Unauthorized use of these marks is strictly prohibited. You're also at greater risk of prostate cancer forming before age 50. Second opinions are more likely to be comprehensive, or inclusive of every possible perspective, when performed in a cancer center with a multidisciplinary team, which usually includes surgeons, oncologists, radiation therapists, and sub-specialist oncologists. Radhakrishnan A, Grande D, Mitra N, Pollack CE. This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. One of the bits of advice the group regularly dispenses is for men to get a second and even a third opinion if you have doubts about the first opinions rendered by your urologist, or your pathologist, or your radiologist, its always okay to seek out a second opinion. Recovery from Prostate Cancer | Bills Story. 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. 4/16 3T MRI performed (reports/re-reads below) When I read the forums and questions on this site everyone mentions their Gleason Score from their biopsy. 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. There is no one-size-fits-all treatment for prostate cancer. LESION 2 lesion. PI-RADS v2 score: 5. Some men may have an enlarged prostate but not notice it. present in bladder. But I've had trouble getting Dr. Chang's office to provide any patient referrals. 8. Note respondents were able to, MeSH 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. A enlarged prostate can also cause blockages in the urethra. No two cases of prostate cancer are alike and an accurate diagnosisis critical to developing the best treatment plan. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. Treatment must be chosen based on stage and your 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 hope my story helps anyone out there just starting the process. -------------------------------------------------------- By basing a treatment 3. All Gleason 6 (3+3). Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. 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. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. My thoughts focus on the fact that I have a disabled son who needs my care. * Other 12 slides not sent Johns Hopkins Medical Laboratories 1620 McElderry St. Reed Hall Rm 315 Baltimore, MD 21205 Fax (410) 614-7712 Phone (410) 955-2405 8 am - 5 pm Normal LAB hours are: 5:30 am - 4:30 pm Mon-Fri Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. official website and that any information you provide is encrypted Second opinions not likely to change prostate cancer treatment I was on disability from work the entire time (not that I was disabled, but as a pilot, I couldn't very well work and get treatment at the same time. Thanks, BigD. About 60% of prostate cancers occur in people older than 65. 3 months has passed, and its time for a PSA and a plan to have an MRI. HHS Vulnerability Disclosure, Help 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. Enter the last name, specialty or keyword for your search below. 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. Note respondents were able to choose more than one reason. He has had a nagging "groin injury" for may years (he played pick up basket ball until he got injured) and we are now wondering if this could be the source of that recurring ache. 2.Tammy Jiang, Christian H. Stillson, Craig Evan Pollack, Linda Crossette, Miupdachelle Ross, Archana Radhakrishnan, and David Grande, How Men with Prostate Cancer Choose Specialists: A Qualitative Study, Journal of the American Board of Family Medicine: JABFM, 30(2), (2017): 220229. 3. I also had my PTEN test by META-MARK ( I don't have much to say about how I was treated by MM, but I won't be using their services again). Your doctor is not sure what is wrong with you. * Size: 1.5 cm A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasnt spread outside of the prostate. This championship swimmer sought a second opinion at Johns Hopkins. Overall my PSA is between 4 and 10. But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). Video consultation and written report from your expert. Over kill and redundancy I know, but it's my money, my prerogative. Send a Consult for Second Opinion | Johns Hopkins Pathology Thank you for your understanding and cooperation. Jonathan Epstein, M.D. 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. Greetings gentlemen! Good pathology readings require experience and a high level of expertise. He schedules appointments with a Radiologist and two local surgeons. OTHER: None. The majority had lower risk tumors and clinical staging of 1 40% sought second opinions with about half having more than one reason Men seeking second opinions tended to be younger and better educated citing the need for more information as their reason. For cancers that are less common, second opinions can offer more treatment options. My dad 82 was diagnosed last week with prostate cancer with high PSA 100 and GLEASON: ( 4 + 4 ) = 8 / 1 0 , he had the PET Ga-68 PSMA image Friday and today we found out the result is stage 4 Metastatic lesions in the bone pelvic area. If pain is present, a digital rectal examination will reveal hard areas. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. The total number of cores with carcinoma is 3 With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. You May Like: Prostate Radiation Treatment Side Effects. 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. 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. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Assessment categories for this lesion: You can find out by reviewing your plan or by reaching out to your insurance company. A doctor may prescribe surgery or perform an endoscopic procedure. I was referred to a urologist and tested again in April at 4.40. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. I followed up with the original pathologist to compare and he was more forthcoming. So the pathologist suggested a second opinion. He never sought treatment for the injury. I requested a second opinion from Johns Hopkins and they found 1 lesion was 3+3=6 and the second lesion was 3+4 =7, with less than 5% pattern 4. 2: Prostate, right lateral base Low volume post-void residual urine is present in the bladder. At a rectal exam 6/20 the urologist told me my prostate felt normal, not enlarged, nor did he feel any tumors. I have requested a second pathologist's opinion from Johns Hopkins based on feedback from this forum. Prostate, left lateral apex: Are you sure you want to block this member? 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. During the next 4 weeks I meet with the recommended Radiologist, and the two local surgeons. I'm going to reach out to UCLA to see what they can do. We will then prepare a written recommendation regarding your treatment plans or options. advising or treating it. Associated fees may be incurred up to $1,800 in a minority of more complicated cases requiring special studies. 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. I have had a second opinion from Johns Hopkins that confirmed the initial pathology of gleason 3+4. 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. Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. * PIRADS v2 Score: 5 This condition causes pain in the lower back and groin area, and may cause urinary retention. Be sure to confirm your diagnosis at a center of excellence. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. When to move from Active Surveillance to Treatment for Prostate Cancer? Men were asked if they obtained a second opinion from a urologist, and the reasons why. Oncologist. My urologist has decided we'll go ahead with the MRI due to the continued elevated PSA scores, in addition to the overall PHI score. Dr. Jonathan Epstein of Johns Hopkins University Hospital. I worked out every day. Benign Processes: For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. In some situations, insurers will even insist on a second opinion. Second opinions from urologists for prostate cancer: Who gets - PubMed The prostates function is to create some of the fluid that insulates sperm cells found in semen. The peripheral zone has a patchy signal pattern. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. And if so, what does being accepted in a AS program look like, do I need to be present at their location? While I have three lesions, they are small and, without 3T mp MRI, might not have been discovered. Further, the two tumors in question have not really changed much in size for more than 2 years. I really liked the new group I went to as they identified the lesion right away, unlike the radiologist who performed the first procedure, and they also have a urologist on staff as well monitoring everything. Centro Diagnostico Italiano , Milan, Italy, Manfred Dietel, M.D.Institute of Pathology Charit, Humboldt University of Medicine, Berlin, Germany, Jonathan I. Epstein, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Robert J. Kurman, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Elizabeth Montgomery, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Manuel Sobrinho-Simes, M.D.University of Porto, Porto, Portugal, Ronald S. Weinstein, M.D.University of Arizona, Tuscon, AZ, Franco VisinoniMilestone Medical Technologies, Bergamo, Italy, Also Check: How Old Can You Be To Get Prostate Cancer. * Gleason Score: 3+4 (4 of 6 specimens), 14 specimens taken My experience at Johns Hopkins was awesome. According to the doctor it is around 3 mm. As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. 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. If you are diagnosed with a urologic cancer, including but not limited to the prostate, bladder, kidney, and testicular or urinary tract, its important to consider a second opinion. Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. John, I was diagnosed on 11 December, 2013. Slight BPH findings. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. They may defer to the recommendation of the specialist, or refer you to a doctor with limited prostate cancer experience. MRI RE-READ #2 (VERY VERY well respected radiologist): prostate cancer; quality of health care; second opinion; specialists; treatment. 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 . Call us with any questions: 410-955-2405, ext. Fear, confusion and uncertainty set in. Obviously the Covid 19 issue is playing a part in all of our decisions. Seems like a simple request. * Membranous urethral length: 1.2 cm We experienced information overload and decision/analysis paralysis. 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. You May Like: Best Treatment For Intermediate Prostate Cancer. As a result, patients struggle to differentiate bias from fact. (TZ) One suspicious area - lesion size: 2cm x 1.4 cm I am also not comfortable making a decision based upon 1 genomics test, when my other prior test(s) disagrees and the gleason score disagrees. Atrophy Can it be salvaged or are the risks of cancer too high? I still have some urgency and frequency issues, but I am not complaining too bad. My profession for forty years was health actuary consultant, so I have a pretty fair understanding of health data, outcomes, and risks. Thank you! Good Luck and God Bless everyone. I could not get a definitive answer from them on how much, how many cells, or any information. 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. 2 cores from left base of 3+4=7 with only 5% involvement. Will these places of excellence consider me, or am I bound to my regular doctor for insurance purposes? 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. Instructions for Second Opinion on Pathology (Gleason score) PREVIOUS MRI RESULTS (LOTS of them) 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). Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. All rights reserved. sharing sensitive information, make sure youre on a federal * Location: Right, anterior, apex, peripheral zone A second opinion can help you make an informed, confident decision about your medical care. I then had the PHI test which showed PSA 8.70 and overall PHI 125.9. There are also many reasons why you may want to seek another opinion during the course of your cancer care. Youve just been diagnosed with prostate cancer. 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. Ask us questions on this webpage. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Consultation with your nurse care manager. Benign Processes: Many thanks for that. The study was published online Nov. 7 in the journal Cancer. 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. Just had my appointment today and they are pleased with the results, so far. Little is known about men with localized prostate cancer who seek second opinions, the reasons why, and the association with treatment and quality of care. Diffuse probable benign peripheral zone changes limit evaluation for 2/23 PSA 4.7/fPSA 12% taken for 4K score (lab #2) - Perineural invasion is present It works. 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. 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 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. Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. 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. Greatest dimension 0.7cm . Prostate, left medial apex: I was on active surveillance after a FLA procedure done in 2018. In order to give treatment for each patient with utmost security we would like to announce that currently there will be no visitors allowed.Please note that only one attendant per in-patients is permitted. It hasn't let me down. Benign Processes: Many health insurance companies will pay for a second opinion, especially if it is for a medically necessary treatment. But I did speak to an oncologist who wanted to order Oncotype, which I did. No extraprostatic extension. Want confirmation about a diagnosis or treatment. Ask your PCP to refer you to several different types of treating doctors before making a treatment decision. Therefore, the value of these second opinions remains unknown. He was right. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . - PI-RADS for this lesion = 4/5 Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. Got my physical and normal DRE with new Dr. No issues identified. Breast Cancer: When to Get a Second Opinion - WebMD JHs just said it was minimal less than 5%. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). I retired as a Dentist at the VA and saw many veterans with a wide range of outcomes as most of them became 100% service connected when diagnosed with prostate Ca due to exposure to Agent Orange if they served in Vietnam. Over 80,000 specimen cases are seen at Johns Hopkins each year. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. 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. 24.5 BMI 2. 3. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). 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. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. This puts PCPs in a unique position to impact the treatment decisionif they only refer to urologists and not to radiation oncologists or medical oncologistssurgery is a likely treatment outcome. And 2 cores from left apex of 3+3=6 with 10% involvement. 8: Prostate, left lateral base IMPRESSION: I worked out every day. Prostate Cancer Grading: Total Gleason score: 7 "We were surprised by the relatively large percentage of men who obtain second opinions for their prostate cancer," said lead author Dr. Archana Radhakrishnan of Johns Hopkins University in . 2. Lesions are all small or very small. Tumor Quantifications: This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. intricate disease and not all doctors have the same amount of experience However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. transition zone. -------------------------------------------------------- Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. Brachytherapy Experience with Dr. Albert Chang at UCLA? You have a rare or unusual cancer. 1. Getting A Second Opinion On Your Pathology Report - Cancer ABCs He is the past president of the International Society of Urological Pathology. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. A second opinion is part of the education process that is critical for many cancer patients. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. 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. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Expert review of your case by a Cleveland Clinic specialist. John Hopkins Prostate Cancer Second Opinion Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. There is no extraprostatic extension. * Sloan only sent partial cores, slides 1 and 4. The more accurate the information we have, the better our treatment decisions. Using the Bullet Volume gives you gland of 25.55. Five years ago I had a TURP. However, it also is possible to seek a pathology second opinion on your own, and it does not require an in-person office visit. restricted diffusion. However, learning more about prostate cancer and prostate-related health issues can help optimize health. It is OK to be overwhelmed with info. Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. 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. Prostate Cancer | Johns Hopkins Medicine This may include imaging, blood tests, prior treatment, and pathology reports. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. Does 3+4 at some point typically evolve into 4+3 and also serve as a trigger point for moving from AS to treatment? 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. 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. So fingers crossed. Second opinion on biopsy slides - malecare.org MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. Second round of Radiation Therapy - t - Advanced Prostate desired outcome. Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. I have searched the country for intervential radiologist that perform FLA on the prostate. I've been on AS for two years after my initial TRUS biopsy showed 3 cores 3+3 (10% volume) on Right side, and 2 cores 3+3 on Left side. It took me awhile but minutes ago received my second opinion from Johns Hopkins. Move ahead to Dec 2020. It was easy. * Prostate volume: 22 cc The percentage of tissue with carcinoma is 70% However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. Younger men also sought the 'best' 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.). Is the destruction of my prostate inevitable and necessary for my survival (my understanding is that both surgery and radiation will do this)? Johns Hopkins Hospital Prostate Cancer - ProstateProHelp.com It was easy. Accessibility Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. Read books and realize as soon as they are published, they are outdated. 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. No one at Hopkins has ever died of prostate cancer if he had Gleason 3 + 3 cancer." In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. In 2006 my PSA was .6. and transmitted securely. * Location: Left, anterior, base to apex, transition zone What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! Noted that some don't even include on report and should be looked as something to note but not obsess about. I'd like to talk with former patients who have gone through the procedure. It can be caused by many factors, including infection and inflammation. The linear amount of tissue with carcinoma is 23 mm 3.
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