GREG'S LEGACY

Specialising in the human experience of Living with prostate cancer – warts and all

Second Opinions

with 3 comments


With the shock of being diagnosed with PCa, many of us want a second opinion.  The following article is from the Prostate Diaries, a blog written by a Urologist with PCa himself.

“Second opinion on a prostate biopsy to be sure that a positive finding is indeed prostate cancer? Been there done that? What I  did was to ask for additional stains to prove it was prostate cancer and not something else. The result? The pathologist found another area with the stains and a higher Gleason’s score and then I got the $2000 bill for my being “clever by half.”

“In my opinion the answer is no. Pathologists see so much prostate cancer that it is an easy call.  They might disagree on the Gleason’s score but it would be rare for the cancer to be missed or over diagnosed. Our office uses LabCorp and each report comes back stating that it had been reviewed by a Pathology Conference and that all were in agreement.

“If your treatment decision hinges on the Gleason’s score or the volume of disease and it is important to you then by all means get a second opinion on the path. Easy to do. Just say you want it done and the slides are sent to institutions that commonly do this. In our area most are sent to Johns Hopkins. I personally have never seen a change in the diagnosis but it does happen I am sure.

“I think  in some patients a confirmatory reading is comforting and in that case it is fine to do.

I think the idea of a second opinion is an attempt to deny the reality of the diagnosis.  In most cases, the shock of learning that you have cancer is so great, the reaction is to try anything that might change the outcome Greg

“Now on a second opinion regarding treatment options? Hell yea! And I’d recommend a radiation therapist not another urologist…that is of course unless it is me.

“Why me you ask?  Cause  ” I ain’t got no dog in this fight.” (Bias…that’s right I am a urologist and have no bias  in the decision that the patient makes and strongly encourage speaking to “another kind of doctor” about this.

“How about a medical oncologist? I wouldn’t. These doctors are excellent but don’t as a rule see people who are newly diagnosed and trying to decide what to do. Great doctors and informed…yes. They just don’t see people at the time of diagnosis. Usually after the original treatment has failed and now the patient is hormone refractory. They will be helpful but I’d get the second opinion with someone who treats the “virgin” disease.

I sought further information from a major oncologist in our premier cancer hospital who works alongside my Urologist.  So, all I got was a confirmation of the Urologist’s diagnosis.  I think the PCa field is so narrow that there are too few specialists to go to in any Australian cityGreg

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Written by Greg Naylor

25 July 2012 at 12:00 am

3 Responses

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  1. Greg: Once again a good article from a uroligist point of view who has the disease. Interesting stuff. I would like to see more of this as this cancer must hit at some point the very people who manage it aka the doctors. Mate keep up the good work and I will keep in touch.
    Lee

    Lee

    25 July 2012 at 12:23 am

  2. It’s great to hear the thought of a urologist in this area. I think you hit the nail on the head with saying “I think the idea of a second opinion is an attempt to deny the reality of the diagnosis. In most cases, the shock of learning that you have cancer is so great, the reaction is to try anything that might change the outcome”. Thanks for sharing.

    Cassy

    26 July 2012 at 3:11 pm

    • Whilst our doctors are not infallible, when they tell you it is terminal, they don’t do that without complete evidence … and you had better believe it.

      Greg Naylor

      26 July 2012 at 3:36 pm


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