Sending slides for a second look-does everyone do it?

Hi,

It was suggested to me that it would be irresponsible to not get a second read on prostate biopsy slides following an initial low grade diagnosis.

My SO had biopsy performed and slides read by a team at Princess Margaret Hospital in Toronto. As PMH is one of the top cancer research hospitals in the world, I'm wondering what the general consensus is on second reads, especially if you are involved with a major cancer center.

I've already researched where I'd send them to if that is the route most recommend.

Thanks.

Pow.

Not everyone gets a second read. Most on this forum would recommend it. I wouldn't use the word irresponsible if you didn't, but I would say that you need the biopsy slides read by a specialist in PC. Here in the US, there are only a handful of pathologists who truly qualify.

If you're going the AS route then it might be prudent to get a second reading, but it's your call really.

Andrew

I disagree on the the handful of specialists comment.Imo just another healingwell "myth". Top notch medical/cancer center them selves have a handful. It is the small hospitals in rural areas that are the weakest in pathological expertise.

If you are predisposed to have an "expert" lab review your slides, why pay for two pathology reports?? Just send the tissue samples to an expert lab to begin with.......

Tudpock18 said...
"irresponsible" is a strong word and I wouldn't be quite that judgmental. However, I DO think it is really smart to get a second opinion from an expert like Bostwick Labs or Dr. Epstein who really focus on PCa pathology. There is ample documentation that shows the significance of changes that an expert reading can make. One study by Dr. Epstein showed that 3 out of 1000 men have their biopsies read as cancerous when, in reality, they are not. There are plenty of anecdotal examples on this forum alone that show how treatment plans have been affected by the reality of an expert second opinion.

So, I sincerely recommend that one of the acknowledged experts read your slides. I have no idea of the expertise and specialization of your pathologist at PMH.

Jim

He said this better than I could have. The thing is, at any top quality lab their man will be consistent and quite good at what he does.. However, as near as I can tell the actual grading is almost like art in that different people see different things in the same painting or slide.

One of the main reasons to select a 2nd opinion from Epstein or Bostwick is since they are the top two, presumably you are getting _a consistent_ read of the gleason level which may go up or down.

Since level determines treatment options, that may or may not mean a lot.

These two guys do nothing but Pca, day in, day out. Their opinion of the slide may well be different than from someone that looks at a wide variety.

IMO, you would be paying for consistency of opinion. I think Epstein charges $250 US. It would be worth that to me for peace of mind.

This in no way reflects poorly on the original opinion. Just as there is nothing wrong with two people seeing different aspects in a painting.

Thank you all so much for your feedback. This is "new normal" for all of us at the beginning and I find a variety of seasoned opinions to be most helpful.

To be accurate, in reference to our doctor stating that a pathology team had looked at the 13 core samples from an ultrasound guided biopsy, someone said "You are making a big bet on the accuracy of those slides". To me, that suggests not getting a second opinion would be irresponsible. Lack of further clarification on the comment prompted this post.

It seems that the general consensus is that you have better peace of mind if you get someone who just looks at prostate tissue. Makes sense.

We have a "screening visit" on Dec 2 for the AS Metformin Trial, to see if V is eligible. If he gets accepted they do further testing on the samples for research purposes but we will get findings reports. I will need to find out from the study coordinator if there is time to send the slides out and have them back in time without holding up the show. That is of course, if he gets accepted.

With appreciation,

Pow

Thanks Bob!

That's exactly where I was thinking!

Pow

My local Uro who did the biopsy sent the samples to Dianon systems in Oklahoma City, and they came back with 3/12 positives at G3+3, with the 3 positives all on the left side. The pathologists at Barnes Hospital/Washington University in St. Louis (a top 10 center), concurred right down the line. My post surgery pathology came in at G3+4, covering all 4 quadrants. So, my biopsy missed both on location and on score. Which happens about 25-30% of the time.

Just another place where there really aren't clear answers.

my slides were read by bostwick. I didn't need a second opinion because I elected for the full monty so it didn't matter. so i'd say depends on who read your slides and what treatment you are leaning toward.

ed