Eager to hear what everyone thinks or has anything they see in the report I wouldn't have thought of. He basically said it was possible, but that he did not agree. What have your doctors told you? * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) IMPRESSION: The urologist offered surgery and radiation as options on 3/10 when we met. About 60% of prostate cancers occur in people older than 65. Be well. Any input on this would really be appreciated. Because I had an implant in my ear, they would only give me a 1.5T MRI. Include Your Primary Care Physician as Member of Your Treatment Team. I recently sent my Pathology Slides to Dr. Epstein for a Second Review. PSA: 4.7 ng/ml/PSA density: 0.27 ng/ml2 3/5 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. Then about a month later I started 28 fractions of Proton Radiation.It was painless. * Other 12 slides not sent 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. 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. My only concerned was heavy metal poisoning and didn't know how long AS would be beneficial since I was starting at a young age. ORIGINAL MRI REPORT (local radiology group): Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. restricted diffusion. 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." have no symptoms, and yet you have cancer? Benign Processes: E. Prostate, left mid, core biopsy: -------------------------------------------------------- We can help with your case. The review process normally takes several days, after which we will send your slides and other materials are returned. The people were great. Asking about other experience with conflicting Prostate Biopsy Opinions. 5. The lesion also shows focal increased permeability. Adenocarcinoma: Benign Processes: Now, I would like to send Radiology for a similar review. It hasn't let me down. I had the slides reviewed at Johns Hopkins and 1 of the HG PIN cores was changed to suspicious for adenocarcinoma while another HG PIN core was changed to benign. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. John, I was diagnosed on 11 December, 2013. 7: Prostate, left lateral apex I had a follow up 3T MRI guided biopsy on March 18 at Emory. 1. Notice of Privacy Practices(Patients & Health Plan Members). PSA was 3.0 in 2011 and rose to 6.0 in late 2013. Let me know what everyone thinks if you see anything interesting or of note here or just have some advice. I still have some urgency and frequency issues, but I am not complaining too bad. However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. Benign Processes: My experience at Johns Hopkins was awesome. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. 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. Unlike pathology labs in most hospitals, Jonathan Epstein's lab at Johns Hopkins has pathologists who specialize in reading prostate tissue samples. * Prostate size: 3.9 x 2.8 x 3. cm I am already positively surprised that I am still alive 4.5 years after my diagnosis. I worked out every day and it wasn't until the last week did I feel a bit fatiguedand experience a bit of urgency and hesitation having to peeflowmax fixed that right up!90 days after treatment my PSA came in at .56. 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. After applying exclusion criteria, the final analytic cohort included 2365 respondents. Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive 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. And again, most of you tell me time is on my side, so I am comforted in hearing that. Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. prostate cancer; quality of health care; second opinion; specialists; treatment. Centro Diagnostico Italiano , Milan, Italy, Manfred Dietel, M.D.Institute of Pathology Charit, Humboldt University of Medicine, Berlin, Germany, Jonathan I. Epstein, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Robert J. Kurman, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Elizabeth Montgomery, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Manuel Sobrinho-Simes, M.D.University of Porto, Porto, Portugal, Ronald S. Weinstein, M.D.University of Arizona, Tuscon, AZ, Franco VisinoniMilestone Medical Technologies, Bergamo, Italy, Read Also: Nhs Prostate Cancer Risk Calculator. 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. My diagnosis is T2c, Gleason 7 (3+4). We had the 3T MRI (no coil) and MRI guided biopsy at Sperling in NY, and then had a 2nd Opinion done by Johns Hopkins. Men with a college education or beyond also were more likely to cite wanting more information about their cancer as a motivation for a second opinion . Good Morning Brothers- Grade Group: 2 We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Surabhi Dangi-Garimella, PhD. Has anyone sent Radiology (mpMRI) reports and images to Hopkins for Second Opinion Review? Hillen MA, Medendorp NM, Daams JG, Smets EMA. My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. 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. I'll post the whole thing, my doc and my own comments, and then cut/paste all my MRI results in case anyone REALLY liked data. And luckily I lived in Chattanooga and had mutual friends with Dr. Joe Busch (my Urologist never mentioned him, yet we could almost see his facility from the exam room in which he broke the news. -------------------------------------------------------- Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. There are also some cases of the test showing no depletion but being wrong. 2: Prostate, right lateral base Greetings gentlemen! I understand that patient privacy is a priority (I'm actually a privacy lawyer), but surely there are patients who would give consent and be happy to talk with a prospective patient about their experiences? J Am Board Fam Med. Thanks to all of you for sharing! Some of the more common treatments that you and your doctor may discuss include: Prostate cancer experts at the Brady Urological Institute have created tools that help patients and doctors across the world assess risk and make treatment decisions. Seek Perspective from a Range of Specialists. When you review your pathology report and are going to be making important decisions, like treatment decisions, which will be based on the information from the pathology report. Obviously the Covid 19 issue is playing a part in all of our decisions. 1: Prostate, right lateral apex AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. Masks are required inside all of our care facilities. Five years ago I had a TURP. Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. 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. I then had the PHI test which showed PSA 8.70 and overall PHI 125.9. So, Radiation Oncologist prescribed Cialis 5mg, daily. These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. 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. (I must say that those low numbers concern me a bit.) Find more COVID-19 testing locations on Maryland.gov. 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. Allow yourself the time to seek multiple opinions. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. Following his residency in anatomic pathology at The Johns Hopkins Hospital in Baltimore, Maryland, and a fellowship in oncologic pathology at Memorial Sloan Kettering Cancer Center in New York., he then joined the staff at The Johns Hopkins Hospital and has been there his entire career. 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. Secondary Gleason grade: 3 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. Estimated prostate volume of 35 cc with an estimated PSA density of 0.11 ng/mL/cc. Therefore, the value of these second opinions remains unknown. Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. Can it be salvaged or are the risks of cancer too high? Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. Because every patient is different, there are several ways to approach prostate cancer treatment. And thanks again for making this such a great support group! He was right. If these do not work, your symptoms could progress and become chronic. present in bladder. Identified an approximate 2 cm lesion of mostly Gleason 7 (3+4) with only 20% being 4, contained in prostate. An acute bacterial infection can cause a burning sensation. The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. A blocked urethra can also damage the kidneys. (I think that it was easier to see because Mayo's MRI technology and procedures are better than SMIL's.) 8600 Rockville Pike My first PSA was 8.03. PROSTATE LESIONS: The primary goal is to be cured with the least toxic, most effective approach. In other words, the cancer is still contained within the prostate. Does this also include HIFU, Cryoablation? Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. 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. Prostatic Adenocarcinoma In unadjusted analyses, younger men , men with college-level education , and privately insured men and Medicare ) were more likely to obtain second opinions . 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. 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! About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasn't spread outside of the prostate. Following the advice of all on here, I need a team of doctors to manage my care. This has only low-level nonspecific activity with SUV max of 2.05 and may be due to degenerative changes at the symphysis pubis." He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. Two things you learn here is get a second opinion from Johns Hopkins on biopsy and get treated at Center of Excellence. asymmetric central zone tissue more pronounced on the left. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of I would really love to hear from you. Some men have minimal or no symptoms at all. Youve just been diagnosed with prostate cancer. Also, a second opinion provides the opportunity to get information from someone other than the physician who will be directing treatment, which is usually the main source of information for most patients. They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. So fingers crossed. Expert review of your case by a Cleveland Clinic specialist. 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. 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.