- 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) They hesitated calling it a TARGET LESION, but scored it PIRADS 4. 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. J Am Board Fam Med. Surgical Delay and Pathological Outcomes for Clinically Localized High-Risk Prostate Cancer. I am relatively new to this forum and trying to educate myself as to my best course of treatment. 3. Seek Perspective from a Range of Specialists. Find more COVID-19 testing locations on Maryland.gov. However, learning more about prostate cancer and prostate-related health issues can help optimize health. His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. The people were great. * Prostate volume: 22 cc 4. Dr. Albert Chang at UCLA appears to be the best in the biz for high dose rate (HDR) focal brachytherapy. 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. PSA: 4.7 ng/ml/PSA density: 0.27 ng/ml2 * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? The purpose of starting this discussion is to gather peoples thoughts and opinions and actual experiences with Prostate Focal Laser Ablation. There are also some cases of the test showing no depletion but being wrong. Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. 1st opinion"Nonspecific sclerotic change of the right pubic bone with low-level radiotracer activity, favor degenerative change rather than osseous metastasis." Some men have minimal or no symptoms at all. An official website of the United States government. very activerun/cycle 6 days a week But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). I luckily found this webpage and I started reading everything I could get my hands on. During puberty, the body produces semen in a large number of cases, including enlarged prostate. You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. Seminal vesicles are normal. The lesion also shows focal increased permeability. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Obtaining a second opinion on your pathology report is no different than getting a second doctors opinion, it is a must for all of us. MY THOUGHTS AND ANYTHING DOCTOR NOTED: Radhakrishnan A, Grande D, Mitra N, Pollack CE. I've been on AS since April 2016. Whats right for you will depend on the stage of the cancer, your level of risk and your general overall health. doi: 10.1002/cncr.30412. So, Radiation Oncologist prescribed Cialis 5mg, daily. 9: Prostate, left anterior MRI lesion 4. 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. and I have already proven to myself that my body is good at cell mutation, so I wanted to be careful.At the 3 year mark (6 months after last MRI), my PSA spiked to > 6. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Bethesda, MD 20894, Web Policies However, older men 75 years were the least likely to report obtaining a second opinion due to dissatisfaction with their initial urologist. Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? At that point I agreed to the TRUS biopsy which I had on October 10, 2020. My PSA went up from 3.5 post FLA (It was 7.2 pre-procedure) to 6.7 in 2021, so I went to another radiologist to do an MRI guided biopsy of the suspected area that was near the prior ablation zone. Thank you for your participation! A second review of Pathology more frequently also brings changes to the cancer grade or stage, which can affect prognosis as well as therapy. * PIRADS v2 Score: 3 Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. I suggest for all that hear, "you have cancer" that you seek more opinions! 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. (PZ) - normal This doctor or team of doctors will review the following: The doctor then communicate their opinion regarding treatment to both the patient and the primary physician. Prostate, right lateral apex: Johns Hopkins is home to many of the world's leaders in Pathology. All Gleason 6 (3+3). Reasons for obtaining a second opinion from urologists. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. 3. These results, if validated in other studies, justify additional investigation on how second opinions can contribute to increasing the value of cancer care, the authors concluded. Breast Cancer: When to Get a Second Opinion - WebMD 1. has now confirmed this assumption through a careful retrospective analysis of data from > 450 men whose records could be identified in the SEARCH database, all of whom received surgical treatment for Gleason 8 to 10 prostate cancer. Symptoms include leaking and discomfort. Find more COVID-19 testing locations on Maryland.gov. An accurate diagnosis is essential to ensure the most effective treatment. Who Should Request a Second Opinion? I just turned 71 in February. 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. 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. We have a surgery date set up for the end of July at Johns Hopkins (our second opinion team).His stats:63yo, non smoker, 167lbs, Vegetarian/Vegan diet no other known health issuesWalks dogs for a living and cares for our small farmPSA 3.3 (Jumped from 1.6 in a year)Biopsy Scores 3+5, 4+3. My involvement is below maximum of 15% of core. Anyone with insight into this and advice? 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. Cleveland Clinics Virtual Second Opinions program connects you to an expert physician who specializes in your specific health needs. My profession for forty years was health actuary consultant, so I have a pretty fair understanding of health data, outcomes, and risks. I recently sent my Pathology Slides to Dr. Epstein for a Second Review. They did 9 patients in Phase I and there have been 12 so far in Phase II. !I've pasted a previous update below for background.I just got my PSA results and the numbers are still trending in the right direction. (I think that it was easier to see because Mayo's MRI technology and procedures are better than SMIL's.) Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. 1. Either the patient or the primary physician can initiate the process of getting a second opinion. Who should I contact at Johns Hopkins to get a second opinion on a biopsy? Hi All, This teamwork ensures the best possible patient outcomes. fibromuscular stroma, anterior prostatic contour is smooth. After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. At this time, I am leaning towards Active Surveillance or FLA. AS would be my choice, except that a total of three lesions, on both sides of Peripheral Zone, makes this controversial. Prostate cancer is a slow growing condition. I had my first of those 2 PSA tests last week and it dropped to 4.77. Two weeks later I meet with my Johns Hopkins Dr. You can call and speak with his assistant at: (410) 614-6330. 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. of tumor in the rectal prostatic angles. Benign prostatic tissue 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. At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Prostate Cancer Treatment: What to Know About Active Surveillance. Over 80,000 specimen cases are seen at Johns Hopkins each year. And just this week, 1 YEAR post treatment, it is .46. Heres What You Need to Know, Prostate Cancer Spotlights in 2020: A Year in Review, Find out about PSMA PET Imaging on Prostate Pros Podcast. JHs just said it was minimal less than 5%. What are your opinions of what that is, and where to get it? Keywords: * Adjacent organ invasion: None. According to the doctor it is around 3 mm. These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. Second opinions not likely to change prostate cancer treatment 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. Masks are required inside all of our care facilities. Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. I have selected Focal Laser Ablation as my future (soon) treatment. 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. This condition causes pain in the lower back and groin area, and may cause urinary retention. 3T MRI with coil is done initially, along with a TRUS biopsy. * Extracapsular extension: Possible involvement of the anterior The symptoms of acute bacterial prostatitis are similar to those of CPPS. But I've had trouble getting Dr. Chang's office to provide any patient referrals. Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. - Perineural invasion is present It got discussions started and questions answered. This is often the case when the primary physician advises an expensive treatment. Biopsy Results: What Do They Mean? - Prostate Cancer Foundation I had a follow up 3T MRI guided biopsy on March 18 at Emory. 4. More medical freakouts. We are vaccinating all eligible patients. The majority had lower risk tumors and clinical staging of 1 40% sought second opinions with about half having more than one reason Men seeking second opinions tended to be younger and better educated citing the need for more information as their reason. Without the genomic test I have I lesion 3+3=6 and another, 3+4=7, with less than 5% pattern 4, and an MRI that shows no ECE, no other suspicious lesions and questionable cellular EPE based upon disagreement of pathologists. Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. They confirm everything except question whether one of the core samples is a 3+3 or 3+ 4. It also rules out Brachytherapy. A report with the diagnosis will be faxed to your doctor. I'd like to talk with former patients who have gone through the procedure. Hello. 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. MRI June 2017 again at SMIL. 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. Maybe lycopene and pomegranate have helped. Men who sought second opinions because they were dissatisfied with their initial urologist were 51 percent less likely to receive definitive treatment, and men who wanted more information about treatment were 30 percent less likely to report excellent quality of cancer care compared with men who did not receive a second opinion. Disclaimer. I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. Some men may have an enlarged prostate but not notice it. Ask your doctor for a copy of your complete medical record. You're at greater risk if you're Black or of African ancestry. mail@prostateoncology.com, 7 Tips for Seeking Second Opinions For Men with Prostate Cancer. 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. I had a very bad experience with an incompetent nurse that did a catheter change. Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. I did a book review with his first book for several veterans groups including the Americal Division Veterans Organization which with I served at age 19. Nov 7, 2016. U.S. News & World Report ranked the institute #7in the country. MM, Much to my dismay my 4th targeted biopsy Oct 12 revealed 5% G4 (upgraded from Grade Group 1 to 2 (Gleason 3+4 intermediate/favorable). Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. If pain is present, a digital rectal examination will reveal hard areas. Benign Processes: Keep in mind that not all PCPs are knowledgeable about prostate cancer or know the skill levels of all the specialists in the field. Especially opinions other than those of the first Urologist you see. My Oncotype rating was GPS 54, with a 26% chance of metastisis within 10 years. In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? 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.