Prostate dimensions: 4.1 x 2.8 x 3.4 cm The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. I had FLA done after first biopsy which staged me at 3+4 = 7. Federal government websites often end in .gov or .mil. I choose surgery over radiation because you can do surgery and then radiation, but it is almost impossible to do it the other way around. I was diagnosed with a 3T MP MRI and a 3T MP MRI guided 4 core biopsy. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. * Prostate size: 3.9 x 2.8 x 3. cm Doctors are skilled at pitching the treatment they specialize in. So I initially thought this makes me a good candidate for AS. He wants me to begin the ADT around 5/1. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. All Gleason 6 (3+3). Your doctor is not sure what is wrong with you. 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. 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! So off I went to see a community urologist who performed a needle biopsy in his office. My direct phone (mobile) number is 703-992-3662, or you can private message me via this platform. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. Accessibility 6 cancers that are the toughest to diagnose are prostate, bladder, head and neck, soft tissue, skin and lymph system. I luckily found this webpage and I started reading everything I could get my hands on. Video consultation and written report from your expert. However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. My questions are: Greetings gentlemen! How could this compare using only partial slide re-reading? 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). There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists. My understanding is that brachy is great for efficacy with less risk to the bowel and the same risk for incontinence and ED as other forms of radiation. In severe cases, a catheter may be required to relieve the symptoms. She put me in the hospital. Low post-void residual volume is Hello. 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. It took me awhile but minutes ago received my second opinion from Johns Hopkins. In the United States, prostate cancer is among the most common cancers found in men. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Im immediately referred to Urologist. Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. Some men have minimal or no symptoms at all. Netto says patients should be proactive in requesting that doctors take another look. This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. The biopsy took 3 samples from the targeted region plus 16 sextant. I'm currently in the process of getting an appointment set up with a Dr. Wang at UCLA. IMPRESSION: (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. 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. MRI June 2017 again at SMIL. - 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) Based on the results, our experts can provide you with an individualized treatment plan before you leave. Greatest dimension 2cm. 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. But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). I guess TWO national centers of excellence are better than one? Due to the spread of the Coronavirus worldwide and the first confirmed case of the Coronavirus disease in Turkey, the executive team of the Anadolu Medical Center has taken preventive measures to protect the patients and their relatives. (I think that it was easier to see because Mayo's MRI technology and procedures are better than SMIL's.) His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. Reasons for obtaining a second opinion from urologists. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Just took time off and then life happened.Thanks in advance for the insights. 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. 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. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. 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. But I refuse to sit still, I continue to research and to plan, as best I can. The survey asked the men if they had opted for a second opinion from a urologist following their diagnosis of prostate cancer, and the reasons for the second opinion. Your doctor is not a specialist in your type of . 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). Dr. Albert Chang at UCLA appears to be the best in the biz for high dose rate (HDR) focal brachytherapy. * Membranous urethral length: 1.2 cm Some men have minimal or no symptoms at all. Here are some recent updates: Uterine cancer.Women who use chemical hair straighteners frequently could have a higher risk of developing uterine cancer than women who have never used the products, according to new findings from a national study that has followed nearly 34,000 U.S. women for more than a decade. Who should I contact at Johns Hopkins to get a second opinion on a biopsy? The results were ambiguous. Metastasis. 4. Notice of Privacy Practices(Patients & Health Plan Members). The percentage of tissue with carcinoma is 70% Be sure to confirm your diagnosis at a center of excellence. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. Prostate, left lateral base: Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. An accurate diagnosis is essential to ensure the most effective treatment. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. Also Check: Prostate Cancer Stage 7 Treatment. Fear, confusion and uncertainty set in. 7. Anything I am overlooking or need to add to my list of considerations? They did 9 patients in Phase I and there have been 12 so far in Phase II. 2. 5. Symptoms include leaking and discomfort. And again, most of you tell me time is on my side, so I am comforted in hearing that. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. 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 would be more convenient to use Mayo but I want the best practitioner regardless. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. Negative cancer in lymph nodes, seminal vesicles, and all margins. I assume the data on gleason scoring is much more robust/reliable than genomics as it has been around longer and used more extensively. Prior to the results, the oncologist said that the literature shows that a 3+4=7 with less than 5% pattern 4 behaves just like a 3+3=6 and basically is an indolent tumor. feel the clock ticking. The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. Then about a month later I started 28 fractions of Proton Radiation.It was painless. Getting a Second Opinion The best time to seek a second opinion is before you start treatment. I worked out every day. 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. 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. 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. This site needs JavaScript to work properly. And in some cases, the information you gain during a second opinion consultation can even change your diagnosis. 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. 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. A report with the diagnosis will be faxed to your doctor. Surgeon wants next PSA in 3 months. Hoping that after I go through this that my advice to others will be able to guide them and that they can learn from my experience, as I feel I am gaining a solid foundation from both a practical and mental standpoint. My diagnosis is T2c, Gleason 7 (3+4). Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. 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. Second opinion Biopsy came after FLA G-9. I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. I assume it is not free. 3/3 4K score 19% (high end of intermediate) Prostate, left lateral apex: Urology. - Benign prostatic tissue We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. He was right. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. One core had 5%, one 20%, and one 40%. If a targeted biopsy is planned, this lesion can be sampled at the same time. It is OK to not understand all the terminology. With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3,500 specialists with extensive experience in all types of cancers. Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. It works. * Gleason Score: 4+5, Slide 4 (vs. Sloan's 3+4) 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. Make an appointment: 410-955-5222 Coordinating with your Treating Physician 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. 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. It was easy. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. A PSA test at time of biopsy revealed my PSA had risen to 6.5. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. 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. Prostate cancer is an I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. At a rectal exam 6/20 the urologist told me my prostate felt normal, not enlarged, nor did he feel any tumors. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. Bethesda, MD 20894, Web Policies Have been diagnosed with a serious or rare health condition. Please don't hesitate to make any observations or ask questions. According to the doctor it is around 3 mm. Its in your best interest to ask for another look at a cancer diagnosisIf youve recently been diagnosed with cancer, its wise to ask for a second opinion on your pathology specimen.Johns Hopkins researchers with the Urological Pathology Consult Division, led by Jonathan Epstein, M.D., first reported on biopsy errors a decade ago, when they found a margin of error in prostate cancer diagnoses large enough to give them pause. I am 62 years old. Overall my PSA is between 4 and 10. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. 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. 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. However, it also is possible to seek a pathology second opinion on your own, and it does not require an in-person office visit. For cancers that are less common, second opinions can offer more treatment options. * Other 12 slides not sent The primary goal is to be cured with the least toxic, most effective approach. And just this week, 1 YEAR post treatment, it is .46. TZ zone more beneficial, but fairly large compared to whole gland and proximity to capsule edge would likely mean treatment would be suggested. 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. All rights reserved. I talked with Dr. Epstein who expressed Johns Hopkins' conservative views to not underestimate GS 6 and to consider surgery and/or radiation that have been used successfully for many years in saving lives. 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. Recovery from Prostate Cancer | Bills Story. While I have three lesions, they are small and, without 3T mp MRI, might not have been discovered. probably organ confined disease. 1: Prostate, right lateral apex Ask us questions on this webpage. lesion. U.S. News & World Report ranked the institute #7in the country. I have actually had a second opinion a while back from Dr. Bush. Would you like email updates of new search results? 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.). With world-renowned expertise, multidisciplinary specialistsand the latest data, we partner with you tomake informed decisions about managing your prostate cancer. The only prescriptions I take are for GERD (Protonix), cholesterol (Atvorstatin), and allopurinol for an episode of gout that I got while doing physical rehab for a bad tibia break (I shattered my tibia plateau 2/2020 and have pretty much recovered). Just had my appointment today and they are pleased with the results, so far. 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. Reinterpretation of imaging scans and lab tests. The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. 1.Rebecca L. Siegel, Kimberly D. Miller, and Ahmedin Jemal, Cancer Statistics, 2019 CA Cancer J Clin. 9. 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. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. There are also some cases of the test showing no depletion but being wrong. * Perineural Invasion also detected 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. Johns Hopkins is home to many of the world's leaders in Pathology. 4. One to a 3+4=7 and the other to a 3+3=6. If they have an enlarged colon, their physician can perform a TURP procedure. Patient-Driven Second Opinions in Oncology: A Systematic Review. Benign prostatic tissue The symptoms of acute bacterial prostatitis are similar to those of CPPS. You're also at greater risk of prostate cancer forming before age 50. Consult Fees In some cases, additional testing may be required. I now have my list whittled down to 3. 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. Prostate, left medial base: Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. Wondering if any of the "gurus" here want to take a stab at looking at this and see if they agree that it says what I think it says (I will be following up with doctor(s) to get their opinion, and I waive all HIPAA rights by allowing this to be seen). However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. Even at the age of 48, he thought I would be a good candidate for AS. What have your doctors told you? Unlike pathology labs in most hospitals, Jonathan Epstein's lab at Johns Hopkins has pathologists who specialize in reading prostate tissue samples. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. In general, a second opinion is a good option for people who have recently received a cancer diagnosis but have not started treatment, as well as for people who have already completed chemotherapy or radiation treatment. Other: There is trace ascites in the mesosigmoid. All views would be appreciated. Netto points to prostate cancer as an example: If your diagnosis changes from a higher grade to a lower grade cancer, it could mean having the option to avoid radical treatment.Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) This is a PI-RADS 5 lesion in A total of 2386 men responded to the survey (adjusted response rate, 51.1%). In some situations, insurers will even insist on a second opinion. I suggest for all that hear, "you have cancer" that you seek more opinions! There is no bony or bulky nodal disease in the pelvis 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. 4. I have completed an exhaustive research effort on Prostate Cancer and PCa treatments. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. Benign fibromuscular stroma; no prostatic glands are identified

John F Kennedy Leadership Qualities, Who Can Receive A Real Estate Referral Fee, Whitefish Bay High School Athletics, Katherine Elizabeth Shaders, Articles J