Seeking a Second (or Third or Fourth) Opinion
Getting a balanced view of all your options
for prostate cancer may involve consulting with several specialists.
Determining a course of treatment for prostate cancer is one
of the most harrowing decisions in modern medicine. Not only
do treatments such as surgery and radiation therapy have troubling
side effects, doctors can’t agree on which treatments work
best—and are more likely to recommend the option that they
specialize in. Hence, to be in the best position for making decisions
about your own treatment, it’s vital to get more than one
Three Types of Specialists
In an often-cited study published in the Journal of the American
Medical Association in 2000, researchers asked more than
1,000 specialists what treatment they would recommend for a
man with early-stage prostate cancer who was expected to live
at least 10 more years. Nearly all the urologists (93%)—who
perform surgery—chose surgery as the preferred treatment,
while most of the radiation oncologists (72%) responded that
radiation therapy and surgery were equally effective treatments.
The study authors’ conclusion? Patients should schedule
a consultation with a member of each specialty before making
If these specialists don’t agree, one option is to schedule
a consultation with a medical oncologist, a specialist in cancer
treatment who does not perform radiation or surgery. Another
option is to see a second urologist or radiation oncologist.
Doctors of the same specialty often have different approaches
to treatment: For example, some radiation oncologists will recommend
external beam radiation therapy; others, brachytherapy; and still
others, a combination.
The Importance of the Pathologist
A final but not-to-be-overlooked reason to seek a second opinion
is that if done at a center that specializes in prostate cancer
treatments, it involves having another pathologist review the
slides from your biopsy specimen. An accurate pathology reading
is essential because it forms the basis for treatment decisions.
Unfortunately, spotting cancerous cells and determining how
abnormal they appear are difficult, and pathologists sometimes
make errors. In one study, pathologists at Johns Hopkins reviewed
biopsy samples of 535 men who had been referred for radical prostatectomy
and reclassified 7 (1.3%) as benign. Upon subsequent clinical
workup, 6 of 7 men were considered not to have prostate cancer,
and their surgery was canceled. Getting an incorrect reading
can limit your treatment options—or lead to having treatments
that you don’t need.
How To Get a Second Opinion
Some patients are reluctant to bring up the matter of second
opinions, thinking that their doctor may not be receptive to
involving another physician. Today, however, doctors in step
with current medical standards welcome such discussions and support
their patients’ desire for additional information whenever
appropriate. Health insurers generally pay for second opinions,
and some even require them before certain procedures.
Your primary care doctor and the urologist who performed the
biopsy are the best sources for referrals. Request that, if possible,
they suggest a colleague affiliated with a different hospital.
Although this is not absolutely necessary, the practice is prudent,
because doctors who work at the same institution often share
similar views and may be reluctant to contradict one another.
Also check to be certain the consultant is board certified in
the appropriate specialty. The American
Medical Association and the American
Urological Association offer referral services. Hospitals,
local health departments, family, and friends are other possible
If your referring doctor is unwilling to discuss the possibility
of a second opinion or makes you feel uncomfortable about the
matter, strongly consider changing doctors.
Before meeting with you, the consultant will require all relevant
medical records. The first doctor’s office can send written
reports and test results directly to the consultant. Be sure
to call before your appointment to confirm their arrival, as
it will be impossible to proceed without proper documentation;
you can also choose to collect the records and deliver them personally.
During the consultation, the doctor will review the information
and may perform a physical examination or order more tests. Recommendations
made in a written report will be sent to the referring physician—and
also to you if you request them.
Be sure that the specialists address all treatment options—surgery,
radiation therapy, and watchful waiting—and discuss the
advantages and disadvantages of each. If your doctors don’t
agree and you don’t know what to do, one or more of the
following approaches can help you reach a decision:
• Have the specialists explain to you why they came
to their respective conclusions.
• Suggest that the specialists discuss the matter with
each other; sometimes such conversations produce an acceptable
• Ask your general practitioner—or, if you wish,
another specialist—to help you sort through the options.
• Consider seeking an opinion at a nationally recognized
cancer center, such as one affiliated with the National
Comprehensive Cancer Network.
• Try talking to men who have been treated for prostate
Don’t panic if you’re having trouble making a decision.
Prostate cancer is generally a slow-growing malignancy, which
means that most people can safely spend up to three months learning
about the disease and consulting with the appropriate specialists.
Making an Appointment at Hopkins
Many people facing a serious health crisis wish to get a second
opinion from a leading academic medical center such as Johns
Hopkins. There are several ways to make appointments at Hopkins.
The most direct way is for your physician to call the Hopkins
Access Line (410-955-9444 in Baltimore and internationally or
800-765-5447 in the rest of the United States).
If you prefer to make an appointment yourself, you may call
the appointment service line (410-955-5464 in Baltimore, or 410-955-8032
outside Baltimore, including international calls).
Finally, Johns Hopkins USA provides one point of contact for
out-of-town patients. A representative can help you identify
an appropriate physician or specialist, coordinate multiple medical
appointments, arrange second opinions, and obtain general information
about Johns Hopkins's many services. To talk with a representative,
call 443-287-0528 weekdays, 8:30 a.m. to 5 p.m. Eastern Time.