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Johns Hopkins Prostate Cancer Second Opinion

Just Because Youre Getting A Second Opinion Doesnt Mean You Have To Change Doctors

Prostate Cancer | Bills Story

Patients are often under the mistaken notion that they have to pick between their oncologist and MSK, but thats often not the case, Dr. Matasar explains. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes.

However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds.

Medical Second Opinions Provide Peace Of Mind

If youve received a new diagnosis or arent seeing results from your current treatment plan, a second opinion can help you move forward with confidence. With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3500 specialists. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home.

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, its 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.

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

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How Much Does A Second Opinion Cost

The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. This fee includes:

  • Consultation with your nurse care manager.
  • Medical record collection from doctors and hospitals.
  • Reinterpretation of imaging scans and lab tests.
  • Expert review of your case by a Cleveland Clinic specialist.
  • Video consultation and written report from your expert.

Why Get A Second Opinion

In My Opinion? Get A Second Opinion

Studies show the clinical and financial benefits of obtaining a pathology second opinion. Getting a second opinion can sometimes lead to a complete change in diagnosis in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions.

A second opinion can change the diagnosis, impacting treatment and prognosis.”

Jonathan Epstein, M.D.

Director of Surgical Pathology

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What You Need To Know About The Prostate Johns Hopkins Prostate Cancer Second Opinion

The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. During puberty, the body produces semen in a large number of cases, including enlarged prostate. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. This is why the prostate is important to the body. It can be caused by many factors, including infection and inflammation.

A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.

While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.

Minimally Invasive Treatments For Bph

We specialize in minimally invasive procedures to treat BPH, including:

  • Transurethral microwave thermotherapy : In selected patients, microwave energy helps to restructure prostate tissue and alleviate symptoms such as incontinence and voiding dysfunction

For selected BPH patients, our specialists also perform transurethral resection of the prostate , a procedure that requires no incisions and has a high rate of success.

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Care For Women And Infants

AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. In the rare chance a baby needs highly specialized care, the team at Johns Hopkins is available to treat rare and complex conditions through breakthrough fetal procedures.

Our OB-GYNs, maternal-fetal medicine specialists, and pediatricians collaborate regularly with the Johns Hopkins team â getting second opinions and access to hundreds of clinical trials. This teamwork ensures the best possible patient outcomes.

Minimally Invasive Treatments For Prostate Cancer

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We specialize in minimally invasive treatments for prostate cancer such as:

  • Laparoscopic prostatectomy: The prostate is removed with a miniature telescopic instrument, which allows for a quicker recovery
  • Robotic surgery: This breakthrough technology, which often is used for prostatectomy surgery, requires only a few small incisions

We place a high priority on sparing the nerves and tissue around the prostate whenever possible. This approach helps to decrease side effects that can affect a patient’s quality of life, such as erectile dysfunction, incontinence or other urinary-tract symptoms.

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When Should I Consider A Second Opinion

You may choose to consider a second opinion if you:

  • Have a condition that isnt improving or is getting worse, despite treatment.
  • Have been diagnosed with a serious or rare health condition.
  • Have been told a health condition is not treatable.
  • Are considering a treatment that involves significant risks, such as surgery.
  • Need guidance choosing from multiple treatment options.
  • Want confirmation about a diagnosis or treatment.

Value Of Second Opinion In Prostate Cancer Uncertain Says Hopkins Study

A new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice among men diagnosed with low-risk prostate cancer.

Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. However, a new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice or the persons perception of the quality of care they receive, at least among low-risk men. Therefore, the value of these second opinions remains unknown.

For this study, published in the journal Cancer, 2386 men in the greater Philadelphia area, who were diagnosed with prostate cancer between 2012 and 2014, responded to survey questions. The survey asked the men if they had opted for a second opinion from a urologist following their diagnosis of prostate cancer, and the reasons for the second opinion. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort.

These results, if validated in other studies, justify additional investigation on how second opinions can contribute to increasing the value of cancer care, the authors concluded.


Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . Cancer. doi: 10.1002/cncr.30412.

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Association Of Second Opinions With Treatment And Perceived Quality Of Care

Overall, nearly 80% of men received definitive treatment 76.5% of men who obtained a second opinion from a urologist received definitive treatment compared to 81.6% who did not . In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Receiving a second opinion was not associated with perceived quality of prostate cancer care.

Finally To Get The Most Out Of Your Second Opinion Appointment Dr Matasar Suggests 5 Key Questions You Should Ask:

Conditions We Treat: Prostate Cancer
  • Are you sure my diagnosis is correct and is as accurate and precise as is necessary? For many cancers, molecular diagnosis is an important part of matching patients with the best treatment. If youre not sure whether you had molecular or genetic testing or if its important for your type of cancer, you should ask.
  • What is the standard-of-care treatment, and is there more than one option? There may be multiple treatments that offer the same likelihood of success. Its important to understand the pros and cons of each one, including how the side effects of various treatments may differ.
  • What are the clinical trials that are relevant to me both at your institution and elsewhere? Every hospital has its own portfolio of clinical trials, and it may be helpful to understand the full landscape of ongoing research.
  • Do I need to receive treatment here? Clinical trial participation is often restricted to certain hospitals, but an expert at an academic medical center may be able to collaborate with your community oncologist to help you get the same treatment.
  • Can I reach out to you with further questions? Even if you return to your first oncologist for care, often your second-opinion oncologist will be glad to receive updates and offer continuing guidance.

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You Always Have Options

When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. An accurate diagnosis is essential to ensure the most effective treatment. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action.

There are also many reasons why you may want to seek another opinion during the course of your cancer care. Not all cancers are the same and not all treatment plans are absolutely clear. Whether you want expert confirmation, lack understanding or confidence in your treatment plan, have a rare or unusual type of cancer, your cancer isnt responding to current treatment its reassuring to know that you have options through a second opinion.

In addition to providing a better understanding of your diagnosis, a second opinion can also shed new light on treatment options and give you confidence in how to proceed with your care. Advances in our understanding of breast cancer have opened up new treatment options or clinical trial opportunities, including targeted drug therapies and tissue-conserving procedures proven to greatly reduce pain and nausea. Because physicians may differ in their approach to treating breast cancer, its very important to check with a breast cancer expert to know youre receiving the best treatment for you.

Make an appointment:

Concept Of Faq Initiative

Centro Diagnostico Italiano , Milan, Italy

Manfred Dietel, M.D.Institute of Pathology Charité, Humboldt University of Medicine, Berlin, Germany

Jonathan I. Epstein, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD

Robert J. Kurman, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD

Elizabeth Montgomery, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD

Manuel Sobrinho-Simões, M.D.University of Porto, Porto, Portugal

Ronald S. Weinstein, M.D.University of Arizona, Tuscon, AZ

Franco VisinoniMilestone Medical Technologies, Bergamo, Italy

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Why Would I Need A Second Opinion

A second opinion can help you make an informed, confident decision about your medical care. Sometimes, you may find out about treatment options you didnt know were available. And in some cases, the information you gain during a second opinion consultation can even change your diagnosis.

Now its easier than ever to get the answers you need and peace of mind you deserve. Cleveland Clinics Virtual Second Opinions program connects you to an expert physician who specializes in your specific health needs. You receive a secure, private online consultation without leaving home.

Why Do I Need A Second Opinion

Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference

A second opinion is part of the education process that is critical for many cancer patients. The treatment of prostate cancer has evolved tremendously. In order to receive appropriate treatment, patients must understand the treatment options that are available. However, there are also many more options for treatment and these options are more complicated than in the past. For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. Also, a second opinion provides the opportunity to get information from someone other than the physician who will be directing treatment, which is usually the main source of information for most patients. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available.

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Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. This condition causes pain in the lower back and groin area, and may cause urinary retention. Symptoms include leaking and discomfort. In severe cases, a catheter may be required to relieve the symptoms. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. If these do not work, your symptoms could progress and become chronic.

An acute bacterial infection can cause a burning sensation. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Patients may experience a fever or chills as a result of the infection.

Who Pays For A Second Opinion

One of the problems with second opinions is that insurers may not cover the expense. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. In some situations, insurers will even insist on a second opinion. This is often the case when the primary physician advises an expensive treatment.

The best protection for cancer patients who are Health Maintenance Organization members is to seek a second opinion even if she or he has to pay for it. HMOs usually try to diagnose and treat patients within their system because the more money the HMO spends on second opinions and treatment outside the HMO, the less money there is available for operation costs and profits. This may cause a conflict of interest between the patient and the HMO, especially if very expensive treatment is only available outside the HMO system. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. For these reasons, it is a good idea for HMO members to get a second opinion and make sure they are informed about clinical trials or other promising new treatments. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. If you are considering undergoing a specialized treatment, such as cancer surgery, within your HMO, it is important to inquire about the number of such procedures performed each year by the HMO and the results.

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What Is A Second Opinion

A second opinion is a review of the cancer diagnosis and the treatment recommendations of the physician who is treating the cancer by another, independent physician. Either the patient or the primary physician can initiate the process of getting a second opinion. Usually, patients obtain a second opinion after being referred to a second physician or to a special team of experts in a cancer center, called a multidisciplinary team. This doctor or team of doctors will review the following:

  • Pathology report ,
  • The extent of cancer
  • The physical condition of the patient
  • The proposed treatment

The doctor then communicate their opinion regarding treatment to both the patient and the primary physician.

Second opinions are more likely to be comprehensive, or inclusive of every possible perspective, when performed in a cancer center with a multidisciplinary team, which usually includes surgeons, oncologists, radiation therapists, and sub-specialist oncologists.

People With Any Cancer Diagnosis Can Benefit From Getting A Second Opinion

Prostate Cancer Second Opinions: Alternate Advice Might Not Force ...

Second opinions offer different things in different circumstances, Dr. Matasar says. If its a common cancer with a well-established standard of care, they can offer insight into clinical trials or novel treatments that may be better than the standard. He adds that second opinions also can provide insight into topics like clinical genetics and family risk or issues related to complementary or integrative medicine approaches to manage symptoms.

For cancers that are less common, second opinions can offer more treatment options. In circumstances where there may not be a single established standard of care, we can ensure the treatment plan integrates the most current, up-to-date data, Dr. Matasar says. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different.

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