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. An acute bacterial infection can cause a burning sensation. His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. A second opinion can help you make an informed, confident decision about your medical care. * IF ANYONE reading this doesn't believe in the value of MRI first and targeted biopsy next then take note that my systematic biopsy cores showed 0 positive in 8 cores and my MRI guided core samples were 6 for 6 being positive! Cancer. 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. Prostate volume: 17.58 cc Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. Some specialists have more expertise and more experience than others. 2. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. I was diagnosed with a 3T MP MRI and a 3T MP MRI guided 4 core biopsy. 4. However, he also said it's treatable even at a 2cm size and the transition zone is a favorable spot. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . Getting a second opinion from us is easy, convenient, and all done remotely. FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. Over 80,000 specimen cases are seen at Johns Hopkins each year. Whether you want expert confirmation, lack understanding or confidence in your treatment plan, have a rare or unusual type of cancer, your cancer isnt responding to current treatment its reassuring to know that you have options through a second opinion. - DWI-ADC = 4/5 About 60% of prostate cancers occur in people older than 65. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. 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. John. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. MRI obtained outsideon 04/16/2021. 2. Over kill and redundancy I know, but it's my money, my prerogative. When first diagnosed with prostate cancer, your PCP will generally refer you to a urologist for a biopsy. We experienced information overload and decision/analysis paralysis. Without your support, I could easily have subjected myself to random biopsies that are risky, don't do a good job of finding lesions, and can mess up the clarity of the prostate for an MRI. 3. Covid turned the 1 year into 16 months and PSA tested at 7.44 in August 2020, followed by another referral back to the urologist. Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. Let me know what everyone thinks if you see anything interesting or of note here or just have some advice. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. Will these places of excellence consider me, or am I bound to my regular doctor for insurance purposes? Hopkins states that the one positive core (10% G6) was visualized by the MRI, so I am hoping that this increases our chances of making it through the screening process. Netto says patients should be proactive in requesting that doctors take another look. Benign Processes: Get a Second Opinion I also sent my biopsy slides to Johns Hopkins for a second opinion (Epstein's read was 3+4, but with lower pattern 4 involvement than the local pathologist.). and transmitted securely. 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. - Benign prostatic tissue He spent an hour on the phone reassuring me that I didn't need to rush into anything, and they he'd love to scan me 6-8 weeks after my TRUS Biopsyhave to let the trauma and all the blood leave the prostate for a good image. official website and that any information you provide is encrypted 7. - DCE = (+) I officially joined the club with diagnosis on March 21: three small lesions with a GS 6 on one side and both a GS 6 and a GS (3+4) 7 on the other side. Good pathology readings require experience and a high level of expertise. Methods: * Location: Right, anterior, apex, peripheral zone 2. The neurovascular bundles are intact. T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive 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. peripheral zone signal intensity on T2-weighted images. 5: Prostate, left medial apex 3. When people recommend going to a Center of Excellence, believe them. Total Gleason score: 7 - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. Benign Processes: * Size: 1.5 cm Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results. Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. BASE DATA: They replied they are sending the slides but they said they're looking into the DX test and will get back to me once they have that information. PROSTATE ADDITIONAL FINDINGS: Benign prostatic lesion. Targeted MR/Fusion biopsy of one 4x8 mm lesion on Right side showed 3+3 in 2 of 5 cores (20% of total volume), and random Right side: 1 core 3+4 (10%, 20% on second opinion from Johns Hopkins) and 1 core 3+3 (10% volume) ; Left Side 1 core 3+3 (10%, no PCa on second opinion from Johns Hopkins). Usually, patients obtain a second opinion after being referred to a second physician or to a special team of experts in a cancer center, called a multidisciplinary team. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. 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. Prostate, left lateral base: 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. Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. (I think that it was easier to see because Mayo's MRI technology and procedures are better than SMIL's.) It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. Is there such a thing as having a team that isnt equipped with the best equipment nor the most experienced radiologists? A man with a father or brother who had prostate cancer is twice as likely to develop the disease. In fact, additional biopsies revealed no additional cancer. Either the patient or the primary physician can initiate the process of getting a second opinion. Know Your Stage. doi: 10.1136/bmjopen-2020-044033. An official website of the United States government. Brief MRI history. Your doctor is not a specialist in your type of . government site. A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. A PSA test at time of biopsy revealed my PSA had risen to 6.5. Dr. Nour is 100% sure that nothing has spread. The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. Prostate Cancer | Johns Hopkins Brady Urological Institute Dr. Nour - Emory in Atlanta. Cancer patients are encouraged to obtain second opinions before starting treatment. Our regional community network integrates academic specialty cancer care at Allegheny General Hospital and West Penn Hospital and at more than 20 community cancer centers throughout the region. Two weeks later I meet with my Johns Hopkins Dr. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. There are so many different departments at Hopkins that I don't know the optimal department to contact. Bring All Labs/Notes to Each Appointment. Prostate, right lateral base: 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. BONES: No suspicious osseous ORIGINAL MRI REPORT (local radiology group): - 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 Second opinions offer different things in different circumstances, Dr. Matasar says. 6. The ADT has daunting side-effects but he said offers some improved chances of eradication, any long-term downsides that I should consider? Some men may have an enlarged prostate but not notice it. And in some cases, the information you gain during a second opinion consultation can even change your diagnosis. My PSA over time has been creeping up over time (1.8 - 5/16, 1.0 8/17, 2.68 8/18, 2.9 12/18, 3.28 2/19, 3.01 8/19, 3.65 2/20, 3.31 6/20, 3.88 12/20) but I was frankly a bit shocked when I received word that I have cancer. Careers. Biopsy in 12/27/11 showed 3/14 cores, Gleason 6 with PSA of 4.5. 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. And when I attempt to ask questions about intradcutal, I get responses about how little is known about it because it's so rare or that it is controversial or that they're not familiar with the study I'm referencing. Secondary Gleason grade: 3 If they have an enlarged colon, their physician can perform a TURP procedure. PREVIOUS MRI RESULTS (LOTS of them) Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. Bookshelf Natural history of progression after PSA elevation following radical The more often a doctor diagnoses and treats prostate cancer the more proficient they become. 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. Got my physical and normal DRE with new Dr. No issues identified. However, something is driving my PSA. 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. After a little experimenting I have been able to achieve a partial erection. It took me awhile but minutes ago received my second opinion from Johns Hopkins. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. Grade Group: 2 The issues in my prostate from the first procedure onward have all been in the same area and the rest of my prostate from the first biopsy and subsequent MRIs onward have never shown any indications of cancer in other areas. 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. For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. I'm currently in the process of getting an appointment set up with a Dr. Wang at UCLA. I have completed an exhaustive research effort on Prostate Cancer and PCa treatments. When I was diagnosed I really thought that I will live only 2 years. I have developed an "abscess" on my prostate. * Extracapsular extension: None. My only concerned was heavy metal poisoning and didn't know how long AS would be beneficial since I was starting at a young age. Symptoms include leaking and discomfort. Prostate Cancer | Johns Hopkins Medicine Perineural invasion is identified 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. John, I was diagnosed on 11 December, 2013. They confirm everything except question whether one of the core samples is a 3+3 or 3+ 4. Am I missing anything? Some pathologists have more experience than others. 1. 2 cores from left base of 3+4=7 with only 5% involvement. I luckily found this webpage and I started reading everything I could get my hands on. Forty percent of the men obtained a second opinion from urologists, most often because they wanted more information about their cancer or wanted to be seen by the best doctor .