And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. Johns Hopkins is home to many of the world's leaders in Pathology. 5. Proton Therapy Case Study - Prostate Cancer - Johns Hopkins Medicine My new Dr however didnt order PSA so I asked him for one. MRI obtained outsideon 04/16/2021. I would appreciate hearing from that 2.8% out there who have an intraductal component. 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. present in bladder. Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. J Am Board Fam Med. MEASUREMENTS: Other Features: probably organ confined disease. Six weeks later I have the biopsy in his office and a week later I get the results. The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Precision Medicine Center of Excellence for Prostate Cancer, robotic-assisted radical laparoscopic prostatectomies, The Brady Urological Institute and the Johns Hopkins Kimmel Cancer Center take a, Our urologic surgeons have extensive experience performing, Our surgeons, oncologists and radiologists are also world leaders in prostate cancer research, giving patients access to the latest discoveries and. In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could . 4. Can it be salvaged or are the risks of cancer too high? Men with a college education or beyond also were more likely to cite wanting more information about their cancer as a motivation for a second opinion . Future study is needed to determine when second opinions contribute to increasing the value of cancer care. Thank you! Prostate, left anterior MRI lesion: BONES: No suspicious osseous My question is regarding the results of an MRI guided biopsy into a distinct tumor vs. subsequent Oncotype Dx Results. B. Prostate, right mid, core biopsy: - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. Reasons for getting a second opinion include: You want to be sure you have explored all options. Dr also stated he was able to totally spare one of my nerves, but to get margin may have damaged one. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. The primary goal is to be cured with the least toxic, most effective approach. Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. Prostate volume: 17.58 cc Watch: Are supplements good for prostate health? I have completed an exhaustive research effort on Prostate Cancer and PCa treatments. I sent a message to my urologist requesting my slides be sent to Dr. Epstein at Johns Hopkins for a second opinion and I also requested an Oncotype DX test to get an idea of risk for my low teal or basic teal cancer. Second opinions from urologists for prostate cancer: Who gets - PubMed Tumor Quantifications: 7. The Johns Hopkins Brady Urological Institute is known around the world for its expertise in diagnosing and treating urologic conditions. Unauthorized use of these marks is strictly prohibited. Whats right for you will depend on the stage of the cancer, your level of risk and your general overall health. It hasn't let me down. the transition zone. radiation, active surveillance, surgery, hormone therapy, and more. 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. Doctors can review their peers treatment suggestions and explain why they agree or disagree. So, Radiation Oncologist prescribed Cialis 5mg, daily. 2020 Dec 1;3(12):e2028320. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. 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. Either the patient or the primary physician can initiate the process of getting a second opinion. 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. I have had a second opinion from Johns Hopkins that confirmed the initial pathology of gleason 3+4. Spent the night in hospital with very little pain after the first couple of hrs. Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. Benign prostatic tissue Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. MRI RE-READ #3 (National Cancer Center of Excellence): * Location: Left, anterior, base to apex, transition zone Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. Given that some 3+4 is now evident, I can no longer say that all my PCa is all 3+3 and that I can stay on AS for an extended period. 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. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. 30%/40% or higher)? Only one core was diagnosed with a small amount of 3+3 (it was one of the three targeted cores). 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. It can: Confirm your original diagnosis and treatment plan Give you more detail about the type of breast cancer you have and stage it's in. So, I asked the Radiologist if she will schedule one for me. About 60% of prostate cancers occur in people older than 65. So, Radiation Oncologist prescribed Cialis 5mg, daily. 2. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. PROSTATE ADDITIONAL FINDINGS: Benign prostatic lesion. 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. Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. 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. They replied they are sending the slides but they said they're looking into the DX test and will get back to me once they have that information. Radhakrishnan A, Grande D, Mitra N, Pollack CE. Potentially inaccurate results can lead to selection of the wrong type of therapy. 2. If these do not work, your symptoms could progress and become chronic. and transmitted securely. - Benign prostatic tissue I have searched the country for intervential radiologist that perform FLA on the prostate. Jonathan Epstein, MD received his doctorate from Boston University. 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. notable articles of 2016 - Johns Hopkins Bloomberg School of The only prescriptions I take are for GERD (Protonix), cholesterol (Atvorstatin), and allopurinol for an episode of gout that I got while doing physical rehab for a bad tibia break (I shattered my tibia plateau 2/2020 and have pretty much recovered). have no symptoms, and yet you have cancer? To learn your stage of prostate cancer, take the staging quiz on keytopc.com. 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. 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. Hello everyone. Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. All rights reserved. Cancer. * Both Sloan and Johns Hopkins admit that large discrepancies are unusual, yet both stand by their opinions. Urology. * Seminal vesicle invasion: None. A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. The site is secure. 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. While I now concluded we need to find "it", I researched the best approach to see what is really going on and to do this safely. What have your doctors told you? A report with the diagnosis will be faxed to your doctor. And thanks again for making this such a great support group! He was right. There is no extraprostatic extension. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. Im also wondering why no one has scheduled me for MRI to see what biopsy missed. 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. 3/5 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. I have been drinking out of an information fire hose. Prostate cancer is the second-most diagnosed cancer in American men. Prurigo Nodularis Cancer: What's the Link? - Verywell Health 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. Also, if any of you have a way to get medicare to pay some portion of the cost, please let me know as well. It can be caused by many factors, including infection and inflammation. Benign Processes: In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . I worked out every day. Either the patient or the primary physician can initiate the process of getting a second opinion. But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). 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. There is no bony or bulky nodal disease in the pelvis * Perineural Invasion also detected This is often the case when the primary physician advises an expensive treatment. Consultation with your nurse care manager. There are lots of lessons learned on the forum. Some men may have an enlarged prostate but not notice it. My experience at Johns Hopkins was awesome. Sought Johns Hopkins second opinion of pathology slides. Most choose treatment they originally planned to follow, study finds. Last year, Epstein's lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions. That being said, they can be a beneficial member of the treatment team. "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 . I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. Cancer ABCs recommends: Johns Hopkins Hospital in Baltimore, Maryland, specifically Dr. Jonathan Epstein. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) You receive a secure, private online consultation without leaving home. And collaborating with Johns Hopkins Medicine means we can provide you with second opinions, streamlined and guided access to clinical trials, and a proven track record of excellence in care. 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. Extracapsular extension: The prostatic capsule is preserved. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. Prostate, left lateral apex: )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. He wants me to begin the ADT around 5/1. The Journal of the American Board of Family Medicine published a study in 2017 that found that many patients do not get a second opinion outside of their PCPs original referral2. This approach helps to decrease side effects that can affect a patients quality of life, such as erectile dysfunction, incontinence or other urinary-tract symptoms. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. Getting a second opinion from us is easy, convenient, and all done remotely. mail@prostateoncology.com, 7 Tips for Seeking Second Opinions For Men with Prostate Cancer. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. We will give that a shot and see how it turns out. However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. Prostate Cancer Grading: Not all cancers are the same and not all treatment plans are absolutely clear. I opted to waive the biopsy, wait 1 year and test again. An acute bacterial infection can cause a burning sensation. It is still important to do your own research. Hope to hear from a bunch of people. The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. This teamwork ensures the best possible patient outcomes. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. Am I wrong? This championship swimmer sought a second opinion at Johns Hopkins. This condition causes pain in the lower back and groin area, and may cause urinary retention. I followed up with the original pathologist to compare and he was more forthcoming. 1. Second Opinions - Bladder Cancer | Johns Hopkins Pathology - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 1 of 2 cores (lateral core: 4 mm, 35%), 0.1 mm to the blue inked tissue edge The average age at the time of prostate cancer diagnosis is about 66. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). 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. A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. restricted diffusion. Good Morning Brothers- Benign fibromuscular stroma; no prostatic glands are identified 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. By seeking second opinions and hearing the benefits and drawbacks of a range of treatment options for your specific stage, you will be more equipped to make educated decisions. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. Check Biopsy and Imaging Results for Accuracy. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . Benign Processes: I had my first of those 2 PSA tests last week and it dropped to 4.77. Your doctor is not sure what is wrong with you. Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. So off I went to see a community urologist who performed a needle biopsy in his office. The primary goal is to be cured with the least toxic, most effective approach. I appreciate any comments or insight that anyone wants to share. Asking for your comments: sharing sensitive information, make sure youre on a federal 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. Slight BPH findings. 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). I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. In some situations, insurers will even insist on a second opinion. 2017 May-Jun;30(3):298-307. doi: 10.3122/jabfm.2017.03.160359. 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". During puberty, the body produces semen in a large number of cases, including enlarged prostate. Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. 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." Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. Now, I would like to send Radiology for a similar review. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. Dr. Jonathan Epstein of Johns Hopkins University Hospital. In the mean time my PSA was movingno longer static, but never back up to 6. Our singular focus on treating cancer, and only cancer, means we have the expertise to confirm a diagnosis or treatment plan and offer options that may not have been considered. You May Like: Prostate Cancer External Beam Radiation Side Effects. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Other labs for second . 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). I'm Gleason 3+4=7, and I believed only 2 cores tested positive. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. So the pathologist suggested a second opinion. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. 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. You can call and speak with his assistant at: (410) 614-6330.