This teamwork ensures the best possible patient outcomes. 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. Reason was large volume of cancer (even though most of mine was Gleason 6), presence of Gleason 7 in biopsy and the rapidly increasing PSA. A enlarged prostate can also cause blockages in the urethra. This condition causes pain in the lower back and groin area, and may cause urinary retention. Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: JHs just said it was minimal less than 5%. A second opinion can accomplish a number of things. [email protected], 7 Tips for Seeking Second Opinions For Men with Prostate Cancer. More medical freakouts. advising or treating it. Good Morning Brothers- Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. And thanks again for making this such a great support group! Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) An acute bacterial infection can cause a burning sensation. In severe cases, a catheter may be required to relieve the symptoms. We are vaccinating all eligible patients. Cleveland Clinics Virtual Second Opinions program connects you to an expert physician who specializes in your specific health needs. Some men may have an enlarged prostate but not notice it. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. radiation, active surveillance, surgery, hormone therapy, and more. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. I am doing my own research, but I am curious as to thoughts of the best possible MRI to obtain to give me the best chance at finding something the needle biopsy didnt find. Cancer 2017;123:1027-34. MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. * Location: Left, anterior, base to apex, transition zone My diagnosis is T2c, Gleason 7 (3+4). Depending on your location, you may be able to have a telemedicine consultation. TRANSPERINEAL MRI GUIDED BIOPSY RESULTS The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. I had a 3T mp MRI with coil bed, without and with contrast, at Emory on March 3. * Extracapsular extension: None. Only one core was diagnosed with a small amount of 3+3 (it was one of the three targeted cores). Unauthorized use of these marks is strictly prohibited. 5. 180 days after treatment PSA was .50. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. -------------------------------------------------------- Based on this forum, Im very lucky for this outcome. 6 cancers that are the toughest to diagnose are prostate, bladder, head and neck, soft tissue, skin and lymph system. 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. My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. I'm currently in the process of getting an appointment set up with a Dr. Wang at UCLA. And when I attempt to ask questions about intradcutal, I get responses about how little is known about it because it's so rare or that it is controversial or that they're not familiar with the study I'm referencing. Here's what JH says (same lesion). Covid turned the 1 year into 16 months and PSA tested at 7.44 in August 2020, followed by another referral back to the urologist. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. I guess TWO national centers of excellence are better than one? A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. 9. Slightly HMOs usually try to diagnose and treat patients within their system because the more money the HMO spends on second opinions and treatment outside the HMO, the less money there is available for operation costs and profits. So off I went to see a community urologist who performed a needle biopsy in his office. I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. Through the AHN Cancer Institute, you benefit from personalized treatment in your community, close to home, from your dedicated care team. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. Some pathologists have more experience than others. Johns Hopkins is home to many of the world's leaders in Pathology. 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. How long do you have left? 1: Prostate, right lateral apex They won't be offended, and they may even be able to recommend a specialist for you to see. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasnt spread outside of the prostate. He also said I would tolerate any option well based on my age and health. 3+4, 4+3, 4+3, 4+5 (1st read)Both docs are recommending surgery.PSMA CT Scan report:"BONES/BONE MARROW: There are sclerotic changes in the right pubic bone adjacent to the symphysis pubis and to lesser extent in the left pubic bone. Suspicion for malignancy left anterior base-to-apex transition zone; Some men may have an enlarged prostate but not notice it. I had my first of those 2 PSA tests last week and it dropped to 4.77. -------------------------------------------------------- An accurate diagnosis is essential to ensure the most effective treatment. Patients may experience a fever or chills as a result of the infection. 2. 6. One Johns Hopkins study showed that out of 14,000 men who had surgery and were found to have Gleason 6 cancer confined to the prostate, "zero of those 14,000 men had lymph node metastases. You May Like: Sbrt Radiation Therapy Prostate Cancer. Find more COVID-19 testing locations on Maryland.gov. I am 65 and in excellent general health. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. Get a Second Opinion When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. 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. When facing an intricate disease like prostate cancer, the above scenario is far too simple to have a promising outcome. This championship swimmer sought a second opinion at Johns Hopkins. We provide second opinions on the full range of gynecologic cancers: Ovarian Uterine Cervical Vulvar Vaginal Fallopian tube Placental tumors Some peritoneal cancers Epub 2010 Oct 20. These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. Jonathan Epstein, M.D. Thank you for your understanding and cooperation. Greatest dimension 0.7cm . 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. Have been told a health condition is not treatable. We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. Dr. Dan Sperling - New York. 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 other option for treatment is either LDR or HDR brachytherapy. Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. 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. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. I worked out every day and it wasn't until the last week did I feel a bit fatiguedand experience a bit of urgency and hesitation having to peeflowmax fixed that right up!90 days after treatment my PSA came in at .56. I just received a second opinion report from Johns Hopkins. If a targeted biopsy is planned, this lesion can be sampled at the same time. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. Noted that some don't even include on report and should be looked as something to note but not obsess about. Have you heard of PRECISE follow up score for an MRI? Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required. Since I have gotten so much out of this forum, I thought Id provide my story to help others. There is no extraprostatic extension. Treatment must be chosen based on stage and your Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Benign Processes: Seems like a simple request. 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. 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. Surgical Delay and Pathological Outcomes for Clinically Localized High-Risk Prostate Cancer. He recommended waiting and watching at that time due to the lower PSA reading. This approach helps to decrease side effects that can affect a patients quality of life, such as erectile dysfunction, incontinence or other urinary-tract symptoms. 6. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. My experience at Johns Hopkins was awesome. 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. In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? 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. I am also not comfortable making a decision based upon 1 genomics test, when my other prior test(s) disagrees and the gleason score disagrees. PREVIOUS MRI RESULTS (LOTS of them) Am I missing anything? H. Prostate, lesion #2, core biopsy: Which Patients Report That Their Urologists Advised Them to Forgo Initial Treatment for Prostate Cancer? While I have three lesions, they are small and, without 3T mp MRI, might not have been discovered. He was right. Now Im still ignorant and dont really know a Gleason from a Duck, so when the Dr says your treatment is radiation or surgery Im devastated. 2. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? Prostate cancer is the second-most diagnosed cancer in American men. Below is the link with instructions and the authorization form for you to use with your doctor. My urologist has decided we'll go ahead with the MRI due to the continued elevated PSA scores, in addition to the overall PHI score. They agreed with the PI-RADS 4. 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. Adenocarcinoma: A second opinion can help you make an informed, confident decision about your medical care. 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 severe cases, a catheter may be required to relieve the symptoms. The presence of any G4 has been my trigger to seek treatment. information. * Other 12 slides not sent He wants me to begin the ADT around 5/1. I opted to waive the biopsy, wait 1 year and test again. This kills both birds with a single stone. 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. 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. G. Prostate, lesion #1, core biopsy: * Adjacent organ invasion: None. - DWI-ADC = 4/5 He also said perinueral invasion, but not extracapsular extension. I have a history where Foley catheters were unable to be placed going back to 2005 for unknown reasons. For this study, published in the journal Cancer, 2386 men in the greater Philadelphia area, who were diagnosed with prostate cancer between 2012 and 2014, responded to survey questions. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. The average age at the time of prostate cancer diagnosis is about 66. FAX 310-574-4002 The review process normally takes several days, after which we will send your slides and other materials are returned. Six weeks later I have the biopsy in his office and a week later I get the results. Brachytherapy Experience with Dr. Albert Chang at UCLA? While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. I want to insure that the Imaging was read correctly and nothing was overlooked or missed. There are lots of lessons learned on the forum. Find more COVID-19 testing locations on Maryland.gov. But I did speak to an oncologist who wanted to order Oncotype, which I did. I have had a second opinion from Johns Hopkins that confirmed the initial pathology of gleason 3+4. Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. 10: Prostate, right anterior MRI lesion Dont Miss: Bladder Control After Prostate Surgery. Your email address will not be published. Consult Fees In some cases, additional testing may be required. Lesion #1 (index): PI-RADS v2.1 score 4, lesion measuring 10 mm centered at the right mid/apex posteromedial peripheral zone; findings equivocal for extraprostatic extension; no evidence of seminal vesicle invasion; The low ADC value in this lesion increases the likelihood of Gleason grade group 2 or higher. You think another treatment might be available. I would appreciate hearing from that 2.8% out there who have an intraductal component. You can find out by reviewing your plan or by reaching out to your insurance company. Of these, 40% obtained second opinions, most commonly because they wanted more information about their cancer (50.8%) and wanted to be seen by the best doctor (46.3%). About this time, I started reading this forum and my ignorance starts going away. The problem is that all 3 pathologies noted an intraductal component. Is the destruction of my prostate inevitable and necessary for my survival (my understanding is that both surgery and radiation will do this)? Would you like email updates of new search results? Thanks, We are vaccinating all eligible patients. Urology. Notice of Privacy Practices(Patients & Health Plan Members). So, Radiation Oncologist prescribed Cialis 5mg, daily. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). There are also many reasons why you may want to seek another opinion during the course of your cancer care. Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. There are also many reasons why you may want to seek another opinion during the course of your cancer care. The results of Oncotype came back and it was a bad report. Instead, I did my homework. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. A 1.4 cm lesion in the left, apex, anterior transition zone demonstrates conflicting T2 and DWI characteristics for PI-RADS classification - an indeterminate lesion. Bookshelf The .gov means its official. Dr. Nour is 100% sure that nothing has spread. 2021 Sep 24;11(9):e044033. Read books and realize as soon as they are published, they are outdated. This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. 5. prostate cancer; quality of health care; second opinion; specialists; treatment. Hello, I apologize upfront for the length of this post, but I was recently diagnosed with prostate cancer (T2C) and figure more information is better than not enough. I suggest for all that hear, "you have cancer" that you seek more opinions! For cancers that are less common, second opinions can offer more treatment options. I would love to hear from anyone who has been involved in the Chicago study. 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. Doctors are skilled at pitching the treatment they specialize in. The people were great. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. The percentage of Gleason grade 4 and/or 5 is 5 % Centro Diagnostico Italiano , Milan, Italy, Manfred Dietel, M.D.Institute of Pathology Charit, Humboldt University of Medicine, Berlin, Germany, Jonathan I. Epstein, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Robert J. Kurman, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Elizabeth Montgomery, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Manuel Sobrinho-Simes, M.D.University of Porto, Porto, Portugal, Ronald S. Weinstein, M.D.University of Arizona, Tuscon, AZ, Franco VisinoniMilestone Medical Technologies, Bergamo, Italy, Read Also: Nhs Prostate Cancer Risk Calculator. When to move from Active Surveillance to Treatment for Prostate Cancer? Our regional community network integrates academic specialty cancer care at Allegheny General Hospital and West Penn Hospital and at more than 20 community cancer centers throughout the region. I have posted here before, now with an update. 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. Low volume post-void residual urine is present in the bladder. Masks are required inside all of our care facilities. The prostates function is to create some of the fluid that insulates sperm cells found in semen. Blessings. Benign Processes: Dont Miss: New Treatments For Stage 4 Prostate Cancer. Overall my PSA is between 4 and 10. 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. )As for side effectsI occasionally have some urgency/hesitancy having to pee. I have actually had a second opinion a while back from Dr. Bush. restricted diffusion. MM, Much to my dismay my 4th targeted biopsy Oct 12 revealed 5% G4 (upgraded from Grade Group 1 to 2 (Gleason 3+4 intermediate/favorable). SO. After a little experimenting I have been able to achieve a partial erection. Maybe lycopene and pomegranate have helped. 2016 American Cancer Society. However, that information will still be included in details such as numbers of replies. Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. If they have an enlarged colon, their physician can perform a TURP procedure. Metastasis. Who should I contact at Johns Hopkins to get a second opinion on a biopsy? F. Prostate, left apex, core biopsy: 2020 Dec 1;3(12):e2028320. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. I am already positively surprised that I am still alive 4.5 years after my diagnosis. 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. Medical record collection from doctors and hospitals. 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. Tumor Quantifications: 2 cores from left base of 3+4=7 with only 5% involvement. 4. Lymph nodes: There is no suspicious lymphadenopathy in the pelvis. Hello everyone. 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. * Seminal vesicle invasion: None. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. I am unfortunately "officially" joining the club after getting my biopsy results today. focal peripheral zone lesions. Hope to hear from a bunch of people. 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 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. * Size: 1.5 cm 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. Negative cancer in lymph nodes, seminal vesicles, and all margins. Prostate dimensions: 4.1 x 2.8 x 3.4 cm Sometimes, you may find out about treatment options you didnt know were available. 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. You're at greater risk if you're Black or of African ancestry. Masks are required inside all of our care facilities. Overall PIRADS Score: 5/5 Obviously the Covid 19 issue is playing a part in all of our decisions. A blocked urethra can also damage the kidneys. 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 Remember if you ship them include the following information: You May Like: Blood In Urine After Prostate Biopsy. Are considering a treatment that involves significant risks, such as surgery. It's a bit confusing since most experts now don't consider Gleason 6 to be a true cancer, so did i test positive in 2 cores or 4? Masks are required inside all of our care facilities. Will these places of excellence consider me, or am I bound to my regular doctor for insurance purposes? asymmetric central zone tissue more pronounced on the left. Greetings gentlemen! But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Seminal vesicles are normal. Recovery from Prostate Cancer | Bills Story. Just had my appointment today and they are pleased with the results, so far. 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. Does 3+4 at some point typically evolve into 4+3 and also serve as a trigger point for moving from AS to treatment? The total number of cores with carcinoma is 3 How much is the fee for an opinion of my recent MRI? 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. First 6 week PSA is undetectable. 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. It is OK to be scared. Perineural invasion is identified Lesion 2: Right mid anterior transition zone. It can: Confirm your original diagnosis and treatment plan Give you more detail about the type of breast cancer you have and stage it's in. Your doctor is not sure what is wrong with you. Usually, patients obtain a second opinion after being referred to a second physician or to a special team of experts in a cancer center, called a multidisciplinary team. The urologist offered surgery and radiation as options on 3/10 when we met. The purpose of starting this discussion is to gather peoples thoughts and opinions and actual experiences with Prostate Focal Laser Ablation. Over 80,000 specimen cases are seen at Johns Hopkins each year. Some men have minimal or no symptoms at all. It was easy. My PSA went up from 3.5 post FLA (It was 7.2 pre-procedure) to 6.7 in 2021, so I went to another radiologist to do an MRI guided biopsy of the suspected area that was near the prior ablation zone. PSA had increased to 5.4. Prostate Cancer Grading: )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge.
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