johns hopkins prostate cancer second opinion

Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. For cancers that are less common, second opinions can offer more treatment options. That said, I have some questions that I derived, keeping in mind that 99% of what I have learned since February has come directly from this group: 5: Prostate, left medial apex Even at the age of 48, he thought I would be a good candidate for AS. 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). Radhakrishnan A, Grande D, Mitra N, Pollack CE. Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. Seminal vesicles and other margins are negative for tumor. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. Hillen MA, Medendorp NM, Daams JG, Smets EMA. Should You Exercise When Youre Expecting? BASE DATA: Primary Gleason grade: 3 Patients may experience a fever or chills as a result of the infection. Get a Second Opinion What can a second opinion tell me? 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. I'm 58 yrs old and had a TRUS random biopsy October 2020 after my PSA continually stayed between 4.4 and 8, and PHI score was 126. But I did speak to an oncologist who wanted to order Oncotype, which I did. 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 second opinion can accomplish a number of things. 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. You think another treatment might be available. In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could . If I am rested, I find that I am more ready than if I am not. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. Thanks to all of you for sharing! - T2 = 3/5 * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) decision on a single medical opinion or the first appointment you get, you may Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Be well. Accessibility There are also some cases of the test showing no depletion but being wrong. 3+4, 4+3, 4+3, 4+5 (1st read)Both docs are recommending surgery.PSMA CT Scan report:"BONES/BONE MARROW: There are sclerotic changes in the right pubic bone adjacent to the symphysis pubis and to lesser extent in the left pubic bone. 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. I really liked the new group I went to as they identified the lesion right away, unlike the radiologist who performed the first procedure, and they also have a urologist on staff as well monitoring everything. Blessings. However, older men 75 years were the least likely to report obtaining a second opinion due to dissatisfaction with their initial urologist. He said that JHs said that it was 2 cores, but it was actually a fragmented core, that the fat did not present on the right place on the slide, that prior FLA (partial hemi-ablation) could affect the results, the MRI did not support, etc. Atrophy ZERO - The End of Prostate Cancer Support Community. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Jonathan Epstein, M.D. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. MY THOUGHTS AND ANYTHING DOCTOR NOTED: 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. 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. My experience at Johns Hopkins was awesome. 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. These findings are suspicious for degenerative changes however a subtle/early metastatic lesion cannot be excluded and continued periodic follow-up is recommended." Thank you for your understanding and cooperation. Getting a second opinion from us is easy, convenient, and all done remotely. -------------------------------------------------------- What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! I would love to hear from anyone who has been involved in the Chicago study. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion PROSTATE LESIONS: The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. And if so, what does being accepted in a AS program look like, do I need to be present at their location? Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. A doctor may prescribe surgery or perform an endoscopic procedure. Is the destruction of my prostate inevitable and necessary for my survival (my understanding is that both surgery and radiation will do this)? 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. Overall my PSA is between 4 and 10. It is still important to do your own research. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . My plan is to choose quality of treatment over cost of the treatment. 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. Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? Low volume post-void residual urine is present in the bladder. 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. During your visit, our specialists will review your medical records, diagnostic tests and other information provided by you or your current physician. My other option for treatment is either LDR or HDR brachytherapy. I have posted here before, now with an update. If you are diagnosed with a urologic cancer, including but not limited to the prostate, bladder, kidney, and testicular or urinary tract, its important to consider a second opinion. You May Like: Prostate Cancer External Beam Radiation Side Effects. asymmetric central zone tissue more pronounced on the left. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. * Perineural Invasion also detected I had a 3T mp MRI with coil bed, without and with contrast, at Emory on March 3. I tried to send the samples out for genetic testing to Prolaris and Decipher, but there was an ordering error and they never went thru. I've been on AS for two years after my initial TRUS biopsy showed 3 cores 3+3 (10% volume) on Right side, and 2 cores 3+3 on Left side. 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. Thank you, After more than three years on active surveillance, I've pretty much decided to have focal brachytherapy for my prostate cancer. Confused about Pathology report and course of action, Phone Number for John's Hopkins Radioogy Second Opinion. I assume the data on gleason scoring is much more robust/reliable than genomics as it has been around longer and used more extensively. I'd like to talk with former patients who have gone through the procedure. 7. PSA: 4.7 ng/ml/PSA density: 0.27 ng/ml2 Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. The neurovascular bundles are intact. 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. The urologist offered surgery and radiation as options on 3/10 when we met. Read Also: What Are The Signs Of Prostate Infection. Discover what's to love about Charm City for yourself. There are so many different departments at Hopkins that I don't know the optimal department to contact. 3. I am also talking with Dr Nour and Dr. Walser and possibly others to see if I am a good candidate for Focal Laser Ablation. peripheral zone signal intensity on T2-weighted images. 5/10 PSA 4.2/fPSA 9% taken at MSKCC (lab #3) A blocked urethra can also damage the kidneys. not hear all the viable treatment options or receive the most up to date Thanks for considering. You May Like: Prostate Radiation Treatment Side Effects. 4/16 3T MRI performed (reports/re-reads below) PMC Just had my appointment today and they are pleased with the results, so far. My question is--what importance do volume levels play in determining when to move from AS to treatment? __________________________________________________________________________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. It starts many years ago. On the first scan (post FLA) a lesion was identified by the local radiologist that performed the scan, but the FLA radiologist that performed my procedure was over reading and monitoring my care and stated strongly that there was no 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. * Size: 1.5 cm 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. Thanks, In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? Unfortunately, monetary incentives create biases that can work against patients best interests. I worked out every day. So, I asked the Radiologist if she will schedule one for me. 9: Prostate, left anterior MRI lesion Specimens Submitted: Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. We experienced information overload and decision/analysis paralysis. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. There is no evidence 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. TZ zone more beneficial, but fairly large compared to whole gland and proximity to capsule edge would likely mean treatment would be suggested. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. This has raised some questions on all the scans so far. After a little experimenting I have been able to achieve a partial erection. Over 80,000 specimen cases are seen at Johns Hopkins each year. It also rules out Brachytherapy. 2/23 PSA 4.7/fPSA 12% taken for 4K score (lab #2) I'm leaning towards SBRT. Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. The total number of cores identified is 3 intricate disease and not all doctors have the same amount of experience Expert review of your case by a Cleveland Clinic specialist. 7. By basing a treatment Reinterpretation of imaging scans and lab tests. It may be a new cancer, but it is more likely a recurrence since it is really near the ablation zone. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. I sent a message to my urologist requesting my slides be sent to Dr. Epstein at Johns Hopkins for a second opinion and I also requested an Oncotype DX test to get an idea of risk for my low teal or basic teal cancer. 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. E. Prostate, left mid, core biopsy: Ex-Uro wanted to do biopsies and keep doing them until we find "it", even though he didn't know the size of the prostate nor had he ruled out prostatitis. Bladder: Normal. Your doctor is not sure what is wrong with you. Many health insurance companies will pay for a second opinion, especially if it is for a medically necessary treatment. The primary goal is to be cured with the least toxic, most effective approach. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. You can call and speak with his assistant at: (410) 614-6330. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Given that some 3+4 is now evident, I can no longer say that all my PCa is all 3+3 and that I can stay on AS for an extended period. 1st opinion"Nonspecific sclerotic change of the right pubic bone with low-level radiotracer activity, favor degenerative change rather than osseous metastasis." Details are here: 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. 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. undefined will no longer be visible to you including posts, replies, and photos. And just this week, 1 YEAR post treatment, it is .46. 3. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Unfortunately, the 12/20/20 PSA reading was higher and that led to an MRI on 2/2/21 when two lesions were discovered. Because I had an implant in my ear, they would only give me a 1.5T MRI. T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive As a result, patients struggle to differentiate bias from fact. Second opinions are more likely to be comprehensive, or inclusive of every possible perspective, when performed in a cancer center with a multidisciplinary team, which usually includes surgeons, oncologists, radiation therapists, and sub-specialist oncologists. Sometimes, you may find out about treatment options you didnt know were available. Same with the amount of how much pattern 4. 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. This is why the prostate is important to the body. Intensity: min 148 / Max 459 Masks are required inside all of our care facilities. I have completed an exhaustive research effort on Prostate Cancer and PCa treatments. 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. There are lots of lessons learned on the forum. Bethesda, MD 20894, Web Policies Consultation with your nurse care manager. 2. How to Get a Second Opinion Our team at Johns Hopkins has a dedicated service to interpretation of brain tumors and render second opinions on a daily basis. The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. Do any of you have an opinion or actual experience with any of the three listed below? You receive a secure, private online consultation without leaving home. I had my first of those 2 PSA tests last week and it dropped to 4.77. 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. Luckily, his report co-coincided with the original QDx report. The people were great. In the mean time my PSA was movingno longer static, but never back up to 6. MRI June 2017 again at SMIL. More medical freakouts. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. 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. However, that information will still be included in details such as numbers of replies. We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. Potentially inaccurate results can lead to selection of the wrong type of therapy. What are you doing about it? 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. Include Your Primary Care Physician as Member of Your Treatment Team. The percentage of tissue with carcinoma is 45% Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. In circumstances where there may not be a single established standard of care, we can ensure the treatment plan integrates the most current, up-to-date data, Dr. Matasar says.

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