Second Opinion?

I'm wondering if many of you have chosen to get a second opinion on your pathology slides and if so was it much different.

I have decided to get a second opinion. I'll be faxing the paperwork to send the stuff to Jon Epstein at Hopkins.

Mel

mel, what are you hoping it will show? if it is the same, then it wasn't needed. if its better, you can't undo what you have done. if its worse, which one do you believe, the better one or the worse one, or do you then get a third opinion and go for best out of three?

not being a wise guy, just trying to understand your thought process here. the bottom line is, your prostate is gone forever, along with the bulk of your cancer. what may or may not happen next, who can say? the jury is out. you still haven't had your first post surgery psa test yet, that will be your new base line, will make all your previous psa tests meaningless in a sense of the word.

i had thought about having mine read elsewhere, because i am suspicious that because of my positive margin, my quick recurrance, and my psa velocity both pre and post surgery, that i am really a stage 3, not a stage 2. but when i think through the process, i come back to the same choices i mentioned above to you.

you can't unscramble eggs as the country folk like to say. so for me, it is what it is, and i deal with one episode at the time.

you need to reach some point, perhaps not now, when you are not so consumed with all the "what ifs" in your case and in PC in general. I know its hard to do, but you can drive yourself crazy.

david in sc

I'm with the advice the guys are giving you. Information is either useful or not useful. If you can't do anything with the added information is is not useful. PSA and not the pathology will dictate your next steps.
JT

Yes x 3 Pre Operative Yes x2 Post Operative Learn anything …NO Do it again…Yes Hero

You all raised good points, mirroring my thinking. I was not going to get a second opinion, figuring that it will not impact any subsequent treatments. In fact, the only reason my biopsy got reviewed was because I had the biopsy done in one place (u. of Mich) and decided to have the surgery done in another place (Dr. Menon at Ford Hospital). They required a second reading.

However, Dr. Strum does urge very strongly that a second opinion be obtained. In my case, it is conceivable that a second opinion might result in a decision to do adjuvent radiation. It probably will not, but it might.

REGARDING cost, that is not an issue for me. I have good insurance that I THINK covers it (I have an inquiry in to them). If I read Dr. Epstein's site correctly, it is $200, but it might be more (one part was unclear). Regardless, Jeff, if I decide to do this and I have to pay the full cost, I would. But that is also a question related to personal finances, too.

David -- you said, "reach some point, perhaps not now, when you are not so consumed with all the "what ifs" in your case and in PC in general. I know its hard to do, but you can drive yourself crazy."

In a sense, you are correct. However, I would hope that every time I post a question, YOU do not conclude that I am obsessing about PC. I think I asked a very legitimate question and I got some interesting replies. 

Mek

 

Mel,

I would say if you are considering adjuvant radiation, then it can't hurt.  If you are adopting the wait until .5 routine, then it may be a questionable exercise.  The $200 may be better spent as a donation to PC prevention.

It is my guess because of the ability to carefully select the best slides that represent your PC, as opposed to a biopsy where there is only a very samll amount of tissue that has been jammed into a needle, the odds of having a different grade is slim.  There are howver, some different variant result numbers that may be able to indicate agressiveness that if JH does them, may be a big help.

Obviously, it's all your show at this point.

 

Compiler

I chose to get a second opinion from another Dr. The second Dr. had me send the slides to him and he told me he was not going to consider operating on me if I didn't have prostate cancer. By the way the second read on the slides were the same as the first. The second opinion was because I didn't trust my first uro and neither did my wife or son. So there you have it.

Good luck to you

Mika

I second Steves remarks,

What would sending the paperwork do as for a second opinion. I could see you sending the actual slides or frozen cells to get them reviewed. Seems like you could only get the same same reading from a "reading" only sample, How realistically could they differ ?

I also would wait to see what the post-op PSA shows first before taking any other action.

Mel...one more thought...check to see if your particular lab that performed the pathology was reviewed by more than one pathologist. In my case my pathology was read by several doctors independently and then signed off by the head pathologist. In essence I had several path opinions with a final conclusion based on those independent readings.

Pathology slides once fully fixed should be available for years to be reviewed. Hero

yes, they are physically transported to other labs. Slides have a glass disc put over the specimens, with a glue type agent that seals them.

Mel- do whatever your desire to do is, nobody else walks in your shoes. Let me say to others that PRIOR to making a decision upon any major modality/treatment that is non-reversible get the best friggin pathology you can get, in straight words the handful of real experts whom know this is the best thing you do for yourself...the others are wanna be'sssss...wanna get best info for prognosis??? Maybe in some cases it doesn't matter...how do you know if you are 'some cases or not'???  Mel I told you see Bostwick first thing on pathology(posted on this forum) and I noticed Dr. Strum replied recently to you and said exactly why and what was lacking on your prior pathologies, that  Dr.Strum  noticed and picked up on, right away. Esptein and Oppenheimer etc. are some of the few others that are worthy. I think that Epstien does not do ploidity analysis, but you probably aren't looking for that...but if you are going this far, why not spend a couple more bucks to know.

Also(for others), even if it costs additional money (and it does for optional pathology things like DNA ploidity analysis and some other things they can do)...maybe pay for it and find out more about what is your dragon version of PCa...there are not only many Gleason scores, but many variants types of PCa that the local patho-doc probably would not even notice the difference, they don't come with a tag on them, and ploidity analysis is more important than you might know...especially as to how you will fair long term...or the value of subsequence drugs and therapies that might be used against your case of PCa.

Enter the twilight zone of PCa...jungle...limbo land

Regarding costs, I just heard from my insurance company. They do cover second opinions. In this case, Epstein is out-of-network so insurance covers 70% (it would be 90% in network).

As I said, I would pay for this out-of-pocket if it wasn't covered. With some of these situations the information CAN prove invaluable.

Mel