2nd Opinion of Biopsy and mpMRI

Well, I have recently been diagnosed with PCa with Gleason (3+3) in 7 of 14 cores with % ranging
5 - 70%. My mpMRI showed 2 suspicious legions, but also indicated the Prostate Capsule to be smooth
in contour with no evidence of extra prostatic malignancy. So, I seemed to be perhaps a candidate for
AS or just put treatment off for a year or two. I decided to consult with Prostate Oncology Specialists in
Marina Del Rey via teleconference and they indicated the first step was to get second readings of my Biopsy
Slides and mpMRI. They advised to get Biopsy Slides and send to Dr Epstein at John's Hopkins and the
mpMRI to UCLA.

Second Reading of Biopsy Slides - Dr. Epstein agreed with the Gleason (3+3) readings in the same cores
as original reading and with similar % though somewhat lower.

Second reading of mpMRI - the second reading was very significantly different noting the same 2 suspicious legions but it noted the capsule adjacent to the 2 legions having irregularities suggesting margin involvement and abuting the neurovascular bundle. Prostate Oncology Specialists doctor recommended I should get treatment and preferred radiation in this case since there is some evidence the capsule and margins are likely partially involved. He advised there was probably some more likely aggressive Gleason Pca involved that was missed by the biopsy. The Dr did say they sometimes do see mis-interpretations of mpMRI's just like sometimes Biopsy slides are mis-read or interpreted differently.

So, I am wondering from others - is this kind of significantly different interpretations of mpMRI's very
common? I must say I was surprised. Any comments or advice much appreciated.

My plans - currently I am going to plan to get appointment at M D Anderson with Radiation Oncologist.

Did you have the mpMRI before the biopsy? Was the biopsy a targeted MRI-guided biopsy? The normal process should be: suspected cancer --> imaging --> biopsy. If the order is the opposite the mpMRI is less reliable due to left blood from the needles. Maybe a re-biopsy is the next step to find out if some cancer was missed?

Gemlin,
Yes the mpMRI was done prior to the Biopsy. The Biopsy included 12 cores, plus there were additional cores taken which was 2 cores each targeted at the 2 suspicious lesions found by the mpMRI.

Tall Allen,
Thanks a lot for your comments. The Radiologist from UCLA that read my mpMRI was Dr. David S Lu.
My Dr from Prostate Oncology Specialists thinks he is one of the best. I am not necessarily going to pursue doing more biopsy but will hope I can get into see the recommended Radiology Oncologist(s) at M D Anderson
and hope that they will develop a treatment plan. I can expect if that happens they will review the mpMRI and likely will do their own scans. I surely hope I can avoid hormone treatment.

Tall Allen,
Once again thanks for you comments. I am still researching and learning.
I have never been officially on AS. Originally, it was discussed as a possible option with my Urologist and part of the reason I originally went to him was he supported doing mpMRI guided biopsies and has an AS program and is an advocate for AS but for me he said even though my Gleason was (3+3) and even with a relatively low PSA ( < 0.15 PSA density) he was against AS because of my relatively high number of positive cores and one core had 70% in the core. He thinks it is likely I have more aggressive cancer cells that were just missed by the Biopsy.
I consulted with Prostate Oncology Specialist to get their thoughts on me being on AS and that led to the second opinion reviews for the Biopsy slides and mpMRI. Since the second opinion review of the mpMRI was negative in the sense of showing likely capsular involvement or irregularities, the recommendation from Prostate Oncology Specialists was to do another mpMRI say at UCLA or go ahead and seek some form of Radiation treatment that is suitable - in his opinion SBRT was not preferred if the capsule / margins were involved. I found the following on the Sperling Center Web site which I thought was interesting and of significance for second reviews of mpMRI's:

In July 2015, Wibmer et al. from Memorial Sloan Kettering (New York, NY) demonstrated that the more specialized and experienced the reader, the more accurate the detection of ECE.[iv] MRI images of 76 patients were read and interpreted by a single radiologist for ECE before prostatectomy. Following surgery and histopathology results, the same images were read (in random order) by specialized genitourinary oncologic radiologists to obtain second opinions; 83% (71 out of 76) images were of diagnostic quality, so those 71 became the study population. The first- and second-opinion reports were then “unpaired and reviewed in random order by a urologist who was blinded to patients’ clinical details and histopathologic data.” The urologist found reporting disagreement in 30% of the cases, and when compared with the histopathology reports, the second opinions by the specialized readers were correct in 86% of the cases. Thus, expert readers increase the rates of correct diagnosis of ECE.

I guess I am thinking if I go to a place like M D Anderson they would either want to do a review of my mpMRI or/and repeat the imaging using their machine and procedures.

Thanks.