All men who come to our clinic do so following a diagnosis of prostate cancer and a recommendation for treatment – mostly from the NHS, sometimes from a private clinic. Indeed, they seek us out because they wish to explore alternatives to those recommendations. We provide, by default, a second opinion.
In considering a patient for focal therapy, our doctors review a range of information, including PSA, MRI reporting, biopsy report and histopathology. This “pathway” information completes a story of the location and severity of a patient’s prostate cancer. And this is where we often find both problems and opportunities.
- Imaging – not all MRI scans are equal. Variability in scanner settings, sequencing, radiographic technique can compromise image quality
- radiological reporting- varies considerably across the NHS in both the quantity and quality of information gleaned from imaging
- biopsy method – the gold standard is a transperineal fusion biopsy and anything else compromises a precision diagnosis
- histopathology – labs and lab techniques vary which can compromise Gleeson scoring and optimal treatment programmes
Suboptimal imaging, image reporting, biopsy method and histopathology will lead to suboptimal treatment recommendations. We often redo the imaging pathway and end up with a very different diagnostic result, supporting very different treatment options.
Even when the quality of data is good, interpretation is subject to experience and opinion – the very stuff of medical professionalism. In any case, all of our patients’ cases go through our rigorous MDT involving urological and radiological input to arrive at a comprehensively reviewed treatment recommendation for each patient.
It’s worth noting that a second opinion is sought by the patient – not offered by the doctor. And so men, and often their partners, have to take the initiative. Many are reticent, often for fear of “offending” their doctor, but there are lots of reasons why and these are addressed in guidance from cancer charities and other medical bodies.
Cancer Research UK offers a comprehensive guide to seeking second opinions on a prostate cancer diagnosis, outlining pros and cons and providing contact points for help. Others are stronger in their guidance,:
“A second opinion is an important part of becoming educated about your prostate cancer and your treatment options. The more you can learn about your diagnosis and your treatment options, the better chance you have of receiving the most appropriate treatment. Prostate cancer is now more treatable than the past, but there are also many more treatment options and more complicated procedures. This is especially true for treatment of early stage localized prostate cancer where there has been constant technical innovation in both surgery and radiation. Getting a second opinion will help you understand these options and help you make an informed decision about which is best for you. “
More often it is conversations with and comments from other men that incentivises a request for a second opinion.
TFTC patient Mark Stubbs would have gone down a very different route with his prostate cancer diagnosis if he hadn’t sought a second opinion:
“I’m actually a stronger advocate of a second opinion now than I would have been at the time of my diagnosis. It was only really when I discussed with Mr. Tim Dudderidge – a telephone consultation – that he actually suggested revisiting the biopsy samples
And he basically said, look, we’ve rechecked the samples. It’s coming out at Gleason 7 rather than Gleason 9, he said, which does give us quite a few more options in terms of nerve sparing during surgery and also sparing the lymph glands, which to me was priceless. If I’d have probably stayed in the NHS loop, I’ve got a feeling I wouldn’t have got the same level of treatment. I wouldn’t have had the second opinion and they would have probably operated assuming that the cancer was Gleason 9. So really the second opinion, I think, was absolutely pivotal in the choice of treatment”
Another patient, Ray Braithwaite, felt his initial experience at diagnosis was rushed and impersonal, and had doubts about the treatment options he was recommended. He had a very different experience with TFTC Consultant Urologist Tim Dudderidge:
“He listened. He had time. And we spent about 20 or 30 minutes and Tim went through all of the potential alternatives, including the surgery and the radiotherapy and the HIFU. And he was also able to tell me about Gleason and PSA and the stuff that I should have been told about months earlier, I think.”
In Graham Ogilvy’s case, a different biopsy changed everything about his initial diagnosis and treatment options:
“the NHS were very good about giving me the records and the MRI scan I had so that Mr Nigam could see that. So the interface there, it was pretty OK. The MRI scan he thought was of a very high quality, etc., but did require to be another biopsy. And this was very interesting because this was a different biopsy from that that is performed in Scotland. It’s more exact, it’s a transperineal, I think they call it.”
If you have any doubts about your diagnosis, are concerned about the impact of your recommended treatment on your quality of life, please get in touch. We’d love to hear from you.