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Thread: Reconciling pathology report with insurance company requirements

  1. #11
    Moderator Top User HighlanderCFH's Avatar
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    Quote Originally Posted by nmguy View Post
    You would think you could go to a prostate cancer forum without someone dragging politics in and giving advice on how to vote. Seems you can't go anywhere on the internet where one side or the other doesn't bring in their political views or lecture. That's fine but I could care less about anyone's political views, I'm here because of PC.
    I agree with you, mmguy. Are you listening, ASA?
    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. #12
    Just as an aside, long term care insurance has nothing to do with health care insurance. It is more related to life insurance. The underwriters look at your conditions to determine rates. Some conditions, like cancer, they will not give you a policy because the numbers show that they will have to pay off too soon. Thus the waiting periods for cancer.

    I ran into the same thing trying to get a long term care policy. I was told T1 PCa would be OK, T2 PCa OK after a year. I was T2. Well, at a year I no longer had an undetectable PSA, so it was a no go.

    At another time I was denied for a short term disability policy because of back issues. Not disabling issues, just annoying. So it goes with those type policies. None of these are related to health care insurance and pre existing conditions.
    There is no right or wrong decision for treatment. Make the decision you are comfortable with and can live with and not second guess if all does not go optimally.

    6/2016 PSA 5.1, negative DRE
    6/2016 Urologist PSA 6.0, %free = <10% chance cancer, negative DRE
    12/2016 PSA 7.7, %free = 50% chance cancer, negative DRE
    2/2017 biopsy Hopkins 5/12, 4 3+3, 1 3+4 (5% 4), perineural invasion
    5/17/2017 Open RP by Dr Alan Partin - Hopkins
    5/2017 Pathology 3+4, T2x, +margin (6mm, 3+3), organ contained except unevaluable at +margin, moderate tumor extent
    seminal vesicles, lymph nodes all neg
    Age: 62 @ surgery
    8/2017 PSA < .1
    11/2017 PSA <.1
    5/2018 uPSA .06, standard .1
    8/2018 uPSA .07, standard .1
    11/2018 uPSA .10, standard .1
    12/29/2018 6 month Lupron shot
    1/22/2019 start SRT, 39 treatments, 5 days per week
    3/15/19 ended SRT with no significant side effects
    6/2019 PSA <.02
    11/2019 PSA < .014 (different lab)

  3. #13
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    Thanks, Djin, very helpful. It was indeed a pathology report, that line of info I provided was summarized from a longer report of about a page and a half that they gave me. And, indeed, they noted signs along seminal vesicles and one or more lymph nodes.

    Your comments inspire me to ask the doctor once again what the IV means. After surgery they specifically told me they did not find anything beyond the immediate region, specifically the very areas near the prostate you mentioned. And that's where RT was targeted. The area under exposure wasn't much bigger than, ps as one med tech told me, a grapefruit.

    I think one disconnect here may be that the urologist/surgeon and radiation oncologist were in different medical groups at different hospitals (they were under the same roof but then the urology clinic moved to a neighboring county just as my RT began). You'd think this wouldn't matter, but getting medical records on my treatment back and forth from these two outfits has not been especially efficient.

  4. #14
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    Appreciate your bedside manner, MichiganMan16. Even though I'm still sorting out my own situation, I've become a mentor to a former colleague who had similar surgery six months after me. His prostate cancer was not as advanced, fortunately.

  5. #15
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    DaveFromMD, Yup, that's my take on LTC coverage. It makes sense. They'd like you to sign up in your 40s or 50s, so those premiums cover expected costs and then some. This LTC plan came via the retirement service of the state government where I worked (Wisconsin) and assurances were made about my eligibility. But they all went right out the window after the biopsy report showed up in mid-application. I get it. I don't think I'm being screwed, just trying to ensure that the data in my file is being interpreted properly by everyone, me included. The upside was that as a retiree I was invited to sign up my wife, and she still got LTC coverage on my plan. Half a loaf.

  6. #16
    All the guesswork ends when you stop the ADT for a few months..If your PSA remains undetectable, you are pretty much home free..If it starts moving upward, you know your journey is not over...
    PSA at age 55: 3.5, DRE negative.
    65: 8.5, DRE " normal", biopsy, 12 core, negative...
    66 9.0 DRE "normal", BPH, (Proscar)
    67 4.5 DRE "normal" second biopsy, negative.
    67.5 5.6, DRE "normal" U-doc worried..
    age 68, 7.0, third biopsy (June 2010) positive for cancer in 4 cores, 2 cores Gleason 6, one core Gleason 7. one core Gleason 9. RALP on Sept. 3, 2010, Positive margin, post-op PSA. 0.9, SRT , HT. Feb.2011 PSA <0.1 Oct 2011 <0.1 Feb 2012 <0.01 Sept 2012 0.8 June 2013 1.1, Casodex added, PSA 0.04 10/2013. PSA 0.32 1/14. On 6/14 PSA 0.4, "T"-5. 10/14 PSA 0.6, T-11. 1/2015 PSA 0.106. 4/15. 0.4, 9/15 1.4, 3/16 Zytiga, 0.04, 5/17 1.4 may switch to Xtandi. 3/1/2018. PSA now 54, chemo will begin next month. 7/19, PSA 2000 starting Lu-177 tomorrow..77 years old now..

 

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