Also, if any of you have a way to get medicare to pay some portion of the cost, please let me know as well. E. Prostate, left mid, core biopsy: Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required. (PZ) - normal He basically said it was possible, but that he did not agree. 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. Low post-void residual volume is A second opinion is part of the education process that is critical for many cancer patients. Epub 2018 Mar 28. 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. * Gleason Score: 4+5, Slide 4 (vs. Sloan's 3+4) In some situations, insurers will even insist on a second opinion. Intensity: min 148 / Max 459 And thanks again for making this such a great support group! If they do not cover this cost and you must pay out of pocket, keep in mind that a second opinion could save you from having to pay (financially and physically) for additional treatment down the line. EDI am now 52 and not quite functioning like I did 4+ years ago. Seek Perspective from a Range of Specialists. This teamwork ensures the best possible patient outcomes. Call us with any questions: 410-955-2405, ext. Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? Surgeon wants next PSA in 3 months. We are vaccinating all eligible patients. He wants me to begin the ADT around 5/1. Men were asked if they obtained a second opinion from a urologist, and the reasons why. 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. Explore our state-of-the-art patient care facilities in the Sheikh Zayed Tower. A second opinion can accomplish a number of things. Dr. Nour is 100% sure that nothing has spread. I want to insure that the Imaging was read correctly and nothing was overlooked or missed. Yet none of my doctors ever mentioned it! Reinterpretation of imaging scans and lab tests. Y'all are in my prayers! ADC: mean 879 / median 839 / st dev 223 Best wishes to all those whose concerns for the day are far more serious than mine. Prostate, left lateral apex: radiation, active surveillance, surgery, hormone therapy, and more. They agreed with the PI-RADS 4. We are vaccinating all eligible patients. 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. Masks are required inside all of our care facilities. 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. Brachytherapy Experience with Dr. Albert Chang at UCLA? * Adjacent organ invasion: None. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. It was easy. Confirm biopsy and imaging results with centers of excellence before making any final decisions. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. It is still important to do your own research. 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. LESION 1 Caused me to bleed heavily. 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. When first diagnosed with prostate cancer, your PCP will generally refer you to a urologist for a biopsy. 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. 3. It starts many years ago. It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. J Am Board Fam Med. See this image and copyright information in PMC. 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. Cancer vaccines.For a long time, the promise of cancer vaccines that would protect healthy people at high risk of cancer has only dangled in front of researchers. * Perineural Invasion also detected As I said, I am 58, so I would really like to preserve my quality of life for as long as possible, but the genomics report has me concerned. There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. 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. C. Prostate, right apex, core biopsy: 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.). This kills both birds with a single stone. Many researchers believe PTEN present is a strong brake on However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. -------------------------------------------------------- Thank you! Someone advised to always get my PSA checked at the same facility in order to make sure the same protocol and lab is used, is that critical? However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. When I read the forums and questions on this site everyone mentions their Gleason Score from their biopsy. Eager to hear what everyone thinks or has anything they see in the report I wouldn't have thought of. Would you like email updates of new search results? Just had my appointment today and they are pleased with the results, so far. 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. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. As a Gleason 3 + 3, with 8 of 12 positive cores all with less than 30% cancer, and bilateral spread, I have determined that I cannot trust a blind biopsy in and of itself. 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. So now things are getting exciting. Adenocarcinoma: 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. They told me to expect a spike in my PSA sometime in the future, and they told me that studies are showing that a slow, steady decline in PSA is often indicative of superior results (whatever that means. 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. Read books and realize as soon as they are published, they are outdated. 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. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. 5. An official website of the United States government. 5/10 PSA 4.2/fPSA 9% taken at MSKCC (lab #3) Watch: Are supplements good for prostate health? 2: Prostate, right lateral base I requested a second opinion from Johns Hopkins and they found 1 lesion was 3+3=6 and the second lesion was 3+4 =7, with less than 5% pattern 4. Prostate, right lateral base: I could not get a definitive answer from them on how much, how many cells, or any information. I fear limiting myself to an inferior treatment because the people I talk to have hammers, therefore everything must be a nail. I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. I appreciate all the input because I am a little overwhelmed and confused as to the best course of treatment. I am 58 and in very good health otherwise. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. 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. Pingback: PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Pingback: Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Your email address will not be published. MRI RE-READ #3 (National Cancer Center of Excellence): Is it done through my doctor or do I do it myself with sending CDs of the MRI? While I have three lesions, they are small and, without 3T mp MRI, might not have been discovered. 1: Prostate, right lateral apex In some situations, insurers will even insist on a second opinion. Patients may experience a fever or chills as a result of the infection. 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. What have your doctors told you? Dont Miss: Screening For Prostate Cancer Icd 10. Low volume post-void residual urine is present in the bladder. TRANSPERINEAL MRI GUIDED BIOPSY RESULTS I made the appointments. Prostate, right medial base: Most reputable HMOs can, however, deliver state of the art treatment for most cancers. Pathology report indicated additional presence of cells at right apex, but unclear whether intraprostatic incision or extraprostatic extension. Last year, Epsteins lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions.Netto says patients should be proactive in requesting that doctors take another look.A second opinion can reverse the diagnosis in up to 5 percent of cases for some types of cancers, he says, like those of the breast and pancreas.Diagnosis Errors by the Numbers. -------------------------------------------------------- Primary Gleason grade: 3 Get a Second Opinion What can a second opinion tell me? * Prostate volume: 22 cc 53 years old 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. Confused about Pathology report and course of action, Phone Number for John's Hopkins Radioogy Second Opinion. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . One of the problems with second opinions is that insurers may not cover the expense. I had a telemed session with Dr. Chang, and it sounds like a pretty simple procedure, with urinary side effects that resolve pretty quickly. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. Below is the link with instructions and the authorization form for you to use with your doctor. fibromuscular stroma, anterior prostatic contour is smooth. Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. 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. Experts believe that this study is the first in history to have achieved such results. have no symptoms, and yet you have cancer? Benign Processes: * Gleason Score: 3+4 (4 of 6 specimens), 14 specimens taken 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. It's really that simple! The more accurate the information we have, the better our treatment decisions. 3 months has passed, and its time for a PSA and a plan to have an MRI. government site. 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. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? 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. Only one core was diagnosed with a small amount of 3+3 (it was one of the three targeted cores). THANKS! So, I asked the Radiologist if she will schedule one for me. You think your doctor is underestimating how serious your cancer is. Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. We have sought a second opinion and all tests are being reviewed by that second team.My question has to do with the symphysis pubis. Have a condition that isnt improving or is getting worse, despite treatment. Seminal vesicles are normal. However, just to be safe she schedules me for TRUS biopsy with the Urologist in another 6 weeks. I was referred to a urologist and tested again in April at 4.40. One of the problems with second opinions is that insurers may not cover the expense. On the first scan (post FLA) a lesion was identified by the local radiologist that performed the scan, but the FLA radiologist that performed my procedure was over reading and monitoring my care and stated strongly that there was no cancer. Maybe lycopene and pomegranate have helped. It is OK to not understand all the terminology. So, I believe I made the right choice. In the mean time my PSA was movingno longer static, but never back up to 6. JAMA Netw Open. present in bladder. The average age at the time of prostate cancer diagnosis is about 66. Consultation with your nurse care manager. 1st opinion"PYL PSMA PET/CT scan demonstrating foci of moderate to intense uptake in the prostate gland consistent with known prostatic cancer. Last year, Epstein's lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions. 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. There are lots of lessons learned on the forum. 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. We will then prepare a written recommendation regarding your treatment plans or options. The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. The primary goal is to be cured with the least toxic, most effective approach. Prostate dimensions: 4.1 x 2.8 x 3.4 cm Following the advice of all on here, I need a team of doctors to manage my care. A biopsy was performed on 2/26. 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. Prostate cancer is a malignant (cancerous) tumor of the prostate, a gland found only in men. Details are here: Extraprostatic extension: negative Fear, confusion and uncertainty set in. - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length * Prostate size: 3.9 x 2.8 x 3. cm - Benign prostatic tissue Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. - Perineural invasion is present Diffusely decreased * PIRADS v2 Score: 3 Youve just been diagnosed with prostate cancer. Have been diagnosed with a serious or rare health condition. After a little experimenting I have been able to achieve a partial erection. Doctors can review their peers treatment suggestions and explain why they agree or disagree. 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. Wow, I sound like a snob now! Note respondents were able to choose more than one reason. Biopsy in 12/27/11 showed 3/14 cores, Gleason 6 with PSA of 4.5. This has raised some questions on all the scans so far. Here are the details: 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). Find more COVID-19 testing locations on Maryland.gov. Atrophy Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. Generally, the symptoms can stabilize over time. The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. Total Gleason score: 6 -------------------------------------------------------- - DWI-ADC = 4/5 About this time, I started reading this forum and my ignorance starts going away. Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. Know Your Stage. 4. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. They basically said it didn't matter. Left mid-base transition zone (PIRADS 5). Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. A enlarged prostate can also cause blockages in the urethra. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. Reasons for obtaining a second opinion from urologists. If pain is present, a digital rectal examination will reveal hard areas. In 2006 my PSA was .6. If the enlarged prostate is not completely removed, it will shrink. MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. Further, the two tumors in question have not really changed much in size for more than 2 years. Grade Group: 1 I've had what I would consider a fluctuating PSA since first tested in November 2018. Medical record collection from doctors and hospitals. No one at Hopkins has ever died of prostate cancer if he had Gleason 3 + 3 cancer." 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. Therefore, the value of these second opinions remains unknown. Luckily, his report co-coincided with the original QDx report. Methods: In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could have a significant impact on treatment and prognosis. and transmitted securely. 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . A man with a father or brother who had prostate cancer is twice as likely to develop the disease. 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. 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. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 10%) involving 2 of 2 cores (medial core: 0.5 mm, 4%; lateral core: 1.5 mm, 10%), 1 mm to the blue inked tissue edge (the closer) 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. 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. My question is regarding the results of an MRI guided biopsy into a distinct tumor vs. subsequent Oncotype Dx Results. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. 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. 7 in 10 PATIENTS WHO GET A SECOND OPINION AT CTCA CHOOSE TO TREAT WITH US Call now to find out why: 800.888.8888 Rosie P. Colorectal Cancer Extracapsular extension: The prostatic capsule is preserved. By taking the extra time to seek a second opinion, you have a better chance at finding the most up-to-date approach and an experienced doctor. I personally have benefitted from second opinions on my so-called cancer journey. 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 . Dr. Jonathan Epstein of Johns Hopkins University Hospital. NOTE: THINK THIS LOWERS MY PSA DENSITY SOME IF MY GLAND ISN'T a 17CC PEANUT! The survey asked the men if they had opted for a second opinion from a urologist following their diagnosis of prostate cancer, and the reasons for the second opinion. Request an Appointment 410-955-6100 The researchers also found that patients who obtained second opinions because they wanted more information, were seeking the best doctor, or had been encouraged to do so by family or friends were more likely to undergo surgery. 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. 1. The linear amount of tissue with carcinoma is 11 mm 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. Benign prostatic tissue Dr stated that after seeing my muscles on the inside during operation he would have predicted this. From what I've learned from Dr. Scholz videos at PCRI, and from posts on this site it would lead me to believe the DX test is fairly common knowledge. HHS Vulnerability Disclosure, Help I appreciate any comments or insight that anyone wants to share. Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. Over 80,000 specimen cases are seen at Johns Hopkins each year. Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. Here are seven tips for seeking second opinions for prostate cancer: 1. If its a common cancer with a well-established standard of care, they can offer insight into clinical trials or novel treatments that may be better than the standard. Consultation with your nurse care manager. Cancer patients are encouraged to obtain second opinions before starting treatment. Receiving a second opinion was not associated with perceived quality of prostate cancer care. That being said, they can be a beneficial member of the treatment team. F. Prostate, left apex, core biopsy: 8: Prostate, left lateral base I talked with Dr. Epstein who expressed Johns Hopkins' conservative views to not underestimate GS 6 and to consider surgery and/or radiation that have been used successfully for many years in saving lives. My first PSA was 8.03. T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive We will give that a shot and see how it turns out. Instead, I did my homework. The lesion also shows focal increased permeability. I assume the data on gleason scoring is much more robust/reliable than genomics as it has been around longer and used more extensively. I'm leaning towards SBRT. You're also at greater risk of prostate cancer forming before age 50. 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. * Seminal vesicle invasion: None. Background: So, Radiation Oncologist prescribed Cialis 5mg, daily. 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: Diffuse probable benign peripheral zone changes limit evaluation for My questions are: In order to receive appropriate treatment, patients must understand the treatment options that are available.
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