What Do You Do When Your 2nd Opinion Is Different From Your First

[Arthro92]

what do you do when your second opinion is different from your first. i sent in a request for my pathology report to john epstein at john hopkins. today i received the results and here's what was written:

A. benign fibromuscular tissue.

B. PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6 (GRADE GROUP 1) DISCONTINUOUSLY INVOLVING 80% OF ONE [1] CORE

C. PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6 (GRADE GROUP 1) INVOLVING 20% OF ONE [1] CORE

now take a look at my first report below and tell me what you think.

D.O.B. | 1973

08.22.2018 | 3T MRI

08.23.2018 | 3 peripheral zone focal abnormalities, 1 PI-RADS 4 lesion and 2 with PI-RADS 3 lesions. No extraprostatic disease, pelvic lymphadenopathy, or enhancing pelvic bone lesions.

02.25.2019 | MRI/Ultrasound Fusion Targeted Biopsy

02.28.2019 | DX @45 with Gleason 4+3=7

A. PROSTATE, LESION 1, LEFT APEX, 3:00, 3D MRI FUSION NEEDLE CORE BIOPSIES:

*BENIGN FIBROMUSCULAR TISSUE.

B. PROSTATE, LESION 2, RIGHT MID GLAND, 10:00, 3D MRI FUSION NEEDLE CORE BIOPSIES:

*PROSTATE CANCER, GLEASON SCORE 4+3=7 (GRADE 3) INVOLVING 3 OF 3 CORES (95% DISCONTINUOUS, <5%, <5%). GLEASON GRADE 4 INVOLVES 60% OF THE TUMOR. PERINEURAL INVASION IS PRESENT. CHRONIC INFLAMMATION.

C. PROSTATE, LESION 3, DIFFUSE LEFT MID GLAND, 3D MRI FUSION NEEDLE CORE BIOPSIES:

*PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7 (GRADE GROUP 2) INVOLVING LESS THAN 5% OF THE FRAGMENTED CORES. GLEASON GRADE 4 COMPONENT INVOLVES 5% OF THE TUMOR.

[Tall_Allen]

There's no question. Epstein's opinion is the gold standard. He, literally, wrote the book.

[Vitruviusman]

that happened to me the two opinions were different one positive one negative. I was advised to get a third opinion and then go with the most popular answer

[Arthro92 in reply to Vitruviusman]

where would you recommend i get my third opinion?

[Vitruviusman in reply to Arthro92]

You need to check around in your area researching other doctor's reputation and making sure your insurance company covers 3rd opinion, and that 3rd doctor accepts your insurance

[tarhoosier]

One man's opinion: Epstein is the acknowledged expert by all sources. There is no third opinion that would overturn his report. Since your first report is the suspect one at this time, then rather than seeking another opinion on the same specimens you can wait and try another biopsy in some period of time determined by you and your urologist. Have Epstein examine that and determine your path at that time.

By the way, what does your doctor say about this pathology difference and whom to trust?

[Arthro92 in reply to tarhoosier]

well, i just found out friday evening, so i hadn't had a chance to talk with him yet. my radio onc, says bring it [the report] in on my next visit. what i decided to do was to email it to both him and my uro through the patient portal and let them take a look.

[tucker_man]

I had three opinions, third was Epstein and he confirmed first which was G6 like you. Second was much more dire. I got a genomic analysis (OncotypeDX) that pushed risk from low to favorable intermediate. Considering the genomic results and the differing second opinion, I didn’t take a chance with AS and started IMRT. I would get a genomic test and tell this group your approximate location. Someone here might know of another facility to get a third opinion.

[Arthro92]

i live in atlanta, ga.

[RichNJ]

Bostwick Laboratories used to be considered one of the best.

uropathdiagnostics.com/

Just Saying.