Urologist recommendation at Johns Hopkins

[nvidia-ati]

Hello All,

Many thanks for all the great advice and support on this great site. It encouraged me to be less stressed out and research more to understand this disease. My first biopsy indicated Gleeson 6 in one core out of 12. The second opinion at Johns Hopkins was not conclusive with the following statement from the patholgist: "Although these findings are highly atypical and suspicious for adenocarcinoma, there is insufficient cytologic and/or architectural atypia to establish a definitive diagnosis."

I would like to switch urologists to one at Johns Hopkins. Who would you recommend?

My TRUS biopsy was done in June 2023. How soon can I get an mpMRI and potentially MRI guided biopsy?

[Tall_Allen]

With that diagnosis, it is unlikely an mpMRI will show anything suspicious at all. The recommendation is usually to repeat the biopsy in 6 months.

[nvidia-ati in reply to Tall_Allen]

Many thanks for your comments, T_A. Do you have any doctors you would recommend at John's Hopkins? I need to leave my current urologist.

[Tall_Allen in reply to nvidia-ati]

Christian Pavlovich is the urologist in charge of the active surveillance program at Johns Hopkins. He would be a good choice for you, IMO.

[nvidia-ati in reply to Tall_Allen]

I will try to schedule an appointment with Christian Pavlovich. Thanks again.

[Murk]

I did research back in 2020 and picked Christian Pavlovich. Hid did my Robotic Prostatectomy, which after recovery, I was fully functional with no incontinence etc. He is the Director of Active Surveillance so his agenda is even keel.

I would suggest you separately visit with a radiation oncologist (RO) to gain their perspective.

For something like Prostate Cancer, research and stick to the best doctors and facilities. May I suggest Dr. Sean Collins (RO at Georgetown) for your second opinion.

[jackwfrench in reply to Murk]

Hi Murk - I am meeting with Dr Collins Monday, is he one of the best? I had RP 2021 and BCR here in 2023 with PSA maxed at 2.2 when I started Lupron and abi, but it bothers me I have a small lesion on right iliac and T10, and some small spots now on lower left sacrum that most ROs have said, "we don't radiate when there are multiple spots". I have met with Dr Tran at UMMC and he would radiate but Hopkins nor Sloan recommended radiation until I have PAIN. I am meeting with Dr Sean Collins on Monday to get a second positive opinion before starting into rad. I figure, if HT becomes resistant in just a few years why would we not also try to reduce burden with radiation? I also had Dr Allaf for RP, but he did not, in my opinion, warn me enough to take post op steps since, per my MO there, recurrence eventually happens to 33% of the patients - afterward you are scrambling like me!

[nvidia-ati in reply to Murk]

Thank you for your thoughtful comments and advice. I will look into scheduling an appointment with Dr. Sean Collins.

[Inspjones]

I second Murk's recommendations. Hopkins has one of the best urology departments in the world. I was successfully treated by Dr. Allaf (RALP) with no incontinence and sexual function back to baseline, but he has limited availability now that he has been promoted to director of the department. Good luck!

[nvidia-ati in reply to Inspjones]

Congratulations on your successful treatment. I appreciate your comments.

[EdinBmore]

Pavlovich was my uro for 7 yrs while I was on active surveillance. Alas, he did not recommended treatment until PSA was 23 and Gleason had changed to 3+4. And, he recommended Danny Song, a radiation oncologist, at Hopkins. I found Song to be one of the worst docs I've ever encountered. My non-Hopkins treatment included IMRT, brachyboost, and ADT (which was devastating for me). In retrospect, I do not think I would have had to suffer through those treatments if Pavlovich had not waited so long.

Bottom line, despite Hopkins' reputation, get second and third opinions from non-Hopkins docs.

EdinBaltimore

[Murk in reply to EdinBmore]

So sorry you had a bad experience EdinBaltimore. I often wonder if Active Surveillance is worth the wait and possible negative outcome. The waiting game would drive me nuts plus the younger you are, you would think the better your body can handle and recover???

[nvidia-ati in reply to EdinBmore]

You experience is most unfortunate. I am sorry it happened to you. I appreciate your advice looking for second opinion outside John's Hopkins.

[Murk]

I talked with Georgetown, Hopkins, and Fox Chase. I like Doc Sean Collins of Georgetown. I just completed PSMAS Scan and Aiming meeting is next week. I am talking to him this Monday as well. Radiation starts in early November. He is a no nonsense, friendly, great communicator and exudes confidence.

Research showed me that Collins & Horwitz are two of the best in the Mid Atlantic area. I got my second opinion from Doc Eric Horwitz. He is very innovative and leading in the treatment of PCa. But for me post RP, I didn't find it much different then Doc Collins credentials, plan and I don't have to drive 6 hours a day or stay over. BTW, Collins & Horwitz are friends and refernce back and forth.

Hopkins was my first choice but no one stood out for me personally.

[nvidia-ati in reply to Murk]

Good luck with your treatment.