When I was diagnosed I really thought that I will live only 2 years. BONES: No suspicious osseous He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. In unadjusted analyses, younger men , men with college-level education , and privately insured men and Medicare ) were more likely to obtain second opinions . When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. Over kill and redundancy I know, but it's my money, my prerogative. Extraprostatic extension: negative It's really that simple! The reasons for opting for treatment: the single lesion - previously Gleason 3+4, with a small percentage of pattern 4 - has grown, and according to a biopsy performed March 25, my Gleason 3+4 is now a Gleason 4+3. I assume it is not free. After all, it seems like good idea to deal with your cancer sooner rather than later. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. No two cases of prostate cancer are alike and an accurate diagnosisis critical to developing the best treatment plan. 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 . have no symptoms, and yet you have cancer? The researchers did not include more minor errors in rating how fast-growing and how advanced a cancer was. Prostate Cancer News, Reviews & Views: Second opinions All Gleason 6 (3+3). SO. 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. Epub 2018 Mar 28. An accurate diagnosis is essential to ensure the most effective treatment. Atrophy I guess TWO national centers of excellence are better than one? )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. Thankfully, prostate cancer is extremely slow growing. 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. 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. Men who sought second opinions because they were dissatisfied with their initial urologist were 51 percent less likely to receive definitive treatment, and men who wanted more information about treatment were 30 percent less likely to report excellent quality of cancer care compared with men who did not receive a second opinion. Over 80,000 specimen cases are seen at Johns Hopkins each year. Is there such a thing as having a team that isnt equipped with the best equipment nor the most experienced radiologists? Greatest dimension 0.7cm . * Perineural Invasion also detected The study was published online Nov. 7 in the journal Cancer. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. Right mid anterior transition zone (PIRADS 2). Hope to hear from a bunch of people. Below is the link with instructions and the authorization form for you to use with your doctor. The presence of any G4 has been my trigger to seek treatment. In other words, the cancer is still contained within the prostate. 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. 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. -------------------------------------------------------- It works. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? 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. Study after study confirms that doctors favor the treatment they are trained to do urologists typically recommend surgery and radiation oncologists recommend radiation. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. 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%). 1. Get directions, important phone numbers, locations and more. Also indicated everything else was "organ confined." The purpose of starting this discussion is to gather peoples thoughts and opinions and actual experiences with Prostate Focal Laser Ablation. This teamwork ensures the best possible patient outcomes. ZERO - The End of Prostate Cancer Support Community. 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. * Membranous urethral length: 1.2 cm Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. Natural history of progression after PSA elevation following radical 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. Negative cancer in lymph nodes, seminal vesicles, and all margins. This condition causes pain in the lower back and groin area, and may cause urinary retention. Reasons for obtaining a second opinion from urologists. 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. - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. Wow, I sound like a snob now! The Johns Hopkins Brady Urological Institute is known around the world for its expertise in diagnosing and treating urologic conditions. Expert review of your case by a Cleveland Clinic specialist. Do I need a third opinion? Doctors can review their peers treatment suggestions and explain why they agree or disagree. 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. A new study by researchers at the Johns Hopkins University has found that . I am already positively surprised that I am still alive 4.5 years after my diagnosis. Only one core was diagnosed with a small amount of 3+3 (it was one of the three targeted cores). The percentage of Gleason grade 4 and/or 5 is 5 % We have a consult on Friday with the 1st opinion doc to review all tests. Second Opinions in Prostate Cancer - American Council on Science and Health Now the oncologist wants to perform a PSMA Pet Scan. 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. I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . If anyone has used him, please let me know what your experience was like. Thank you! Surabhi Dangi-Garimella, PhD. Thank you! desired outcome. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. It got discussions started and questions answered. * Sloan only sent partial cores, slides 1 and 4. Potentially inaccurate results can lead to selection of the wrong type of therapy. Confirm biopsy and imaging results with centers of excellence before making any final decisions. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. Four had 60-70%, five have between 5-10%. Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. Second opinions not likely to change prostate cancer treatment Video consultation and written report from your expert. Noted that some don't even include on report and should be looked as something to note but not obsess about. How important is Oncotype DX test for Gleason 7? Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. 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. 1. 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. 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? While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Depending on your location, you may be able to have a telemedicine consultation. 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. Prostate Cancer Grading: Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. Some men have minimal or no symptoms at all. 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. 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. You think your doctor is underestimating how serious your cancer is. (I must say that those low numbers concern me a bit.) Hopkins states that the one positive core (10% G6) was visualized by the MRI, so I am hoping that this increases our chances of making it through the screening process. * He said probably not candidate for watchful waiting because of tumor volume shown and seen on MRI. Last checkup (July 2022) my PSA was .46 and it is currently at .32.I am still eating primarily a plant based diet (only lean meats/cheeses/eggs about 10% of my diet) and maintaining steady weight and I am still quite active physically.As for symptomswith 5mg Daily Cialis the occasional ED symptoms have pretty much gone away. MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. 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. One of the problems with second opinions is that insurers may not cover the expense. There are so many different departments at Hopkins that I don't know the optimal department to contact. I have posted here before, now with an update. A second review of Pathology more frequently also brings changes to the cancer grade or stage, which can affect prognosis as well as therapy. 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. 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. Request an Appointment 410-955-6100 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. 7. Jonathan Epstein, M.D. Using an Ellipsoid Volume the dimensions would give you a volume of 20.44. (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. My thoughts focus on the fact that I have a disabled son who needs my care. Good pathology readings require experience and a high level of expertise. EDI am now 52 and not quite functioning like I did 4+ years ago. A. Prostate, right base, core biopsy: Prostate, right medial base: My question is--what importance do volume levels play in determining when to move from AS to treatment? If I don't meter fluids before bed, I can expect to get up 3-4 times in the night. Brief MRI history. Our team approach brings together highly experienced prostate cancer experts from across disciplines to collaborate on each patients total care, from diagnosis through treatment and recovery. A newly published paper by Fischer et al. It is OK to not understand all the terminology. Bring All Labs/Notes to Each Appointment. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. First 6 week PSA is undetectable. 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. 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. Be well. Find more COVID-19 testing locations on Maryland.gov. Second opinions offer different things in different circumstances, Dr. Matasar says. Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? The primary goal is to be cured with the least toxic, most effective approach. H. Prostate, lesion #2, core biopsy: Background: Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. poorly defined margins and intermediate to low T2. This is a PI-RADS 5 lesion in I have completed an exhaustive research effort on Prostate Cancer and PCa treatments. MRI June 2017 again at SMIL. Epub 2010 Oct 20. He recommended waiting and watching at that time due to the lower PSA reading. Prostate cancer is an 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.). I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. - Benign prostatic tissue Lymph nodes: There is no suspicious lymphadenopathy in the pelvis. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. 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. - PI-RADS for this lesion = 4/5 Masks are required inside all of our care facilities.