I had a 3T mp MRI with coil bed, without and with contrast, at Emory on March 3. 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. That is literally the first time I heard that term other than seeing it in my pathology report. They find that one of my 5-10% Gleason 6 core is actually a 50% Gleason 7(3+4) and the MRI was so cloudy with blood from original biopsy they said they couldnt determine much. A 1.4 cm lesion in the left, apex, anterior transition zone demonstrates conflicting T2 and DWI characteristics for PI-RADS classification - an indeterminate lesion. Conflicting Prostate Biopsy OpinionsWhat to Do? Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. * Gleason Score: 3+4 (4 of 6 specimens), 14 specimens taken The lesion also shows focal increased permeability. 6. curing cancer, prostate cancer questions johns hopkins hospital, josef issels wikipedia, cancer a second opinion a look at book by josef issels, coping with metastatic cancer cancer net, pdf americans health priorities curing cancer and, what is immunotherapy cancer research institute cri, cancer a second opinion a . In some situations, insurers will even insist on a second opinion. I retested in January 2019 and scored 4.20. 1. I had a very bad experience with an incompetent nurse that did a catheter change. Dr. Jonathan Epstein of Johns Hopkins University Hospital. While I have three lesions, they are small and, without 3T mp MRI, might not have been discovered. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. My question is regarding the results of an MRI guided biopsy into a distinct tumor vs. subsequent Oncotype Dx Results. His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. However, older men 75 years were the least likely to report obtaining a second opinion due to dissatisfaction with their initial urologist. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. An acute bacterial infection can cause a burning sensation. 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. Bookshelf My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. 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. I have had a second opinion from Johns Hopkins that confirmed the initial pathology of gleason 3+4. Estimated prostate volume of 35 cc with an estimated PSA density of 0.11 ng/mL/cc. Receiving a second opinion was not associated with perceived quality of prostate cancer care. How to Get a Second Opinion Our team at Johns Hopkins has a dedicated service to interpretation of brain tumors and render second opinions on a daily basis. Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. Thank you for your understanding and cooperation. I talked with Dr. Epstein who expressed Johns Hopkins' conservative views to not underestimate GS 6 and to consider surgery and/or radiation that have been used successfully for many years in saving lives. Here are the details: Prostatic Adenocarcinoma 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. * Adjacent organ invasion: None. - High grade prostatic intraepithelial neoplasia (HGPIN) - DWI-ADC = 4/5 MRI RE-READ #2 (VERY VERY well respected radiologist): - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 2 of 2 cores (medial core: 3.5 mm, 30%; lateral core: 2.5 mm, 20%), 0.5 mm to the blue inked tissue edge (the closer) TZ zone more beneficial, but fairly large compared to whole gland and proximity to capsule edge would likely mean treatment would be suggested. Interesting differences: The results were ambiguous. MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. They did 9 patients in Phase I and there have been 12 so far in Phase II. * Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project SMIL radiologist reported nothing found. (PZ) - normal Five years ago I had a TURP. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. I am also not comfortable making a decision based upon 1 genomics test, when my other prior test(s) disagrees and the gleason score disagrees. Transurethral microwave thermotherapy : In selected patients, microwave energy helps to restructure prostate tissue and alleviate symptoms such as incontinence and voiding dysfunction, Laparoscopic prostatectomy: The prostate is removed with a miniature telescopic instrument, which allows for a quicker recovery, Robotic surgery: This breakthrough technology, which often is used for prostatectomy surgery, requires only a few small incisions. 4. A biopsy was performed on 2/26. I'm Gleason 3+4=7, and I believed only 2 cores tested positive. 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. Know Your Stage. Background: images and markedly reduced ADC. He basically said it was possible, but that he did not agree. 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. If pain is present, a digital rectal examination will reveal hard areas. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. Did robotic radical prostatectomy 1/25/12. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. Not all cancers are the same and not all treatment plans are absolutely clear. Surgery took about 3 hrs. Spent the night in hospital with very little pain after the first couple of hrs. Greatest dimension 2cm. - Benign prostatic tissue 3. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. An official website of the United States government. They basically said it didn't matter. It is not uncommon that two different pathologists looking at the same slide come to a different interpretation and opinion about what is in their microscope! Get directions, important phone numbers, locations and more. We provide second opinions on the full range of gynecologic cancers: Ovarian Uterine Cervical Vulvar Vaginal Fallopian tube Placental tumors Some peritoneal cancers Even at the age of 48, he thought I would be a good candidate for AS. Experts believe that this study is the first in history to have achieved such results. Six weeks later I have the biopsy in his office and a week later I get the results. So now things are getting exciting. So fingers crossed. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. transition zone. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasnt spread outside of the prostate. 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. 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. Caused me to bleed heavily. I've had what I would consider a fluctuating PSA since first tested in November 2018. 2. Netto says patients should be proactive in requesting that doctors take another look. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Benign Processes: We are vaccinating all eligible patients. 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. Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. Prostate cancer is the second-most diagnosed cancer in American men. 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. 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. The best protection for cancer patients who are Health Maintenance Organization members is to seek a second opinion even if she or he has to pay for it. This championship swimmer sought a second opinion at Johns Hopkins. C. Prostate, right apex, core biopsy: 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). 5. Conclusions: 2/13 PSA 5.2/fPSA 12.5% taken AFTER DRE (negative DRE) (lab #1) * Membranous urethral length: 1.2 cm A blocked urethra can also damage the kidneys. And just this week, 1 YEAR post treatment, it is .46. Treatment options include immunotherapy, PELVIC LYMPH NODES: No adenopathy. Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. Instead, I did my homework. 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. Also, a second opinion provides the opportunity to get information from someone other than the physician who will be directing treatment, which is usually the main source of information for most patients. This condition causes pain in the lower back and groin area, and may cause urinary retention. __________________________________________________________________________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. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. Four had 60-70%, five have between 5-10%. Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. My experience at Johns Hopkins was awesome. mail@prostateoncology.com, 7 Tips for Seeking Second Opinions For Men with Prostate Cancer. Can it be salvaged or are the risks of cancer too high? 3: Prostate, right medial apex They did another 3T-MPMRI (Siemens machine) and it showed a faint area, near the margin, and very close to the down stream sphincter of prostate. Careers. intricate disease and not all doctors have the same amount of experience My prior Prolaris study (2018) before the FLA was very low risk. I had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. 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. There is no bony or bulky nodal disease in the pelvis Assessment categories for this lesion: -------------------------------------------------------- And 2 cores from left apex of 3+3=6 with 10% involvement. Ask us questions on this webpage. 10. 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. - DCE = (+) Patients may experience a fever or chills as a result of the infection. An acute bacterial infection can cause a burning sensation. 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. He also said I would tolerate any option well based on my age and health. However, learning more about prostate cancer and prostate-related health issues can help optimize health. Most choose treatment they originally planned to follow, study finds. Prostatic Adenocarcinoma I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. BONES: No suspicious osseous All Gleason 6 (3+3). To schedule an in-person visit for a second opinion or to determine if a telemedicine consultation is possible, call: In addition to cancer, our urologic team provides second opinions regarding urinary stone disease, urinary tract reconstruction, incontinence, male infertility and sexual health, and many other urologic conditions or procedures. 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. 1. You think your doctor is underestimating how serious your cancer is. 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. 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." Now, I would like to send Radiology for a similar review. I was to follow up with my new Urologist (another surgeon) for 3 months PSA checks and annual 3T-MPMRI.My PSA checks were static and the next year's MRI looked just like the first. Epub 2018 Mar 28. Read books and realize as soon as they are published, they are outdated. 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. Best wishes to all those whose concerns for the day are far more serious than mine. 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". Diffuse probable benign peripheral zone changes limit evaluation for My Oncotype rating was GPS 54, with a 26% chance of metastisis within 10 years. TRANSPERINEAL MRI GUIDED BIOPSY RESULTS 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'm trying to figure out why the PSA keeps rising. About this time, I started reading this forum and my ignorance starts going away. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. 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. I appreciate any comments or insight that anyone wants to share. Grade Group: 1 I have been drinking out of an information fire hose. A. Prostate, right base, core biopsy: I am unfortunately "officially" joining the club after getting my biopsy results today. 2. 1. * PIRADS v2 Score: 5 3. Find more COVID-19 testing locations on Maryland.gov. 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. By Dec 2019, my PSA reached 4.13. A blocked urethra can also damage the kidneys. 2017 May-Jun;30(3):298-307. doi: 10.3122/jabfm.2017.03.160359. 3 months has passed, and its time for a PSA and a plan to have an MRI. There are lots of lessons learned on the forum. For this study, published in the journal Cancer, 2386 men in the greater Philadelphia area, who were diagnosed with prostate cancer between 2012 and 2014, responded to survey questions. Some men have minimal or no symptoms at all. It didnt look at changes of grading of the cancer.The chances for some type of modification based on a second opinion are even greater than the study indicated.Asking for a second opinion could lead to a significant change in surgical or medical intervention, Netto says.Even if the diagnosis error isnt catastrophic, such as advising a patient that he has cancer when he really doesnt, an error in grading can be consequential.
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