Learn More About Jonathan Epstein Md
Jonathan Epstein, MD received his doctorate from Boston University. Following his residency in anatomic pathology at The Johns Hopkins Hospital in Baltimore, Maryland, and a fellowship in oncologic pathology at Memorial Sloan Kettering Cancer Center in New York., he then joined the staff at The Johns Hopkins Hospital and has been there his entire career. At the Johns Hopkins Medical Institutions, he is Professor of Pathology, Urology, and Oncology the recipient of the Reinhard Chair of Urological Pathology and Director of Surgical Pathology. He is the past president of the International Society of Urological Pathology. Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. His most-frequently cited first or last authored publications is Pathological and Clinical Findings to Predict Tumor Extent of Nonpalpable Prostate Cancer, published in JAMA, which established the criteria for active surveillance. Learn more through his bio:
New Developments In Cancer Research
Progress in the field.In recent years, advancements in research have changed the way cancer is treated. Here are some recent updates:
Uterine cancer.Women who use chemical hair straighteners frequently could have a higher risk of developing uterine cancer than women who have never used the products, according to new findings from a national study that has followed nearly 34,000 U.S. women for more than a decade.
Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether.
Cancer vaccines.For a long time, the promise of cancer vaccines that would protect healthy people at high risk of cancer has only dangled in front of researchers. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic.
Rectal cancer.A small trial that saw 18 rectal cancer patients taking the same drug, dostarlimab, appears to have produced an astonishing result: The cancer vanished in every single participant. Experts believe that this study is the first in history to have achieved such results.
The researchers did not include more minor errors in rating how fast-growing and how advanced a cancer was. These so-called grading and staging errors are more common and can affect how aggressively a patient is treated.
Concept Of Faq Initiative
Centro Diagnostico Italiano , Milan, Italy
Manfred Dietel, M.D.Institute of Pathology Charité, Humboldt University of Medicine, Berlin, Germany
Jonathan I. Epstein, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD
Robert J. Kurman, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD
Elizabeth Montgomery, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD
Manuel Sobrinho-Simões, M.D.University of Porto, Porto, Portugal
Ronald S. Weinstein, M.D.University of Arizona, Tuscon, AZ
Franco VisinoniMilestone Medical Technologies, Bergamo, Italy
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A Meeting Of The Brightest Minds In Cancer
With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. Our regional community network integrates academic specialty cancer care at Allegheny General Hospital and West Penn Hospital and at more than 20 community cancer centers throughout the region.
Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. Through the AHN Cancer Institute, you benefit from personalized treatment in your community, close to home, from your dedicated care team. And collaborating with Johns Hopkins Medicine means we can provide you with second opinions, streamlined and guided access to clinical trials, and a proven track record of excellence in care.
Association Of Second Opinions With Treatment And Perceived Quality Of Care
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 . In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Receiving a second opinion was not associated with perceived quality of prostate cancer care.
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Who Pays For A Second Opinion
One of the problems with second opinions is that insurers may not cover the expense. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. In some situations, insurers will even insist on a second opinion. This is often the case when the primary physician advises an expensive treatment.
The best protection for cancer patients who are Health Maintenance Organization members is to seek a second opinion even if she or he has to pay for it. HMOs usually try to diagnose and treat patients within their system because the more money the HMO spends on second opinions and treatment outside the HMO, the less money there is available for operation costs and profits. 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. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. 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. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. 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.
People With Any Cancer Diagnosis Can Benefit From Getting A Second Opinion
Second opinions offer different things in different circumstances, Dr. Matasar says. 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. He adds that second opinions also can provide insight into topics like clinical genetics and family risk or issues related to complementary or integrative medicine approaches to manage symptoms.
For cancers that are less common, second opinions can offer more treatment options. In circumstances where there may not be a single established standard of care, we can ensure the treatment plan integrates the most current, up-to-date data, Dr. Matasar says. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different.
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Value Of Second Opinion In Prostate Cancer Uncertain Says Hopkins Study
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.
Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. However, a new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice or the persons perception of the quality of care they receive, at least among low-risk men. Therefore, the value of these second opinions remains unknown.
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. 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. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort.
These results, if validated in other studies, justify additional investigation on how second opinions can contribute to increasing the value of cancer care, the authors concluded.
Reference
Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . Cancer. doi: 10.1002/cncr.30412.
How Much Does A Second Opinion Cost
The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. This fee includes:
- Consultation with your nurse care manager.
- Medical record collection from doctors and hospitals.
- Reinterpretation of imaging scans and lab tests.
- Expert review of your case by a Cleveland Clinic specialist.
- Video consultation and written report from your expert.
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Just Because Youre Getting A Second Opinion Doesnt Mean You Have To Change Doctors
Patients are often under the mistaken notion that they have to pick between their oncologist and MSK, but thats often not the case, Dr. Matasar explains. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes.
However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds.
Medical Second Opinions Provide Peace Of Mind For Those Diagnosed With Cancer
If youve received a new cancer diagnosis or arent seeing results from your current treatment plan, an expert second opinion can help you move forward with confidence. With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3,500 specialists with extensive experience in all types of cancers. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home.
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Care For Women And Infants
AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. In the rare chance a baby needs highly specialized care, the team at Johns Hopkins is available to treat rare and complex conditions through breakthrough fetal procedures.
Our OB-GYNs, maternal-fetal medicine specialists, and pediatricians collaborate regularly with the Johns Hopkins team â getting second opinions and access to hundreds of clinical trials. This teamwork ensures the best possible patient outcomes.
To The Attention Of Our Patients Who Plan Admission To Our Hospital
First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. Due to the spread of the Coronavirus worldwide and the first confirmed case of the Coronavirus disease in Turkey, the executive team of the Anadolu Medical Center has taken preventive measures to protect the patients and their relatives. In order to give treatment for each patient with utmost security we would like to announce that currently there will be no visitors allowed.Please note that only one attendant per in-patients is permitted.
Thank you for your understanding and cooperation.
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Does Second Opinion Sway Prostate Cancer Patients
Most choose treatment they originally planned to follow, study finds
HealthDay Reporter
MONDAY, Nov. 7, 2016 — Second opinions have little impact on prostate cancer patients’ treatment decisions, new research suggests.
The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer.
Forty percent of the men obtained a second opinion from urologists, most often because they wanted more information about their cancer or wanted to be seen by the best doctor .
Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care.
The researchers also found that patients who obtained second opinions because they wanted more information, were seeking the best doctor, or had been encouraged to do so by family or friends were more likely to undergo surgery.
This suggests that for some men, second opinions offer a way to pursue the treatment they already planned on, rather than to explore other treatment options, according to study authors Dr. Archana Radhakrishnan, of Johns Hopkins University in Baltimore, and her colleagues.
The study was published online Nov. 7 in the journal Cancer.
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What Is A Second Opinion
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. Either the patient or the primary physician can initiate the process of getting a second opinion. 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. This doctor or team of doctors will review the following:
- Pathology report ,
- The physical condition of the patient
- The proposed treatment
The doctor then communicate their opinion regarding treatment to both the patient and the primary physician.
Second opinions are more likely to be comprehensive, or inclusive of every possible perspective, when performed in a cancer center with a multidisciplinary team, which usually includes surgeons, oncologists, radiation therapists, and sub-specialist oncologists.
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Association Between Patient Characteristics And Second Opinions
In unadjusted analyses, younger men , men with college-level education , and privately insured men and Medicare ) were more likely to obtain second opinions . In adjusted analyses, however, only age and education were significantly associated with obtaining second opinions from urologists. Compared to younger men, men 70-74 years old and men ⥠75 years were less likely to obtain a second opinion whereas men with college graduate level education or beyond were more likely compared to men with less than high school level education. Younger men were more likely to cite wanting more information about their cancer and to see the best doctor as the reason to seek a second opinion . However, older men â¥75 years were the least likely to report obtaining a second opinion due to dissatisfaction with their initial urologist. Men with a college education or beyond also were more likely to cite wanting more information about their cancer as a motivation for a second opinion .
Getting A Second Opinion On Your Pathology Report
Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. This is not true.
Pathology reports are subjective. They are not objective. Pathology reports are the opinion and interpretation of the individual pathologist viewing the tissue samples. 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!
Good pathology readings require experience and a high level of expertise. Some specialists have more expertise and more experience than others.
Some pathologists have more experience than others. Some specialize in reading only slides that come from a specific organ while others are generalists who read many different pathology slides from many different organ systems.
When you review your pathology report and are going to be making important decisions, like treatment decisions, which will be based on the information from the pathology report. Best practices dictate that you obtain a second confirmatory pathology evaluation. Obtaining a second opinion on your pathology report is no different than getting a second doctors opinion, it is a must for all of us.
The more accurate the information we have, the better our treatment decisions.
Remember if you ship them include the following information:
1- Your name
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Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. This condition causes pain in the lower back and groin area, and may cause urinary retention. Symptoms include leaking and discomfort. In severe cases, a catheter may be required to relieve the symptoms. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. If these do not work, your symptoms could progress and become chronic.
An acute bacterial infection can cause a burning sensation. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Patients may experience a fever or chills as a result of the infection.
Minimally Invasive Treatments For Prostate Cancer
We specialize in minimally invasive treatments for prostate cancer such as:
- Laparoscopic prostatectomy: The prostate is removed with a miniature telescopic instrument, which allows for a quicker recovery
- Robotic surgery: This breakthrough technology, which often is used for prostatectomy surgery, requires only a few small incisions
We place a high priority on sparing the nerves and tissue around the prostate whenever possible. This approach helps to decrease side effects that can affect a patientâs quality of life, such as erectile dysfunction, incontinence or other urinary-tract symptoms.
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A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.
While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.