Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. F. Prostate, left apex, core biopsy: In fact, additional biopsies revealed no additional cancer. Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. 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. I had my first of those 2 PSA tests last week and it dropped to 4.77. I just turned 71 in February. Four had 60-70%, five have between 5-10%. Im immediately referred to Urologist. Original Sloan Biopsy Results: When facing an intricate disease like prostate cancer, the above scenario is far too simple to have a promising outcome. By basing a treatment 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. I certainly would - after all, there's a certain brotherhood bond here. Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancer, Schaufeld Program for Prostate Cancer in Black Men, Read about the latest prostate cancer discoveries by our world-renowned researchers, Learn more about prostate cancer in our health library, Watch: What to expect during your post-surgery hospital stay. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. I'm trying to figure out why the PSA keeps rising. Emotional outlook is fragile at times and straight clinical approach of doctors does not help. However, older men 75 years were the least likely to report obtaining a second opinion due to dissatisfaction with their initial urologist. Due to the spread of the Coronavirus worldwide and the first confirmed case of the Coronavirus disease in Turkey, the executive team of the Anadolu Medical Center has taken preventive measures to protect the patients and their relatives. I then had the PHI test which showed PSA 8.70 and overall PHI 125.9. So fingers crossed. Check Biopsy and Imaging Results for Accuracy. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. Types of questions that pathologists often address in our second opinions: And it is OK to have paralysis by over-analysis. A second review of Pathology more frequently also brings changes to the cancer grade or stage, which can affect prognosis as well as therapy. Required fields are marked *, PHONE 310-827-7707 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. His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. EDI am now 52 and not quite functioning like I did 4+ years ago. Diffuse probable benign peripheral zone changes limit evaluation for To learn your stage of prostate cancer, take the staging quiz on keytopc.com. Call us with any questions: 410-955-2405, ext. Doctors can review their peers treatment suggestions and explain why they agree or disagree. We specialize in minimally invasive procedures to treat BPH, including: For selected BPH patients, our specialists also perform transurethral resection of the prostate , a procedure that requires no incisions and has a high rate of success. However, that information will still be included in details such as numbers of replies. I officially joined the club with diagnosis on March 21: three small lesions with a GS 6 on one side and both a GS 6 and a GS (3+4) 7 on the other side. 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. Heres What You Need to Know, Prostate Cancer Spotlights in 2020: A Year in Review, Find out about PSMA PET Imaging on Prostate Pros Podcast. Thank you! 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. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. First 6 week PSA is undetectable. IMPRESSION: An acute bacterial infection can cause a burning sensation. I was confident I was making the right decision. 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). - Benign prostatic tissue If I am rested, I find that I am more ready than if I am not. - Benign prostatic tissue Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. I'm 58 yrs old and had a TRUS random biopsy October 2020 after my PSA continually stayed between 4.4 and 8, and PHI score was 126. 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. Benign Processes: B. Prostate, right mid, core biopsy: However, it also is possible to seek a pathology second opinion on your own, and it does not require an in-person office visit. Will these places of excellence consider me, or am I bound to my regular doctor for insurance purposes? The percentage of Gleason grade 4 and/or 5 is 5 % Had my PSA remained static I'd have remained on AS and had I grown a Target Lesion I'd have sought focal treatment.This science is emerging and only getting better. * Membranous urethral length: 1.2 cm How could this compare using only partial slide re-reading? Many researchers believe PTEN present is a strong brake on Study after study confirms that doctors favor the treatment they are trained to do urologists typically recommend surgery and radiation oncologists recommend radiation. (I must say that those low numbers concern me a bit.) 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. poorly defined margins and intermediate to low T2. doi: 10.1136/bmjopen-2020-044033. Dont Miss: Bladder Control After Prostate Surgery. Without the genomic test I have I lesion 3+3=6 and another, 3+4=7, with less than 5% pattern 4, and an MRI that shows no ECE, no other suspicious lesions and questionable cellular EPE based upon disagreement of pathologists. Reinterpretation of imaging scans and lab tests. My profession for forty years was health actuary consultant, so I have a pretty fair understanding of health data, outcomes, and risks. However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. Five years ago I had a TURP. Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. The more accurate the information we have, the better our treatment decisions. 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. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. I find that when I'm trapped in the cockpit not able to use the bathroom for a long time is when I experience that most. The symptoms of acute bacterial prostatitis are similar to those of CPPS. No two cases of prostate cancer are alike and an accurate diagnosisis critical to developing the best treatment plan. Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. And if so, what does being accepted in a AS program look like, do I need to be present at their location? While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. We are vaccinating all eligible patients. Unfortunately, the 12/20/20 PSA reading was higher and that led to an MRI on 2/2/21 when two lesions were discovered. Know Your Stage. Prostate Cancer Grading: Prostate, right lateral base: ---------------------------------------------------- A week later had catheter removed and had no bladder leakage problems. * Both Sloan and Johns Hopkins admit that large discrepancies are unusual, yet both stand by their opinions. That being said, they can be a beneficial member of the treatment team. 3. Secondary Gleason grade: 4 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. He is the past president of the International Society of Urological Pathology. Reinterpretation of imaging scans and lab tests. If they have an enlarged colon, their physician can perform a TURP procedure. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. 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. 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. An official website of the United States government. You can find out by reviewing your plan or by reaching out to your insurance company. Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated. Anyone else encounter something like this? The lesion also shows focal increased permeability. 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. Have been told a health condition is not treatable. Overall PIRADS Score: 5/5 * Location: Left, anterior, base to apex, transition zone She put me in the hospital. I'm leaning towards SBRT. - DWI-ADC = 4/5 Be well. Ramsey SD, Zeliadt SB, Fedorenko CR, Blough DK, Moinpour CM, Hall IJ, Smith JL, Ekwueme DU, Fairweather ME, Thompson IM, Keane TE, Penson DF. Urology. During puberty, the body produces semen in a large number of cases, including enlarged prostate. Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. 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. Include Your Primary Care Physician as Member of Your Treatment Team. 2020 Dec 1;3(12):e2028320. asymmetric central zone tissue more pronounced on the left. Value of Second Opinion in Prostate Cancer Uncertain, Says Hopkins Study. We will give that a shot and see how it turns out. Especially opinions other than those of the first Urologist you see. I worked out every day. I appreciate any comments or insight that anyone wants to share. A doctor may prescribe surgery or perform an endoscopic procedure. and transmitted securely. Should You Exercise When Youre Expecting? Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasn't spread outside of the prostate. 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. Family history of prostate cancer. There are lots of lessons learned on the forum. It will be interesting to see, I think. But if I include the 3+3=6 cores then 4 cores tested positive and that moves me into the basic teal category and no longer a strong candidate for AS. With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3500 specialists. They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. I made the appointments. Youve just been diagnosed with prostate cancer. You receive a secure, private online consultation without leaving home. (The pathology report from Cedars-Sinai kept my diagnosis at 3+4, but a second opinion at Johns Hopkins upgraded me to 4+3.) 7. - PI-RADS for this lesion = 4/5 PREVIOUS MRI RESULTS (LOTS of them) MRI RE-READ #3 (National Cancer Center of Excellence): During the next 4 weeks I meet with the recommended Radiologist, and the two local surgeons. Reasons for obtaining a second opinion from urologists. This condition causes pain in the lower back and groin area, and may cause urinary retention. 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). In the United States, prostate cancer is among the most common cancers found in men. Confused about Pathology report and course of action, Phone Number for John's Hopkins Radioogy Second Opinion. 2nd opinion"Sclerotic change at the right pubic bone with max SUV of 1.4." Consult Fees In some cases, additional testing may be required. Left mid-base transition zone (PIRADS 5). Based on this forum, Im very lucky for this outcome. Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. I am 62 years old. But I don't want to do a radical prostatectomy or radiation that would have large side effects now if the laser is a viable option given my data set. Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. 4: Prostate, right medial base 2018 May;115:133-138. doi: 10.1016/j.urology.2018.01.048. Symptoms include leaking and discomfort. 3. This doctor or team of doctors will review the following: The doctor then communicate their opinion regarding treatment to both the patient and the primary physician. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. 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. JAMA Netw Open. A few weeks later and just before my meeting with my new Johns Hopkins Dr I get the second opinion results from both biopsy and MRI. 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. My diagnosis is T2c, Gleason 7 (3+4). I luckily found this webpage and I started reading everything I could get my hands on. Dr. Albert Chang at UCLA appears to be the best in the biz for high dose rate (HDR) focal brachytherapy. You think another treatment might be available. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. I have had a CT of the pelvic area - negative and a whole body bone scan - negative. Thank you! They hesitated calling it a TARGET LESION, but scored it PIRADS 4. You May Like: Sbrt Radiation Therapy Prostate Cancer. Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. A blocked urethra can also damage the kidneys. 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. 4. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? Using an Ellipsoid Volume the dimensions would give you a volume of 20.44. This has raised some questions on all the scans so far. :) (I think that it was easier to see because Mayo's MRI technology and procedures are better than SMIL's.) 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. Men need to be educated on all treatment options to protect themselves from a biased industry. An increase of 1.1 in 3 months is not good news. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. So the pathologist suggested a second opinion. The https:// ensures that you are connecting to the (PZ) - normal PMC PELVIC LYMPH NODES: No adenopathy. Does every biopsy provide a Gleason Score? T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive prostate cancer; quality of health care; second opinion; specialists; treatment. 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm Their opinions are widely held to be definitive. Results: 2016 American Cancer Society. The average age at the time of prostate cancer diagnosis is about 66. Either the patient or the primary physician can initiate the process of getting a second opinion. More medical freakouts. Not all cancers are the same and not all treatment plans are absolutely clear. Thank you for your participation! 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. I am also doing a vegan diet with additional complementary substances. They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. If youve received a new cancer diagnosis or arent seeing results from your current treatment plan, an expert second opinion can help you move forward with confidence. Some men have minimal or no symptoms at all. 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. 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. About this time, I started reading this forum and my ignorance starts going away. It is OK to be overwhelmed with info. You May Like: Prostate Cancer External Beam Radiation Side Effects. I had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. Getting a second opinion can sometimes lead to a complete change in diagnosis in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. What have your doctors told you? * Seminal vesicle invasion: None. Patients may experience a fever or chills as a result of the infection. Do any of you have an opinion or actual experience with any of the three listed below? Future study is needed to determine when second opinions contribute to increasing the value of cancer care. DIAGNOSIS: When to move from Active Surveillance to Treatment for Prostate Cancer? He never sought treatment for the injury. With that alone, I would likely be a candidate for continued Active Surveillance. Second opinions offer different things in different circumstances, Dr. Matasar says. Prostatic Adenocarcinoma John. fibromuscular stroma, anterior prostatic contour is smooth. 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: After all, it seems like good idea to deal with your cancer sooner rather than later. No definitive evidence of distant metastatic disease is seen." And in some cases, the information you gain during a second opinion consultation can even change your diagnosis. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. LESION 1 Please don't hesitate to make any observations or ask questions. - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. 3. 6. I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. It is best to begin by talking with the doctor who made your initial prostate cancer diagnosis. ADC: mean 879 / median 839 / st dev 223 Even at the age of 48, he thought I would be a good candidate for AS. They did another 3T-MPMRI (Siemens machine) and it showed a faint area, near the margin, and very close to the down stream sphincter of prostate. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. Many health insurance companies will pay for a second opinion, especially if it is for a medically necessary treatment. Second opinions offer different things in different circumstances, Dr. Matasar says. Good Morning Brothers- An accurate diagnosis is essential to ensure the most effective treatment. 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. Further, the two tumors in question have not really changed much in size for more than 2 years. - Perineural invasion is present Contact us or find a patient care location. Some men may have an enlarged prostate but not notice it. The Johns Hopkins Brady Urological Institute is known around the world for its expertise in diagnosing and treating urologic conditions. There are also some cases of the test showing no depletion but being wrong. 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 The biopsy took 3 samples from the targeted region plus 16 sextant. I am 58 and in very good health otherwise. Hope to hear from a bunch of people. 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. My goals are to control PCa, to minimize side effects, and to keep options open in the future. 1st opinion"Note is made of sclerotic changes in the right pubic bone adjacent to the symphysis pubis having only low-level activity and this is thought to be more likely due to degenerative changes rather than bony metastasis." The average age at the time of prostate cancer diagnosis is about 66. I have a history where Foley catheters were unable to be placed going back to 2005 for unknown reasons. 1. J Am Board Fam Med. * Gleason Score: 3+3 (2 of 6 specimens) * PIRADS v2 Score: 5 H. Prostate, lesion #2, core biopsy: Anything I am overlooking or need to add to my list of considerations? Pathology report indicated additional presence of cells at right apex, but unclear whether intraprostatic incision or extraprostatic extension. In the rare chance a baby needs highly specialized care, the team at Johns Hopkins is available to treat rare and complex conditions through breakthrough fetal procedures. Metastatic disease considered less likely for this pattern. My involvement is below maximum of 15% of core. As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. Most choose treatment they originally planned to follow, study finds. Low post-void residual volume is I'm turning 58 in one week. -------------------------------------------------------- For all other cancer appointments, please call: 1-855-702-8222. Since I have gotten so much out of this forum, I thought Id provide my story to help others. Only one core was diagnosed with a small amount of 3+3 (it was one of the three targeted cores). Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. We will then prepare a written recommendation regarding your treatment plans or options. Also, in 2018 I had an exosome Dx test which scored 45.34, but I also retook that test this year and it went down to 30.79. 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