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I was diagnosed in Nov 2008 3+3=6 stage T1c. 2 cores out of 10. These 2 core less than 5% involvement. The Dr. stated I had time to study my options. After reading several books and reading info on the YANA site I sent my slides to another lab for a second opinion. The pathology lab I sent my slides to for the second opinion was Ourlab lead by Dr. Jon
Oppenheimer in Nashville TN. Last Friday Ourlab called and said that my
suspect tissue samples were in their opinion "Atypical" meaning they were
suspicious for cancer but not enough abnormality to definitively call cancer. They had placed a call with my Dr. to inform him of the findings.
Ourlab is suggesting a third opinion (Jon Epstein of John Hopkins) or another
biopsy. My Dr. (Dr. Koch of IU Med center in Indianapolis) is to review this second opinion report and get back with me. Dr. Koch was the Urologist who did my biopsy. I really have no reason to
doubt the first pathology since IU Med has a noted pathologist (Dr. David Gringnon) but this does
muddy the water a bit.
I really do not know what to do. Even if the third opinion comes back
"Atypical" I know that the cells are still highly suspicious and will
probably become cancer soon. Or, if the third pathology comes back positive
same as the first does that mean my cancer is just barely cancer? I am not sure what all this means. At this time I am quit confused. Any suggestions?
Any advise on a Lab for a third opinion? Does anyone know the reputation of Dr. Jon Oppenheimer of Ourlab?
Will- read my story on YANA mentors. Have the color doppler ultrasound done. The doc is right there with you as he looks at your prostate. He'll only biop the suspicious spots. Seriously, read my story. Dave
Firstly Dr Jon Oppenheimer is one of the leading pathologists in the US and is recognized as such by his colleagues. He has this to say on his on his BLOGFor the vast majority of men with a recent diagnosis of prostate cancer the most important question is not what treatment is needed, but whether any treatment at all is required. Active surveillance is the logical choice for most men (and the families that love them) to make.
If you go to the blog you will see his rationale for differentiating between the prostate cancer that will prove to be life threatening if left untreated and the condition currently labelled “prostate cancer” that is unlikely to ever prove to be life threatening.
Dr Christopher Logothetis, a leading expert in advanced prostate cancer was asked a question at a US-TOO meeting in Texas many years ago. He had been commenting on the relative inaccuracy of the diagnostic process. The question was: "Does this mean that a lot of people who are diagnosed as having cancer really don't?”
His answer was: "Yes, if one accepts the diagnosis that the cancer is a disease that is potentially lethal……. One of the problems with prostate cancer is definition. They label it as a cancer, and they force us all to behave in a way that introduces us to a cascade of events that sends us to very morbid therapy. It's sort of like once that cancer label is put on there we are obligated to behave in a certain way, and its driven by physician beliefs and patient beliefs and frequently they don't have anything to do with reality. And they are only worrisome because the pathologist has decided to call it a cancer.”
To quote a third expert – Dr Tom Stamey - I believe that when the final chapter of this disease is written, which is unlikely to be in my lifetime, never in the history of oncology will so many men have been so overtreated for one disease. ………Clearly we are overdiagnosing this disease.
Take your time to look around at your options, you are unlikely to be at any risk (from prostate cancer) for many months/years if at all.
Only you can decide what's right for you but I'll add my thoughts to the others. If Jon Oppenheimer said your biopsy only contained atypical cells and not cancer I'd definitely get another opinion, and Jon Epstein would be a good person to get it from. You didn't mention your age so I'd be interested in knowing that if you don't mind.
The only thing I'll say for sure is do your research because the thoughts on treatment and no treatment is huge and splits the horizon on prostate cancer wide open.
Some prostate cancers are aggressive and need treatment quickly, but from what you've been told by your Doctors so far, your's isn't. So it looks like you have plenty of time for research which will not affect your treatment success rate if you go that path. But of course only you and your Doctor can decide that, we can only give general opinions.
Ourlab diagnostics of the slides in question stated: "The slides do not show the presence of basal cells and is suggestive of malignancy. However there is neither enough cytologic or architechtural abnormality for a definitive malignant diagnosis. Repeat biopsy is suggested if clinically indicated."
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Replying to:
William,
Only you can decide what's right for you but I'll add my thoughts to the others. If Jon Oppenheimer said your biopsy only contained atypical cells and not cancer I'd definitely get another opinion, and Jon Epstein would be a good person to get it from. You didn't mention your age so I'd be interested in knowing that if you don't mind.
The only thing I'll say for sure is do your research because the thoughts on treatment and no treatment is huge and splits the horizon on prostate cancer wide open.
Some prostate cancers are aggressive and need treatment quickly, but from what you've been told by your Doctors so far, your's isn't. So it looks like you have plenty of time for research which will not affect your treatment success rate if you go that path. But of course only you and your Doctor can decide that, we can only give general opinions.
Thanks. I'm 61. The report definitely makes you wonder what's going on and I think if I wanted treatment I'd get a second biopsy or at least more definitive answers on the one you have. There's guys that had more than one biopsy and then were told they didn't have prostate cancer, it's a tough call when things aren't solid, and that looks like where you are. Good luck with whatever you decide to do. I'm a Christian so I'll pray for you.
