Being self-employed, I’m on a public marketplace health insurance plan (United States) at the moment. I’ve been getting my care at Virginia Mason (VM) hospital in Seattle, which also has its own lab where I get my (currently monthly) PSA readings.
I’m considering changing my health insurance to one that covers care at Fred Hutch (in large part because it’s an NCI-designated cancer center and think that’s where I’ll get the best care).
However, I’m a bit confused about what to do about my PSA labs. I know going to the same lab is important, but if I change plans, then Virginia Mason will likely become out of network for me. Do I just suck it up and change labs this one time? Is it reasonable to seek the same assay as the one done at VM or is that a fool’s errand? Or do I just not change health insurance plans because this is a mess? I don’t know why this is such a mental blocker for me but it is.
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I regularly use different labs, and have done so for two decades. By regularly I mean sometimes as frequently as monthly; so a large number over the years. By different labs I mean in different US States and different countries, so not just different labs, different assays too. Always consistent, always reliable.
I do ponder, if two different lab results are so different that next step (no action/further investigation/treatment) would be different, how do you know which lab is correct? And if one lab is significantly in error, what of the men using that 'bad' lab?
Whether one lab or many, isn't a pattern the key? If one tests only once a year, how do you know the result is correct?
Bring in the variable meaning of 'undetectable'. Are <0.2, <0.1, <0.05, <0.01, <0.006 the same? They could be, or not. Hope this helps.
Use Quest or Labcorp they typically use the same location for USPSA tests. It might take a bit longer for results. For example, I'm in Harrisburg PA area and my Quest USPSA sample is sent to their lab in VA. It does take a week for results but I would imagine if I moved to a different area the same lab in VA would be used. Also, my secondary insurance picks up anything my primary doesn't if I use Quest.
Most often I use LabCorp, actually getting my latest in a few hours - will have result tomorrow. As I travel, the Labcorp results will indicate different lab locations; Houston, Phoenix, Seattle, etc. Assays will be same.
Hi, I’m in Tacoma. And I’m also getting insurance on the marketplace. I have experience with the Fred Hutch and Swedish systems (but not VM). I’m happy to share what I’ve learned along the way, either here or in DM.
As far as labs, my Swedish MO uses Labcorp which is in network for my current insurance. He orders it, the Tacoma lab can view the orders. And Fred Hutch docs can read the results as well since they share the same MyChart software.
The assay & analyzer used are two of the parameters of the equation but IMO, not the most critical. I have been using two labs one equipped with the Roche Cobas 8K (ECLIA) series analyzer and the other with Abbott Alinity. When recently calibrated the former prints out PSA results within a +5% excess over the latter. What is more important, IMO, is to select a lab that has the analyzing facilities in-house so that from the blood draw till the vials enter the analyzer 2 hours are max allowed. PSA has a half life of 2.5 to 3.5 days translating to a natural decay of 11% or 8% for a 10 hours transportation delay. This elevates the variance to twice-thrice compared to that due to the dissimilar assay & analyzer.
I respect the technical prowess but does an 11% variance (perhaps yielding very slightly lower value than actual at time of the draw - depending on reporting range) really matter, when IMO, trend line and actionable value points are at least equal parameters?
Post RP I rely on <0.010 as best indicator. Come 0.03X range, where I have been hanging since June 2021, I begin triangulating these pesky little cells with imaging and liquid blood biopsies. Between 0.05X (my RP nadir) and 0.10 (when ePLND confirmed six cancerous pelvic lymph nodes) I will take action. I am not longer willing to give this beast time and disparity.
Here in the US, I confirmed once again this morning at the LabCorp phlebotomy office (not the lab ), that the vile will sit until afternoon, awaiting pick up and delivery to any number of labs (based on contract pricing, volume, availability?) that will analyze my blood. More than a few times the phlebotomy lab I use is in one state and the analyzing lab is in another. But again, if I am looking for a trend line with multiple data points does an 11% variance really matter? At 0.2 an 11% variance is only 0.022.
I understand thought behind using the same in house lab shortly after the draw, but how likely is this? I am aware for some docs/medical centers using their in house lab provides additional revenue. Similar to in house imaging - isn't it? Maybe more financial incentive than science behind the recommendation?
My post was meant to stress the fact that over simplifications of the sort "use the same lab" are far from optimal. The foundation for any quality measurement is maintaining all interfering variables constant, or if not possible, apply suitable corrections. The "same lab" outsourcing analysis hap-hazardly is inferior to different labs implementing tight tolerances.
Not really for trends. Multiple samples compensate for random, or even systematic, errors. For actionable values, how do you define "actionable values"? Are they the "magic" easy to remember round values that SoC put in place, so that docs learn them by heart? If yes, they are just a joke, nothing the do with measurements and decision making. Better to toss a coin.
I would just say it might be worth getting a lab that measures to the .00 level. I had a prostatectomy at a University Health hospital that measured to .00. At six months my PSA was undetectable (.01). I then moved to a different state and kept the original doctor but for convenience but had my PSA checked at a clinic near me and their system only measured to .0. Everything looked okay, PSA was recorded as >.1, but my doctor wanted an assay the measured .00, so I went to the University hospital near my new location. With their system the PSA was .08, not exactly undetectable. So I was given a little early warning on a rising PSA which I wouldn't have gotten with the less accurate lab.
I think the gain in moving to an NCI center of excellence far outweighs any variability in PSA measurements. You're really looking at trends, and on your second month you will have a new trend line if your current lab is really off what your new lab will be. And I'd trust the NCI lab more than the one you're using now.
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