Tumor Quantifications: Patients are often under the mistaken notion that they have to pick between their oncologist and MSK, but thats often not the case, Dr. Matasar explains. Jonathan Epstein, MD received his doctorate from Boston University. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. However, that information will still be included in details such as numbers of replies. Identified an approximate 2 cm lesion of mostly Gleason 7 (3+4) with only 20% being 4, contained in prostate. It's really that simple! Thanks for Everyone's Help, Would it be rational to stay on AS until biopsy results show a higher volume of PCa for sampled cores (i.e. Ask us questions on this webpage. If a targeted biopsy is planned, this lesion can be sampled at the same time. In the mean time my PSA was movingno longer static, but never back up to 6. And in some cases, the information you gain during a second opinion consultation can even change your diagnosis. So I initially thought this makes me a good candidate for AS. - DCE = (+) Some of the more common treatments that you and your doctor may discuss include: Prostate cancer experts at the Brady Urological Institute have created tools that help patients and doctors across the world assess risk and make treatment decisions. He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. * Perineural Invasion detected I still have some urgency and frequency issues, but I am not complaining too bad. We specialize in minimally invasive treatments for prostate cancer such as: We place a high priority on sparing the nerves and tissue around the prostate whenever possible. Dr stated that after seeing my muscles on the inside during operation he would have predicted this. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. 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. 5. Little is known about men with localized prostate cancer who seek second opinions, the reasons why, and the association with treatment and quality of care. Brief MRI history. * Both Sloan and Johns Hopkins admit that large discrepancies are unusual, yet both stand by their opinions. This is not true. I did ask some questions about the study, if anyone is interested. While I have three lesions, they are small and, without 3T mp MRI, might not have been discovered. More medical freakouts. The margin of error is 1.4 percent, which is equivalent to 30,000 cancer diagnosis mistakes annually in the U.S. Of 6,171 biopsy slides sent since late 2008 for a second review at Johns Hopkins, pathologists disagreed with the diagnosis on 86 of them. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. More medical freakouts. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. Prostate, right medial apex: Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. Have been told a health condition is not treatable. Reinterpretation of imaging scans and lab tests. If they have an enlarged colon, their physician can perform a TURP procedure. I've had what I would consider a fluctuating PSA since first tested in November 2018. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. MRI RE-READ #3 (National Cancer Center of Excellence): If they have an enlarged colon, their physician can perform a TURP procedure. The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Precision Medicine Center of Excellence for Prostate Cancer, robotic-assisted radical laparoscopic prostatectomies, The Brady Urological Institute and the Johns Hopkins Kimmel Cancer Center take a, Our urologic surgeons have extensive experience performing, Our surgeons, oncologists and radiologists are also world leaders in prostate cancer research, giving patients access to the latest discoveries and. 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. All wanted to do what they do, schedule treatment which at this time is only Gleason 6 which I now know is not life threating. Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. 1. 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've tried to find out about Dr. Wong but there's very little info on him. 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. -------------------------------------------------------- This championship swimmer sought a second opinion at Johns Hopkins. * Size: 1.1 cm I am unfortunately "officially" joining the club after getting my biopsy results today. They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. Benign Processes: Only one core was diagnosed with a small amount of 3+3 (it was one of the three targeted cores). 2. !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. 2: Prostate, right lateral base Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. Sought Johns Hopkins second opinion of pathology slides. Find more COVID-19 testing locations on Maryland.gov. intricate disease and not all doctors have the same amount of experience Question anemia. No definitive evidence of distant metastatic disease is seen." They are not objective. 53 years old Dr also stated he was able to totally spare one of my nerves, but to get margin may have damaged one. * Gleason Score: 3+4 (4 of 6 specimens), 14 specimens taken I had a very bad experience with an incompetent nurse that did a catheter change. After applying exclusion criteria, the final analytic cohort included 2365 respondents. To learn more about how to get a Neuropathology second opinion, please visit our Neuropathology Division second opinions website. 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. Background: 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 results of Oncotype came back and it was a bad report. I'm currently in the process of getting an appointment set up with a Dr. Wang at UCLA. My prior Prolaris study (2018) before the FLA was very low risk. One of the problems with second opinions is that insurers may not cover the expense. Also, infection was noted, so the current PSA is high in part due to prostatitis. 1. During your visit, our specialists will review your medical records, diagnostic tests and other information provided by you or your current physician. Thank you for your participation! I'm turning 58 in one week. 2. Even if I go the radiation route, should I try for Proton radiation or some other type? Have you heard of PRECISE follow up score for an MRI? If anyone has used him, please let me know what your experience was like. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. Enter the last name, specialty or keyword for your search below. However, a new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice or the persons perception of the quality of care they receive, at least among low-risk men. I made the appointments. 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. The total number of cores with carcinoma is 3 3. Just took time off and then life happened.Thanks in advance for the insights. I am also doing a vegan diet with additional complementary substances. The primary goal is to be cured with the least toxic, most effective approach. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. Younger men also sought the 'best' doctor. The total number of cores identified is 3 I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? 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. FOIA Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. Benign prostatic tissue 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. When I inquired with the oncologist that I had selected for my therapy before receiving the second opinion whether I would be a candidate for Active Surveillance considering the downgrading, she said 'no' due to the intraductal component. Our regional community network integrates academic specialty cancer care at Allegheny General Hospital and West Penn Hospital and at more than 20 community cancer centers throughout the region. Urology. I am already positively surprised that I am still alive 4.5 years after my diagnosis. The researchers did not include more minor errors in rating how fast-growing and how advanced a cancer was. How long do you have left? 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. 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. Either the patient or the primary physician can initiate the process of getting a second opinion. * Gleason Score: 4+5, Slide 4 (vs. Sloan's 3+4) 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. Left mid-base transition zone (PIRADS 5). My thoughts focus on the fact that I have a disabled son who needs my care. Benign Processes: In severe cases, a catheter may be required to relieve the symptoms. Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results. We are vaccinating all eligible patients. Some specialize in reading only slides that come from a specific organ while others are generalists who read many different pathology slides from many different organ systems. They basically said it didn't matter. 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. Some men have minimal or no symptoms at all. * Extracapsular extension: None. During puberty, the body produces semen in a large number of cases, including enlarged prostate. Knowing your stage and information specific to that stage makes you more medically sophisticated and enables you to navigate through the potential biases of surgeons and radiation therapists. We will give that a shot and see how it turns out. Hello everyone. Check Biopsy and Imaging Results for Accuracy. 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. Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. No two cases of prostate cancer are alike and an accurate diagnosisis critical to developing the best treatment plan. When people recommend going to a Center of Excellence, believe them. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Your email address will not be published. LESION 1 Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. This puts PCPs in a unique position to impact the treatment decisionif they only refer to urologists and not to radiation oncologists or medical oncologistssurgery is a likely treatment outcome. Expert review of your case by a Cleveland Clinic specialist. 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. At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). 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. 5. The study was published online Nov. 7 in the journal Cancer. Prostate, right medial base: I am also talking with Dr Nour and Dr. Walser and possibly others to see if I am a good candidate for Focal Laser Ablation. Prostate, right lateral apex: Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. We have sought a second opinion and all tests are being reviewed by that second team.My question has to do with the symphysis pubis. Spent the night in hospital with very little pain after the first couple of hrs. But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). Cancer vaccines.For a long time, the promise of cancer vaccines that would protect healthy people at high risk of cancer has only dangled in front of researchers. I now have my list whittled down to 3. This suggests that for some men, second opinions offer a way to pursue the treatment they already planned on, rather than to explore other treatment options, according to study authors Dr. Archana Radhakrishnan, of Johns Hopkins University in Baltimore, and her colleagues. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Move ahead to Dec 2020. 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. Ramsey SD, Zeliadt SB, Fedorenko CR, Blough DK, Moinpour CM, Hall IJ, Smith JL, Ekwueme DU, Fairweather ME, Thompson IM, Keane TE, Penson DF. Do I need a third opinion? Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. Biopsy in 12/27/11 showed 3/14 cores, Gleason 6 with PSA of 4.5. Discover what's to love about Charm City for yourself. Ex-Uro wanted to do biopsies and keep doing them until we find "it", even though he didn't know the size of the prostate nor had he ruled out prostatitis. A few weeks later and just before my meeting with my new Johns Hopkins Dr I get the second opinion results from both biopsy and MRI. I have developed an "abscess" on my prostate. Director of Surgical Pathology- Johns Hopkins, http://pathology.jhu.edu/department/services/secondopinion.cfm, The guy I used along with everyone else is Jonathan Epstein, M.D. Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. There is no bony or bulky nodal disease in the pelvis Find more COVID-19 testing locations on Maryland.gov. Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. 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. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! 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. Cancer. -------------------------------------------------------- The side effects of the cut, radiate, hormone regime are unacceptable to me. I trust the second opinion Dr. Bush gave. -------------------------------------------------------- I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. I'm going to reach out to UCLA to see what they can do. have no symptoms, and yet you have cancer? Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. Jonathan Epstein, M.D. If pain is present, a digital rectal examination will reveal hard areas. PSA: 4.7 ng/ml/PSA density: 0.27 ng/ml2 Thanks, We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm Because I had an implant in my ear, they would only give me a 1.5T MRI. As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. 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. 8. Masks are required inside all of our care facilities. Before They did 9 patients in Phase I and there have been 12 so far in Phase II. Nov 7, 2016. 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.). Note respondents were able to, MeSH Cancer. There are lots of lessons learned on the forum. Surgical Delay and Pathological Outcomes for Clinically Localized High-Risk Prostate Cancer. The site is secure. It works. I am at that critical juncture in which I at least need to formalize a plan, select a doctor/facility to work with, and continue my testing to make sure I have what I think I have. We are vaccinating all eligible patients. Johns Hopkins said I have options of adjuvant radiation approach up to 3-4months or wait to see if there are two successive rises in PSA and then do "salvage" approach. 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.
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