Read books and realize as soon as they are published, they are outdated. Unlike pathology labs in most hospitals, Jonathan Epstein's lab at Johns Hopkins has pathologists who specialize in reading prostate tissue samples. Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? He also said I would tolerate any option well based on my age and health. 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. Ask us questions on this webpage. Therefore, the value of these second opinions remains unknown. I'm going to reach out to UCLA to see what they can do. 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. My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. Using an Ellipsoid Volume the dimensions would give you a volume of 20.44. J Am Board Fam Med. My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. The neurovascular bundles are intact. MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): Unable to load your collection due to an error, Unable to load your delegates due to an error. Should You Exercise When Youre Expecting? PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Considering Prostate Cancer Clinical Trials? That is literally the first time I heard that term other than seeing it in my pathology report. - T2 = 3/5 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. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. My direct phone (mobile) number is 703-992-3662, or you can private message me via this platform. We are vaccinating all eligible patients. IMPRESSION: In fact, additional biopsies revealed no additional cancer. About this time, I started reading this forum and my ignorance starts going away. 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. Adenocarcinoma: Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. Any input on this would really be appreciated. 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. One of the problems with second opinions is that insurers may not cover the expense. 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. 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. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasn't spread outside of the prostate. A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. An increase of 1.1 in 3 months is not good news. If you are considering undergoing a specialized treatment, such as cancer surgery, within your HMO, it is important to inquire about the number of such procedures performed each year by the HMO and the results. ADC: mean 879 / median 839 / st dev 223 My thoughts focus on the fact that I have a disabled son who needs my care. Greenfield G, Shmueli L, Harvey A, Quezada-Yamamoto H, Davidovitch N, Pliskin JS, Rawaf S, Majeed A, Hayhoe B. BMJ Open. This teamwork ensures the best possible patient outcomes. 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. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. You Secondary Gleason grade: 4 Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Good pathology readings require experience and a high level of expertise. Clipboard, Search History, and several other advanced features are temporarily unavailable. Prostate cancer is an I am also not comfortable making a decision based upon 1 genomics test, when my other prior test(s) disagrees and the gleason score disagrees. I was to follow up with my new Urologist (another surgeon) for 3 months PSA checks and annual 3T-MPMRI.My PSA checks were static and the next year's MRI looked just like the first. I appreciate all the input because I am a little overwhelmed and confused as to the best course of treatment. When you review your pathology report and are going to be making important decisions, like treatment decisions, which will be based on the information from the pathology report. I followed up with the original pathologist to compare and he was more forthcoming. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. )As for side effectsI occasionally have some urgency/hesitancy having to pee. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. Further, the two tumors in question have not really changed much in size for more than 2 years. Sometimes, you may find out about treatment options you didnt know were available. The total number of cores identified is 3 An official website of the United States government. As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. This Dr is in charge of active surveillance program at JH so I knew that he wouldnt recommend surgery unless it was really needed. A PSA test at time of biopsy revealed my PSA had risen to 6.5. Generally, the symptoms can stabilize over time. It has been 2.5 years and the PSA has still not doubled as well. Other Features: 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. Send a Consult for Second Opinion | Johns Hopkins Pathology * Extracapsular extension: Possible involvement of the anterior Their opinions are widely held to be definitive. The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) Disclaimer. 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. Benign fibromuscular stroma; no prostatic glands are identified 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. When I was diagnosed I really thought that I will live only 2 years. !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. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. Only took Motrin and Tylenol for pain after release. This teamwork ensures the best possible patient outcomes. 5: Prostate, left medial apex Anyone else encounter something like this? :) The Journal of the American Board of Family Medicine published a study in 2017 that found that many patients do not get a second opinion outside of their PCPs original referral2. 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. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. Reasons for getting a second opinion include: You want to be sure you have explored all options. Consultation with your nurse care manager. 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). No extraprostatic extension. Visit and Like ZERO - The End of Prostate Cancer on Facebook, Sign up to receive emails and news from ZERO - The End of Prostate Cancer, Search prostate cancer clinical trials and studies. Results: I had FLA done after first biopsy which staged me at 3+4 = 7. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. Some men have minimal or no symptoms at all. So, I also sent this MRI result to Johns Hopkins for a second opinion. not hear all the viable treatment options or receive the most up to date Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. A new study by researchers at the Johns Hopkins University has found that . Men have plenty of time to seek multiple opinions and thoroughly research each option before making a decision. Benign prostatic tissue For men with prostate cancer and who live in the United States, there are some highly regarded pathology labs from which you can obtain your second opinion. Second opinion Biopsy came after FLA G-9. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. 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. I've tried to find out about Dr. Wong but there's very little info on him. The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. images and markedly reduced ADC. 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). Details are here: 3 months has passed, and its time for a PSA and a plan to have an MRI. All views would be appreciated. (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. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. Through the AHN Cancer Institute, you benefit from personalized treatment in your community, close to home, from your dedicated care team. MRI obtained outsideon 04/16/2021. But I don't want to do a radical prostatectomy or radiation that would have large side effects now if the laser is a viable option given my data set. Heres What You Need to Know, Prostate Cancer Spotlights in 2020: A Year in Review, Find out about PSMA PET Imaging on Prostate Pros Podcast. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. I am unfortunately "officially" joining the club after getting my biopsy results today. But I did speak to an oncologist who wanted to order Oncotype, which I did. Men were asked if they obtained a second opinion from a urologist, and the reasons why. The total number of cores with carcinoma is 3 Not all men with Gleason 8-10 disease are going to do badly after I really just want the results of their innovative PTEN test. You're at greater risk if you're Black or of African ancestry. So I initially thought this makes me a good candidate for AS. 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.). Seek Perspective from a Range of Specialists. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. * Perineural Invasion also detected An accurate diagnosis is essential to ensure the most effective treatment. Prostate Cancer | Johns Hopkins Medicine Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: I was to follow up with my new Urologist (another surgeon) for 3 months PSA checks and annual 3T-MPMRI.My PSA checks were static and the next year's MRI looked just like the first. Those readings were reported on a second opinion by Dr. Epstein. All rights reserved. 1st opinion"Nonspecific sclerotic change of the right pubic bone with low-level radiotracer activity, favor degenerative change rather than osseous metastasis." First 6 week PSA is undetectable. This shows very high signal intensity on the diffusion-weighted A man with a father or brother who had prostate cancer is twice as likely to develop the disease. Comments appreciated, After a little experimenting I have been able to achieve a partial erection. (PZ) - normal The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. I suggest for all that hear, "you have cancer" that you seek more opinions! BONES: No suspicious osseous * Sloan only sent partial cores, slides 1 and 4. MRI RE-READ #2 (VERY VERY well respected radiologist): Get a Second Opinion | Johns Hopkins Pathology Study after study confirms that doctors favor the treatment they are trained to do urologists typically recommend surgery and radiation oncologists recommend radiation. Be well. Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, The Sidney Kimmel Comprehensive Cancer Center. This condition causes pain in the lower back and groin area, and may cause urinary retention. If they have an enlarged colon, their physician can perform a TURP procedure. Greatest dimension 0.7cm . Dr. Nour is 100% sure that nothing has spread. In unadjusted analyses, younger men , men with college-level education , and privately insured men and Medicare ) were more likely to obtain second opinions . It is OK to be overwhelmed with info. At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). One core had 5%, one 20%, and one 40%. There are also many reasons why you may want to seek another opinion during the course of your cancer care. With world-renowned expertise, multidisciplinary specialistsand the latest data, we partner with you tomake informed decisions about managing your prostate cancer. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. - DWI-ADC = 4/5 Who should I contact at Johns Hopkins to get a second opinion on a biopsy? This is why the prostate is important to the body. 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. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. 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. 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.