Will insurance pay for repeated Axumin PET scans?

[kapakahi]

I see guys here having repeated PET scans to see how their treatments for mets are going, but I'm unclear on whether these repeat scans are the Axumin scans or just regular PET scans. The Axumin scans are so expensive that I figured I'd be on the hook for repeats, and I figure too that an ordinary PET wouldn't reveal PC mets. But each Axumin scan would cost me $7700, and at that price...well...say goodbye to retirement savings, leaving my wife with just about nothing.

So, you guys having repeated scans however many times a year, like after each bout of radiation/chemo/hormone - are those the Axumin PET scans? And is insurance paying for them? Is there a limit of some kind?

[Schwah]

I understand that the psma scans are better and less $$$. I’m doing mind next week for $2,700 at Ucla. Still a lot but about a third of what you’re talking about. If insurance won’t pay anyway you may want to ask your MO about that route.

Schwah

[Fairwind]

Once your treatment has switched from curative to palliative, there is really no reason to perform hyper-expensive scans as the standard scans can provide all the needed information..Once metastasis has been verified with PC and most cancers (stage 4) further treatment becomes palliative....The discussion then becomes the cost / benefit ratio this treatment provides....

[Tall_Allen]

It only is worth getting a PET scan if it will make a difference in your treatment decision. What decision do you have to make?

[cesanon]

"It only is worth getting a PET scan if it will make a difference in your treatment decision. What decision do you have to make?" Tall_Allen

That sums it up. I would expect most insurance companies to respect that logic.

The price you are being quoted seems a bit high, and is the retail price at that. If you shop around you should get a much better price, but you have to negotiate for it.

Make sure whoever is doing it does a lot of them. I think you'll find an inverse relationship between cost and experience. And a direct relationship between experience and quality.

Even out of pocket, the cost should not be more than what you might spend on a bad day on an auto repair.

Once it metastasies, the only reason for the scan is to determine if any of the Mets is impinging on a dangerous area and needs a good shot of focused sbrt radiation treatment. I wouldn't think most people will need more than 1, 2, or 3 of such scans over a lifetime (tall_allen, what do you think?)

[kapakahi in reply to cesanon]

the imaging center told me the retail price of the Axumin is $9,000 but I'd have to pay only $4600 - plus $2600 for the scan (instead of $3300) and $428 for the radiologist - I got quoted almost the exact same price at OHSU (Oregon's medical school). As far as the radiologist's experience goes, well...it's Oregon, small state, and I'm in a small(ish) town, Eugene - of course the imaging center says its radiologists are highly trained, so...I get the scan today so I can't back out now - results in a few days - my doc says treatment would be radiation if it's still contained or metastasis is local, if systemic I'd get hormonal treatment, which I really don't want (I don't understand why HIFU isn't used for spot metastases) - and I'm seriously considering the fenbendazole/NTZ (nitazoxanide) route first (or in addition) - but my wife and I are hoping for the best, of course, we've been living with this for almost as long as we've been married and after 4 HIFUs were hoping it was finally gone - I got jitterbugs just writing this - thanks everybody for your responses, this site is an education

[j-o-h-n]

Greeting Kapakahi, Could you provide some more info about yourself and your Pca. All info is voluntary and it helps us help you as well as helps us too. If you do please do so in a future post and not to me. Thank you..

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 06/04/2019 10:42 PM DST

[kapakahi]

My June 4 Axumin scan showed NO metastases! Dodged a bullet there. Also " Moderate activity in the midline prostate, concerning for viable malignancy." Yeah, well, that thing has been viable for 11 years now. My urologist said if the scan showed this situation, he would recommend radiation - SBRT I think he said. My HIFU surgeon in France said SBRT is getting very good results these days, depending on the machine and skill levels.

I'm wondering if I actually belong on this forum, "Advanced Prostate Cancer." When I was searching for info, after my PSA results but before I saw the doctor, I just kind of zeroed in on this site and if I saw the word "Advanced" it didn't register - like a lot of stuff doesn't register the older I get (I'm 72). I don't want to waste anybody's time here - I've become truly impressed not only by the knowledge I've found but by the matter-of-fact attitudes expressed in the face of some truly difficult, even devastating developments and procedures you guys endure. One thing I've learned here for sure - I've been extraordinarily lucky so far - my cancer was small, not very aggressive, Gleason 3+4, at the time of diagnosis the PSA had gone from 4 to 6.6 to 8.8 in less than 2 months and I had like 6% free PSA. I chose HIFU - 4 times. My urologist did biopsies annually and it seemed like every other year after the first HIFU he found cancer, so back to Europe I'd go. No biopsy this time - has Axumin PET taken the place of physical biopsies? I see my new doctor in a few minutes and he'll show me my options, I guess. Cesanon advised me to insist on a newer SBRT machine - I don't know what they use here in Eugene. Another thing I've learned in the last 11 years - don't surrender hope and don't surrender autonomy. Just because a doctor says it doesn't mean it's right for me. Over time I've noticed that doctors seem to be adjusting to this kind of assertiveness.

Lost my train of thought there - l was saying that I may not belong on this forum, but nevertheless I profoundly appreciate the wisdom and compassion and courage I've found here. It's inspiring.