Sounds like Hopkins was your second opinion. Was that before or after Dr. Epstein went on leave in May? Did the results agree with those from Mayo in Jax?
I'm not a doctor. But I would probably leave things alone if the results match.
If they don't you might consider Dr. Ming Zhou or ask his advice.
Some patients were upset and concerned after the news involving Dr. Epstein came out in May. My understanding was Hopkins offered patients another read of their pathology results to reassure them.
Epstein was on leave. Matoso is a highly regarded Pathologist and Urologist. No the report was different, infact we just spoke again this last Friday by phone. Mayo's pathology doesn't provide the details needed to make good decisions, because they are general pathology and don't specialize. JH's report included the grade grp 4 percentage which is what you need to make an informed decision regards AS. They make determinations about cribriform morphology which is also needed, I asked Matoso about why other centers don't offer the detail and he said its because they dont specialize in it; at JH that is all they do is prostate analysis and pathology, so they know exactly what they are looking at. So in my 3+4 G7, my grade group 4 was less than 5%, and I was super happy to hear this.
I also learned that the majority of these other pathology reports that have a percentage as part of the Gleason score is actually the volume of tissue that is recovered from the core itself and Not a Grade grp 4 percentage, as an example- Gleason 3+4 =G7 with 60% of one core. When it should actually read, Gleason 3+4=G7 with 60% of one core, & 10% or less of Grade group 4 identified. That is why it is so important to get a second opinion at a center that has a prostate specialty group. I recently brought this up on a FB post, and Dr. Bert Vorstman agreed with my explanation, and I learned that from Dr. Matoso at John Hopkins.
I used Dr. Andres Matoso at John Hopkins for a second opinion (the original pathology was from Mayo Jacksonville), his secretary said he worked under Epstein. Should I resend this to Tufts and Dr. Ming??
I have made an arrangement with one of the top uro-radiology experts. I am trying not to overwhelm him. He's willing to give second opinions. All he asks is that a donation be made to his university program.
Saw interview with Dr. Mark Scholtz regarding importance of second opinions of MRI, as well. Specifically by a radiologist experienced in reading scans of prostate.
I have the disk. Howard, are you aware of who might provide this? I checked with JH but (at least according to information I received) they only provide 2nd opinion on biopsy not MRI. Thanks!
Howard, Thanks for a much needed post. Sorry it took so long for me to read it. I hope the 'Epstein Mystery' will soon be solved and results brought to light. Once more men dealing with the stress and pressure of PCa find another another burden to bear. mason
Sometimes expert pathologists downgrade--or upgrade--Gleason scores. Be aware if there are extra findings such as cribriform. Based on what you say, you could be a candidate for surveillance even if that small 3+4 is confirmed. Ask Dr. Zhou. If you are comfortable with this, please do share your experience and findings with me. howard.wolinsky@gmail.com
Thanks, James. Be sure to discuss your case personally with Dr. Zhou. Zhou, like the Hopkins group, will talk directly to patients and offer recommendations.
I'm sending my slides to Dr. Zhou. My original diagnoses were out of 17 cores taken, 3 x 3+3 and 1 3+4 at 5%. what if it's really 3+3. I'll see in a year with next biopsy, I guess.
Howard, thanks for your response. No cribriform pattern or perineural invasion identified. I spoke with Dr. Baraban at Hopkins. He did not recommend treatment plan. Probably should have asked him but I limited discussion to what was included in written report.
First pathologist is general pathologist as far I can tell. Do not see anything in his credentials that would indicate uropathologist and do not see any indication that hospital is a Center of Excellence.
No family history of PCa. Had Genomic Prostate Score of favorable intermediate risk, GPS 41 after first biopsy (oncotype DX).
Have not participated in Promise study but would like to. Can you share how to join/register?
A newly diagnosed patient wrote to ask if he should be concerned that Dr. Epstein is sidelined. He went out of his way to have Dr. E. read his slides.
I reassured him he was in good hands at Hopkins.
Then, he told me "The admin person at Epstein's office gave me her unsolicited advice of: Don't spend too much time reading about Gleason 6/Prostate Cancer."
I see her point. I know some patients want to learn as much they can about their diagnoses. Others don't.
But jeez. I recommend that patients go to Hopkins, and the admin tells them not to read my newsletter? That hurts like a prostate punch or a DRE.
BTW, Dr. Epstein has been a subscriber and haS suggested topics to be covered in The Active Surveillor. So there. HW
Thanks for posting this. I may need a tiebreaker. I recently received 2nd opinion from Hopkins on biopsy that was done last month at my local hospital. Original diagnosis from my hospital: Gleason score 3+4 (10-20% Pattern 4). The opinion from pathologist at Hopkins: Gleason 3+3.
Spoke with pathologist at Hopkins who was very knowledgeable and patient in answering questions but I am left with conflicting results, nonetheless. In addition, experience matters and it would have been a plus to have Dr. Epstein as part of the review. I also have an upcoming consult with pathologist at my hospital who rendered first opinion but really expect the same information about different interpretation and judgement. The real decision will be treatment or not.
Howard, when you posed my question to Dr. Epstein during the webinar that you speak of regarding how I used the PSMA PET scan rather than have another MRI or biopsy he dismissed it out of hand. Imagine though what would happen to his business and that of urologists if the number of biopsy's produced during a year dropped in half.
Sounds like a good outcome.
If you feel the need for a 3rd opinion, suggest you reach out to Dr. Zhou.
Patrick,
Sounds like Hopkins was your second opinion. Was that before or after Dr. Epstein went on leave in May? Did the results agree with those from Mayo in Jax?
I'm not a doctor. But I would probably leave things alone if the results match.
If they don't you might consider Dr. Ming Zhou or ask his advice.
Some patients were upset and concerned after the news involving Dr. Epstein came out in May. My understanding was Hopkins offered patients another read of their pathology results to reassure them.
One of the docs there told me about this.
Does that help?
Howard
Epstein was on leave. Matoso is a highly regarded Pathologist and Urologist. No the report was different, infact we just spoke again this last Friday by phone. Mayo's pathology doesn't provide the details needed to make good decisions, because they are general pathology and don't specialize. JH's report included the grade grp 4 percentage which is what you need to make an informed decision regards AS. They make determinations about cribriform morphology which is also needed, I asked Matoso about why other centers don't offer the detail and he said its because they dont specialize in it; at JH that is all they do is prostate analysis and pathology, so they know exactly what they are looking at. So in my 3+4 G7, my grade group 4 was less than 5%, and I was super happy to hear this.
I also learned that the majority of these other pathology reports that have a percentage as part of the Gleason score is actually the volume of tissue that is recovered from the core itself and Not a Grade grp 4 percentage, as an example- Gleason 3+4 =G7 with 60% of one core. When it should actually read, Gleason 3+4=G7 with 60% of one core, & 10% or less of Grade group 4 identified. That is why it is so important to get a second opinion at a center that has a prostate specialty group. I recently brought this up on a FB post, and Dr. Bert Vorstman agreed with my explanation, and I learned that from Dr. Matoso at John Hopkins.
I used Dr. Andres Matoso at John Hopkins for a second opinion (the original pathology was from Mayo Jacksonville), his secretary said he worked under Epstein. Should I resend this to Tufts and Dr. Ming??
Suggestions for second opinion on prostate MRI? Any experiences with ndximaging, docpanel, or NationalRad for second opinions? Thank you!
I have made an arrangement with one of the top uro-radiology experts. I am trying not to overwhelm him. He's willing to give second opinions. All he asks is that a donation be made to his university program.
So write me at howard.wolinsky@gmail.com. and I can make the connection.
The exchange is strictly between you, the doctor and his program.
Thanks so much Howard.
Saw interview with Dr. Mark Scholtz regarding importance of second opinions of MRI, as well. Specifically by a radiologist experienced in reading scans of prostate.
I have the disk. Howard, are you aware of who might provide this? I checked with JH but (at least according to information I received) they only provide 2nd opinion on biopsy not MRI. Thanks!
Howard, Thanks for a much needed post. Sorry it took so long for me to read it. I hope the 'Epstein Mystery' will soon be solved and results brought to light. Once more men dealing with the stress and pressure of PCa find another another burden to bear. mason
Sometimes expert pathologists downgrade--or upgrade--Gleason scores. Be aware if there are extra findings such as cribriform. Based on what you say, you could be a candidate for surveillance even if that small 3+4 is confirmed. Ask Dr. Zhou. If you are comfortable with this, please do share your experience and findings with me. howard.wolinsky@gmail.com
Thanks, James. Be sure to discuss your case personally with Dr. Zhou. Zhou, like the Hopkins group, will talk directly to patients and offer recommendations.
I'm sending my slides to Dr. Zhou. My original diagnoses were out of 17 cores taken, 3 x 3+3 and 1 3+4 at 5%. what if it's really 3+3. I'll see in a year with next biopsy, I guess.
Bill, These pathologists can opine on AS vs. treatment.
I'm not a doctor. But did you have any additional information, such as whether you have cribriform pattern or other unusual findings?
Who did you speak with at Hopkins? Did the pathologist recommend AS or treatment?
Your first pathologist. Is he or she a uropathologist? Or a general pathologist? Is this at a Center of Excellence?
Do you have family history of PCa? Have you participated in the Promise study? Is a genomic test of your tumor in order?
You might need a tiebreaker. In my opinion, as a fellow patient.
Howard, thanks for your response. No cribriform pattern or perineural invasion identified. I spoke with Dr. Baraban at Hopkins. He did not recommend treatment plan. Probably should have asked him but I limited discussion to what was included in written report.
First pathologist is general pathologist as far I can tell. Do not see anything in his credentials that would indicate uropathologist and do not see any indication that hospital is a Center of Excellence.
No family history of PCa. Had Genomic Prostate Score of favorable intermediate risk, GPS 41 after first biopsy (oncotype DX).
Have not participated in Promise study but would like to. Can you share how to join/register?
Much appreciation for all you do.
I have heard good things about Dr. B. Glad that worked out.
I recommend that PCa patients sign up for the free Promise study at https://www.prostatecancerpromise.org/
This just in:
A newly diagnosed patient wrote to ask if he should be concerned that Dr. Epstein is sidelined. He went out of his way to have Dr. E. read his slides.
I reassured him he was in good hands at Hopkins.
Then, he told me "The admin person at Epstein's office gave me her unsolicited advice of: Don't spend too much time reading about Gleason 6/Prostate Cancer."
I see her point. I know some patients want to learn as much they can about their diagnoses. Others don't.
But jeez. I recommend that patients go to Hopkins, and the admin tells them not to read my newsletter? That hurts like a prostate punch or a DRE.
BTW, Dr. Epstein has been a subscriber and haS suggested topics to be covered in The Active Surveillor. So there. HW
Thanks for posting this. I may need a tiebreaker. I recently received 2nd opinion from Hopkins on biopsy that was done last month at my local hospital. Original diagnosis from my hospital: Gleason score 3+4 (10-20% Pattern 4). The opinion from pathologist at Hopkins: Gleason 3+3.
Spoke with pathologist at Hopkins who was very knowledgeable and patient in answering questions but I am left with conflicting results, nonetheless. In addition, experience matters and it would have been a plus to have Dr. Epstein as part of the review. I also have an upcoming consult with pathologist at my hospital who rendered first opinion but really expect the same information about different interpretation and judgement. The real decision will be treatment or not.
Over time, maybe this will happen. So maybe Dr. E. is getting out while the getting is good? Maybe pathologists are like blacksmiths back in the day?
Howard, when you posed my question to Dr. Epstein during the webinar that you speak of regarding how I used the PSMA PET scan rather than have another MRI or biopsy he dismissed it out of hand. Imagine though what would happen to his business and that of urologists if the number of biopsy's produced during a year dropped in half.