Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. Ask us questions on this webpage. When people recommend going to a Center of Excellence, believe them. With that alone, I would likely be a candidate for continued Active Surveillance. Does this also include HIFU, Cryoablation? If the problem is unresponsive to other treatments, your doctor may suggest a surgical 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. Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. Prostate, left anterior MRI lesion: PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Considering Prostate Cancer Clinical Trials? official website and that any information you provide is encrypted Therefore, the value of these second opinions remains unknown. OTHER: None. * PIRADS v2 Score: 3 Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. Even if I go the radiation route, should I try for Proton radiation or some other type? * PIRADS v2 Score: 5 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. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. The researchers did not include more minor errors in rating how fast-growing and how advanced a cancer was. Blessings. 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. Right mid anterior transition zone (PIRADS 2). I'm turning 58 in one week. Lesions are all small or very small. To learn your stage of prostate cancer, take the staging quiz on keytopc.com. An increase of 1.1 in 3 months is not good news. Second Opinions (Adults) For stem cell transplant, please call 1-773-702-1994. A man with a father or brother who had prostate cancer is twice as likely to develop the disease. 3. 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. Symptoms include leaking and discomfort. Johns Hopkins is home to many of the world's leaders in Pathology. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. * Adjacent organ invasion: None. 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. A new study by researchers at the Johns Hopkins University has found that . doi: 10.1001/jamanetworkopen.2020.28320. After extensive discussion of his management options with his local urologist, primary care physician, and radiation oncologist, he also sought a second opinion at the Johns Hopkins Prostate Cancer Multidisciplinary Clinic at Sibley Memorial Hospital.The patient expressed an overwhelming desire to avoid surgery and any other invasive treatments. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Dr. Nour is 100% sure that nothing has spread. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. A week later had catheter removed and had no bladder leakage problems. The biopsy took 3 samples from the targeted region plus 16 sextant. An acute bacterial infection can cause a burning sensation. Atrophy You're also at greater risk of prostate cancer forming before age 50. For cancers that are less common, second opinions can offer more treatment options. A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. Therefore, the value of these second opinions remains unknown. Conflicting Prostate Biopsy OpinionsWhat to Do? 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. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Video consultation and written report from your expert. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! 2 cores from left base of 3+4=7 with only 5% involvement. - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length It hasn't let me down. doi: 10.1002/cncr.30412. Second opinion Johns Hopkins? - Prostate cancer PMC Whats right for you will depend on the stage of the cancer, your level of risk and your general overall health. Some men have minimal or no symptoms at all. -------------------------------------------------------- I was to follow up with my new Urologist (another surgeon) for 3 months PSA checks and annual 3T-MPMRI.My PSA checks were static and the next year's MRI looked just like the first. Note respondents were able to choose more than one reason. The local pathologist read the biopsy and said 3+4=7 10% pattern 4 for both lesions. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. 7. 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. Remember if you ship them include the following information: You May Like: Blood In Urine After Prostate Biopsy. Left mid-base transition zone (PIRADS 5). 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. 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. The total number of cores with carcinoma is 3 The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. -------------------------------------------------------- There are also many reasons why you may want to seek another opinion during the course of your cancer care. Prostate cancer is a slow growing condition. 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. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. PELVIC LYMPH NODES: No adenopathy. Prostate cancer is the second-most diagnosed cancer in American men. Based on this forum, Im very lucky for this outcome. Does 3+4 at some point typically evolve into 4+3 and also serve as a trigger point for moving from AS to treatment? 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. 5. I had a 3T mp MRI with coil bed, without and with contrast, at Emory on March 3. Five years ago I had a TURP. What are you doing about it? One to a 3+4=7 and the other to a 3+3=6. Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. 5. My long-term prognosis appears to be good with minimal side effects. Details are here: If I don't meter fluids before bed, I can expect to get up 3-4 times in the night.At this point, I am convinced I made the right treatment choiceOHFOR THOSE THAT DON'T KNOW, THE VA HAS MADE REPRODUCTIVE CANCERS A PRESUMPTIVE CONDITION FOR THOSE THAT SERVED IN MOST OF THE WAR ON TERROR LOCATIONS.Good luck fellas and my prayers are with all of you having to contend with this disease. 3. This has only low-level nonspecific activity with SUV max of 2.05 and may be due to degenerative changes at the symphysis pubis." Advances in our understanding of breast cancer have opened up new treatment options or clinical trial opportunities, including targeted drug therapies and tissue-conserving procedures proven to greatly reduce pain and nausea. There is no extraprostatic extension. In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? When facing an intricate disease like prostate cancer, the above scenario is far too simple to have a promising outcome. The TRUS biopsy is behind me, the second opinion from Johns Hopkins is behind me, and its time for next steps. He also stated that he would ONLY recommend FLA if done within a trial. My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. has now confirmed this assumption through a careful retrospective analysis of data from > 450 men whose records could be identified in the SEARCH database, all of whom received surgical treatment for Gleason 8 to 10 prostate cancer. I made the appointments. 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. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. The problem is that all 3 pathologies noted an intraductal component. Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. Extracapsular extension: The prostatic capsule is preserved. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). The percentage of Gleason grade 4 and/or 5 is 5 % * Gleason Score: 3+4 (4 of 6 specimens), 14 specimens taken A. Prostate, right base, core biopsy: 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. Overall my PSA is between 4 and 10. Same with the amount of how much pattern 4. Prostate Cancer Grading: probably organ confined disease. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. The best protection for cancer patients who are Health Maintenance Organization members is to seek a second opinion even if she or he has to pay for it. Their opinions are widely held to be definitive. Original Sloan Biopsy Results: Just took time off and then life happened.Thanks in advance for the insights. 4/16 3T MRI performed (reports/re-reads below) 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). 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. So, I also sent this MRI result to Johns Hopkins for a second opinion. We experienced information overload and decision/analysis paralysis. No one at Hopkins has ever died of prostate cancer if he had Gleason 3 + 3 cancer." At a rectal exam 6/20 the urologist told me my prostate felt normal, not enlarged, nor did he feel any tumors. 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. MM, Much to my dismay my 4th targeted biopsy Oct 12 revealed 5% G4 (upgraded from Grade Group 1 to 2 (Gleason 3+4 intermediate/favorable). I was confident I was making the right decision. It is best to begin by talking with the doctor who made your initial prostate cancer diagnosis. Identified an approximate 2 cm lesion of mostly Gleason 7 (3+4) with only 20% being 4, contained in prostate. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. Your doctor is not sure what is wrong with you. Especially opinions other than those of the first Urologist you see. He was right. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. 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. Should You Exercise When Youre Expecting? 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. They may defer to the recommendation of the specialist, or refer you to a doctor with limited prostate cancer experience. So fingers crossed. He wants me to begin the ADT around 5/1. I have had a second opinion from Johns Hopkins that confirmed the initial pathology of gleason 3+4. Based on the results, our experts can provide you with an individualized treatment plan before you leave. A second opinion is part of the education process that is critical for many cancer patients. Specimens Submitted: 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. The presence of any G4 has been my trigger to seek treatment. Had a little complication a day after release, excessive blood/clots in urine. The neurovascular bundles are intact. Bladder: Normal. There are so many different departments at Hopkins that I don't know the optimal department to contact. Prostate, right lateral apex: MRI obtained outsideon 04/16/2021. The linear amount of tissue with carcinoma is 23 mm In other words, the cancer is still contained within the prostate. Question anemia. 3/3 4K score 19% (high end of intermediate) Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? We will give that a shot and see how it turns out. Tumor Quantifications: Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. Our regional community network integrates academic specialty cancer care at Allegheny General Hospital and West Penn Hospital and at more than 20 community cancer centers throughout the region. Jonathan Epstein, M.D. Possible additional organ confined malignant lesion in right apex Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Now its easier than ever to get the answers you need and peace of mind you deserve. ZERO - The End of Prostate Cancer Support Community. Patients are often under the mistaken notion that they have to pick between their oncologist and MSK, but thats often not the case, Dr. Matasar explains. Send a Consult for Second Opinion | Johns Hopkins Pathology When I inquired with the oncologist that I had selected for my therapy before receiving the second opinion whether I would be a candidate for Active Surveillance considering the downgrading, she said 'no' due to the intraductal component. Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, The Sidney Kimmel Comprehensive Cancer Center. 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. Men have plenty of time to seek multiple opinions and thoroughly research each option before making a decision. Stanford Medicine Online Second Opinion Program Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. 4, Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion. I assume it is not free. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. 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 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. 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. * Perineural Invasion detected Prostate Cancer Grading: AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. With world-renowned expertise, multidisciplinary specialists and the latest data, we partner with you to make informed decisions about managing your prostate cancer. However, he also said it's treatable even at a 2cm size and the transition zone is a favorable spot. Have a condition that isnt improving or is getting worse, despite treatment.