Whats right for you will depend on the stage of the cancer, your level of risk and your general overall health. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. Read Also: What Are The Signs Of Prostate Infection. When people recommend going to a Center of Excellence, believe them. I'm trying to figure out why the PSA keeps rising. With world-renowned expertise, multidisciplinary specialists and the latest data, we partner with you to make informed decisions about managing your prostate cancer. Here are some recent updates: Uterine cancer.Women who use chemical hair straighteners frequently could have a higher risk of developing uterine cancer than women who have never used the products, according to new findings from a national study that has followed nearly 34,000 U.S. women for more than a decade. So, Radiation Oncologist prescribed Cialis 5mg, daily. At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). Based on the results, our experts can provide you with an individualized treatment plan before you leave. And should I treat prostatitis before FLA? Greatest dimension 2cm. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. I appreciate any comments or insight that anyone wants to share. Patients may experience a fever or chills as a result of the infection. Best practices dictate that you obtain a second confirmatory pathology evaluation. 4. The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. I've had what I would consider a fluctuating PSA since first tested in November 2018. I'm 58 yrs old and had a TRUS random biopsy October 2020 after my PSA continually stayed between 4.4 and 8, and PHI score was 126. I had a very bad experience with an incompetent nurse that did a catheter change. 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. My family physician for years told me that small increases PSA was common so when it went over 4 it didnt bother me and my Dr who was retiring, didnt say anything either. Getting a second opinion from us is easy, convenient, and all done remotely. Benign prostatic tissue Methods: He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. )As for side effectsI occasionally have some urgency/hesitancy having to pee. The reasons for opting for treatment: the single lesion - previously Gleason 3+4, with a small percentage of pattern 4 - has grown, and according to a biopsy performed March 25, my Gleason 3+4 is now a Gleason 4+3. Find more COVID-19 testing locations on Maryland.gov. The total number of cores identified is 3 Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. If you are considering undergoing a specialized treatment, such as cancer surgery, within your HMO, it is important to inquire about the number of such procedures performed each year by the HMO and the results. 10: Prostate, right anterior MRI lesion The problem is that all 3 pathologies noted an intraductal component. 3/5 Find more COVID-19 testing locations on Maryland.gov. 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. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. Dont Miss: Is Coffee Bad For Your Prostate. U.S. News & World Report ranked the institute #7in the country. I am relatively new to this forum and trying to educate myself as to my best course of treatment. Visit and Like ZERO - The End of Prostate Cancer on Facebook, Sign up to receive emails and news from ZERO - The End of Prostate Cancer, Search prostate cancer clinical trials and studies. Thank you for your participation! I guess TWO national centers of excellence are better than one? Before Most reputable HMOs can, however, deliver state of the art treatment for most cancers. has now confirmed this assumption through a careful retrospective analysis of data from > 450 men whose records could be identified in the SEARCH database, all of whom received surgical treatment for Gleason 8 to 10 prostate cancer. It can be caused by many factors, including infection and inflammation. 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. 4. Urology. A enlarged prostate can also cause blockages in the urethra. - 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) 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. 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. Using the Bullet Volume gives you gland of 25.55. Surgery seems like overkill for me with too many risks for incontinence and permanent ED, am I overlooking something? 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. They are not objective. Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. A second opinion is a review of the cancer diagnosis and the treatment recommendations of the physician who is treating the cancer by another, independent physician. Please don't hesitate to make any observations or ask questions. After a little experimenting I have been able to achieve a partial erection. 2. 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. I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. In the United States, prostate cancer is among the most common cancers found in men. They basically said it didn't matter. They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. 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. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! To learn your stage of prostate cancer, take the staging quiz on keytopc.com. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. Unfortunately, what you do not realize may harm you! What are your opinions of what that is, and where to get it? Both Drs and nurses knew what they were doing and had lots of experience. 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. Prostate, left anterior MRI lesion: The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. It is still important to do your own research. Cancer patients are encouraged to obtain second opinions before starting treatment. Seek Perspective from a Range of Specialists. They won't be offended, and they may even be able to recommend a specialist for you to see. 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. I am also doing a vegan diet with additional complementary substances. If you are diagnosed with a urologic cancer, including but not limited to the prostate, bladder, kidney, and testicular or urinary tract, its important to consider a second opinion. Grade Group: 2 Second round of Radiation Therapy - t - Advanced Prostate 6. 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. However, learning more about prostate cancer and prostate-related health issues can help optimize health. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. I'm currently in the process of getting an appointment set up with a Dr. Wang at UCLA. * Adjacent organ invasion: None. My diagnosis is T2c, Gleason 7 (3+4). I am already positively surprised that I am still alive 4.5 years after my diagnosis. - Perineural invasion is present There are also some cases of the test showing no depletion but being wrong. I'm going to reach out to UCLA to see what they can do. I still have some urgency and frequency issues, but I am not complaining too bad. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. 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. Two 1cc tumors, gleason score 3+4 each, one in each lobe. I would really love to hear from you. T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive 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. Benign prostatic tissue 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. This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. Hoping that after I go through this that my advice to others will be able to guide them and that they can learn from my experience, as I feel I am gaining a solid foundation from both a practical and mental standpoint. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night. Get a Urology Second Opinion | Johns Hopkins Brady - Hopkins Medicine An increase of 1.1 in 3 months is not good news. His most-frequently cited first or last authored publications is Pathological and Clinical Findings to Predict Tumor Extent of Nonpalpable Prostate Cancer, published in JAMA, which established the criteria for active surveillance. of tumor in the rectal prostatic angles. At that point I agreed to the TRUS biopsy which I had on October 10, 2020. Thanks for Everyone's Help, 7. Greenfield G, Shmueli L, Harvey A, Quezada-Yamamoto H, Davidovitch N, Pliskin JS, Rawaf S, Majeed A, Hayhoe B. BMJ Open. MY THOUGHTS AND ANYTHING DOCTOR NOTED: Dr. Dan Sperling - New York. We have a surgery date set up for the end of July at Johns Hopkins (our second opinion team).His stats:63yo, non smoker, 167lbs, Vegetarian/Vegan diet no other known health issuesWalks dogs for a living and cares for our small farmPSA 3.3 (Jumped from 1.6 in a year)Biopsy Scores 3+5, 4+3. He also said perinueral invasion, but not extracapsular extension. The results of Oncotype came back and it was a bad report. 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. 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". Oncologist. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. You have a rare or unusual cancer. More medical freakouts. __________________________________________________________________________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. Some men may have an enlarged prostate but not notice it. Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. It works. Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. 180 days after treatment PSA was .50. He was right. In general, a second opinion is a good option for people who have recently received a cancer diagnosis but have not started treatment, as well as for people who have already completed chemotherapy or radiation treatment. The percentage of tissue with carcinoma is 70% 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. The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. Cancer. I made the appointments. 9: Prostate, left anterior MRI lesion JAMA Netw Open. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. And 2 cores from left apex of 3+3=6 with 10% involvement. Also, a second opinion provides the opportunity to get information from someone other than the physician who will be directing treatment, which is usually the main source of information for most patients. 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. desired outcome. 2020 Dec 1;3(12):e2028320. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night.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. It also rules out Brachytherapy. You may be concerned that the cancer will grow rapidly out of control before you are able to get a second opinion. Reasons for obtaining a second opinion from urologists. At the Breast Cancer Program at the Johns Hopkins Kimmel Cancer Center in Baltimore, MD, a second opinion requires only that you or your doctor send us your pathology slides, key medical records and signed paperwork requesting the opinion. 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. A doctor may prescribe surgery or perform an endoscopic procedure. Get a Second Opinion What can a second opinion tell me? I was confident I was making the right decision. 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions. Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. 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. How to Get a Second Opinion Our team at Johns Hopkins has a dedicated service to interpretation of brain tumors and render second opinions on a daily basis. Which Patients Report That Their Urologists Advised Them to Forgo Initial Treatment for 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. TZ zone more beneficial, but fairly large compared to whole gland and proximity to capsule edge would likely mean treatment would be suggested. My new Dr however didnt order PSA so I asked him for one. My question is--what importance do volume levels play in determining when to move from AS to treatment? Receiving a second opinion was not associated with perceived quality of prostate cancer care. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. Dr stated that after seeing my muscles on the inside during operation he would have predicted this. Hope to hear from a bunch of people. PCPs can be a great help to navigate the medical marketplace and provide an unbiased voice of reason when it comes to making hard choices. Compared to younger men, men 70-74 years old and men 75 years were less likely to obtain a second opinion whereas men with college graduate level education or beyond were more likely compared to men with less than high school level education. Value of Second Opinion in Prostate Cancer Uncertain, Says Hopkins Study. Diffuse probable benign peripheral zone changes limit evaluation for Prostate, right anterior MRI lesion: very activerun/cycle 6 days a week I am 62 years old. The best protection for cancer patients who are Health Maintenance Organization members is to seek a second opinion even if she or he has to pay for it. 2nd opinion"Sclerotic change at the right pubic bone with max SUV of 1.4." You receive a secure, private online consultation without leaving home. 3. I have actually had a second opinion a while back from Dr. Bush. Other Features: 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. Required fields are marked *, PHONE 310-827-7707 I don't know if the FLA could affect the results, or if it was just done because it was not in the study parameters of the test. Its in your best interest to ask for another look at a cancer diagnosisIf youve recently been diagnosed with cancer, its wise to ask for a second opinion on your pathology specimen.Johns Hopkins researchers with the Urological Pathology Consult Division, led by Jonathan Epstein, M.D., first reported on biopsy errors a decade ago, when they found a margin of error in prostate cancer diagnoses large enough to give them pause. 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. 5. Make an appointment: 410-955-5222 Coordinating with your Treating Physician At the Breast Cancer Program at the Johns Hopkins Kimmel Cancer Center in Baltimore, MD, a second opinion requires only that you or your doctor send us your pathology slides, key medical records and signed paperwork requesting the opinion.