1. < Prostate Cancer

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.

heavyphil | @heavyphil | Apr 28 6:31am
In reply to @hudsonlivinglife "Thanks for sharing this. I'm 51 and just got confirmation of diagnosis (i.e., after PSA of..." + (show)
@hudsonlivinglife

Thanks for sharing this. I'm 51 and just got confirmation of diagnosis (i.e., after PSA of 7.5, MRI showing suspicious growths, and biopsy results just coming in) and doctor recommends surgery as the only option he supports. I had thought targeted radiation might be an option, but sounds like based on my age and loss of options if I go the radiation route that this is the best direction of travel. It's bilateral with 3 + 4 =7 (group 2) on one side and 3 + 3 =6 (group 2) on the other side.

Not sure I have specific questions right now but if there is something I should be asking please tell me.

This came as a shock to me (but it's not like I knew much going into this) but after 24 hours I had really started to process that first and foremost now I am a cancer patient - not just a guy with a prostate problem.

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I would only voice my opinion that your age is the single most important factor in your diagnosis.
That doesn’t mean that you MUST have surgery, since many focal therapies such as TulsaPro have come a long way.
Did you get a Decipher score or other genetic tests from your biopsy?
Your G3+4 could be more/less aggressive based on these tests and your treatment will vary accordingly.
Phil

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edinmaryland | @edinmaryland | Apr 28 9:59am
In reply to @hudsonlivinglife "Thanks for sharing this. I'm 51 and just got confirmation of diagnosis (i.e., after PSA of..." + (show)
@hudsonlivinglife

Thanks for sharing this. I'm 51 and just got confirmation of diagnosis (i.e., after PSA of 7.5, MRI showing suspicious growths, and biopsy results just coming in) and doctor recommends surgery as the only option he supports. I had thought targeted radiation might be an option, but sounds like based on my age and loss of options if I go the radiation route that this is the best direction of travel. It's bilateral with 3 + 4 =7 (group 2) on one side and 3 + 3 =6 (group 2) on the other side.

Not sure I have specific questions right now but if there is something I should be asking please tell me.

This came as a shock to me (but it's not like I knew much going into this) but after 24 hours I had really started to process that first and foremost now I am a cancer patient - not just a guy with a prostate problem.

Jump to this post

Please get more opinions. Surgery may end up being the best option However, get in touch with a few other urologists and oncologists.

Do you live near any teaching hospitals?

check out the many, many options that are out there please do not just jump on one option because of the first recommendation

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chippydoo | @chippydoo | Apr 28 10:19am

I'll post because I had a second opinion last week from the genitourinary cancer specialist at our local CCcenter. The communication between my SO and I had gotten so bad that I had no idea where I was in the process. He wouldn't break it down and I felt the need to get a second opinion and/or another doctor for peace of mind. Got lucky and got the best in town. I will own fear through uncertainty. All I can say is I got a master's class in how a doctor should treat and talk to a patient. He obtained all my testing and biopsy slides and read my story to me through the data. Told me to visit him if I ever get to a PSA of 2 and they will find it and treat it. Gave me a 70% chance of never having to revisit this again. When in doubt get a second opinion. Soooo glad I did.

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Moderator
Colleen Young, Connect Director | @colleenyoung | 3 days ago
In reply to @hudsonlivinglife "Thanks for sharing this. I'm 51 and just got confirmation of diagnosis (i.e., after PSA of..." + (show)
@hudsonlivinglife

Thanks for sharing this. I'm 51 and just got confirmation of diagnosis (i.e., after PSA of 7.5, MRI showing suspicious growths, and biopsy results just coming in) and doctor recommends surgery as the only option he supports. I had thought targeted radiation might be an option, but sounds like based on my age and loss of options if I go the radiation route that this is the best direction of travel. It's bilateral with 3 + 4 =7 (group 2) on one side and 3 + 3 =6 (group 2) on the other side.

Not sure I have specific questions right now but if there is something I should be asking please tell me.

This came as a shock to me (but it's not like I knew much going into this) but after 24 hours I had really started to process that first and foremost now I am a cancer patient - not just a guy with a prostate problem.

Jump to this post

@hudsonlivinglife, I thought I'd check in. How are you doing now after processing the cancer diagnosis a bit more?

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ppettis | @ppettis | 2 days ago

69 yo, Gleason 3+4, BPH with 75g prostate. My primary Dr., chair of the Urology department at a major teaching hospital, and very well respected, recommended robotic surgery. Second opinion from another highly regarded Urologist who recommended radiation. My understanding is that either option has statistically the same outcomes in regards to efficacy and side effects. I really feel like it’s a roll of the dice and I’m having a hard time deciding which route to take.

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2 replies
heavyphil | @heavyphil | 1 day ago
In reply to @ppettis "69 yo, Gleason 3+4, BPH with 75g prostate. My primary Dr., chair of the Urology department..." + (show)
@ppettis

69 yo, Gleason 3+4, BPH with 75g prostate. My primary Dr., chair of the Urology department at a major teaching hospital, and very well respected, recommended robotic surgery. Second opinion from another highly regarded Urologist who recommended radiation. My understanding is that either option has statistically the same outcomes in regards to efficacy and side effects. I really feel like it’s a roll of the dice and I’m having a hard time deciding which route to take.

Jump to this post

It’s an ‘educated’ roll. Outcomes are the same, however side effects are different.
I had surgery done by a very reputable surgeon - a pioneer in robotics. I became completely impotent, but not incontinent for which I am grateful.
I then had salvage radiation which, so far, has given me no side effects (the surgery took care of most of them!). The main advantage of surgery is that it gives you the chance to do radiation if your cancer returns. Not so much if you do radiation first.
But if you are a solid G 3+4 with a low Decipher score and no presence of cribriform cells in your pathology, IMO radiation (either SBRT or IMRT) is an excellent treatment with less side effects than surgery. Just my opinion based on personal experience and that of friends who also had PCa.
Phil

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1 reply
ppettis | @ppettis | 1 day ago
In reply to @heavyphil "It’s an ‘educated’ roll. Outcomes are the same, however side effects are different. I had surgery..." + (show)
@heavyphil

It’s an ‘educated’ roll. Outcomes are the same, however side effects are different.
I had surgery done by a very reputable surgeon - a pioneer in robotics. I became completely impotent, but not incontinent for which I am grateful.
I then had salvage radiation which, so far, has given me no side effects (the surgery took care of most of them!). The main advantage of surgery is that it gives you the chance to do radiation if your cancer returns. Not so much if you do radiation first.
But if you are a solid G 3+4 with a low Decipher score and no presence of cribriform cells in your pathology, IMO radiation (either SBRT or IMRT) is an excellent treatment with less side effects than surgery. Just my opinion based on personal experience and that of friends who also had PCa.
Phil

Jump to this post

Thank you @heavyphil

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jcf58 | @jcf58 | 7 hours ago
In reply to @ppettis "69 yo, Gleason 3+4, BPH with 75g prostate. My primary Dr., chair of the Urology department..." + (show)
@ppettis

69 yo, Gleason 3+4, BPH with 75g prostate. My primary Dr., chair of the Urology department at a major teaching hospital, and very well respected, recommended robotic surgery. Second opinion from another highly regarded Urologist who recommended radiation. My understanding is that either option has statistically the same outcomes in regards to efficacy and side effects. I really feel like it’s a roll of the dice and I’m having a hard time deciding which route to take.

Jump to this post

You might want to check out a focal therapy. I did Tulsa Pro at Mayo last year for 4+3. Very happy with results so far.

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ppettis | @ppettis | 6 hours ago

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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1 reply
workmanbiff | @workmanbiff | 2 hours ago

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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