7 Tips for Seeking Second Opinions For Men with Prostate Cancer

You’ve just been diagnosed with prostate cancer.  Fear, confusion and uncertainty set in.  You feel healthy, you aren’t in pain, you have no symptoms, and yet you have cancer?  How long do you have left?  You feel the clock ticking. 

Fear motivates you to want to treat this as soon as possible.  After all, it seems like good idea to deal with your cancer sooner rather than later.  Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. This urologist can get you in for surgery next week.  Everything seems to be on track to remove the cancer and be cured!

Unfortunately, what you do not realize may harm you! When facing an intricate disease like prostate cancer, the above scenario is far too simple to have a promising outcome. 

There is no one-size-fits-all treatment for prostate cancer.  Treatment options include immunotherapy, radiation, active surveillance, surgery, hormone therapy, and more.  Treatment must be chosen based on stage and your desired outcome.  By basing a treatment decision on a single medical opinion or the first appointment you get, you may not hear all the viable treatment options or receive the most up to date information.  Prostate cancer is an intricate disease and not all doctors have the same amount of experience advising or treating it.

You may be concerned that the cancer will grow rapidly out of control before you are able to get a second opinion. Thankfully, prostate cancer is extremely slow growing.  Men have plenty of time to seek multiple opinions and thoroughly research each option before making a decision.  Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority.  The primary goal is to be cured with the least toxic, most effective approach.  By taking the extra time to seek a second opinion, you have a better chance at finding the most up-to-date approach and an experienced doctor.

Here are seven tips for seeking second opinions for prostate cancer:

1. Know Your Stage

Before getting a second opinion, it’s important to know your stage of prostate cancer.  Knowing your stage and information specific to that stage makes you more medically sophisticated and enables you to navigate through the potential biases of surgeons and radiation therapists.  To learn your stage of prostate cancer, take the staging quiz on keytopc.com.

2. Seek Perspective from a Range of Specialists

There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists.  Urologists are trained as surgeons, radiation oncologists administer radiation, and medical oncologists provide cognitive oversight and general management of the cancer. Unfortunately, monetary incentives create biases that can work against patients’ best interests.  Study after study confirms that doctors favor the treatment they are trained to do— urologists typically recommend surgery and radiation oncologists recommend radiation.  Doctors are skilled at pitching the treatment they specialize in.  As a result, patients struggle to differentiate bias from fact.  By seeking second opinions and hearing the benefits and drawbacks of a range of treatment options for your specific stage, you will be more equipped to make educated decisions. 

3. Choose Experienced Physicians

Surprisingly, while one in nine men will get diagnosed with prostate cancer in their lifetime¹, there are very few doctors who specialize exclusively in treating prostate cancer. The more often a doctor diagnoses and treats prostate cancer the more proficient they become. By choosing the first doctor you speak with to be your treating physician, you may be putting your health in the hands of someone who lacks the expertise to accurately and safely treat your prostate cancer. Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. 

4. Check Biopsy and Imaging Results for Accuracy

Second opinions apply to biopsies and imaging as well.  Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results.  Be sure to confirm your diagnosis at a center of excellence. Potentially inaccurate results can lead to selection of the wrong type of therapy.     

5. Include Your Primary Care Physician as Member of Your Treatment Team

The Journal of the American Board of Family Medicine published a study in 2017 that found that many patients do not get a second opinion outside of their PCP’s original referral².  When first diagnosed with prostate cancer, your PCP will generally refer you to a urologist for a biopsy.  Many men name the diagnosing urologist as their treating doctor and do not seek other opinions.  This puts PCPs in a unique position to impact the treatment decision—if they only refer to urologists and not to radiation oncologists or medical oncologists—surgery is a likely treatment outcome. Ask your PCP to refer you to several different types of treating doctors before making a treatment decision. PCPs can be a great help to navigate the medical marketplace and provide an unbiased voice of reason when it comes to making hard choices.  

Keep in mind that not all PCPs are knowledgeable about prostate cancer or know the skill levels of all the specialists in the field. They may defer to the recommendation of the specialist, or refer you to a doctor with limited prostate cancer experience.  It is still important to do your own research. That being said, they can be a beneficial member of the treatment team.  

6. Check Your Insurance Policy

Many health insurance companies will pay for a second opinion, especially if it is for a medically necessary treatment.  You can find out by reviewing your plan or by reaching out to your insurance company.  If they do not cover this cost and you must pay out of pocket, keep in mind that a second opinion could save you from having to pay (financially and physically) for additional treatment down the line. 

7. Bring All Labs/Notes to Each Appointment

Ask your doctor for a copy of your complete medical record.  This may include imaging, blood tests, prior treatment, and pathology reports.  Doctors can review their peers’ treatment suggestions and explain why they agree or disagree.  Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. 

Conclusion

Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required. Prostate cancer is a slow growing condition.  Allow yourself the time to seek multiple opinions.  Men need to be educated on all treatment options to protect themselves from a biased industry.  Confirm biopsy and imaging results with centers of excellence before making any final decisions.  Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. 

References

1.Rebecca L. Siegel, Kimberly D. Miller, and Ahmedin Jemal, “Cancer Statistics, 2019” CA Cancer J Clin. 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551.

2.Tammy Jiang, Christian H. Stillson, Craig Evan Pollack, Linda Crossette, Miupdachelle Ross, Archana Radhakrishnan, and David Grande, “How Men with Prostate Cancer Choose Specialists: A Qualitative Study,” Journal of the American Board of Family Medicine: JABFM, 30(2), (2017): 220–229.