But in the spirit of disclosure for those of you with BPH a TURP can complicate a future Radical Prostatectomy (or possibly Cryo) and increase the risk of side effect risks. Masks are required inside all of our care facilities. 2nd opinionBone Scan:"Mild increased activity is seen in the right symphysis corresponding to the abnormalities on the prior PET/CT examination. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) My strong preference would be to do FLA again and monitor. 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. Extraprostatic extension: negative (I must say that those low numbers concern me a bit.) I personally have benefitted from second opinions on my so-called cancer journey. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of Keywords: Johns Hopkins is home to many of the world's leaders in Pathology. I have actually had a second opinion a while back from Dr. Bush. of tumor in the rectal prostatic angles. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). Thank you for your understanding and cooperation. Caused me to bleed heavily. Are you sure you want to block this member? Has anyone sent Radiology (mpMRI) reports and images to Hopkins for Second Opinion Review? Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. 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. OTHER: None. That being said, they can be a beneficial member of the treatment team. - PI-RADS for this lesion = 4/5 Also these lesions did not abut or touch the wall of the prostate. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. * Asked and Dr. said he isn't overly concerned about perineural finding with the grade and it won't impact treatment options or overall prognosis. Blessings. My question is--what importance do volume levels play in determining when to move from AS to treatment? However, just to be safe she schedules me for TRUS biopsy with the Urologist in another 6 weeks. * Perineural Invasion also detected 1. Prostate cancer is the second-most diagnosed cancer in American men. 1st opinion"Nonspecific sclerotic change of the right pubic bone with low-level radiotracer activity, favor degenerative change rather than osseous metastasis." Epub 2017 Jun 12. 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. This teamwork ensures the best possible patient outcomes. PSA had increased to 5.4. I appreciate all the input because I am a little overwhelmed and confused as to the best course of treatment. Negative cancer in lymph nodes, seminal vesicles, and all margins. Benign Processes: At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). 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. peripheral zone signal intensity on T2-weighted images. He was right. - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. I certainly would - after all, there's a certain brotherhood bond here. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. 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. 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. I was confident I was making the right decision. The prostates function is to create some of the fluid that insulates sperm cells found in semen. Discover what's to love about Charm City for yourself. Read books and realize as soon as they are published, they are outdated. I have selected Focal Laser Ablation as my future (soon) treatment. 1. Dont Miss: Bladder Control After Prostate Surgery. The site is secure. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. And when I attempt to ask questions about intradcutal, I get responses about how little is known about it because it's so rare or that it is controversial or that they're not familiar with the study I'm referencing. Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. 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. Second opinion Biopsy came after FLA G-9. This championship swimmer sought a second opinion at Johns Hopkins. I frequently make a 2 hour car ride and I have to stop about 25% of the time and when I don't, the urgency is a bit more evident and with the urgency come some hesitancy, but not terrible. Have a condition that isnt improving or is getting worse, despite treatment. Cancer patients are encouraged to obtain second opinions before starting treatment. * Size: 1.1 cm I've had what I would consider a fluctuating PSA since first tested in November 2018. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Cancer. Read Also: What Are The Signs Of Prostate Infection. It also rules out Brachytherapy. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. Some men may have an enlarged prostate but not notice it. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) Lesion 1: Left mid-base transition zone. 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. Only one core was diagnosed with a small amount of 3+3 (it was one of the three targeted cores). 5. Oncologist. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. 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. - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length The more often a doctor diagnoses and treats prostate cancer the more proficient they become. During the next 4 weeks I meet with the recommended Radiologist, and the two local surgeons. Benign Processes: Is it done through my doctor or do I do it myself with sending CDs of the MRI? From what I've learned from Dr. Scholz videos at PCRI, and from posts on this site it would lead me to believe the DX test is fairly common knowledge. - Perineural invasion is present - High grade prostatic intraepithelial neoplasia (HGPIN) I worked out every day. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Targeted MR/Fusion biopsy of one 4x8 mm lesion on Right side showed 3+3 in 2 of 5 cores (20% of total volume), and random Right side: 1 core 3+4 (10%, 20% on second opinion from Johns Hopkins) and 1 core 3+3 (10% volume) ; Left Side 1 core 3+3 (10%, no PCa on second opinion from Johns Hopkins). An acute bacterial infection can cause a burning sensation. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. A newly published paper by Fischer et al. B. Prostate, right mid, core biopsy: I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. My thoughts focus on the fact that I have a disabled son who needs my care. ZERO - The End of Prostate Cancer Support Community. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. You can find out by reviewing your plan or by reaching out to your insurance company. 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. * Membranous urethral length: 1.2 cm Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. Want confirmation about a diagnosis or treatment. If a targeted biopsy is planned, this lesion can be sampled at the same time. 2/23 PSA 4.7/fPSA 12% taken for 4K score (lab #2) He wants me to begin the ADT around 5/1. The total number of cores identified is 3 Shore ND, Karsh L, Gomella LG, Keane TE, Concepcion RS, Crawford ED. Visit and Like ZERO - The End of Prostate Cancer on Facebook, Sign up to receive emails and news from ZERO - The End of Prostate Cancer, Search prostate cancer clinical trials and studies. Out of 12 cores, 9 are positive. 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. I had two no-risk, non-invasive tests: a Free PSA with an adverse score of 9% and a PCA3 test with a disappointing 41. 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. 10: Prostate, right anterior MRI lesion Then about a month later I started 28 fractions of Proton Radiation.It was painless. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. Accessibility 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. Anyone else encounter something like this? 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. intricate disease and not all doctors have the same amount of experience Most reputable HMOs can, however, deliver state of the art treatment for most cancers. The .gov means its official. 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. Lesion 2: Right mid anterior transition zone. His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. 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: 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. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. Seminal vesicles and other margins are negative for tumor. 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. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . C. Prostate, right apex, core biopsy: He basically said it was possible, but that he did not agree. - Perineural invasion is present Careers. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. On the first scan (post FLA) a lesion was identified by the local radiologist that performed the scan, but the FLA radiologist that performed my procedure was over reading and monitoring my care and stated strongly that there was no cancer. 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. Youve just been diagnosed with prostate cancer. Diffuse probable benign peripheral zone changes limit evaluation for Identified an approximate 2 cm lesion of mostly Gleason 7 (3+4) with only 20% being 4, contained in prostate. * PIRADS v2 Score: 5 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. Consultation with your nurse care manager. (PZ) - normal If pain is present, a digital rectal examination will reveal hard areas. Y'all are in my prayers! Slight BPH findings. Also Check: Prostate Cancer Stage 7 Treatment. 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. 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. 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. Diffusely decreased I really just want the results of their innovative PTEN test. Find more COVID-19 testing locations on Maryland.gov. A doctor may prescribe surgery or perform an endoscopic procedure. Had a little complication a day after release, excessive blood/clots in urine. Hillen MA, Medendorp NM, Daams JG, Smets EMA. 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. The people were great. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? 5: Prostate, left medial apex I suggest for all that hear, "you have cancer" that you seek more opinions! Tumor Quantifications: Dr. Jonathan Epstein of Johns Hopkins University Hospital. Netto says patients should be proactive in requesting that doctors take another look. 3T MRI with coil is done initially, along with a TRUS biopsy. 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. And thanks again for making this such a great support group! 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. My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. In some situations, insurers will even insist on a second opinion. ORIGINAL MRI REPORT (local radiology group): Benign Processes: The symptoms of acute bacterial prostatitis are similar to those of CPPS. 8: Prostate, left lateral base The neurovascular bundles are intact. It's really that simple! First 6 week PSA is undetectable. This has raised some questions on all the scans so far. -------------------------------------------------------- Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). This is why the prostate is important to the body. Secondary Gleason grade: 3 No extraprostatic extension. Dr stated that after seeing my muscles on the inside during operation he would have predicted this. But I've had trouble getting Dr. Chang's office to provide any patient referrals. 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. 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. A man with a father or brother who had prostate cancer is twice as likely to develop the disease. 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. There are also many reasons why you may want to seek another opinion during the course of your cancer care. If I am rested, I find that I am more ready than if I am not. 3. Comments appreciated, decision on a single medical opinion or the first appointment you get, you may No extraprostatic extension. 6. Urology. It starts many years ago. I have searched the country for intervential radiologist that perform FLA on the prostate. 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. Low volume post-void residual urine is present in the bladder. Call us with any questions: 410-955-2405, ext. But if I include the 3+3=6 cores then 4 cores tested positive and that moves me into the basic teal category and no longer a strong candidate for AS. Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. Just got my pathology results. 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. fedex supply chain warehouse, wellington balloon festival, rise of the black pharaohs transcript,

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