There is universal agreement among prostate cancer (PCa) experts, educators, and support organizations that second opinions matter greatly. This applies to your biopsy slides, imaging results, and recommended treatment options. Authoritative sources offer consistent wisdom. For instance:

1. The American Cancer Society urges all cancer patients to seek at least one other viewpoint. “Getting a second opinion can help you feel more sure about your diagnosis and treatment plan.”
2. Fox Chase Cancer Center points out that “…seeking a second opinion might also give you an opportunity to consider additional treatment options that may not have been discussed or previously offered.”
3. A blog posted by PCa support group moderator on ZeroCancer reminds patients that 2nd and even 3rd opinions are good. “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.”
4. CancerConnect underscores the importance of additional input, and promises PCa patients that, “Second opinions will not offend competent physicians, they provide reassurance to you and your family, and they ultimately allow you to receive the most appropriate therapy.

What is a second opinion?

A new diagnosis of a potentially life-threatening disease like cancer raises big problems. In trying to solve them, it’s said that two heads are better than one. A single person may miss important details or be limited in generating creative ideas, while an additional contributor can supply missing links. The most important initial problem is identifying the best treatment in each unique case.

The first diagnosis is based on a pathology report from the biopsy, results from tests (PSA, digital rectal exam, genomic analysis), imaging scans, particularly multiparametric MRI (mpMRI), and the patient’s medical/family history, including exposure to environmental factors, and patient age. Like jigsaw puzzle pieces, when all factors are assembled, the doctor forms a mental “picture” of this patient’s PCa.

A 2nd opinion doctor reviews all of these plus the first doctor’s conclusion. Since the first doctor may end up performing the treatment, a second opinion can balance that doctor’s treatment bias, especially if the obtained from an expert, specialist, or clinical team. CancerConnect points out, “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.”

Resistance to getting a 2nd opinion

According to research, uncertainty is a key driver for seeking second opinions. Anxiety and doubt are a natural response to the challenge of finding the right treatment. Patients are motivated by uncertainty to look for more thorough knowledge, though the uncertainty can continue even during the process of getting another opinion.^[i] Yet, even with uncertainty goading them, some PCa patients resist seeking alternative information. Many patients may be concerned about a financial burden if they think their insurance won’t cover another review/consultation. In another scenario, if their own doctor didn’t suggest getting another opinion and offering a referral, a patient may be unsure as to how to go about getting another opinion. And of course, there are often emotional reasons why it’s hard to mobilize and do what it takes to make the necessary appointment, transfer records, etc.

A common reason why men avoid second opinions is fear that their doctor will be upset or offended. Most doctors today are open to—and even encourage—obtaining a review of their interpretation, but there are still some who don’t like their patients turning to another resource. This is unfortunate, but doctors are human after all, and if they are emotionally attached to their advice, their ego may be bruised. However, the mark of a mature, professional doctor is openness to review and to consider what a second “head” can add to the first. Some PCa patient advocates even go so far as to tell patients to fire a doctor who discourages getting another opinion; instead, get another doctor AND a second opinion.

How to get a 2nd opinion

Here’s some advice from WebMD:

The best place to start the process is with your general doctor. If they haven’t offered you a referral to a specialist, ask for one. If you’re already seeing a specialist, ask to see another doctor who has at least the same level of training and expertise and who isn’t their close peer.

If you feel you can’t ask your current doctor, there are other ways to get a second opinion. You can try:

• Asking your insurance provider to recommend a specialist
• Asking a local clinic for a recommendation
• Asking a local hospital for a recommendation
• Searching a medical association for a specialist near you

Also check with your insurance company to make sure your second opinion is covered and if there are any special instructions.

At our Center, we welcome second opinions when requested by our patients. We are also proud to provide expert review of patients’ mpMRI scans. Visit our website to learn more.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Hillen MA, Gutheil CM, Smets EMA, et al. The evolution of uncertainty in second opinions about prostate cancer treatment. Health Expect. 2017;20(6):1264-1274.