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Second Opinions in Prostate Cancer

Posted by rick137 @rick137, May 11, 2024

This is a solicitation for second opinions related to all aspects of prostate cancer, i.e. MRI, pathology, scans, treatment pathways, ...
If there are previous discussions on this topic they could be listed in a post.

I am starting this discussion not because I have either sought or had a second opinion. However, resources for a second opinion is money in the bank.

Free form as usual but why you asked for a second opinion, what for, the difference between the original and second opinion, which opinion was chosen, and the outcome would seem relevant.

Implicitly, Mayo Clinic Connect is a source for second opinions every day.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

jcf58 | @jcf58 | 22 hours ago
In reply to @ppettis "Thanks for the input. Did you have any incontinence or ED issues? How was the procedure..." + (show)
@ppettis

Thanks for the input. Did you have any incontinence or ED issues? How was the procedure itself and do you have anyone to recommend for the procedure? Thanks in advance.

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I had it done at Mayo Rochester by David Woodrum, Radiologist. Zero issues with side effects. I had 30% of my 45 cc prostate ablated. I had zero pain and did not even take a Tylenol. I walked 2 miles the day after and started sex again at one week. You can read my description of the procedure if you click on my profile.

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heavyphil | @heavyphil | 6 hours ago
In reply to @workmanbiff "Hi everyone - Husband was diagnosed with Stage 3 on 4/15/25 by a local urologist (we..." + (show)
@workmanbiff

Hi everyone -
Husband was diagnosed with Stage 3 on 4/15/25 by a local urologist (we are located in upstate NY) from a biopsy. Two opinions were obtained - local pathologist and 2nd from Michigan State.
We forwarded the results to MSK for their evaluation.
An MRI was Done (locally) /Pet Scan Done (locally)/Decipher Test (MSK)- Is in Process
MSK has all those test results.
We are in consultation with both the MSK Chief of Radiology. He is advising Hormone Therapy and 26 days of Radiation. And the MSK Chief of Urology Service to determine our course of action.
The surgical consult date is June 16th.
Husband is 72 years old and has a family history of cancer - mother, father and both sisters.
Kindest thanks for any words of wisdom . . . I am very grateful for this site.
Best,
=========================================
MSK Pathology Report:
Final Diagnosis
1. Prostate, R ant med; biopsy (HS25-000493, A, 1 H&E); Collected: 3/26/2025: Atypical small acinar proliferation (ASAP)
2. Prostate, R post med; biopsy (HS25-000493, B, 1 H&E); Collected: 3/26/2025:
Prostatic adenocarcinoma
Histologic Grade: Grade Group 3 (Gleason score 4+3=7) Percentage of pattern 4/5: 55%
Number of cores involved: 2 out of 3
Tumor length: 6.5 mm
Percentage of tissue involved by tumor: 35% Cribriform pattern 4: Not identified Perineural invasion is present
3. Prostate, left base; biopsy (HS25-000493, C, 1 H&E); Collected: 3/26/2025:
Prostatic adenocarcinoma
Histologic Grade: Grade Group 2 (Gleason score 3+4=7) Percentage of pattern 4/5: 5%
Number of cores involved: 1 out of 1
Tumor length: 3.5 mm
Percentage of tissue involved by tumor: 30% Cribriform pattern 4: Not identified
4. Prostate, L post med; biopsy (HS25-000493, D, 1 H&E); Collected: 3/26/2025:
Prostatic adenocarcinoma
Histologic Grade: Grade Group 1 (Gleason score 3+3=6) Number of cores involved: 1 out of 1
Tumor length: 0.4 mm
Percentage of tissue involved by tumor: 3%
Results
New Clinical Information
5. Prostate, L ant med; biopsy (HS25-000493, E, 1 H&E); Collected: 3/26/2025:
Benign prostatic tissue
Benign prostatic tissue
6. Prostate, R ant lat; biopsy (HS25-000493, F, 1 H&E); Collected: 3/26/2025:
Prostatic adenocarcinoma
Histologic Grade: Grade Group 3 (Gleason score 4+3=7) Percentage of pattern 4/5: 55%
Number of cores involved: 1 out of 1
Tumor length: 1.8 mm
Percentage of tissue involved by tumor: 15% Cribriform pattern 4: Identified
7. Prostate, R lat post MRI lesion; biopsy (HS25-000493, G, 1 H&E); Collected: 3/26/2025:
Prostatic adenocarcinoma
Histologic Grade: Grade Group 3 (Gleason score 4+3=7) Percentage of pattern 4/5: 80%
Number of cores involved: 3 out of 3
Tumor length: 9 mm
Percentage of tissue involved by tumor: 80% Cribriform pattern 4: Identified
Perineural invasion is present
8. Prostate, right base; biopsy (HS25-000493, H, 1 H&E); Collected: 3/26/2025: Benign prostatic tissue
9. Prostate, L ant lat; biopsy (HS25-000493, I, 1 H&E); Collected: 3/26/2025: Benign prostatic tissue
10. Prostate, L post lat; biopsy (HS25-000493, J, 1 H&E); Collected: 3/26/2025: Benign prostatic tissue

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Hi workmanbiff, I just completed the same regimen at Sloan, although for salvage radiation ((surgery 2019).
Your husband’s biopsy is eerily similar to mine in that there was a lot of G4+3 in the gland. However, the presence of cribriform cells in one sample is concerning.
That’s an aggressive form that does not respond as readily to radiation as adeno/acinar cells.
You might ask about an HDR brachytherapy ‘boost’ (seed placement) prior to the 26 sessions.
During my stay at Sloan in Commack I met 3 men who had this done in conjunction with 5 visits of Cyberknife ( not 26 of IMRT).
Sloan is one of the best but you MUST ASK QUESTIONS!! My first RO (chief also) was an older man who did things the old fashioned way; didn’t care for his approach.
My next was a young, dynamic, tech savvy guy- Dr Andrew Barsky - who was up on all the latest research and tailored my treatment from 39 visits to 25 and 6 months Orgovyx.
You gotta do this the best way possible the FIRST time, because when radiation treatment fails it usually involves a lifetime of hormones and whack a mole SBRT treatments. Best of luck to you!
Phil

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