in Prostate Cancer Uncertain, Says - AJMC Advances in our understanding of breast cancer have opened up new treatment options or clinical trial opportunities, including targeted drug therapies and tissue-conserving procedures proven to greatly reduce pain and nausea. In unadjusted analyses, younger men , men with college-level education , and privately insured men and Medicare ) were more likely to obtain second opinions . asymmetric central zone tissue more pronounced on the left. Masks are required inside all of our care facilities. 4. Second Opinions & Consultations - Brain Tumor | Johns Hopkins Pathology One of the problems with second opinions is that insurers may not cover the expense. I made the appointments. Men need to be educated on all treatment options to protect themselves from a biased industry. While I have three lesions, they are small and, without 3T mp MRI, might not have been discovered. Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. We can help with your case. This is why the prostate is important to the body. 1: Prostate, right lateral apex Prostatic Adenocarcinoma Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, The Sidney Kimmel Comprehensive Cancer Center. Recently diagnosed a Gleason 3 + 3. Johns Hopkins Health - Second Opinions, Second Chances, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, High Blood Pressure May Take Its Toll on Your Kidneys. 2. It has been 2.5 years and the PSA has still not doubled as well. 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. The percentage of Gleason grade 4 and/or 5 is 5 % Do second opinions matter in prostate cancer care? - ecancer C. Prostate, right apex, core biopsy: This teamwork ensures the best possible patient outcomes. The total number of cores identified is 3 Since I have gotten so much out of this forum, I thought Id provide my story to help others. Ask your PCP to refer you to several different types of treating doctors before making a treatment decision. He also said perinueral invasion, but not extracapsular extension. Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. I've been on AS since April 2016. 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. Greetings gentlemen! Check Biopsy and Imaging Results for Accuracy. Did robotic radical prostatectomy 1/25/12. PDF Cancer A Second Opinion A Look At Understanding Controlling And Curing * Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project -------------------------------------------------------- Studies show the clinical and financial benefits of obtaining a pathology second opinion. Fear, confusion and uncertainty set in. Five years ago I had a TURP. Heres What You Need to Know, Prostate Cancer Spotlights in 2020: A Year in Review, Find out about PSMA PET Imaging on Prostate Pros Podcast. Emotional outlook is fragile at times and straight clinical approach of doctors does not help. The results of Oncotype came back and it was a bad report. The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. I retested in January 2019 and scored 4.20. That is literally the first time I heard that term other than seeing it in my pathology report. Clipboard, Search History, and several other advanced features are temporarily unavailable. He is the past president of the International Society of Urological Pathology. HMOs usually try to diagnose and treat patients within their system because the more money the HMO spends on second opinions and treatment outside the HMO, the less money there is available for operation costs and profits. advising or treating it. 9. 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. Dont Miss: Screening For Prostate Cancer Icd 10. The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! Types of questions that pathologists often address in our second opinions: If I don't meter fluids before bed, I can expect to get up 3-4 times in the night. You're at greater risk if you're Black or of African ancestry. My involvement is below maximum of 15% of core. 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. I hope my story helps anyone out there just starting the process. Second opinions offer different things in different circumstances, Dr. Matasar says. Youve just been diagnosed with prostate cancer. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . It hasn't let me down. 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. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. There are lots of lessons learned on the forum. The total number of cores identified is 3 I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. There is no extraprostatic extension. focal peripheral zone lesions. 5. There is no evidence Accessibility Benign fibromuscular stroma; no prostatic glands are identified - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 10%) involving 2 of 2 cores (medial core: 0.5 mm, 4%; lateral core: 1.5 mm, 10%), 1 mm to the blue inked tissue edge (the closer) When first diagnosed with prostate cancer, your PCP will generally refer you to a urologist for a biopsy. Oncologist. A enlarged prostate can also cause blockages in the urethra. Four had 60-70%, five have between 5-10%. 1. I was confident I was making the right decision. With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3500 specialists. It works. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. A blocked urethra can also damage the kidneys. Surgery seems like overkill for me with too many risks for incontinence and permanent ED, am I overlooking something? The more accurate the information we have, the better our treatment decisions. 6: Prostate, left medial base 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. All Gleason 6 (3+3). Even if I go the radiation route, should I try for Proton radiation or some other type? I am at that critical juncture in which I at least need to formalize a plan, select a doctor/facility to work with, and continue my testing to make sure I have what I think I have. E. Prostate, left mid, core biopsy: I can do radiation as a monotherapy. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. Find more COVID-19 testing locations on Maryland.gov. I had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. Im immediately referred to Urologist. I worked out every day. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. Your doctor is not sure what is wrong with you. Brief MRI history. Cleveland Clinics Virtual Second Opinions program connects you to an expert physician who specializes in your specific health needs. 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. I was offered to have my first biopsy sent to Johns Hopkins for second opinion and said why not? which came back with Gleason 9 three weeks after having the what we thought was G-7 ablated. To learn your stage of prostate cancer, take the staging quiz on keytopc.com. It is OK to be overwhelmed with info. "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 . Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. Primary Gleason grade: 3 About 60% of prostate cancers occur in people older than 65. Get a Second Opinion: Johns Hopkins Kimmel Cancer Center However, there are also many more options for treatment and these options are more complicated than in the past. Symptoms include leaking and discomfort. Thanks for considering. official website and that any information you provide is encrypted I am 62 years old. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Prostate cancer is the second-most diagnosed cancer in American men. Unable to load your collection due to an error, Unable to load your delegates due to an error. I frequently make a 2 hour car ride and I have to stop about 25% of the time and when I don't, the urgency is a bit more evident and with the urgency come some hesitancy, but not terrible. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. Secondary Gleason grade: 4 So my question for you is have you ever heard of PRECISE and if so what should I make of it? 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. The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. the transition zone. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. PMC 5. restricted diffusion. 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. All rights reserved. Benign Processes: Men with a college education or beyond also were more likely to cite wanting more information about their cancer as a motivation for a second opinion . * Sloan only sent partial cores, slides 1 and 4. Prostate Cancer | Johns Hopkins Brady Urological Institute Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. !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. Johns Hopkins Prostate Cancer Doctors - HealthyProstateClub.com * Gleason Score: 4+5, Slide 4 (vs. Sloan's 3+4) Metastatic disease considered less likely for this pattern. 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. have no symptoms, and yet you have cancer? HMOs usually try to diagnose and treat patients within their system because the more money the HMO spends on second opinions and treatment outside the HMO, the less money there is available for operation costs and profits. and transmitted securely. Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. I did ask some questions about the study, if anyone is interested. Some men may have an enlarged prostate but not notice it. Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. -------------------------------------------------------- I'm Gleason 3+4=7, and I believed only 2 cores tested positive. MRI obtained outsideon 04/16/2021. Methods: radiation, active surveillance, surgery, hormone therapy, and more. 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. * Location: Right, anterior, apex, peripheral zone When I read the forums and questions on this site everyone mentions their Gleason Score from their biopsy. 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. When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. In some situations, insurers will even insist on a second opinion. My thoughts focus on the fact that I have a disabled son who needs my care. Two from one lesion were positive as was one of the two from the other. The ADT has daunting side-effects but he said offers some improved chances of eradication, any long-term downsides that I should consider? 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 people were great. Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. I am 65 and in excellent general health. And collaborating with Johns Hopkins Medicine means we can provide you with second opinions, streamlined and guided access to clinical trials, and a proven track record of excellence in care. -------------------------------------------------------- With that alone, I would likely be a candidate for continued Active Surveillance. The site is secure. 180 days after treatment PSA was .50. 7 Tips for Seeking Second Opinions For Men with Prostate Cancer * Prostate volume: 22 cc 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. My question is--what importance do volume levels play in determining when to move from AS to treatment? This suggests that for some men, second opinions offer a way to pursue the treatment they already planned on, rather than to explore other treatment options, according to study authors Dr. Archana Radhakrishnan, of Johns Hopkins University in Baltimore, and her colleagues. curing cancer, prostate cancer questions johns hopkins hospital, josef issels wikipedia, cancer a second opinion a look at book by josef issels, coping with metastatic cancer cancer net, pdf americans health priorities curing cancer and, what is immunotherapy cancer research institute cri, cancer a second opinion a . In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. If you're seeking a second opinion on treatment (see below), the specialist you choose often will be able to order a pathology second opinion for you, through his or her hospital's pathology department. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. My first PSA was 8.03. Prostate dimensions: 4.1 x 2.8 x 3.4 cm 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. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasn't spread outside of the prostate. - Johns Hopkins Medicine -- Get a Second Opinion )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. Hopkins states that the one positive core (10% G6) was visualized by the MRI, so I am hoping that this increases our chances of making it through the screening process. Experts believe that this study is the first in history to have achieved such results. 1. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. This has raised some questions on all the scans so far. I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. The Johns Hopkins Brady Urological Institute is known around the world for its expertise in diagnosing and treating urologic conditions. Second opinions are more likely to be comprehensive, or inclusive of every possible perspective, when performed in a cancer center with a multidisciplinary team, which usually includes surgeons, oncologists, radiation therapists, and sub-specialist oncologists. 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. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Without your support, I could easily have subjected myself to random biopsies that are risky, don't do a good job of finding lesions, and can mess up the clarity of the prostate for an MRI. Also, if any of you have a way to get medicare to pay some portion of the cost, please let me know as well. 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. Getting A Second Opinion On Your Pathology Report - Cancer ABCs It is not uncommon that two different pathologists looking at the same slide come to a different interpretation and opinion about what is in their microscope! Pathology reports are the opinion and interpretation of the individual pathologist viewing the tissue samples. Just had my appointment today and they are pleased with the results, so far. Yet none of my doctors ever mentioned it! By seeking second opinions and hearing the benefits and drawbacks of a range of treatment options for your specific stage, you will be more equipped to make educated decisions. Second opinions not likely to change prostate cancer treatment Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care. I am doing one in 6 weeks, regardless. Prostate, left anterior MRI lesion: One core had 5%, one 20%, and one 40%. Primary Gleason grade: 3 Thanks! Dr also stated he was able to totally spare one of my nerves, but to get margin may have damaged one. Lesions are all small or very small. 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. An official website of the United States government. Just had my appointment today and they are pleased with the results, so far. An accurate diagnosis is essential to ensure the most effective treatment. probably organ confined disease. of tumor in the rectal prostatic angles. 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. After a little experimenting I have been able to achieve a partial erection. Treatment must be chosen based on stage and your Overall, nearly 80% of men received definitive treatment 76.5% of men who obtained a second opinion from a urologist received definitive treatment compared to 81.6% who did not . Total Gleason score: 7 Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. So I initially thought this makes me a good candidate for AS. That said, I have some questions that I derived, keeping in mind that 99% of what I have learned since February has come directly from this group: Here are the details: What have your doctors told you? Lesion 1: Left mid-base transition zone. 1st opinion"Note is made of sclerotic changes in the right pubic bone adjacent to the symphysis pubis having only low-level activity and this is thought to be more likely due to degenerative changes rather than bony metastasis." Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. I assume the data on gleason scoring is much more robust/reliable than genomics as it has been around longer and used more extensively. Especially opinions other than those of the first Urologist you see. 2nd opinionBone Scan:"Mild increased activity is seen in the right symphysis corresponding to the abnormalities on the prior PET/CT examination. Unfortunately, monetary incentives create biases that can work against patients best interests. I've been on AS for two years after my initial TRUS biopsy showed 3 cores 3+3 (10% volume) on Right side, and 2 cores 3+3 on Left side. In the United States, prostate cancer is among the most common cancers found in men. PSA that brought me to this was 7.1. Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference, Why Prostate Cancer Survivor John Shearron Thinks Its Important To Do Your Research | PCRI, John Hopkins Prostate Cancer Second Opinion, a higher risk of developing uterine cancer, surgery may not always be necessary for all breast cancer patients, The cancer vanished in every single participant, Long Term Side Effects Of Brachytherapy For Prostate Cancer, treat rare and complex conditions through breakthrough fetal procedures, Prostate Cancer External Beam Radiation Side Effects, Can Enlarged Prostate Cause Blood Clots In Urine, Life Expectancy Stage 4 Prostate Cancer No Treatment, Prostate Cancer Spread To Skull Prognosis, Diagnostic Procedures For Prostate Cancer. Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged.
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