My husband had RP Jan 30th and learned May 9 that his PSA level is .22
While understandably low, it is evident that we have some issue remaining. Read bio for deatails on pathology report. The positive surgical margins I do not think is the cause for the PSA persistence. I learned after a follow up question that it was ‘very focaly positive with one gland showing evidence of cancer’.
The next step was supposed to be the scan and then radiation.
According to Cigna, my husband didn’t meet the criteria in the following ways:
PSA is not above 2.0
There are not two consecutive elevated PSAs.
My questions for this group:
1.) Would you pay for the scan out of pocket and fight later?
2.) Wait for PSA to reach 2.0 ?
3.) Move to another scan which would be approved by the insurance company?
Written by
JosephineS
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Having this scan done now offers no real benefit to you..When a BCR is confirmed, with the positive margin, they will probably do "Full Pelvic" radiation with no real need for a scan.. If you have not yet talked with an MO now might be a good time..
Hi, my name is Lynn,live in Pa. My husband was told we have to travel to Indiana for a scan for PSMA. Jefferson here in philly can do the infusions, but does not have the machine that scans for PSMA. Would really love to know if we could go to Maryland... so much closer to us. Plus I have family there. If you could email me I would so appreciate the information.
More to the point, with his adverse pathology report, there is no question that cancer is in the prostate bed, and possibly the pelvic lymph nodes too (he had LVI). The only value to you of a PET scan is to rule out more distant metastases, but at his PSA, it is unlikely.
Thanks TA, He callee is RO to ask him for assistance in seeing if the clinical trial might be an option for him. I echoed your thoughts on Question#2. RO said early salvage Radiation at .2 still leaves solid hope for a cure. The option letting the cancer grow enough to produce enough PSA for the scan felt counterintuitive.
Would you agree early salvage might give us a cure?
It's highly likely that he will benefit from immediately starting ADT plus irradiation to the prostatic bed and pelvic lymph nodes. I agree with those above who suggest speaking with a MO or RO.
Go old school. A baseline is needed for down the road. Ask your RO for a nuclear bone scan and a soft tissue abdominal CT scan. He will use the information to design a tomography program and radiate the offending areas. They are there.
Do not wait to 2.0 PSA. I hope he is doing monthly PSA tests. Three rises, ie in 90 days, will give an indicator of failure.
If three rises, do another set of scans, and compare. After the RO does his magic and if PSA is riding. Again three consecutive rises. See a MO to talk about systemic treatment.
With this said there may still be clinical trial still available that studies, adjunctive chemotherapy (a short course) after a surgery or radiation to cover the bases...,
Now, there are people who say all of this is overkill. I say, stay aggressive in your treatment; especially when the tumor burden is minimal and the body is strong.
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Rising PSA what to do next? 
GA-68 scan Availability in US.
Accuracy of PSMA PET scan?
I’m frustrated (damned if we do and damned if we don’t question doctors)
PSA rising while on ADT mono therapy 
