Prostate Cancer: Do you need to have a second opinion…on the biopsy path report?

About the above picture…there is no way that Penelope could not be chosen for a calendar. Is she beautiful or what?

Second opinion on a prostate biopsy to be sure that a positive finding is indeed prostate cancer? Been there done that? What I did was to ask for additional stains to prove it was prostate cancer and not something else. The result? The pathologist found another area with the stains and a higher Gleason’s score and then I got the $2000 bill for my being “clever by half.”

In my opinion the answer is no. Pathologists see so much prostate cancer that it is an easy call.  They might disagree on the Gleason’s score but it would be rare for the cancer to missed or over diagnosed. Our office uses LabCorp and each report comes back stating that it had been reviewed by a Pathology Conference and that all were in agreement.

If your treatment decision hinges on the Gleason’s score or the volume of disease and it is important to you then by all means get a second opinion on the path. Easy to do. Just say you want it done and the slides are sent to institutions that commonly do this. In our area most are sent to Johns Hopkins. I personally have never seen a change in the diagnosis but it does happen I am sure.

I think  in some patients a confirmatory reading is comforting and in that case it is fine to do.

Now on a second opinion regarding treatment options? Hell yea! And I’d recommend a radiation therapist not another urologist…that is of course unless it is me.

Why me you ask?  Cause  ” I ain’t got no dog in this fight.” (Bias…that’s right I am a urologist and have no bias  in the decision that the patient makes and strongly encourage speaking to “another kind of doctor” about this.

How about a medical oncologist? I wouldn’t. These doctors are excellent but don’t as a rule see people who are newly diagnosed and trying to decide what to do. Great doctors and informed…yes. They just don’t see people at the time of diagnosis. Usually after the original treatment has failed and now the patient is hormone refractory. They will be helpful but I’d get the second opinion with someone who treats the “virgin” disease.