Second Opinion On Biopsy Results..

It would seem that getting a second opinion on ones biopsy results from one of the two expert labs that specialize in prostate pathology is recommended quite often..So often in fact that it might make more sense just to have Bostwick or Epstein do the original pathology..Why pay for TWO pathology reports (about $800) if it's a forgone conclusion a second evaluation will be done??

How often does the second opinion contradict the first one enough to alter the course of treatment?

Fairwind said...

How often does the second opinion contradict the first one enough to alter the course of treatment?

There have been multiple studies done that come close to answering your question -- many of them at JHU. A couple of important conclusions from these studies are:

1. In about 20% of the cases, the expert review caused a change in Gleason score when compared to the non-expert review.

2. In 1.3% of the situations, the non-expert review classified the sample as malignant (cancerous) when the expert review reversed this and classified the tissue sample as benign.

This is fairly compelling as to why it's worthwhile to get an expert opinion rather than relying on a pathologist that does not specialize in prostate samples.

Jim

Fairwind: There is a value to having a second set of eyes look at the slides, even if one of the pathologists is an expert. Also, as I recall, three out of four biopsies are negative and second opinions are seldom sought for the negative results. So a second opinion is not always inevitable and it is probably not a good use of a scarce resource to have Bostwick or Epstein reading thousands of negative biopsy results.

Steve: I've been there. You go for a second opinion and danmed if you don't get a second opinion... when what you wanted was the same opinion from a second doctor. Then you have to go looking for a third opinion to break the tie...

I all for second opinions in biopsies.
I had mine sent to Johns Hopkins (Epstein) and my cancer was upgraded from Glason 6 stage 1 to Gleason 7 stage 2. Therefore, I'm off Active Surveillance and scheduled surgery for November at Johns Hopkins.

I assumed that since my biopsy was examined by an experienced and skilled top-pathologists who was known to provide safe and reliable results, it was no point in getting a second opinion by a less experienced pathologist. And with two different results how to know which one to believe in? My post surgery Gleason was also the same as the biopsy result.