Second Opinions - Pathology
In May of 2016, I was diagnosed with prostate cancer after a two-year period of a doubling PSA. Though the initial biopsy revealed intermediate grade cancer (Gleason 7 (3+4)) – the tumor was found in fewer than five percent of one core.
I decided on surgery. Prior to surgery, I decided to get a second pathology opinion and I sent the biopsy slides to a renowned pathologist at John Hopkins for examination. The pathologist who reviewed the slides couldn’t establish a definitive diagnosis, requesting a follow-up with further testing. Based on the report from this second pathologist, I canceled the surgery.
Another biopsy
On the recommendation from the John Hopkins pathologist, I went back to my urologist for a repeat biopsy. The repeat biopsy revealed low-grade cancer (Gleason 6) and the tumor was again found in fewer than five percent of one core. There was not enough cancerous tissue to do any genomic testing to predict the aggressiveness of his cancer. Once again, I decided to get a second pathology opinion of the biopsy slides and again I sent these slides to John Hopkins for examination. This time the pathologist at John Hopkins confirmed the diagnosis of low-grade prostate cancer.
The initial pathologist then consulted another renowned pathologist from Memorial Sloan Kettering, who confirmed the low-grade prostate cancer diagnosis on both biopsies. Having three different pathology opinions on my first biopsy was a large source of stress.
Choosing active surveillance
The second biopsy revealed low-grade prostate cancer, and though getting additional pathology opinions was stressful, I am thankful I did. I have decided on active surveillance and I see my urologist to repeat the PSA every six months. The PSA will help me determine the frequency of repeat biopsies. I try not to think about possible further treatment.
I certainly understand that diagnosing prostate cancer from small tissue samples may be difficult, however, at least in my case, I took control of my situation and I'm glad I did.
In cases like mine, shouldn't the urologist always request a second opinion on the pathology?
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