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Does every biopsy provide a Gleason Score? See this image and copyright information in PMC. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. 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. Seek Perspective from a Range of Specialists. More medical freakouts. What are you doing about it? Prostate cancer is a slow growing condition. Brief MRI history. Prostatic Adenocarcinoma !I'll try editing a previous post and see if it reads like a journal instead of creating a new thread every update.I just got my PSA results and the numbers are still trending in the right direction. Unbelievable that this happened!!! - High grade prostatic intraepithelial neoplasia (HGPIN) PREVIOUS MRI RESULTS (LOTS of them) When I read the forums and questions on this site everyone mentions their Gleason Score from their biopsy. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. 1. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. No two cases of prostate cancer are alike and an accurate diagnosisis critical to developing the best treatment plan. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). The linear amount of tissue with carcinoma is 23 mm 2/23 PSA 4.7/fPSA 12% taken for 4K score (lab #2) Should You Exercise When Youre Expecting? Seminal vesicles are normal. poorly defined margins and intermediate to low T2. Original Sloan Biopsy Results: 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. Some men may have an enlarged prostate but not notice it. If I am rested, I find that I am more ready than if I am not. 3/5 Dont Miss: New Treatments For Stage 4 Prostate Cancer. Seems like a simple request. I'm going to reach out to UCLA to see what they can do. 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. Thank you for your understanding and cooperation. The problem is that all 3 pathologies noted an intraductal component. 5. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. Johns Hopkins is home to many of the world's leaders in Pathology. 5: Prostate, left medial apex - High grade prostatic intraepithelial neoplasia (HGPIN) Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. Be sure to confirm your diagnosis at a center of excellence. This teamwork ensures the best possible patient outcomes. I suggest for all that hear, "you have cancer" that you seek more opinions! Both Drs and nurses knew what they were doing and had lots of experience. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. Reason was large volume of cancer (even though most of mine was Gleason 6), presence of Gleason 7 in biopsy and the rapidly increasing PSA. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasn't spread outside of the prostate. Find more COVID-19 testing locations on Maryland.gov. I've been on AS for two years after my initial TRUS biopsy showed 3 cores 3+3 (10% volume) on Right side, and 2 cores 3+3 on Left side. Has anyone sent Radiology (mpMRI) reports and images to Hopkins for Second Opinion Review? Youve just been diagnosed with prostate cancer. In 2006 my PSA was .6. * Perineural Invasion also detected Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. desired outcome. 1. Please enable it to take advantage of the complete set of features! IMPRESSION: If these do not work, your symptoms could progress and become chronic. For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. I have selected Focal Laser Ablation as my future (soon) treatment. I appreciate any comments or insight that anyone wants to share. A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. There is hope. After sending off all of our records, CD of MRI and path reports, my husband is booked for screening in December. Also indicated everything else was "organ confined." 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. 2. Call us with any questions: 410-955-2405, ext. I just turned 71 in February. In some situations, insurers will even insist on a second opinion. 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. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) I've tried to find out about Dr. Wong but there's very little info on him. The site is secure. Am I wrong? Unfortunately, monetary incentives create biases that can work against patients best interests. 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. Second opinion Biopsy came after FLA G-9. 1st opinion"Nonspecific sclerotic change of the right pubic bone with low-level radiotracer activity, favor degenerative change rather than osseous metastasis." 8: Prostate, left lateral base Bladder: Normal. I would appreciate hearing from that 2.8% out there who have an intraductal component. 3/3 4K score 19% (high end of intermediate) The lesion also shows focal increased permeability. 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. Perineural invasion is identified Have a condition that isnt improving or is getting worse, despite treatment. My diagnosis is T2c, Gleason 7 (3+4). But I refuse to sit still, I continue to research and to plan, as best I can. But I did speak to an oncologist who wanted to order Oncotype, which I did. Let me know what everyone thinks if you see anything interesting or of note here or just have some advice. Benign Processes: The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. I've had what I would consider a fluctuating PSA since first tested in November 2018. The treatment of prostate cancer has evolved tremendously. They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. __________________________________________________________________________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. PSA that brought me to this was 7.1. Expert review of your case by a Cleveland Clinic specialist. A blocked urethra can also damage the kidneys. I'm turning 58 in one week. Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. 2. -------------------------------------------------------- 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. How to Get a Second Opinion Our team at Johns Hopkins has a dedicated service to interpretation of brain tumors and render second opinions on a daily basis. 4. Prostatic Adenocarcinoma Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. I was diagnosed with a 3T MP MRI and a 3T MP MRI guided 4 core biopsy. - Benign prostatic tissue I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. The results were ambiguous. Most choose treatment they originally planned to follow, study finds. Your doctor is not a specialist in your type of . Hillen MA, Medendorp NM, Daams JG, Smets EMA. 2nd opinionBone Scan:"Mild increased activity is seen in the right symphysis corresponding to the abnormalities on the prior PET/CT examination. * PIRADS v2 Score: 5 Conflicting Prostate Biopsy OpinionsWhat to Do? He basically said it was possible, but that he did not agree. At a rectal exam 6/20 the urologist told me my prostate felt normal, not enlarged, nor did he feel any tumors. Adenocarcinoma: Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. Unfortunately, what you do not realize may harm you! Jonathan Epstein, MD received his doctorate from Boston University. 8. The only prescriptions I take are for GERD (Protonix), cholesterol (Atvorstatin), and allopurinol for an episode of gout that I got while doing physical rehab for a bad tibia break (I shattered my tibia plateau 2/2020 and have pretty much recovered). 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. If you're seeking a second opinion on treatment (see below), the specialist you choose often will be able to order a pathology second opinion for you, through his or her hospital's pathology department. MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): 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." Prostate Cancer Grading: If pain is present, a digital rectal examination will reveal hard areas. A. Prostate, right base, core biopsy: Based on the results, our experts can provide you with an individualized treatment plan before you leave. My new Dr however didnt order PSA so I asked him for one. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. Did robotic radical prostatectomy 1/25/12. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. For this study, published in the journal Cancer, 2386 men in the greater Philadelphia area, who were diagnosed with prostate cancer between 2012 and 2014, responded to survey questions. I had a 3T mp MRI with coil bed, without and with contrast, at Emory on March 3. This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. * Gleason Score: 4+5, Slide 4 (vs. Sloan's 3+4) The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. There were several areas of interest - but nothing in seminal vesicles, lymph, or bones. I had FLA done after first biopsy which staged me at 3+4 = 7. 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. Lesion 1: Left mid-base transition zone. * Sloan only sent partial cores, slides 1 and 4. Surprisingly, while one in nine men will get diagnosed with prostate cancer in their lifetime1, there are very few doctors who specialize exclusively in treating prostate cancer. Emotional outlook is fragile at times and straight clinical approach of doctors does not help. I retested in January 2019 and scored 4.20. The presence of any G4 has been my trigger to seek treatment. Advances in our understanding of breast cancer have opened up new treatment options or clinical trial opportunities, including targeted drug therapies and tissue-conserving procedures proven to greatly reduce pain and nausea. About 60% of prostate cancers occur in people older than 65. 8600 Rockville Pike Specimens Submitted: Possible additional organ confined malignant lesion in right apex I'm currently in the process of getting an appointment set up with a Dr. Wang at UCLA. 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. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. How much is the fee for an opinion of my recent MRI? The average age at the time of prostate cancer diagnosis is about 66. I guess the PET scan will be the next step in what type of treatment options are in store.Has this occurred to anyone else? 3. -------------------------------------------------------- If pain is present, a digital rectal examination will reveal hard areas. I am relatively new to this forum and trying to educate myself as to my best course of treatment. We are vaccinating all eligible patients. 4. SMIL radiologist reported nothing found. 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. 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. My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. Careers. Us Too Prostate is a great club and many of you have helped me a lot already. So I initially thought this makes me a good candidate for AS. BJU Int. J Am Board Fam Med. )As for side effectsI occasionally have some urgency/hesitancy having to pee. Advances in our understanding of breast cancer have opened up new treatment options or clinical trial opportunities, including targeted drug therapies and tissue-conserving procedures proven to greatly reduce pain and nausea. Ask your doctor for a copy of your complete medical record. And it is OK to have paralysis by over-analysis. Check Biopsy and Imaging Results for Accuracy. 6. 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. Hello, I apologize upfront for the length of this post, but I was recently diagnosed with prostate cancer (T2C) and figure more information is better than not enough. Good Luck and God Bless everyone. :) Federal government websites often end in .gov or .mil. At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Prostate Cancer Treatment: What to Know About Active Surveillance. I have posted here before, now with an update. With world-renowned expertise, multidisciplinary specialistsand the latest data, we partner with you tomake informed decisions about managing your prostate cancer. One to a 3+4=7 and the other to a 3+3=6. Maybe lycopene and pomegranate have helped. Y'all are in my prayers! Any input on this would really be appreciated. A second opinion is part of the education process that is critical for many cancer patients. 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. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. 10. A week later had catheter removed and had no bladder leakage problems. Also these lesions did not abut or touch the wall of the prostate. Some men have minimal or no symptoms at all. PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Considering Prostate Cancer Clinical Trials?