Should You Exercise When Youre Expecting? 4. We experienced information overload and decision/analysis paralysis. 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. Conflicting Prostate Biopsy OpinionsWhat to Do? 2nd opinionBone Scan:"Mild increased activity is seen in the right symphysis corresponding to the abnormalities on the prior PET/CT examination. There is no extraprostatic extension. I had a follow up 3T MRI guided biopsy on March 18 at Emory. A newly published paper by Fischer et al. Seminal vesicles and other margins are negative for tumor. There are also many reasons why you may want to seek another opinion during the course of your cancer care. Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. Instructions for Second Opinion on Pathology (Gleason score) Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. Benign prostatic tissue And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. 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. A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. -------------------------------------------------------- I had a very bad experience with an incompetent nurse that did a catheter change. 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. One of the problems with second opinions is that insurers may not cover the expense. At the Johns Hopkins Medical Institutions, he is Professor of Pathology, Urology, and Oncology the recipient of the Reinhard Chair of Urological Pathology and Director of Surgical Pathology. 1. Slightly We specialize in minimally invasive treatments for prostate cancer such as: We place a high priority on sparing the nerves and tissue around the prostate whenever possible. 30%/40% or higher)? 1st opinion. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. Some men have minimal or no symptoms at all. Assessment categories for this lesion: Seeking a Second Opinion - American Cancer Society 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. Not all cancers are the same and not all treatment plans are absolutely clear. I appreciate any comments or insight that anyone wants to share. Original Sloan Biopsy Results: Director of Surgical Pathology- Johns Hopkins, http://pathology.jhu.edu/department/services/secondopinion.cfm, The guy I used along with everyone else is Jonathan Epstein, M.D. 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. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. MRI June 2017 again at SMIL. official website and that any information you provide is encrypted 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, Read Also: Nhs Prostate Cancer Risk Calculator. Getting a second opinion from us is easy, convenient, and all done remotely. 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: Atrophy 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). Call us with any questions: 410-955-2405, ext. 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. I could not get a definitive answer from them on how much, how many cells, or any information. F. Prostate, left apex, core biopsy: Read books and realize as soon as they are published, they are outdated. Enter the last name, specialty or keyword for your search below. (The pathology report from Cedars-Sinai kept my diagnosis at 3+4, but a second opinion at Johns Hopkins upgraded me to 4+3.) The presence of any G4 has been my trigger to seek treatment. I say bullshit to them. Most choose treatment they originally planned to follow, study finds. 3 months has passed, and its time for a PSA and a plan to have an MRI. 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. No two cases of prostate cancer are alike and an accurate diagnosisis critical to developing the best treatment plan. 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 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 other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? * PIRADS v2 Score: 3 Also these lesions did not abut or touch the wall of the prostate. Reasons for obtaining a second opinion from urologists. - High grade prostatic intraepithelial neoplasia (HGPIN) Lesion 2: Right mid anterior transition zone. We can help with your case. Pingback: PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Pingback: Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Your email address will not be published. Request an Appointment 410-955-6100 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. Maybe lycopene and pomegranate have helped. the transition zone. The total number of cores with carcinoma is 3 This doctor or team of doctors will review the following: The doctor then communicate their opinion regarding treatment to both the patient and the primary physician. * Adjacent organ invasion: None. How much is the fee for an opinion of my recent MRI? If I don't meter fluids before bed, I can expect to get up 3-4 times in the night.At this point, I am convinced I made the right treatment choiceOHFOR THOSE THAT DON'T KNOW, THE VA HAS MADE REPRODUCTIVE CANCERS A PRESUMPTIVE CONDITION FOR THOSE THAT SERVED IN MOST OF THE WAR ON TERROR LOCATIONS.Good luck fellas and my prayers are with all of you having to contend with this disease. 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? You May Like: Prostate Radiation Treatment Side Effects. Note respondents were able to, MeSH Youve just been diagnosed with prostate cancer. I have been drinking out of an information fire hose. 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. A second opinion can accomplish a number of things. 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. PSA: 4.7 ng/ml/PSA density: 0.27 ng/ml2 Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Using an Ellipsoid Volume the dimensions would give you a volume of 20.44. 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. The Radiation Oncologist said he would be comfortable waiting a little more, but he wasn't confident that I'd grow a target lesion, nor would I be able to wait years before having to do "something." PDF Cancer A Second Opinion A Look At Understanding Controlling And Curing Prostate cancer is an 2021 Sep 24;11(9):e044033. * Adjacent organ invasion: None. First 6 week PSA is undetectable. 2/23 PSA 4.7/fPSA 12% taken for 4K score (lab #2) It didnt look at changes of grading of the cancer.The chances for some type of modification based on a second opinion are even greater than the study indicated.Asking for a second opinion could lead to a significant change in surgical or medical intervention, Netto says.Even if the diagnosis error isnt catastrophic, such as advising a patient that he has cancer when he really doesnt, an error in grading can be consequential. Thanks, Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required. -------------------------------------------------------- Find more COVID-19 testing locations on Maryland.gov. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. In some situations, insurers will even insist on a second opinion. His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. Masks are required inside all of our care facilities. 10: Prostate, right anterior MRI lesion The peripheral zone has a patchy signal pattern. Future study is needed to determine when second opinions contribute to increasing the value of cancer care. Not all cancers are the same and not all treatment plans are absolutely clear. Thank you! doi: 10.1002/cncr.30412. 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm A second opinion is part of the education process that is critical for many cancer patients. 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. You can call and speak with his assistant at: (410) 614-6330. 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. Slight BPH findings. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. Prostate cancer is a malignant (cancerous) tumor of the prostate, a gland found only in men. Thank you for your understanding and cooperation. Caused me to bleed heavily. But if I include the 3+3=6 cores then 4 cores tested positive and that moves me into the basic teal category and no longer a strong candidate for AS. Consult Fees In some cases, additional testing may be required. Prostate volume: 17.58 cc Value of Second Opinion in Prostate Cancer Uncertain, Says Hopkins Study. I had my first of those 2 PSA tests last week and it dropped to 4.77. 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. 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. 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. 53 years old Expert review of your case by a Cleveland Clinic specialist. 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. 3. 5. Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. Call us with any questions: 410-955-2405, ext. He was right. And 2 cores from left apex of 3+3=6 with 10% involvement. Lesion 1: Left mid-base transition zone. Younger men also sought the 'best' doctor. Can it be salvaged or are the risks of cancer too high? So fingers crossed. 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. Because physicians may differ in their approach to treating breast cancer, its very important to check with a breast cancer expert to know youre receiving the best treatment for you. But in the spirit of disclosure for those of you with BPH a TURP can complicate a future Radical Prostatectomy (or possibly Cryo) and increase the risk of side effect risks. If the enlarged prostate is not completely removed, it will shrink. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Benign prostatic tissue * Asked and Dr. said he isn't overly concerned about perineural finding with the grade and it won't impact treatment options or overall prognosis. Johns Hopkins Health - Second Opinions, Second Chances - Hopkins Medicine Here are some recent updates: Uterine cancer.Women who use chemical hair straighteners frequently could have a higher risk of developing uterine cancer than women who have never used the products, according to new findings from a national study that has followed nearly 34,000 U.S. women for more than a decade. This Dr is in charge of active surveillance program at JH so I knew that he wouldnt recommend surgery unless it was really needed. If the enlarged prostate is not completely removed, it will shrink. (TZ) One suspicious area - lesion size: 2cm x 1.4 cm Contact us or find a patient care location. In severe cases, a catheter may be required to relieve the symptoms. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. I luckily found this webpage and I started reading everything I could get my hands on. Good Day Everyone. All rights reserved. These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. Prostate, right anterior MRI lesion: My diagnosis is T2c, Gleason 7 (3+4). Day 7 after surgery I took my last pain pill. 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. 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. 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. The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. 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. * Sloan only sent partial cores, slides 1 and 4. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Got my physical and normal DRE with new Dr. No issues identified. Your email address will not be published. All Gleason 6 (3+3). Hillen MA, Medendorp NM, Daams JG, Smets EMA. The biopsy took 3 samples from the targeted region plus 16 sextant. Second opinion on biopsy slides - malecare.org The average age at the time of prostate cancer diagnosis is about 66. Based on the results, our experts can provide you with an individualized treatment plan before you leave. Especially opinions other than those of the first Urologist you see. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. I have selected Focal Laser Ablation as my future (soon) treatment. Would you like email updates of new search results? I luckily found this webpage and I started reading everything I could get my hands on. 7. 5. Does every biopsy provide a Gleason Score? This is why the prostate is important to the body. After applying exclusion criteria, the final analytic cohort included 2365 respondents. Epub 2010 Oct 20. What have your doctors told you? 1: Prostate, right lateral apex 9: Prostate, left anterior MRI lesion A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. Medical record collection from doctors and hospitals. )As for side effectsI occasionally have some urgency/hesitancy having to pee. Benign prostatic tissue Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. 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. Oncologist. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! Patients may experience a fever or chills as a result of the infection. 3. 10. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. Johns Hopkins said I have options of adjuvant radiation approach up to 3-4months or wait to see if there are two successive rises in PSA and then do "salvage" approach. Even at the age of 48, he thought I would be a good candidate for AS. My only concerned was heavy metal poisoning and didn't know how long AS would be beneficial since I was starting at a young age. Cancer patients are encouraged to obtain second opinions before starting treatment. Emotional outlook is fragile at times and straight clinical approach of doctors does not help. After a second opinion from both Johns Hopkins and Stanford, the two 4+3's were downgraded. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. With that alone, I would likely be a candidate for continued Active Surveillance. Sometimes, you may find out about treatment options you didnt know were available. How important is Oncotype DX test for Gleason 7? Total Gleason score: 6 In My Opinion? Get A Second Opinion | ZERO Prostate Cancer So the pathologist suggested a second opinion. However, he also said it's treatable even at a 2cm size and the transition zone is a favorable spot. Generally, the symptoms can stabilize over time. ZERO - The End of Prostate Cancer Support Community. The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) Johns Hopkins Prostate Cancer Second Opinion LESION 1 Have you heard of PRECISE follow up score for an MRI? EDI am now 52 and not quite functioning like I did 4+ years ago. Prostate, left lateral base: The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. Find more COVID-19 testing locations on Maryland.gov. However, there are also many more options for treatment and these options are more complicated than in the past. You think your doctor is underestimating how serious your cancer is. 2017 May-Jun;30(3):298-307. doi: 10.3122/jabfm.2017.03.160359. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). Results: Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. There is no extraprostatic extension. Study after study confirms that doctors favor the treatment they are trained to do urologists typically recommend surgery and radiation oncologists recommend radiation. 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. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. 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. Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. Just took time off and then life happened.Thanks in advance for the insights. Receiving a second opinion was not associated with perceived quality of prostate cancer care. After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. * Extracapsular extension: Possible involvement of the anterior Prostate cancer is the second-most diagnosed cancer in American men. Men need to be educated on all treatment options to protect themselves from a biased industry. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. 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. T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive Prostate cancer is a slow growing condition. poorly defined margins and intermediate to low T2. 4. The problem is that all 3 pathologies noted an intraductal component. 5/10 PSA 4.2/fPSA 9% taken at MSKCC (lab #3) What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! 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. Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? 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 . How long do you have left? What are you doing about it? I can do radiation as a monotherapy. Read Also: What Are The Signs Of Prostate Infection. No extraprostatic extension. FOIA 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. * Perineural Invasion detected We are vaccinating all eligible patients. Jonathan Epstein, MD received his doctorate from Boston University. -------------------------------------------------------- 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. Dr. Jonathan Epstein of Johns Hopkins University Hospital. My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. They won't be offended, and they may even be able to recommend a specialist for you to see. Also Check: Prostate Cancer Stage 7 Treatment. PROSTATE LESIONS: Cancer. IMPRESSION: Adenocarcinoma: 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. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. It is OK to be scared. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . * He said probably not candidate for watchful waiting because of tumor volume shown and seen on MRI. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. PMC You Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. * Location: Right, anterior, apex, peripheral zone Get a Second Opinion Every year I got a PSA and DRE during my annual physical. Best wishes to all those whose concerns for the day are far more serious than mine. Unbelievable that this happened!!! 24.5 BMI 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. Prostate cancer is the second-most diagnosed cancer in American men. Many researchers believe PTEN present is a strong brake on Know Your Stage. Netto says patients should be proactive in requesting that doctors take another look. Getting a second opinion can sometimes lead to a complete change in diagnosis in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. Knowing your stage and information specific to that stage makes you more medically sophisticated and enables you to navigate through the potential biases of surgeons and radiation therapists. My other option for treatment is either LDR or HDR brachytherapy. At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). By basing a treatment Most reputable HMOs can, however, deliver state of the art treatment for most cancers. I recently sent my Pathology Slides to Dr. Epstein for a Second Review. Benign prostatic tissue 3: Prostate, right medial apex Transition Zone: In the left base, mid and apical transition zone there is a large mass measuring 2 cm in size which has Younger men were more likely to cite wanting more information about their cancer and to see the best doctor as the reason to seek a second opinion . Federal government websites often end in .gov or .mil. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? Most reputable HMOs can, however, deliver state of the art treatment for most cancers. B. Prostate, right mid, core biopsy:

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