3. 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. Types of questions that pathologists often address in our second opinions: Low post-void residual volume is Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. I could not get a definitive answer from them on how much, how many cells, or any information. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. 3T MRI with coil is done initially, along with a TRUS biopsy. 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. Brief MRI history. I fear limiting myself to an inferior treatment because the people I talk to have hammers, therefore everything must be a nail. Your doctor is not sure what is wrong with you. 10. Prostate volume: 17.58 cc Benign fibromuscular stroma; no prostatic glands are identified (Recommended by my oncologist, Dr. Mark Scholz.) The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. lesion. 2016 American Cancer Society. Benign Processes: About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasnt spread outside of the prostate. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. 2: Prostate, right lateral base Reasons for getting a second opinion include: You want to be sure you have explored all options. Bladder: Normal. This is often the case when the primary physician advises an expensive treatment. HMOs usually try to diagnose and treat patients within their system because the more money the HMO spends on second opinions and treatment outside the HMO, the less money there is available for operation costs and profits. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . Following his residency in anatomic pathology at The Johns Hopkins Hospital in Baltimore, Maryland, and a fellowship in oncologic pathology at Memorial Sloan Kettering Cancer Center in New York., he then joined the staff at The Johns Hopkins Hospital and has been there his entire career. So, I also sent this MRI result to Johns Hopkins for a second opinion. G. Prostate, lesion #1, core biopsy: I choose surgery over radiation because you can do surgery and then radiation, but it is almost impossible to do it the other way around. If these do not work, your symptoms could progress and become chronic. 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. Benign Processes: Patients may experience a fever or chills as a result of the infection. Prostate Cancer News, Reviews & Views: Second opinions I guess the PET scan will be the next step in what type of treatment options are in store.Has this occurred to anyone else? Johns Hopkins is home to many of the world's leaders in Pathology. Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. 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. 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." Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. -------------------------------------------------------- I had the slides reviewed at Johns Hopkins and 1 of the HG PIN cores was changed to suspicious for adenocarcinoma while another HG PIN core was changed to benign. Prostate dimensions: 4.1 x 2.8 x 3.4 cm Even at the age of 48, he thought I would be a good candidate for AS. After a little experimenting I have been able to achieve a partial erection. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. Bring All Labs/Notes to Each Appointment. 1.Rebecca L. Siegel, Kimberly D. Miller, and Ahmedin Jemal, Cancer Statistics, 2019 CA Cancer J Clin. Blessings. My Oncotype rating was GPS 54, with a 26% chance of metastisis within 10 years. Ex-Uro wanted to do biopsies and keep doing them until we find "it", even though he didn't know the size of the prostate nor had he ruled out prostatitis. focal peripheral zone lesions. J Am Board Fam Med. Conflicting Prostate Biopsy OpinionsWhat to Do? Also these lesions did not abut or touch the wall of the prostate. Dr. Nour - Emory in Atlanta. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. I am doing one in 6 weeks, regardless. 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. Lymph nodes: There is no suspicious lymphadenopathy in the pelvis. Check Biopsy and Imaging Results for Accuracy. 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). But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. __________________________________________________________________________July 2022I've neglected to make journal entries for a couple years, so I will recap below and continue with what I have done and what I have learned.In 2018, at the age of 48, after a routine physical that showed a PSA of (4.X) and after a TRUS biopsy, I was diagnosed with PCa. Masks are required inside all of our care facilities. Generally, the symptoms can stabilize over time. Unbelievable that this happened!!! 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. Methods: Using an Ellipsoid Volume the dimensions would give you a volume of 20.44. Call us with any questions: 410-955-2405, ext. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. The problem is that all 3 pathologies noted an intraductal component. Even at the age of 48, he thought I would be a good candidate for AS. Finally, things are set and I know what is going to happen. An accurate diagnosis is essential to ensure the most effective treatment. Just had my appointment today and they are pleased with the results, so far. FAX 310-574-4002 Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. Dont Miss: Screening For Prostate Cancer Icd 10. Symptoms include leaking and discomfort. I just turned 71 in February. 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. 4, Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion. Anyway, I'm reaching out to this group to see if anyone would be willing to chat with me about their brachytherapy experience at UCLA (even to talk me out of it). I recently sent my Pathology Slides to Dr. Epstein for a Second Review. My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. Thanks for Everyone's Help, The presence of any G4 has been my trigger to seek treatment. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. I would love to hear from anyone who has been involved in the Chicago study. Forty percent of the men obtained a second opinion from urologists, most often because they wanted more information about their cancer or wanted to be seen by the best doctor . 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. With world-renowned expertise, multidisciplinary specialists and the latest data, we partner with you to make informed decisions about managing your prostate cancer. Patient-Driven Second Opinions in Oncology: A Systematic Review. 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. You may be concerned that the cancer will grow rapidly out of control before you are able to get a second opinion. 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. Obviously the Covid 19 issue is playing a part in all of our decisions. 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. Fear, confusion and uncertainty set in. - High grade prostatic intraepithelial neoplasia (HGPIN) Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. I have completed an exhaustive research effort on Prostate Cancer and PCa treatments. Dont Miss: Bladder Control After Prostate Surgery. 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, Read Also: Nhs Prostate Cancer Risk Calculator. It is still important to do your own research. Oncologist. Benign prostatic tissue Read Also: What Are The Signs Of Prostate Infection. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. HMOs usually try to diagnose and treat patients within their system because the more money the HMO spends on second opinions and treatment outside the HMO, the less money there is available for operation costs and profits. 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. Expert review of your case by a Cleveland Clinic specialist. When to move from Active Surveillance to Treatment for Prostate Cancer? You May Like: Prostate Cancer External Beam Radiation Side Effects. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Best practices dictate that you obtain a second confirmatory pathology evaluation. Those readings were reported on a second opinion by Dr. Epstein. This is not true. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. They told me to expect a spike in my PSA sometime in the future, and they told me that studies are showing that a slow, steady decline in PSA is often indicative of superior results (whatever that means. 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). 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. doi: 10.1002/cncr.30412. John Hopkins Prostate Cancer Second Opinion This championship swimmer sought a second opinion at Johns Hopkins. I had a very bad experience with an incompetent nurse that did a catheter change. Your doctor is not a specialist in your type of . However, learning more about prostate cancer and prostate-related health issues can help optimize health. Anyone with insight into this and advice? Low volume post-void residual urine is present in the bladder. That said, I have some questions that I derived, keeping in mind that 99% of what I have learned since February has come directly from this group: Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan.