Prostate Cancer | Johns Hopkins Medicine He is the past president of the International Society of Urological Pathology. You My question is regarding the results of an MRI guided biopsy into a distinct tumor vs. subsequent Oncotype Dx Results. What have your doctors told you? 7: Prostate, left lateral apex When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. It hasn't let me down. Only took Motrin and Tylenol for pain after release.
Prostate Cancer: Symptoms, Causes & Treatment - Cleveland Clinic You think another treatment might be available. I have searched the country for intervential radiologist that perform FLA on the prostate. 2 cores from left base of 3+4=7 with only 5% involvement. If pain is present, a digital rectal examination will reveal hard areas. Dont Miss: Screening For Prostate Cancer Icd 10. 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. Noted that some don't even include on report and should be looked as something to note but not obsess about. * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. PMC 3. doi: 10.1002/cncr.30412. T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive
Second Opinions - Bladder Cancer | Johns Hopkins Pathology 1. Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions.
In fact, additional biopsies revealed no additional cancer. 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. I made the appointments. 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). 2. They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. Anyone with insight into this and advice? All rights reserved. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. !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. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. The https:// ensures that you are connecting to the The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. Everything seems to be on track to remove the cancer and be cured! If a targeted biopsy is planned, this lesion can be sampled at the same time. Prostate, left lateral base: It can: Confirm your original diagnosis and treatment plan Give you more detail about the type of breast cancer you have and stage it's in. The results of Oncotype came back and it was a bad report. 1: Prostate, right lateral apex It starts many years ago. He was right. Prostate, right medial base: One core had 5%, one 20%, and one 40%. Masks are required inside all of our care facilities. The primary goal is to be cured with the least toxic, most effective approach. Thanks for considering. And when I attempt to ask questions about intradcutal, I get responses about how little is known about it because it's so rare or that it is controversial or that they're not familiar with the study I'm referencing. 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. Benign fibromuscular stroma; no prostatic glands are identified 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. Now Im still ignorant and dont really know a Gleason from a Duck, so when the Dr says your treatment is radiation or surgery Im devastated. 24.5 BMI * Extracapsular extension: None. Our OB-GYNs, maternal-fetal medicine specialists, and pediatricians collaborate regularly with the Johns Hopkins team getting second opinions and access to hundreds of clinical trials. Thank you! The Johns Hopkins Brady Urological Institute is known around the world for its expertise in diagnosing and treating urologic conditions. 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. 30%/40% or higher)? After extensive discussion of his management options with his local urologist, primary care physician, and radiation oncologist, he also sought a second opinion at the Johns Hopkins Prostate Cancer Multidisciplinary Clinic at Sibley Memorial Hospital.The patient expressed an overwhelming desire to avoid surgery and any other invasive treatments. 2nd opinionBone Scan:"Mild increased activity is seen in the right symphysis corresponding to the abnormalities on the prior PET/CT examination. 2015 Feb;115(2):188-97. doi: 10.1111/bju.12665. Recovery from Prostate Cancer | Bills Story. The prostates function is to create some of the fluid that insulates sperm cells found in semen. poorly defined margins and intermediate to low T2. Dr. Albert Chang at UCLA appears to be the best in the biz for high dose rate (HDR) focal brachytherapy. 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. Second opinions offer different things in different circumstances, Dr. Matasar says.
Where Should I Go for a Second Opinion? - breast cancer - Benign prostatic tissue He never sought treatment for the injury. Jonathan Epstein, M.D. * PIRADS v2 Score: 5 Oncologist. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. Prostate cancer is an Low volume post-void residual urine is present in the bladder. have no symptoms, and yet you have cancer? 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. Benign Processes: 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. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. One of the problems with second opinions is that insurers may not cover the expense. 1. Family history of prostate cancer. Consult Fees In some cases, additional testing may be required. 1. 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. * Extracapsular extension: Possible involvement of the anterior 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.
John Hopkins Prostate Cancer Second Opinion 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 . Medical record collection from doctors and hospitals. This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. 3. However, learning more about prostate cancer and prostate-related health issues can help optimize health. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. transition zone.
- PI-RADS for this lesion = 4/5 Prostate Cancer Grading: I'm Gleason 3+4=7, and I believed only 2 cores tested positive. My prior Prolaris study (2018) before the FLA was very low risk. What are you doing about it?
Johns Hopkins Hospital Prostate Cancer - ProstateProHelp.com My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. 2. 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. Further, the two tumors in question have not really changed much in size for more than 2 years. IMPRESSION: * Prostate volume: 22 cc (PZ) - normal 9: Prostate, left anterior MRI lesion The majority had lower risk tumors and clinical staging of 1 40% sought second opinions with about half having more than one reason Men seeking second opinions tended to be younger and better educated citing the need for more information as their reason. They agreed with the PI-RADS 4. I certainly would - after all, there's a certain brotherhood bond here. I'm going to reach out to UCLA to see what they can do. H. Prostate, lesion #2, core biopsy: I luckily found this webpage and I started reading everything I could get my hands on. Cancer ABCs recommends: Johns Hopkins Hospital in Baltimore, Maryland, specifically Dr. Jonathan Epstein. It was easy. Urology. When first diagnosed with prostate cancer, your PCP will generally refer you to a urologist for a biopsy. My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. 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). feel the clock ticking. Your doctor is not sure what is wrong with you. fibromuscular stroma, anterior prostatic contour is smooth. When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. Remember if you ship them include the following information: You May Like: Blood In Urine After Prostate Biopsy. MY THOUGHTS AND ANYTHING DOCTOR NOTED: Surprisingly, while one in nine men will get diagnosed with prostate cancer in their lifetime1, there are very few doctors who specialize exclusively in treating prostate cancer. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. As a Gleason 3 + 3, with 8 of 12 positive cores all with less than 30% cancer, and bilateral spread, I have determined that I cannot trust a blind biopsy in and of itself. 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. A 1.4 cm lesion in the left, apex, anterior transition zone demonstrates conflicting T2 and DWI characteristics for PI-RADS classification - an indeterminate lesion. Thank you! Five years ago I had a TURP. 2/13 PSA 5.2/fPSA 12.5% taken AFTER DRE (negative DRE) (lab #1) Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. Spent the night in hospital with very little pain after the first couple of hrs. I trust the second opinion Dr. Bush gave. If anyone has used him, please let me know what your experience was like. MRI June 2017 again at SMIL. Is the destruction of my prostate inevitable and necessary for my survival (my understanding is that both surgery and radiation will do this)? Two things you learn here is get a second opinion from Johns Hopkins on biopsy and get treated at Center of Excellence. (Scores above 55 have a greater than 50% chance of finding clinically significant cancer on a biopsy) The biopsy showed 2 or 3 cores containing HG PIN but no cancer. 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. prostate cancer; quality of health care; second opinion; specialists; treatment. Study after study confirms that doctors favor the treatment they are trained to do urologists typically recommend surgery and radiation oncologists recommend radiation. PROSTATE ADDITIONAL FINDINGS: Benign prostatic lesion. Luckily, his report co-coincided with the original QDx report. There is no bony or bulky nodal disease in the pelvis I am doing one in 6 weeks, regardless.
Get a Urology Second Opinion | Johns Hopkins Brady - Hopkins Medicine Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. I question the potential EPE and he said it didn't matter, but went ahead and ordered Oncotype. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? That being said, they can be a beneficial member of the treatment team. 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. No extraprostatic extension. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. By taking the extra time to seek a second opinion, you have a better chance at finding the most up-to-date approach and an experienced doctor. Slightly Same with the amount of how much pattern 4. LESION 1 The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. You can find out by reviewing your plan or by reaching out to your insurance company. 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 linear amount of tissue with carcinoma is 11 mm There are so many different departments at Hopkins that I don't know the optimal department to contact. Keep in mind that not all PCPs are knowledgeable about prostate cancer or know the skill levels of all the specialists in the field. 3 months has passed, and its time for a PSA and a plan to have an MRI. 4, Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion. 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. Contact us or find a patient care location. Seminal vesicles are normal. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. 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. Johns Hopkins is home to many of the world's leaders in Pathology. * Gleason Score: 3+4 (4 of 6 specimens), 14 specimens taken They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. I guess the PET scan will be the next step in what type of treatment options are in store.Has this occurred to anyone else? A. Prostate, right base, core biopsy: )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. Following his residency in anatomic pathology at The Johns Hopkins Hospital in Baltimore, Maryland, and a fellowship in oncologic pathology at Memorial Sloan Kettering Cancer Center in New York., he then joined the staff at The Johns Hopkins Hospital and has been there his entire career. Did robotic radical prostatectomy 1/25/12. My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. After sending off all of our records, CD of MRI and path reports, my husband is booked for screening in December. Some men have minimal or no symptoms at all.
However, it also is possible to seek a pathology second opinion on your own, and it does not require an in-person office visit. I have selected Focal Laser Ablation as my future (soon) treatment. Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. 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. I worked out every day and it wasn't until the last week did I feel a bit fatiguedand experience a bit of urgency and hesitation having to peeflowmax fixed that right up!90 days after treatment my PSA came in at .56. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. 3. Surgeon wants next PSA in 3 months. I have actually had a second opinion a while back from Dr. Bush. You're more likely to develop prostate cancers that are more likely to spread. - 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 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).
Prurigo Nodularis Cancer: What's the Link? - Verywell Health I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. Because every patient is different, there are several ways to approach prostate cancer treatment. Am I wrong? EDI am now 52 and not quite functioning like I did 4+ years ago. Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. Good Morning Brothers- The symptoms of acute bacterial prostatitis are similar to those of CPPS. Surgical Delay and Pathological Outcomes for Clinically Localized High-Risk Prostate Cancer. Treatment options include immunotherapy, Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. You think your doctor is underestimating how serious your cancer is. At that point I agreed to the TRUS biopsy which I had on October 10, 2020. * Size: 1.1 cm It hasn't let me down. We will give that a shot and see how it turns out. I luckily found this webpage and I started reading everything I could get my hands on. I was referred to a urologist and tested again in April at 4.40. * Adjacent organ invasion: None. Would it be rational to stay on AS until biopsy results show a higher volume of PCa for sampled cores (i.e. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. This championship swimmer sought a second opinion at Johns Hopkins. 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. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. Benign Processes: 1st opinion. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . Forty percent of the men obtained a second opinion from urologists, most often because they wanted more information about their cancer or wanted to be seen by the best doctor . Anyway, would appreciate knowing how to contact Johns Hopkins. Results: First let me just say what so many others have previously stated, the thought of going on this journey alone is frightening, I cant imagine traveling this road alone. 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. 5. Does this also include HIFU, Cryoablation? My question is--what importance do volume levels play in determining when to move from AS to treatment? Greetings gentlemen! Caused me to bleed heavily. Some specialize in reading only slides that come from a specific organ while others are generalists who read many different pathology slides from many different organ systems. E. Prostate, left mid, core biopsy: We can help with your case. But I refuse to sit still, I continue to research and to plan, as best I can. -------------------------------------------------------- Either the patient or the primary physician can initiate the process of getting a second opinion. How important is Oncotype DX test for Gleason 7? I was confident I was making the right decision. I am unfortunately "officially" joining the club after getting my biopsy results today. Second opinions apply to biopsies and imaging as well. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. Biopsy in 12/27/11 showed 3/14 cores, Gleason 6 with PSA of 4.5. Im currently 67 years old. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Required fields are marked *, PHONE 310-827-7707 That's the good news. Intensity: min 148 / Max 459 See this image and copyright information in PMC. While I have three lesions, they are small and, without 3T mp MRI, might not have been discovered. Thanks to all of you for sharing! Know Your Stage. However, older men 75 years were the least likely to report obtaining a second opinion due to dissatisfaction with their initial urologist. 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.
Patient-Driven Second Opinions in Oncology: A Systematic Review. The people were great. 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. The study was published online Nov. 7 in the journal Cancer. We are vaccinating all eligible patients. - Perineural invasion is present Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. You May Like: Best Treatment For Intermediate Prostate Cancer. There is hope. I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. Enter the last name, specialty or keyword for your search below. Second opinion Biopsy came after FLA G-9. The average age at the time of prostate cancer diagnosis is about 66.
7 Tips for Seeking Second Opinions For Men with Prostate Cancer