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And it is OK to have paralysis by over-analysis. 4. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) More medical freakouts. 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. My first PSA was 8.03. Getting a second opinion from us is easy, convenient, and all done remotely. fibromuscular stroma, anterior prostatic contour is smooth. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. Based on the results, our experts can provide you with an individualized treatment plan before you leave. It hasn't let me down. And luckily I lived in Chattanooga and had mutual friends with Dr. Joe Busch (my Urologist never mentioned him, yet we could almost see his facility from the exam room in which he broke the news. 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. 4, Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion. The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. Whether you want expert confirmation, lack understanding or confidence in your treatment plan, have a rare or unusual type of cancer, your cancer isnt responding to current treatment its reassuring to know that you have options through a second opinion. These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. Thanks for Everyone's Help, 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. Suspicion for malignancy left anterior base-to-apex transition zone; U.S. News & World Report ranked the institute #7in the country. 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. Dr. Dan Sperling - New York. 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. - DCE = (+) What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! You may also complete an online appointment request form and we'll respond to schedule an appointment. 2nd opinionBone Scan:"Mild increased activity is seen in the right symphysis corresponding to the abnormalities on the prior PET/CT examination. You May Like: Sbrt Radiation Therapy Prostate Cancer. One core had 5%, one 20%, and one 40%. In circumstances where there may not be a single established standard of care, we can ensure the treatment plan integrates the most current, up-to-date data, Dr. Matasar says. Get a Second Opinion Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. It hasn't let me down. His second opinion just came back. Steve, Groucho was wrong when he said "i don't want to belong to any club that would have me as a member." 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. However, that information will still be included in details such as numbers of replies. Do any of you have an opinion or actual experience with any of the three listed below? Other: There is trace ascites in the mesosigmoid. mail@prostateoncology.com, 7 Tips for Seeking Second Opinions For Men with Prostate Cancer. No two cases of prostate cancer are alike and an accurate diagnosisis critical to developing the best treatment plan. A PSA test at time of biopsy revealed my PSA had risen to 6.5. Have been diagnosed with a serious or rare health condition. 3T MRI with coil is done initially, along with a TRUS biopsy. They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. A biopsy was performed on 2/26. It works. I have actually had a second opinion a while back from Dr. Bush. Include Your Primary Care Physician as Member of Your Treatment Team. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . Yet none of my doctors ever mentioned it! 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. Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. Johns Hopkins Prostate Cancer Doctors - HealthyProstateClub.com Total Gleason score: 7 Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. PSA had increased to 5.4. Note that I'm trying to get a second opinion from Johns Hopkins but Mayo, where the biopsy was performed, appears incapable of processing my request. Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. 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. Either the patient or the primary physician can initiate the process of getting a second opinion. I was on active surveillance after a FLA procedure done in 2018. doi: 10.1002/cncr.30412. Pathology reports are subjective. This kills both birds with a single stone. My involvement is below maximum of 15% of core. Second opinion Johns Hopkins? - Prostate cancer According to the doctor it is around 3 mm. 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 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). PROSTATE ADDITIONAL FINDINGS: Benign prostatic lesion. Doctors can review their peers treatment suggestions and explain why they agree or disagree. 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. MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. 4/16 3T MRI performed (reports/re-reads below) Especially opinions other than those of the first Urologist you see. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. The prostates function is to create some of the fluid that insulates sperm cells found in semen. Request an Appointment 410-955-6100 Thank you! Caused me to bleed heavily. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. Need guidance choosing from multiple treatment options. EVERY DAY, they'd take a low dose X-RAY and low dose CT to align the fiducials and ensure my bladder was full and the bowel was empty. 10. There is hope. This has only low-level nonspecific activity with SUV max of 2.05 and may be due to degenerative changes at the symphysis pubis." So, Radiation Oncologist prescribed Cialis 5mg, daily. When I inquired with the oncologist that I had selected for my therapy before receiving the second opinion whether I would be a candidate for Active Surveillance considering the downgrading, she said 'no' due to the intraductal component. No definitive evidence of distant metastatic disease is seen." Anyway, would appreciate knowing how to contact Johns Hopkins. :) I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. Here are some recent updates: Uterine cancer.Women who use chemical hair straighteners frequently could have a higher risk of developing uterine cancer than women who have never used the products, according to new findings from a national study that has followed nearly 34,000 U.S. women for more than a decade. For all other cancer appointments, please call: 1-855-702-8222. Prostate, right medial apex: Advances in our understanding of breast cancer have opened up new treatment options or clinical trial opportunities, including targeted drug therapies and tissue-conserving procedures proven to greatly reduce pain and nausea. Send a Consult for Second Opinion | Johns Hopkins Pathology Original Sloan Biopsy Results: 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. desired outcome. Johns Hopkins is home to many of the world's leaders in Pathology. 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'm going to reach out to UCLA to see what they can do. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. * Location: Right, anterior, apex, peripheral zone Grade Group: 2 Receiving a second opinion was not associated with perceived quality of prostate cancer care. Surabhi Dangi-Garimella, PhD. As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. Hoping that after I go through this that my advice to others will be able to guide them and that they can learn from my experience, as I feel I am gaining a solid foundation from both a practical and mental standpoint. 4. You think your doctor is underestimating how serious your cancer is. 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. Hello. Metastasis. 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 world-renowned expertise, multidisciplinary specialists and the latest data, we partner with you to make informed decisions about managing your prostate cancer. He also said I would tolerate any option well based on my age and health. The results were ambiguous. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. They did 9 patients in Phase I and there have been 12 so far in Phase II. Two 1cc tumors, gleason score 3+4 each, one in each lobe. However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. FLA DONE AT FIRST BIOPSY G- 7. Maybe lycopene and pomegranate have helped. 6. Would you like email updates of new search results? Lesion 2: Right mid anterior transition zone. The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. I luckily found this webpage and I started reading everything I could get my hands on. I was referred to a urologist and tested again in April at 4.40. Unlike pathology labs in most hospitals, Jonathan Epstein's lab at Johns Hopkins has pathologists who specialize in reading prostate tissue samples. 10: Prostate, right anterior MRI lesion Emotional outlook is fragile at times and straight clinical approach of doctors does not help. Intensity: min 148 / Max 459 National Library of Medicine Someone advised to always get my PSA checked at the same facility in order to make sure the same protocol and lab is used, is that critical? Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could . My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. An accurate diagnosis is essential to ensure the most effective treatment. 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. I suggest for all that hear, "you have cancer" that you seek more opinions! Here's what JH says (same lesion). Studies show the clinical and financial benefits of obtaining a pathology second opinion. He is the past president of the International Society of Urological Pathology. 2/23 PSA 4.7/fPSA 12% taken for 4K score (lab #2) Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. John. doi: 10.1002/cncr.30412. 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. I'm trying to figure out why the PSA keeps rising. Brief MRI history. Second round of Radiation Therapy - t - Advanced Prostate It is still important to do your own research. Patients may experience a fever or chills as a result of the infection. Fear, confusion and uncertainty set in. 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.). 7. John, I was diagnosed on 11 December, 2013. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. C. Prostate, right apex, core biopsy: Not all cancers are the same and not all treatment plans are absolutely clear. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. This urologist can get you in for surgery next week. Since I have gotten so much out of this forum, I thought Id provide my story to help others. Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. Good Day Everyone. A second review of Pathology more frequently also brings changes to the cancer grade or stage, which can affect prognosis as well as therapy. Low volume post-void residual urine is present in the bladder. 9. 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. For cancers that are less common, second opinions can offer more treatment options. I am 58 and in very good health otherwise. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care.