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by Howard Wolinsky   |   December 27, 2020

In My Opinion? Get A Second Opinion

As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. One of the bits of advice the group regularly dispenses is for men to get a second and even a third opinion; if you have doubts about the first opinions rendered by your urologist, or your pathologist, or your radiologist, it’s always okay to seek out a second opinion. I personally have benefitted from second opinions on my so-called cancer journey.

Dr. Jonathan Epstein of Johns Hopkins University Hospital

I had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. So off I went to see a community urologist who performed a needle biopsy in his office.

The results were ambiguous. The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. More medical freakouts. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer.

So the pathologist suggested a second opinion. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months.

In December 2010, I dutifully had my second biopsy. The urologist anesthetized my prostate — something not all urologists did. Then, he took the samples. It felt like 14 snaps of rubber bands where the sun don’t shine. This time it was clear I had actual cancer, a tiny sliver of about a millimeter in a single core, out of 14 cores. 

The urologist called me on a Friday when the results came in and asked me to come to his office on the following Tuesday. It was the most anxious weekend I had in my life — I knew I was facing bad news. But I had already studied my options, with surgery being at the top of the list, accompanied by the not insignificant chance it would cause incontinence and impotence. 

So my wife Judi and I went in to face the music. The urologist presented the good news-bad news bit: The bad news is you have cancer; the good news is I have an opening in the OR next Tuesday. I had done my homework and asked about active surveillance, a relatively new approach of monitoring prostate cancer rather than rushing in for surgery or other interventions. I asked the urologist, and he dismissed it as an option. 

I already had an appointment for a second opinion set up with Scott Eggener, MD, a leading prostate expert at the University of Chicago. Eggener stressed that my Gleason 6 was good news and that my cancer burden was quite low, a speck of cancer in a single core, plus this was a slow-growing cancer. An oasis of calm. He declared me the “poster child” for active surveillance and predicted that in 10 years my cancer likely would be the same as it was on that cold December morning.

He was right. In fact, additional biopsies revealed no additional cancer. 

So here’s my advice for those who have been newly-diagnosed with low-risk prostate cancerland: Maintain calm. This is a slow-growing cancer in most cases, so don’t rush into surgery or other interventions. If you don’t believe me, get a second opinion.

I have another opinion for men on active surveillance or those considering it: You will learn a lot about AS if you join the webinar with none other than Gleason expert and the man with a respected second opinion Dr. Jonathan  Epstein. The session will be at 8 p.m. Eastern on December 30. Register at https://register.gotowebinar.com/register/5244900670920775691 The webinar is sponsored by ZERO – The End of Prostate Cancer, AnCan, Us TOO International, PCai, PCRI, and Cancer ABCs. This is the fourth and final webinar in the “AS & Beyond” series.