Should we go outside of state for surgery

Kit,

Please call the Arkansas Prostate Cancer Foundation (on N. Grant St. in LR). They know what is available in state, or can find out for you. Tell them I sent you.

There is no reason to NOT reach out of state unless you have some specific insurance limitation. For medical purposes, Dallas/Ft Worth is in the neighborhood.

Kit, you are getting excellent advice. Most importantly to slow down and do your research before deciding on a treatment. The real research means visiting several different doctors for assessments in their specific treatment method. No doctor knows everything and you should not listen to any doctor about some other treatment method. Do not ask a urologist about radiation. Do not ask an external beam specialist about brachytherapy, and so on. Seek out several different treatment specialists and consult with each for a complete assessment. Then you can make a decision. And you have plenty of time to do so. I saw six different doctors in about 30 days before deciding. I am in Atlanta and that was an advantage, but you have doctors around you that you are not yet aware of.

Regarding insurance, Tall Allen has given you excellent advice regarding Medicare. I second his advice. You will actually be in a better position under Medicare. Financially you will have much lower co-pays and deductibles, especially if your choose Supplement F or G. I wouldn’t bother with any of the others. From a treatment perspective, all providers that accept Medicare are now in your preferred network, regardless of where in the USA they are located. I am sure that is far better than his current insurance.

If you have trouble finding the right doctors locally then you have received many great suggestions in other cities. If you want to come to Atlanta I can refer you to excellent surgeons and radiation oncologists. Heck, you can even camp out with us as we have three unused bedrooms upstairs, and our two dogs are very friendly!!

Here is a great website that will help you understand the prostate anatomy and how brachytherapy works. Go to www.cetmc.com. This is by the father of High Dose Rate brachytherapy, Dr Jeffrey Demanes, head of the department at the UCLA Medical Center. He, and UCLA will be in your network in July. All you have to do is call them.

You have a lot of good options but if you choose surgery, I would try and locate the best surgeon and not worry about location. I went to MSKCC which is a ten hour drive from where I live. I had a visit in May 2017 where I met both with the surgeon and radiation oncologist to consider my options. After I decided on surgery I had to go back to New York in late May for pre-opt testing and then another trip in the middle of June for the surgery. My wife and I flew to NYC on a Wednesday. Surgery was on Thursday and I was released from the hospital on Friday. We rented a car and drove home on Sunday. We talked about making the trip home a 2 day trip but I felt well enough to do it in a single day. My local urologist’s nurse removed the catheter 8 days after surgery. No complications nor significant pain and continent after the removal of the catheter.

KIT: We are all here for you and Dan. Everyone here at HW will help as they can. Some with personal stories others with the technical data. In the end you and Dan will have to decide but when it is based on understanding you can at least feel good that you have done your due diligence.

Be well and check out the places/Dr's that TA and others have suggested if you possibly can. Get the best in whatever TX plan you decide on.

Roger

Kit. Hard to improve on all the solid advice you've been given. I can't tell you how grateful my wife and I are to this site and the great information we've found here. Don't feel bad about not knowing and understanding the function of a man's prostate since most men know nothing about it as well until they face this disease. Since Dan is close to 65 I would research all of the the options and have treatment under Medicare. You can use this time to investigate all of your options. It's an important decision and you want to get it right.

Although we have a great supplemental insurance policy we did have to go 'out of network' to be treated at Cleveland Clinic with SBRT. The trip from Western PA was only 2.5 hours each way and we found a lot of new restaurants for lunch in our travels. In the end we saved our insurance about $10K instead of having IMRT. SBRT was only 5 treatments instead of 42 with IMRT. If we had not found this site I probably would have gone with the first treatment option (surgery) provided by our Urologist. In hindsight that would have been a big mistake given my low risk diagnosis and lack of any urinary issues.

The precision of the latest radiation treatments for PCa today is truly amazing. The success of RT is at least equal to surgery with in most cases far fewer life altering side effects. When a surgeon cuts wide he compromises some very important tissue function. With RT they can treat wider margins with far less long term risks to healthy tissue while still effectively treating the cancer tissue. No matter what choice you make please be sure of the skill of the team you chose for that treatment; it can make a huge difference. Good luck and keep posting.

@Kit we are in Arkansas also. You didn't say what part? If you don't mind I can email you. Are you using AR Prostate Cancer Foundation and talking to Cara? Please call her at 1-800-338-1383 tell her I suggested you to call. We've had no problems in LR.~Miki

Edit to add I know two that have had treatment in Hot Springs (both surgery) both have done very well even though we prefer Dr. Mooney in LR. Stay away from Texarkana!!!

Lived in Northern Ar for many years. Salem, Pyatt, Brunno and Yellville. I know the nature of the area..................

Be well and choose wisely based on full understanding.

Roger

Did not see these yesterday. We will make an appointment with Cara for this week.
We went to a seminar on insurance two weeks ago. The speaker told us she would go
with G for Medicare. It helps that they cannot ask you about pre- existing on your first go round
Just wondering if they can dump us next year. We live in Little Rock. So, as far as Ar goes, this area has, I think, decent practitioners and hospitals? We have not ruled out traveling for tx,


Thanks so much to all of you. This site is a life saver.

I'll defer to JNF as to best Medigap plan. But it appears we are in agreement.

I am in full research mode with a local agent (know to my PCa support group as reliable and very helpful), and am leaning toward G as opposed to F. Same discussion, the F is more expensive to avoid the $183 annual deductible. And my local agent advised that the F plans will go away in the near future. For some companies, they promise to grandfather you in to their G programs, others I've talked to say they don't know. That clearly was the wrong answer.

If you are already on Social Security, they can deduct the monthly Medicare part B cost from that, and it will remove potential issues of missed / late / incorrect payments. I am on SS and will be using that option.

Most of the G plans I've seen want an auto debit for payments, so plan to have a buffer for those charges built into your account, and keep the account data up to date. They all have offered a tiny credit for paying yearly or quarterly, but they have not been worth it as I see it.

So for now it is which G is best coverage, best price, and has stable and minimum annual rate increases, and has no issues with my myriad of medical issues.

The UAMS Med Center in LR has a good staff and facilities, but I am not familiar with the physicians at present. The folks at the PC Foundation there in LR will be able to help you.

I'm so glad you got in touch with Cara and that ya'll feel better after talking to her. She's a big help especially when dealing with what's available in the state, etc. It's a lot to take in I know, sometimes our options are limited here but that's not always a bad thing. A friend on here uses a doctor in NY that everything his doctor has said, has been said by our doctor. Have I been frustrated by some lack in some latest treatments and diagnostic tests? Yes, but my husband is alive 4 years into this and is doing well. Have you set up an appointment with Dr. Wang (RO so you can go over radiation options)? That would be a suggestion from me. Dr. Wang is very informed, familiar w/ all the latest studies, and is good at answering questions. I think AR Prostate Cancer Center and AR Urology are going to be the best we have in state.

Kit, It's good to hear that you're getting some solid information and good referrals. With the 4+3, that bumps your risk category up a notch, so treatment is going to be sooner instead of later..but you still have time to make an informed decision.

Make sure you get information on the multiple 'flavors' of radiation therapy. A number of guys in here did find it worthwhile to travel for some of the newer, less common therapies like HDB and SBRT--just a few treatments (2 for HDB and 5 for SBRT), compared to the standard 40 or so for IMRT. Many of the major centers have hotels connected to the hospitals so you can stay right there for the week or so of treatment.

Keep us posted and keep asking questions.

Kit: All I really know about various RO's are what I have read here, except for the several I spoke with personally. I will say this though, I self referred to Swedish Medical Center, Dr. Meier in Seattle. I got an appointment in under 3 weeks and could have had the 5 fractions of SBRT 4 weeks after that visit with the Cat/MRI and marker placement in between. They also fully accept medicare. Swedish also had rooms right in the same building complex for patients and family to stay in at about 1/3 the going rate for local hotel/motels.

I know they are far away for you but I feel there must be other, equally qualified, facilities that would operate about the same.

Actually once you go more than a car trip away it really doesn't make any difference does it?

Stay diligent and keep a positive attitude and I am sure it will all work out for the best.

Roger

Kit, remember that the biopsy requires healing as well (I had to wait 8 weeks before surgery, as best I can remember). I'm not sure which doctors require referrals. Some are because of the insurance program (we did have that sort of plan once), others simply because they don't have time for walk-ins, and they want at least a report from the uro and pathologist they can review before seeing you.