So which biopsy report do I believe?

Mel.......I think you're right about it being moot; especially with the two findings. If the second had shown a radically different Gleason, one way or the other, it might give you pause for treatment, maybe not. I think that what matters is what you get on the surgical path report. I had my biopsy done and read locally, and then had my slides sent to Hopkins where I believe Epstein read them. Both came back as a Gleason 6; with the difference being the volume % in certain cores, which differed only slightly (even the number of cores remained the same-4)

But my Gleason was upgraded to G-7 (3+4) after the surgical path read at HUP. IMO, you should continue on the path on which you have decided, treatment-wise....and best wishes!

Arnie in DE

 

Zufus:

I certainly did note your suggestion. However, Dr. Menon's team did need to see and evaluate the slides. So, it had to go there first.

At this juncture, there really is absolutely no point in getting that third opinion. It certainly is not going to change my treatment options (well, I guess I am assuming that there would not be a huge disparity after that third opinion). Also, after surgery, I'll get the more accurate pathology (compared to the biopsy).

Incidentally, I wonder if many folks get second opinions after the pathology results (post-surgery)?

Mel

Your post surgery results are important.  My wife works in a hospital lab and her pathologist carefully reviewed all of my case slides.  I was happy to get the second opinion that matched the original results.

Best wishes for successful treatment.

Dan 

zufus,

my reply was directly and specifically directed to mel's post, not a general statement of fact. i say again, unless the man has any second thoughts about his primary treatment method, which is surgery in this case with a top notch surgeon in a top notch hospital (and if he did have doubts or second thoughts or if something was known now that wasn't known before, then he should put a stop on things until resolved), then any other information or opinions is mute.

you don't need to take 3 different PSA tests by 3 different labs every time you need a psa test. i know that is a bit absurd, but the point is still the same. at what point, do you trust a test result, or a slides results, etc.

at some point, you still have to make decisions and act upon them. if you are going to distrust every doctor you meet, then you might as well treat yourself, and disregard sound medical advice that is based on a lot of experience and practice.

david in sc

I hope my posts were quite clear. I have no doubt whatsoever that surgery is PROBABLY my best option (there is always a degree of uncertainty/probability with all of this).

There is no point that I can see in getting yet a third opinion regarding my biopsy as it will not change my treatment.

My surgery is in 2 weeks. In 3 weeks I should have a more definitive pathological result, but of course there will still be uncertainty with this disease, regardless.

I guess my question was more whimsical than anything else: is a second opinion more valuable/accurate than the first opinion? Is the second opinion completely independent of the first opinion or do they actually look at the first biopsy report (and have that influence their opinion)? I tend to think its the former.

I agree with Zufus in that we do need to embrace many opinions as this is a life/death issue. But given the facts as I've stated, I think Medved and David are on target. There comes a point where getting more opinions/tests can be counter-productive.

Mel

Mel,
To answer your question; a 2nd opinion by a recognized expert pathologist like Bostich, Epstien or Oppenhiemer is much more valuable then a 2nd opinion from another pathologist. If you are going to get a 2nd opinion for anything then get it from the best available. It doesn't make sense to get a 2nd opinion from anyone who is not an expert. This pertains to everything involving PC.
Being a math teacher you know that everything follows a normal distribution curve. The same goes for doctors. There are a few that are 3 sigmas and these are the ones you want to use. Why use the average when the best is available. This is such a simple concept and it is rarely followed.
JohnT

John T:

You really make it sound like the few you mentioned are Gods and everyone else is just a peon. Now, I agree the ones you mentioned are certainly recognized as the very best. But why do I think that pathologists from well-known places (Umich and VUI) are also very good? Yes, I am a mathematician. First of all, not everything follows a normal distribution curve. In fact, not even close. There are many other distributions. (Bi-modal, Poisson, binomial, etc.) Regardless, that point is moot-- unless you advocate my having 1000 pathologists read my slides!

Couldn't you make the same case for surgeons? You can mention the top ten and then assume that anyone else is just chopped liver.

Ohio State: You are acting like I am being foolish and rushing into surgery. I have studied the issues and I am not rushing, but neither am I dawdling. Having studied the issue, I am well aware of the side effects. You act like I am not. I am certainly NOT ignoring them. In fact, if there were no side effects then perhaps surgery would be a no-brainer.

Frankly, I think David hit it on the head when he said that Zufus seemed to take a response and fashion it into the same old mantra (the jungle theme). I think some folks seem to have one particular axe/nail to grind and they turn every post into that hammer. But having said that I also welcome and respect those views. But this is why I strongly recommend to newbies (and I am almost a newbie anyway) that they read all the posts and after perusing a totality of posts they can reach some rational decisions as best they can in this rather irrational disease.

Mel

Mel,

I wasn't trying to say anything to you, I was actually just trying to be a little humorous, and point out the problem with second opinions. They are just that, opinions. Every one, even Ohio has one. I really can't for the life of me figure where he is coming from. Some opinions of course are better than other ones based on their expertise,or lack of it.

You have undoubtedly researched the PC topic to a higher degree than most of us. I hope you are feeling as confident as any man does who is about to have something he holds in very high regard worked on.

Good luck, and job well done. We'll see you on the other side soon !

Goodlife

Zufus:

Mixed emotions regarding waiting (head-in-sand-syndrome?).

I am in mid-Michigan, 3 hours from Detroit. So that would not be convenient. I think my regular physician would probably give the lab orders whenever I want, more or less.

Mel

John:

If I just wanted to choose someone to get a 2nd opinion on the biopsy slides, I would definitely pick one of the top guys such as Epstein.

But, as I said, at the same time I was looking for a top-notch surgeon and I found one in Michigan. They required a second reading of the slides (by them). That's still two readings and I truly doubt that these were below-average pathologists. Umich and VUI are not podunk town USA.

Again, given the information in my signature I think I have enough information to decide.

Realistically speaking, do you really think a 3rd reading would suddenly result in a changed treatment plan?

Mel

Mel,
While I generally agree with multiple opinions, I, like you, find redundancy in checking again what two pathologist from different centers have found as "actionable" biopsy reviews. In other words, another review by Bostwick or Epstein likely won't change what action is appropriate with the first two findings. But if you like, get another review, I had three and one was with Epstein. But they were all similar findings.

You have multiple choices available on how to proceed, and as I said before, Dr. Menon is a well established prostate cancer expert oncologist and surgeon. There are no one single experts that are "the best" and if anyone makes that claim, that's when you should run fast away from them.

Tony

I am sensing the need to put this out there for a few of our group members,

Compiler has made it clear his intentions on how he will treat his prostate cancer and has been met with unsupportive resistance by some of our members. For those doing so, please cool the jets on your attempts to recruit him to your beliefs and philosophy about what you think is best for him. His decision on treatment modality and methodology is neither wrong nor irrational. I would say the same in fairness for the decisions of those who are critical of him have made. But it is disrespectful to continue to try to push the matter any further.

We don't have to subscribe to the decisions anyone here makes. We would better serve the forum by providing support and understanding for the patients regardless of their decisions.

Forum Rules
Don'ts...
11. No posts of an overtly political or religious nature OR posts promoting advocacy of particular personal, medical, legal, religious, political, or non-profit causes. The forums are intended for offering mutual personal support. Debating controversial subjects should be taken elsewhere...

Do's...
4. Use good judgement. NEVER rely on information or opinions exchanged via the forums or chat rooms to replace necessary, personal consultation(s) with qualified health or medical professionals to meet your individual health or medical needs. Remember that what's right or has worked for one person may not be what's right for another.

Tony