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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. Surabhi Dangi-Garimella, PhD. A new study by researchers at the Johns Hopkins University has found that . * Prostate volume: 22 cc Symptoms include leaking and discomfort. 3T MRI with coil is done initially, along with a TRUS biopsy. Some pathologists have more experience than others. There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists. Given that some 3+4 is now evident, I can no longer say that all my PCa is all 3+3 and that I can stay on AS for an extended period.
Second Opinions for Cancer Care - UChicago Medicine Who Should Request a Second Opinion? Who should I contact at Johns Hopkins to get a second opinion on a biopsy? IMPRESSION: It is OK to be scared. 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. 53 years old 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 wish the VA would be more informative about this disease they owe it to our veterans. When facing an intricate disease like prostate cancer, the above scenario is far too simple to have a promising outcome. (TZ) One suspicious area - lesion size: 2cm x 1.4 cm It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. 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. ADC: mean 879 / median 839 / st dev 223 During puberty, the body produces semen in a large number of cases, including enlarged prostate. Good Morning Brothers- Over kill and redundancy I know, but it's my money, my prerogative. )As for side effectsI occasionally have some urgency/hesitancy having to pee. SMIL radiologist reported nothing found. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. 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. For cancers that are less common, second opinions can offer more treatment options. Careers. 3. Associated fees may be incurred up to $1,800 in a minority of more complicated cases requiring special studies. The symptoms of acute bacterial prostatitis are similar to those of CPPS. 3 months has passed, and its time for a PSA and a plan to have an MRI. You think your doctor is underestimating how serious your cancer is. 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. Am I wrong? First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. 4. Thanks, BigD. I worked out every day. Required fields are marked *, PHONE 310-827-7707 intricate disease and not all doctors have the same amount of experience 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. Read Also: What Are The Signs Of Prostate Infection. Diffusely decreased 7. The biopsy took 12 cores, two from each lesion area and 8 randomly. Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. 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. Second opinions offer different things in different circumstances, Dr. Matasar says. See this image and copyright information in PMC. 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. Prostate volume: 17.58 cc Surgeon wants next PSA in 3 months. After sending off all of our records, CD of MRI and path reports, my husband is booked for screening in December. This teamwork ensures the best possible patient outcomes. I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. More medical freakouts. Also Check: Prostate Cancer Stage 7 Treatment. PCPs can be a great help to navigate the medical marketplace and provide an unbiased voice of reason when it comes to making hard choices.
Seeking a Second Opinion - American Cancer Society * Both Sloan and Johns Hopkins admit that large discrepancies are unusual, yet both stand by their opinions. So, Radiation Oncologist prescribed Cialis 5mg, daily. So, Radiation Oncologist prescribed Cialis 5mg, daily. Dont Miss: Is Coffee Bad For Your Prostate. At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Prostate Cancer Treatment: What to Know About Active Surveillance. The total number of cores with carcinoma is 3 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. 2018 May;115:133-138. doi: 10.1016/j.urology.2018.01.048. 4. Dr. Nour is 100% sure that nothing has spread. Medical record collection from doctors and hospitals. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! DRE is always normal.
Get a Urology Second Opinion | Johns Hopkins Brady - Hopkins Medicine Proton Therapy Case Study - Prostate Cancer - Johns Hopkins Medicine 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. Metastatic disease considered less likely for this pattern. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. Benign Processes: We are vaccinating all eligible patients. You can find out by reviewing your plan or by reaching out to your insurance company. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. Depending on your location, you may be able to have a telemedicine consultation. 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). My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. I was disappointed that only TRUS was being used, but I did find out that this was for screening only and IF you pass screeningthey use MRI guided biopsy for post-ablation follow up. It will be interesting to see, I think. 7: Prostate, left lateral apex It is OK to be overwhelmed with info. SO.
Breast Cancer: When to Get a Second Opinion - WebMD However, he also said it's treatable even at a 2cm size and the transition zone is a favorable spot. No extraprostatic extension. My urologist has decided we'll go ahead with the MRI due to the continued elevated PSA scores, in addition to the overall PHI score. Reasons for obtaining a second opinion from urologists. We are vaccinating all eligible patients. The Johns Hopkins Brady Urological Institute is known around the world for its expertise in diagnosing and treating urologic conditions. Also, infection was noted, so the current PSA is high in part due to prostatitis. Jonathan Epstein, MD received his doctorate from Boston University. Thanks, The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. We experienced information overload and decision/analysis paralysis. A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) You May Like: Prostate Cancer External Beam Radiation Side Effects. My new Dr however didnt order PSA so I asked him for one. Note that I'm trying to get a second opinion from Johns Hopkins but Mayo, where the biopsy was performed, appears incapable of processing my request. and I have already proven to myself that my body is good at cell mutation, so I wanted to be careful.At the 3 year mark (6 months after last MRI), my PSA spiked to > 6. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. 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. How to Get a Second Opinion Our team at Johns Hopkins has a dedicated service to interpretation of brain tumors and render second opinions on a daily basis. 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. According to the doctor it is around 3 mm. doi: 10.1136/bmjopen-2020-044033. 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. Prostate, left lateral apex: 4, Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion. Pathology reports are the opinion and interpretation of the individual pathologist viewing the tissue samples. 4: Prostate, right medial base
Second Opinion For Cancer Treatment And Care | CTCA | City of Hope 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. For cancers that are less common, second opinions can offer more treatment options. has now confirmed this assumption through a careful retrospective analysis of data from > 450 men whose records could be identified in the SEARCH database, all of whom received surgical treatment for Gleason 8 to 10 prostate cancer. I am also doing a vegan diet with additional complementary substances. There is no bony or bulky nodal disease in the pelvis Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . 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 . I still have some urgency and frequency issues, but I am not complaining too bad. 5. I worked out every day. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. 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. Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. According to the study, one in every 600 diagnoses showed mistakes.This study only addressed major changes in diagnoses, such as a diagnosis of cancer being reversed to no cancer, says Johns Hopkins pathologist George Netto, M.D. - PI-RADS for this lesion = 4/5 Two from one lesion were positive as was one of the two from the other. This urologist can get you in for surgery next week. 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. Assessment categories for this lesion: I have completed an exhaustive research effort on Prostate Cancer and PCa treatments. I am doing my own research, but I am curious as to thoughts of the best possible MRI to obtain to give me the best chance at finding something the needle biopsy didnt find.
Possible additional organ confined malignant lesion in right apex The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) Below is the link with instructions and the authorization form for you to use with your doctor. I question the potential EPE and he said it didn't matter, but went ahead and ordered Oncotype. Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. doi: 10.1001/jamanetworkopen.2020.28320. As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care.
John Hopkins Prostate Cancer Second Opinion Some men have minimal or no symptoms at all. Time moves fast when dealing with cancer, but Doctors dont. 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. Noted that some don't even include on report and should be looked as something to note but not obsess about. I asked the urologist who did our Second Opinion at Johns Hopkins and although he thinks RP is the way to go (due to higher PSA of 10.18), he highly recommended Dr. Eggenger (Chicago). Had my PSA remained static I'd have remained on AS and had I grown a Target Lesion I'd have sought focal treatment.This science is emerging and only getting better. Generally, the symptoms can stabilize over time. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. Tumor Quantifications: But I refuse to sit still, I continue to research and to plan, as best I can. 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. Need guidance choosing from multiple treatment options. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. Johns Hopkins second opinion - nothing found. 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. Has anyone sent Radiology (mpMRI) reports and images to Hopkins for Second Opinion Review? I hope my story helps anyone out there just starting the process. One of the problems with second opinions is that insurers may not cover the expense. For all other cancer appointments, please call: 1-855-702-8222. Even at the age of 48, he thought I would be a good candidate for AS. 5. Had a little complication a day after release, excessive blood/clots in urine. Cancer 2017;123:1027-34. A biopsy was performed on 2/26. 6: Prostate, left medial base The side effects of the cut, radiate, hormone regime are unacceptable to me. I now have my list whittled down to 3. Benign fibromuscular stroma; no prostatic glands are identified But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. If a targeted biopsy is planned, this lesion can be sampled at the same time. 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. Will these places of excellence consider me, or am I bound to my regular doctor for insurance purposes?
Second Opinions in Prostate Cancer - American Council on Science and Health You feel healthy, you arent in pain, you Keywords: With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. Dr. Albert Chang at UCLA appears to be the best in the biz for high dose rate (HDR) focal brachytherapy. PREVIOUS MRI RESULTS (LOTS of them) Find more COVID-19 testing locations on Maryland.gov. Without your support, I could easily have subjected myself to random biopsies that are risky, don't do a good job of finding lesions, and can mess up the clarity of the prostate for an MRI. * Perineural Invasion also detected They won't be offended, and they may even be able to recommend a specialist for you to see. However, learning more about prostate cancer and prostate-related health issues can help optimize health. In the mean time my PSA was movingno longer static, but never back up to 6. Just got my pathology results. poorly defined margins and intermediate to low T2. If they have an enlarged colon, their physician can perform a TURP procedure. 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. Unfortunately, what you do not realize may harm you! Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. 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 . Get directions, important phone numbers, locations and more. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! So off I went to see a community urologist who performed a needle biopsy in his office. I have searched the country for intervential radiologist that perform FLA on the prostate. Y'all are in my prayers! * Sloan only sent partial cores, slides 1 and 4. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. Reinterpretation of imaging scans and lab tests.
Biopsy Results: What Do They Mean? - Prostate Cancer Foundation Greatest dimension 2cm. The average age at the time of prostate cancer diagnosis is about 66. Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. Prostate cancer is an Lymph nodes: There is no suspicious lymphadenopathy in the pelvis. It was easy. Anyway, I'm reaching out to this group to see if anyone would be willing to chat with me about their brachytherapy experience at UCLA (even to talk me out of it).
Some specialists have more expertise and more experience than others. I would really love to hear from you. If they have an enlarged colon, their physician can perform a TURP procedure. Call us with any questions: 410-955-2405, ext. 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 had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. I say bullshit to them. One of the problems with second opinions is that insurers may not cover the expense. Please don't hesitate to make any observations or ask questions. Ask your PCP to refer you to several different types of treating doctors before making a treatment decision. They find that one of my 5-10% Gleason 6 core is actually a 50% Gleason 7(3+4) and the MRI was so cloudy with blood from original biopsy they said they couldnt determine much. Treatment must be chosen based on stage and your Some men may have an enlarged prostate but not notice it. I personally have benefitted from second opinions on my so-called cancer journey.