My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. 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. Out of 12 cores, 9 are positive. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. Am I wrong? official website and that any information you provide is encrypted In 2006 my PSA was .6. doi: 10.1001/jamanetworkopen.2020.28320. A man with a father or brother who had prostate cancer is twice as likely to develop the disease. Suspicion for malignancy left anterior base-to-apex transition zone; Immediate means 6 weeks just to see his NP. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. J Am Board Fam Med. * Extracapsular extension: Possible involvement of the anterior The Radiation Oncologist said he would be comfortable waiting a little more, but he wasn't confident that I'd grow a target lesion, nor would I be able to wait years before having to do "something." According to The National Institute on Aging, prostate problems are common after age 50. The percentage of Gleason grade 4 and/or 5 is 5 % Therefore, the value of these second opinions remains unknown. Low volume post-void residual urine is present in the bladder. - Benign prostatic tissue * Size: 1.1 cm Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. You may also complete an online appointment request form and we'll respond to schedule an appointment. For all other cancer appointments, please call: 1-855-702-8222. A second opinion can accomplish a number of things. Patients may experience a fever or chills as a result of the infection. Unfortunately, what you do not realize may harm you! Now, I would like to send Radiology for a similar review. 4/16 3T MRI performed (reports/re-reads below) Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. The linear amount of tissue with carcinoma is 23 mm -------------------------------------------------------- * Adjacent organ invasion: None. 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 other words, the cancer is still contained within the prostate. I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. 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. (PZ) - normal Medical record collection from doctors and hospitals. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. Overall my PSA is between 4 and 10. It is best to begin by talking with the doctor who made your initial prostate cancer diagnosis. Now its easier than ever to get the answers you need and peace of mind you deserve. undefined will no longer be visible to you including posts, replies, and photos. If they have an enlarged colon, their physician can perform a TURP procedure. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. the transition zone. 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. FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. Dr. Erick Walser at University of Texas Medical Center. Does every biopsy provide a Gleason Score? 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. Careers. Getting a second opinion from us is easy, convenient, and all done remotely. At this time, I am leaning towards Active Surveillance or FLA. AS would be my choice, except that a total of three lesions, on both sides of Peripheral Zone, makes this controversial. MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of 2016 American Cancer Society. If they have an enlarged colon, their physician can perform a TURP procedure. Also Check: Prostate Cancer Stage 7 Treatment. I really liked the new group I went to as they identified the lesion right away, unlike the radiologist who performed the first procedure, and they also have a urologist on staff as well monitoring everything. That's the good news. As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. I wish the VA would be more informative about this disease they owe it to our veterans. information. * 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. You receive a secure, private online consultation without leaving home. And thanks again for making this such a great support group! John. For cancers that are less common, second opinions can offer more treatment options. Dont Miss: New Treatments For Stage 4 Prostate Cancer. This is why the prostate is important to the body. You May Like: Best Treatment For Intermediate Prostate Cancer. FAX 310-574-4002 I frequently make a 2 hour car ride and I have to stop about 25% of the time and when I don't, the urgency is a bit more evident and with the urgency come some hesitancy, but not terrible. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Methods: The .gov means its official. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 2 of 2 cores (combined: 10.5 mm, 40%), 0.2 mm to the blue inked tissue edge Through the AHN Cancer Institute, you benefit from personalized treatment in your community, close to home, from your dedicated care team. Those readings were reported on a second opinion by Dr. Epstein. I'm trying to figure out why the PSA keeps rising. The review process normally takes several days, after which we will send your slides and other materials are returned. Best practices dictate that you obtain a second confirmatory pathology evaluation. Seek Perspective from a Range of Specialists. doi: 10.1136/bmjopen-2020-044033. Required fields are marked *, PHONE 310-827-7707 I suggest for all that hear, "you have cancer" that you seek more opinions! Unbelievable that this happened!!! Did robotic radical prostatectomy 1/25/12. PELVIC LYMPH NODES: No adenopathy. Cleveland Clinics Virtual Second Opinions program connects you to an expert physician who specializes in your specific health needs. I was on disability from work the entire time (not that I was disabled, but as a pilot, I couldn't very well work and get treatment at the same time. 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. The percentage of tissue with carcinoma is 45% He also said I would tolerate any option well based on my age and health. The lesion also shows focal increased permeability. Do I need a third opinion? I retired as a Dentist at the VA and saw many veterans with a wide range of outcomes as most of them became 100% service connected when diagnosed with prostate Ca due to exposure to Agent Orange if they served in Vietnam. A second review of Pathology more frequently also brings changes to the cancer grade or stage, which can affect prognosis as well as therapy. Other: There is trace ascites in the mesosigmoid. The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. Not all cancers are the same and not all treatment plans are absolutely clear. He never sought treatment for the injury. Thanks, BigD. I have had a CT of the pelvic area - negative and a whole body bone scan - negative. The https:// ensures that you are connecting to the PROSTATE LESIONS: 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. * Prostate volume: 22 cc - 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 I just turned 71 in February. After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. Second Opinions (Adults) For stem cell transplant, please call 1-773-702-1994. Us Too Prostate is a great club and many of you have helped me a lot already. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night. Be well. He basically said it was possible, but that he did not agree. Background: How much is the fee for an opinion of my recent MRI? Anyone with insight into this and advice? Because I had an implant in my ear, they would only give me a 1.5T MRI. It is still important to do your own research. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could have a significant impact on treatment and prognosis. 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. It is OK to be overwhelmed with info. A doctor may prescribe surgery or perform an endoscopic procedure. Reinterpretation of imaging scans and lab tests. I have completed an exhaustive research effort on Prostate Cancer and PCa treatments. MY THOUGHTS AND ANYTHING DOCTOR NOTED: Prior to the results, the oncologist said that the literature shows that a 3+4=7 with less than 5% pattern 4 behaves just like a 3+3=6 and basically is an indolent tumor. Got my physical and normal DRE with new Dr. No issues identified. Confirm biopsy and imaging results with centers of excellence before making any final decisions. First let me just say what so many others have previously stated, the thought of going on this journey alone is frightening, I cant imagine traveling this road alone. You can find out by reviewing your plan or by reaching out to your insurance company. 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. 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. I made the appointments. Lymph nodes: There is no suspicious lymphadenopathy in the pelvis. It starts many years ago. Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. 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. Some pathologists have more experience than others. A PSA test at time of biopsy revealed my PSA had risen to 6.5. No one at Hopkins has ever died of prostate cancer if he had Gleason 3 + 3 cancer." * Seminal vesicle invasion: None. 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. Heres What You Need to Know, Prostate Cancer Spotlights in 2020: A Year in Review, Find out about PSMA PET Imaging on Prostate Pros Podcast. 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. prostate volume). FLA DONE AT FIRST BIOPSY G- 7. It was easy. 6 cancers that are the toughest to diagnose are prostate, bladder, head and neck, soft tissue, skin and lymph system. Four had 60-70%, five have between 5-10%. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). Wow, I sound like a snob now! One Johns Hopkins study showed that out of 14,000 men who had surgery and were found to have Gleason 6 cancer confined to the prostate, "zero of those 14,000 men had lymph node metastases. -------------------------------------------------------- Thanks to all of you for sharing! The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. Using the Bullet Volume gives you gland of 25.55. Diffusely decreased The peripheral zone has a patchy signal pattern. Epub 2010 Oct 20. Im immediately referred to Urologist. Experts believe that this study is the first in history to have achieved such results. The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. One of the bits of advice the group regularly dispenses is for men to get a second and even a third opinion if you have doubts about the first opinions rendered by your urologist, or your pathologist, or your radiologist, its always okay to seek out a second opinion. TRANSPERINEAL MRI GUIDED BIOPSY RESULTS 5. Assessment categories for this lesion: So the pathologist suggested a second opinion. 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 . 6. The biopsy took 3 samples from the targeted region plus 16 sextant. ORIGINAL MRI REPORT (local radiology group): 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. These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasn't spread outside of the prostate. 4, Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion. Good Luck and God Bless everyone. I was offered to have my first biopsy sent to Johns Hopkins for second opinion and said why not? which came back with Gleason 9 three weeks after having the what we thought was G-7 ablated. Lesions are all small or very small. This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. ---------------------------------------------------------- Prostate, right medial apex: After applying exclusion criteria, the final analytic cohort included 2365 respondents. Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. Shore ND, Karsh L, Gomella LG, Keane TE, Concepcion RS, Crawford ED. How important is Oncotype DX test for Gleason 7? Anything I am overlooking or need to add to my list of considerations? Two things you learn here is get a second opinion from Johns Hopkins on biopsy and get treated at Center of Excellence. - DCE = (+) Spent the night in hospital with very little pain after the first couple of hrs. And it is OK to have paralysis by over-analysis. Both Drs and nurses knew what they were doing and had lots of experience. 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. Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. MRI RE-READ #3 (National Cancer Center of Excellence): FOIA 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). Netto says patients should be proactive in requesting that doctors take another look. * PIRADS v2 Score: 3 Johns Hopkins Medical Laboratories 1620 McElderry St. Reed Hall Rm 315 Baltimore, MD 21205 Fax (410) 614-7712 Phone (410) 955-2405 8 am - 5 pm Normal LAB hours are: 5:30 am - 4:30 pm Mon-Fri Request an Appointment 410-955-6100 He wants me to begin the ADT around 5/1. Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. * Both Sloan and Johns Hopkins admit that large discrepancies are unusual, yet both stand by their opinions. I have actually had a second opinion a while back from Dr. Bush. 2020 Jul 21;19(1):112. doi: 10.1186/s12904-020-00619-9. Benign Processes: 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. 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. Get a Second Opinion What can a second opinion tell me? If these do not work, your symptoms could progress and become chronic. Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. They won't be offended, and they may even be able to recommend a specialist for you to see. and transmitted securely. 1. My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. I then had the PHI test which showed PSA 8.70 and overall PHI 125.9. This has raised some questions on all the scans so far. You May Like: Prostate Cancer External Beam Radiation Side Effects. However, something is driving my PSA. Benign Processes: 24.5 BMI Johns Hopkins said I have options of adjuvant radiation approach up to 3-4months or wait to see if there are two successive rises in PSA and then do "salvage" approach. I talked with Dr. Epstein who expressed Johns Hopkins' conservative views to not underestimate GS 6 and to consider surgery and/or radiation that have been used successfully for many years in saving lives. TZ zone more beneficial, but fairly large compared to whole gland and proximity to capsule edge would likely mean treatment would be suggested.