MRI obtained outsideon 04/16/2021. * Membranous urethral length: 1.2 cm 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. Grade Group: 1 He basically said it was possible, but that he did not agree. Hillen MA, Medendorp NM, Daams JG, Smets EMA. With that alone, I would likely be a candidate for continued Active Surveillance. Prostate, left anterior MRI lesion: I opted to waive the biopsy, wait 1 year and test again. After a little experimenting I have been able to achieve a partial erection. They told me to expect a spike in my PSA sometime in the future, and they told me that studies are showing that a slow, steady decline in PSA is often indicative of superior results (whatever that means. 3. Dr stated that after seeing my muscles on the inside during operation he would have predicted this. Second Opinions (Adults) For stem cell transplant, please call 1-773-702-1994. With world-renowned expertise, multidisciplinary specialistsand the latest data, we partner with you tomake informed decisions about managing your prostate cancer. Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. 8. * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) Two 1cc tumors, gleason score 3+4 each, one in each lobe. Adenocarcinoma: doi: 10.1136/bmjopen-2020-044033. B. Prostate, right mid, core biopsy: 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. 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. Surgical Delay and Pathological Outcomes for Clinically Localized High-Risk Prostate Cancer. 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. Also these lesions did not abut or touch the wall of the prostate. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. MRI RE-READ #3 (National Cancer Center of Excellence): Original Sloan Biopsy Results: I worked out every day. I would appreciate hearing from that 2.8% out there who have an intraductal component. 180 days after treatment PSA was .50. Enter the last name, specialty or keyword for your search below. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). (PZ) - normal 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. He spent an hour on the phone reassuring me that I didn't need to rush into anything, and they he'd love to scan me 6-8 weeks after my TRUS Biopsyhave to let the trauma and all the blood leave the prostate for a good image. You May Like: Prostate Cancer External Beam Radiation Side Effects. I had two no-risk, non-invasive tests: a Free PSA with an adverse score of 9% and a PCA3 test with a disappointing 41. Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Shore ND, Karsh L, Gomella LG, Keane TE, Concepcion RS, Crawford ED. Caused me to bleed heavily. Race and ethnicity. Generally, the symptoms can stabilize over time. 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? If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. Be sure to confirm your diagnosis at a center of excellence. Benign Processes: 10. Same with the amount of how much pattern 4. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care. So, I go one better, I call up Johns Hopkins and find a Dr who does DaVinci Prostate Surgery. I made the appointments. Dr. Jonathan Epstein of Johns Hopkins University Hospital. Thankfully, prostate cancer is extremely slow growing. 24.5 BMI PSA that brought me to this was 7.1. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). 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. Call us with any questions: 410-955-2405, ext. __________________________________________________________________________July 2022I've neglected to make journal entries for a couple years, so I will recap below and continue with what I have done and what I have learned.In 2018, at the age of 48, after a routine physical that showed a PSA of (4.X) and after a TRUS biopsy, I was diagnosed with PCa. * Size: 1.5 cm There are also many reasons why you may want to seek another opinion during the course of your cancer care. Your doctor is not sure what is wrong with you. 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. 9: Prostate, left anterior MRI lesion No one at Hopkins has ever died of prostate cancer if he had Gleason 3 + 3 cancer." Please don't hesitate to make any observations or ask questions. My prior Prolaris study (2018) before the FLA was very low risk. Spent the night in hospital with very little pain after the first couple of hrs. 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. Metastatic disease considered less likely for this pattern. After extensive discussion of his management options with his local urologist, primary care physician, and radiation oncologist, he also sought a second opinion at the Johns Hopkins Prostate Cancer Multidisciplinary Clinic at Sibley Memorial Hospital.The patient expressed an overwhelming desire to avoid surgery and any other invasive treatments. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. Without your support, I could easily have subjected myself to random biopsies that are risky, don't do a good job of finding lesions, and can mess up the clarity of the prostate for an MRI. I have had a CT of the pelvic area - negative and a whole body bone scan - negative. 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. 2018 May;115:133-138. doi: 10.1016/j.urology.2018.01.048. You're more likely to develop prostate cancers that are more likely to spread. I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. I am doing my own research, but I am curious as to thoughts of the best possible MRI to obtain to give me the best chance at finding something the needle biopsy didnt find. Getting a second opinion from us is easy, convenient, and all done remotely. This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. Include Your Primary Care Physician as Member of Your Treatment Team. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. However, it also is possible to seek a pathology second opinion on your own, and it does not require an in-person office visit. 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. Recovery from Prostate Cancer | Bills Story. Benign prostatic tissue I was on active surveillance after a FLA procedure done in 2018. My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. Studies show the clinical and financial benefits of obtaining a pathology second opinion. Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. Immediate means 6 weeks just to see his NP. There is hope. Advances in our understanding of breast cancer have opened up new treatment options or clinical trial opportunities, including targeted drug therapies and tissue-conserving procedures proven to greatly reduce pain and nausea. Symptoms include leaking and discomfort. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. This urologist can get you in for surgery next week. Remember if you ship them include the following information: You May Like: Blood In Urine After Prostate Biopsy. The neurovascular bundles are intact. Primary Gleason grade: 3 Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. Jonathan Epstein, MD received his doctorate from Boston University. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. BASE DATA: The total number of cores identified is 3 If I am rested, I find that I am more ready than if I am not. Will these places of excellence consider me, or am I bound to my regular doctor for insurance purposes? As a result, patients struggle to differentiate bias from fact. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. Diffuse probable benign peripheral zone changes limit evaluation for 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. 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. By basing a treatment But I've had trouble getting Dr. Chang's office to provide any patient referrals. Since I have gotten so much out of this forum, I thought Id provide my story to help others. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. 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. This may include imaging, blood tests, prior treatment, and pathology reports. MEASUREMENTS: - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length Find more COVID-19 testing locations on Maryland.gov. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Background: Lesion 2: Right mid anterior transition zone. Prostate, right medial base: Most reputable HMOs can, however, deliver state of the art treatment for most cancers. Here are seven tips for seeking second opinions for prostate cancer: Before getting a second opinion, its important to know your stage of prostate cancer. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Discover what's to love about Charm City for yourself. We have a consult on Friday with the 1st opinion doc to review all tests. 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. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. * Seminal vesicle invasion: None. So I initially thought this makes me a good candidate for AS. feel the clock ticking. - Benign prostatic tissue Can it be salvaged or are the risks of cancer too high? Overall my PSA is between 4 and 10. 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. Fear motivates you to want to treat this as soon as possible. More medical freakouts. And collaborating with Johns Hopkins Medicine means we can provide you with second opinions, streamlined and guided access to clinical trials, and a proven track record of excellence in care. Estimated prostate volume of 35 cc with an estimated PSA density of 0.11 ng/mL/cc. Epub 2017 Jun 12. All rights reserved. Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. If pain is present, a digital rectal examination will reveal hard areas. 4: Prostate, right medial base Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. 6. Clipboard, Search History, and several other advanced features are temporarily unavailable. Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. I find that when I'm trapped in the cockpit not able to use the bathroom for a long time is when I experience that most. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. * Asked and Dr. said he isn't overly concerned about perineural finding with the grade and it won't impact treatment options or overall prognosis. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? My first PSA was 8.03. Would you like email updates of new search results? T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive Have you heard of PRECISE follow up score for an MRI? No definitive evidence of distant metastatic disease is seen." Just had my appointment today and they are pleased with the results, so far. And 2 cores from left apex of 3+3=6 with 10% involvement. You think another treatment might be available. 2: Prostate, right lateral base You have a rare or unusual cancer. Expert review of your case by a Cleveland Clinic specialist. Also indicated everything else was "organ confined." However, there are also many more options for treatment and these options are more complicated than in the past. An acute bacterial infection can cause a burning sensation. There are lots of lessons learned on the forum. When you review your pathology report and are going to be making important decisions, like treatment decisions, which will be based on the information from the pathology report. FOIA Associated fees may be incurred up to $1,800 in a minority of more complicated cases requiring special studies. Not all cancers are the same and not all treatment plans are absolutely clear. Your email address will not be published. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. 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. Then about a month later I started 28 fractions of Proton Radiation.It was painless. Recently diagnosed a Gleason 3 + 3. Prostate cancer is a slow growing condition. Their opinions are widely held to be definitive. They won't be offended, and they may even be able to recommend a specialist for you to see. 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. If the enlarged prostate is not completely removed, it will shrink. The biopsy took 3 samples from the targeted region plus 16 sextant. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Extraprostatic extension: negative When people recommend going to a Center of Excellence, believe them. When facing an intricate disease like prostate cancer, the above scenario is far too simple to have a promising outcome. Seek Perspective from a Range of Specialists. I have selected Focal Laser Ablation as my future (soon) treatment. 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 met with the radiologist 3/17 and he leans toward an IMRT radiation regimen of 5 or 20 sessions TBD combined with ADT (6-month shot but maybe 4 months was enough). Cancer. Consultation with your nurse care manager. 7: Prostate, left lateral apex An official website of the United States government. Comments appreciated, During your visit, our specialists will review your medical records, diagnostic tests and other information provided by you or your current physician. (I must say that those low numbers concern me a bit.) 2/13 PSA 5.2/fPSA 12.5% taken AFTER DRE (negative DRE) (lab #1) Netto says patients should be proactive in requesting that doctors take another look. How could this compare using only partial slide re-reading? However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. Masks are required inside all of our care facilities. While I now concluded we need to find "it", I researched the best approach to see what is really going on and to do this safely. SO. Note that I'm trying to get a second opinion from Johns Hopkins but Mayo, where the biopsy was performed, appears incapable of processing my request. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Two from one lesion were positive as was one of the two from the other. A blocked urethra can also damage the kidneys. No extraprostatic extension. Other Features: However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. Some men have minimal or no symptoms at all. The biopsy took 12 cores, two from each lesion area and 8 randomly. Also, in 2018 I had an exosome Dx test which scored 45.34, but I also retook that test this year and it went down to 30.79. 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. Bring All Labs/Notes to Each Appointment. For cancers that are less common, second opinions can offer more treatment options. A fusion biopsy was performed in late May and I just received those results last Thursday. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) 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. !I'll try editing a previous post and see if it reads like a journal instead of creating a new thread every update.I just got my PSA results and the numbers are still trending in the right direction. -------------------------------------------------------- Because every patient is different, there are several ways to approach prostate cancer treatment. Five years ago I had a TURP. Johns Hopkins Health - Second Opinions, Second Chances, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, High Blood Pressure May Take Its Toll on Your Kidneys. 3/3 4K score 19% (high end of intermediate) I assume the data on gleason scoring is much more robust/reliable than genomics as it has been around longer and used more extensively. Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. Everything seems to be on track to remove the cancer and be cured! With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. I've been on AS since April 2016. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. I've been on AS for two years after my initial TRUS biopsy showed 3 cores 3+3 (10% volume) on Right side, and 2 cores 3+3 on Left side. Six weeks later I have the biopsy in his office and a week later I get the results. government site. Just took time off and then life happened.Thanks in advance for the insights. Now, I would like to send Radiology for a similar review. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. I was confident I was making the right decision. Brief MRI history. The more accurate the information we have, the better our treatment decisions. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. 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). 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. Over 80,000 specimen cases are seen at Johns Hopkins each year. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. Interesting differences: So, I also sent this MRI result to Johns Hopkins for a second opinion. Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? 3. 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. Bladder: Normal. 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. TZ zone more beneficial, but fairly large compared to whole gland and proximity to capsule edge would likely mean treatment would be suggested. LESION 1 First 6 week PSA is undetectable. 2nd opinion"Sclerotic change at the right pubic bone with max SUV of 1.4." My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. Thank you! 4, Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion. The percentage of tissue with carcinoma is 70% Find more COVID-19 testing locations on Maryland.gov. Secondary Gleason grade: 4 Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? * Adjacent organ invasion: None. Ozzieville (Michael), Hello All and thanks for being here~This is my first post.My husband was diagnosed with PC (adenocarcinoma with Extensive Intraductal Carcinoma Present) a few weeks ago.
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