7. Now its easier than ever to get the answers you need and peace of mind you deserve. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) We will then prepare a written recommendation regarding your treatment plans or options. 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 kills both birds with a single stone. I have actually had a second opinion a while back from Dr. Bush. 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. He was right. I am 65 and in excellent general health. 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.). 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. A blocked urethra can also damage the kidneys. One core had 5%, one 20%, and one 40%. Sought Johns Hopkins second opinion of pathology slides. I really just want the results of their innovative PTEN test. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. This condition causes pain in the lower back and groin area, and may cause urinary retention. Lesion 2: Right mid anterior transition zone. 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. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. Our regional community network integrates academic specialty cancer care at Allegheny General Hospital and West Penn Hospital and at more than 20 community cancer centers throughout the region. Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. If its a common cancer with a well-established standard of care, they can offer insight into clinical trials or novel treatments that may be better than the standard. So, I also sent this MRI result to Johns Hopkins for a second opinion. The margin of error is 1.4 percent, which is equivalent to 30,000 cancer diagnosis mistakes annually in the U.S. Of 6,171 biopsy slides sent since late 2008 for a second review at Johns Hopkins, pathologists disagreed with the diagnosis on 86 of them. U.S. News & World Report ranked the institute #7in the country. They agreed with the PI-RADS 4. Second Opinions (Adults) For stem cell transplant, please call 1-773-702-1994. 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion Ask us questions on this webpage. Its gone.I have been advised to have a Axumin Pet scan as follow up as the first pathology report indicated perineural invasion present as well as probable introductal carcinoma. I've been on AS since April 2016. Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? 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. sharing sensitive information, make sure youre on a federal Our team approach brings together highly experienced prostate cancer experts from across disciplines to collaborate on each patients total care, from diagnosis through treatment and recovery. The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! More medical freakouts. In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? Even if I go the radiation route, should I try for Proton radiation or some other type? If these do not work, your symptoms could progress and become chronic. Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. Pathology reports are subjective. 1. About this time, I started reading this forum and my ignorance starts going away. Prostate Cancer | Johns Hopkins Brady Urological Institute 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. It's a bit confusing since most experts now don't consider Gleason 6 to be a true cancer, so did i test positive in 2 cores or 4? It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. Consultation with your nurse care manager. 30%/40% or higher)? Some men will have a very enlarged prostate, whereas others will have a mild enlargement. 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. By choosing the first doctor you speak with to be your treating physician, you may be putting your health in the hands of someone who lacks the expertise to accurately and safely treat your prostate cancer. Thank you for your participation! If pain is present, a digital rectal examination will reveal hard areas. Assessment categories for this lesion: It is OK to not understand all the terminology. 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? IMPRESSION: 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. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. Masks are required inside all of our care facilities. I am also talking with Dr Nour and Dr. Walser and possibly others to see if I am a good candidate for Focal Laser Ablation. Reasons for obtaining a second opinion from urologists. 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. 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. Men have plenty of time to seek multiple opinions and thoroughly research each option before making a decision. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. This may include imaging, blood tests, prior treatment, and pathology reports. 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. The biopsy took 12 cores, two from each lesion area and 8 randomly. Some men have minimal or no symptoms at all. MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. Johns Hopkins Hospital Prostate Cancer - ProstateProHelp.com A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. Recently diagnosed a Gleason 3 + 3. Value of Second Opinion in Prostate Cancer Uncertain, Says - AJMC I followed up with the original pathologist to compare and he was more forthcoming. Benign prostatic tissue It is best to begin by talking with the doctor who made your initial prostate cancer diagnosis. Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. Get directions, important phone numbers, locations and more. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. A PSA test at time of biopsy revealed my PSA had risen to 6.5. No one at Hopkins has ever died of prostate cancer if he had Gleason 3 + 3 cancer." But I don't want to do a radical prostatectomy or radiation that would have large side effects now if the laser is a viable option given my data set. As a Gleason 3 + 3, with 8 of 12 positive cores all with less than 30% cancer, and bilateral spread, I have determined that I cannot trust a blind biopsy in and of itself. of tumor in the rectal prostatic angles. 5. Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? However, he also said it's treatable even at a 2cm size and the transition zone is a favorable spot. Unfortunately, the 12/20/20 PSA reading was higher and that led to an MRI on 2/2/21 when two lesions were discovered. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. According to the study, one in every 600 diagnoses showed mistakes.This study only addressed major changes in diagnoses, such as a diagnosis of cancer being reversed to no cancer, says Johns Hopkins pathologist George Netto, M.D. I am doing one in 6 weeks, regardless. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. fibromuscular stroma, anterior prostatic contour is smooth. The out-of-pocket cost may be in the $300 range (insurance may not cover it), and it is a simple matter to call your urologist to forward the slides to them. You can find out by reviewing your plan or by reaching out to your insurance company. Do I need a third opinion? Contact us or find a patient care location. When to move from Active Surveillance to Treatment for Prostate Cancer? 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. !I'll try editing a previous post and see if it reads like a journal instead of creating a new thread every update.I just got my PSA results and the numbers are still trending in the right direction. We will give that a shot and see how it turns out. Benign Processes: Also, if any of you have a way to get medicare to pay some portion of the cost, please let me know as well. 2. * Gleason Score: 4+5, Slide 4 (vs. Sloan's 3+4) A doctor may prescribe surgery or perform an endoscopic procedure. In the rare chance a baby needs highly specialized care, the team at Johns Hopkins is available to treat rare and complex conditions through breakthrough fetal procedures. Some men have minimal or no symptoms at all. * Other 12 slides not sent She put me in the hospital. -------------------------------------------------------- There were several areas of interest - but nothing in seminal vesicles, lymph, or bones. Jonathan Epstein, M.D. Especially opinions other than those of the first Urologist you see. I have requested a second pathologist's opinion from Johns Hopkins based on feedback from this forum. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Thank you! 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. There is no bony or bulky nodal disease in the pelvis Based on the results, our experts can provide you with an individualized treatment plan before you leave. 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. An accurate diagnosis is essential to ensure the most effective treatment. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. Prostate, right lateral base: 1. His most-frequently cited first or last authored publications is Pathological and Clinical Findings to Predict Tumor Extent of Nonpalpable Prostate Cancer, published in JAMA, which established the criteria for active surveillance. But I've had trouble getting Dr. Chang's office to provide any patient referrals. You're more likely to develop prostate cancers that are more likely to spread. 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. I worked out every day. I have been drinking out of an information fire hose. 53 years old An acute bacterial infection can cause a burning sensation. 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). The local pathologist read the biopsy and said 3+4=7 10% pattern 4 for both lesions. Here's what JH says (same lesion). Didn't know if she had the catheter in far enough and not getting any urine through itwondered if she had inflated the balloon enough and wondering if it was the reason that I have developed an abscess. 1. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. 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. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. Prostate cancer is a malignant (cancerous) tumor of the prostate, a gland found only in men. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. I'm 58 yrs old and had a TRUS random biopsy October 2020 after my PSA continually stayed between 4.4 and 8, and PHI score was 126. Prostate cancer is an The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. The linear amount of tissue with carcinoma is 23 mm Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. Im immediately referred to Urologist. A second opinion can help you make an informed, confident decision about your medical care. Find more COVID-19 testing locations on Maryland.gov. Instead, I did my homework. 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. 2017 May-Jun;30(3):298-307. doi: 10.3122/jabfm.2017.03.160359. 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. Spent the night in hospital with very little pain after the first couple of hrs. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. I applaud Dr Scholz for his dedication and explanation of such a complex cancer, that has not had his common sense help available for men with prostate cancer. He schedules appointments with a Radiologist and two local surgeons. International Patients: How to Request a Remote Second Opinion Natural history of progression after PSA elevation following radical HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. Lesion #1 (index): PI-RADS v2.1 score 4, lesion measuring 10 mm centered at the right mid/apex posteromedial peripheral zone; findings equivocal for extraprostatic extension; no evidence of seminal vesicle invasion; The low ADC value in this lesion increases the likelihood of Gleason grade group 2 or higher. radiation, active surveillance, surgery, hormone therapy, and more. Lymph nodes: There is no suspicious lymphadenopathy in the pelvis. undefined will no longer be visible to you including posts, replies, and photos. 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. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. Thanks! Second opinion Johns Hopkins? - Prostate cancer For a second opinion on the results of your prostate biopsy, there is no place better to get one than from the well known prostate pathologist, Dr. Jonathan Epstein at Johns Hopkins. 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. Greatest dimension 0.7cm . Johns Hopkins Prostate Cancer Second Opinion Of these, 40% obtained second opinions, most commonly because they wanted more information about their cancer (50.8%) and wanted to be seen by the best doctor (46.3%). 1. 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. So, Radiation Oncologist prescribed Cialis 5mg, daily. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night. Transition Zone: In the left base, mid and apical transition zone there is a large mass measuring 2 cm in size which has Sometimes, you may find out about treatment options you didnt know were available. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine.