BIL PSA increase post RP

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New Member

Date Joined Dec 2010
Total Posts : 2
   Posted 12/13/2010 10:23 PM (GMT -6)   
My brother in law had a RP in May. First post surgical PSA was 0.1 in September. On Dec 1st his next PSA was 0.29. He had an MRI about a week later that was completely normal. Dr is recommendin radiation for 6-7 weeks. My sister has made him an appt for a second opinion at Dana Farber for the end of this week and just found out today that their insurance company is refusing to pay for this. My sister is a mess......our parents both died young from lung cancer and she, herself, is a breast cancer survivor. My BIL is 58yo and is healthy. He is having no pain, etc. Any recommendations, suggestions would be greatly appreciated!

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 12/13/2010 11:51 PM (GMT -6)   
The insurance won't pay for radiation, or the 2nd opinion? You aren't clear. Then you should pay for a second opinion if you have to on your own. Sounds like his surgery failed, and if his PSA has climbed all the way to .29, most would feel that he would need salvage radiation, and sooner rather than later.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Veteran Member

Date Joined Apr 2008
Total Posts : 847
   Posted 12/14/2010 12:08 AM (GMT -6)   
Jilliebean, welcome and sorry you have to be here.

A rising PSA means the surgery didn't remove all the cancer. The Dr, thinks the PCa is still somewhere in the prostate bed, and hence the radiation to zap it. Salvage radiation is standard second-line treatment for a failed surgery. If your BIL's Gleason score was 6 or 7, with perhaps positive margins, there is a good chance he is right, and a "cure" is still possible. Even if not, there are other treatments that will slow the progress of the PCa, and it is possible to survive many years.

It is normal for MRI to not show anything at this stage and for there to be no symptoms.

I can't comment on the insurance aspect, but I am sure that others here can...

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 12/14/2010 10:14 AM (GMT -6)   
Jilliebean, welcome to the forum, sorry you have to be here with such bad news. As the others have said, it does sem like it back returned, so SRT is next in line, in the fight. Hope you can stay with us, and bring the BIL or your sister here to join us.
James C. Age 63
Gonna Make Myself A Better Man
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RRP, Path: pT2c, 110 gms., all clear except:
Probable microscopic involvement of the left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09- Uh-Oh, next in Feb.
ED-total-Bimix 30cc

Cajun Jeff
Veteran Member

Date Joined Mar 2009
Total Posts : 4119
   Posted 12/14/2010 10:38 AM (GMT -6)   
I just hate fighting with darn Insurance Companies. I hope you are saying that they won't pay for second opinion. They should cover RT. Do keep us posted.

Cajun jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
2 year PSA <0.1
Only issue at this time is ED but getting better

New Member

Date Joined Dec 2010
Total Posts : 2
   Posted 12/14/2010 4:33 PM (GMT -6)   
Thank you all for your replies. I guess I was not very clear....the insurance company is refusing to pay for the second opinion and unfortunately, my sister and her husband are not in a position to pay out of pocket for a second opinion. I just spoke with my sister and they are just going to go with the proposed radiation which will begin in early January.
My BIL had negative margins and his Gleason was a 7. He had a repeat PSA done this past Friday and jut got the results showing the PSA is now 0.26.
I will continue to follow this forum in hopes of gathering as much info as possible for them as I can. I do hope that he and my sister will join when they feel ready to do so. I keep telling them about what a wonderful group you are and about all of the information they can find here. Thank you all so much!!

Veteran Member

Date Joined Jan 2010
Total Posts : 1011
   Posted 12/14/2010 5:00 PM (GMT -6)   
I was in your BIL's position not too long ago. I got a second opinion at Dana Farber thinking that my insurance company would clearly cover it. I was shocked when I got the denial. However, it was because DF was "out of network". Luckily my PCP went to bat for me and they ended up paying for the second opinion. I am very suprized that they won't pay for it. Is it because DF is out of network for you? You would think that they would want a second opinion before shelling out the money for SRT. Best of luck. BB
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