This will be my last blog for a while. I’ll make sporadic updates, mostly if I have a checkup or want to post about a news story or something related to prostate health. There’s one question I can now answer, but only for myself. Was it necessary? Was it all worth it? Outside the standard tests that would normally be done for someone in my situation, did I waste time, money and effort trying to avoid a prostate biopsy that I ultimately had anyway?
In terms of time, I spent the morning of Christmas Eve getting a prostate massage that was necessary for a PCA3 urine test. I spent a night and two days in New York City for a power doppler ultrasound. I spent 5 nights and the better part of 6 days on a trip to Washington D.C. for an MRI and a targeted fusion biopsy at the National Institutes of Health. Granted, I got to visit with some friends on those trips, so it wasn’t a waste of time outside of the medical procedures.
In terms of cost, my PCA3 test was covered by insurance. My portion was $9.60. The visit to the NIH was free and they even paid a good part of my travel related expenses. The big cost was the $950 for my power doppler ultrasound with Dr. Robert L. Bard in New York City. I had to pay all of it up front, being told that at least part would be covered by most insurance plans as an out of network expense. Ultimately, my insurance plan (Anthem Blue Cross) did consider the full amount as a covered expense. Unfortunately, we have a high deductible plan and since it was the beginning of the year, I was not directly reimbursed by insurance for any of the amount. On the plus side, it will count toward my deductible and out-of-pocket maximum limits for later in the year and will also be paid in pre-tax dollars once we are repaid from our HSA.
In terms of effort and risk, only the trip to the NIH was a big hassle. I wish it could have been done in just a few nights, rather than 5. Being sedated is always a risk, as are the risks of an invasive procedure like a biopsy and even just a hospital stay in general.
The trade off for the time, cost and hassle? I now have peace of mind in that it is quite unlikely I have an undiagnosed prostate cancer. I had hoped to avoid a biopsy, but ultimately my relatively high PSA and a couple areas identified as “very low risk” on my 3T MRI led me to decide that I should go ahead with the biopsy I had hoped to avoid. At least the biopsy was targeted, presumably reducing the chances of a false negative.
So, was it worth it? Would I do it all again? Knowing what I do now, I probably would not have done the power doppler ultrasound. At the very least, I would have tried to find a different physician to do it; preferably one who had published, peer-reviewed results, wasn’t so “commercial” in terms of hawking books and supplements and one who clearly agreed to provide a full copy of all images to me for future reference. The PCA3 test is non-invasive and relatively low cost and effort. The fusion MRI and biopsy was a bit of a hassle, but offset by zero cost and a nice weekend in Washington D.C. If I have indications of risk in the future, I would strongly consider these two diagnostics again, depending on what other options are available at the time.
Obviously, my situation is unique. Everyone else has different circumstances and different preferences on treatment. In that I’m not a doctor and have no medical training, my opinions are not valid for anyone else. What I do know is that everyone should question their doctor if they think they aren’t getting enough information to make an informed choice, especially if that decision involves cancer or another serious condition. The internet is a powerful tool for research and if you find your physician was too busy to answer your questions or perhaps even underinformed about options, you should definitely seek out another physician or specialist for a second or third opinion.
If you find yourself in a similar situation as mine, I wish you the best of luck in your research, diagnosis and treatment. Peace, and good health!
If you happen to be interested in sponsoring my blog in exchange for a banner advertisement, please send an email to webmaster “at” prostatebiopsyblog “dot” com . I’d love to recoup the costs for that ultrasound and donate some more money to related charities, like the PCF. Prostatebiopsyblog.com now gets reasonable google search placement on relevant terms.
4 thoughts on “Prostate Biopsy Alternatives: Are They Necessary? Are They Worth It?”
getting biop thursday, psa score is 9
no insurance, so not sure what to do if i have cancer
Remember that PSA scores generally indicate a large prostate. Cancer is a less common cause of high PSA than prostatitis or BPH. Also, since high PSA is not a diagnosis of cancer, it shouldn’t be an issue as a pre-existing condition unless you have a positive biopsy. Perhaps you can take advantage of the insurance reform and get state mandated insurance for at least a time, before you have a biopsy?
You can read more about my opinions of the doppler ultrasound and Dr. Bard in other blog entries. Ultimately, my 3T MRI and biopsy results did not support the conclusions of the doppler ultrasound. Granted, none of these methods are able to detect small, early cancers with any real degree of certainty. If insurance is paying for your ultrasound and the trip isn’t a big hassle for you in terms of time or money, then the only real issue is that you won’t learn a whole lot, as the results could well be false positives or false negatives.
i am to see dr. bard on monday for a power doppler. i have medicare. i am currently on active surveilance and wanted another opinion after a gleason 6,psa 2.4 after taking 6months proscar, and after dre t1c. from your blog you said you would not do it or at least with this dr. was it his manner,cost, but to me most important were the results accurate. thank you bruce saltzman