For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. Jonathan Epstein, M.D. * Extracapsular extension: None. There are also many reasons why you may want to seek another opinion during the course of your cancer care. decision on a single medical opinion or the first appointment you get, you may 2. Their opinions are widely held to be definitive. 2021 Sep 24;11(9):e044033. Now the oncologist wants to perform a PSMA Pet Scan. 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. 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. FOIA Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. - Benign prostatic tissue And it is OK to have paralysis by over-analysis. Based on this forum, Im very lucky for this outcome. Recovery from Prostate Cancer | Bills Story. All Gleason 6 (3+3). And again, most of you tell me time is on my side, so I am comforted in hearing that. But you have to do both. Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. He said that JHs said that it was 2 cores, but it was actually a fragmented core, that the fat did not present on the right place on the slide, that prior FLA (partial hemi-ablation) could affect the results, the MRI did not support, etc. Watch: Are supplements good for prostate health? I had FLA done after first biopsy which staged me at 3+4 = 7. First 6 week PSA is undetectable. 3. Federal government websites often end in .gov or .mil. 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. The people were great. Visit and Like ZERO - The End of Prostate Cancer on Facebook, Sign up to receive emails and news from ZERO - The End of Prostate Cancer, Search prostate cancer clinical trials and studies. On the first scan (post FLA) a lesion was identified by the local radiologist that performed the scan, but the FLA radiologist that performed my procedure was over reading and monitoring my care and stated strongly that there was no cancer. Even at the age of 48, he thought I would be a good candidate for AS. 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. Consultation with your nurse care manager. 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. I suggest for all that hear, "you have cancer" that you seek more opinions! Have been diagnosed with a serious or rare health condition. So off I went to see a community urologist who performed a needle biopsy in his office. That's the good news. - High grade prostatic intraepithelial neoplasia (HGPIN) 1. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. With world-renowned expertise, multidisciplinary specialistsand the latest data, we partner with you tomake informed decisions about managing your prostate cancer. Hillen MA, Medendorp NM, Daams JG, Smets EMA. 3. Negative cancer in lymph nodes, seminal vesicles, and all margins. But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. Let me know what everyone thinks if you see anything interesting or of note here or just have some advice. This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. Get a Second Opinion What can a second opinion tell me? However, there are also many more options for treatment and these options are more complicated than in the past. 4/16 3T MRI performed (reports/re-reads below) I had two no-risk, non-invasive tests: a Free PSA with an adverse score of 9% and a PCA3 test with a disappointing 41. 2. T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive Overall my PSA is between 4 and 10. The side effects of the cut, radiate, hormone regime are unacceptable to me. My question is--what importance do volume levels play in determining when to move from AS to treatment? Anyway, would appreciate knowing how to contact Johns Hopkins. Johns Hopkins is home to many of the world's leaders in Pathology. Extracapsular extension: The prostatic capsule is preserved. Bethesda, MD 20894, Web Policies 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. Keywords: Following the advice of all on here, I need a team of doctors to manage my care. 1: Prostate, right lateral apex Also, in 2018 I had an exosome Dx test which scored 45.34, but I also retook that test this year and it went down to 30.79. Even at the age of 48, he thought I would be a good candidate for AS. Some men may have an enlarged prostate but not notice it. I assume the data on gleason scoring is much more robust/reliable than genomics as it has been around longer and used more extensively. Has anyone sent Radiology (mpMRI) reports and images to Hopkins for Second Opinion Review? In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. If these do not work, your symptoms could progress and become chronic. Caused me to bleed heavily. This Dr is in charge of active surveillance program at JH so I knew that he wouldnt recommend surgery unless it was really needed. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. PSA that brought me to this was 7.1. Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. When you review your pathology report and are going to be making important decisions, like treatment decisions, which will be based on the information from the pathology report. Of these, 40% obtained second opinions, most commonly because they wanted more information about their cancer (50.8%) and wanted to be seen by the best doctor (46.3%). Low volume post-void residual urine is present in the bladder. Just had my appointment today and they are pleased with the results, so far. I just turned 71 in February. When people recommend going to a Center of Excellence, believe them. Just took time off and then life happened.Thanks in advance for the insights. This is often the case when the primary physician advises an expensive treatment. Last year, Epstein's lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions. If a targeted biopsy is planned, this lesion can be sampled at the same time. Are considering a treatment that involves significant risks, such as surgery. Im currently 67 years old. Is there such a thing as having a team that isnt equipped with the best equipment nor the most experienced radiologists? Surgeon wants next PSA in 3 months. Two things you learn here is get a second opinion from Johns Hopkins on biopsy and get treated at Center of Excellence. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. undefined will no longer be visible to you including posts, replies, and photos. 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. Many thanks for that. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Prostate cancer is an ORIGINAL MRI REPORT (local radiology group): So, I go one better, I call up Johns Hopkins and find a Dr who does DaVinci Prostate Surgery. 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. 2. Rectal cancer.A small trial that saw 18 rectal cancer patients taking the same drug, dostarlimab, appears to have produced an astonishing result: The cancer vanished in every single participant. * Gleason Score: 3+3 (2 of 6 specimens) 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm I luckily found this webpage and I started reading everything I could get my hands on. 9. Therefore, the value of these second opinions remains unknown. Overall PIRADS Score: 2/5 You May Like: Sbrt Radiation Therapy Prostate Cancer. He is the past president of the International Society of Urological Pathology. Allow yourself the time to seek multiple opinions. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. 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. So, I asked the Radiologist if she will schedule one for me. Types of questions that pathologists often address in our second opinions: 7. Over 80,000 specimen cases are seen at Johns Hopkins each year. The https:// ensures that you are connecting to the 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. When first diagnosed with prostate cancer, your PCP will generally refer you to a urologist for a biopsy. fibromuscular stroma, anterior prostatic contour is smooth. Unfortunately, what you do not realize may harm you! 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). Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. With that alone, I would likely be a candidate for continued Active Surveillance. 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. I opted to waive the biopsy, wait 1 year and test again. Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. 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. Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. It starts many years ago. In adjusted analyses, however, only age and education were significantly associated with obtaining second opinions from urologists. Read Also: What Are The Signs Of Prostate Infection. Benign Processes: Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. ADC: mean 879 / median 839 / st dev 223 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 . I recently sent my Pathology Slides to Dr. Epstein for a Second Review. You can call and speak with his assistant at: (410) 614-6330. This kills both birds with a single stone. asymmetric central zone tissue more pronounced on the left. Instead, I did my homework. How important is Oncotype DX test for Gleason 7? I am 65 and in excellent general health. Results: He was right. Dr. Dan Sperling - New York. Find more COVID-19 testing locations on Maryland.gov. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. 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. Patients are often under the mistaken notion that they have to pick between their oncologist and MSK, but thats often not the case, Dr. Matasar explains. I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. TZ zone more beneficial, but fairly large compared to whole gland and proximity to capsule edge would likely mean treatment would be suggested. 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. There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists. Using an Ellipsoid Volume the dimensions would give you a volume of 20.44. We specialize in minimally invasive procedures to treat BPH, including: For selected BPH patients, our specialists also perform transurethral resection of the prostate , a procedure that requires no incisions and has a high rate of success. I was never under the misconception that I'd never have to do something, but I was going to wait until I needed to do something. Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. 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 . Had my PSA remained static I'd have remained on AS and had I grown a Target Lesion I'd have sought focal treatment.This science is emerging and only getting better. 2020 Jul 21;19(1):112. doi: 10.1186/s12904-020-00619-9. MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): Eager to hear what everyone thinks or has anything they see in the report I wouldn't have thought of. Prostate, right medial apex: According to The National Institute on Aging, prostate problems are common after age 50. What are you doing about it? 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. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. government site. Consultation with your nurse care manager. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. Clipboard, Search History, and several other advanced features are temporarily unavailable. Receiving a second opinion was not associated with perceived quality of prostate cancer care. Hello, I apologize upfront for the length of this post, but I was recently diagnosed with prostate cancer (T2C) and figure more information is better than not enough. 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. Reasons for obtaining a second opinion from urologists. In general, a second opinion is a good option for people who have recently received a cancer diagnosis but have not started treatment, as well as for people who have already completed chemotherapy or radiation treatment. If I am rested, I find that I am more ready than if I am not. Prostate dimensions: 4.1 x 2.8 x 3.4 cm However, a new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice or the persons perception of the quality of care they receive, at least among low-risk men. You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. [email protected], 7 Tips for Seeking Second Opinions For Men with Prostate Cancer. A biopsy was performed on 2/26. Unauthorized use of these marks is strictly prohibited. * Size: 1.5 cm Benign fibromuscular stroma; no prostatic glands are identified Studies show the clinical and financial benefits of obtaining a pathology second opinion. 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. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. Estimated prostate volume of 35 cc with an estimated PSA density of 0.11 ng/mL/cc. Ex-Uro wanted to do biopsies and keep doing them until we find "it", even though he didn't know the size of the prostate nor had he ruled out prostatitis. Move ahead to Dec 2020. Not all cancers are the same and not all treatment plans are absolutely clear. His second opinion just came back. Primary Gleason grade: 3 PSA had increased to 5.4. Would you like email updates of new search results? And thanks again for making this such a great support group! The people were great. His most-frequently cited first or last authored publications is Pathological and Clinical Findings to Predict Tumor Extent of Nonpalpable Prostate Cancer, published in JAMA, which established the criteria for active surveillance. PMC The site is secure. Required fields are marked *, PHONE 310-827-7707 Call us with any questions: 410-955-2405, ext. For men with prostate cancer and who live in the United States, there are some highly regarded pathology labs from which you can obtain your second opinion. How long do you have left? Some men have minimal or no symptoms at all. In other words, the cancer is still contained within the prostate. These results, if validated in other studies, justify additional investigation on how second opinions can contribute to increasing the value of cancer care, the authors concluded. Will these places of excellence consider me, or am I bound to my regular doctor for insurance purposes? In 2006 my PSA was .6. While I now concluded we need to find "it", I researched the best approach to see what is really going on and to do this safely. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. Identified an approximate 2 cm lesion of mostly Gleason 7 (3+4) with only 20% being 4, contained in prostate. 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. has now confirmed this assumption through a careful retrospective analysis of data from > 450 men whose records could be identified in the SEARCH database, all of whom received surgical treatment for Gleason 8 to 10 prostate cancer. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. A man with a father or brother who had prostate cancer is twice as likely to develop the disease. I just received a second opinion report from Johns Hopkins. BONES: No suspicious osseous 4. I did a book review with his first book for several veterans groups including the Americal Division Veterans Organization which with I served at age 19. 4. Prostate, left medial apex: 6. Request an Appointment 410-955-6100 In addition to cancer, our urologic team provides second opinions regarding urinary stone disease, urinary tract reconstruction, incontinence, male infertility and sexual health, and many other urologic conditions or procedures. information. Because I had an implant in my ear, they would only give me a 1.5T MRI.
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