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. It also rules out Brachytherapy. Luckily, his report co-coincided with the original QDx report. I want to insure that the Imaging was read correctly and nothing was overlooked or missed. Second opinions offer different things in different circumstances, Dr. Matasar says. 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? Original Sloan Biopsy Results: Good Luck and God Bless everyone. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. ZERO - The End of Prostate Cancer Support Community. Details are here: Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. I was never under the misconception that I'd never have to do something, but I was going to wait until I needed to do something. Thanks, Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. I am 65 and in excellent general health. Benign Processes: 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. Unfortunately, what you do not realize may harm you! I retested in January 2019 and scored 4.20. And luckily I lived in Chattanooga and had mutual friends with Dr. Joe Busch (my Urologist never mentioned him, yet we could almost see his facility from the exam room in which he broke the news. A PSA test at time of biopsy revealed my PSA had risen to 6.5. It was easy. It is OK to be scared. Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. Only one core was diagnosed with a small amount of 3+3 (it was one of the three targeted cores). Cancer patients are encouraged to obtain second opinions before starting treatment. I did a book review with his first book for several veterans groups including the Americal Division Veterans Organization which with I served at age 19. 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. For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. It works. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). There is no evidence * Adjacent organ invasion: None. Wow, I sound like a snob now! They may defer to the recommendation of the specialist, or refer you to a doctor with limited prostate cancer experience. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. SO. Some men may have an enlarged prostate but not notice it. H. Prostate, lesion #2, core biopsy: Benign prostatic tissue Enter the last name, specialty or keyword for your search below. Clipboard, Search History, and several other advanced features are temporarily unavailable. In order to receive appropriate treatment, patients must understand the treatment options that are available. You May Like: Prostate Cancer External Beam Radiation Side Effects. 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 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. According to The National Institute on Aging, prostate problems are common after age 50. If youve received a new diagnosis or arent seeing results from your current treatment plan, a second opinion can help you move forward with confidence. 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. The https:// ensures that you are connecting to the Maybe lycopene and pomegranate have helped. Six weeks later I have the biopsy in his office and a week later I get the results. I'm currently in the process of getting an appointment set up with a Dr. Wang at UCLA. Dr stated that after seeing my muscles on the inside during operation he would have predicted this. I'm trying to figure out why the PSA keeps rising. Learn MoreFor more information about pathology second opinions, visit pathology.jhu.edu or call 877-546-1872. Visit and Like ZERO - The End of Prostate Cancer on Facebook, Sign up to receive emails and news from ZERO - The End of Prostate Cancer, Search prostate cancer clinical trials and studies. When people recommend going to a Center of Excellence, believe them. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. Notice of Privacy Practices(Patients & Health Plan Members). These results, if validated in other studies, justify additional investigation on how second opinions can contribute to increasing the value of cancer care, the authors concluded. I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. Unfortunately, monetary incentives create biases that can work against patients best interests. However, just to be safe she schedules me for TRUS biopsy with the Urologist in another 6 weeks. 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. 3. Bladder: Normal. Men with a college education or beyond also were more likely to cite wanting more information about their cancer as a motivation for a second opinion . But I've had trouble getting Dr. Chang's office to provide any patient referrals. Because I had an implant in my ear, they would only give me a 1.5T MRI. 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. I did ask some questions about the study, if anyone is interested. The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. The total number of cores identified is 3 Accessibility Reasons for obtaining a second opinion from urologists. However, there were no other suspicious areas on MRI. But in the spirit of disclosure for those of you with BPH a TURP can complicate a future Radical Prostatectomy (or possibly Cryo) and increase the risk of side effect risks. ---------------------------------------------------------- Here's what JH says (same lesion). * Prostate volume: 22 cc Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. lesion. Primary Gleason grade: 3 If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. Three lesions: 1) GS 6 involving 30% of one core; 2) GS 6 involving less than 5% in one core; and 3) GS 6 involving less than 5% in another core. I would really love to hear from you. Epub 2018 Mar 28. Most choose treatment they originally planned to follow, study finds. 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. My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. This kills both birds with a single stone. Anyone with insight into this and advice? official website and that any information you provide is encrypted probably organ confined disease. Metastasis. If they do not cover this cost and you must pay out of pocket, keep in mind that a second opinion could save you from having to pay (financially and physically) for additional treatment down the line. When I inquired with the oncologist that I had selected for my therapy before receiving the second opinion whether I would be a candidate for Active Surveillance considering the downgrading, she said 'no' due to the intraductal component. Have you heard of PRECISE follow up score for an MRI? This urologist can get you in for surgery next week. -------------------------------------------------------- It would be more convenient to use Mayo but I want the best practitioner regardless. 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. It may be a new cancer, but it is more likely a recurrence since it is really near the ablation zone. - Benign prostatic tissue Just got my pathology results. desired outcome. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. This Dr is in charge of active surveillance program at JH so I knew that he wouldnt recommend surgery unless it was really needed. Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? This condition causes pain in the lower back and groin area, and may cause urinary retention. Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required. And thanks again for making this such a great support group! NOTE: THINK THIS LOWERS MY PSA DENSITY SOME IF MY GLAND ISN'T a 17CC PEANUT! Masks are required inside all of our care facilities. My direct phone (mobile) number is 703-992-3662, or you can private message me via this platform. Second opinions apply to biopsies and imaging as well. Steve, Groucho was wrong when he said "i don't want to belong to any club that would have me as a member." Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. The issues in my prostate from the first procedure onward have all been in the same area and the rest of my prostate from the first biopsy and subsequent MRIs onward have never shown any indications of cancer in other areas. They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. Low volume post-void residual urine is present in the bladder. I've been on AS for two years after my initial TRUS biopsy showed 3 cores 3+3 (10% volume) on Right side, and 2 cores 3+3 on Left side. 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 really just want the results of their innovative PTEN test. Possible additional organ confined malignant lesion in right apex This is a PI-RADS 5 lesion in So, I go one better, I call up Johns Hopkins and find a Dr who does DaVinci Prostate Surgery. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Now, I would like to send Radiology for a similar review. You may be concerned that the cancer will grow rapidly out of control before you are able to get a second opinion. 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. There are also many reasons why you may want to seek another opinion during the course of your cancer care. 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. 1. After extensive discussion of his management options with his local urologist, primary care physician, and radiation oncologist, he also sought a second opinion at the Johns Hopkins Prostate Cancer Multidisciplinary Clinic at Sibley Memorial Hospital.The patient expressed an overwhelming desire to avoid surgery and any other invasive treatments. So, I asked the Radiologist if she will schedule one for me. Using the Bullet Volume gives you gland of 25.55. I wish the VA would be more informative about this disease they owe it to our veterans. 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. Two from one lesion were positive as was one of the two from the other. 1st opinion"PYL PSMA PET/CT scan demonstrating foci of moderate to intense uptake in the prostate gland consistent with known prostatic cancer. All rights reserved. I worked out every day. The .gov means its official. * Seminal vesicle invasion: None. Reasons for getting a second opinion include: You want to be sure you have explored all options. I'm Gleason 3+4=7, and I believed only 2 cores tested positive. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. A second opinion is a review of the cancer diagnosis and the treatment recommendations of the physician who is treating the cancer by another, independent physician. Second opinions offer different things in different circumstances, Dr. Matasar says. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. Read books and realize as soon as they are published, they are outdated. A. Prostate, right base, core biopsy: Everything seems to be on track to remove the cancer and be cured! Benign Processes: Prostate, left lateral apex: As a result, patients struggle to differentiate bias from fact. MRI June 2017 again at SMIL. The Journal of the American Board of Family Medicine published a study in 2017 that found that many patients do not get a second opinion outside of their PCPs original referral2. The Johns Hopkins Brady Urological Institute is known around the world for its expertise in diagnosing and treating urologic conditions. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. 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. Because physicians may differ in their approach to treating breast cancer, its very important to check with a breast cancer expert to know youre receiving the best treatment for you. By basing a treatment He never sought treatment for the injury. 2021 Sep 24;11(9):e044033. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. Good pathology readings require experience and a high level of expertise. Cancer ABCs recommends: Johns Hopkins Hospital in Baltimore, Maryland, specifically Dr. Jonathan Epstein. Find more COVID-19 testing locations on Maryland.gov. Read Also: What Are The Signs Of Prostate Infection. Future study is needed to determine when second opinions contribute to increasing the value of cancer care. IMPRESSION: Even if I go the radiation route, should I try for Proton radiation or some other type? Even at the age of 48, he thought I would be a good candidate for AS. Let me know what everyone thinks if you see anything interesting or of note here or just have some advice. You're at greater risk if you're Black or of African ancestry. This condition causes pain in the lower back and groin area, and may cause urinary retention. Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. -------------------------------------------------------- -------------------------------------------------------- For a second opinion on the results of your prostate biopsy, there is no place better to get one than from the well known prostate pathologist, Dr. Jonathan Epstein at Johns Hopkins. 2. A second review of Pathology more frequently also brings changes to the cancer grade or stage, which can affect prognosis as well as therapy. The side effects of the cut, radiate, hormone regime are unacceptable to me. 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. PCPs can be a great help to navigate the medical marketplace and provide an unbiased voice of reason when it comes to making hard choices. There are lots of lessons learned on the forum. Spent the night in hospital with very little pain after the first couple of hrs. EVERY DAY, they'd take a low dose X-RAY and low dose CT to align the fiducials and ensure my bladder was full and the bowel was empty. Good Morning Brothers- If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. Epub 2017 Jun 12. Any input on this would really be appreciated. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. 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. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. - PI-RADS for this lesion = 4/5 Benign prostatic tissue 8600 Rockville Pike Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. I frequently make a 2 hour car ride and I have to stop about 25% of the time and when I don't, the urgency is a bit more evident and with the urgency come some hesitancy, but not terrible. And again, most of you tell me time is on my side, so I am comforted in hearing that. Asking for your comments: 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, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. 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. This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. 3. 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. Brachytherapy Experience with Dr. Albert Chang at UCLA? Johns Hopkins is home to many of the world's leaders in Pathology. In fact, additional biopsies revealed no additional cancer. 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. BASE DATA: The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. In the mean time my PSA was movingno longer static, but never back up to 6. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. Emotional outlook is fragile at times and straight clinical approach of doctors does not help. When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. I just turned 71 in February. 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. Does 3+4 at some point typically evolve into 4+3 and also serve as a trigger point for moving from AS to treatment? Prostate, left medial base: During your visit, our specialists will review your medical records, diagnostic tests and other information provided by you or your current physician. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. 3/3 4K score 19% (high end of intermediate) Read books and realize as soon as they are published, they are outdated. I have posted here before, now with an update. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. When to move from Active Surveillance to Treatment for Prostate Cancer? Keywords: My experience at Johns Hopkins was awesome. Ask your PCP to refer you to several different types of treating doctors before making a treatment decision. 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." We are vaccinating all eligible patients. Dont Miss: Bladder Control After Prostate Surgery. If they have an enlarged colon, their physician can perform a TURP procedure. So now things are getting exciting. As soon as pathology slides were ready, Emory sent them to Dr. Epstein at Johns Hopkins. 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%). I have developed an "abscess" on my prostate. Some men have minimal or no symptoms at all. 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. 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. Adenocarcinoma: Symptoms include leaking and discomfort. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. Greenfield G, Shmueli L, Harvey A, Quezada-Yamamoto H, Davidovitch N, Pliskin JS, Rawaf S, Majeed A, Hayhoe B. BMJ Open. 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. Over 80,000 specimen cases are seen at Johns Hopkins each year. A second opinion can accomplish a number of things. - Perineural invasion is present - High grade prostatic intraepithelial neoplasia (HGPIN) 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.