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Did you get a PET scan prior to radical prostatectomy?
My husband has Gleason 7 (4+3) PCA with regional lymphadenopathy. Bone scan, CT negative. Current plan is radical prostatectomy. When originally asked surgeon about PET scan prior to surgery, reply was short and basically could do if extra money to spend (in Canada, don’t have insurance). That was part of a larger phone conversation with the original diagnosis and PET scan query wasn’t pursued further at time. Based on our research, it sounds like historically PET scan used primary after primary treatment to look for remaining metastases. It seems to me that a PET scan prior to surgery would be helpful to determine if the lymph nodes are definitely positive (in which case perhaps more extensive LN chain removal would be planned). I realize if PET scan negative then can still have positive nodes but if positive then specificity if good for true positive, correct? We are trying to see if we should push for PET scan prior to the surgery (currently scheduled in one month). Also, local urologist who would be performing surgery is planning open RP. I believe that is required over laparoscopic when surgical plan is to remove all local LNs, correct? So the second question - does robotic assisted open RP have better side effect profile (urinary incontinence and erectile dysfunction) than open without robotic assistance? Looked at a NCBI article that said outcomes same but not sure if more recent advances have changed anything?
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US here.
My doc ordered a PSMA PET before RP, insurance company "was going to reject" per Doc's staff.
I wrote them a "nice" email expressing my concern and requested an explanation as to why they were considering rejection. I was approved two days later.
PSAM PET detected no metastasis, RP done 4 weeks ago, PSA <0.1 last Friday.
Good luck, glad to see you were approved!
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1 ReactionHi, very glad your advocating for yourself helped the psma pet scan be approved. And that it didn’t show mets of course! My husband’s urologist wasn’t going to order a psma pet scan as he felt it was primarily used for patients with rising PSA post initial PCA treatment. My husband discussed with him the benefits of discovering mets if present before initial treatment decision. Doc was still waffling sending in a requisition. Then my husband discussed that psma pet scan imaging at initial diagnosis would become standard of care once it became more available. That swayed the doctor and he agreed and requested the scan. Still had to wait for health Canada approval but they did approve. 🎉
Glad it finally worked out. It just seems that the PSMA PET can provide important information that could influence any decision on treatment. Hopefully all goes well for you folks.
we requested ct and bone scans prior radical prostatectomy and when recurrence At 3 mos requested PMSA PET SCAN
From what I understand most insurance require the CT, Bone scan or Pet Scan prior to PMSA Pet scan accept in recurrence
Pre-RP CT and bone scan was back up if PSMA was rejected. Insurance did ultimately allow Pre-RP PSMA PET.
Here in the US, my understanding is that PSMA PET was only recently (last March) approved by FDA, so I suspect a lot of insurance companies are not yet fully on board.