2nd Opinion Back From Johns Hopkins

Very Good News!

That odd ball 3+5 was downgraded to a 3+4, which sends me from a G8, and a Group 4, down to a G7 and Group 2.

Congratulations!

very good. That's a game changer.

Well, this is certainly good news. I'm a big advocate of the second opinion (although in my case I went the other way: G8 to G9) and 3+5 is a pretty weird (and alarming) score so I'm glad you got clarity. Oh, and glad to hear about the clean bone scans! Good luck on the treatment decisions and I think you're on the right track about going for the best docs and facility that you can find.

Good news indeed. Duke is probably the better place for your evaluation and treatment recommendations. After that, it depends on what treatment(s) you end up considering. You may find with standard radiation (IMRT/IGRT) that there are some good facilities closer to home that make the many treatments easier to accommodate. On the other hand, treatments that are shorter in duration like brachytherapy, SBRT, and even surgery can be done a distant location with less inconvenience. Good luck with your scheduled Duke meeting as I would stay with your plan and check out other places after you get the benefit of their opinion.

I live in western NC and also went to Duke's prostate cancer clinic for my second opinion following a downgrade from Dr. Epstein. My biopsy slides were sent to Duke and reviewed by the panel prior to my visit. I had pattern 4 disease in a lesion, but pattern 3 in all other cores. The pathology lab at Duke saw 5% pattern 4, while JH and the local hospital lab saw 10%. The clinic at Duke was extremely informative although I didn't feel comfortable with the URO part of the consultation. The RO and the MO phoned me at home 1-2 weeks later to followup. Eventually, I decided to go with radiation (SBRT) as my primary therapy and had a second visit with the local RO. Finally, I made the decision to get my treatment locally as the only difference was that Duke used a Varian machine and the local facility had a second generation Cyberknife. The local RO has a history of very good results. Before deciding to stay local I did notice that some of the Duke satellite treatment facilities (Wake Forest) could offer most, but not all, treatments.

So, once you make your treatment decision don't hesitate to give your local facilities and doctors a good look. For me, had I decided to get my treatment at Duke it wouldn't have been a hardship. I just couldn't see any treatment advantage.

manich, that is similar to what I looked at when I was making the treatment decision. Small town, 2 hours drive to St. Louis, 4 hours drive to either Chicago or Nashville (Vanderbilt). I ended up going to St. Louis. Barnes-Jewish Hospital/Washington University/Siteman Cancer center. Taking the travel needs into account is an important consideration that sometimes gets minimized.

Congrats on the new reading. If you opt for surgery, you can go anywhere to find the best doc. But standard IMRT radiation is often a long and drawn out affair that you will want to do as close to home as possible. SBRT can be done in a week or so, and you can also probably go long distance to get that. Is the Duke PC clinic having you consult with both surgeons and radiation oncologists?

Munich,
I traveled 2.5 hours each way for SBRT treatment and enjoyed special lunches with my Honey on each trip. Was a whole lot easier than nine weeks of five days per week. Follow up has been by ‘virtual’ visit from the comfort of my recliner. Investigate them both and get a review of your slides and data. After you do your homework you still end up trusting your instinct. My son went to UNC and lives near Raleigh and it’s my understanding that both medical centers have excellent facilities. Good luck and keep us posted.

hrpufnstuf said...

(HR...the site owner asks us not to bash specific docs for liability reasons, hence the edit. Trust you understand. Jim)

Unfortunately, all below average urologists count on that. What we need is a way to monitor the performance results of physicians. Manipulated on-line ratings are meaningless. The fastest growing noses I ever encountered, was when asking a urologist exactly how many surgeries he/she had done. Integrity flew out the window. What surgeon doesn't know exactly how many he/she has done, AND what the complication results were. Liability fear is a major impediment to decent medical care decisions....as well as lots of other things.

I completely understand the edit. Sorry for the violation.