Just took time off and then life happened.Thanks in advance for the insights. 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. 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). I am at that critical juncture in which I at least need to formalize a plan, select a doctor/facility to work with, and continue my testing to make sure I have what I think I have. My thoughts focus on the fact that I have a disabled son who needs my care. You May Like: Best Treatment For Intermediate Prostate Cancer. Be well. It starts many years ago. They confirm everything except question whether one of the core samples is a 3+3 or 3+ 4. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? A new study by researchers at the Johns Hopkins University has found that . (The pathology report from Cedars-Sinai kept my diagnosis at 3+4, but a second opinion at Johns Hopkins upgraded me to 4+3.) Seems like a simple request. Yet none of my doctors ever mentioned it! 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. Thanks for Everyone's Help, 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. 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! Cancer patients are encouraged to obtain second opinions before starting treatment. So, Radiation Oncologist prescribed Cialis 5mg, daily. 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. 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). feel the clock ticking. The out-of-pocket cost may be in the $300 range (insurance may not cover it), and it is a simple matter to call your urologist to forward the slides to them. 180 days after treatment PSA was .50. A second opinion is part of the education process that is critical for many cancer patients. I still have some urgency and frequency issues, but I am not complaining too bad. Y'all are in my prayers! Prostate, left lateral apex: I am doing my own research, but I am curious as to thoughts of the best possible MRI to obtain to give me the best chance at finding something the needle biopsy didnt find. It is best to begin by talking with the doctor who made your initial prostate cancer diagnosis. I was referred to a urologist and tested again in April at 4.40. They are not objective. However, there are also many more options for treatment and these options are more complicated than in the past. -------------------------------------------------------- PDF Cancer A Second Opinion A Look At Understanding Controlling And Curing * Location: Left, anterior, base to apex, transition zone However, he also said it's treatable even at a 2cm size and the transition zone is a favorable spot. Do I need a third opinion? 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. I luckily found this webpage and I started reading everything I could get my hands on. I had a very bad experience with an incompetent nurse that did a catheter change. Sought Johns Hopkins second opinion of pathology slides. They did another 3T-MPMRI (Siemens machine) and it showed a faint area, near the margin, and very close to the down stream sphincter of prostate. I am doing one in 6 weeks, regardless. In other words, the cancer is still contained within the prostate. This teamwork ensures the best possible patient outcomes. Benign prostatic tissue __________________________________________________________________________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. Greatest dimension 2cm. And it is OK to have paralysis by over-analysis. MRI obtained outsideon 04/16/2021. I'm leaning towards SBRT. The presence of any G4 has been my trigger to seek treatment. Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. This doctor or team of doctors will review the following: The doctor then communicate their opinion regarding treatment to both the patient and the primary physician. If a targeted biopsy is planned, this lesion can be sampled at the same time. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! official website and that any information you provide is encrypted Interesting differences: Generally, the symptoms can stabilize over time. 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. The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) A week later had catheter removed and had no bladder leakage problems. Surprisingly, while one in nine men will get diagnosed with prostate cancer in their lifetime1, there are very few doctors who specialize exclusively in treating prostate cancer. You have a rare or unusual cancer. DRE is always normal. BASE DATA: Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. 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. 2018 May;115:133-138. doi: 10.1016/j.urology.2018.01.048. 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 am an airline pilot with exposure to radiation, jet fuels/fumes, etc. A enlarged prostate can also cause blockages in the urethra. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. Discover what's to love about Charm City for yourself. I was on active surveillance after a FLA procedure done in 2018. With world-renowned expertise, multidisciplinary specialists and the latest data, we partner with you to make informed decisions about managing your prostate cancer. In addition to providing a better understanding of your diagnosis, a second opinion can also shed new light on treatment options and give you confidence in how to proceed with your care. I applaud Dr Scholz for his dedication and explanation of such a complex cancer, that has not had his common sense help available for men with prostate cancer. Director of Surgical Pathology- Johns Hopkins, http://pathology.jhu.edu/department/services/secondopinion.cfm, The guy I used along with everyone else is Jonathan Epstein, M.D. It hasn't let me down. Abstract Context: In men who develop an elevated serum prostate-specific antigen level (PSA) after having undergone a radical prostatectomy, the natural history of progression to distant metastases and death due to prostate cancer is unknown. Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. If I am rested, I find that I am more ready than if I am not. Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: Second Opinions for Cancer Care - UChicago Medicine The treatment of prostate cancer has evolved tremendously. Masks are required inside all of our care facilities. * Extracapsular extension: None. Ask us questions on this webpage. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). If these do not work, your symptoms could progress and become chronic. My understanding is that brachy is great for efficacy with less risk to the bowel and the same risk for incontinence and ED as other forms of radiation. Last year, Epstein's lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions. peripheral zone signal intensity on T2-weighted images. Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. Get directions, important phone numbers, locations and more. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Reinterpretation of imaging scans and lab tests. 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. 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. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. If they have an enlarged colon, their physician can perform a TURP procedure. Original Sloan Biopsy Results: Transition Zone: In the left base, mid and apical transition zone there is a large mass measuring 2 cm in size which has Also these lesions did not abut or touch the wall of the prostate. You may also complete an online appointment request form and we'll respond to schedule an appointment. Prostate dimensions: 4.1 x 2.8 x 3.4 cm For all other cancer appointments, please call: 1-855-702-8222. Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? I would really love to hear from you. 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. Read Also: What Are The Signs Of Prostate Infection. They agreed with the PI-RADS 4. Am I missing anything? Prostate, right medial base: You can call and speak with his assistant at: (410) 614-6330. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. I fear limiting myself to an inferior treatment because the people I talk to have hammers, therefore everything must be a nail. Primary Gleason grade: 3 Benign prostatic tissue I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. My long-term prognosis appears to be good with minimal side effects. Here are the details: 3 months has passed, and its time for a PSA and a plan to have an MRI. 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. 7: Prostate, left lateral apex In My Opinion? Get A Second Opinion | ZERO Prostate Cancer Due to the spread of the Coronavirus worldwide and the first confirmed case of the Coronavirus disease in Turkey, the executive team of the Anadolu Medical Center has taken preventive measures to protect the patients and their relatives. We have a consult on Friday with the 1st opinion doc to review all tests. lesion. 24.5 BMI There are also some cases of the test showing no depletion but being wrong. -------------------------------------------------------- Prostate volume: 17.58 cc He schedules appointments with a Radiologist and two local surgeons. Treatment Advice: Sloans radiation oncologist says radiation treatment will likely be the same whichever pathologist report prevails, but may add hormone therapy for about 2 months. I have requested a second pathologist's opinion from Johns Hopkins based on feedback from this forum. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. If anyone has used him, please let me know what your experience was like. And it is OK to have paralysis by over-analysis. doi: 10.1136/bmjopen-2020-044033. Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Second opinions offer different things in different circumstances, Dr. Matasar says. images and markedly reduced ADC. 1. Tumor Quantifications: 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. 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. Required fields are marked *, PHONE 310-827-7707 The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. Thanks! A biopsy was performed on 2/26. Note respondents were able to, MeSH Although a large proportion of men with localized prostate cancer obtained a second opinion, the reasons for doing so were not associated with treatment choice or perceived quality of cancer care. The ADT has daunting side-effects but he said offers some improved chances of eradication, any long-term downsides that I should consider? There are so many different departments at Hopkins that I don't know the optimal department to contact. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. 2. The total number of cores identified is 3 This fluid causes the prostate to swell and cause a number of bladder-related symptoms. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. My mind goes all over the place as to why this is. This site needs JavaScript to work properly. The more accurate the information we have, the better our treatment decisions. They did another 3T-MPMRI (Siemens machine) and it showed a faint area, near the margin, and very close to the down stream sphincter of prostate. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 2 of 2 cores (medial core: 3.5 mm, 30%; lateral core: 2.5 mm, 20%), 0.5 mm to the blue inked tissue edge (the closer) A fusion biopsy was performed in late May and I just received those results last Thursday. I suggest for all that hear, "you have cancer" that you seek more opinions! Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. 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 Johns Hopkins Brady Urological Institute is known around the world for its expertise in diagnosing and treating urologic conditions. Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm When facing an intricate disease like prostate cancer, the above scenario is far too simple to have a promising outcome. Thank you! My first PSA was 8.03. Good Morning Brothers- Patients may experience a fever or chills as a result of the infection. We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. Two things you learn here is get a second opinion from Johns Hopkins on biopsy and get treated at Center of Excellence. There are also many reasons why you may want to seek another opinion during the course of your cancer care. Unable to load your collection due to an error, Unable to load your delegates due to an error. I had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. As soon as pathology slides were ready, Emory sent them to Dr. Epstein at Johns Hopkins. I was disappointed that only TRUS was being used, but I did find out that this was for screening only and IF you pass screeningthey use MRI guided biopsy for post-ablation follow up. 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 assume it is not free. JHs just said it was minimal less than 5%. This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. The .gov means its official. Getting a second opinion can sometimes lead to a complete change in diagnosis (such as cancerous to benign or vice versa) in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. Make an appointment: 410-955-5222 Coordinating with your Treating Physician At the Breast Cancer Program at the Johns Hopkins Kimmel Cancer Center in Baltimore, MD, a second opinion requires only that you or your doctor send us your pathology slides, key medical records and signed paperwork requesting the opinion. Cancer 2017;123:1027-34. And just this week, 1 YEAR post treatment, it is .46. Got my physical and normal DRE with new Dr. No issues identified. 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. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. Just had my appointment today and they are pleased with the results, so far. (TZ) One suspicious area - lesion size: 2cm x 1.4 cm 3T MRI with coil is done initially, along with a TRUS biopsy. Background: Please don't hesitate to make any observations or ask questions. Youve just been diagnosed with prostate cancer. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. 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. Anyone else encounter something like this? Spent the night in hospital with very little pain after the first couple of hrs. Negative cancer in lymph nodes, seminal vesicles, and all margins. All Gleason 6 (3+3). The lesion also shows focal increased permeability. Getting a second opinion from us is easy, convenient, and all done remotely. ORIGINAL MRI REPORT (local radiology group): - DWI-ADC = 4/5 Younger men also sought the 'best' doctor. I have posted here before, now with an update. According to The National Institute on Aging, prostate problems are common after age 50. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. About 60% of prostate cancers occur in people older than 65. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes.