There are lots of lessons learned on the forum. Extracapsular extension: The prostatic capsule is preserved. My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. Patients may experience a fever or chills as a result of the infection. It will be interesting to see, I think. Masks are required inside all of our care facilities. I appreciate any comments or insight that anyone wants to share. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. The presence of any G4 has been my trigger to seek treatment. I personally have benefitted from second opinions on my so-called cancer journey. Compared to younger men, men 70-74 years old and men 75 years were less likely to obtain a second opinion whereas men with college graduate level education or beyond were more likely compared to men with less than high school level education. Associated fees may be incurred up to $1,800 in a minority of more complicated cases requiring special studies. Benign Processes: T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive fibromuscular stroma, anterior prostatic contour is smooth. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. Ex-Uro wanted to do biopsies and keep doing them until we find "it", even though he didn't know the size of the prostate nor had he ruled out prostatitis. It works. More medical freakouts. Clipboard, Search History, and several other advanced features are temporarily unavailable. Benign Processes: Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. I understand that patient privacy is a priority (I'm actually a privacy lawyer), but surely there are patients who would give consent and be happy to talk with a prospective patient about their experiences? Not all cancers are the same and not all treatment plans are absolutely clear. Johns Hopkins Health - Second Opinions, Second Chances - Hopkins Medicine I suggest for all that hear, "you have cancer" that you seek more opinions! 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. Even if I go the radiation route, should I try for Proton radiation or some other type? Value of Second Opinion in Prostate Cancer Uncertain, Says Hopkins Study. I have developed an "abscess" on my prostate. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasn't spread outside of the prostate. In adjusted analyses, however, only age and education were significantly associated with obtaining second opinions from urologists. They basically said it didn't matter. He also said I would tolerate any option well based on my age and health. I wish the VA would be more informative about this disease they owe it to our veterans. Perineural invasion is identified I want to insure that the Imaging was read correctly and nothing was overlooked or missed. Ask your doctor for a copy of your complete medical record. It starts many years ago. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. Other labs for second . Read books and realize as soon as they are published, they are outdated. National Library of Medicine 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. 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. 6. We will give that a shot and see how it turns out. Prostate cancer is a slow growing condition. Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. Benign Processes: Is it done through my doctor or do I do it myself with sending CDs of the MRI? It is OK to be overwhelmed with info. Especially opinions other than those of the first Urologist you see. MEASUREMENTS: Find more COVID-19 testing locations on Maryland.gov. Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. You're more likely to develop prostate cancers that are more likely to spread. Does this also include HIFU, Cryoablation? 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. A biopsy was performed on 2/26. - High grade prostatic intraepithelial neoplasia (HGPIN) A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. I still have some urgency and frequency issues, but I am not complaining too bad. 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. My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. Thankfully, prostate cancer is extremely slow growing. He said that JHs said that it was 2 cores, but it was actually a fragmented core, that the fat did not present on the right place on the slide, that prior FLA (partial hemi-ablation) could affect the results, the MRI did not support, etc. After applying exclusion criteria, the final analytic cohort included 2365 respondents. Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. 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. Also, if any of you have a way to get medicare to pay some portion of the cost, please let me know as well. There is no bony or bulky nodal disease in the pelvis We provide second opinions on the full range of gynecologic cancers: Ovarian Uterine Cervical Vulvar Vaginal Fallopian tube Placental tumors Some peritoneal cancers I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. 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. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results. My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. 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. For all other cancer appointments, please call: 1-855-702-8222. C. Prostate, right apex, core biopsy: 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. Total Gleason score: 7 That is literally the first time I heard that term other than seeing it in my pathology report. 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). Call us with any questions: 410-955-2405, ext. )As for side effectsI occasionally have some urgency/hesitancy having to pee. To learn your stage of prostate cancer, take the staging quiz on keytopc.com. Im also wondering why no one has scheduled me for MRI to see what biopsy missed. 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 primary goal is to be cured with the least toxic, most effective approach. Prostate Cancer Grading: 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. 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. Seek Perspective from a Range of Specialists. 2. - T2 = 3/5 Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. __________________________________________________________________________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. 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. Symptoms include leaking and discomfort. This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. Brief MRI history. There are also many reasons why you may want to seek another opinion during the course of your cancer care. Some of the more common treatments that you and your doctor may discuss include: Prostate cancer experts at the Brady Urological Institute have created tools that help patients and doctors across the world assess risk and make treatment decisions. The more accurate the information we have, the better our treatment decisions. There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists. I retested in January 2019 and scored 4.20. If a targeted biopsy is planned, this lesion can be sampled at the same time. You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. 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. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. poorly defined margins and intermediate to low T2. * Extracapsular extension: Possible involvement of the anterior Seminal vesicles are normal. 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. However, there are also many more options for treatment and these options are more complicated than in the past. Learn MoreFor more information about pathology second opinions, visit pathology.jhu.edu or call 877-546-1872. Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. You May Like: Prostate Cancer External Beam Radiation Side Effects. Shore ND, Karsh L, Gomella LG, Keane TE, Concepcion RS, Crawford ED. Caused me to bleed heavily. As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. A second opinion can help you make an informed, confident decision about your medical care. Asking for your comments: Studies show the clinical and financial benefits of obtaining a pathology second opinion. * Gleason Score: 3+3 (2 of 6 specimens) asymmetric central zone tissue more pronounced on the left. Our OB-GYNs, maternal-fetal medicine specialists, and pediatricians collaborate regularly with the Johns Hopkins team getting second opinions and access to hundreds of clinical trials. There are also some cases of the test showing no depletion but being wrong. Do any of you have an opinion or actual experience with any of the three listed below? So, Radiation Oncologist prescribed Cialis 5mg, daily. I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. 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! Assessment categories for this lesion: PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Considering Prostate Cancer Clinical Trials? I'm trying to figure out why the PSA keeps rising. One core had 5%, one 20%, and one 40%. Adenocarcinoma: 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. And just this week, 1 YEAR post treatment, it is .46. I am 58 and in very good health otherwise. After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. I'd like to talk with former patients who have gone through the procedure. If they have an enlarged colon, their physician can perform a TURP procedure. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Any input on this would really be appreciated. -------------------------------------------------------- My diagnosis is T2c, Gleason 7 (3+4). Hopkins states that the one positive core (10% G6) was visualized by the MRI, so I am hoping that this increases our chances of making it through the screening process. (PZ) - normal 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. I sent a message to my urologist requesting my slides be sent to Dr. Epstein at Johns Hopkins for a second opinion and I also requested an Oncotype DX test to get an idea of risk for my low teal or basic teal cancer. The treatment of prostate cancer has evolved tremendously. IMPRESSION: There is no extraprostatic extension. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. 2.Tammy Jiang, Christian H. Stillson, Craig Evan Pollack, Linda Crossette, Miupdachelle Ross, Archana Radhakrishnan, and David Grande, How Men with Prostate Cancer Choose Specialists: A Qualitative Study, Journal of the American Board of Family Medicine: JABFM, 30(2), (2017): 220229. Are considering a treatment that involves significant risks, such as surgery. A second opinion is part of the education process that is critical for many cancer patients. Then about a month later I started 28 fractions of Proton Radiation.It was painless. Primary Gleason grade: 3 He has had a nagging "groin injury" for may years (he played pick up basket ball until he got injured) and we are now wondering if this could be the source of that recurring ache. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. Am I missing anything? 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. 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. Notice of Privacy Practices(Patients & Health Plan Members). His second opinion just came back. 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. And 2 cores from left apex of 3+3=6 with 10% involvement. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. -------------------------------------------------------- According to the doctor it is around 3 mm. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. Finally, things are set and I know what is going to happen. 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. You can find out by reviewing your plan or by reaching out to your insurance company. * Seminal vesicle invasion: None. For men with prostate cancer and who live in the United States, there are some highly regarded pathology labs from which you can obtain your second opinion. MY THOUGHTS AND ANYTHING DOCTOR NOTED: Second round of Radiation Therapy - t - Advanced Prostate Johns Hopkins Medical Laboratories 1620 McElderry St. Reed Hall Rm 315 Baltimore, MD 21205 Fax (410) 614-7712 Phone (410) 955-2405 8 am - 5 pm Normal LAB hours are: 5:30 am - 4:30 pm Mon-Fri Over 80,000 specimen cases are seen at Johns Hopkins each year. Reinterpretation of imaging scans and lab tests. 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. Dont Miss: Can Prostate Problems Cause Burning Urination, Why Prostate Cancer Survivor John Shearron Thinks Its Important To Do Your Research | PCRI, Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference, Johns Hopkins Prostate Cancer Second Opinion, treat rare and complex conditions through breakthrough fetal procedures, Function Of The Prostate Gland And Seminal Vesicles, Best Treatment For Intermediate Prostate Cancer, How Old Can You Be To Get Prostate Cancer, New Treatments For Stage 4 Prostate Cancer, Prostate Radiation Treatment Side Effects, Can Prostate Problems Cause Burning Urination, Prostate Cancer Spread To Skull Prognosis, Life Expectancy Stage 4 Prostate Cancer No Treatment, Diagnostic Procedures For Prostate Cancer. Two weeks later I meet with my Johns Hopkins Dr. 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. 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. 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 really just want the results of their innovative PTEN test. * Size: 1.1 cm Y'all are in my prayers! The prostates function is to create some of the fluid that insulates sperm cells found in semen. An increase of 1.1 in 3 months is not good news. Doctors are skilled at pitching the treatment they specialize in. 5. (TZ) One suspicious area - lesion size: 2cm x 1.4 cm This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. He spent an hour on the phone reassuring me that I didn't need to rush into anything, and they he'd love to scan me 6-8 weeks after my TRUS Biopsyhave to let the trauma and all the blood leave the prostate for a good image. I don't know if the FLA could affect the results, or if it was just done because it was not in the study parameters of the test. Find more COVID-19 testing locations on Maryland.gov. Pathology Second Opinion-J.Epstein,M.D. Pathologist-Johns Hopkins
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