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Thread: Sticky: What I Need to Know about HIFU

  1. #41
    Moderator Top User HighlanderCFH's Avatar
    Join Date
    Nov 2011
    Posts
    7,281
    Hi,

    Welcome to the forum. Not sure about insurance & HIFU, but others here may jump in with some answers.

    Can you give us your biopsy stats & PSA history so we can have a better idea of your case?
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Eight annual post-op exams 2012 through 2019: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  2. #42
    This might be helpful:

    In July 2017, a reimbursement code went into effect for HIFU ablation of the prostate.
    This code, called a c-code, is specifically for patients covered under Medicare and only applies to a hospital outpatient facility or ambulatory surgery center (ASC).
    At this time, it does not apply to commercial insurers.
    It does not apply to procedures performed in a physician’s office or to a physician’s services.
    The c-code is C9747, Ablation of prostate, transrectal, high intensity focused ultrasound (HIFU), including image guidance.

    This only concerns Medicare payment to the facility. It does not cover the costs of the physician or anesthesiologist.
    DOB: May 1944
    In Active Surveillance program at Johns Hopkins
    Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
    Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
    PSA has varied up and down from 3 to 10 over the years. Is 4.0 as of September 2019.
    Hopefully, I can remain untreated. So far, so good.

  3. #43
    Newbie New User
    Join Date
    Jan 2018
    Posts
    2
    Thanks for the info,
    5/17 PSA 5.32
    DRE Negitive
    6/17 Biopsy 1/12 pos 2%
    7/17 CT and Bone scan possible mets
    8/17 PSA 5.56
    9/17 started 4 mth Lupron shot
    2nd opinion in Little Rock
    9/17 Biopsy 7/24 pos 2-40%
    10/17 PSA 2.55
    DRE negitive
    10/17 Pet scan rib lit up
    11/17 Bone biopsy of rib neg
    scheduled T3 MRI 2/18

  4. #44
    Experienced User
    Join Date
    Jul 2013
    Posts
    60
    I'm just now seeing your posts, as I've not been active in forum lately. Here is a link to the Ark. Urology page on HIFU: http://www.arkansasurology.com/hifu-treatment. Dr. Goodson there (who I don't know) is one offering HIFU, but he is partnering with Vituro Health. Dr. Scioniti in Sarasota is medical director and trainer for Vituro, and he performed my HIFU.

    I was able to get BCBS partial payment, but I think that was because when I called before procedure, I told the customer service rep of the applicable billable code and she said it would be covered. After I appealed denial and pointed out that phone call and promise, BCBS changed position. She was also sympathetic because her dad had PCa.
    David W

    PSA:
    1/04: 2.3
    2/09: 3.2
    3/12: 3.9
    5/13: 4.1
    5/14: 4.5
    8/15: 4.9 (10.5 years to double)
    10/15: MRI, two lesions, equivocal suspicion
    11/15: Biopsy positive, in 9/14 cores, both lobes, Gleason 3+3=6
    11/15: CT scan, PCa confined to prostate
    12/15: Researching treatment choices.
    2/16: Scheduled for HIFU on 2/26/16 with TURP laser vaporization 3 days before (to reduce size of prostate to <40 cm)
    2/16: TURP Laser vaporization peformed pre-HIFU even though prostate was <40cc. Uro recommended to minimize risk of blockage post-HIFU
    2/1: HIFU on 2/26/16
    3/16: Catheter removed 3/3/16. No incontinence issues.
    5/16: First post-HIFU PSA 0.58
    7/16: PSA 1.13 (contemporaneous with blood in urine after 30+ mi. bike ride)
    9/16 PSA 1.48
    11/16 PSA back down to 0.59 (Whew! What a relief it is!)
    12/16 PSA 1.12
    1/17 PSA 0.60
    2/17 PSA 0.47
    4/17 PSA 1.03
    7/17 PSA 0.44
    10/17 PSA 0.13
    5/18 PSA 0.24
    9/18 PSA 0.11

  5. #45
    Regular User
    Join Date
    Jul 2018
    Posts
    11
    DaDavid---any updates on your HIFU? I have spoken to Dr. Brian Miles about this and he thinks I'm an excellent candidate. He has done 4250 RP in his career and he could have pushed for that, but didn't. He would be using the EDAP Focal One computer guided machine. Thanks for your advice!
    Age 58
    DRE Normal
    BIOPSY 8/14/2018
    T1C diagnosis
    Gleason 4+3=7
    PSA 25
    RMB, Prostatic Adenocarcinoma, Grade Group 3, involving 10% of one (1) core, Length of cancer 1.5mm Tumor focally in contact with extraprostatic extension
    LMA: Rare atypical glands suspicious for carcinoma
    Focal chronic inflammation in RMA, LLM, LMM
    Mild chronic inflammation RLB
    Bone/CT Scan Negative

  6. #46
    FrankB, I find I interesting that you spoke with a urologist who performed thousands of RP’s and is now offering HIFU.

    That resonates with me because I recently spent time on a cruise with another veteran uro with similar RP experience, and he was now into focal laser ablation using new technology. If they destroyed all the seen lesions, because they have you in a 3T MRI during the entire procedure, then I guess that maybe that would be a “whole gland” procedure? Don’t know.

    My point is, that with all the recurrences after surgery, there may be some senior urologists who are open to trying radically different types of cures.
    DOB: May 1944
    In Active Surveillance program at Johns Hopkins
    Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
    Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
    PSA has varied up and down from 3 to 10 over the years. Is 4.0 as of September 2019.
    Hopefully, I can remain untreated. So far, so good.

  7. #47
    Experienced User
    Join Date
    Jul 2013
    Posts
    60
    Hi, I just had a PSA test and it's now 0.11. Yay! I am really glad I opted for HIFU over RP. I'm not up on the latest but at the time of my HIFU, I read a LOT and was under the impression that the Sonablate machine allowed for more precise control although it required more user input and monitoring by the uro during HIFU. The EDAP seemed to be more of map it, mark it, and go! idea. Scioniti compared it to cooking the prostate in increments the size of a grain of rice.
    David W

    PSA:
    1/04: 2.3
    2/09: 3.2
    3/12: 3.9
    5/13: 4.1
    5/14: 4.5
    8/15: 4.9 (10.5 years to double)
    10/15: MRI, two lesions, equivocal suspicion
    11/15: Biopsy positive, in 9/14 cores, both lobes, Gleason 3+3=6
    11/15: CT scan, PCa confined to prostate
    12/15: Researching treatment choices.
    2/16: Scheduled for HIFU on 2/26/16 with TURP laser vaporization 3 days before (to reduce size of prostate to <40 cm)
    2/16: TURP Laser vaporization peformed pre-HIFU even though prostate was <40cc. Uro recommended to minimize risk of blockage post-HIFU
    2/1: HIFU on 2/26/16
    3/16: Catheter removed 3/3/16. No incontinence issues.
    5/16: First post-HIFU PSA 0.58
    7/16: PSA 1.13 (contemporaneous with blood in urine after 30+ mi. bike ride)
    9/16 PSA 1.48
    11/16 PSA back down to 0.59 (Whew! What a relief it is!)
    12/16 PSA 1.12
    1/17 PSA 0.60
    2/17 PSA 0.47
    4/17 PSA 1.03
    7/17 PSA 0.44
    10/17 PSA 0.13
    5/18 PSA 0.24
    9/18 PSA 0.11

 

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