Thanks, That being said, they can be a beneficial member of the treatment team. Types of questions that pathologists often address in our second opinions: Further, the two tumors in question have not really changed much in size for more than 2 years. * He said probably not candidate for watchful waiting because of tumor volume shown and seen on MRI. Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. 4. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. How long do you have left? Even at the age of 48, he thought I would be a good candidate for AS. This shows very high signal intensity on the diffusion-weighted The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. Recovery from Prostate Cancer | Bills Story. He also said perinueral invasion, but not extracapsular extension. 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? All wanted to do what they do, schedule treatment which at this time is only Gleason 6 which I now know is not life threating. 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. Seems like a simple request. Brachytherapy Experience with Dr. Albert Chang at UCLA? After sending off all of our records, CD of MRI and path reports, my husband is booked for screening in December. Why It's Worth Seeking a Second Opinion for Prostate Cancer 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. However, there are also many more options for treatment and these options are more complicated than in the past. 3. I just received a second opinion report from Johns Hopkins. Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. I did ask some questions about the study, if anyone is interested. The biopsy took 3 samples from the targeted region plus 16 sextant. Cancer vaccines.For a long time, the promise of cancer vaccines that would protect healthy people at high risk of cancer has only dangled in front of researchers. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. I am relatively new to this forum and trying to educate myself as to my best course of treatment. Now the oncologist wants to perform a PSMA Pet Scan. More medical freakouts. 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. Greatest dimension 0.7cm . Slightly 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. Of course that was before I found this webpage and I really didn't know what 1 core of 18 samples showing 3+4=7 Gleason meant. If its a common cancer with a well-established standard of care, they can offer insight into clinical trials or novel treatments that may be better than the standard. Proton Therapy Case Study - Prostate Cancer - Johns Hopkins Medicine I was disappointed that only TRUS was being used, but I did find out that this was for screening only and IF you pass screeningthey use MRI guided biopsy for post-ablation follow up. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. Specimens Submitted: These findings are suspicious for degenerative changes however a subtle/early metastatic lesion cannot be excluded and continued periodic follow-up is recommended." Here are seven tips for seeking second opinions for prostate cancer: 1. 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. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. information. (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. (PZ) - normal 2: Prostate, right lateral base 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. H. Prostate, lesion #2, core biopsy: I also sent my biopsy slides to Johns Hopkins for a second opinion (Epstein's read was 3+4, but with lower pattern 4 involvement than the local pathologist.). Seminal vesicles and other margins are negative for tumor. Reinterpretation of imaging scans and lab tests. Prostate, left anterior MRI lesion: - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 10%) involving 2 of 2 cores (medial core: 0.5 mm, 4%; lateral core: 1.5 mm, 10%), 1 mm to the blue inked tissue edge (the closer) By seeking second opinions and hearing the benefits and drawbacks of a range of treatment options for your specific stage, you will be more equipped to make educated decisions. Benign fibromuscular stroma; no prostatic glands are identified This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Same with the amount of how much pattern 4. 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. 180 days after treatment PSA was .50. Seminal vesicles are normal. It also rules out Brachytherapy. 4. At the Johns Hopkins Medical Institutions, he is Professor of Pathology, Urology, and Oncology the recipient of the Reinhard Chair of Urological Pathology and Director of Surgical Pathology. 3/5 * Prostate volume: 22 cc Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. Associated fees may be incurred up to $1,800 in a minority of more complicated cases requiring special studies. The majority had lower risk tumors and clinical staging of 1 40% sought second opinions with about half having more than one reason Men seeking second opinions tended to be younger and better educated citing the need for more information as their reason. It is OK to be scared. I am at that critical juncture in which I at least need to formalize a plan, select a doctor/facility to work with, and continue my testing to make sure I have what I think I have. J Am Board Fam Med. Benign Processes: The results of Oncotype came back and it was a bad report. My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. At Johns Hopkins, you can feel confident knowing our multidisciplinary cancer clinics combine the very best resources and specialists all within in a single location for a highly coordinated experience that delivers exceptional care while conserving time, money and energy. They won't be offended, and they may even be able to recommend a specialist for you to see. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. intricate disease and not all doctors have the same amount of experience Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. * Both Sloan and Johns Hopkins admit that large discrepancies are unusual, yet both stand by their opinions. Depending on your location, you may be able to have a telemedicine consultation. Seeking a Second Opinion - American Cancer Society 1.Rebecca L. Siegel, Kimberly D. Miller, and Ahmedin Jemal, Cancer Statistics, 2019 CA Cancer J Clin. Perineural invasion is identified Even if I go the radiation route, should I try for Proton radiation or some other type? I am also doing a vegan diet with additional complementary substances. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. Even at the age of 48, he thought I would be a good candidate for AS. Read books and realize as soon as they are published, they are outdated. Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated. He recommended waiting and watching at that time due to the lower PSA reading. You may also complete an online appointment request form and we'll respond to schedule an appointment. Caused me to bleed heavily. I have searched the country for intervential radiologist that perform FLA on the prostate. There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists. Bring All Labs/Notes to Each Appointment. 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm But I don't want to do a radical prostatectomy or radiation that would have large side effects now if the laser is a viable option given my data set. 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 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. 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). As I said, I am 58, so I would really like to preserve my quality of life for as long as possible, but the genomics report has me concerned. If they have an enlarged colon, their physician can perform a TURP procedure. We specialize in minimally invasive procedures to treat BPH, including: For selected BPH patients, our specialists also perform transurethral resection of the prostate , a procedure that requires no incisions and has a high rate of success. Eager to hear what everyone thinks or has anything they see in the report I wouldn't have thought of. It has been 2.5 years and the PSA has still not doubled as well. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. 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. Have you heard of PRECISE follow up score for an MRI? Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. I have had a second opinion from Johns Hopkins that confirmed the initial pathology of gleason 3+4. Johns Hopkins second opinion - nothing found. When I was diagnosed I really thought that I will live only 2 years. Overall PIRADS Score: 2/5 Secondary Gleason grade: 4 It is still important to do your own research. If pain is present, a digital rectal examination will reveal hard areas. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 2 of 2 cores (medial core: 3.5 mm, 30%; lateral core: 2.5 mm, 20%), 0.5 mm to the blue inked tissue edge (the closer) How much is the fee for an opinion of my recent MRI? 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). SMIL radiologist reported nothing found. -------------------------------------------------------- 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. 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. Patients may experience a fever or chills as a result of the infection. I had my first of those 2 PSA tests last week and it dropped to 4.77. (TZ) One suspicious area - lesion size: 2cm x 1.4 cm 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. Us Too Prostate is a great club and many of you have helped me a lot already. 5. Required fields are marked *, PHONE 310-827-7707 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? My profession for forty years was health actuary consultant, so I have a pretty fair understanding of health data, outcomes, and risks. Bethesda, MD 20894, Web Policies 2nd opinion"Sclerotic change at the right pubic bone with max SUV of 1.4." See this image and copyright information in PMC. He wants me to begin the ADT around 5/1. Surgery took about 3 hrs. Based on the results, our experts can provide you with an individualized treatment plan before you leave. Second opinion Johns Hopkins? - Prostate cancer My question is--what importance do volume levels play in determining when to move from AS to treatment? mail@prostateoncology.com, 7 Tips for Seeking Second Opinions For Men with Prostate Cancer. * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. Estimated prostate volume of 35 cc with an estimated PSA density of 0.11 ng/mL/cc. So now things are getting exciting. Benign Processes: I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. A newly published paper by Fischer et al. 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. * Extracapsular extension: Possible involvement of the anterior The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. Johns Hopkins Hospital Prostate Cancer - ProstateProHelp.com MRI obtained outsideon 04/16/2021. 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. Adenocarcinoma: EDI am now 52 and not quite functioning like I did 4+ years ago. Get directions, important phone numbers, locations and more. doi: 10.1002/cncr.30412. This suggests that for some men, second opinions offer a way to pursue the treatment they already planned on, rather than to explore other treatment options, according to study authors Dr. Archana Radhakrishnan, of Johns Hopkins University in Baltimore, and her colleagues. Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. Now, I would like to send Radiology for a similar review. Here's what JH says (same lesion). Send a Consult for Second Opinion | Johns Hopkins Pathology Those readings were reported on a second opinion by Dr. Epstein. 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. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. 3. Thanks for considering. Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: I have requested a second pathologist's opinion from Johns Hopkins based on feedback from this forum. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). A doctor may prescribe surgery or perform an endoscopic procedure. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. Second Opinions for Cancer Care - UChicago Medicine What are you doing about it? At this time, I am leaning towards Active Surveillance or FLA. AS would be my choice, except that a total of three lesions, on both sides of Peripheral Zone, makes this controversial. You have a rare or unusual cancer. 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. There are also some cases of the test showing no depletion but being wrong. You're at greater risk if you're Black or of African ancestry. My only concerned was heavy metal poisoning and didn't know how long AS would be beneficial since I was starting at a young age. I was offered to have my first biopsy sent to Johns Hopkins for second opinion and said why not? which came back with Gleason 9 three weeks after having the what we thought was G-7 ablated. It is not uncommon that two different pathologists looking at the same slide come to a different interpretation and opinion about what is in their microscope! Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of Breast Cancer: When to Get a Second Opinion - WebMD I appreciate all the input because I am a little overwhelmed and confused as to the best course of treatment. Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. Prostate Cancer News, Reviews & Views: Second opinions 2nd opinionBone Scan:"Mild increased activity is seen in the right symphysis corresponding to the abnormalities on the prior PET/CT examination. Some men may have an enlarged prostate but not notice it. Comments appreciated, Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. feel the clock ticking. However, he also said it's treatable even at a 2cm size and the transition zone is a favorable spot. Receiving a second opinion was not associated with perceived quality of prostate cancer care. Request an Appointment 410-955-6100 There is no one-size-fits-all treatment for prostate cancer. Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. 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.
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