FOIA Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. 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? During puberty, the body produces semen in a large number of cases, including enlarged prostate. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Accessibility Is it done through my doctor or do I do it myself with sending CDs of the MRI? Six weeks later I have the biopsy in his office and a week later I get the results. doi: 10.1136/bmjopen-2020-044033. 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. I personally have benefitted from second opinions on my so-called cancer journey. The total number of cores with carcinoma is 3 Because physicians may differ in their approach to treating breast cancer, its very important to check with a breast cancer expert to know youre receiving the best treatment for you. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. MY THOUGHTS AND ANYTHING DOCTOR NOTED: Estimated prostate volume of 35 cc with an estimated PSA density of 0.11 ng/mL/cc. 1. Therefore, the value of these second opinions remains unknown. I would appreciate hearing from that 2.8% out there who have an intraductal component. Methods: Identified an approximate 2 cm lesion of mostly Gleason 7 (3+4) with only 20% being 4, contained in prostate. My plan is to choose quality of treatment over cost of the treatment. Im immediately referred to Urologist. 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. So now things are getting exciting. 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. Include Your Primary Care Physician as Member of Your Treatment Team. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Second opinions offer different things in different circumstances, Dr. Matasar says. More medical freakouts. 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. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. Am I missing anything? So off I went to see a community urologist who performed a needle biopsy in his office. Prostatic Adenocarcinoma You May Like: Best Treatment For Intermediate Prostate Cancer. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) 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. Many researchers believe PTEN present is a strong brake on Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. * Perineural Invasion also detected My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. After a little experimenting I have been able to achieve a partial erection. 2/13 PSA 5.2/fPSA 12.5% taken AFTER DRE (negative DRE) (lab #1) Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. It is OK to be overwhelmed with info. PREVIOUS MRI RESULTS (LOTS of them) Primary Gleason grade: 3 Prostate volume: 17.58 cc 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. If youve received a new diagnosis or arent seeing results from your current treatment plan, a second opinion can help you move forward with confidence. 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. And it is OK to have paralysis by over-analysis. Someone advised to always get my PSA checked at the same facility in order to make sure the same protocol and lab is used, is that critical? Hello. Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. Hi All, Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. This may include imaging, blood tests, prior treatment, and pathology reports. I have been drinking out of an information fire hose. My prior Prolaris study (2018) before the FLA was very low risk. It is OK to not understand all the terminology. To learn your stage of prostate cancer, take the staging quiz on keytopc.com. Second opinions apply to biopsies and imaging as well. 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. You feel healthy, you arent in pain, you I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. Does this also include HIFU, Cryoablation? Now the oncologist wants to perform a PSMA Pet Scan. I question the potential EPE and he said it didn't matter, but went ahead and ordered Oncotype. Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. Let me know what everyone thinks if you see anything interesting or of note here or just have some advice. That is literally the first time I heard that term other than seeing it in my pathology report. Four had 60-70%, five have between 5-10%. Greatest dimension 0.7cm . focal peripheral zone lesions. 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. An acute bacterial infection can cause a burning sensation. I have a history where Foley catheters were unable to be placed going back to 2005 for unknown reasons. 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. Not all cancers are the same and not all treatment plans are absolutely clear. T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive - 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) C. Prostate, right apex, core biopsy: All Gleason 6 (3+3). The treatment of prostate cancer has evolved tremendously. The lesion also shows focal increased permeability. * Extracapsular extension: None. Oncologist. FLA DONE AT FIRST BIOPSY G- 7. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) In severe cases, a catheter may be required to relieve the symptoms. So, I also sent this MRI result to Johns Hopkins for a second opinion. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. Get a Second Opinion I've had what I would consider a fluctuating PSA since first tested in November 2018. I worked out every day. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. 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. And just this week, 1 YEAR post treatment, it is .46. Because physicians may differ in their approach to treating breast cancer, its very important to check with a breast cancer expert to know youre receiving the best treatment for you. -------------------------------------------------------- I now have my list whittled down to 3. One of the problems with second opinions is that insurers may not cover the expense. So, I go one better, I call up Johns Hopkins and find a Dr who does DaVinci Prostate Surgery. 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. Get directions, important phone numbers, locations and more. And 2 cores from left apex of 3+3=6 with 10% involvement. Just had my appointment today and they are pleased with the results, so far. It starts many years ago. An accurate diagnosis is essential to ensure the most effective treatment. fibromuscular stroma, anterior prostatic contour is smooth. I wish the VA would be more informative about this disease they owe it to our veterans. Y'all are in my prayers! Greetings gentlemen! 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. For cancers that are less common, second opinions can offer more treatment options. 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. I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. * Both Sloan and Johns Hopkins admit that large discrepancies are unusual, yet both stand by their opinions. Learn MoreFor more information about pathology second opinions, visit pathology.jhu.edu or call 877-546-1872. I made the appointments. I have searched the country for intervential radiologist that perform FLA on the prostate. There is no extraprostatic extension. Specimens Submitted: But I did speak to an oncologist who wanted to order Oncotype, which I did. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. So the pathologist suggested a second opinion. 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. Surabhi Dangi-Garimella, PhD. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. It's really that simple! Some men may have an enlarged prostate but not notice it. So my question for you is have you ever heard of PRECISE and if so what should I make of it? I followed up with the original pathologist to compare and he was more forthcoming. 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. My thoughts focus on the fact that I have a disabled son who needs my care. My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. My experience at Johns Hopkins was awesome. Hello, I apologize upfront for the length of this post, but I was recently diagnosed with prostate cancer (T2C) and figure more information is better than not enough. This Dr is in charge of active surveillance program at JH so I knew that he wouldnt recommend surgery unless it was really needed. I sent a message to my urologist requesting my slides be sent to Dr. Epstein at Johns Hopkins for a second opinion and I also requested an Oncotype DX test to get an idea of risk for my low teal or basic teal cancer. Didn't know if she had the catheter in far enough and not getting any urine through itwondered if she had inflated the balloon enough and wondering if it was the reason that I have developed an abscess. However, something is driving my PSA. 1st opinion"PYL PSMA PET/CT scan demonstrating foci of moderate to intense uptake in the prostate gland consistent with known prostatic cancer. This approach helps to decrease side effects that can affect a patients quality of life, such as erectile dysfunction, incontinence or other urinary-tract symptoms. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. Wow, I sound like a snob now! 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. Epub 2017 Jun 12. 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. FAX 310-574-4002 Pingback: PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Pingback: Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Your email address will not be published. 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). * Seminal vesicle invasion: None. ---------------------------------------------------- Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Thank you for your understanding and cooperation. I had FLA done after first biopsy which staged me at 3+4 = 7. 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. This urologist can get you in for surgery next week. I had a telemed session with Dr. Chang, and it sounds like a pretty simple procedure, with urinary side effects that resolve pretty quickly. But you have to do both. 3/5 Overall, nearly 80% of men received definitive treatment 76.5% of men who obtained a second opinion from a urologist received definitive treatment compared to 81.6% who did not . Even if I go the radiation route, should I try for Proton radiation or some other type? Have been told a health condition is not treatable. Unfortunately, monetary incentives create biases that can work against patients best interests. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Note respondents were able to, MeSH My diagnosis is T2c, Gleason 7 (3+4). 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. and transmitted securely. Metastatic disease considered less likely for this pattern. The purpose of starting this discussion is to gather peoples thoughts and opinions and actual experiences with Prostate Focal Laser Ablation. 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. TRANSPERINEAL MRI GUIDED BIOPSY RESULTS Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Nov 7, 2016. Your doctor is not a specialist in your type of . Lesion #1 (index): PI-RADS v2.1 score 4, lesion measuring 10 mm centered at the right mid/apex posteromedial peripheral zone; findings equivocal for extraprostatic extension; no evidence of seminal vesicle invasion; The low ADC value in this lesion increases the likelihood of Gleason grade group 2 or higher. Two from one lesion were positive as was one of the two from the other. Now Im still ignorant and dont really know a Gleason from a Duck, so when the Dr says your treatment is radiation or surgery Im devastated. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). What are your opinions of what that is, and where to get it? Its gone.I have been advised to have a Axumin Pet scan as follow up as the first pathology report indicated perineural invasion present as well as probable introductal carcinoma. 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. )As for side effectsI occasionally have some urgency/hesitancy having to pee. 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. The peripheral zone has a patchy signal pattern. Expert review of your case by a Cleveland Clinic specialist. - Johns Hopkins Medicine -- Get a Second Opinion Expert review of your case by a Cleveland Clinic specialist. 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. Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. 1: Prostate, right lateral apex They are not objective. 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.