Last spring I was diagnosed with prostate cancer: Gleason 10 on all cores, with single bone met and one swollen lymph. PSA of 22. Immeidately put on hormone therapy shots. After 6 treatments of taxotere over basically 18 weeks, scans showed "no evidence of osseous metastatic disease" and lymphs normal. Currently PSA is .18. Great news. Oncologist sent me to radiology for follow-on radiation treatment but BCBS of Illinois denied the pre-auth. The radiation oncologist had call with BCBS, and informed me that they still denied her. My next step is to appeal BCBS Illinois directly.
This seems like it's case-by-case basis(?) or state-by-state? I thought I had read posts somewhere that insurance did cover follow-on radiation, and in some cases after appeal. My question for any of you is: are you aware of cases where insurance has covered radiation for prostate cancer as follow-on treatment to chemo? Or cases where it was denied but then later covered after appeal?
Written by
DD50
To view profiles and participate in discussions please or .
That is going to be hard to prove. I think the best way to make your case is to highlight the STAMPEDE trial that showed the benefit of debulking the primary in newly diagnosed men:
No, I meant that it's going to be hard to prove to an insurance company that debulking the prostate with radiation is still an effective therapy after systemic treatments have already been used. The only data we have as proof is among newly diagnosed patients.
Not sure if ADT is considered systemic and may well be but it is not the same level as taxotere which is a chemotherapy. The follow up of radiation after chemotherapy is the issue here.
Most definitely ADT is systemic and yes is different from chemo. What’s the difference of ADT then radiation vs chemo then radiation as again both chemo and ADT are systemic treatments?
The only difference I would point out here is the insurance company pays for radiation after ADT but apparently not after Chemo. Also I believe TA says there's no science showing a benefit which is why the insurance co is probably denying it. If no benefit there really is no reason to put your body through it IMO.
I said in my post " Immeidately put on hormone therapy shots. After 6 treatments of taxotere over basically 18 weeks, scans showed "no evidence of osseous metastatic disease" and lymphs normal. "
The study from Mayo suggested the opposite- there was no benefit to treating oligometastatic bone metastases. But that was in recurrent patients, after treatment of the prostate (RP or RT), not in patients who have not received prostate treatment.
Please tell us your bio. Age? Location? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)? Thank You!!!
All info is voluntary, but it helps us help you and helps us too. If you do respond, copy and paste it in your home page for your use and for other members’ reference.
You may want to ask your MO and RO to run additional serum testing for circulating tumor cells. If they are present in your blood that is further evidence that you cancer is still active. That data can be used in your pre-athorization narrative. Best wishes for getting treatment approved.
Well, my insurance changed the company that they were using for pre-approvals / screening. I hadn't completed the appeal paperwork and since my insurance is no longer using that company, there was no point in sending all of the appeal paperwork along to them. So my radiation oncologist's office (re)submitted the pre-approval request, and it was approved this time. Thank God. The office said that they pretty much denied everything at the end of the year.
Anyway, I read the STAMPEDE study (thank you Tall_Allen) and it seems to indicate that radiation after chemo was significant/worthwhile in cases of low metastatic burden, of which I was/am in that category so I'm hopeful that this will be worthwhile. If any surprises come up with insurance, I'll have that study in my back pocket for the appeal narrative.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Bleeding after salvage radiation 
Treatment options for local PC that is resistant to radiation 
Radiate just the prostate when there is extensive lymph node involvement?
Is surgery, radiation or Lu-177 therapy appropriate for my case? 
hormone therapy and Salvage radiation with PSA at 2.41 
