* Gleason Score: 3+4 (4 of 6 specimens), 14 specimens taken My urologist has decided we'll go ahead with the MRI due to the continued elevated PSA scores, in addition to the overall PHI score. 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. doi: 10.1136/bmjopen-2020-044033. A new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice among men diagnosed with low-risk prostate cancer. * Extracapsular extension: None. Medical record collection from doctors and hospitals. Also Check: Prostate Cancer Stage 7 Treatment. Suspicion for malignancy left anterior base-to-apex transition zone; 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. 3. The Journal of the American Board of Family Medicine published a study in 2017 that found that many patients do not get a second opinion outside of their PCPs original referral2. The people were great. NONE of the many radiation oncologists, surgeons or urologists I've spoken with in my journey have ever mentioned the term to me so I had to look it up. 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. Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. The results were ambiguous. have no symptoms, and yet you have cancer? How much is the fee for an opinion of my recent MRI? I asked the urologist who did our Second Opinion at Johns Hopkins and although he thinks RP is the way to go (due to higher PSA of 10.18), he highly recommended Dr. Eggenger (Chicago). Since I have gotten so much out of this forum, I thought Id provide my story to help others. For all other cancer appointments, please call: 1-855-702-8222. We have a surgery date set up for the end of July at Johns Hopkins (our second opinion team).His stats:63yo, non smoker, 167lbs, Vegetarian/Vegan diet no other known health issuesWalks dogs for a living and cares for our small farmPSA 3.3 (Jumped from 1.6 in a year)Biopsy Scores 3+5, 4+3. A few weeks later and just before my meeting with my new Johns Hopkins Dr I get the second opinion results from both biopsy and MRI. 7. Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care. Seminal vesicles and other margins are negative for tumor. You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm My mind goes all over the place as to why this is. The survey asked the men if they had opted for a second opinion from a urologist following their diagnosis of prostate cancer, and the reasons for the second opinion. So, I asked the Radiologist if she will schedule one for me. Not all cancers are the same and not all treatment plans are absolutely clear. If these do not work, your symptoms could progress and become chronic. Benign fibromuscular stroma; no prostatic glands are identified For a second opinion on the results of your prostate biopsy, there is no place better to get one than from the well known prostate pathologist, Dr. Jonathan Epstein at Johns Hopkins. 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. Have a condition that isnt improving or is getting worse, despite treatment. I am doing one in 6 weeks, regardless. What are your opinions of what that is, and where to get it? Pathology reports are the opinion and interpretation of the individual pathologist viewing the tissue samples. - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length A week later had catheter removed and had no bladder leakage problems. The Johns Hopkins Brady Urological Institute is known around the world for its expertise in diagnosing and treating urologic conditions. 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. The margin of error is 1.4 percent, which is equivalent to 30,000 cancer diagnosis mistakes annually in the U.S. Of 6,171 biopsy slides sent since late 2008 for a second review at Johns Hopkins, pathologists disagreed with the diagnosis on 86 of them. Two 1cc tumors, gleason score 3+4 each, one in each lobe. Thank you! I am also doing a vegan diet with additional complementary substances. But if I include the 3+3=6 cores then 4 cores tested positive and that moves me into the basic teal category and no longer a strong candidate for AS. Jonathan Epstein, M.D. 1.Rebecca L. Siegel, Kimberly D. Miller, and Ahmedin Jemal, Cancer Statistics, 2019 CA Cancer J Clin. 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. In fact, additional biopsies revealed no additional cancer. 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. * Prostate size: 3.9 x 2.8 x 3. cm HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. 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. (I must say that those low numbers concern me a bit.) NOTE: THINK THIS LOWERS MY PSA DENSITY SOME IF MY GLAND ISN'T a 17CC PEANUT! Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. I would really love to hear from you. He said that JHs said that it was 2 cores, but it was actually a fragmented core, that the fat did not present on the right place on the slide, that prior FLA (partial hemi-ablation) could affect the results, the MRI did not support, etc. PSA that brought me to this was 7.1. 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. Greetings gentlemen! One to a 3+4=7 and the other to a 3+3=6. Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. Original Sloan Biopsy Results: 4: Prostate, right medial base Especially opinions other than those of the first Urologist you see. 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." Noted that some don't even include on report and should be looked as something to note but not obsess about. Shore ND, Karsh L, Gomella LG, Keane TE, Concepcion RS, Crawford ED. Using an Ellipsoid Volume the dimensions would give you a volume of 20.44. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. 2nd opinionBone Scan:"Mild increased activity is seen in the right symphysis corresponding to the abnormalities on the prior PET/CT examination. The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. 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. You think your doctor is underestimating how serious your cancer is. feel the clock ticking. Greetings gentlemen! Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. 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. I luckily found this webpage and I started reading everything I could get my hands on. * Prostate volume: 22 cc not hear all the viable treatment options or receive the most up to date Cancer. Reasons for obtaining a second opinion from urologists. -------------------------------------------------------- It is not uncommon that two different pathologists looking at the same slide come to a different interpretation and opinion about what is in their microscope! My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. I did a book review with his first book for several veterans groups including the Americal Division Veterans Organization which with I served at age 19. A blocked urethra can also damage the kidneys. Secondary Gleason grade: 3 2. A PSA test at time of biopsy revealed my PSA had risen to 6.5. I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. 1. 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 . T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive If a targeted biopsy is planned, this lesion can be sampled at the same time. Receiving a second opinion was not associated with perceived quality of prostate cancer care.