Looking for Recommendations for a Urologist Second Opinion

Posted by gtiml @gtiml, 23 hours ago

I was recently diagnosed with Gleason 4+3=7 prostate cancer, with "potential" extracapsular extension (ECE) with a PSA of approximately 3 and I'm 63 years of age. The radiologist that read the MRI stated "Broad-based capsular abutment raising consideration for ECE without capsular irregularity or bulging event". The pathologist also mentioned "FINDINGS SUGGESTIVE OF EXTRAPROSTATIC EXTENSION" in the biopsy but did not make any mention of the biopsy sample containing either membrane material or fatty tissue from outside the prostate gland. The PSMA Pet scan showed everything contained to the prostate at this time,

I have decided to have the Robotic Surgery which is scheduled for October 9, 2025 but because my pathology results mention that the Cribriform pattern is present coupled with my low PSA score of 2.91 I am concerned that follow-on treatment options may pose problems given the aggressiveness of the Cribriform pattern coupled with the lower PSA score and would like to find a Urologist with solid experience with this scenario to give a second opinion. I live in Georgia and would prefer to stay on the eastern side of the country.

Thanks so much in advance.

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jeff Marchi | @jeffmarc | 22 hours ago

I don’t know of a doctor in your area that would be the right one to contact. If you attend the next ancan.org Weekly advanced prostate cancer meeting. You can get that answer from the people at the meeting. The next meeting is next Tuesday the 23rd at 3 PM Pacific time 6 PM eastern. You need to have GOTO meeting installed in order to attend the meeting, but it is free. You should get there 10 minutes early and they will give you priority as the first person they will talk to and give advice to. If you go to ancan.org And sign up you’ll get a email notification about the meeting.. I know a real good doctor in Houston, but that’s 800 miles from Atlanta.

One option is you could have your biopsy reviewed by a different doctor.

Dr. Jonathan Epstein with Advanced uropathology Is a global expert in analyzing biopsy results?. Costs around $500
https://advanceduropathology.com/
He’s going to give a talk on September 30 about his Biopsy reviews. That’s a little late considering when you’re having your surgery. You probably couldn’t get your results sent to him in time for him to review if he waited until that presentation.

More information

Interpreting Prostate Needle Biopsies in Today's World"

with global expert Dr.Jonathan Epstein, Advanced Uropathology

Tuesday, September 30th at 8 pm Eastern

Registration Link: https://ow.ly/PpoX50WVsJ4

QR code on poster

FREE

Reliable biopsies are critical to selecting the right treatment at all stages of prostate cancer - we're talking needle tissue biopsies not liquid blood, btw. Get it wrong and you may get too much or too little treatment.

Reading pathology is part art and part science! AnCan Advisory Board Member, Dr. Jonathan Epstein is globally acknowledged to have the best eye in the genitourinary pathology world. AnCan frequently refers men to him for a 2nd opinion.

His presentation will include:

how to get the most out of a 2nd opinion
the relevance of cribriform and intraductal and ductal cells
biopsy report terms lik perineural invasion
the role of artificial intelligence
Host: Dr. John Antonucci, MD, AnCan Advisory Board

Guest Panellist: Dr. Randy Jones PhD, Bot Image/ ProstateID

This webinar is for ALL grades of prostate cancer from recently diagnosed (any stage) to advanced disease.

Plenty of time for Q&A. Questions may be submitted in advanceto to dr.john@ancan.org and asked live.

Registration Link: https://ow.ly/PpoX50WVsJ4

surftohealth88 | @surftohealth88 | 21 hours ago

I would strongly suggest that you get Decipher test done (ask your doctor to order that test - it is done on tissue that was removed during biopsy.

My husband had biopsy, MRI, detailed TRUS that checked if cancer was really still contained inside the gland, PSMA and alllll missed the actual aggressiveness of his cancer EXCEPT Decipher . His biopsy showed 4+3 unfavorable and post RP was gleason 9 (4+5) with EPE. Decipher was "1" - the highest that can be.

So, if you wish to know how aggressive your cancer is - ask for Decipher and if it is above 0.5 , I would strongly advise you to have treatment ASAP , no matter if doctor tells you "to take time" to decide , like we were told *sigh even with such high Decipher. If you have high Decipher your cancer is a ticking bomb.

Wishing you all the best and super successful treatment, whichever you decide to have 🍀🍀🍀