Prostate, left medial apex: My thoughts focus on the fact that I have a disabled son who needs my care. A blocked urethra can also damage the kidneys. 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion If the enlarged prostate is not completely removed, it will shrink. 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. In order to give treatment for each patient with utmost security we would like to announce that currently there will be no visitors allowed.Please note that only one attendant per in-patients is permitted. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). He wants me to begin the ADT around 5/1. 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. IMPRESSION: 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. Also these lesions did not abut or touch the wall of the prostate. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. 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. If youve received a new cancer diagnosis or arent seeing results from your current treatment plan, an expert second opinion can help you move forward with confidence. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. Sought Johns Hopkins second opinion of pathology slides. It also rules out Brachytherapy. The ADT has daunting side-effects but he said offers some improved chances of eradication, any long-term downsides that I should consider? Lesion 1: Left mid-base transition zone. J Am Board Fam Med. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. I recently sent my Pathology Slides to Dr. Epstein for a Second Review. Surgery took about 3 hrs. Enter the last name, specialty or keyword for your search below. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. Any input on this would really be appreciated. I had my first of those 2 PSA tests last week and it dropped to 4.77. Cancer patients are encouraged to obtain second opinions before starting treatment. Anyone with insight into this and advice? (The pathology report from Cedars-Sinai kept my diagnosis at 3+4, but a second opinion at Johns Hopkins upgraded me to 4+3.) After applying exclusion criteria, the final analytic cohort included 2365 respondents. 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. Anything I am overlooking or need to add to my list of considerations? The people were great. You may be concerned that the cancer will grow rapidly out of control before you are able to get a second opinion. 5/10 PSA 4.2/fPSA 9% taken at MSKCC (lab #3) 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. He schedules appointments with a Radiologist and two local surgeons. 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 . There are also many reasons why you may want to seek another opinion during the course of your cancer care. Who should I contact at Johns Hopkins to get a second opinion on a biopsy? I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. During puberty, the body produces semen in a large number of cases, including enlarged prostate. Get directions, important phone numbers, locations and more. Future study is needed to determine when second opinions contribute to increasing the value of cancer care. The average age at the time of prostate cancer diagnosis is about 66. radiation, active surveillance, surgery, hormone therapy, and more. 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. I have selected Focal Laser Ablation as my future (soon) treatment. * Perineural Invasion also detected Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions. I would love to hear from anyone who has been involved in the Chicago study. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. PROSTATE LESIONS: Unable to load your collection due to an error, Unable to load your delegates due to an error. As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. 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. * Extracapsular extension: Possible involvement of the anterior The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 2 of 2 cores (combined: 10.5 mm, 40%), 0.2 mm to the blue inked tissue edge Men have plenty of time to seek multiple opinions and thoroughly research each option before making a decision. It's really that simple! Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. Benign prostatic tissue 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. This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. Potentially inaccurate results can lead to selection of the wrong type of therapy. You May Like: Sbrt Radiation Therapy Prostate Cancer. 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. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. Three lesions: 1) GS 6 involving 30% of one core; 2) GS 6 involving less than 5% in one core; and 3) GS 6 involving less than 5% in another core. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. 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.). Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. Nov 7, 2016. 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 respondents were able to, MeSH Value of Second Opinion in Prostate Cancer Uncertain, Says Hopkins Study. 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. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Im also wondering why no one has scheduled me for MRI to see what biopsy missed. And thanks again for making this such a great support group! 9: Prostate, left anterior MRI lesion But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. You can find out by reviewing your plan or by reaching out to your insurance company. 8600 Rockville Pike Study after study confirms that doctors favor the treatment they are trained to do urologists typically recommend surgery and radiation oncologists recommend radiation. 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. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. F. Prostate, left apex, core biopsy: Younger men were more likely to cite wanting more information about their cancer and to see the best doctor as the reason to seek a second opinion . 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. Over 80,000 specimen cases are seen at Johns Hopkins each year. Our OB-GYNs, maternal-fetal medicine specialists, and pediatricians collaborate regularly with the Johns Hopkins team getting second opinions and access to hundreds of clinical trials. 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. Benign prostatic tissue (I think that it was easier to see because Mayo's MRI technology and procedures are better than SMIL's.) Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . Generally, the symptoms can stabilize over time. not hear all the viable treatment options or receive the most up to date Dont Miss: Can Prostate Problems Cause Burning Urination, Why Prostate Cancer Survivor John Shearron Thinks Its Important To Do Your Research | PCRI, Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference, Johns Hopkins Prostate Cancer Second Opinion, treat rare and complex conditions through breakthrough fetal procedures, Function Of The Prostate Gland And Seminal Vesicles, Best Treatment For Intermediate Prostate Cancer, How Old Can You Be To Get Prostate Cancer, New Treatments For Stage 4 Prostate Cancer, Prostate Radiation Treatment Side Effects, Can Prostate Problems Cause Burning Urination, Prostate Cancer Spread To Skull Prognosis, Life Expectancy Stage 4 Prostate Cancer No Treatment, Diagnostic Procedures For Prostate Cancer. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. Hi All, They are not objective. The purpose of starting this discussion is to gather peoples thoughts and opinions and actual experiences with Prostate Focal Laser Ablation. Extracapsular extension: The prostatic capsule is preserved. Thank you, After more than three years on active surveillance, I've pretty much decided to have focal brachytherapy for my prostate cancer. Who Should Request a Second Opinion? Race and ethnicity. I am relatively new to this forum and trying to educate myself as to my best course of treatment. Now the oncologist wants to perform a PSMA Pet Scan. Thank you for your understanding and cooperation. Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. 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. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . Thank you! If they do not cover this cost and you must pay out of pocket, keep in mind that a second opinion could save you from having to pay (financially and physically) for additional treatment down the line. Men need to be educated on all treatment options to protect themselves from a biased industry. A new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice among men diagnosed with low-risk prostate cancer. Does this also include HIFU, Cryoablation? My PSA over time has been creeping up over time (1.8 - 5/16, 1.0 8/17, 2.68 8/18, 2.9 12/18, 3.28 2/19, 3.01 8/19, 3.65 2/20, 3.31 6/20, 3.88 12/20) but I was frankly a bit shocked when I received word that I have cancer. Every year I got a PSA and DRE during my annual physical. And if so, what does being accepted in a AS program look like, do I need to be present at their location? Symptoms include leaking and discomfort. I luckily found this webpage and I started reading everything I could get my hands on. Not all cancers are the same and not all treatment plans are absolutely clear. Metastatic disease considered less likely for this pattern. Grade Group: 1 - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length 5: Prostate, left medial apex The biopsy took 3 samples from the targeted region plus 16 sextant. - Johns Hopkins Medicine -- Get a Second Opinion )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. BJU Int. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. Dr. Jonathan Epstein of Johns Hopkins University Hospital. My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. The results of Oncotype came back and it was a bad report. Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. Just had my appointment today and they are pleased with the results, so far. He never sought treatment for the injury. 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, Also Check: How Old Can You Be To Get Prostate Cancer.