johns hopkins prostate cancer second opinion
The results were ambiguous. During the next 4 weeks I meet with the recommended Radiologist, and the two local surgeons. Lesions are all small or very small. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. Find more COVID-19 testing locations on Maryland.gov. PMC Dont Miss: New Treatments For Stage 4 Prostate Cancer. Pathology reports are subjective. Will these places of excellence consider me, or am I bound to my regular doctor for insurance purposes? Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. * Location: Left, anterior, base to apex, transition zone They are not objective. 1. 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. 4. Prostate, left lateral apex: The percentage of Gleason grade 4 and/or 5 is 5 % Nov 7, 2016. The linear amount of tissue with carcinoma is 11 mm An acute bacterial infection can cause a burning sensation. - Perineural invasion is present Race and ethnicity. And collaborating with Johns Hopkins Medicine means we can provide you with second opinions, streamlined and guided access to clinical trials, and a proven track record of excellence in care. You receive a secure, private online consultation without leaving home. Reinterpretation of imaging scans and lab tests. You may also complete an online appointment request form and we'll respond to schedule an appointment. 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. 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. Does this also include HIFU, Cryoablation? Read books and realize as soon as they are published, they are outdated. With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3500 specialists. You're at greater risk if you're Black or of African ancestry. Prostate cancer is the second-most diagnosed cancer in American men. Only one core was diagnosed with a small amount of 3+3 (it was one of the three targeted cores). I trust the second opinion Dr. Bush gave. Dr. Erick Walser at University of Texas Medical Center. DRE is always normal. According to the study, one in every 600 diagnoses showed mistakes.This study only addressed major changes in diagnoses, such as a diagnosis of cancer being reversed to no cancer, says Johns Hopkins pathologist George Netto, M.D. Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. Here are the details: Getting a second opinion from us is easy, convenient, and all done remotely. Overall, nearly 80% of men received definitive treatment 76.5% of men who obtained a second opinion from a urologist received definitive treatment compared to 81.6% who did not . Greatest dimension 2cm. Because I had an implant in my ear, they would only give me a 1.5T MRI. Surgery seems like overkill for me with too many risks for incontinence and permanent ED, am I overlooking something? - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length See this image and copyright information in PMC. Study after study confirms that doctors favor the treatment they are trained to do urologists typically recommend surgery and radiation oncologists recommend radiation. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. After a second opinion from both Johns Hopkins and Stanford, the two 4+3's were downgraded. Either the patient or the primary physician can initiate the process of getting a second opinion. Out of 12 cores, 9 are positive. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Intensity: min 148 / Max 459 Contact us or find a patient care location. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. Caused me to bleed heavily. MRI RE-READ #3 (National Cancer Center of Excellence): Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. 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. Background: The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. If I am rested, I find that I am more ready than if I am not. Thank you for your understanding and cooperation. World J Urol. Comments appreciated, You May Like: Best Treatment For Intermediate Prostate Cancer. I could not get a definitive answer from them on how much, how many cells, or any information. have no symptoms, and yet you have cancer? Identified an approximate 2 cm lesion of mostly Gleason 7 (3+4) with only 20% being 4, contained in prostate. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Would it be rational to stay on AS until biopsy results show a higher volume of PCa for sampled cores (i.e. Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. They basically said it didn't matter. 2nd opinion"Sclerotic change at the right pubic bone with max SUV of 1.4." We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. EDI am now 52 and not quite functioning like I did 4+ years ago. This may cause a conflict of interest between the patient and the HMO, especially if very expensive treatment is only available outside the HMO system. I've been on AS since April 2016. However, just to be safe she schedules me for TRUS biopsy with the Urologist in another 6 weeks. 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. If these do not work, your symptoms could progress and become chronic. I guess the PET scan will be the next step in what type of treatment options are in store.Has this occurred to anyone else? He was right. Spent the night in hospital with very little pain after the first couple of hrs. 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. Dr also stated he was able to totally spare one of my nerves, but to get margin may have damaged one. We have a consult on Friday with the 1st opinion doc to review all tests. Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. Second opinions offer different things in different circumstances, Dr. Matasar says. Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results. Specimens Submitted: Read Also: What Are The Signs Of Prostate Infection. Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. 2020 Jul 21;19(1):112. doi: 10.1186/s12904-020-00619-9. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. I had FLA done after first biopsy which staged me at 3+4 = 7. PSA: 4.7 ng/ml/PSA density: 0.27 ng/ml2 So, I also sent this MRI result to Johns Hopkins for a second opinion. Adenocarcinoma: When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. He also said perinueral invasion, but not extracapsular extension. Doctors can review their peers treatment suggestions and explain why they agree or disagree. Bladder: Normal. Further, the two tumors in question have not really changed much in size for more than 2 years. PREVIOUS MRI RESULTS (LOTS of them) Pathology reports are the opinion and interpretation of the individual pathologist viewing the tissue samples. Netto says patients should be proactive in requesting that doctors take another look. Unfortunately, monetary incentives create biases that can work against patients best interests. 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. It was easy. Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference, Why Prostate Cancer Survivor John Shearron Thinks Its Important To Do Your Research | PCRI, John Hopkins Prostate Cancer Second Opinion, a higher risk of developing uterine cancer, surgery may not always be necessary for all breast cancer patients, The cancer vanished in every single participant, Long Term Side Effects Of Brachytherapy For Prostate Cancer, treat rare and complex conditions through breakthrough fetal procedures, Prostate Cancer External Beam Radiation Side Effects, Can Enlarged Prostate Cause Blood Clots In Urine, Life Expectancy Stage 4 Prostate Cancer No Treatment, Prostate Cancer Spread To Skull Prognosis, Diagnostic Procedures For Prostate Cancer. Prostate Cancer Grading: Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. By taking the extra time to seek a second opinion, you have a better chance at finding the most up-to-date approach and an experienced doctor. An accurate diagnosis is essential to ensure the most effective treatment. Depending on your location, you may be able to have a telemedicine consultation. Confirm biopsy and imaging results with centers of excellence before making any final decisions. 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. Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. Time moves fast when dealing with cancer, but Doctors dont. Read books and realize as soon as they are published, they are outdated. His most-frequently cited first or last authored publications is Pathological and Clinical Findings to Predict Tumor Extent of Nonpalpable Prostate Cancer, published in JAMA, which established the criteria for active surveillance. Then about a month later I started 28 fractions of Proton Radiation.It was painless. This urologist can get you in for surgery next week. I have had a second opinion from Johns Hopkins that confirmed the initial pathology of gleason 3+4. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. * Seminal vesicle invasion: None. I assume it is not free. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. When first diagnosed with prostate cancer, your PCP will generally refer you to a urologist for a biopsy. I have completed an exhaustive research effort on Prostate Cancer and PCa treatments. That being said, they can be a beneficial member of the treatment team. So, Radiation Oncologist prescribed Cialis 5mg, daily. 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. 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. Advances in our understanding of breast cancer have opened up new treatment options or clinical trial opportunities, including targeted drug therapies and tissue-conserving procedures proven to greatly reduce pain and nausea. Note respondents were able to, MeSH The percentage of tissue with carcinoma is 45% This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. I have searched the country for intervential radiologist that perform FLA on the prostate. - T2 = 3/5 Any input on this would really be appreciated. My questions are: All views would be appreciated. A week later had catheter removed and had no bladder leakage problems. 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. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. It is OK to be overwhelmed with info. You can find out by reviewing your plan or by reaching out to your insurance company. * Asked and Dr. said he isn't overly concerned about perineural finding with the grade and it won't impact treatment options or overall prognosis. Benign Processes: 1. 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. The peripheral zone has a patchy signal pattern. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. Enter the last name, specialty or keyword for your search below. One to a 3+4=7 and the other to a 3+3=6. The biopsy took 12 cores, two from each lesion area and 8 randomly. * Adjacent organ invasion: None. Therefore, the value of these second opinions remains unknown. We are vaccinating all eligible patients. In circumstances where there may not be a single established standard of care, we can ensure the treatment plan integrates the most current, up-to-date data, Dr. Matasar says. Dr. Nour is 100% sure that nothing has spread. Im also wondering why no one has scheduled me for MRI to see what biopsy missed. information. images and markedly reduced ADC. And just this week, 1 YEAR post treatment, it is .46. He recommended waiting and watching at that time due to the lower PSA reading. As a Gleason 3 + 3, with 8 of 12 positive cores all with less than 30% cancer, and bilateral spread, I have determined that I cannot trust a blind biopsy in and of itself. 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. If pain is present, a digital rectal examination will reveal hard areas. * Membranous urethral length: 1.2 cm The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. One core had 5%, one 20%, and one 40%. You're also at greater risk of prostate cancer forming before age 50. However, learning more about prostate cancer and prostate-related health issues can help optimize health. My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. I am also talking with Dr Nour and Dr. Walser and possibly others to see if I am a good candidate for Focal Laser Ablation. Low post-void residual volume is Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. I am 62 years old. Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. An increase of 1.1 in 3 months is not good news. You May Like: Prostate Radiation Treatment Side Effects. The total number of cores identified is 3 * Other 12 slides not sent JAMA Netw Open. My urologist suggested a couple more PSA tests followed by an MRI. My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions. They told me to expect a spike in my PSA sometime in the future, and they told me that studies are showing that a slow, steady decline in PSA is often indicative of superior results (whatever that means. I have a history where Foley catheters were unable to be placed going back to 2005 for unknown reasons. In 2006 my PSA was .6. 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. It hasn't let me down. I made the appointments. Second Opinions (Adults) For stem cell transplant, please call 1-773-702-1994. 180 days after treatment PSA was .50. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. Two weeks later I meet with my Johns Hopkins Dr. A fusion biopsy was performed in late May and I just received those results last Thursday. ---------------------------------------------------- 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. Dr. Albert Chang at UCLA appears to be the best in the biz for high dose rate (HDR) focal brachytherapy. 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. Cancer 2017;123:1027-34. FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. 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. 2020 Dec 1;3(12):e2028320. When facing an intricate disease like prostate cancer, the above scenario is far too simple to have a promising outcome. The researchers did not include more minor errors in rating how fast-growing and how advanced a cancer was. SMIL radiologist reported nothing found. doi: 10.1136/bmjopen-2020-044033. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. Here are seven tips for seeking second opinions for prostate cancer: Before getting a second opinion, its important to know your stage of prostate cancer. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. It is OK to not understand all the terminology. 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. My profession for forty years was health actuary consultant, so I have a pretty fair understanding of health data, outcomes, and risks. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). The Johns Hopkins Brady Urological Institute is known around the world for its expertise in diagnosing and treating urologic conditions. In other words, the cancer is still contained within the prostate. Get a Second Opinion What can a second opinion tell me? Then about a month later I started 28 fractions of Proton Radiation.It was painless. 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. Learn MoreFor more information about pathology second opinions, visit pathology.jhu.edu or call 877-546-1872. Anyway, would appreciate knowing how to contact Johns Hopkins. And again, most of you tell me time is on my side, so I am comforted in hearing that. My experience at Johns Hopkins was awesome. 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. Over 80,000 specimen cases are seen at Johns Hopkins each year. Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. Someone advised to always get my PSA checked at the same facility in order to make sure the same protocol and lab is used, is that critical? The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! 3T MRI with coil is done initially, along with a TRUS biopsy. Thanks to all of you for sharing! You may be concerned that the cancer will grow rapidly out of control before you are able to get a second opinion. Knowing your stage and information specific to that stage makes you more medically sophisticated and enables you to navigate through the potential biases of surgeons and radiation therapists. 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. The presence of any G4 has been my trigger to seek treatment. 4: Prostate, right medial base 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. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. A man with a father or brother who had prostate cancer is twice as likely to develop the disease. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) What have your doctors told you? The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. Prostate, right anterior MRI lesion: My strong preference would be to do FLA again and monitor. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. - Perineural invasion is present 4. (I must say that those low numbers concern me a bit.) Didn't know if she had the catheter in far enough and not getting any urine through itwondered if she had inflated the balloon enough and wondering if it was the reason that I have developed an abscess. Instead, I did my homework. If a targeted biopsy is planned, this lesion can be sampled at the same time. Tumor Quantifications: Benign prostatic tissue Six weeks later I have the biopsy in his office and a week later I get the results. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. The primary goal is to be cured with the least toxic, most effective approach. Masks are required inside all of our care facilities. At that point I agreed to the TRUS biopsy which I had on October 10, 2020. Am I missing anything? 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). This is the most common urinary tract problem in men under 50, and the third most common in men over 65. A new study by researchers at the Johns Hopkins University has found that . curing cancer, prostate cancer questions johns hopkins hospital, josef issels wikipedia, cancer a second opinion a look at book by josef issels, coping with metastatic cancer cancer net, pdf americans health priorities curing cancer and, what is immunotherapy cancer research institute cri, cancer a second opinion a . * Location: Right, anterior, apex, peripheral zone About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasn't spread outside of the prostate. I was confident I was making the right decision. Obtaining a second opinion on your pathology report is no different than getting a second doctors opinion, it is a must for all of us. The more often a doctor diagnoses and treats prostate cancer the more proficient they become. This may include imaging, blood tests, prior treatment, and pathology reports. Thank you for your participation! MEASUREMENTS: Even if I go the radiation route, should I try for Proton radiation or some other type? If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. This kills both birds with a single stone. lesion. * PIRADS v2 Score: 5 MRI RE-READ #2 (VERY VERY well respected radiologist): Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. Clipboard, Search History, and several other advanced features are temporarily unavailable. Find more COVID-19 testing locations on Maryland.gov. 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. Benign fibromuscular stroma; no prostatic glands are identified 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. 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. I am also doing a vegan diet with additional complementary substances. It is OK to not understand all the terminology. -------------------------------------------------------- Four had 60-70%, five have between 5-10%. Watch: Are supplements good for prostate health?