Prostatectomy follow up (Other than PSA testing)

Posted by Tom @tom86, Sep 16 5:07pm

What type of follow up is required after a diagnosis of PCa and a Prostatectomy? Other than regular PSA testing. My PCP says yearly follow up with Urology.....Urology says yearly follow up with PCP.
Is there some type of 'protocol' for making sure you are staying healthy and something else has not occurred with your health. PCP informs Medicare does not pay for a yearly physical. Any suggestions or knowledge as to follow up? TYIA

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As previously noted; it is the time of life when physicals are needed the most. Makes no sense. When my MD first pointed it out to me, I was shocked and couldn't believe something I had done all my life was being 'cut off' in older age.

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Profile picture for Tom @tom86

Congrats!! I am just passing the 5 year mark with undetectable PSA. Was doing it every 3 months (for the 5 years) as mine was high risk, and now have extended the test out to every 4 months. Likely indefinitely.
Prayers for all here in the group we did not choose to join.

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Good for you! I was also diagnosed high risk following my RP pathology report. I was getting a PSA test every 3 months, and my urologist moved my upcoming one to 6 months. After reading that you were in 3 month intervals for 5 years, I’m wondering if I should get tested in shorter durations for a longer period of time. We know everyone is different and doctors treat differently, but what’s your opinion? I plan to talk about this with him in my upcoming appointment. Thanks KJ

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Profile picture for kjacko @kjacko

Good for you! I was also diagnosed high risk following my RP pathology report. I was getting a PSA test every 3 months, and my urologist moved my upcoming one to 6 months. After reading that you were in 3 month intervals for 5 years, I’m wondering if I should get tested in shorter durations for a longer period of time. We know everyone is different and doctors treat differently, but what’s your opinion? I plan to talk about this with him in my upcoming appointment. Thanks KJ

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After a prostatectomy 30 to 40% of the people have reoccurrences. The rest do not. Three months tests for a couple of years may be enough. It did take 3 1/2 years before mine reoccurred after surgery. I was on six month tests and it was rising extremely slowly.

You can base what your recurrence chance is on your Gleason score, and whether there was spread outside the prostate. You can also base it on the decipher score if you have one.

My Gleason was 4+3 and there was no spread so six months was adequate. My first test was at seven weeks.

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Profile picture for kjacko @kjacko

Good for you! I was also diagnosed high risk following my RP pathology report. I was getting a PSA test every 3 months, and my urologist moved my upcoming one to 6 months. After reading that you were in 3 month intervals for 5 years, I’m wondering if I should get tested in shorter durations for a longer period of time. We know everyone is different and doctors treat differently, but what’s your opinion? I plan to talk about this with him in my upcoming appointment. Thanks KJ

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My surgeon's group suggested I could stretch out my testing to every 6 months after the 3 year mark. I told them (with the risk being what it was) I preferred to continue every 3 months for a full 5 years. My thought was; if there were any changes in the level of PSA, I would rather know sooner rather than later. I used the Memorial Sloan Kettering calculator for risk in my category and I felt as long as the 'risk' was substantial, better to stay on top of it. My cancer was T3b with SVI, and 4+3 (high risk). Also, my Decipher was considered high. I am now on 4 month intervals. Best, Tom

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My doctor is having me do PSA tests every 3 months for the first two years after the surgery, then every six months for years 3-5.

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Profile picture for Tom @tom86

My surgeon's group suggested I could stretch out my testing to every 6 months after the 3 year mark. I told them (with the risk being what it was) I preferred to continue every 3 months for a full 5 years. My thought was; if there were any changes in the level of PSA, I would rather know sooner rather than later. I used the Memorial Sloan Kettering calculator for risk in my category and I felt as long as the 'risk' was substantial, better to stay on top of it. My cancer was T3b with SVI, and 4+3 (high risk). Also, my Decipher was considered high. I am now on 4 month intervals. Best, Tom

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I was 3+4 after my biopsy; 4+5 after pathology report after my removal. Clear margins; lymph nodes clean. My doctor said the highest risk for recurrence is within the first two years; after 5 risk goes way down(you’ve cleared a major hurdle!). When I meet with him, hopefully I’m still undetectable, but I’m going to ask him to do more frequent testing. Your story convinced me that’s the way to approach this. Thanks again. KJ

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Profile picture for Tom @tom86

Hi Jeff,
Check the coverage. Medicare pays for a 'AWV - Annual Wellness Visit' of sorts by not an Annual Physical. Just when we need it the most as we age. UC has informed me several times it is not technically covered. On the Medicare site it states specifically "Physicals are not covered". Their AWV does a bunch of talking and updates on preventative care, Advanced directive updates, family history, cognitive function. No bloodwork, vaccines, examining, etc. Makes no sense. Doctors have to have a 'reason' to completely examine you and a diagnosis to do so.
Thanks to all who responded. I guess we need to wait to have an issue rather than get ahead of it. Certain things like Colonoscopy, PSA, etc. are (of course) covered......fortunately. Tom

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@tom86 True - Medicare does pay for annual wellness visits. But then, based on that “… bunch of talking and updates on preventative care, etc….” the primary care physician can - separately from the wellness exam - discuss with you and prescribe whatever other tests needed (bloodwork, vaccines, etc.) that are covered under Medicare. (They’ll keep the billing codes separate.)

You don’t have to wait to have an issue.

If the discussions are kept separate and distinct, they’re covered. It’s part of that separate discussion that my PCP always asks if I want a PSA test; I tell her that my medical oncologist is already handling that.

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