Second Opinions Not Always Enough

Prostate cancer misdiagnosis a reminder to explore every avenue before surgery.

ByABC News
November 16, 2010, 11:46 AM

Nov. 19, 2010— -- I was five days from surgery to remove a cancerous prostate that wasn't. Five days from the sobering risk of side effects that have rendered thousands of men incontinent or impotent, or both.

But the thought of possibly losing my Mojo paled in comparison with the fear of prostate cancer that can skip to the lymph nodes, bone marrow or Lord knows where if not irradiated or excised. I opted for the latter after two pathologist reports concluded that I was host to what can best be described as cancer bordering on intermediate risk.

I met the first report at the urologist's office Sept. 14, after a routine prostate-specific antigen (PSA) blood test discovered that the level of enzyme given off by my prostate had jumped into red-flag territory. A subsequent biopsy, in which a needle was inserted into my walnut-sized prostate in 12 different places to take tiny samples, confirmed my worst fears.

I hemmed and hawed for a few days, talked to a couple of people who had first-hand experience, prayed with my wife, Beverly, and doubled back to my primary care physician of 21 years, whom I trust impeccably. He agreed with the urologist's recommendation to operate, reasoning that I have too many years ahead of me to risk letting any cancer lurk about.

The next hurdle was to confirm that no cancer had spread beyond the prostate. The pelvic, stomach and full-body bone scans came back negative, so the solution seemed obvious to me: Out comes the prostate, out comes the cancer. The other treatment options of radiation or "active surveillance" were both unappealing because, perhaps irrationally, I just wanted it over and done with.

We scheduled the radical prostatectomy for Oct. 13 at a reputable New York hospital where the pathology department had confirmed the initial diagnosis performed by the urologist's outside lab. Two analyses, two findings of cancer.

But I was also deep into a new book by then on the subject: "Invasion of the Prostate Snatchers," subtitled, "No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual Potency," by Dr. Mark Scholz and Ralph Blum.

No Objections to a Third Opinion

It's a powerful and empowering script on how to manage a course of action for an illness that sneaks up on more than 200,000 men annually, resulting in death for about 32,000 of them. The authors make a plausible argument that urologists are as reflexively quick to recommend surgery as patients are to succumb to the scalpel.

I finished the book still more or less confident that surgery was the best option for a man of my age, as suggested by my urologist, who said more than once that he wanted me to be comfortable with the decision. I appreciated that.

Among the book's recommendations that resonated loudest was the one to have my biopsy samples sent to a world-class, cancer research facility. OK, I'll confess that I gave in to sentimentalism and symbolism, choosing Johns Hopkins in Baltimore mostly because I was born at the hospital 52 years ago and grew up across town. Many locals treat Hopkins with church-like reverence and, while short of that for me, it remains my benchmark for medical research and health care.

And best of all was the simple online access to a printable form that gets the process started. No need to have a hospital contact or doctor's name; no need for me to leave New York City.