Both Drs and nurses knew what they were doing and had lots of experience. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. Benign prostatic tissue Before 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. A enlarged prostate can also cause blockages in the urethra. 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! Dont Miss: New Treatments For Stage 4 Prostate Cancer. 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. Many researchers believe PTEN present is a strong brake on 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. 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. I appreciate any comments or insight that anyone wants to share. 3. In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could . You think another treatment might be available. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. He basically said it was possible, but that he did not agree. I also had my PTEN test by META-MARK ( I don't have much to say about how I was treated by MM, but I won't be using their services again). Had a little complication a day after release, excessive blood/clots in urine. - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. 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. 3+4, 4+3, 4+3, 4+5 (1st read)Both docs are recommending surgery.PSMA CT Scan report:"BONES/BONE MARROW: There are sclerotic changes in the right pubic bone adjacent to the symphysis pubis and to lesser extent in the left pubic bone. Because I had an implant in my ear, they would only give me a 1.5T MRI. It is OK to not understand all the terminology. 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 wants me to begin the ADT around 5/1. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Grade Group: 2 Low post-void residual volume is I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. With that alone, I would likely be a candidate for continued Active Surveillance. Am I wrong? I have developed an "abscess" on my prostate. Johns Hopkins Medical Laboratories 1620 McElderry St. Reed Hall Rm 315 Baltimore, MD 21205 Fax (410) 614-7712 Phone (410) 955-2405 8 am - 5 pm Normal LAB hours are: 5:30 am - 4:30 pm Mon-Fri PCPs can be a great help to navigate the medical marketplace and provide an unbiased voice of reason when it comes to making hard choices. Pathology report indicated additional presence of cells at right apex, but unclear whether intraprostatic incision or extraprostatic extension. 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. Expert review of your case by a Cleveland Clinic specialist. You think your doctor is underestimating how serious your cancer is. Last checkup (July 2022) my PSA was .46 and it is currently at .32.I am still eating primarily a plant based diet (only lean meats/cheeses/eggs about 10% of my diet) and maintaining steady weight and I am still quite active physically.As for symptomswith 5mg Daily Cialis the occasional ED symptoms have pretty much gone away. Further, the two tumors in question have not really changed much in size for more than 2 years. Dont Miss: Screening For Prostate Cancer Icd 10. Luckily, his report co-coincided with the original QDx report. Prostate volume: 17.58 cc By basing a treatment I worked out every day. 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. And it is OK to have paralysis by over-analysis. Epub 2010 Oct 20. poorly defined margins and intermediate to low T2. * Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project 6: Prostate, left medial base Johns Hopkins is home to many of the world's leaders in Pathology. Note respondents were able to, MeSH I have actually had a second opinion a while back from Dr. Bush. * Size: 1.5 cm Your doctor is not sure what is wrong with you. Thanks for Everyone's Help, Also, infection was noted, so the current PSA is high in part due to prostatitis. No extraprostatic extension. Men need to be educated on all treatment options to protect themselves from a biased industry. The primary goal is to be cured with the least toxic, most effective approach. Dont Miss: Is Coffee Bad For Your Prostate. Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. At the Breast Cancer Program at the Johns Hopkins Kimmel Cancer Center in Baltimore, MD, a second opinion requires only that you or your doctor send us your pathology slides, key medical records and signed paperwork requesting the opinion. decision on a single medical opinion or the first appointment you get, you may 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. Who should I contact at Johns Hopkins to get a second opinion on a biopsy? 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. This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. You may also complete an online appointment request form and we'll respond to schedule an appointment. Those readings were reported on a second opinion by Dr. Epstein. 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. I did genetic testing and there were no mutations of concern, and everyone agreed that there probably wasn't "enough meat on the bone" to get a good genomic test from the biopsy.After seeing Dr Joe Busch, he said he didn't see any target lesions (PIRADS2), nor did he think I was in any danger. No extraprostatic extension. I would love to hear from anyone who has been involved in the Chicago study. Last year, Epstein's lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions. That's the good news. Just took time off and then life happened.Thanks in advance for the insights. restricted diffusion. -------------------------------------------------------- Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. I am doing one in 6 weeks, regardless. The TRUS biopsy is behind me, the second opinion from Johns Hopkins is behind me, and its time for next steps. My mind goes all over the place as to why this is. You can call and speak with his assistant at: (410) 614-6330. I still have some urgency and frequency issues, but I am not complaining too bad. 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. Keywords: Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. I didn't study for the test and it's possible some morning activities might have affected my test score :) Anything I am overlooking or need to add to my list of considerations? Netto says patients should be proactive in requesting that doctors take another look. My strong preference would be to do FLA again and monitor. How much is the fee for an opinion of my recent MRI? Second Opinions & Consultations - Johns Hopkins Pathology First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. 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.). 2. PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Considering Prostate Cancer Clinical Trials? Younger men also sought the 'best' doctor. A second opinion is a review of the cancer diagnosis and the treatment recommendations of the physician who is treating the cancer by another, independent physician. Get a Second Opinion | Johns Hopkins Pathology Benign Processes: I had a telemed session with Dr. Chang, and it sounds like a pretty simple procedure, with urinary side effects that resolve pretty quickly. This is why the prostate is important to the body. 8. I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. Anyway, would appreciate knowing how to contact Johns Hopkins. Other labs for second . Prostate cancer is the second-most diagnosed cancer in American men. 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). The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. Second Opinions in Prostate Cancer - American Council on Science and Health A PSA test at time of biopsy revealed my PSA had risen to 6.5. Identified an approximate 2 cm lesion of mostly Gleason 7 (3+4) with only 20% being 4, contained in prostate. He said that JHs said that it was 2 cores, but it was actually a fragmented core, that the fat did not present on the right place on the slide, that prior FLA (partial hemi-ablation) could affect the results, the MRI did not support, etc. Thank you, After more than three years on active surveillance, I've pretty much decided to have focal brachytherapy for my 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. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. Consult Fees In some cases, additional testing may be required. Bethesda, MD 20894, Web Policies This site needs JavaScript to work properly. Now its easier than ever to get the answers you need and peace of mind you deserve. Seminal vesicles and other margins are negative for tumor. The only prescriptions I take are for GERD (Protonix), cholesterol (Atvorstatin), and allopurinol for an episode of gout that I got while doing physical rehab for a bad tibia break (I shattered my tibia plateau 2/2020 and have pretty much recovered). Call us with any questions: 410-955-2405, ext. 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. In severe cases, a catheter may be required to relieve the symptoms. Find more COVID-19 testing locations on Maryland.gov. - Benign prostatic tissue Masks are required inside all of our care facilities. Overall, nearly 80% of men received definitive treatment 76.5% of men who obtained a second opinion from a urologist received definitive treatment compared to 81.6% who did not . Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Prostate Cancer | Johns Hopkins Medicine About this time, I started reading this forum and my ignorance starts going away. A doctor may prescribe surgery or perform an endoscopic procedure. TZ zone more beneficial, but fairly large compared to whole gland and proximity to capsule edge would likely mean treatment would be suggested. Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. I guess TWO national centers of excellence are better than one? In 2006 my PSA was .6. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Benign Processes: It works. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. A fusion biopsy was performed in late May and I just received those results last Thursday. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. 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. Secondary Gleason grade: 3 4. It is OK to be overwhelmed with info. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. It would be more convenient to use Mayo but I want the best practitioner regardless. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. The issues in my prostate from the first procedure onward have all been in the same area and the rest of my prostate from the first biopsy and subsequent MRIs onward have never shown any indications of cancer in other areas. Value of Second Opinion in Prostate Cancer Uncertain, Says - AJMC Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. A report with the diagnosis will be faxed to your doctor. Treatment Advice: Sloans radiation oncologist says radiation treatment will likely be the same whichever pathologist report prevails, but may add hormone therapy for about 2 months. And 2 cores from left apex of 3+3=6 with 10% involvement. The total number of cores with carcinoma is 3 Other: There is trace ascites in the mesosigmoid. Tumor Quantifications: -------------------------------------------------------- FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. 7: Prostate, left lateral apex Specimens Submitted: Greetings gentlemen! I did genetic testing and there were no mutations of concern, and everyone agreed that there probably wasn't "enough meat on the bone" to get a good genomic test from the biopsy.After seeing Dr Joe Busch, he said he didn't see any target lesions (PIRADS2), nor did he think I was in any danger. Reasons for obtaining a second opinion from urologists. 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%). Pathology reports are subjective. Its in your best interest to ask for another look at a cancer diagnosisIf youve recently been diagnosed with cancer, its wise to ask for a second opinion on your pathology specimen.Johns Hopkins researchers with the Urological Pathology Consult Division, led by Jonathan Epstein, M.D., first reported on biopsy errors a decade ago, when they found a margin of error in prostate cancer diagnoses large enough to give them pause. Benign prostatic tissue It was easy. 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. According to The National Institute on Aging, prostate problems are common after age 50. If pain is present, a digital rectal examination will reveal hard areas. Prostatic Adenocarcinoma The average age at the time of prostate cancer diagnosis is about 66. Now, I would like to send Radiology for a similar review. Over 80,000 specimen cases are seen at Johns Hopkins each year. doi: 10.1136/bmjopen-2020-044033. It works. Some men may have an enlarged prostate but not notice it. Dont Miss: Bladder Control After Prostate Surgery. 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. Not all men with Gleason 8-10 disease are going to do badly after Studies show the clinical and financial benefits of obtaining a pathology second opinion. My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. B. Prostate, right mid, core biopsy: The results seemed fairly benign and my urologist and I decided to continue to monitor with 2 more PSA tests and then consider an MRI in April 2021. 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.
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