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 Adenocarcinoma: Thanks for Everyone's Help, I've had what I would consider a fluctuating PSA since first tested in November 2018. Benign Processes: Thanks, Anyone with insight into this and advice? They hesitated calling it a TARGET LESION, but scored it PIRADS 4. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. - Perineural invasion is present Of these, 40% obtained second opinions, most commonly because they wanted more information about their cancer (50.8%) and wanted to be seen by the best doctor (46.3%). I suggest for all that hear, "you have cancer" that you seek more opinions! Based on this forum, Im very lucky for this outcome. Tumor Quantifications: The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! 1: Prostate, right lateral apex I choose surgery over radiation because you can do surgery and then radiation, but it is almost impossible to do it the other way around. The purpose of starting this discussion is to gather peoples thoughts and opinions and actual experiences with Prostate Focal Laser Ablation. Some specialists have more expertise and more experience than others. So I initially thought this makes me a good candidate for AS. I did ask some questions about the study, if anyone is interested. A biopsy was performed on 2/26. How important is Oncotype DX test for Gleason 7? Men have plenty of time to seek multiple opinions and thoroughly research each option before making a decision. Reinterpretation of imaging scans and lab tests. After extensive discussion of his management options with his local urologist, primary care physician, and radiation oncologist, he also sought a second opinion at the Johns Hopkins Prostate Cancer Multidisciplinary Clinic at Sibley Memorial Hospital.The patient expressed an overwhelming desire to avoid surgery and any other invasive treatments. Be well. I have selected Focal Laser Ablation as my future (soon) treatment. ZERO - The End of Prostate Cancer Support Community. 4/16 3T MRI performed (reports/re-reads below) My understanding is that brachy is great for efficacy with less risk to the bowel and the same risk for incontinence and ED as other forms of radiation. Question anemia. Dont Miss: Is Coffee Bad For Your Prostate. Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. Find more COVID-19 testing locations on Maryland.gov. So now things are getting exciting. I luckily found this webpage and I started reading everything I could get my hands on. However, that information will still be included in details such as numbers of replies. 2. So, I go one better, I call up Johns Hopkins and find a Dr who does DaVinci Prostate Surgery. 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. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. It didnt look at changes of grading of the cancer.The chances for some type of modification based on a second opinion are even greater than the study indicated.Asking for a second opinion could lead to a significant change in surgical or medical intervention, Netto says.Even if the diagnosis error isnt catastrophic, such as advising a patient that he has cancer when he really doesnt, an error in grading can be consequential. Cancer. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. In severe cases, a catheter may be required to relieve the symptoms. It may be a new cancer, but it is more likely a recurrence since it is really near the ablation zone. I had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. 180 days after treatment PSA was .50. I recently sent my Pathology Slides to Dr. Epstein for a Second Review. The TRUS biopsy is behind me, the second opinion from Johns Hopkins is behind me, and its time for next steps. Second opinion Biopsy came after FLA G-9. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. Contact us or find a patient care location. The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. Potentially inaccurate results can lead to selection of the wrong type of therapy. Reasons for obtaining a second opinion from urologists. Family history of prostate cancer. Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. 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. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. They told me to expect a spike in my PSA sometime in the future, and they told me that studies are showing that a slow, steady decline in PSA is often indicative of superior results (whatever that means. The local pathologist read the biopsy and said 3+4=7 10% pattern 4 for both lesions. Prostate, right medial base: I assume it is not free. 3. The presence of any G4 has been my trigger to seek treatment. One of the problems with second opinions is that insurers may not cover the expense. Note respondents were able to choose more than one reason. According to the doctor it is around 3 mm. MRI RE-READ #3 (National Cancer Center of Excellence): Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated. I could not get a definitive answer from them on how much, how many cells, or any information. 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.). The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. PSA that brought me to this was 7.1. Hillen MA, Medendorp NM, Daams JG, Smets EMA. My new Dr however didnt order PSA so I asked him for one. I was disappointed that only TRUS was being used, but I did find out that this was for screening only and IF you pass screeningthey use MRI guided biopsy for post-ablation follow up. Dont Miss: Bladder Control After Prostate Surgery. Race and ethnicity. Transition Zone: In the left base, mid and apical transition zone there is a large mass measuring 2 cm in size which has You may also complete an online appointment request form and we'll respond to schedule an appointment. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . While I now concluded we need to find "it", I researched the best approach to see what is really going on and to do this safely. 2 cores from left base of 3+4=7 with only 5% involvement. Prostate dimensions: 4.1 x 2.8 x 3.4 cm 2015 Feb;115(2):188-97. doi: 10.1111/bju.12665. The more often a doctor diagnoses and treats prostate cancer the more proficient they become. 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. A doctor may prescribe surgery or perform an endoscopic procedure. We are vaccinating all eligible patients. 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. :) 180 days after treatment PSA was .50. Before Suspicion for malignancy left anterior base-to-apex transition zone; A week later had catheter removed and had no bladder leakage problems. Please don't hesitate to make any observations or ask questions. Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. I worked out every day. With world-renowned expertise, multidisciplinary specialists and the latest data, we partner with you to make informed decisions about managing your prostate cancer. Diffuse probable benign peripheral zone changes limit evaluation for It hasn't let me down. Dr also stated he was able to totally spare one of my nerves, but to get margin may have damaged one. I'm going to reach out to UCLA to see what they can do. Treatment Advice: Sloans radiation oncologist says radiation treatment will likely be the same whichever pathologist report prevails, but may add hormone therapy for about 2 months. EDI am now 52 and not quite functioning like I did 4+ years ago. Lesions are all small or very small. Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care. Anyone else encounter something like this? Want confirmation about a diagnosis or treatment. We had the 3T MRI (no coil) and MRI guided biopsy at Sperling in NY, and then had a 2nd Opinion done by Johns Hopkins. Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. Im immediately referred to Urologist. 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. 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. Anything I am overlooking or need to add to my list of considerations? Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. - 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 There are also many reasons why you may want to seek another opinion during the course of your cancer care. As a result, patients struggle to differentiate bias from fact. Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) 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. Greenfield G, Shmueli L, Harvey A, Quezada-Yamamoto H, Davidovitch N, Pliskin JS, Rawaf S, Majeed A, Hayhoe B. BMJ Open. - 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 Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference, Why Prostate Cancer Survivor John Shearron Thinks Its Important To Do Your Research | PCRI, John Hopkins Prostate Cancer Second Opinion, a higher risk of developing uterine cancer, surgery may not always be necessary for all breast cancer patients, The cancer vanished in every single participant, Long Term Side Effects Of Brachytherapy For Prostate Cancer, treat rare and complex conditions through breakthrough fetal procedures, Prostate Cancer External Beam Radiation Side Effects, Can Enlarged Prostate Cause Blood Clots In Urine, Life Expectancy Stage 4 Prostate Cancer No Treatment, Prostate Cancer Spread To Skull Prognosis, Diagnostic Procedures For Prostate Cancer. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. Your doctor is not sure what is wrong with you. 9. Some men have minimal or no symptoms at all. Bookshelf He was right. One of the problems with second opinions is that insurers may not cover the expense. Either the patient or the primary physician can initiate the process of getting a second opinion. I am unfortunately "officially" joining the club after getting my biopsy results today. The percentage of tissue with carcinoma is 45% Primary Gleason grade: 3 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. Assessment categories for this lesion: Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. Types of questions that pathologists often address in our second opinions: 5. I wish the VA would be more informative about this disease they owe it to our veterans. 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. Unlike pathology labs in most hospitals, Jonathan Epstein's lab at Johns Hopkins has pathologists who specialize in reading prostate tissue samples. It is OK to not understand all the terminology. The researchers did not include more minor errors in rating how fast-growing and how advanced a cancer was. I have had a CT of the pelvic area - negative and a whole body bone scan - negative. When to move from Active Surveillance to Treatment for Prostate Cancer? HHS Vulnerability Disclosure, Help DIAGNOSIS: Some men may have an enlarged prostate but not notice it. 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. MRI June 2017 again at SMIL. This has only low-level nonspecific activity with SUV max of 2.05 and may be due to degenerative changes at the symphysis pubis." The total number of cores with carcinoma is 3 Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. My diagnosis is T2c, Gleason 7 (3+4). But in the spirit of disclosure for those of you with BPH a TURP can complicate a future Radical Prostatectomy (or possibly Cryo) and increase the risk of side effect risks. If I am rested, I find that I am more ready than if I am not. Over 80,000 specimen cases are seen at Johns Hopkins each year. doi: 10.1001/jamanetworkopen.2020.28320. Y'all are in my prayers! Just got my pathology results. I worked out every day. What are your opinions of what that is, and where to get it? - Perineural invasion is present 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. Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. This condition causes pain in the lower back and groin area, and may cause urinary retention. Surabhi Dangi-Garimella, PhD. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. More medical freakouts. I'd like to talk with former patients who have gone through the procedure. 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."
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