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Re: Referral suggestions? - Johns Hopkins or in this vicinity
Here's the information. To be clear, I'm not looking to get an opinion on which therapy to pursue, but rather which physician to consult.
FRANK SAID - the following information would be helpful: 3 + 3 gleason score 3 of 13 needles, all 13 P504S results were at least FAINT or greater (more positive)
biopsy results 3.55, increase from 2.4 PSA 56 age Dr. Clark, Geisinger MD - who recommended surgery
Re: Referral suggestions? - Johns Hopkins or in this vicinity
Chris,
John Hopkins or Sloan Kettering have excellent reputations. I live up in Canada so haven't been to either of them. I did ask for and got referred to a prostate center and not a specific doctor. At any of the Prostate Centers you will probably get put on a "converyor belt" of seeing a bunch of different experts and probably at least one world class expert during your visit. In the end they will give advice and ask what you want to do.
I would strongly recommend active surveillance (AS)and they probably will give that as an option. If they don't give you that option then they probably know something more. I haven't heard of the P504S test in a standard pathology report so in your case it might mean that they didn't diagnosed cancer initially or they think there is something unusual in your case. The fact that it was faint would make me think that your cancer is very low threat.
The reason AS is a getting to be a better option for very low threat PC like yours is that treatments like vaccine therapies are now becoming available, so possibly within 5 years you could get a cure with no side effects.
Re: Referral suggestions? - Johns Hopkins or in this vicinity
Chris,
You say you have decided on surgery and do not wish to discuss any other options, so I will respect that, despite my personal views on what might be a better option.
I was interested to see your comments on the P504S test - one of which I was unaware until now (you truly do learn something new every day!). One of the studies I found was P504S immunohistochemical detectionand I found it interesting to read that (my emphases}:
In 81 of 377 (21%) foci of benign prostatic tissue there was staining that was almost always focal, faint, and noncircumferential. .......Circumferential luminal to subluminal and diffuse cytoplasmic staining is the most specific staining pattern for prostatic carcinoma and is almost never associated with benign prostatic tissue.
If you had faint staining and it was focal and noncircumferential (whatever that may mean) then the chances seem high that prostate cancer may not be an issue. For this reason I would strongly suggest that you have your biopsy results read by an EXPERT PATHOLOGIST
If you are close to Johns Hopkins it would seem logical to use Jon Epstein and his lab and to consult the expert surgeons there if the pathology second opipnion still shows that surgery is your best option.
Re: Referral suggestions? - Johns Hopkins or in this vicinity
Regarding the Immunohistochemistry results (p504s), as I said, all were faintly positive or greater. Of the 8, three were positive, 3 were focally positive, two were "faint positivity.
Thanks for the update on the A/S suggestion. There are other, fairly sound reasons for recommending surgery vs A/S - prostate size (50cc), frequency of urination, age/health, etc.