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Center of Excellence questions/recommendations for CA resident
Recently diagnosed with PC (details below).
Current recommendation is to have the robotic radical prostatectomy.
In my research here, everyone is adamant that you are treated at a "Center of Excellence". Starting my research on this so not even sure what this means yet.
- Are there specific hospitals/treatment centers that have been given this title?
- Is there a recommended "center of excellence" for me here in the Bay Area/Central Valley CA that specializes in prostate cancer evaluation/treatment?
- Am I rolling the dice by just having it done through my health care provider (has performed about 150 robot radical prostatectomies)?
- Is medical insurance less likely to cover or will it cover less if I opt for treatment at a better known/more experienced "center of excellence" facility?
I am younger (53), so maximizing the odds for minimal after effects from treatment is also very important to me.
Thanks so much for your input/help.
A few details of my diagnosis below:
Diagnosis:
1. Left crossing midline to right apex to mid gland peripheral zone lesion
#1 : Prostatic adenocarcinoma. Gleason score 3+3 = 6 (Grade Group 1); in 1 of
1 cores, (4mm, 55%).
2. Left crossing midline to right apex to mid gland peripheral zone lesion
#2 : Prostatic adenocarcinoma. Gleason score 3+3 = 6 (Grade Group 1); in 1 of
3 cores, (1mm, 5%).
3. Left crossing midline to right apex to mid gland peripheral zone lesion
#3 : Prostatic adenocarcinoma. Gleason score 3+3 = 6 (Grade Group 1); in 1 of
2 cores, (2mm, 10%).
4. Left crossing midline to right apex to mid gland peripheral zone lesion
#4 : Benign non-keratinizing squamous mucosa and stroma.
5. Left crossing midline to right apex to mid gland peripheral zone lesion
#5 : Benign stromal tissue.
6. Left lateral base : Benign stromal tissue.
7. Left lateral mid : Prostatic adenocarcinoma. Gleason score 3+3 = 6
(Grade Group 1); in 1 of 3 cores, (2mm, 20%).
8. Left lateral apex : Prostatic adenocarcinoma. Gleason score 3+3 = 6
(Grade Group 1); in 1 of 3 cores, (3mm, 15%).
9. Left medial base : Benign prostatic tissue.
10. Left medial mid : Prostatic adenocarcinoma. Gleason score 3+3 = 6 (Grade
Group 1); in 1 of 4 cores, (5.5mm, 40%).
11. Left medial apex : Prostatic adenocarcinoma. Gleason score 3+3 = 6 (Grade
Group 1); in 1 of 3 cores, (3mm, 25%).
12. Right lateral base : Benign stromal tissue.
13. Right lateral mid : Prostatic adenocarcinoma. Gleason score 3+3 = 6
(Grade Group 1); in 1 of 4 cores, (2.5mm, 10%).
14. Right lateral apex : Benign stromal tissue.
15. Right medial base : Benign stromal tissue.
16. Right medial mid : Prostatic adenocarcinoma. Gleason score 3+4 = 7 (Grade
Group 2); in 1 of 4 cores, (3mm, 25%).
17. Right medial apex : Benign stromal tissue.
ASSESSMENT: 53 year old male with history of no medical issues who has intermediate risk prostate cancer (PSA 8.6, 3+4 = 7 in 8/17 cores, cT1c.
Multiparametric MRI of the prostate from 12/18/2023 showed a prostatic volume of 29.1 cc. No pelvic lymphadenopathy. Mild capsular bulge at the left neurovascular bundle zone. No skeletal lesions.
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Thank you.
The other RO I met wants to preform LD Brachytherapy. Permanent seed placement. Dr Kurtzman, Who is a LD Brachytherpy expert I believe. this treatment option also is highly effective. Maybe even more curative than SBRT I have read
Thoughts? Difficult to choose between radiation options
jarjlb2,
how is it that you find the best doctors? Kurtzman would be THE LD brachytherapy expert.
This treatment would be the most protective of surrounding tissue. Ask how close they you be to the nerve bundle? Ask about the long term BCR with ld brachytherapy.
Have you had the generic serum lab for cancer.
With as much information as you have given, I'd choose SBRT, but not at UCSF. I'd go for the MRidian Viewray. It will be interesting to see your PSMA. Could switch things up a little if it is even more definitive on the nerve bundle involvement.
You can search me under the Prostate Board. My boyfriend was treated at UCSF, by Dr. Peter Carroll with stellar results. Surgery August of last summer, 2023.
Thank you
Thanks so much to everyone for your input. I will certainly seek out 2nd and 3rd opinions. Likely from UCSF and UCI. But my next question is cost. As this treatment would be done outside my healthcare network if I go through a center for excellence, I'd love to get some idea of how much more the treatment/procedure would be going to UCSF/UCI?
So any insight/guidance on that front would also be helpful. As a 53 year old/semi-retired man (recently laid off after 30 years in the semiconductor industry), I pay for my own health insurance.
I guess I just call UCSF and tell them I would like to have a consult?
Thanks again to all for your past and continued support.
I have an appointment with Percy LEE Monday, March 18th. Lennar center is just 15 minutes from my house. But when I looked up his experience is in Lung cancer not prostate cancer!
Do you have any information that he treats PC patients often?
I also have an appointment Kishan at UCLA next Friday at UCLA, about 55 miles from my house, not a problem.
I have G9 PC with no Metastasis from PSMA Pet scan just yesterday.
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1 ReactionJust a laymen here but with 12 years of being part of this journey, I think a consult with a medical team (oncologist, radiation, surgeon) might be 0.5 hours for prepare time and 1.0 hours for actual meeting, so 1.5 hours per professional for a total of 4.5 hours. At a bill rate of $500 and adding on some additional expenses, perhaps $2,000 out of pocket. Even if this is off by 25%, it serves as general order of magnitude, and relative to the cost of a RALP.
A big part of this is education and also bed-side manner. You may find that as you get more knowledge base and comfort with questions and answers, the professional in your network may be a really good candidate.
Depending on what state you are in, some affordable health care plans have a Medicaid option that provides free health care if you are unemployed. It usually isn't the most robust package, but that might be an angle to look into.
keep the faith
I am going to UCLA Westwood and I see Nick Donan. I would like to hear your option about Kishan. Also G 9 here.
avall,
Percy Lee has more experience with thoracic cancers, though I think that list may not be current. His education is stellar. And I found him fascinating. He had the Mridian.
Kishan is confidently exhuberant. He says he can get close to the 2mm with the advances in imaging. The only trouble was that he was competing against his video. He worked with Percy Lee at UCLA.
With the drs in new york and phoenix and I felt that they were surprised that anyone would walk away from Kishan. He gets praise from every corner. You may have a more difficult decision because I think soon he'll have the Viewray up and running soon.
I'm very happy with Dr, Lee. I would want each of the doctors to discuss the particulars of your tumor.
I have the idea that with the MRidian Viewray there is protocol 40Gy in doses of 8 with protection that the urethra doesn't receive more than the 40.
Lee treats prostate every weekday but I don't know how many times a day, nor do I know how long he has been treating prostate.
Also, ask about orgovyx if you aren't on ADT. There is some noise about Cialis 5mg for vascular protection during radiation.
No metastasis. Hooray!
Best
Ava11, last of 5 Monday morning with Percy Lee. Very happy with Lee. You must have been there in the afternoon. It will be interesting to see what Kishan recommends on Friday. You'll be impressed, again.
You have such great choices.