Since the thread he posted to runs to five pages I am starting a new thread for him so people can respond without paging through pages of old comments.
TUG BOATER said...
Dave & group,
Thanks for posting this tread, I am currently age 73 and have rapid raising PSA in less than one year following robotics surgery. We are currently scheduled for a consultation with Loma Linda regarding salvage radiation. Following is my pre & post-surgery history:
PSA: pre-surgery: 2/09 = 3.09 (69 years old)
6/10 = 4.79 (70 yrs. Old)
1/12 = 5.16 (scheduled biopsy)
I do not have the pre-surgery biopsy report on hand but L.L. has a copy. My local urologist group “had never seen this” intra-ductal involvement at this low PSA. Tissue sent to Stanford Medical, CA, they concurred “aggressive”. I asked for, bone scan and CT abdominal scan, results negative.
Robotics PT done on 5/8/12 Very good functional recovery, no issues.
Post-surgery biopsy: Gleason 4+3=7, with13% involvement, margins “uninvolved”, perineural invasion “present”, additional findings “PIN”.
Now the part we didn’t want to hear. Post-surgery PSA results.
8/3/12 = .13, (3 months post-surgery )
11/12 = .42, (6 months post-surgery)
2/8/13 = 5.45 (9 month post-surgery)
2/14/13 = 7.70 (retested)
My questions to the group are, best type of treatment?, we are assuming salvage radiation and pursuing Proton beam at L.L. We have a consultation set for 4/16/13 and hoping for an earlier date if they have cancellations. Next is the value of a Prostascint scan prior to consultation.
The last question (for now) is regarding Medicare and United Health Care. They have denied coverage for Proton beam treatment because “the original” treatment was surgery. Has anyone out there had proton beam as post-surgery salvage treatment that was “not denied”?
Welcome to the forum TUG.
I'll also pull up the comment from Tall Allen in response:
Tall Allen said...Original comment was here -- PeterDisAbelard]
There has so far never been any evidence that proton is any better than IMRT for primary treatment, let alone for salvage. Since they do protons plus IMRT for salvage, what is the added value of the protons? With salvage after failed RP, what you want is to treat a wider and deeper field -- neither of which protons are good for. It's easy to see why your insurance denied coverage.
I don't think Prostascint will show you much. NaF18 PET scans are becoming more widely available and may show more. Still more accurate are the C11 Acetate PET scan, available at UCLA, if you are in California.
Post Edited (PeterDisAbelard) : 3/25/2013 2:43:44 PM (GMT-6)