johns hopkins prostate cancer second opinion johns hopkins prostate cancer second opinion

Other labs for second . Overall PIRADS Score: 5/5 My experience at Johns Hopkins was awesome. Four had 60-70%, five have between 5-10%. However, there were no other suspicious areas on MRI. Background: In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. One of the bits of advice the group regularly dispenses is for men to get a second and even a third opinion if you have doubts about the first opinions rendered by your urologist, or your pathologist, or your radiologist, its always okay to seek out a second opinion. Now the oncologist wants to perform a PSMA Pet Scan. Epub 2010 Oct 20. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of However, there are also many more options for treatment and these options are more complicated than in the past. A second opinion is part of the education process that is critical for many cancer patients. Wondering if any of the "gurus" here want to take a stab at looking at this and see if they agree that it says what I think it says (I will be following up with doctor(s) to get their opinion, and I waive all HIPAA rights by allowing this to be seen). Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. 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. * Adjacent organ invasion: None. Dr. Albert Chang at UCLA appears to be the best in the biz for high dose rate (HDR) focal brachytherapy. Reasons for obtaining a second opinion from urologists. There is no extraprostatic extension. After a little experimenting I have been able to achieve a partial erection. 3. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. Dr also stated he was able to totally spare one of my nerves, but to get margin may have damaged one. - 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 will say, the people I dealt with at Johns Hopkins were extremely nice and professional. But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). A few weeks later and just before my meeting with my new Johns Hopkins Dr I get the second opinion results from both biopsy and MRI. Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? Thank you for your understanding and cooperation. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? 4: Prostate, right medial base I just turned 71 in February. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. Secondary Gleason grade: 3 This fluid causes the prostate to swell and cause a number of bladder-related symptoms. Low post-void residual volume is Immediate means 6 weeks just to see his NP. The biopsy took 12 cores, two from each lesion area and 8 randomly. He spent an hour on the phone reassuring me that I didn't need to rush into anything, and they he'd love to scan me 6-8 weeks after my TRUS Biopsyhave to let the trauma and all the blood leave the prostate for a good image. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night. 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. The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. 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. 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 . Many health insurance companies will pay for a second opinion, especially if it is for a medically necessary treatment. My plan is to choose quality of treatment over cost of the treatment. When I was diagnosed I really thought that I will live only 2 years. Benign fibromuscular stroma; no prostatic glands are identified A biopsy was performed on 2/26. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. G. Prostate, lesion #1, core biopsy: Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference, Why Prostate Cancer Survivor John Shearron Thinks Its Important To Do Your Research | PCRI, John Hopkins Prostate Cancer Second Opinion, a higher risk of developing uterine cancer, surgery may not always be necessary for all breast cancer patients, The cancer vanished in every single participant, Long Term Side Effects Of Brachytherapy For Prostate Cancer, treat rare and complex conditions through breakthrough fetal procedures, Prostate Cancer External Beam Radiation Side Effects, Can Enlarged Prostate Cause Blood Clots In Urine, Life Expectancy Stage 4 Prostate Cancer No Treatment, Prostate Cancer Spread To Skull Prognosis, Diagnostic Procedures For Prostate Cancer. notable articles of 2016 - Johns Hopkins Bloomberg School of Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. The percentage of tissue with carcinoma is 70% 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. Reinterpretation of imaging scans and lab tests. Our regional community network integrates academic specialty cancer care at Allegheny General Hospital and West Penn Hospital and at more than 20 community cancer centers throughout the region. 4. Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. Unable to load your collection due to an error, Unable to load your delegates due to an error. My PSA over time has been creeping up over time (1.8 - 5/16, 1.0 8/17, 2.68 8/18, 2.9 12/18, 3.28 2/19, 3.01 8/19, 3.65 2/20, 3.31 6/20, 3.88 12/20) but I was frankly a bit shocked when I received word that I have cancer. * Adjacent organ invasion: None. We will give that a shot and see how it turns out. Second Opinion For Cancer Treatment And Care | CTCA | City of Hope I was confident I was making the right decision. Doctors are skilled at pitching the treatment they specialize in. Dont Miss: Bladder Control After Prostate Surgery. You can call and speak with his assistant at: (410) 614-6330. It works. 30%/40% or higher)? AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. 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. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. 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. Have a condition that isnt improving or is getting worse, despite treatment. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. One of the problems with second opinions is that insurers may not cover the expense. If the enlarged prostate is not completely removed, it will shrink. 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. My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. Assessment categories for this lesion: 180 days after treatment PSA was .50. My involvement is below maximum of 15% of core. Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. Benign prostatic tissue 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. Symptoms include leaking and discomfort. - Johns Hopkins Medicine -- Get a Second Opinion Some men may have an enlarged prostate but not notice it. PMC Will these places of excellence consider me, or am I bound to my regular doctor for insurance purposes? Find more COVID-19 testing locations on Maryland.gov. 4. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. * Location: Right, anterior, apex, peripheral zone In fact, additional biopsies revealed no additional cancer. Those readings were reported on a second opinion by Dr. Epstein. peripheral zone signal intensity on T2-weighted images. The purpose of starting this discussion is to gather peoples thoughts and opinions and actual experiences with Prostate Focal Laser Ablation. 10. I have searched the country for intervential radiologist that perform FLA on the prostate. Did robotic radical prostatectomy 1/25/12. Find more COVID-19 testing locations on Maryland.gov. Cleveland Clinics Virtual Second Opinions program connects you to an expert physician who specializes in your specific health needs. Ozzieville (Michael), Hello All and thanks for being here~This is my first post.My husband was diagnosed with PC (adenocarcinoma with Extensive Intraductal Carcinoma Present) a few weeks ago. He never sought treatment for the injury. 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. 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. Without the genomic test I have I lesion 3+3=6 and another, 3+4=7, with less than 5% pattern 4, and an MRI that shows no ECE, no other suspicious lesions and questionable cellular EPE based upon disagreement of pathologists. Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. Have been told a health condition is not treatable. We experienced information overload and decision/analysis paralysis. ADC: mean 879 / median 839 / st dev 223 7 Tips for Seeking Second Opinions For Men with Prostate Cancer With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3500 specialists. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Which Patients Report That Their Urologists Advised Them to Forgo Initial Treatment for Prostate Cancer? -------------------------------------------------------- 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. MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. 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%). Dr. Erick Walser at University of Texas Medical Center. This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. How much is the fee for an opinion of my recent MRI? I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. Treatment options include immunotherapy, and transmitted securely. 4. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. That is literally the first time I heard that term other than seeing it in my pathology report. Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. 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. You have a rare or unusual cancer. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. Good Morning Brothers- If youve received a new diagnosis or arent seeing results from your current treatment plan, a second opinion can help you move forward with confidence. 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. Where Should I Go for a Second Opinion? - breast cancer MRI June 2017 again at SMIL. At Johns Hopkins, you can feel confident knowing our multidisciplinary cancer clinics combine the very best resources and specialists all within in a single location for a highly coordinated experience that delivers exceptional care while conserving time, money and energy. It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. According to The National Institute on Aging, prostate problems are common after age 50. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! The primary goal is to be cured with the least toxic, most effective approach. If youve received a new cancer diagnosis or arent seeing results from your current treatment plan, an expert second opinion can help you move forward with confidence. In 2006 my PSA was .6. Thanks, Johns Hopkins Medical Laboratories 1620 McElderry St. Reed Hall Rm 315 Baltimore, MD 21205 Fax (410) 614-7712 Phone (410) 955-2405 8 am - 5 pm Normal LAB hours are: 5:30 am - 4:30 pm Mon-Fri He adds that second opinions also can provide insight into topics like clinical genetics and family risk or issues related to complementary or integrative medicine approaches to manage symptoms. Because I had an implant in my ear, they would only give me a 1.5T MRI. I have selected Focal Laser Ablation as my future (soon) treatment. I hope my story helps anyone out there just starting the process. Types of questions that pathologists often address in our second opinions: Benign prostatic tissue I trust the second opinion Dr. Bush gave. They did 9 patients in Phase I and there have been 12 so far in Phase II. Pathology reports are subjective. Biopsy in 12/27/11 showed 3/14 cores, Gleason 6 with PSA of 4.5. Thanks for Everyone's Help, It starts many years ago. 2020 Jul 21;19(1):112. doi: 10.1186/s12904-020-00619-9. Transurethral microwave thermotherapy : In selected patients, microwave energy helps to restructure prostate tissue and alleviate symptoms such as incontinence and voiding dysfunction, Laparoscopic prostatectomy: The prostate is removed with a miniature telescopic instrument, which allows for a quicker recovery, Robotic surgery: This breakthrough technology, which often is used for prostatectomy surgery, requires only a few small incisions. 3. 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). Benign Processes: In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive To schedule an in-person visit for a second opinion or to determine if a telemedicine consultation is possible, call: 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. Prostate, left medial apex: Be sure to confirm your diagnosis at a center of excellence. Reasons for obtaining a second opinion from urologists. 2: Prostate, right lateral base FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. Through the AHN Cancer Institute, you benefit from personalized treatment in your community, close to home, from your dedicated care team. The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Prostate Cancer | Johns Hopkins Brady Urological Institute 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. transition zone. I really just want the results of their innovative PTEN test. I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. 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. Call us with any questions: 410-955-2405, ext. Bring All Labs/Notes to Each Appointment. 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%). However, that information will still be included in details such as numbers of replies. Treatment must be chosen based on stage and your Potentially inaccurate results can lead to selection of the wrong type of therapy. My questions are: Is there such a thing as having a team that isnt equipped with the best equipment nor the most experienced radiologists? He said that it will improve in the future due to future improvements in the treatments. Right mid anterior transition zone (PIRADS 2). I really liked the new group I went to as they identified the lesion right away, unlike the radiologist who performed the first procedure, and they also have a urologist on staff as well monitoring everything. Thanks, 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. Of course that was before I found this webpage and I really didn't know what 1 core of 18 samples showing 3+4=7 Gleason meant. I have had a CT of the pelvic area - negative and a whole body bone scan - negative. * Gleason Score: 3+4 (4 of 6 specimens), 14 specimens taken Conflicting Prostate Biopsy OpinionsWhat to Do? Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. This has only low-level nonspecific activity with SUV max of 2.05 and may be due to degenerative changes at the symphysis pubis." A blocked urethra can also damage the kidneys. * PIRADS v2 Score: 3 Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. The linear amount of tissue with carcinoma is 11 mm It is OK to be scared. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. 6. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) My family physician for years told me that small increases PSA was common so when it went over 4 it didnt bother me and my Dr who was retiring, didnt say anything either. Greetings gentlemen! 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). Symptoms include leaking and discomfort. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. Shore ND, Karsh L, Gomella LG, Keane TE, Concepcion RS, Crawford ED. Benign fibromuscular stroma; no prostatic glands are identified - DWI-ADC = 4/5 Seeking a Second Opinion - American Cancer Society 3: Prostate, right medial apex And it is OK to have paralysis by over-analysis. Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. 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. Family history of prostate cancer. 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. Read Also: What Are The Signs Of Prostate Infection. Benign prostatic tissue Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. Luckily, his report co-coincided with the original QDx report. In unadjusted analyses, younger men , men with college-level education , and privately insured men and Medicare ) were more likely to obtain second opinions . Greatest dimension 2cm. IMPRESSION: I am doing one in 6 weeks, regardless. For cancers that are less common, second opinions can offer more treatment options. Results: Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. * Size: 1.1 cm Discover what's to love about Charm City for yourself. In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could . )As for side effectsI occasionally have some urgency/hesitancy having to pee. If these do not work, your symptoms could progress and become chronic. 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." Nov 7, 2016. However, learning more about prostate cancer and prostate-related health issues can help optimize health. Total Gleason score: 7 radiation, active surveillance, surgery, hormone therapy, and more. Even at the age of 48, he thought I would be a good candidate for AS. Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. My PSA went up from 3.5 post FLA (It was 7.2 pre-procedure) to 6.7 in 2021, so I went to another radiologist to do an MRI guided biopsy of the suspected area that was near the prior ablation zone. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. 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.