Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. 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. Be well. Expert review of your case by a Cleveland Clinic specialist. We had the 3T MRI (no coil) and MRI guided biopsy at Sperling in NY, and then had a 2nd Opinion done by Johns Hopkins. 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. In circumstances where there may not be a single established standard of care, we can ensure the treatment plan integrates the most current, up-to-date data, Dr. Matasar says. not hear all the viable treatment options or receive the most up to date Prostatic Adenocarcinoma of tumor in the rectal prostatic angles. Most choose treatment they originally planned to follow, study finds. They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. Federal government websites often end in .gov or .mil. No two cases of prostate cancer are alike and an accurate diagnosisis critical to developing the best treatment plan. It's really that simple! Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. I trust the second opinion Dr. Bush gave. Getting a Second Opinion The best time to seek a second opinion is before you start treatment. 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. There are also some cases of the test showing no depletion but being wrong. -------------------------------------------------------- Its gone.I have been advised to have a Axumin Pet scan as follow up as the first pathology report indicated perineural invasion present as well as probable introductal carcinoma. I assume it is not free. 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. These findings are suspicious for degenerative changes however a subtle/early metastatic lesion cannot be excluded and continued periodic follow-up is recommended." I have searched the country for intervential radiologist that perform FLA on the prostate. Some men may have an enlarged prostate but not notice it. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. 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. The best protection for cancer patients who are Health Maintenance Organization members is to seek a second opinion even if she or he has to pay for it. Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. U.S. News & World Report ranked the institute #7in the country. A second opinion is part of the education process that is critical for many cancer patients. It would be more convenient to use Mayo but I want the best practitioner regardless. This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? Prior to the results, the oncologist said that the literature shows that a 3+4=7 with less than 5% pattern 4 behaves just like a 3+3=6 and basically is an indolent tumor. 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. Bethesda, MD 20894, Web Policies I have had a CT of the pelvic area - negative and a whole body bone scan - negative. The prostates function is to create some of the fluid that insulates sperm cells found in semen. An acute bacterial infection can cause a burning sensation. 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. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. Emotional outlook is fragile at times and straight clinical approach of doctors does not help. 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. lesion. 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). Prostate Cancer Grading: I say bullshit to them. The problem is that all 3 pathologies noted an intraductal component. This condition causes pain in the lower back and groin area, and may cause urinary retention. 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. Perineural invasion is identified 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. FAX 310-574-4002 PSA was 3.0 in 2011 and rose to 6.0 in late 2013. Notice of Privacy Practices(Patients & Health Plan Members). Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. We are vaccinating all eligible patients. You think another treatment might be available. If you are diagnosed with a urologic cancer, including but not limited to the prostate, bladder, kidney, and testicular or urinary tract, its important to consider a second opinion. If I am rested, I find that I am more ready than if I am not. G. Prostate, lesion #1, core biopsy: Secondary Gleason grade: 4 To learn your stage of prostate cancer, take the staging quiz on keytopc.com. I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. !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. Thankfully, prostate cancer is extremely slow growing. BJU Int. The best protection for cancer patients who are Health Maintenance Organization members is to seek a second opinion even if she or he has to pay for it. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. )As for side effectsI occasionally have some urgency/hesitancy having to pee. Johns Hopkins is home to many of the world's leaders in Pathology. Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. It was easy. THANKS! You can find out by reviewing your plan or by reaching out to your insurance company. Noted that some don't even include on report and should be looked as something to note but not obsess about. (The pathology report from Cedars-Sinai kept my diagnosis at 3+4, but a second opinion at Johns Hopkins upgraded me to 4+3.) * Prostate size: 3.9 x 2.8 x 3. cm Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. Seminal vesicles are normal. He also said perinueral invasion, but not extracapsular extension. 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). A blocked urethra can also damage the kidneys. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Reinterpretation of imaging scans and lab tests. But I did speak to an oncologist who wanted to order Oncotype, which I did. Youve just been diagnosed with prostate cancer. Men have plenty of time to seek multiple opinions and thoroughly research each option before making a decision. About this time, I started reading this forum and my ignorance starts going away. I certainly would - after all, there's a certain brotherhood bond here. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. There were several areas of interest - but nothing in seminal vesicles, lymph, or bones. As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. In adjusted analyses, however, only age and education were significantly associated with obtaining second opinions from urologists. I appreciate all the input because I am a little overwhelmed and confused as to the best course of treatment. Get a Second Opinion | Johns Hopkins Pathology Value of Second Opinion in Prostate Cancer Uncertain, Says - AJMC Not all cancers are the same and not all treatment plans are absolutely clear. Left mid-base transition zone (PIRADS 5). Nov 7, 2016. Treatment Advice: Sloans radiation oncologist says radiation treatment will likely be the same whichever pathologist report prevails, but may add hormone therapy for about 2 months. Potentially inaccurate results can lead to selection of the wrong type of therapy. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. It was easy. 2 cores from left base of 3+4=7 with only 5% involvement. 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). Thanks, BigD. 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. This may include imaging, blood tests, prior treatment, and pathology reports. I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. The review process normally takes several days, after which we will send your slides and other materials are returned. Prostate, right medial base: Five years ago I had a TURP. PSA that brought me to this was 7.1. One of the problems with second opinions is that insurers may not cover the expense. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. 3+4, 4+3, 4+3, 4+5 (1st read)Both docs are recommending surgery.PSMA CT Scan report:"BONES/BONE MARROW: There are sclerotic changes in the right pubic bone adjacent to the symphysis pubis and to lesser extent in the left pubic bone. FLA DONE AT FIRST BIOPSY G- 7. To learn more about how to get a Neuropathology second opinion, please visit our Neuropathology Division second opinions website. Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care. Therefore, the value of these second opinions remains unknown. 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. With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3,500 specialists with extensive experience in all types of cancers. Please enable it to take advantage of the complete set of features! Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. 2018 May;115:133-138. doi: 10.1016/j.urology.2018.01.048. Adenocarcinoma: Also indicated everything else was "organ confined." ADC: mean 879 / median 839 / st dev 223 Covid turned the 1 year into 16 months and PSA tested at 7.44 in August 2020, followed by another referral back to the urologist. feel the clock ticking. Asking about other experience with conflicting Prostate Biopsy Opinions. In circumstances where there may not be a single established standard of care, we can ensure the treatment plan integrates the most current, up-to-date data, Dr. Matasar says. The more often a doctor diagnoses and treats prostate cancer the more proficient they become. Patient-Driven Second Opinions in Oncology: A Systematic Review. Over 80,000 specimen cases are seen at Johns Hopkins each year. Epub 2017 Jun 12. Surabhi Dangi-Garimella, PhD. According to The National Institute on Aging, prostate problems are common after age 50. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. My new Dr however didnt order PSA so I asked him for one. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). I have been drinking out of an information fire hose. I luckily found this webpage and I started reading everything I could get my hands on. Either the patient or the primary physician can initiate the process of getting a second opinion. We will give that a shot and see how it turns out. A second opinion can help you make an informed, confident decision about your medical care. I also had my PTEN test by META-MARK ( I don't have much to say about how I was treated by MM, but I won't be using their services again). )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. Seminal vesicles are normal. They did 9 patients in Phase I and there have been 12 so far in Phase II. 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. * Size: 1.5 cm Low post-void residual volume is Other labs for second . TZ zone more beneficial, but fairly large compared to whole gland and proximity to capsule edge would likely mean treatment would be suggested. :) 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. Men who sought second opinions because they were dissatisfied with their initial urologist were 51 percent less likely to receive definitive treatment, and men who wanted more information about treatment were 30 percent less likely to report excellent quality of cancer care compared with men who did not receive a second opinion. Here are seven tips for seeking second opinions for prostate cancer: Before getting a second opinion, its important to know your stage of prostate cancer. He recommended waiting and watching at that time due to the lower PSA reading. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. When I inquired with the oncologist that I had selected for my therapy before receiving the second opinion whether I would be a candidate for Active Surveillance considering the downgrading, she said 'no' due to the intraductal component. 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. They may defer to the recommendation of the specialist, or refer you to a doctor with limited prostate cancer experience. 7: Prostate, left lateral apex 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. ZERO - The End of Prostate Cancer Support Community. Rectal cancer.A small trial that saw 18 rectal cancer patients taking the same drug, dostarlimab, appears to have produced an astonishing result: The cancer vanished in every single participant. This Dr is in charge of active surveillance program at JH so I knew that he wouldnt recommend surgery unless it was really needed. Benign Processes: TRANSPERINEAL MRI GUIDED BIOPSY RESULTS 5: Prostate, left medial apex Ramsey SD, Zeliadt SB, Fedorenko CR, Blough DK, Moinpour CM, Hall IJ, Smith JL, Ekwueme DU, Fairweather ME, Thompson IM, Keane TE, Penson DF. This is often the case when the primary physician advises an expensive treatment. Transition Zone: In the left base, mid and apical transition zone there is a large mass measuring 2 cm in size which has Thank you! Doctors can review their peers treatment suggestions and explain why they agree or disagree. However, he also said it's treatable even at a 2cm size and the transition zone is a favorable spot. When people recommend going to a Center of Excellence, believe them. Treatment options include immunotherapy, He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. So, I believe I made the right choice. 3 months has passed, and its time for a PSA and a plan to have an MRI. Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. - DCE = (+) For cancers that are less common, second opinions can offer more treatment options. If a targeted biopsy is planned, this lesion can be sampled at the same time. Through the AHN Cancer Institute, you benefit from personalized treatment in your community, close to home, from your dedicated care team. You can call and speak with his assistant at: (410) 614-6330. Johns Hopkins Medicine A commercially available genomic test may help oncologists better determine which patients with recurrent prostate cancer may benefit from hormone therapy, according to new research from the Johns Hopkins Kimmel Cancer Centerand 15 other medical centers. This is a PI-RADS 5 lesion in Receiving a second opinion was not associated with perceived quality of prostate cancer care. Anything I am overlooking or need to add to my list of considerations? 9: Prostate, left anterior MRI lesion __________________________________________________________________________July 2022I've neglected to make journal entries for a couple years, so I will recap below and continue with what I have done and what I have learned.In 2018, at the age of 48, after a routine physical that showed a PSA of (4.X) and after a TRUS biopsy, I was diagnosed with PCa. DIAGNOSIS: My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. In some situations, insurers will even insist on a second opinion. 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. Patients are often under the mistaken notion that they have to pick between their oncologist and MSK, but thats often not the case, Dr. Matasar explains. Im currently 67 years old. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. Greetings gentlemen! Discover what's to love about Charm City for yourself. ---------------------------------------------------- Greatest dimension 2cm. This puts PCPs in a unique position to impact the treatment decisionif they only refer to urologists and not to radiation oncologists or medical oncologistssurgery is a likely treatment outcome. You May Like: Prostate Cancer External Beam Radiation Side Effects. Contact us or find a patient care location. Assessment categories for this lesion: The biopsy took 12 cores, two from each lesion area and 8 randomly. It is OK to be scared. The treatment of prostate cancer has evolved tremendously. Where to start for newly diagnosed advance prostate cancer Urology. Had a little complication a day after release, excessive blood/clots in urine. Prostate Cancer News, Reviews & Views: Second opinions Below is the link with instructions and the authorization form for you to use with your doctor. Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. Ask us questions on this webpage. - Benign prostatic tissue Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. This condition causes pain in the lower back and groin area, and may cause urinary retention. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. Getting a second opinion can sometimes lead to a complete change in diagnosis (such as cancerous to benign or vice versa) in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. Read books and realize as soon as they are published, they are outdated. The https:// ensures that you are connecting to the -------------------------------------------------------- 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. If the enlarged prostate is not completely removed, it will shrink. 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. C. Prostate, right apex, core biopsy: Second round of Radiation Therapy - t - Advanced Prostate The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. Masks are required inside all of our care facilities. Us Too Prostate is a great club and many of you have helped me a lot already. Fear motivates you to want to treat this as soon as possible. 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. * Seminal vesicle invasion: None. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. The results seemed fairly benign and my urologist and I decided to continue to monitor with 2 more PSA tests and then consider an MRI in April 2021. Over 80,000 specimen cases are seen at Johns Hopkins each year. I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. A report with the diagnosis will be faxed to your doctor. Negative cancer in lymph nodes, seminal vesicles, and all margins. This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. 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. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! After a second opinion from both Johns Hopkins and Stanford, the two 4+3's were downgraded. My strong preference would be to do FLA again and monitor. Bookshelf 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. Our singular focus on treating cancer, and only cancer, means we have the expertise to confirm a diagnosis or treatment plan and offer options that may not have been considered. Associated fees may be incurred up to $1,800 in a minority of more complicated cases requiring special studies. J Am Board Fam Med. Brachytherapy Experience with Dr. Albert Chang at UCLA? This may cause a conflict of interest between the patient and the HMO, especially if very expensive treatment is only available outside the HMO system. 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. Seminal vesicles and other margins are negative for tumor. 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. A second review of Pathology more frequently also brings changes to the cancer grade or stage, which can affect prognosis as well as therapy. The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. This shows very high signal intensity on the diffusion-weighted 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: Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Video consultation and written report from your expert. Also, infection was noted, so the current PSA is high in part due to prostatitis. * Gleason Score: 3+3 (2 of 6 specimens) 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. 9. Thanks for considering. But you have to do both. 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. Johns Hopkins Health - Second Opinions, Second Chances - Hopkins Medicine Two from one lesion were positive as was one of the two from the other. 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. Request an Appointment 410-955-6100 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.
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