I am relatively new to this forum and trying to educate myself as to my best course of treatment. Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. Left mid-base transition zone (PIRADS 5). Brief MRI history. Atrophy Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! 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. * Size: 1.1 cm My mind goes all over the place as to why this is. * Location: Right, anterior, apex, peripheral zone There were several areas of interest - but nothing in seminal vesicles, lymph, or bones. Hoping that after I go through this that my advice to others will be able to guide them and that they can learn from my experience, as I feel I am gaining a solid foundation from both a practical and mental standpoint. Dr. Dan Sperling - New York. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. If these do not work, your symptoms could progress and become chronic. Call us with any questions: 410-955-2405, ext. Has anyone sent Radiology (mpMRI) reports and images to Hopkins for Second Opinion Review? 3 months has passed, and its time for a PSA and a plan to have an MRI. Metastatic disease considered less likely for this pattern. Prostate Cancer News, Reviews & Views: Second opinions In the United States, prostate cancer is among the most common cancers found in men. A second opinion is part of the education process that is critical for many cancer patients. I have searched the country for intervential radiologist that perform FLA on the prostate. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. 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. Cancer 2017;123:1027-34. transition zone. You receive a secure, private online consultation without leaving home. Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. 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. I suggest for all that hear, "you have cancer" that you seek more opinions! You're more likely to develop prostate cancers that are more likely to spread. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. P/ 310-827-7707 | F/ 310-574-4002 | MAIL@PROSTATEONCOLOGY.COM. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. Younger men also sought the 'best' doctor. The lesion also shows focal increased permeability. 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. My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. Lesion 1: Left mid-base transition zone. These findings are suspicious for degenerative changes however a subtle/early metastatic lesion cannot be excluded and continued periodic follow-up is recommended." Those readings were reported on a second opinion by Dr. Epstein. Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. Careers. Receiving a second opinion was not associated with perceived quality of prostate cancer care. Note respondents were able to choose more than one reason. I wanted to keep my options open. 9: Prostate, left anterior MRI lesion In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Over 80,000 specimen cases are seen at Johns Hopkins each year. 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. 3/3 4K score 19% (high end of intermediate) This approach helps to decrease side effects that can affect a patients quality of life, such as erectile dysfunction, incontinence or other urinary-tract symptoms. HMOs usually try to diagnose and treat patients within their system because the more money the HMO spends on second opinions and treatment outside the HMO, the less money there is available for operation costs and profits. LESION 1 Where Should I Go for a Second Opinion? - breast cancer She put me in the hospital. My plan is to choose quality of treatment over cost of the treatment. PDF Cancer A Second Opinion A Look At Understanding Controlling And Curing NONE of the many radiation oncologists, surgeons or urologists I've spoken with in my journey have ever mentioned the term to me so I had to look it up. 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. The purpose of starting this discussion is to gather peoples thoughts and opinions and actual experiences with Prostate Focal Laser Ablation. Get a Urology Second Opinion | Johns Hopkins Brady - Hopkins Medicine Reinterpretation of imaging scans and lab tests. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . Therefore, the value of these second opinions remains unknown. During puberty, the body produces semen in a large number of cases, including enlarged prostate. After sending off all of our records, CD of MRI and path reports, my husband is booked for screening in December. His most-frequently cited first or last authored publications is Pathological and Clinical Findings to Predict Tumor Extent of Nonpalpable Prostate Cancer, published in JAMA, which established the criteria for active surveillance. - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). Maybe lycopene and pomegranate have helped. 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. He never sought treatment for the injury. Dont Miss: New Treatments For Stage 4 Prostate Cancer. focal peripheral zone lesions. 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. E. Prostate, left mid, core biopsy: Prostate cancer is an 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. 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. Know Your Stage. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. 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. asymmetric central zone tissue more pronounced on the left. Benign fibromuscular stroma; no prostatic glands are identified Men need to be educated on all treatment options to protect themselves from a biased industry. Not all men with Gleason 8-10 disease are going to do badly after There is no extraprostatic extension. For cancers that are less common, second opinions can offer more treatment options. Especially opinions other than those of the first Urologist you see. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Expert review of your case by a Cleveland Clinic specialist. First 6 week PSA is undetectable. I had the slides reviewed at Johns Hopkins and 1 of the HG PIN cores was changed to suspicious for adenocarcinoma while another HG PIN core was changed to benign. Enter the last name, specialty or keyword for your search below. However, that information will still be included in details such as numbers of replies. Second opinion Biopsy came after FLA G-9. The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! 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. Dr. Nour - Emory in Atlanta. It's really that simple! Now, I would like to send Radiology for a similar review. - Johns Hopkins Medicine -- Get a Second Opinion When first diagnosed with prostate cancer, your PCP will generally refer you to a urologist for a biopsy. For cancers that are less common, second opinions can offer more treatment options. Obtaining a second opinion on your pathology report is no different than getting a second doctors opinion, it is a must for all of us. 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. The linear amount of tissue with carcinoma is 11 mm Prostate, left anterior MRI lesion: I retired as a Dentist at the VA and saw many veterans with a wide range of outcomes as most of them became 100% service connected when diagnosed with prostate Ca due to exposure to Agent Orange if they served in Vietnam. 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. By choosing the first doctor you speak with to be your treating physician, you may be putting your health in the hands of someone who lacks the expertise to accurately and safely treat your prostate cancer. Wow, I sound like a snob now! Then about a month later I started 28 fractions of Proton Radiation.It was painless. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. After applying exclusion criteria, the final analytic cohort included 2365 respondents. It is not uncommon that two different pathologists looking at the same slide come to a different interpretation and opinion about what is in their microscope! Thanks for considering. However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. Epub 2017 Jun 12. We can help with your case. Keep in mind that not all PCPs are knowledgeable about prostate cancer or know the skill levels of all the specialists in the field. 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. It was easy. He schedules appointments with a Radiologist and two local surgeons. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. 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 . In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. Masks are required inside all of our care facilities. Prostate, left medial base: The site is secure. That is literally the first time I heard that term other than seeing it in my pathology report. 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. Benign Processes: The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. Who Should Request a Second Opinion? Unauthorized use of these marks is strictly prohibited. Finally, things are set and I know what is going to happen. 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. Second opinions apply to biopsies and imaging as well. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Most choose treatment they originally planned to follow, study finds. Nov 7, 2016. Get a Second Opinion | Johns Hopkins Pathology Secondary Gleason grade: 3 In other words, the cancer is still contained within the prostate. (Recommended by my oncologist, Dr. Mark Scholz.) Ask your doctor for a copy of your complete medical record. I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. 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). They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. I have posted here before, now with an update. I am already positively surprised that I am still alive 4.5 years after my diagnosis. I'm currently in the process of getting an appointment set up with a Dr. Wang at UCLA. Find more COVID-19 testing locations on Maryland.gov. My strong preference would be to do FLA again and monitor. Hello everyone. He wants me to begin the ADT around 5/1. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Clipboard, Search History, and several other advanced features are temporarily unavailable. A second opinion can help you make an informed, confident decision about your medical care. When people recommend going to a Center of Excellence, believe them. 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). PROSTATE LESIONS: 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. 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. During the next 4 weeks I meet with the recommended Radiologist, and the two local surgeons. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. He is the past president of the International Society of Urological Pathology. Some men have minimal or no symptoms at all. I have completed an exhaustive research effort on Prostate Cancer and PCa treatments. Dont Miss: Screening For Prostate Cancer Icd 10. Confirm biopsy and imaging results with centers of excellence before making any final decisions. My question is--what importance do volume levels play in determining when to move from AS to treatment? In some situations, insurers will even insist on a second opinion. Primary Gleason grade: 3 Extracapsular extension: The prostatic capsule is preserved. 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. The more often a doctor diagnoses and treats prostate cancer the more proficient they become. Patients may experience a fever or chills as a result of the infection. Patients may experience a fever or chills as a result of the infection. Allow yourself the time to seek multiple opinions. MRI June 2017 again at SMIL. He also stated that he would ONLY recommend FLA if done within a trial. * Gleason Score: 3+3 (2 of 6 specimens) 2017 May-Jun;30(3):298-307. doi: 10.3122/jabfm.2017.03.160359. Need guidance choosing from multiple treatment options. Thanks! T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive I also learned a lot more about the high undisclosed risk of side effects of various treatment plans. While I have three lesions, they are small and, without 3T mp MRI, might not have been discovered. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. 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. The reasons for opting for treatment: the single lesion - previously Gleason 3+4, with a small percentage of pattern 4 - has grown, and according to a biopsy performed March 25, my Gleason 3+4 is now a Gleason 4+3. Thank you, After more than three years on active surveillance, I've pretty much decided to have focal brachytherapy for my prostate cancer. PSA: 4.7 ng/ml/PSA density: 0.27 ng/ml2 Seeking a Second Opinion - American Cancer Society Check Biopsy and Imaging Results for Accuracy. Please don't hesitate to make any observations or ask questions. Eager to hear what everyone thinks or has anything they see in the report I wouldn't have thought of. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care.