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Do any of you have an opinion or actual experience with any of the three listed below? This has only low-level nonspecific activity with SUV max of 2.05 and may be due to degenerative changes at the symphysis pubis." Who Should Request a Second Opinion? D. Prostate, left base, core biopsy: Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care. Seminal vesicles are normal. I have a history where Foley catheters were unable to be placed going back to 2005 for unknown reasons. But I've had trouble getting Dr. Chang's office to provide any patient referrals. Enter the last name, specialty or keyword for your search below. 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'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. - 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) 5/10 PSA 4.2/fPSA 9% taken at MSKCC (lab #3) A few weeks later and just before my meeting with my new Johns Hopkins Dr I get the second opinion results from both biopsy and MRI. Find more COVID-19 testing locations on Maryland.gov. 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. -------------------------------------------------------- 3: Prostate, right medial apex Lesion 2: Right mid anterior transition zone. Then about a month later I started 28 fractions of Proton Radiation.It was painless. Especially opinions other than those of the first Urologist you see. Dr. Nour - Emory in Atlanta. Anyone with insight into this and advice? Prostate, right medial base: the transition zone. Did robotic radical prostatectomy 1/25/12. 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. In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could . PMC I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. I don't know if the FLA could affect the results, or if it was just done because it was not in the study parameters of the test. Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. * Gleason Score: 4+5, Slide 4 (vs. Sloan's 3+4) 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. 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. fibromuscular stroma, anterior prostatic contour is smooth. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. My family physician for years told me that small increases PSA was common so when it went over 4 it didnt bother me and my Dr who was retiring, didnt say anything either. During puberty, the body produces semen in a large number of cases, including enlarged prostate. However, a new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice or the persons perception of the quality of care they receive, at least among low-risk men. Be well. Please enable it to take advantage of the complete set of features! I was on active surveillance after a FLA procedure done in 2018. OTHER: None. Move ahead to Dec 2020. One to a 3+4=7 and the other to a 3+3=6. Johns Hopkins Health - Second Opinions, Second Chances - Hopkins Medicine Blessings. Ask us questions on this webpage. I can do radiation as a monotherapy. Getting A Second Opinion On Your Pathology Report - Cancer ABCs He adds that second opinions also can provide insight into topics like clinical genetics and family risk or issues related to complementary or integrative medicine approaches to manage symptoms. 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). Some men will have a very enlarged prostate, whereas others will have a mild enlargement. 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion Based on the results, our experts can provide you with an individualized treatment plan before you leave. And if so, what does being accepted in a AS program look like, do I need to be present at their location? My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. It has been 2.5 years and the PSA has still not doubled as well. 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. Secondary Gleason grade: 4 Which Patients Report That Their Urologists Advised Them to Forgo Initial Treatment for Prostate Cancer? 3. Reinterpretation of imaging scans and lab tests. Ask us questions on this webpage. MRI June 2017 again at SMIL. 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. Expert review of your case by a Cleveland Clinic specialist. Immediate means 6 weeks just to see his NP. 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. Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. Medical record collection from doctors and hospitals. NOTE: THINK THIS LOWERS MY PSA DENSITY SOME IF MY GLAND ISN'T a 17CC PEANUT! My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. Why It's Worth Seeking a Second Opinion for Prostate Cancer I'd like to talk with former patients who have gone through the procedure. Primary Gleason grade: 3 Thank you! FOIA 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. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. You feel healthy, you arent in pain, you Johns Hopkins is home to many of the world's leaders in Pathology. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. It can be caused by many factors, including infection and inflammation. Low post-void residual volume is Grade Group: 2 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. As a Gleason 3 + 3, with 8 of 12 positive cores all with less than 30% cancer, and bilateral spread, I have determined that I cannot trust a blind biopsy in and of itself. Lesion 1: Left mid-base transition zone. 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. 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). 1. I was confident I was making the right decision. Good Day Everyone. Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. Just had my appointment today and they are pleased with the results, so far. 1.Rebecca L. Siegel, Kimberly D. Miller, and Ahmedin Jemal, Cancer Statistics, 2019 CA Cancer J Clin. The results seemed fairly benign and my urologist and I decided to continue to monitor with 2 more PSA tests and then consider an MRI in April 2021. Both Drs and nurses knew what they were doing and had lots of experience. * PIRADS v2 Score: 5 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. In general, a second opinion is a good option for people who have recently received a cancer diagnosis but have not started treatment, as well as for people who have already completed chemotherapy or radiation treatment. I wanted to keep my options open. I guess TWO national centers of excellence are better than one? Three lesions: 1) GS 6 involving 30% of one core; 2) GS 6 involving less than 5% in one core; and 3) GS 6 involving less than 5% in another core. desired outcome. It is OK to not understand all the terminology. 6 cancers that are the toughest to diagnose are prostate, bladder, head and neck, soft tissue, skin and lymph system. I worked out every day. 2/13 PSA 5.2/fPSA 12.5% taken AFTER DRE (negative DRE) (lab #1) 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. Over 80,000 specimen cases are seen at Johns Hopkins each year. 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. 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. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. 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. I luckily found this webpage and I started reading everything I could get my hands on. SO. I have been drinking out of an information fire hose. Dr. Dan Sperling - New York. Hillen MA, Medendorp NM, Daams JG, Smets EMA. MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. It will be interesting to see, I think. Second Opinions & Consultations - Johns Hopkins Pathology I still have some urgency and frequency issues, but I am not complaining too bad. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. 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. 3 months has passed, and its time for a PSA and a plan to have an MRI. Those readings were reported on a second opinion by Dr. Epstein. 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. Request an Appointment 410-955-6100 In addition to cancer, our urologic team provides second opinions regarding urinary stone disease, urinary tract reconstruction, incontinence, male infertility and sexual health, and many other urologic conditions or procedures. Benign Processes: If its a common cancer with a well-established standard of care, they can offer insight into clinical trials or novel treatments that may be better than the standard. However, there were no other suspicious areas on MRI. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. Seminal vesicles and other margins are negative for tumor. I really just want the results of their innovative PTEN test. PELVIC LYMPH NODES: No adenopathy. * Prostate volume: 22 cc 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.