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We are vaccinating all eligible patients. They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. Value of Second Opinion in Prostate Cancer Uncertain, Says Hopkins Study. Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. Maybe lycopene and pomegranate have helped. 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. DIAGNOSIS: Unfortunately, monetary incentives create biases that can work against patients best interests. You think your doctor is underestimating how serious your cancer is. Now, I would like to send Radiology for a similar review. It is OK to not understand all the terminology. I'm turning 58 in one week. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Overall PIRADS Score: 5/5 T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive * Adjacent organ invasion: None. Four had 60-70%, five have between 5-10%. Recovery from Prostate Cancer | Bills Story. Only one core was diagnosed with a small amount of 3+3 (it was one of the three targeted cores). Read books and realize as soon as they are published, they are outdated. World J Urol. Specimens Submitted: Fear, confusion and uncertainty set in. 2020 Dec 1;3(12):e2028320. advising or treating it. Dont Miss: Screening For Prostate Cancer Icd 10. I requested a second opinion from Johns Hopkins and they found 1 lesion was 3+3=6 and the second lesion was 3+4 =7, with less than 5% pattern 4. This is not true. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. I am unfortunately "officially" joining the club after getting my biopsy results today. 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 Us Too Prostate is a great club and many of you have helped me a lot already. Diffusely decreased Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . They did 9 patients in Phase I and there have been 12 so far in Phase II. 53 years old Epub 2018 Mar 28. By Dec 2019, my PSA reached 4.13. The linear amount of tissue with carcinoma is 23 mm - Johns Hopkins Medicine -- Get a Second Opinion MRI RE-READ #2 (VERY VERY well respected radiologist): So the pathologist suggested a second opinion. Unable to load your collection due to an error, Unable to load your delegates due to an error. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. If these do not work, your symptoms could progress and become chronic. 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. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. * Gleason Score: 3+3 (2 of 6 specimens) 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. This shows very high signal intensity on the diffusion-weighted This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. This has raised some questions on all the scans so far. 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. Bookshelf Using an Ellipsoid Volume the dimensions would give you a volume of 20.44. One Johns Hopkins study showed that out of 14,000 men who had surgery and were found to have Gleason 6 cancer confined to the prostate, "zero of those 14,000 men had lymph node metastases. Are considering a treatment that involves significant risks, such as surgery. I opted to waive the biopsy, wait 1 year and test again. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. Thanks to all of you for sharing! Noted that some don't even include on report and should be looked as something to note but not obsess about. 3. Allow yourself the time to seek multiple opinions. P60 MD006900/MD/NIMHD NIH HHS/United States, T32 HL007180/HL/NHLBI NIH HHS/United States, K07 CA151910/CA/NCI NIH HHS/United States, P30 CA016520/CA/NCI NIH HHS/United States, K07 CA163616/CA/NCI NIH HHS/United States. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Reinterpretation of imaging scans and lab tests. 2. 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. 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. Adenocarcinoma: 4. I just turned 71 in February. A 1.4 cm lesion in the left, apex, anterior transition zone demonstrates conflicting T2 and DWI characteristics for PI-RADS classification - an indeterminate lesion. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Conflicting Prostate Biopsy OpinionsWhat to Do? Either the patient or the primary physician can initiate the process of getting a second opinion. I suggest for all that hear, "you have cancer" that you seek more opinions! 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. Dr. Nour - Emory in Atlanta. Epub 2017 Jun 12. Brief MRI history. 4. - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length Enter the last name, specialty or keyword for your search below. It is very rare (<3% of all prostrate cancers) and potentially very lethal (one study showed that 59% of men in the study with Gleason scores of 5 had died within 3 years and it had metastasized in 13% of the remaining men). If youve received a new diagnosis or arent seeing results from your current treatment plan, a second opinion can help you move forward with confidence. * Perineural Invasion also detected Thanks for considering. My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. And if so, what does being accepted in a AS program look like, do I need to be present at their location? Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. PROSTATE LESIONS: Surgery took about 3 hrs. And thanks again for making this such a great support group! 1. During puberty, the body produces semen in a large number of cases, including enlarged prostate. The percentage of Gleason grade 4 and/or 5 is 5 % This puts PCPs in a unique position to impact the treatment decisionif they only refer to urologists and not to radiation oncologists or medical oncologistssurgery is a likely treatment outcome. Need guidance choosing from multiple treatment options. In order to receive appropriate treatment, patients must understand the treatment options that are available. Visit and Like ZERO - The End of Prostate Cancer on Facebook, Sign up to receive emails and news from ZERO - The End of Prostate Cancer, Search prostate cancer clinical trials and studies. Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. Either the patient or the primary physician can initiate the process of getting a second opinion. He has had a nagging "groin injury" for may years (he played pick up basket ball until he got injured) and we are now wondering if this could be the source of that recurring ache. Results: I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). Dr. Albert Chang at UCLA appears to be the best in the biz for high dose rate (HDR) focal brachytherapy. A fusion biopsy was performed in late May and I just received those results last Thursday. 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). My dad 82 was diagnosed last week with prostate cancer with high PSA 100 and GLEASON: ( 4 + 4 ) = 8 / 1 0 , he had the PET Ga-68 PSMA image Friday and today we found out the result is stage 4 Metastatic lesions in the bone pelvic area. 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." My mind goes all over the place as to why this is. Day 7 after surgery I took my last pain pill. desired outcome. I hope my story helps anyone out there just starting the process. Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. And should I treat prostatitis before FLA? Men have plenty of time to seek multiple opinions and thoroughly research each option before making a decision. Move ahead to Dec 2020. 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%). ---------------------------------------------------- 2nd opinion"Sclerotic change at the right pubic bone with max SUV of 1.4." BJU Int. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Benign fibromuscular stroma; no prostatic glands are identified Would you like email updates of new search results? Doctors are skilled at pitching the treatment they specialize in. Greetings gentlemen! According to The National Institute on Aging, prostate problems are common after age 50. Over kill and redundancy I know, but it's my money, my prerogative. Nov 7, 2016. Then about a month later I started 28 fractions of Proton Radiation.It was painless. Following the advice of all on here, I need a team of doctors to manage my care. It may be a new cancer, but it is more likely a recurrence since it is really near the ablation zone. I have requested a second pathologist's opinion from Johns Hopkins based on feedback from this forum. Even at the age of 48, he thought I would be a good candidate for AS. -------------------------------------------------------- The people were great. I had a follow up 3T MRI guided biopsy on March 18 at Emory. Prostate, right lateral apex: With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. Many researchers believe PTEN present is a strong brake on Last year, Epstein's lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions. At a rectal exam 6/20 the urologist told me my prostate felt normal, not enlarged, nor did he feel any tumors. So, I go one better, I call up Johns Hopkins and find a Dr who does DaVinci Prostate Surgery. Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. Reasons for getting a second opinion include: You want to be sure you have explored all options. 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. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. It is OK to be overwhelmed with info. I've been on AS since April 2016. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) It took me awhile but minutes ago received my second opinion from Johns Hopkins. 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. 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. So off I went to see a community urologist who performed a needle biopsy in his office. However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. Disclaimer. Also, their protocol would be another biopsy, but he was comfortable with the image and velocity of PSA that he didn't have to have one to start treatmentand I was pretty hesitant (given the image and PSA) to take ADT, and didn't see a biopsy changing my mind regarding treatment and/or ADT.Oh. __________________________________________________________________________July 2022I've neglected to make journal entries for a couple years, so I will recap below and continue with what I have done and what I have learned.In 2018, at the age of 48, after a routine physical that showed a PSA of (4.X) and after a TRUS biopsy, I was diagnosed with PCa. 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. Those readings were reported on a second opinion by Dr. Epstein. All Gleason 6 (3+3). So, I believe I made the right choice. 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? Slight BPH findings. Five years ago I had a TURP. !I've pasted a previous update below for background.I just got my PSA results and the numbers are still trending in the right direction. Reinterpretation of imaging scans and lab tests. F. Prostate, left apex, core biopsy: The lesion also shows focal increased permeability. When facing an intricate disease like prostate cancer, the above scenario is far too simple to have a promising outcome. Dont Miss: Bladder Control After Prostate Surgery. 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. Since I have gotten so much out of this forum, I thought Id provide my story to help others. * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) I've had what I would consider a fluctuating PSA since first tested in November 2018. 30%/40% or higher)? I was confident I was making the right decision. Im currently 67 years old. 2: Prostate, right lateral base Also indicated everything else was "organ confined." Get directions, important phone numbers, locations and more. JAMA Netw Open. An acute bacterial infection can cause a burning sensation. J Am Board Fam Med. Dr. Nour is 100% sure that nothing has spread. 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. I frequently make a 2 hour car ride and I have to stop about 25% of the time and when I don't, the urgency is a bit more evident and with the urgency come some hesitancy, but not terrible. There is no extraprostatic extension. Little is known about men with localized prostate cancer who seek second opinions, the reasons why, and the association with treatment and quality of care. Other: There is trace ascites in the mesosigmoid. Total Gleason score: 6 Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? Doctors can review their peers treatment suggestions and explain why they agree or disagree. Thank you for your understanding and cooperation. However, older men 75 years were the least likely to report obtaining a second opinion due to dissatisfaction with their initial urologist. However, there are also many more options for treatment and these options are more complicated than in the past. Estimated prostate volume of 35 cc with an estimated PSA density of 0.11 ng/mL/cc. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. And it is OK to have paralysis by over-analysis. As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. 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%). 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. I have completed an exhaustive research effort on Prostate Cancer and PCa treatments. My direct phone (mobile) number is 703-992-3662, or you can private message me via this platform. Read Also: What Are The Signs Of Prostate Infection. Any input on this would really be appreciated. BONES: No suspicious osseous You May Like: Prostate Radiation Treatment Side Effects. Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. My PSA went up from 3.5 post FLA (It was 7.2 pre-procedure) to 6.7 in 2021, so I went to another radiologist to do an MRI guided biopsy of the suspected area that was near the prior ablation zone. So, I also sent this MRI result to Johns Hopkins for a second opinion. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) 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). 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. Ask us questions on this webpage. 1. MEASUREMENTS: Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated.