Confused by 2nd Opinion From Johns Hopkins

The criteria on percentage of core involvement vary among AS programs.
I’ve even had a professor of urology at JH tell me that he believed that the percentage was not a significant factor. That was contrary to the official criteria.

I recommend that you buy Dr. Mark Scholz’ new book The Key to Prostate Cancer. He interviewed 30 prostate cancer experts and presents their descriptions of the treatments that they provide for men at different risk levels. He has an excellent discussion for Gleason 6 men.

I also suggest you visit websites of major PCa centers like JH, MSK, Mayo. MD Anderson. Winship, etc. and learn of their criteria for AS. Then question urologists in your are to de who runs a stringent and active AS program.

You will see variations, but you can compare your current diagnosis and second opinion to see where you fit in. You may even choose a center or doctor based on your investigation.

I would have to think a downgrade from G7 to G6 trumps all else in the overall scheme of things.

Congratulations!

https://www.nccn.org/professionals/physician_gls/pdf/prostate_blocks.pdf

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Welcome to HW.

Epstein is generally considered the gold standard. Reading the biopsy is a bit subjective and Epstein wrote the book on this.

At this point you have all your options open to you, AS, surgery, RT (in its many forms).
Time to start talking to doctors about your options.

Andrew

Visiting the institution for the information you’re seeking may not be required. It wasn’t in my case.

I had so many consults with so many different disciplines at so many different institutions, it would have been a physical impossibility to visit every one.

What I learned when i began asking was, if I sent all of my records to the doctor I wanted to speak with, after reviewing my case, would he call me on the phone and talk. It’s surprising how giving of their time many doctors are at these institutions are. Every single one did. Some talked for an hour.

One would think that AS information would be easily available by phone consult. But, they want it all. Complete medical records from basically your whole life. It can be hand written by you on a sheet of paper. It doesn’t have to come from your doctors. But include whatever official test results you do have from doctors. Just write the letter in your own words.

They’ll also want to know your current health status. Even if it has nothing to do with prostate cancer. The more information you can send, the better. The Fed Ex envelope was fairly thick. It’s a stack of paper work, so make several copies one time. This makes the exercise a lot easier.

I had 3 or 4 consults this way.
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My docs said to treat to the worst indicator.