We have a surgery date set up for the end of July at Johns Hopkins (our second opinion team).His stats:63yo, non smoker, 167lbs, Vegetarian/Vegan diet no other known health issuesWalks dogs for a living and cares for our small farmPSA 3.3 (Jumped from 1.6 in a year)Biopsy Scores 3+5, 4+3. P/ 310-827-7707 | F/ 310-574-4002 | MAIL@PROSTATEONCOLOGY.COM. 4. That is literally the first time I heard that term other than seeing it in my pathology report. 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. Asking about other experience with conflicting Prostate Biopsy Opinions. Benign Processes: Read books and realize as soon as they are published, they are outdated. Their opinions are widely held to be definitive. 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. One core had 5%, one 20%, and one 40%. 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. I had my first of those 2 PSA tests last week and it dropped to 4.77. Background: Men who sought second opinions because they were dissatisfied with their initial urologist were less likely to receive definitive treatment (odds ratio, 0.49; 95% confidence interval, 0.32-0.73), and men who wanted more information about treatment were less likely to report excellent quality of cancer care (odds ratio, 0.70; 95% confidence interval, 0.49-0.99) compared with men who did not receive a second opinion. I have actually had a second opinion a while back from Dr. Bush. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Your doctor is not sure what is wrong with you. I have a history where Foley catheters were unable to be placed going back to 2005 for unknown reasons. Benign Processes: 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). Potentially inaccurate results can lead to selection of the wrong type of therapy. Diffuse probable benign peripheral zone changes limit evaluation for Second opinions offer different things in different circumstances, Dr. Matasar says. With world-renowned expertise, multidisciplinary specialists and the latest data, we partner with you to make informed decisions about managing your prostate cancer. The problem is that all 3 pathologies noted an intraductal component. * Prostate size: 3.9 x 2.8 x 3. cm While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Prostate, right lateral apex: A report with the diagnosis will be faxed to your doctor. I also sent my biopsy slides to Johns Hopkins for a second opinion (Epstein's read was 3+4, but with lower pattern 4 involvement than the local pathologist.). Second opinions offer different things in different circumstances, Dr. Matasar says. Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. He was right. IMPRESSION: images and markedly reduced ADC. 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. MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. Johns Hopkins Medicine A commercially available genomic test may help oncologists better determine which patients with recurrent prostate cancer may benefit from hormone therapy, according to new research from the Johns Hopkins Kimmel Cancer Centerand 15 other medical centers. 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. Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions. 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. 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. Dr also stated he was able to totally spare one of my nerves, but to get margin may have damaged one. There are so many different departments at Hopkins that I don't know the optimal department to contact. Surgical Delay and Pathological Outcomes for Clinically Localized High-Risk Prostate Cancer. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. Second Opinions for Cancer Care - UChicago Medicine 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. 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. 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. I retested in January 2019 and scored 4.20. Masks are required inside all of our care facilities. Other labs for second . So, I go one better, I call up Johns Hopkins and find a Dr who does DaVinci Prostate Surgery. 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. He also said perinueral invasion, but not extracapsular extension. We can help with your case. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. I made the appointments. Adenocarcinoma: He recommended waiting and watching at that time due to the lower PSA reading. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. Asking for your comments: Over 80,000 specimen cases are seen at Johns Hopkins each year. I can do radiation as a monotherapy. Send a Consult for Second Opinion | Johns Hopkins Pathology Some men have minimal or no symptoms at all. Its in your best interest to ask for another look at a cancer diagnosisIf youve recently been diagnosed with cancer, its wise to ask for a second opinion on your pathology specimen.Johns Hopkins researchers with the Urological Pathology Consult Division, led by Jonathan Epstein, M.D., first reported on biopsy errors a decade ago, when they found a margin of error in prostate cancer diagnoses large enough to give them pause. 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. 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. I have searched the country for intervential radiologist that perform FLA on the prostate. LESION 1 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. I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. 2. Clipboard, Search History, and several other advanced features are temporarily unavailable. Some specialists have more expertise and more experience than others. The purpose of starting this discussion is to gather peoples thoughts and opinions and actual experiences with Prostate Focal Laser Ablation. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. Second opinions apply to biopsies and imaging as well. You think your doctor is underestimating how serious your cancer is. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. information. 4. 5/10 PSA 4.2/fPSA 9% taken at MSKCC (lab #3) We will give that a shot and see how it turns out. And thanks again for making this such a great support group! focal peripheral zone lesions. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. I didn't study for the test and it's possible some morning activities might have affected my test score :) It is OK to be scared. Request an Appointment 410-955-6100 Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. The people were great. Its gone.I have been advised to have a Axumin Pet scan as follow up as the first pathology report indicated perineural invasion present as well as probable introductal carcinoma. 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. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. I did genetic testing and there were no mutations of concern, and everyone agreed that there probably wasn't "enough meat on the bone" to get a good genomic test from the biopsy.After seeing Dr Joe Busch, he said he didn't see any target lesions (PIRADS2), nor did he think I was in any danger. After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. 2/23 PSA 4.7/fPSA 12% taken for 4K score (lab #2) -------------------------------------------------------- Do second opinions matter in prostate cancer care? - ecancer I am already positively surprised that I am still alive 4.5 years after my diagnosis. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . -------------------------------------------------------- Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . If a targeted biopsy is planned, this lesion can be sampled at the same time. P60 MD006900/MD/NIMHD NIH HHS/United States, T32 HL007180/HL/NHLBI NIH HHS/United States, K07 CA151910/CA/NCI NIH HHS/United States, P30 CA016520/CA/NCI NIH HHS/United States, K07 CA163616/CA/NCI NIH HHS/United States. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. Greetings gentlemen! EDI am now 52 and not quite functioning like I did 4+ years ago. THANKS! The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. Unfortunately, monetary incentives create biases that can work against patients best interests. Every year I got a PSA and DRE during my annual physical. PSA: 4.7 ng/ml/PSA density: 0.27 ng/ml2 1. Confirm biopsy and imaging results with centers of excellence before making any final decisions. ADC: mean 879 / median 839 / st dev 223 Last year, Epstein's lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions. * Size: 1.1 cm Prostate Cancer | Johns Hopkins Brady Urological Institute The symptoms of acute bacterial prostatitis are similar to those of CPPS. 3. 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. 5. Im immediately referred to Urologist. Benign prostatic tissue - DCE = (+) John Hopkins Prostate Cancer Second Opinion I had FLA done after first biopsy which staged me at 3+4 = 7. As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. doi: 10.1001/jamanetworkopen.2020.28320. -------------------------------------------------------- If youve received a new diagnosis or arent seeing results from your current treatment plan, a second opinion can help you move forward with confidence. My involvement is below maximum of 15% of core. Possible additional organ confined malignant lesion in right apex 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. Patients may experience a fever or chills as a result of the infection. In severe cases, a catheter may be required to relieve the symptoms. 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. But I did speak to an oncologist who wanted to order Oncotype, which I did. 8: Prostate, left lateral base They basically said it didn't matter. Do I need a third opinion? We can help with your case. 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. Please enable it to take advantage of the complete set of features! 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 by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Good pathology readings require experience and a high level of expertise. There are lots of lessons learned on the forum. It works. PDF Cancer A Second Opinion A Look At Understanding Controlling And Curing I have been drinking out of an information fire hose. The .gov means its official. These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. 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. Rectal cancer.A small trial that saw 18 rectal cancer patients taking the same drug, dostarlimab, appears to have produced an astonishing result: The cancer vanished in every single participant. 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 . MRI RE-READ #3 (National Cancer Center of Excellence): Targeted MR/Fusion biopsy of one 4x8 mm lesion on Right side showed 3+3 in 2 of 5 cores (20% of total volume), and random Right side: 1 core 3+4 (10%, 20% on second opinion from Johns Hopkins) and 1 core 3+3 (10% volume) ; Left Side 1 core 3+3 (10%, no PCa on second opinion from Johns Hopkins). Expert review of your case by a Cleveland Clinic specialist. My questions are: Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. Brief MRI history. Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. I'm turning 58 in one week. Second Opinions & Consultations - Brain Tumor | Johns Hopkins Pathology Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. Instead, I did my homework. My strong preference would be to do FLA again and monitor. 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. 2. I am 62 years old. NONE of the many radiation oncologists, surgeons or urologists I've spoken with in my journey have ever mentioned the term to me so I had to look it up. 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. Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. The local pathologist read the biopsy and said 3+4=7 10% pattern 4 for both lesions. However, there were no other suspicious areas on MRI. This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion.

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