* Seminal vesicle invasion: None. Have been diagnosed with a serious or rare health condition. Can it be salvaged or are the risks of cancer too high? About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasnt spread outside of the prostate. Accessibility Time moves fast when dealing with cancer, but Doctors dont. Good pathology readings require experience and a high level of expertise. Because every patient is different, there are several ways to approach prostate cancer treatment. Methods: My questions are: 2. They confirm everything except question whether one of the core samples is a 3+3 or 3+ 4. This has raised some questions on all the scans so far. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. Get a Urology Second Opinion | Johns Hopkins Brady - Hopkins Medicine So I initially thought this makes me a good candidate for AS. 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 men with Gleason 8-10 disease are going to do badly after Yet none of my doctors ever mentioned it! A week later had catheter removed and had no bladder leakage problems. What are you doing about it? I choose surgery over radiation because you can do surgery and then radiation, but it is almost impossible to do it the other way around. 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. Extracapsular extension: The prostatic capsule is preserved. When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. ADC: mean 879 / median 839 / st dev 223 Bethesda, MD 20894, Web Policies Also these lesions did not abut or touch the wall of the prostate. focal peripheral zone lesions. I still have some urgency and frequency issues, but I am not complaining too bad. 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. A enlarged prostate can also cause blockages in the urethra. Consultation with your nurse care manager. Let me know what everyone thinks if you see anything interesting or of note here or just have some advice. So, Radiation Oncologist prescribed Cialis 5mg, daily. And again, most of you tell me time is on my side, so I am comforted in hearing that. A. Prostate, right base, core biopsy: )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. Five years ago I had a TURP. Dr. Nour is 100% sure that nothing has spread. Assessment categories for this lesion: This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. 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. Abstract Context: In men who develop an elevated serum prostate-specific antigen level (PSA) after having undergone a radical prostatectomy, the natural history of progression to distant metastases and death due to prostate cancer is unknown. 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. Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. Prurigo Nodularis Cancer: What's the Link? - Verywell Health Remember if you ship them include the following information: You May Like: Blood In Urine After Prostate Biopsy. Obtaining a second opinion on your pathology report is no different than getting a second doctors opinion, it is a must for all of us. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. * Adjacent organ invasion: None. In severe cases, a catheter may be required to relieve the symptoms. 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. 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. There is no extraprostatic extension. Men need to be educated on all treatment options to protect themselves from a biased industry. 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. You may also complete an online appointment request form and we'll respond to schedule an appointment. PSA had increased to 5.4. Are you sure you want to block this member? The people were great. of tumor in the rectal prostatic angles. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. 4. To schedule an in-person visit for a second opinion or to determine if a telemedicine consultation is possible, call: 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. 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. I guess the PET scan will be the next step in what type of treatment options are in store.Has this occurred to anyone else? * Seminal vesicle invasion: None. Hope to hear from a bunch of people. Benign Processes: Want confirmation about a diagnosis or treatment. At a rectal exam 6/20 the urologist told me my prostate felt normal, not enlarged, nor did he feel any tumors. This urologist can get you in for surgery next week. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. PI-RADS v2 score: 5. My involvement is below maximum of 15% of core. - Benign prostatic tissue * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) If its a common cancer with a well-established standard of care, they can offer insight into clinical trials or novel treatments that may be better than the standard. Y'all are in my prayers! * Adjacent organ invasion: None. 3. Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? the transition zone. Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? I also learned a lot more about the high undisclosed risk of side effects of various treatment plans. I am 58 and in very good health otherwise. Identified an approximate 2 cm lesion of mostly Gleason 7 (3+4) with only 20% being 4, contained in prostate. Fear motivates you to want to treat this as soon as possible. A enlarged prostate can also cause blockages in the urethra. 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. 1st opinion. 2. 5. There were several areas of interest - but nothing in seminal vesicles, lymph, or bones. Need guidance choosing from multiple treatment options. It is still important to do your own research. 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. Second round of Radiation Therapy - t - Advanced Prostate Got my physical and normal DRE with new Dr. No issues identified. You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. Men who sought second opinions because they were dissatisfied with their initial urologist were less likely to receive definitive treatment (odds ratio, 0.49; 95% confidence interval, 0.32-0.73), and men who wanted more information about treatment were less likely to report excellent quality of cancer care (odds ratio, 0.70; 95% confidence interval, 0.49-0.99) compared with men who did not receive a second opinion. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? I guess TWO national centers of excellence are better than one? undefined will no longer be visible to you including posts, replies, and photos. They may defer to the recommendation of the specialist, or refer you to a doctor with limited prostate cancer experience. ---------------------------------------------------- We have a consult on Friday with the 1st opinion doc to review all tests. Specimens Submitted: Prostate dimensions: 4.1 x 2.8 x 3.4 cm Negative cancer in lymph nodes, seminal vesicles, and all margins. I'm going to reach out to UCLA to see what they can do. Spent the night in hospital with very little pain after the first couple of hrs. Some men may have an enlarged prostate but not notice it. At that point I agreed to the TRUS biopsy which I had on October 10, 2020. Is there such a thing as having a team that isnt equipped with the best equipment nor the most experienced radiologists? Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). I'm currently in the process of getting an appointment set up with a Dr. Wang at UCLA. He also said perinueral invasion, but not extracapsular extension. Does 3+4 at some point typically evolve into 4+3 and also serve as a trigger point for moving from AS to treatment? Men were asked if they obtained a second opinion from a urologist, and the reasons why. Only took Motrin and Tylenol for pain after release. We are vaccinating all eligible patients. Find more COVID-19 testing locations on Maryland.gov. I worked out every day and it wasn't until the last week did I feel a bit fatiguedand experience a bit of urgency and hesitation having to peeflowmax fixed that right up!90 days after treatment my PSA came in at .56. This doctor or team of doctors will review the following: The doctor then communicate their opinion regarding treatment to both the patient and the primary physician. Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. If I am rested, I find that I am more ready than if I am not. 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. The average age at the time of prostate cancer diagnosis is about 66. 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. If pain is present, a digital rectal examination will reveal hard areas. PMC 4. Luckily, his report co-coincided with the original QDx report. 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. I have completed an exhaustive research effort on Prostate Cancer and PCa treatments. In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? 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. I did a book review with his first book for several veterans groups including the Americal Division Veterans Organization which with I served at age 19. As a Gleason 3 + 3, with 8 of 12 positive cores all with less than 30% cancer, and bilateral spread, I have determined that I cannot trust a blind biopsy in and of itself. Wow, I sound like a snob now! sharing sensitive information, make sure youre on a federal Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. No definitive evidence of distant metastatic disease is seen." Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. That's the good news. Should You Exercise When Youre Expecting? I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. We experienced information overload and decision/analysis paralysis. Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. 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. 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. Thanks, I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. There are also many reasons why you may want to seek another opinion during the course of your cancer care. T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive * Gleason Score: 4+5, Slide 4 (vs. Sloan's 3+4) - 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) First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. 6: Prostate, left medial base Bladder: Normal.
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