Second Opinions Not Always Enough


My urologist's assistant, without batting an eye, even volunteered to track down the biopsy samples and send them to Baltimore for what was to be a third analysis. I appreciated that, too, as I grasped for one final way out.

But I had already made enough peace with the surgical treatment that I trudged over to the New York hospital for pre-operation screening.

I also met with my manager and a human resources rep to explain that I would be out of work for two to three weeks, at least. I had their unwavering support. I had even bought the absorbent underwear, antibiotics and painkillers I would need to help ease the recovery.

Then, on the Friday afternoon before Wednesday's scheduled surgery, that same assistant left me a message at work to call her at the urologist's office ASAP. I returned the call and the doctor was soon on the line, a first in the weeks' worth of phone calls to the office. My initial thought: "This cannot be good."

The doctor explained that Hopkins had found insufficient evidence to "establish a definitive diagnosis," adding that the Baltimore pathologists recommended a repeat biopsy to clarify their "highly atypical and suspicious" findings.

Translation: With no consensus, the surgery was off for the time being.

Mistakes Do Happen

So, just as unexpectedly as the diagnosis had sent me into a funk, here was the same doctor telling me he couldn't operate because of the conflicting reports. Oddly, I was disappointed because I was oh so close to getting this "thing" out of me. But the fatalism soon gave way to a more rational wave of relief that if this couldn't be a dream, then maybe, just maybe, it could be a mistake.

Emotionally and physically spent by then, I put off the repeat biopsy for a couple weeks. And the whole process seemed less suffocating after the Hopkins diagnosis, or non-diagnosis. Knowing what to expect even made the thought of another biopsy much less dreadful.

Afterwards, I was back at the urologist's office Nov. 9, eight weeks to the day after he told me I had cancer. Repeat biopsy from the same outside lab in hand, he delivered the jaw-dropper -- I have "atypical" prostate cells but no malignancy. The similarities between the two are apparently enough to play tricks on the pathologists.

There's no known cause, there's no treatment. I'm relatively fit so the urologist was at a loss to recommend any drastic lifestyle changes.

But the condition is sometimes a precursor to cancer, sometimes not. That means I'll require aggressive monitoring for the foreseeable future, with quarterly PSA blood tests (instead of yearly) although as few biopsies as possible to avoid, as my urologist joked, "making Swiss cheese out of your prostate." I'll take the deal.

I now better appreciate that urologists and all other MDs are at the mercy of pathologists, who're doctors themselves tasked with deciphering the cellular-level behavior of tissue and organs. So I have no problems with my urologist. He can take my prostate anytime, if it comes to that.

It just won't be today.

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