Insurance company has denied request to approve Axumin Scan with persistent PSA post surgery - What next?

[JosephineS]

Folks,

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?

[packardlover1949]

Wait awhile, things may change and he has time to evaluate.

[Fairwind]

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..

[Longterm101]

Would u be willing to travel to Bethesa Maryland to NIH

[JosephineS in reply to Longterm101]

Yes, I am certain he would be willing to travel there.

[Longterm101 in reply to JosephineS]

message me your email and i'll connect you with NIH clinical trial Corrdinator.

I just finished have a PSMA scan at NIH (all free)

Very impressive place. thx

[ronnie1943 in reply to Longterm101]

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.

[e-mail]

Best wishes,

Thank you, Lynn

[Longterm101 in reply to ronnie1943]

Happy to help

[Longterm101 in reply to Longterm101]

I’ll send info now

[ronnie1943 in reply to Longterm101]

Thank you so much! It would for sure be wonderful to travel to Maryland for a scan verses Indiana.

Lynn

[Longterm101 in reply to ronnie1943]

sent u an email... Good luck and reach out if I can help

[Tall_Allen]

1.) Would you pay for the scan out of pocket and fight later?

No. I don't think it will make a difference in his treatment.

2.) Wait for PSA to reach 2.0 ?

Definitely not. That's a self-fulfilling prophecy and is very dangerous.

3.) Move to another scan which would be approved by the insurance company?

Possibly, at one of the sites for the test of DCFPyL.

clinicaltrials.gov/ct2/show...

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.

[JosephineS in reply to Tall_Allen]

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?

[JosephineS]

Thank you. My concern is if the cancer is elsewhere does pelvic radiation still make sense .

[Tall_Allen]

The earlier the better:

pcnrv.blogspot.com/2016/09/...

You can call or email yourself to the contact info they provide. They are usually happy to deal directly with patients.

[tallguy2]

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.

[Hidden]

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.

GD

[Longterm101]

I’ll email u info now

[Break60]

Definitely wait for Psa to approach 2.0 then you’ll get approved and the scan will be more accurate.