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FAX 310-574-4002 images and markedly reduced ADC. 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. Get a Second Opinion: Johns Hopkins Kimmel Cancer Center As I said, I am 58, so I would really like to preserve my quality of life for as long as possible, but the genomics report has me concerned. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. Not all cancers are the same and not all treatment plans are absolutely clear. If pain is present, a digital rectal examination will reveal hard areas. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. * Seminal vesicle invasion: None. I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. Prostate cancer is a malignant (cancerous) tumor of the prostate, a gland found only in men. Surgical Delay and Pathological Outcomes for Clinically Localized High-Risk Prostate Cancer. - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. Prostate, right lateral base: It is OK to be scared. PSA had increased to 5.4. Find more COVID-19 testing locations on Maryland.gov. Netto points to prostate cancer as an example: If your diagnosis changes from a higher grade to a lower grade cancer, it could mean having the option to avoid radical treatment.Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. PDF Cancer A Second Opinion A Look At Understanding Controlling And Curing Netto says patients should be proactive in requesting that doctors take another look. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. He wants me to begin the ADT around 5/1. Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. peripheral zone signal intensity on T2-weighted images. I trust the second opinion Dr. Bush gave. Proton Therapy Case Study - Prostate Cancer - Johns Hopkins Medicine Cleveland Clinics Virtual Second Opinions program connects you to an expert physician who specializes in your specific health needs. We can help with your case. I have searched the country for intervential radiologist that perform FLA on the prostate. probably organ confined disease. Many health insurance companies will pay for a second opinion, especially if it is for a medically necessary treatment. Greetings gentlemen! 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. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference, Why Prostate Cancer Survivor John Shearron Thinks Its Important To Do Your Research | PCRI, John Hopkins Prostate Cancer Second Opinion, a higher risk of developing uterine cancer, surgery may not always be necessary for all breast cancer patients, The cancer vanished in every single participant, Long Term Side Effects Of Brachytherapy For Prostate Cancer, treat rare and complex conditions through breakthrough fetal procedures, Prostate Cancer External Beam Radiation Side Effects, Can Enlarged Prostate Cause Blood Clots In Urine, Life Expectancy Stage 4 Prostate Cancer No Treatment, Prostate Cancer Spread To Skull Prognosis, Diagnostic Procedures For Prostate Cancer. However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. 3. * PIRADS v2 Score: 5 I was never under the misconception that I'd never have to do something, but I was going to wait until I needed to do something. )As for side effectsI occasionally have some urgency/hesitancy having to pee. In the United States, studies estimate 72 new cases of PN for every 100,000 people between the ages of 18 and 64 years old. 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. Second Opinions for Cancer Care - UChicago Medicine I assume it is not free. The people were great. By choosing the first doctor you speak with to be your treating physician, you may be putting your health in the hands of someone who lacks the expertise to accurately and safely treat your prostate cancer. OTHER: None. After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. Many researchers believe PTEN present is a strong brake on This is the most common urinary tract problem in men under 50, and the third most common in men over 65. You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. The survey asked the men if they had opted for a second opinion from a urologist following their diagnosis of prostate cancer, and the reasons for the second opinion. 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. The .gov means its official. Thanks to all of you for sharing! notable articles of 2016 - Johns Hopkins Bloomberg School of Reasons for obtaining a second opinion from urologists. 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. The primary goal is to be cured with the least toxic, most effective approach. 2020 Dec 1;3(12):e2028320. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. - Benign prostatic tissue Prostatic Adenocarcinoma Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. Unlike pathology labs in most hospitals, Jonathan Epstein's lab at Johns Hopkins has pathologists who specialize in reading prostate tissue samples. Value of Second Opinion in Prostate Cancer Uncertain, Says - AJMC PSA was 3.0 in 2011 and rose to 6.0 in late 2013. He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. Read Also: What Are The Signs Of Prostate Infection. Does every biopsy provide a Gleason Score? PROSTATE LESIONS: Yet none of my doctors ever mentioned it! 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. Recently diagnosed a Gleason 3 + 3. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. Greatest dimension 0.7cm . Your doctor is not sure what is wrong with you. Get a Second Opinion | Johns Hopkins Pathology The linear amount of tissue with carcinoma is 23 mm Have been told a health condition is not treatable. 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. It got discussions started and questions answered. Request an Appointment 410-955-6100 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. 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion 2 cores from left base of 3+4=7 with only 5% involvement. 180 days after treatment PSA was .50. T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive However, something is driving my PSA. I had the slides reviewed at Johns Hopkins and 1 of the HG PIN cores was changed to suspicious for adenocarcinoma while another HG PIN core was changed to benign. Patients may experience a fever or chills as a result of the infection. The researchers did not include more minor errors in rating how fast-growing and how advanced a cancer was. In addition to providing a better understanding of your diagnosis, a second opinion can also shed new light on treatment options and give you confidence in how to proceed with your care. Benign Processes: Even at the age of 48, he thought I would be a good candidate for AS. 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 am unfortunately "officially" joining the club after getting my biopsy results today. More medical freakouts. Dont Miss: New Treatments For Stage 4 Prostate Cancer. Jonathan Epstein, M.D. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. Second opinions not likely to change prostate cancer treatment I followed up with the original pathologist to compare and he was more forthcoming. I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. Here are seven tips for seeking second opinions for prostate cancer: 1. sharing sensitive information, make sure youre on a federal 3T MRI with coil is done initially, along with a TRUS biopsy. A second opinion can help you make an informed, confident decision about your medical care. The urologist offered surgery and radiation as options on 3/10 when we met. With world-renowned expertise, multidisciplinary specialistsand the latest data, we partner with you tomake informed decisions about managing your prostate cancer. The ADT has daunting side-effects but he said offers some improved chances of eradication, any long-term downsides that I should consider? However, older men 75 years were the least likely to report obtaining a second opinion due to dissatisfaction with their initial urologist. Seeking a Second Opinion - American Cancer Society Anything I am overlooking or need to add to my list of considerations? Please enable it to take advantage of the complete set of features! So the pathologist suggested a second opinion. 24.5 BMI I requested a second opinion from Johns Hopkins and they found 1 lesion was 3+3=6 and the second lesion was 3+4 =7, with less than 5% pattern 4. 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. We will give that a shot and see how it turns out. 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. These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. - 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) Masks are required inside all of our care facilities. 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. So, I go one better, I call up Johns Hopkins and find a Dr who does DaVinci Prostate Surgery. It was easy. As a result, patients struggle to differentiate bias from fact. Im immediately referred to Urologist. Symptoms include leaking and discomfort. Primary Gleason grade: 3 Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. MRI RE-READ #3 (National Cancer Center of Excellence): 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". My goals are to control PCa, to minimize side effects, and to keep options open in the future. Types of questions that pathologists often address in our second opinions: