These results, if validated in other studies, justify additional investigation on how second opinions can contribute to increasing the value of cancer care, the authors concluded. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. Our OB-GYNs, maternal-fetal medicine specialists, and pediatricians collaborate regularly with the Johns Hopkins team getting second opinions and access to hundreds of clinical trials. As I said, I am 58, so I would really like to preserve my quality of life for as long as possible, but the genomics report has me concerned. If the enlarged prostate is not completely removed, it will shrink. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. 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. We experienced information overload and decision/analysis paralysis. A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. * He said probably not candidate for watchful waiting because of tumor volume shown and seen on MRI. A 1.4 cm lesion in the left, apex, anterior transition zone demonstrates conflicting T2 and DWI characteristics for PI-RADS classification - an indeterminate lesion. Not all men with Gleason 8-10 disease are going to do badly after Also, infection was noted, so the current PSA is high in part due to prostatitis. Now Im still ignorant and dont really know a Gleason from a Duck, so when the Dr says your treatment is radiation or surgery Im devastated. 3. World J Urol. In the mean time my PSA was movingno longer static, but never back up to 6. Are you sure you want to block this member? In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could have a significant impact on treatment and prognosis. I'm Gleason 3+4=7, and I believed only 2 cores tested positive. 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. If the enlarged prostate is not completely removed, it will shrink. 2020 Dec 1;3(12):e2028320. Good Morning Brothers- Transition Zone: In the left base, mid and apical transition zone there is a large mass measuring 2 cm in size which has Now its easier than ever to get the answers you need and peace of mind you deserve. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. Men have plenty of time to seek multiple opinions and thoroughly research each option before making a decision. This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. By taking the extra time to seek a second opinion, you have a better chance at finding the most up-to-date approach and an experienced doctor. Reason was large volume of cancer (even though most of mine was Gleason 6), presence of Gleason 7 in biopsy and the rapidly increasing PSA. A newly published paper by Fischer et al. fibromuscular stroma, anterior prostatic contour is smooth. International Patients: How to Request a Remote Second Opinion Second opinions from urologists for prostate cancer: Who gets - PubMed Receiving a second opinion was not associated with perceived quality of prostate cancer care. 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! 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. 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. I hope my story helps anyone out there just starting the process. Second opinion Biopsy came after FLA G-9. Anything I am overlooking or need to add to my list of considerations? (PZ) - normal The percentage of Gleason grade 4 and/or 5 is 5 % In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. Your email address will not be published. Cancer. 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. Immediate means 6 weeks just to see his NP. Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: This is why the prostate is important to the body. Fear motivates you to want to treat this as soon as possible. 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. Prostate dimensions: 4.1 x 2.8 x 3.4 cm Second opinions apply to biopsies and imaging as well. However, it also is possible to seek a pathology second opinion on your own, and it does not require an in-person office visit. P/ 310-827-7707 | F/ 310-574-4002 | [email protected]. There are so many different departments at Hopkins that I don't know the optimal department to contact. Last year, Epstein's lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions. Benign Processes: It is OK to be overwhelmed with info. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. IMPRESSION: JHs just said it was minimal less than 5%. It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. Consultation with your nurse care manager. -------------------------------------------------------- Transurethral microwave thermotherapy : In selected patients, microwave energy helps to restructure prostate tissue and alleviate symptoms such as incontinence and voiding dysfunction, Laparoscopic prostatectomy: The prostate is removed with a miniature telescopic instrument, which allows for a quicker recovery, Robotic surgery: This breakthrough technology, which often is used for prostatectomy surgery, requires only a few small incisions. - Perineural invasion is present There is no one-size-fits-all treatment for prostate cancer. Move ahead to Dec 2020. Ask us questions on this webpage. 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. I made the appointments. 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. Seems like a simple request. How long do you have left? The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. 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). 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. and transmitted securely. This kills both birds with a single stone. 2. You May Like: Prostate Cancer External Beam Radiation Side Effects. Without your support, I could easily have subjected myself to random biopsies that are risky, don't do a good job of finding lesions, and can mess up the clarity of the prostate for an MRI. Many researchers believe PTEN present is a strong brake on Breast Cancer: When to Get a Second Opinion - WebMD 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. So now things are getting exciting. Expert review of your case by a Cleveland Clinic specialist. Netto points to prostate cancer as an example: If your diagnosis changes from a higher grade to a lower grade cancer, it could mean having the option to avoid radical treatment.Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. The total number of cores identified is 3 4, Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion. Some men have minimal or no symptoms at all. Epub 2018 Mar 28. That is literally the first time I heard that term other than seeing it in my pathology report. I have searched the country for intervential radiologist that perform FLA on the prostate. Compared to younger men, men 70-74 years old and men 75 years were less likely to obtain a second opinion whereas men with college graduate level education or beyond were more likely compared to men with less than high school level education. At Johns Hopkins, you can feel confident knowing our multidisciplinary cancer clinics combine the very best resources and specialists all within in a single location for a highly coordinated experience that delivers exceptional care while conserving time, money and energy. 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm F. Prostate, left apex, core biopsy: DIAGNOSIS: MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. In fact, additional biopsies revealed no additional cancer. Have a condition that isnt improving or is getting worse, despite treatment. 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. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Dont Miss: Screening For Prostate Cancer Icd 10. Biopsy Results: What Do They Mean? - Prostate Cancer Foundation Federal government websites often end in .gov or .mil. That being said, they can be a beneficial member of the treatment team. You The survey asked the men if they had opted for a second opinion from a urologist following their diagnosis of prostate cancer, and the reasons for the second opinion. 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 from urologists for prostate cancer: who gets them, why, and their link to treatment . Do any of you have an opinion or actual experience with any of the three listed below? So, I believe I made the right choice. However, there are also many more options for treatment and these options are more complicated than in the past. You're also at greater risk of prostate cancer forming before age 50. MRI obtained outsideon 04/16/2021. According to The National Institute on Aging, prostate problems are common after age 50. In 2006 my PSA was .6. Have been diagnosed with a serious or rare health condition. 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. It is OK to not understand all the terminology. 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. Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. Find more COVID-19 testing locations on Maryland.gov. Thankfully, prostate cancer is extremely slow growing. 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. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. Most choose treatment they originally planned to follow, study finds. Johns Hopkins Hospital Prostate Cancer - ProstateProHelp.com 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. Now the oncologist wants to perform a PSMA Pet Scan. They agreed with the PI-RADS 4. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. 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. Read Also: What Are The Signs Of Prostate Infection. Through the AHN Cancer Institute, you benefit from personalized treatment in your community, close to home, from your dedicated care team. FLA DONE AT FIRST BIOPSY G- 7. By taking the extra time to seek a second opinion, you have a better chance at finding the most up-to-date approach and an experienced doctor. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. 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. 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. Ozzieville (Michael), Hello All and thanks for being here~This is my first post.My husband was diagnosed with PC (adenocarcinoma with Extensive Intraductal Carcinoma Present) a few weeks ago. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! They may defer to the recommendation of the specialist, or refer you to a doctor with limited prostate cancer experience. NOTE: THINK THIS LOWERS MY PSA DENSITY SOME IF MY GLAND ISN'T a 17CC PEANUT! 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. We are vaccinating all eligible patients. I'm trying to figure out why the PSA keeps rising. And it is OK to have paralysis by over-analysis. Overall PIRADS Score: 2/5 Call us with any questions: 410-955-2405, ext. Finally, things are set and I know what is going to happen. I really just want the results of their innovative PTEN test. The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. -------------------------------------------------------- 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. I've had what I would consider a fluctuating PSA since first tested in November 2018. A doctor may prescribe surgery or perform an endoscopic procedure. I understand that patient privacy is a priority (I'm actually a privacy lawyer), but surely there are patients who would give consent and be happy to talk with a prospective patient about their experiences? PDF Cancer A Second Opinion A Look At Understanding Controlling And Curing It works. Maybe lycopene and pomegranate have helped. Is it done through my doctor or do I do it myself with sending CDs of the MRI? Benign Processes: I have had a CT of the pelvic area - negative and a whole body bone scan - negative. feel the clock ticking. Hello, I apologize upfront for the length of this post, but I was recently diagnosed with prostate cancer (T2C) and figure more information is better than not enough. Heres What You Need to Know, Prostate Cancer Spotlights in 2020: A Year in Review, Find out about PSMA PET Imaging on Prostate Pros Podcast. In severe cases, a catheter may be required to relieve the symptoms. J Am Board Fam Med. This has only low-level nonspecific activity with SUV max of 2.05 and may be due to degenerative changes at the symphysis pubis." Benign fibromuscular stroma; no prostatic glands are identified Urology. Adenocarcinoma: MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): The ADT has daunting side-effects but he said offers some improved chances of eradication, any long-term downsides that I should consider? 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. So off I went to see a community urologist who performed a needle biopsy in his office. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. If I am rested, I find that I am more ready than if I am not. 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. They basically said it didn't matter. Six weeks later I have the biopsy in his office and a week later I get the results. The Radiation Oncologist said he would be comfortable waiting a little more, but he wasn't confident that I'd grow a target lesion, nor would I be able to wait years before having to do "something." Be well.
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