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Is it worth getting the second BIOPSY opinion

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Posted 12/13/2014 3:16 AM (GMT 0)
from the experts at JH in Baltimore if all of my cancerous cores (5/12, T2b) originally came back as
GL 6? Perhaps the % amounts could be modified if that makes a difference?

Just not sure of what more I could gain from that second opinion.

Thanks

MS
Posted 12/13/2014 3:19 AM (GMT 0)
For a couple hundred bucks more, yes.... to me anyway.
Posted 12/13/2014 3:34 AM (GMT 0)
If money is tight, it probably won't change a thing.

You are most likely not T2b, btw. It is not based on biopsy results, as your signature suggests.
Posted 12/13/2014 3:39 AM (GMT 0)
I was initially GS6 but wanted that 2nd opinion to be sure.

Some have been downgraded to non-PCa avoiding unnecessary treatment (rare but happens). Some are upgraded. If you were considering active surveillance based on GS6, then I'd definitely want the GS6 confirmed...
Posted 12/13/2014 3:53 AM (GMT 0)
Aside from the money, what's the downside? Would you want to know if it's really aG7? Would you feel better if Johns Hopkins confirmed the G6?

Different people may have different answers to these questions. So I'm not suggesting anything one way or the other.

Unless a change in pathology would change treatment options or choice.
Posted 12/13/2014 4:00 AM (GMT 0)
No worries!
Posted 12/13/2014 4:06 AM (GMT 0)
Looks like forum misreading fatigue to me smhair
Posted 12/13/2014 4:16 AM (GMT 0)
I confused yours with bill positives, oops, aluminum showers. Im sure your thread makes sense to the others. I will exit without prejudice!
Posted 12/13/2014 5:20 AM (GMT 0)
Second opinion - YES.
always, yes.

Next question... :)

Andrew
Posted 2/7/2015 10:55 PM (GMT 0)
BenSam

Who is the urologist that you are using at John Hopkins?
Would you recommend him?
I am looking a urologist at Hopkins that uses mpMRI in prostate diagnosis.

turn
Posted 2/8/2015 1:26 AM (GMT 0)
I did not go to JH so I do not have counsel on UROS
there......sorry.. others might be able to suggest..
Posted 2/8/2015 3:45 PM (GMT 0)
BenSam, I'll be honest, when I first read the title of your thread I thought to myself "well of course it's worth it!" But then I started thinking - so what if the 2nd opinion disagrees with the first, either up or down. Which one do you believe? ? ? ?
Posted 2/8/2015 4:32 PM (GMT 0)
It's worth it.

They (Johns Hopkins) charged me $250 and my insurance paid 80% of that.

I'd go with their readings over most any other lab. Mine matched pretty close but at least it gave me confidence.
Posted 2/8/2015 4:40 PM (GMT 0)
Here's my recent experience: My 12 core showed 3 Gleason 6's and 3 Gleason 3+4's. Before the Biopsy I had made up my mind to send them to Dr. Epstein (JH) and after those results I couldn't get them to him fast enough! And despite my Uro saying it would not matter to him if they were changed--I still had significant cancer and strongly implied (the word "significant" makes me use the word implied) a should seek treatment. When he said he would not do nerve sparing RP he lost me instantly.
So when the report came back that all the 7's were now 6's I was elated because I very much do NOT want my quality of life to suffer if I could avoid it. No, I am not the ideal AS candidate so I will get a Focal MRI and another biopsy before deciding but there is little doubt that if I indeed have/had G7's AS would be very risky. And even with G6 results I cannot stay fixated on that "safe" number because it is what was not found that is the concern--one mm to the side of where any of those needles snatched could be lurking a G7.
The second opinion, if given by one of the best in the world as compared to a lab whose pathologist may do other organ evaluations, was a no brainer to me. Good luck.
Posted 2/8/2015 5:25 PM (GMT 0)
There are two guys in my support group who were downgraded (one by Epstein, one by Bostwick) and went on AS instead of radical treatment. Epstein, Bostwick and Oppenheimer are names you can take to the bank, and clinicians worldwide respect their opinions. Their huge experience trumps any local pathologists, who must be experts in all kinds of cancers and tissue analysis.

That said, there are situations where upgrading or downgrading one step (it's usually just one step) won't make a difference, or the precise cancer volume won't make a difference in treatment decisions.

- Allen
Posted 2/8/2015 6:52 PM (GMT 0)
Getting second opinion is always a good plan. You're taking advantage of a term that is thrown around a lot by people who don't have a clue what it means: peer review. If multiple 'looks' at the same set of slides give identical or near-identical results, then you have consensus and a solid idea of what is happening. One wonders, if one of the 'big 3' does a second look, does his opinion go back to the original pathologist, who could (should) use that opinion as a training tool.

It's what all of us do here, as we move down our chosen paths. We seek information about what is on the branches of the path, and we gather enough to make us comfortable with our choice.
Posted 2/8/2015 10:10 PM (GMT 0)
Excellent point Halbert.
When my G8 (3+5) was downgraded to a G6 by Epstein, it was not a difference of opinion on the way the cells looked, which can be very subjective. It was the basic premise used by the local pathologist, for calling the secondary cells a grade 5.

In Epsteins report he q tally stated that the basic premise used by the original pathologist was wrong, and not a reason to call it a grade 5 in a "well differentiated gland" . I questioned Epstein by phone to be sure I understood and he confirmed that it was basically an "incorrect premise" used in the original report.

Subsequently when I went back to my Uro, I gave him the report and said I hope the original pathologist gets a copy of it.

I've qctually wondered if I should send the entire post RP specimen to Epstein for 2nd opinion, but decided against it, because 1. I was told by my surgeons office that the pathologist who looked at the slides specializes in Genuitory cancers, and has a lot of experience with PC slides, and 2. If Epstein downgraded it from G7 to g6, I would feel better but it wouldn't change my treatment or non treatment. (On the other hand if he upgraded it to a G8... I don't even wanna go there)
Def should be a teaching moment though for the original pathologist.
Posted 2/10/2015 3:49 AM (GMT 0)
Mine was 2 G6 and 2 "what are these?" And 8 Neg.

Epstien confirmed the 2 G6 and made one of the "what are these?" A G6 and one a HGPIN. He also turned the mm of cancer in the core to a percentage of cancer in the core. Sooo...

What it did for me was .... to make me realize there's more knowledgeable people "out there" where prostate cancer is concerned.
Posted 2/10/2015 11:14 AM (GMT 0)
It would matter only if it could potentially change your treatment decision. Could that be the difference between AS and something else. If so, I suppose it it worth a second opinion, but then, as Yoop says, which one do you believe more or do you need a rubber match??
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