If the enlarged prostate is not completely removed, it will shrink. This is a PI-RADS 5 lesion in I'm Gleason 3+4=7, and I believed only 2 cores tested positive. Caused me to bleed heavily. )As for side effectsI occasionally have some urgency/hesitancy having to pee. A second opinion can help you make an informed, confident decision about your medical care. 2/13 PSA 5.2/fPSA 12.5% taken AFTER DRE (negative DRE) (lab #1) A man with a father or brother who had prostate cancer is twice as likely to develop the disease. 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. During your visit, our specialists will review your medical records, diagnostic tests and other information provided by you or your current physician. Second opinions offer different things in different circumstances, Dr. Matasar says. Even at the age of 48, he thought I would be a good candidate for AS. Thanks, At that point I agreed to the TRUS biopsy which I had on October 10, 2020. And it is OK to have paralysis by over-analysis. Dont Miss: Is Coffee Bad For Your Prostate. * Adjacent organ invasion: None. focal peripheral zone lesions. For all other cancer appointments, please call: 1-855-702-8222. And 2 cores from left apex of 3+3=6 with 10% involvement. Expert review of your case by a Cleveland Clinic specialist. 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. Cleveland Clinics Virtual Second Opinions program connects you to an expert physician who specializes in your specific health needs. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. I have requested a second pathologist's opinion from Johns Hopkins based on feedback from this forum. 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? 180 days after treatment PSA was .50. One of the bits of advice the group regularly dispenses is for men to get a second and even a third opinion if you have doubts about the first opinions rendered by your urologist, or your pathologist, or your radiologist, its always okay to seek out a second opinion. It's really that simple! SMIL radiologist reported nothing found. See this image and copyright information in PMC. The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. Conflicting Prostate Biopsy OpinionsWhat to Do? In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? 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." I was on disability from work the entire time (not that I was disabled, but as a pilot, I couldn't very well work and get treatment at the same time. In the mean time my PSA was movingno longer static, but never back up to 6. More medical freakouts. Fear motivates you to want to treat this as soon as possible. An accurate diagnosis is essential to ensure the most effective treatment. Therefore, the value of these second opinions remains unknown. I had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. 1.Rebecca L. Siegel, Kimberly D. Miller, and Ahmedin Jemal, Cancer Statistics, 2019 CA Cancer J Clin. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. F. Prostate, left apex, core biopsy: 2/23 PSA 4.7/fPSA 12% taken for 4K score (lab #2) Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. 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. Also, if any of you have a way to get medicare to pay some portion of the cost, please let me know as well. Now, I would like to send Radiology for a similar review. DIAGNOSIS: 2. Urologists are trained as surgeons, radiation oncologists administer radiation, and medical oncologists provide cognitive oversight and general management of the cancer. EDI am now 52 and not quite functioning like I did 4+ years ago. My involvement is below maximum of 15% of core. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Surabhi Dangi-Garimella, PhD. Metastatic disease considered less likely for this pattern. The urologist offered surgery and radiation as options on 3/10 when we met. Radhakrishnan A, Grande D, Mitra N, Pollack CE. Johns Hopkins is home to many of the world's leaders in Pathology. probably organ confined disease. Because I had an implant in my ear, they would only give me a 1.5T MRI. How much is the fee for an opinion of my recent MRI? Out of 12 cores, 9 are positive. 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. But you have to do both. Day 7 after surgery I took my last pain pill. Types of questions that pathologists often address in our second opinions: 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. I have actually had a second opinion a while back from Dr. Bush. Younger men were more likely to cite wanting more information about their cancer and to see the best doctor as the reason to seek a second opinion . I would really love to hear from you. The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. You have a rare or unusual cancer. EDI am now 52 and not quite functioning like I did 4+ years ago. Family history of prostate cancer. A PSA test at time of biopsy revealed my PSA had risen to 6.5. Also indicated everything else was "organ confined." Slight BPH findings. Emotional outlook is fragile at times and straight clinical approach of doctors does not help. Thank you! 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. You're also at greater risk of prostate cancer forming before age 50. At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). Thanks for Everyone's Help, The neurovascular bundles are intact. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. I'm trying to figure out why the PSA keeps rising. I can do radiation as a monotherapy. The review process normally takes several days, after which we will send your slides and other materials are returned. 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. The Radiation Oncologist said he would be comfortable waiting a little more, but he wasn't confident that I'd grow a target lesion, nor would I be able to wait years before having to do "something." Therefore, the value of these second opinions remains unknown. An acute bacterial infection can cause a burning sensation. I asked the urologist who did our Second Opinion at Johns Hopkins and although he thinks RP is the way to go (due to higher PSA of 10.18), he highly recommended Dr. Eggenger (Chicago). World J Urol. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. Here are seven tips for seeking second opinions for prostate cancer: 1. PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Considering Prostate Cancer Clinical Trials? Netto says patients should be proactive in requesting that doctors take another look. E. Prostate, left mid, core biopsy: Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. PELVIC LYMPH NODES: No adenopathy. Anyway, I'm reaching out to this group to see if anyone would be willing to chat with me about their brachytherapy experience at UCLA (even to talk me out of it). However, it also is possible to seek a pathology second opinion on your own, and it does not require an in-person office visit. The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. You may choose to consider a second opinion if you: 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. 10: Prostate, right anterior MRI lesion Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. * PIRADS v2 Score: 3 Will these places of excellence consider me, or am I bound to my regular doctor for insurance purposes? They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. 1. 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. This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could . I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. According to the doctor it is around 3 mm. After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. You may also complete an online appointment request form and we'll respond to schedule an appointment. 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. I have posted here before, now with an update. For cancers that are less common, second opinions can offer more treatment options. This is often the case when the primary physician advises an expensive treatment. We will then prepare a written recommendation regarding your treatment plans or options. I luckily found this webpage and I started reading everything I could get my hands on. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. - 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) The problem is that all 3 pathologies noted an intraductal component. Benign fibromuscular stroma; no prostatic glands are identified - Perineural invasion is present I was confident I was making the right decision. 1. Getting a second opinion from us is easy, convenient, and all done remotely. Yet none of my doctors ever mentioned it! Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . SO. I trust the second opinion Dr. Bush gave. The lesion also shows focal increased permeability. 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. 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. 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. Do any of you have an opinion or actual experience with any of the three listed below? No two cases of prostate cancer are alike and an accurate diagnosisis critical to developing the best treatment plan. My long-term prognosis appears to be good with minimal side effects. 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. 4. 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. Please don't hesitate to make any observations or ask questions. Surgery seems like overkill for me with too many risks for incontinence and permanent ED, am I overlooking something? His second opinion just came back. I recently sent my Pathology Slides to Dr. Epstein for a Second Review. Experts believe that this study is the first in history to have achieved such results. 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 The local pathologist read the biopsy and said 3+4=7 10% pattern 4 for both lesions. "We were surprised by the relatively large percentage of men who obtain second opinions for their prostate cancer," said lead author Dr. Archana Radhakrishnan of Johns Hopkins University in . Masks are required inside all of our care facilities. My other option for treatment is either LDR or HDR brachytherapy. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, The Sidney Kimmel Comprehensive Cancer Center. Two 1cc tumors, gleason score 3+4 each, one in each lobe. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. Study after study confirms that doctors favor the treatment they are trained to do urologists typically recommend surgery and radiation oncologists recommend radiation. Ramsey SD, Zeliadt SB, Fedorenko CR, Blough DK, Moinpour CM, Hall IJ, Smith JL, Ekwueme DU, Fairweather ME, Thompson IM, Keane TE, Penson DF. Read books and realize as soon as they are published, they are outdated. Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. Other Features: One to a 3+4=7 and the other to a 3+3=6. - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. official website and that any information you provide is encrypted This has only low-level nonspecific activity with SUV max of 2.05 and may be due to degenerative changes at the symphysis pubis." Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . The primary goal is to be cured with the least toxic, most effective approach. I have developed an "abscess" on my prostate. (I must say that those low numbers concern me a bit.) Thank you for your participation! 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%). of tumor in the rectal prostatic angles. PROSTATE LESIONS: When facing an intricate disease like prostate cancer, the above scenario is far too simple to have a promising outcome. First let me just say what so many others have previously stated, the thought of going on this journey alone is frightening, I cant imagine traveling this road alone. I had two no-risk, non-invasive tests: a Free PSA with an adverse score of 9% and a PCA3 test with a disappointing 41. Am I wrong? 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? These findings are suspicious for degenerative changes however a subtle/early metastatic lesion cannot be excluded and continued periodic follow-up is recommended." Metastasis. 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. Low volume post-void residual urine is present in the bladder. Find more COVID-19 testing locations on Maryland.gov. I now have my list whittled down to 3. )As for side effectsI occasionally have some urgency/hesitancy having to pee. 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. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. not hear all the viable treatment options or receive the most up to date In some situations, insurers will even insist on a second opinion. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. images and markedly reduced ADC. Only took Motrin and Tylenol for pain after release. * Extracapsular extension: None. I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. This has raised some questions on all the scans so far. 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. Prostate, right anterior MRI lesion: Asking for your comments: Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. 10. 3. T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive (PZ) - normal Assessment categories for this lesion: Estimated prostate volume of 35 cc with an estimated PSA density of 0.11 ng/mL/cc. What have your doctors told you? fibromuscular stroma, anterior prostatic contour is smooth. Note that I'm trying to get a second opinion from Johns Hopkins but Mayo, where the biopsy was performed, appears incapable of processing my request. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Then about a month later I started 28 fractions of Proton Radiation.It was painless. 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. The results were ambiguous. Using an Ellipsoid Volume the dimensions would give you a volume of 20.44. 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. PMC feel the clock ticking. (I think that it was easier to see because Mayo's MRI technology and procedures are better than SMIL's.) We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. Prostate, left anterior MRI lesion: However, older men 75 years were the least likely to report obtaining a second opinion due to dissatisfaction with their initial urologist. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) 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. This condition causes pain in the lower back and groin area, and may cause urinary retention. If I am rested, I find that I am more ready than if I am not. Johns Hopkins is home to many of the world's leaders in Pathology. When to move from Active Surveillance to Treatment for Prostate Cancer? Consultation with your nurse care manager. 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. Would you like email updates of new search results? 2018 May;115:133-138. doi: 10.1016/j.urology.2018.01.048. It is OK to be overwhelmed with info. - 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 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.
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