How do we determine if cancer is in remission

[GrantB47]

Just had my fourth of five Cyber Knife treatments and my doctor said everything has been going "great." It turns out that means when the treatment was performed my bladder was full and my rectum was empty. When I asked if another Petscan was on the horizon he told me that it was unlikely that my insurer would pay for one. Is the only method of determining my health status, with regard to the cancer in the future, my Psa test?

[GrantB47]

Hi: Merry Xmas to all. I forgot to say my cancer had metasticized to my lumbar region with three spots. I don't know if that is relevant to my question or not, but thanks to all who participate here.

[GP24]

You can trust that the radiation killed the affected nodes seen on the PSMA PET/CT. However, usually there are smaller mets not yet seen on the PSMA PET/CT. These will now grow and show up in about a years time. Therefore I recommend to continue with ADT after the radiation, even if your RO means you can avoid that. If the PSA value has increased significantly, you can schedule another PSMA PET/CT to see where the new mets are. You can then treat these with SBRT or Lutetium 177.

[GrantB47 in reply to GP24]

Thanks a lot.

[Tall_Allen]

A PET scan would be useless.

You are on lifelong ADT for your metastatic cancer, so your PSA will be undetectable until it isn't.

"Remission" is a meaningless term medically. For patients it just means there is no evidence of progression, which is your situation. So if you want to consider yourself "in remission", go ahead, you earned it!

[GrantB47 in reply to Tall_Allen]

I don't really feel like I "earned" anything, but thanks for the education.

[TJGuy]

What insurance do you have, this just might be a insurance opinion by your doctor. You should be able to get followup PSMA scans after a treatment to determine the effectiveness of the treatment.This of course could then dictate if additional treatment is necessary.

Tall Allen has always as long as I've been a participant in this forum said after targeting your found metastatic PC with radiation, that PSMA scan are necessary for the remainder of your life as you may have killed the large PSA generating PC and you can't just go by PSA any longer.

Let me tell you this, it may all have to do with your health insurance and your doctor.

I go to three doctors and hospitals. This is because I live in multiple states. So I recently had two PSMA scans three months apart, and then SBRT to one lymph node. I go back after three months for a third PSMA scan to determine the effectiveness of the radiation. You should be able to as well. Three months is the standard to wait to be able to get another PSMA scan or other scans as well. Your doctor just needs to state the scan is medically necessary to the insurance company. This is a standard statement.

So get this, one of the doctors at a different facility in another state said they were impressed that I had had two recent PSMA scans, saying they get denied for PSMA scans in general, and have performed very few.

This area is HMO and Medicare Advantage plans dominated, so these types of insurance are known to deny legitimate health care coverage. I have PPO insurance from another state which allows me coverage anywhere.

What is your health insurance? You may have to fight for your healthcare with appeals.

Going into remission is a term that doesn't really mean much they way it's used. For PC that usually means your PSA is <0.1 using a standard PSA test from the late 1980s. Hospitals still use these ancient PSA tests.

But using newer ultrasenitive PSA tests, LabCorp ultrasenitive PSA tests go to <0.006. This is what is really going to tell you is your really undetectable, in remission, NED. Along with Cancer scans.

Request or demand that your doctor write you a prescription for ultrasenitive PSA test (I recommend LabCorp because they are the lowest available at this time) when you are at low levels of PSA. This tells you much more than the "ancient" PSA tests.

These ultrasenitive tests cost another $50 or so, there are two ultrasenitive PSA test they are actually the exact same test, but one gives you your PSA results in graph form and the charge you another maybe $40 for that. Just get the ultrasenitive WO serial monitoring, WO stands for with out, it's cheaper than the W serial monitoring which means graph form with prior PSA results shown on the graph If your PSA is into double digits, the standard PSA test is legitimate to use as that level of precision is not needed in those cases.

[Mischa1111111 in reply to TJGuy]

That response was ana éducation in itseld. Thanks and Happy Holidays!!!

[GrantB47 in reply to TJGuy]

TJGuy, thank you so much for that response. I use the VA but also have Medicare Advantage with Aetna (Medicare HMO.) I use it so rarely that I really don't have any idea what it covers. My VA facility does not have a Cyber Knife machine up and running so I was sent to a doctor outside the system and he was the one who told me my insurance probably would not cover the PETScan. I don't think he was referring to VA insurance but rather a general comment. The VA is a little hard to deal with as they seem to try and keep costs down by keeping the patient in the dark on the various options. I will be asking more questions at the VA. Thanks again.

[j-o-h-n in reply to TJGuy]

Great job TJ............ I nominate you for Poster of the month.....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/26/2023 7:33 PM EST

[dhccpa]

Great question about a slippery issue.

[Boywonder56]

Shouldnt run with knives....cyber or not..so i was told