Recommendation for second opinion on prostate MRI scan?

Thank you. I plan to move on this quickly if I receive confirmation.
However, I had three different interpretations on the same biopsy within a week. The first oncologist amended his report and downgraded from grade group 3 to grade group 2. Second opinion from Johns Hopkins downgraded to grade group 1 (Gleason score 3+3, no pattern 4). Treatment is generally not recommended for 3+3.
The MRI procedure was stopped and then continued because they said the image was not clear. I also did the procedure without contrast. I've read how subjective interpreting both biopsies and MRI results can be and how important second opinions are before proceeding with treatment.
I appreciate what you're saying and certainly don't plan to postpone treatment if warranted but wanted to explain my rationale.

@ftd3, to request a second opinion, you have to make an appointment. It would not be limited to just reviewing an MRI result, but rather a review of all imaging, diagnosis and treatment plan.

I've read that mpMRI (Multiparametric MRI) has distinct advantages over standard MRI. The gold standard for an MRI machine is rated as a 3T (T=Tesla), but not sure if the mpMRI has the same designation. The following site says "Multiparametric (mp)-MRI has emerged as a robust method for localizing prostate tumors and determining their size, aggressiveness, and invasiveness, thereby improving disease detection, staging, and risk stratification (Hoeks et al., 2011)." https://sperlingprostatecenter.com/who-says-prostate-mri-is-too-expensive/ Then, another site states "What You Need to Know Before Reading Multiparametric MRI for Prostate Cancer" which really gets you into the technical weeds. However, the takeaway is that you need to find someone very experienced in interpreting the mpMRI scans. See https://www.ajronline.org/doi/full/10.2214/AJR.19.22751 A word about biopsy slide results. I read a comment from a J Hopkins pathologist who felt that some pathologists knowingly overstate what they see on the slide for fear of being sued. Regarding mpMRI scans, one could ask how many of these scans they perform in a year as an indication of their experience?? If you are on the East coast I found this large company that does scans, but only a few do mpMRI scans. See https://www.universityradiology.com/

Unfortunately more opinions do not usually make treatment decisions easier. Whatever urologist and team you are using you need to trust. If you switch teams, that may mean a delay in addressing the cancer.
I had a second mp-MRI shortly after the first. It was done in a different city and state with different equipment and pathologists that were considered more expert by the referring urologist and it found more cancer. The subsequent biopsy found higher grade cancer in that second location.
But as your urologist pointed out, you already have found actionable cancer that provides some clarity as to how you should proceed. It sounds like it may be time to move on without delay, as others have suggested.
Two options: If you're going to trust this urologist and team, get on with it! If you are not going to trust this urologist, find one you can trust quickly.
One certainty: Whatever we have going on cognitively and emotionally can be as much a factor in our treatment journeys as the medical evidence and treatment team. We all need to figure out how to address these challenges as we encounter them.

Thanks for information. Very helpful. I belong to three support groups (one local, the other two are online). They all stress the importance of second opinions because of the subjectivity involved and because of the reasons you mentioned above. Dr. Mark Scholtz, founder of the Prostate Cancer Research Institute and double board certified medical oncologist has an excellent series on seeking opinions from radiologists who are experienced in reading prostate MRIs before making a decision on treatment.

More opinions don't make treatment decisions any easier but in my case I believe it's necessary. I don't presume to advise what is right for someone else in different circumstances.
I'm 72. If I were younger, at higher risk, and had an aggressive case of prostate cancer then I would certainly feel pressure to "get on with it" as you say. Getting second opinions doesn't indicate a lack of trust. It's simply an acknowledgement that diagnostic tools and the personnel who use them aren't perfect. Dr. Mark Scholtz, founder of the Prostate Cancer Research Institute and double board certified medical oncologist has discussed the importance of second opinions and, more importantly, finding medical professionals who are experienced in interpreting prostate cancer biopsies and scans before seeking treatment.

I had three different Gleason scores on the same biopsy slides in one week from two pathologists (one of those pathologists downgraded his score). If that isn't cause for a few questions then I don't know what would be.
If my biopsy results from J. Hopkins are correct (Gleason 3+3) then treatment would not be recommended. In most cases, the biopsy is the most important diagnostic tool that we have. In my case, if the initial interpretation of my MRI is correct then the the results would be "discordant" to use the word of my urologist) with the interpretation of biopsy from Johns Hopkins.
In any event, my urologist indicated that I had a couple of months to think through my options and that's exactly what I'm doing.

As you can see you will get a lot of different opinions. But that is good. One size does not fit all.

What I found out on research is that the diagnosis of biopsies is at some level subjective. It is a kind of cancer that the growth is different from normal cells. Thus one oncologist might rate slightly different from another. I can't remember which site I saw a picture of prostrate cancer cells compared to normal cells that showed the differences. I wish I could recommend that site but have been on so many just can't remember.

Different opinions on biopsies is to be expected. But should not be extremely different. I am not sure who reads the biopsies (urologist, oncologist, pathologist). I thought they were sent to a lab and a pathologist did the test. But that shows my need to know more and do more research.

I was diagnosed as intermediate risks based on one biopsies as the others showed low risk. I think I had 20 using MRI/Fusion method and think 4-5 biopsies showed cancer. This risk means risk of metastasizing. My original oncologist/radiologist recommended a Decipher test. I agreed. They sent the biopsy to a special lab that does Decipher tests. That came back low risk not intermediate and my oncologist now changed my diagnosis to low risk.

Since I have heart failure the hormone treatment the original recommendation for hormone treatment for intermediate risk could not be done. When oncologist got Decipher results he sent portal message that said the hormone treatments would not be necessary just the curative radiation treatments based on Decipher results.

I did go to a different provider to get proton treatments but got the same treatment plan radiation of prostrate and margins no hormone treatment recommended.

Having the Decipher test done does not require any additional visits, biopsies it is a genetic test on your already taken biopsies. So it is kind of getting a second opinion. But my oncologist recommended doing it to get a more accurate diagnosis and I agreed.

Again don't get overwhelmed with all the opinions and recommendations as we are all different. We all have different personalities and abilities to cope with stress or not. Just know you are not alone there millions with this disease and we are all going through the stages or diagnoses, worry, questions, treatment and recovery. So your worries and questions are completely normal experience for all of us.

The MRI scan shows suspicious areas. A biopsy will be the diagnosis confirmation. When they did my MRI they found two suspicious areas. My urologist said I had a 70% chance that those suspicious areas would be cancer. I am not sure what your urologist or radiologist is stating but I chose to find out thus biopsy.

You medical records can be sent to another provider for a second opinion. But I hate to say this you are not going to know if cancer or not without a biopsy. My urologist was quite adamant about just he MRI showing suspicious areas as prostrate cancer is very different from other type cancers.

I do not know where you live but Mayo Clinics do second opinions. My MRI used a barium and a probe (in rectum) that made the prostrate stand out and be more clear. It was done a Mayo. Even though I have a pacemaker/ICD they worked with Pace Clinic and were able to do the MRI.

Thanks for your response. As I mentioned in the initial post, I've had a biopsy and second opinion on that biopsy. I was able to locate someone to offer second opinion on the MRI results and am now awaiting the results.

Looks like from all you provided your's is probably low risk. But man we are just novices on this but sharing our knowledge of our experiences not medical professionals giving advice. Did any of your providers recommended monitoring? What was your PSA?

On the PSA I am an example that the PSA is not definitive factor in having cancer or not. My PSA was still within normal range but I had cancer. It is why monitoring of PSA is important to see if rising on consistent basis as a indicator just as much as a high PSA level.

Yes I too found out the reading of biopsies and MRI scans is subjective and can be iterpreted differently. It seems the common type of prostrate cancer is hard to rate as degree is the difference between normal tissues and and cancer ones. I think you said you did the MRI without the barieum contrast. Did they put in a probe? Both of these are done to get a more accurate reading of your prostrate. Was there a reason they did not do the barieum and/or contrast with the MRI?

I am not sure but did I asked if you were offered the Decipher test. If not asked about it because it is what changed my reading and final diagnosis from intermediate to low.