1. < Prostate Cancer

Is a PSMA PET SCAN the next step

Posted by kenporter @kenporter, Aug 12 10:46pm

Prostate MRI conclusion: large mass with extracapsular extension and seminal vesicle invasion. T3bNO (PI-RADS 5/5). Transrectal ultrasound biopsy: Gleason 7 (4-3). Moderately aggressive cancer. Doctor says next step is a PSMA PET SCAN. Medicare has denied coverage. Filed an appeal and still denied coverage. This has been going on for 7 weeks and driving me crazy. I have a Blue Cross Blue Shield Medicare Advantage Plan. They will do nothing claiming they follow Medicare rules. Anyone familiar with this situation. I’m a fighter but after many hours of phone calls over 7 weeks they have beaten me down and I’m ready to quit. Any input will be appreciated. Thanks , Ken

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heavyphil | @heavyphil | Aug 15 4:36am
In reply to @kenporter "Hello heavyphil, thanks for your input and I sure hope you are doing well and feeling..." + (show)
@kenporter

Hello heavyphil, thanks for your input and I sure hope you are doing well and feeling good. You are right on target about the BCBS Advantage plan. When I had Bladder cancer (5 year battle started 2008) I had Medicare and a Medicare Supplement Plan. Never had an issue with any procedure, surgery or chemo. I think the cost exceeded $300,000. I was cancer free for 11 years until prostate cancer arrived in May. I just read that anyone having bladder cancer has a 70% chance of getting prostate cancer. Oh, I also read that if your life expectancy is less than 10 years they basically don’t want to pay for treatment. I’ll be 79 this month but I’m no where near ready call it quits. Thanks again, Ken

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Hey Ken, The damned actuaries just crunch numbers and could care less about human morality - just MORTALITY!
I had to use an actuary to set up a pension plan. He was an odd one for sure. When I retired we spoke about the $$ in the plan, how it would be disbursed, etc.
So he says to me, “You are good, my friend, no worries. You’re gonna be fine to at least 85”. So then I said “Really - you do remember that I had bladder and prostate cancer, right?”
Without skipping a beat he said, “OK, so 75 then”…..just a cold blooded man😂😂

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1 reply
grandpun | @grandpun | Aug 16 6:58am

Phil,
OUCH
I wish there was a word beyond "cold" for that but I can't think of one.
I think we all in this group are forced, even subliminally, to address our longevity (or limits thereof). That's a necessity for maintaining our fragile mental health and concern for our family members.
For my part, though my PC has seemed to be a 'mild' case so far, I'm working my End Game every day. Even though as the months and years go by with declining energy and strength, every day I try to get the most out of play, necessary projects, play, social connections, play, and faith witness and study. Of course there's also time made for play - you might have noticed.
Here's to us all in this brotherhood of challenge. Now let's go and find some blessings and fun - - - -
- bob

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northoftheborder | @northoftheborder | Aug 16 9:15am
In reply to @heavyphil "Hey Ken, The damned actuaries just crunch numbers and could care less about human morality -..." + (show)
@heavyphil

Hey Ken, The damned actuaries just crunch numbers and could care less about human morality - just MORTALITY!
I had to use an actuary to set up a pension plan. He was an odd one for sure. When I retired we spoke about the $$ in the plan, how it would be disbursed, etc.
So he says to me, “You are good, my friend, no worries. You’re gonna be fine to at least 85”. So then I said “Really - you do remember that I had bladder and prostate cancer, right?”
Without skipping a beat he said, “OK, so 75 then”…..just a cold blooded man😂😂

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Ouch!

It's usually a bad idea to casually speculate that someone is "on the spectrum" — Autism is a complex diagnosis that needs a lot of time and a qualified psychologist or psychiatrist — but I'm going to make an exception just this once and speculate that your actuary might have been tending in that direction.

I've noticed personally that careers that involve lots of work with numbers, computer code, machines etc tend to attract people who find it challenging understanding and reacting to the emotions of others.

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1 reply
heavyphil | @heavyphil | Aug 16 9:47am
In reply to @northoftheborder "Ouch! It's usually a bad idea to casually speculate that someone is "on the spectrum" —..." + (show)
@northoftheborder

Ouch!

It's usually a bad idea to casually speculate that someone is "on the spectrum" — Autism is a complex diagnosis that needs a lot of time and a qualified psychologist or psychiatrist — but I'm going to make an exception just this once and speculate that your actuary might have been tending in that direction.

I've noticed personally that careers that involve lots of work with numbers, computer code, machines etc tend to attract people who find it challenging understanding and reacting to the emotions of others.

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Oh jeez, he is much more than that!!! To call him autistic would be a compliment!😂😂

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1 reply
northoftheborder | @northoftheborder | Aug 16 9:57am
In reply to @heavyphil "Oh jeez, he is much more than that!!! To call him autistic would be a compliment!😂😂" + (show)
@heavyphil

Oh jeez, he is much more than that!!! To call him autistic would be a compliment!😂😂

Jump to this post

Whatever the cause, I'm sorry you had to hear that, and I'm glad you're laughing about it.

Also, did you hear that actuaries have determined the "average" human has one breast and one testicle? Just sayin' 😉

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jackph | @jackph | Aug 16 10:41am

The PSMA Pet Scan is important in identifying potential spread.
I would ask you doctor to have a doctor to doctor consult with the insurance company.
This can make a difference in the decision,
I would start with Blue Cross although they may want you to contact Medicare first.

Hope this works for you,

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