What Is Typically Private Insurance Salvage RT Approval Requirements?
I had PS < 0.02 fo 18 months post RP and go my first reading that is = 0.02 (most likely it's 0.020-0.024 I'm guessing if the test when 3 digits). Recently moved out of state and post COVID you can't do telehealth out of state and I just use my Primary to order the PSA tests so I don't have an in-state Urologist I can call to see what the plan going forward would be. So while I'm waiting for my appointment I've got burning questions maybe some people here can answer?
I would assume it would be another test in 3 months to see if it has gone to 0.03 or above.
But my question really that I'm very curious about is for most private insurance, what are the requirements to get post-RP salvage therapy? I know in the past recurrence was considered two successive readings of 0.2 or higher but there's quite a few studies out that say earlier is better on salvage RT.
How early will insurance approve it? Is there a certain minimum PSA reading and/or velocity?
I began salvage therapy when my PSA jumped for .02 to .05 (then another test within 2 weeks also came back at .05). There were no insurance thresholds that I was made aware of - everything was covered. Hope this helps
That helps. What was your post-surgery pathology like? How long post surgery did you hit .02? And how long did it take to go from .02 to .05?
I was told that .2 PSA was generally considered reoccurrence, but also 2 consecutive increases in PSA was also confirmation.
Pathology after my RP found cancer at the margin. I was given the option for salvage radiation right away, but opted to wait. After a year, had a PSA .04 reading and Urology referred me to Radiology. I had already been confirmed to have the BRCA2 gene defect, so maybe because of this and the RP pathology, insurance coverage was never an issue.
My Radiologist did not believe in waiting to get a .2 reading, but we agreed to retest in one month and I was at .05 so moved forward with the savage radiation. The treatment was really easier than I though and no side effects and 2 years out and PSA is still undetectable.
