I haven't received the invoice for the 2nd and 3rd fraction of SBRT. The date of service was June 2 and that was my first fraction . Maybe they billed for all three fractions at one time? If so the cost for 3 fractions was $29800 and was fully reimbursed. I believe I had 10 gray per fraction. But may have been 9. I'll get back to you when this is clarified.
As far as low dose IMRT by Dattoli they wanted to do six weeks or 30 fractions. Assuming they would use 1.5 gray per fraction (the dose administered to my pelvic lymph nodes) that would have been 45 grays. At $2200 per fraction that would have totaled $66000 for low dose IMRT to a single 9 mm bone met but reimbursed at only 20%. So the net cost to the insurer is MUCH LESS for IMRT. Dattoli has two linacs which he keeps well utilized. But his reimbursement rate from Medicare is very low as I said. So he needs volume. His nurse commented that he would get a higher reimbursement for SBRT but preferred the safety of IMRT for his patients. He is however getting a machine which administers SBRT later this year. He will make more money administering SBRT. He's a great doctor with a great team but he'll be forced to administer SBRT due to convenience to patients. I still don't understand why the reimbursement rates are so different.
Clearly, for mets located away from other vital organs SBRT is the way to go.
DOB January 1944 (now age 73)
PSA: 8/12 2.7; 5/13, 6.6 (actually double due to finasteride)
7/13 (age 69) Bx GS 4+4=8 (Bostwick); GS 4+5=9 (Epstein); 2 of 6 cores, 10%, 40%; stage Pt1c
8/13 bone scan negative
9/13 ORRP at John Hopkins, GS 4+5=9, BLSVIs+, margin+ (4mm,G7), EPE, 10 Nodes resected (clear); stage upgraded to pt3bN0M0
PSA: 11/13 0.1; 2/14 0.2; 5/14 0.3
6/14 SRT by IMRT/IGRT, Lewis cancer Ctr. 68.2 grays/38 sessions to prostate bed, ADT (6 months Lupron)
PSA: 9/14 to 8/15: <.1, <.1, .1, .3, .7, 1.2
7/15 CT-PET f-18 bone scan negative
9/15 MRI, CT-PET at Sand Lake Imaging find iliac lymph nodes suspicious for PCa; organs and soft tissue clear
9/15-12/15 IMRT/D.A.R.T. at Dattoli , 75 grays/50 sessions to all pelvic lymph nodes
9/15-11/16: 13 months ADT3 (Lupron, bicaludimide, dutasteride) plus Metformin, Cabergoline, Estradiol patch, Prolia , Vitamin D3, calcium
6/16: color-flow Doppler ultrasound, combined helical CT pelvis, abdomen and chest and QCT for bone density and FDG 18 Pet scan negative for PCa
12/16: color-flow Doppler ultrasound, combined helical CT pelvis, abdomen and chest and QCT for bone density negative for PCa; finasteride added to dutasteride.
PSA: 11/15 .084; 3/16 .034; 6/16 .028; 9/16 .045; 12/16 .194; 1/17 .484; 2/17 1.1; 3/17 1.3;
Post Edited (Break60) : 6/25/2017 8:35:07 AM (GMT-6)