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Value of Second Opinion and Treatment Options

Michael R. Kuettel, MD, PhD, MBA, says that prostate patients should thoroughly weigh their treatment options before deciding what to do.

"When a diagnosis of prostate cancer is made, don’t panic. Step back and don’t rush into any decisions," recommends the Chairman of Roswell Park Cancer Institute's (RPCI) Department of Radiation Medicine.

Kuettel says that it’s important to get a second opinion, or possibly even a third opinion or more. "For many of the ‘second-opinion’ patients that we see at RPCI, it’s not unusual for us to offer additional options based on current national guidelines and standards."

So, what should one do before making a decision?

"Do your homework," says Kuettel, whose definition of "homework" involves consulting reputable sources such as the National Comprehensive Cancer Network (NCCN), National Cancer Institute and American Cancer Society. "Don’t just go to the Internet, type in ‘prostate cancer’ and start reading what may be inaccurate or even a hidden advertisement for a profit-driven center."

And, warns Kuettel, make sure evidence-based medicine — and not finance-based medicine — drives your decision-making. Patients often acquire different opinions from different specialists – a surgeon will most likely recommend surgery, a radiation oncologist will most likely recommend radiation. "Much of the information out there is marketing, as doctors try to recoup their investments in expensive equipment," explains Kuettel. "Many treatments will have similar outcomes, but different side effects, so patients shouldn’t feel pressured into making a decision that may not feel right to them."

NCCN disease-specific guidelines can help patients sort out their options. Using flow charts, prostate patients can enter their PSA, exam results and other data and classify themselves as having a low-, intermediate- or high-aggressive prostate cancer. Then they follow the arrows to their treatment choices.

RPCI takes a multidisciplinary approach to prostate cancer, presenting patients with a variety of choices. Dr. James Mohler, Chair of the Urologic Oncology Department, said each patient receives a three-quarter-inch-thick notebook describing all their options, including information on diagnosis and staging, side effects and support groups. The notebook is based on NCCN-recommended national guidelines, which Mohler and Kuettel helped co-author.

"We often send the notebook to patients in advance of their clinic visit so they can begin to think about options. We also give patients a photocopy of notes taken at the follow-up counseling session to help them remember what we talked about and how we arrived at recommendations."

Many patients go home, re-read the notebook, review the recommendations and then decide. Some are already prepared and know walking in what treatment is right for them.