It took me awhile but minutes ago received my second opinion from Johns Hopkins. I didn't study for the test and it's possible some morning activities might have affected my test score :) 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. 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). Dr stated that after seeing my muscles on the inside during operation he would have predicted this. He also stated that he would ONLY recommend FLA if done within a trial. Luckily, his report co-coincided with the original QDx report. Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. Hoping that after I go through this that my advice to others will be able to guide them and that they can learn from my experience, as I feel I am gaining a solid foundation from both a practical and mental standpoint. Get a Second Opinion | Johns Hopkins Pathology A biopsy was performed on 2/26. I was referred to a urologist and tested again in April at 4.40. Reinterpretation of imaging scans and lab tests. A PSA test at time of biopsy revealed my PSA had risen to 6.5. Have been diagnosed with a serious or rare health condition. The prostates function is to create some of the fluid that insulates sperm cells found in semen. 9. If I am rested, I find that I am more ready than if I am not. Some pathologists have more experience than others. 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. The urologist offered surgery and radiation as options on 3/10 when we met. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. In My Opinion? Get A Second Opinion | ZERO Prostate Cancer Anyone with insight into this and advice? This urologist can get you in for surgery next week. Greatest dimension 0.7cm . Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. We are vaccinating all eligible patients. Didn't know if she had the catheter in far enough and not getting any urine through itwondered if she had inflated the balloon enough and wondering if it was the reason that I have developed an abscess. 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. It also rules out Brachytherapy. Is it done through my doctor or do I do it myself with sending CDs of the MRI? He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. As I said, I am 58, so I would really like to preserve my quality of life for as long as possible, but the genomics report has me concerned. E. Prostate, left mid, core biopsy: As soon as pathology slides were ready, Emory sent them to Dr. Epstein at Johns Hopkins. Thanks to all of you for sharing! Shore ND, Karsh L, Gomella LG, Keane TE, Concepcion RS, Crawford ED. Second round of Radiation Therapy - t - Advanced Prostate He was right. 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion Although a large proportion of men with localized prostate cancer obtained a second opinion, the reasons for doing so were not associated with treatment choice or perceived quality of cancer care. My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. Nov 7, 2016. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). 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. It is OK to be overwhelmed with info. Whether you want expert confirmation, lack understanding or confidence in your treatment plan, have a rare or unusual type of cancer, your cancer isnt responding to current treatment its reassuring to know that you have options through a second opinion. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. Lesion 2: Right mid anterior transition zone. 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. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . Second opinion Biopsy came after FLA G-9. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. A blocked urethra can also damage the kidneys. Your email address will not be published. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. Fear motivates you to want to treat this as soon as possible. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. John, I was diagnosed on 11 December, 2013. This teamwork ensures the best possible patient outcomes. Based on this forum, Im very lucky for this outcome. Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. Know Your Stage. * Both Sloan and Johns Hopkins admit that large discrepancies are unusual, yet both stand by their opinions. - PI-RADS for this lesion = 4/5 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. It works. Anything I am overlooking or need to add to my list of considerations? Dr. Nour is 100% sure that nothing has spread. 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. peripheral zone signal intensity on T2-weighted images. Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. MRI obtained outsideon 04/16/2021. 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. I want to insure that the Imaging was read correctly and nothing was overlooked or missed. 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. (PZ) - normal 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. It would be more convenient to use Mayo but I want the best practitioner regardless. 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. I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. It was easy. Background: Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Through the AHN Cancer Institute, you benefit from personalized treatment in your community, close to home, from your dedicated care team. OTHER: None. Just had my appointment today and they are pleased with the results, so far. Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. PREVIOUS MRI RESULTS (LOTS of them) After all, it seems like good idea to deal with your cancer sooner rather than later. IMPRESSION: Pathology reports are the opinion and interpretation of the individual pathologist viewing the tissue samples. Patients may experience a fever or chills as a result of the infection. A report with the diagnosis will be faxed to your doctor. Instead, I did my homework. If they have an enlarged colon, their physician can perform a TURP procedure. 1: Prostate, right lateral apex 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. NOTE: THINK THIS LOWERS MY PSA DENSITY SOME IF MY GLAND ISN'T a 17CC PEANUT! 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. If the enlarged prostate is not completely removed, it will shrink. Eager to hear what everyone thinks or has anything they see in the report I wouldn't have thought of. P/ 310-827-7707 | F/ 310-574-4002 | MAIL@PROSTATEONCOLOGY.COM. 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. 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. The margin of error is 1.4 percent, which is equivalent to 30,000 cancer diagnosis mistakes annually in the U.S. Of 6,171 biopsy slides sent since late 2008 for a second review at Johns Hopkins, pathologists disagreed with the diagnosis on 86 of them. I also learned a lot more about the high undisclosed risk of side effects of various treatment plans. A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. Who should I contact at Johns Hopkins to get a second opinion on a biopsy? Thanks for Everyone's Help, I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. Dr. Nour - Emory in Atlanta. Johns Hopkins second opinion - nothing found. SMIL radiologist reported nothing found. Seminal vesicles and other margins are negative for tumor. The primary goal is to be cured with the least toxic, most effective approach. 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. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . * Gleason Score: 3+4 (4 of 6 specimens), 14 specimens taken He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. Everything seems to be on track to remove the cancer and be cured! Not all cancers are the same and not all treatment plans are absolutely clear. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night. They basically said it didn't matter. Last year, Epsteins lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions.Netto says patients should be proactive in requesting that doctors take another look.A second opinion can reverse the diagnosis in up to 5 percent of cases for some types of cancers, he says, like those of the breast and pancreas.Diagnosis Errors by the Numbers. You May Like: Prostate Cancer External Beam Radiation Side Effects. * Location: Left, anterior, base to apex, transition zone For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. 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. An official website of the United States government. Also, if any of you have a way to get medicare to pay some portion of the cost, please let me know as well. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. What are your opinions of what that is, and where to get it? Thanks, restricted diffusion. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. No extraprostatic extension. According to the doctor it is around 3 mm. The local pathologist read the biopsy and said 3+4=7 10% pattern 4 for both lesions. Two weeks later I meet with my Johns Hopkins Dr. Ask your PCP to refer you to several different types of treating doctors before making a treatment decision. I also sent my biopsy slides to Johns Hopkins for a second opinion (Epstein's read was 3+4, but with lower pattern 4 involvement than the local pathologist.). Its in your best interest to ask for another look at a cancer diagnosisIf youve recently been diagnosed with cancer, its wise to ask for a second opinion on your pathology specimen.Johns Hopkins researchers with the Urological Pathology Consult Division, led by Jonathan Epstein, M.D., first reported on biopsy errors a decade ago, when they found a margin of error in prostate cancer diagnoses large enough to give them pause. Would you like email updates of new search results? So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. All views would be appreciated. Due to the spread of the Coronavirus worldwide and the first confirmed case of the Coronavirus disease in Turkey, the executive team of the Anadolu Medical Center has taken preventive measures to protect the patients and their relatives. - Benign prostatic tissue This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Consult Fees In some cases, additional testing may be required. Prostate cancer is the second-most diagnosed cancer in American men. My urologist suggested a couple more PSA tests followed by an MRI. Patient-Driven Second Opinions in Oncology: A Systematic Review. Oncologist. Interesting differences: !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. Low post-void residual volume is 3/3 4K score 19% (high end of intermediate) Centro Diagnostico Italiano , Milan, Italy, Manfred Dietel, M.D.Institute of Pathology Charit, Humboldt University of Medicine, Berlin, Germany, Jonathan I. Epstein, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Robert J. Kurman, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Elizabeth Montgomery, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Manuel Sobrinho-Simes, M.D.University of Porto, Porto, Portugal, Ronald S. Weinstein, M.D.University of Arizona, Tuscon, AZ, Franco VisinoniMilestone Medical Technologies, Bergamo, Italy, Also Check: How Old Can You Be To Get Prostate Cancer. How important is Oncotype DX test for Gleason 7? His second opinion just came back. You're more likely to develop prostate cancers that are more likely to spread. PDF Cancer A Second Opinion A Look At Understanding Controlling And Curing Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. My Oncotype rating was GPS 54, with a 26% chance of metastisis within 10 years. However, there are also many more options for treatment and these options are more complicated than in the past. I can do radiation as a monotherapy. Extracapsular extension: The prostatic capsule is preserved. (TZ) One suspicious area - lesion size: 2cm x 1.4 cm My direct phone (mobile) number is 703-992-3662, or you can private message me via this platform. In order to receive appropriate treatment, patients must understand the treatment options that are available. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Time moves fast when dealing with cancer, but Doctors dont. Reason was large volume of cancer (even though most of mine was Gleason 6), presence of Gleason 7 in biopsy and the rapidly increasing PSA. I was confident I was making the right decision. 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. DRE is always normal. The peripheral zone has a patchy signal pattern. They are not objective. 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." They hesitated calling it a TARGET LESION, but scored it PIRADS 4. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. 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: 3. Men who sought second opinions because they were dissatisfied with their initial urologist were less likely to receive definitive treatment (odds ratio, 0.49; 95% confidence interval, 0.32-0.73), and men who wanted more information about treatment were less likely to report excellent quality of cancer care (odds ratio, 0.70; 95% confidence interval, 0.49-0.99) compared with men who did not receive a second opinion. 4. 6: Prostate, left medial base 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. 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. All Gleason 6 (3+3). Prostate, right lateral base: 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. 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm Treatment options include immunotherapy,
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