Ramsey SD, Zeliadt SB, Fedorenko CR, Blough DK, Moinpour CM, Hall IJ, Smith JL, Ekwueme DU, Fairweather ME, Thompson IM, Keane TE, Penson DF. For these reasons, it is a good idea for HMO members to get a second opinion and make sure they are informed about clinical trials or other promising new treatments. It was easy. Therefore, the value of these second opinions remains unknown. This teamwork ensures the best possible patient outcomes. Benign fibromuscular stroma; no prostatic glands are identified Steve, Groucho was wrong when he said "i don't want to belong to any club that would have me as a member." 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 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. FOIA We specialize in minimally invasive treatments for prostate cancer such as: We place a high priority on sparing the nerves and tissue around the prostate whenever possible. 7 Tips for Seeking Second Opinions For Men with Prostate Cancer But I don't want to do a radical prostatectomy or radiation that would have large side effects now if the laser is a viable option given my data set. Get directions, important phone numbers, locations and more. * Asked and Dr. said he isn't overly concerned about perineural finding with the grade and it won't impact treatment options or overall prognosis. I had a very bad experience with an incompetent nurse that did a catheter change. In the United States, studies estimate 72 new cases of PN for every 100,000 people between the ages of 18 and 64 years old. 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. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of J Am Board Fam Med. The more accurate the information we have, the better our treatment decisions. I made the appointments. We are vaccinating all eligible patients. Pathology reports are the opinion and interpretation of the individual pathologist viewing the tissue samples. I trust the second opinion Dr. Bush gave. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. )As for side effectsI occasionally have some urgency/hesitancy having to pee. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasn't spread outside of the prostate. - Johns Hopkins Medicine -- Get a Second Opinion Clipboard, Search History, and several other advanced features are temporarily unavailable. I wanted to keep my options open. We experienced information overload and decision/analysis paralysis. You feel healthy, you arent in pain, you Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. Hello. The researchers also found that patients who obtained second opinions because they wanted more information, were seeking the best doctor, or had been encouraged to do so by family or friends were more likely to undergo surgery. I have posted here before, now with an update. And when I attempt to ask questions about intradcutal, I get responses about how little is known about it because it's so rare or that it is controversial or that they're not familiar with the study I'm referencing. Other: There is trace ascites in the mesosigmoid. Are you sure you want to block this member? An acute bacterial infection can cause a burning sensation. Johns Hopkins said I have options of adjuvant radiation approach up to 3-4months or wait to see if there are two successive rises in PSA and then do "salvage" approach. I'm trying to figure out why the PSA keeps rising. 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. * Membranous urethral length: 1.2 cm Second Opinion Pathology | MD Anderson Cancer Center 10: Prostate, right anterior MRI lesion Nov 7, 2016. Prior to the results, the oncologist said that the literature shows that a 3+4=7 with less than 5% pattern 4 behaves just like a 3+3=6 and basically is an indolent tumor. Depending on your location, you may be able to have a telemedicine consultation. To learn your stage of prostate cancer, take the staging quiz on keytopc.com. Now its easier than ever to get the answers you need and peace of mind you deserve. Didn't know if she had the catheter in far enough and not getting any urine through itwondered if she had inflated the balloon enough and wondering if it was the reason that I have developed an abscess. The primary goal is to be cured with the least toxic, most effective approach. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists. It also rules out Brachytherapy. Low volume post-void residual urine is present in the bladder. 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. A second opinion can help you make an informed, confident decision about your medical care. Finally, things are set and I know what is going to happen. 8600 Rockville Pike However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. Without the genomic test I have I lesion 3+3=6 and another, 3+4=7, with less than 5% pattern 4, and an MRI that shows no ECE, no other suspicious lesions and questionable cellular EPE based upon disagreement of pathologists. Slight BPH findings. Learn MoreFor more information about pathology second opinions, visit pathology.jhu.edu or call 877-546-1872. * PIRADS v2 Score: 5 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. Instead, I did my homework. In some situations, insurers will even insist on a second opinion. 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. Dr also stated he was able to totally spare one of my nerves, but to get margin may have damaged one. I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. Does 3+4 at some point typically evolve into 4+3 and also serve as a trigger point for moving from AS to treatment? Even at the age of 48, he thought I would be a good candidate for AS. Good Morning Brothers- JHs just said it was minimal less than 5%. Therefore, the value of these second opinions remains unknown. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. Generally, the symptoms can stabilize over time. Your doctor is not a specialist in your type of . radiation, active surveillance, surgery, hormone therapy, and more. Some specialists have more expertise and more experience than others. 2 cores from left base of 3+4=7 with only 5% involvement. * Prostate size: 3.9 x 2.8 x 3. cm Some men will have a very enlarged prostate, whereas others will have a mild enlargement. The peripheral zone has a patchy signal pattern. Consultation with your nurse care manager. Johns Hopkins is home to many of the world's leaders in Pathology. The problem is that all 3 pathologies noted an intraductal component. You receive a secure, private online consultation without leaving home. Dr. Albert Chang at UCLA appears to be the best in the biz for high dose rate (HDR) focal brachytherapy. Second Opinions & Consultations - Johns Hopkins Pathology Your doctor is not sure what is wrong with you. The margin of error is 1.4 percent, which is equivalent to 30,000 cancer diagnosis mistakes annually in the U.S. Of 6,171 biopsy slides sent since late 2008 for a second review at Johns Hopkins, pathologists disagreed with the diagnosis on 86 of them. They told me to expect a spike in my PSA sometime in the future, and they told me that studies are showing that a slow, steady decline in PSA is often indicative of superior results (whatever that means. The results were ambiguous. For men with prostate cancer and who live in the United States, there are some highly regarded pathology labs from which you can obtain your second opinion. Seminal vesicles are normal. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 5: Prostate, left medial apex and I have already proven to myself that my body is good at cell mutation, so I wanted to be careful.At the 3 year mark (6 months after last MRI), my PSA spiked to > 6. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. There is no evidence According to The National Institute on Aging, prostate problems are common after age 50. - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length 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. Second Opinions - Bladder Cancer | Johns Hopkins Pathology 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. I was confident I was making the right decision. A doctor may prescribe surgery or perform an endoscopic procedure. Confused about Pathology report and course of action, Phone Number for John's Hopkins Radioogy Second Opinion. Prostate Cancer Grading: Some specialize in reading only slides that come from a specific organ while others are generalists who read many different pathology slides from many different organ systems. My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. My prior Prolaris study (2018) before the FLA was very low risk. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. Not all cancers are the same and not all treatment plans are absolutely clear. 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. 4. Receiving a second opinion was not associated with perceived quality of prostate cancer care. After applying exclusion criteria, the final analytic cohort included 2365 respondents. 3T MRI with coil is done initially, along with a TRUS biopsy. At this time, I am leaning towards Active Surveillance or FLA. AS would be my choice, except that a total of three lesions, on both sides of Peripheral Zone, makes this controversial. Anyone with insight into this and advice? However, there are also many more options for treatment and these options are more complicated than in the past. Have a condition that isnt improving or is getting worse, despite treatment. prostate volume). Most reputable HMOs can, however, deliver state of the art treatment for most cancers. Your email address will not be published. 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. (I think that it was easier to see because Mayo's MRI technology and procedures are better than SMIL's.) Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results. In 2006 my PSA was .6. It is OK to not understand all the terminology. - 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) However, that information will still be included in details such as numbers of replies. 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 . The percentage of Gleason grade 4 and/or 5 is 5 % I have requested a second pathologist's opinion from Johns Hopkins based on feedback from this forum. Benign Processes: MEASUREMENTS: 5. Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. Lesion 1: Left mid-base transition zone. I was never under the misconception that I'd never have to do something, but I was going to wait until I needed to do something. According to the doctor it is around 3 mm. I am also doing a vegan diet with additional complementary substances. A doctor may prescribe surgery or perform an endoscopic procedure. 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. My experience at Johns Hopkins was awesome. Surgeon wants next PSA in 3 months. Metastatic disease considered less likely for this pattern. About this time, I started reading this forum and my ignorance starts going away. (The pathology report from Cedars-Sinai kept my diagnosis at 3+4, but a second opinion at Johns Hopkins upgraded me to 4+3.) 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. Everything seems to be on track to remove the cancer and be cured! For this study, published in the journal Cancer, 2386 men in the greater Philadelphia area, who were diagnosed with prostate cancer between 2012 and 2014, responded to survey questions. That is literally the first time I heard that term other than seeing it in my pathology report. 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. The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. 3: Prostate, right medial apex Some men may have an enlarged prostate but not notice it. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. No extraprostatic extension. So I initially thought this makes me a good candidate for AS. He was right. It's really that simple! I luckily found this webpage and I started reading everything I could get my hands on. Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. Get a Second Opinion Race and ethnicity. 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. Secondary Gleason grade: 3 But if I include the 3+3=6 cores then 4 cores tested positive and that moves me into the basic teal category and no longer a strong candidate for AS. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. For a second opinion on the results of your prostate biopsy, there is no place better to get one than from the well known prostate pathologist, Dr. Jonathan Epstein at Johns Hopkins. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. There is no extraprostatic extension. Adenocarcinoma: Benign prostatic tissue Where Should I Go for a Second Opinion? - breast cancer These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. This shows very high signal intensity on the diffusion-weighted Intensity: min 148 / Max 459 It works. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Biopsy in 12/27/11 showed 3/14 cores, Gleason 6 with PSA of 4.5. Negative cancer in lymph nodes, seminal vesicles, and all margins. I am 65 and in excellent general health. * Prostate volume: 22 cc 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. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. Diffuse probable benign peripheral zone changes limit evaluation for Whats right for you will depend on the stage of the cancer, your level of risk and your general overall health. Prostate, right lateral apex: They find that one of my 5-10% Gleason 6 core is actually a 50% Gleason 7(3+4) and the MRI was so cloudy with blood from original biopsy they said they couldnt determine much. But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. They confirm everything except question whether one of the core samples is a 3+3 or 3+ 4. Using the Bullet Volume gives you gland of 25.55. Had my PSA remained static I'd have remained on AS and had I grown a Target Lesion I'd have sought focal treatment.This science is emerging and only getting better. A fusion biopsy was performed in late May and I just received those results last Thursday. Men need to be educated on all treatment options to protect themselves from a biased industry. The local pathologist read the biopsy and said 3+4=7 10% pattern 4 for both lesions. When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. Second Opinions for Cancer Care - UChicago Medicine Noted that some don't even include on report and should be looked as something to note but not obsess about. Cancer 2017;123:1027-34. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) undefined will no longer be visible to you including posts, replies, and photos. He spent an hour on the phone reassuring me that I didn't need to rush into anything, and they he'd love to scan me 6-8 weeks after my TRUS Biopsyhave to let the trauma and all the blood leave the prostate for a good image. Last year, Epsteins lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions.Netto says patients should be proactive in requesting that doctors take another look.A second opinion can reverse the diagnosis in up to 5 percent of cases for some types of cancers, he says, like those of the breast and pancreas.Diagnosis Errors by the Numbers. If I am rested, I find that I am more ready than if I am not. 3. SMIL radiologist reported nothing found. 8. E. Prostate, left mid, core biopsy: Two weeks later I meet with my Johns Hopkins Dr. Thank you! 7. 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 A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. One to a 3+4=7 and the other to a 3+3=6. 2020 Jul 21;19(1):112. doi: 10.1186/s12904-020-00619-9. * Adjacent organ invasion: None. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. Other labs for second . The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Precision Medicine Center of Excellence for Prostate Cancer, robotic-assisted radical laparoscopic prostatectomies, The Brady Urological Institute and the Johns Hopkins Kimmel Cancer Center take a, Our urologic surgeons have extensive experience performing, Our surgeons, oncologists and radiologists are also world leaders in prostate cancer research, giving patients access to the latest discoveries and. 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. Specimens Submitted: I also learned a lot more about the high undisclosed risk of side effects of various treatment plans. 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. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. 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 may be concerned that the cancer will grow rapidly out of control before you are able to get a second opinion. Reasons for obtaining a second opinion from urologists. Suspicion for malignancy left anterior base-to-apex transition zone; Grade Group: 1 Thanks, have no symptoms, and yet you have cancer? However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. The Johns Hopkins Brady Urological Institute is known around the world for its expertise in diagnosing and treating urologic conditions. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. 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). The symptoms of acute bacterial prostatitis are similar to those of CPPS. I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. So, Radiation Oncologist prescribed Cialis 5mg, daily. It may be a new cancer, but it is more likely a recurrence since it is really near the ablation zone. Emotional outlook is fragile at times and straight clinical approach of doctors does not help. You think another treatment might be available. Greatest dimension 0.7cm . You think your doctor is underestimating how serious your cancer is. My new Dr however didnt order PSA so I asked him for one. Six weeks later I have the biopsy in his office and a week later I get the results. the transition zone. I did a book review with his first book for several veterans groups including the Americal Division Veterans Organization which with I served at age 19. Thank you! Over 80,000 specimen cases are seen at Johns Hopkins each year. And collaborating with Johns Hopkins Medicine means we can provide you with second opinions, streamlined and guided access to clinical trials, and a proven track record of excellence in care. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. images and markedly reduced ADC. 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. He recommended waiting and watching at that time due to the lower PSA reading. His second opinion just came back. Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) I appreciate any comments or insight that anyone wants to share. 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. 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. Asking for your comments: Benign fibromuscular stroma; no prostatic glands are identified -------------------------------------------------------- This is often the case when the primary physician advises an expensive treatment. He also stated that he would ONLY recommend FLA if done within a trial. 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. 3/5 Prostate, left lateral base: 2015 Feb;115(2):188-97. doi: 10.1111/bju.12665. Metastasis. 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). Seems like a simple request. With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3,500 specialists with extensive experience in all types of cancers. Unfortunately, what you do not realize may harm you! The neurovascular bundles are intact. 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.