Positive biopsy; second opinion advice

I had a brief conversation on my biopsy results Friday in a poor reception area, and today my doctor's out.  I did hear that it was positive, a Gleason 3 + 3, and that it was 85% throughout the right half.  For context, I'm 58, and my PSA went from 4.06 in 8/14 to 5.57 in 3/15 and 6.28 in 5/15.  A couple of quick questions before I begin my research:

1) I know from Dr. Patrick Walsh's book that a second opinion on reading the biopsy is recommended.  Where can this be done?

2) Where are the centers of excellence in diagnosis and treatment besides Johns Hopkins?  I'm based in Montana but can travel.

Thank you for your advice.  To have only partial info from my urologist is frustrating.

That wasn't the result you wanted. Still, it could be worse.

The second reading on the slides can be done by a number of places, I believe JH has someone who does that. You'll also hear about Boswick. Other's who have had this done will be along with better suggestions soon.

How far are you willing to travel? Again JH is a good choice, and you can drive yourself crazy with the options.

And that's going to be your problem. At G6, you have tons of options, everything from active surveillance to surgery to various radiation treatments. There are some good AS programs you may want to look into.

Andrew

Jock, you don't say where in Montana you are..it's a big state. That being said, there are some awesome PC docs in Seattle going West. Coming back easterly, there is, of course Mayo in Minnesota. I'd recommend looking at major academic medical centers. Denver might be another somewhat closer environment to look into.

MD Anderson will do a second opinion on all grades (at least they did when I checked last June). You can get on their website for more information.
Best of luck to you. It was a year ago tomorrow that I found out the results of my biopsy (my wife's birthday) and then I ended up deciding on surgery in August. Check out all options and do what is right for you.

TUCC in Denver is a one stop shop for prostate cancer..And in your case, a second, expert pathology reading would be advisable. Be aware this may cost you around $850 and your insurance company is likely to object paying for it....Check with them first....

No worries, JockMT. Now that you know it's there, the sticky thread is fairly obvious...but for many people it isn't obvious until it's pointed out.

So, according to the "Newly diagnosed" thread, one of the most important questions a newly diagnosed man should be able to answer definitively is: What risk level is your case?

So, what's yours?


(please do continue to recognize the spirit in which this is asked/presented)

I'll give a hint...the NCCN will help you define your risk level. According to the NCCN, it's either:
*Very low risk
*Low risk
*Intermediate risk
*High risk

Not included in the "Newly diagnosed" thread is the newer definitions which sub-divided Intermediate risk into two categories:
*Favorable intermediate risk
*Un-favorable intermediate risk
That definition was posted in another recent thread HERE .

So there's a total of four choices of risk level, which got recently expanded to five choices. Which are you?

Jock, there are several members here from Seattle who have said good things about treatment they've gotten there. I'm sure eventually one of them will check in and comment. I had my treatment at Barnes-Jewish in St. Louis and things have turned out well. You do point out something useful: the world of PC specialists is fairly small, and the good ones all know each other.

If your local guy (or gal) trained at JH, Mayo, Cleveland Clinic, etc, then you're a step up.

Bruce Dalkin urological oncologist/surgeon… U of Washington

Prostate Cancer Center SEA BT

We used Henry Ford Hospital in Detroit, MI, The Vattakuti Institute.
The urologist there is Dr. Mani Menon who was the first to use the Davinci robotics for prostatectomies in the U.S.
Excellent facility, care, surgery, associates. He has performed thousands of these procedures and is world reknowned for his work. Can't say enough about the quality of care.
My husband was a G3+4 but that biopsy at our local hospital was not accurate.
After surgery, the pathology noted it was a 4+3. He has some residual cancer in tissue but has a 70% chance of not needing radiation in the next 10 yrs. 3 mo PSA will be done to monitor the numbers.
All cases are different even if the numbers are the same. Age, the direction of the surgery (rectum side or other) patient health, size tumor, etc. all have an impact on recovery and post op symptoms and progression.
Go to a large reputable hospital and doctor at least for peace of mind that you are in good hands.