Seeking a Second Opinion - American Cancer Society Interesting differences: HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. __________________________________________________________________________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. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. 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. And if so, what does being accepted in a AS program look like, do I need to be present at their location? * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) However, that information will still be included in details such as numbers of replies. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. Lesion 2: Right mid anterior transition zone. This condition causes pain in the lower back and groin area, and may cause urinary retention. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 1 of 2 cores (lateral core: 4 mm, 35%), 0.1 mm to the blue inked tissue edge You're at greater risk if you're Black or of African ancestry. Patients may experience a fever or chills as a result of the infection. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Bladder: Normal. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . 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. Both Drs and nurses knew what they were doing and had lots of experience. 2016 American Cancer Society. Getting a second opinion can sometimes lead to a complete change in diagnosis (such as cancerous to benign or vice versa) in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. Prostate, left medial apex: It is OK to be overwhelmed with info. I also learned a lot more about the high undisclosed risk of side effects of various treatment plans. Prostate cancer is the second-most diagnosed cancer in American men. Medical record collection from doctors and hospitals. Get a Second Opinion | Johns Hopkins Pathology feel the clock ticking. Surgeon wants next PSA in 3 months. I am relatively new to this forum and trying to educate myself as to my best course of treatment. Our team approach brings together highly experienced prostate cancer experts from across disciplines to collaborate on each patients total care, from diagnosis through treatment and recovery. An acute bacterial infection can cause a burning sensation. Y'all are in my prayers! It is OK to be scared. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. desired outcome. My question is--what importance do volume levels play in determining when to move from AS to treatment? Depending on your location, you may be able to have a telemedicine consultation. And thanks again for making this such a great support group! Overall PIRADS Score: 5/5 Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. I fear limiting myself to an inferior treatment because the people I talk to have hammers, therefore everything must be a nail. If anyone has used him, please let me know what your experience was like. An official website of the United States government. I am unfortunately "officially" joining the club after getting my biopsy results today. -------------------------------------------------------- Medical record collection from doctors and hospitals. Getting A Second Opinion On Your Pathology Report - Cancer ABCs Get a Urology Second Opinion | Johns Hopkins Brady - Hopkins Medicine And just this week, 1 YEAR post treatment, it is .46. It hasn't let me down. Two 1cc tumors, gleason score 3+4 each, one in each lobe. We are vaccinating all eligible patients. Perineural invasion is identified -------------------------------------------------------- Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of Unbelievable that this happened!!! Luckily, his report co-coincided with the original QDx report. As soon as pathology slides were ready, Emory sent them to Dr. Epstein at Johns Hopkins. 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. Through the AHN Cancer Institute, you benefit from personalized treatment in your community, close to home, from your dedicated care team. Johns Hopkins Medicine A commercially available genomic test may help oncologists better determine which patients with recurrent prostate cancer may benefit from hormone therapy, according to new research from the Johns Hopkins Kimmel Cancer Centerand 15 other medical centers. I then had the PHI test which showed PSA 8.70 and overall PHI 125.9. * Adjacent organ invasion: None. TRANSPERINEAL MRI GUIDED BIOPSY RESULTS 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. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. 2/13 PSA 5.2/fPSA 12.5% taken AFTER DRE (negative DRE) (lab #1) It was easy. * Location: Right, anterior, apex, peripheral zone Explore our state-of-the-art patient care facilities in the Sheikh Zayed Tower. A 1.4 cm lesion in the left, apex, anterior transition zone demonstrates conflicting T2 and DWI characteristics for PI-RADS classification - an indeterminate lesion. Given that some 3+4 is now evident, I can no longer say that all my PCa is all 3+3 and that I can stay on AS for an extended period. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. Who Should Request a Second Opinion? My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. My PSA went up from 3.5 post FLA (It was 7.2 pre-procedure) to 6.7 in 2021, so I went to another radiologist to do an MRI guided biopsy of the suspected area that was near the prior ablation zone. 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. Bookshelf Other labs for second . Metastasis. You feel healthy, you arent in pain, you Then about a month later I started 28 fractions of Proton Radiation.It was painless. My first PSA was 8.03. 2017 May-Jun;30(3):298-307. doi: 10.3122/jabfm.2017.03.160359. Background: Further, the two tumors in question have not really changed much in size for more than 2 years. Greatest dimension 2cm. Johns Hopkins Prostate Cancer Second Opinion 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. Cleveland Clinics Virtual Second Opinions program connects you to an expert physician who specializes in your specific health needs. 2020 Dec 1;3(12):e2028320. 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. the transition zone. However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. 4/16 3T MRI performed (reports/re-reads below) He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. Spent the night in hospital with very little pain after the first couple of hrs. A newly published paper by Fischer et al. Caused me to bleed heavily. Surabhi Dangi-Garimella, PhD. The results of Oncotype came back and it was a bad report. The review process normally takes several days, after which we will send your slides and other materials are returned. My experience at Johns Hopkins was awesome. Im currently 67 years old. Also indicated everything else was "organ confined." The total number of cores identified is 3 Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. 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. 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. 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. Thanks to all of you for sharing! Have been diagnosed with a serious or rare health condition. 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. They agreed with the PI-RADS 4. HHS Vulnerability Disclosure, Help With world-renowned expertise, multidisciplinary specialists and the latest data, we partner with you to make informed decisions about managing your prostate cancer. Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. These results, if validated in other studies, justify additional investigation on how second opinions can contribute to increasing the value of cancer care, the authors concluded. 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. Dr. Jonathan Epstein of Johns Hopkins University Hospital. We will then prepare a written recommendation regarding your treatment plans or options. 1. The primary goal is to be cured with the least toxic, most effective approach. 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. Studies show the clinical and financial benefits of obtaining a pathology second opinion. See this image and copyright information in PMC. Get directions, important phone numbers, locations and more. Metastatic disease considered less likely for this pattern. He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. Tumor Quantifications: The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. Request an Appointment 410-955-6100 Potentially inaccurate results can lead to selection of the wrong type of therapy. Would you like email updates of new search results? One core had 5%, one 20%, and one 40%. Reasons for obtaining a second opinion from urologists. 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. 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. Seminal vesicles are normal. Benign Processes: Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. Now its easier than ever to get the answers you need and peace of mind you deserve. Find more COVID-19 testing locations on Maryland.gov. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. Even if I go the radiation route, should I try for Proton radiation or some other type? Will these places of excellence consider me, or am I bound to my regular doctor for insurance purposes? - DCE = (+) Prostate dimensions: 4.1 x 2.8 x 3.4 cm We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. These findings are suspicious for degenerative changes however a subtle/early metastatic lesion cannot be excluded and continued periodic follow-up is recommended." In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. I am also not comfortable making a decision based upon 1 genomics test, when my other prior test(s) disagrees and the gleason score disagrees. I say bullshit to them. Johns Hopkins Health - Second Opinions, Second Chances - Hopkins Medicine A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. Prostate Cancer Grading: This may cause a conflict of interest between the patient and the HMO, especially if very expensive treatment is only available outside the HMO system. Due to the spread of the Coronavirus worldwide and the first confirmed case of the Coronavirus disease in Turkey, the executive team of the Anadolu Medical Center has taken preventive measures to protect the patients and their relatives. Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancer, Schaufeld Program for Prostate Cancer in Black Men, Read about the latest prostate cancer discoveries by our world-renowned researchers, Learn more about prostate cancer in our health library, Watch: What to expect during your post-surgery hospital stay. 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. I have completed an exhaustive research effort on Prostate Cancer and PCa treatments. 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. Second Opinions in Prostate Cancer - American Council on Science and Health (TZ) One suspicious area - lesion size: 2cm x 1.4 cm The out-of-pocket cost may be in the $300 range (insurance may not cover it), and it is a simple matter to call your urologist to forward the slides to them. Atrophy MRI obtained outsideon 04/16/2021. We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. I trust the second opinion Dr. Bush gave. Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. No definitive evidence of distant metastatic disease is seen." Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! We experienced information overload and decision/analysis paralysis. Dr. Erick Walser at University of Texas Medical Center. A PSA test at time of biopsy revealed my PSA had risen to 6.5. Of course that was before I found this webpage and I really didn't know what 1 core of 18 samples showing 3+4=7 Gleason meant. Good Day Everyone. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. I appreciate any comments or insight that anyone wants to share. 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.
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