At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required. We have a surgery date set up for the end of July at Johns Hopkins (our second opinion team).His stats:63yo, non smoker, 167lbs, Vegetarian/Vegan diet no other known health issuesWalks dogs for a living and cares for our small farmPSA 3.3 (Jumped from 1.6 in a year)Biopsy Scores 3+5, 4+3. ---------------------------------------------------- MY THOUGHTS AND ANYTHING DOCTOR NOTED: 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. Day 7 after surgery I took my last pain pill. Thanks, I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). There are so many different departments at Hopkins that I don't know the optimal department to contact. My dad 82 was diagnosed last week with prostate cancer with high PSA 100 and GLEASON: ( 4 + 4 ) = 8 / 1 0 , he had the PET Ga-68 PSMA image Friday and today we found out the result is stage 4 Metastatic lesions in the bone pelvic area. Blessings. LESION 1 Surgeon wants next PSA in 3 months. My profession for forty years was health actuary consultant, so I have a pretty fair understanding of health data, outcomes, and risks. Request an Appointment 410-955-6100 Does this also include HIFU, Cryoablation? 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. Now, I would like to send Radiology for a similar review. 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. 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. Move ahead to Dec 2020. Younger men were more likely to cite wanting more information about their cancer and to see the best doctor as the reason to seek a second opinion . However, there are also many more options for treatment and these options are more complicated than in the past. There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists.
Luckily, his report co-coincided with the original QDx report. 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. Metastatic disease considered less likely for this pattern. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of Conflicting Prostate Biopsy OpinionsWhat to Do? 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion 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. Secondary Gleason grade: 4 Thanks, 3T MRI with coil is done initially, along with a TRUS biopsy. 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. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. Especially opinions other than those of the first Urologist you see. The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. images and markedly reduced ADC. 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. Benign prostatic tissue Fear, confusion and uncertainty set in. Want confirmation about a diagnosis or treatment. 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. Greatest dimension 0.7cm . A blocked urethra can also damage the kidneys. 2/13 PSA 5.2/fPSA 12.5% taken AFTER DRE (negative DRE) (lab #1) This may include imaging, blood tests, prior treatment, and pathology reports. Thanks to all of you for sharing!
My first PSA was 8.03. This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. What are you doing about it? Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. 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. Radhakrishnan A, Grande D, Mitra N, Pollack CE. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. However, that information will still be included in details such as numbers of replies. * He said probably not candidate for watchful waiting because of tumor volume shown and seen on MRI. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Here are the details: I then had the PHI test which showed PSA 8.70 and overall PHI 125.9.
Second Opinion Pathology | MD Anderson Cancer Center If these do not work, your symptoms could progress and become chronic. Prostate, right medial base: 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). 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. Y'all are in my prayers! - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. 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. 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. 1. (Scores above 55 have a greater than 50% chance of finding clinically significant cancer on a biopsy) The biopsy showed 2 or 3 cores containing HG PIN but no cancer. If you're seeking a second opinion on treatment (see below), the specialist you choose often will be able to order a pathology second opinion for you, through his or her hospital's pathology department. 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. 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. 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. My question is--what importance do volume levels play in determining when to move from AS to treatment? Just took time off and then life happened.Thanks in advance for the insights. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway.
Get a Urology Second Opinion | Johns Hopkins Brady - Hopkins Medicine The Radiation Oncologist said he would be comfortable waiting a little more, but he wasn't confident that I'd grow a target lesion, nor would I be able to wait years before having to do "something." Those readings were reported on a second opinion by Dr. Epstein. Expert review of your case by a Cleveland Clinic specialist. T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive I am 58 and in very good health otherwise. Tumor Quantifications: In order to receive appropriate treatment, patients must understand the treatment options that are available. Generally, the symptoms can stabilize over time. I fear limiting myself to an inferior treatment because the people I talk to have hammers, therefore everything must be a nail. Your doctor is not sure what is wrong with you. EDI am now 52 and not quite functioning like I did 4+ years ago. We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. Although a large proportion of men with localized prostate cancer obtained a second opinion, the reasons for doing so were not associated with treatment choice or perceived quality of cancer care. -------------------------------------------------------- Benign Processes: Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated. For cancers that are less common, second opinions can offer more treatment options. - PI-RADS for this lesion = 4/5 Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. 10. Thank you for your participation! By basing a treatment With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3,500 specialists with extensive experience in all types of cancers. There is no extraprostatic extension. H. Prostate, lesion #2, core biopsy: 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". FAX 310-574-4002 In some situations, insurers will even insist on a second opinion. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. 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. 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. When I read the forums and questions on this site everyone mentions their Gleason Score from their biopsy. 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. 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. Value of Second Opinion in Prostate Cancer Uncertain, Says Hopkins Study. Can it be salvaged or are the risks of cancer too high? Dr. Erick Walser at University of Texas Medical Center. Surgery took about 3 hrs. How important is Oncotype DX test for Gleason 7? Reinterpretation of imaging scans and lab tests. C. Prostate, right apex, core biopsy: I am doing one in 6 weeks, regardless. If the enlarged prostate is not completely removed, it will shrink. The linear amount of tissue with carcinoma is 11 mm Assessment categories for this lesion: HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. 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. A second opinion can accomplish a number of things. Whats right for you will depend on the stage of the cancer, your level of risk and your general overall health. Noted that some don't even include on report and should be looked as something to note but not obsess about. Lesion 2: Right mid anterior transition zone. Include Your Primary Care Physician as Member of Your Treatment Team. Only one core was diagnosed with a small amount of 3+3 (it was one of the three targeted cores). Ask your doctor for a copy of your complete medical record. 3. 7. This condition causes pain in the lower back and groin area, and may cause urinary retention. This has raised some questions on all the scans so far. I met with the radiologist 3/17 and he leans toward an IMRT radiation regimen of 5 or 20 sessions TBD combined with ADT (6-month shot but maybe 4 months was enough). 4: Prostate, right medial base The more often a doctor diagnoses and treats prostate cancer the more proficient they become. In severe cases, a catheter may be required to relieve the symptoms. !I've pasted a previous update below for background.I just got my PSA results and the numbers are still trending in the right direction. Cancer ABCs recommends: Johns Hopkins Hospital in Baltimore, Maryland, specifically Dr. Jonathan Epstein. * Adjacent organ invasion: None. 9. A man with a father or brother who had prostate cancer is twice as likely to develop the disease. I assume it is not free. Spent the night in hospital with very little pain after the first couple of hrs. The presence of any G4 has been my trigger to seek treatment. 3/3 4K score 19% (high end of intermediate) Thanks, BigD. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. Doctors are skilled at pitching the treatment they specialize in. We can help with your case. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. Prostatic Adenocarcinoma Methods: I didn't study for the test and it's possible some morning activities might have affected my test score :) Because I had an implant in my ear, they would only give me a 1.5T MRI. A newly published paper by Fischer et al. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. 3. Some men have minimal or no symptoms at all. 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. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. Note respondents were able to, MeSH Seminal vesicles and other margins are negative for tumor. B. Prostate, right mid, core biopsy: Ask us questions on this webpage. In addition to providing a better understanding of your diagnosis, a second opinion can also shed new light on treatment options and give you confidence in how to proceed with your care. Details are here: Brief MRI history. My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. Good Day Everyone. Thanks for considering. 2021 Sep 24;11(9):e044033. 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. 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 fibromuscular stroma; no prostatic glands are identified This shows very high signal intensity on the diffusion-weighted present in bladder. Some men have minimal or no symptoms at all. Seminal vesicles are normal. 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. At that point I agreed to the TRUS biopsy which I had on October 10, 2020. Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. DRE is always normal. Who should I contact at Johns Hopkins to get a second opinion on a biopsy? Even if I go the radiation route, should I try for Proton radiation or some other type? --------------------------------------------------------
Prostate Cancer | Johns Hopkins Brady Urological Institute Ask your PCP to refer you to several different types of treating doctors before making a treatment decision. The neurovascular bundles are intact.
Natural history of progression after PSA elevation following radical With that alone, I would likely be a candidate for continued Active Surveillance. * Other 12 slides not sent Benign Processes: Obtaining a second opinion in Pathology can in a small percent of cases lead to a complete change in diagnosis in a wide range of conditions including non-cancerous growths, inflammatory disorders, infections, and cancer. * Gleason Score: 3+4 (4 of 6 specimens), 14 specimens taken The total number of cores with carcinoma is 3 "We were surprised by the relatively large percentage of men who obtain second opinions for their prostate cancer," said lead author Dr. Archana Radhakrishnan of Johns Hopkins University in . Would it be rational to stay on AS until biopsy results show a higher volume of PCa for sampled cores (i.e. My questions are: 1. There is hope.
Where to start for newly diagnosed advance prostate cancer radiation, active surveillance, surgery, hormone therapy, and more. I am 65 and in excellent general health. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. 7: Prostate, left lateral apex Targeted MR/Fusion biopsy of one 4x8 mm lesion on Right side showed 3+3 in 2 of 5 cores (20% of total volume), and random Right side: 1 core 3+4 (10%, 20% on second opinion from Johns Hopkins) and 1 core 3+3 (10% volume) ; Left Side 1 core 3+3 (10%, no PCa on second opinion from Johns Hopkins). Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. About this time, I started reading this forum and my ignorance starts going away. Prostate Cancer Grading: Thankfully, prostate cancer is extremely slow growing. Instead, I did my homework. One of the problems with second opinions is that insurers may not cover the expense. 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. I'm leaning towards SBRT. Unbelievable that this happened!!! Prostate, left medial apex: I have actually had a second opinion a while back from Dr. Bush. However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. 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 I am already positively surprised that I am still alive 4.5 years after my diagnosis. Unauthorized use of these marks is strictly prohibited. Then about a month later I started 28 fractions of Proton Radiation.It was painless. - Benign prostatic tissue Get directions, important phone numbers, locations and more.
Pathology Second Opinion-J.Epstein,M.D. Pathologist-Johns Hopkins Johns Hopkins second opinion - nothing found. Maybe lycopene and pomegranate have helped. If these do not work, your symptoms could progress and become chronic. 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.