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How much does prostate surgery cost in the US?

KJN
Posts: 6
Joined: Jan 2010

I am a 52 year-old American working in Japan, recently married, just diagnosed with prostate cancer. My PSA is 6, Gleason score is 6, pattern 3+3. I have been following this forum since my first high PSA results last July. I appreciate all the great information, honesty, and compassion.

Two urologist surgeons in Japan told me that at my age, I should go back to the US if I want nerve-sparing surgery done. In Japan, it is still new. I am considering returning to the United States to have a da Vinci robotic, or laparascopic, prostatectomy done. I am wondering if I can afford it.

Question: Can anyone give me a general idea of how much either one of these surgeries might cost “out the door”, including all the hospital, doctor, and anesthesiologist’s fees? I need to get an idea if this is even remotely possible for me. I may get little, or no, reimbursement from my overseas medical insurance.

KJN

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

I have only recieved my Hospital bill (which to me was rediculous) $26,015.00 Some of the rediculous line items:

Pharmacy Services $1,876.25
Supplies = $2,655.50

I would imagine my Surgeon Teams bill will be about the same amount or slightly less putting it at $40,000 to $50,000. I had mine done in Carmel Indiana heartland of america...should be way cheaper than east or west coast.

I'll report my surgeons bill once received.

Randy in Indy

142
Posts: 169
Joined: Dec 2009

I went back and added up all of the original "billed" amounts from all of the doctors, hospitals, and labs involved. This has nothing to do with what insurance paid, nor any negotiating one might do before going in.
This starts with the exam where they found the high PSA, includes the 12 sample biopsy, second opinion from the radiation oncologist, CT & Bone scans, two brief physicals to be sure I could undergo surgery, flu & pneumonia vaccinations to be sure I didn't get sick enough to have to reschedule surgery.
Then DaVinci surgery, 4 days in the hospital, followups.
I hope all the bills have arrived, but no promises.
There is no consideration for any of the non-Rx stuff to get the house ready, travel, hotels, etc.
I am 12 weeks out as of yesterday. My stats are very similar to yours, They are in my profile.
$66,157.30 USD
Now, as you pick yourself up off the floor, I had asked my Dr. what the real cost would be if I had to pay out of pocket - this all happened as jobs were disappearing by the day here in the States - he speculated $45-$50,000 for any of DaVinci, open, or radiation only.

This was in a Baylor system hospital in the Dallas area, prior workups done at Medical Center Plano (really good people at all of these providers).

To compare with Randy's numbers, my hospital stand-alone bill was $34k. I never saw the actual paperwork, so can't say where the differences are or what was included. I did stay a couple of days more in the hosp. due to the extent of the surgery.

lion1
Posts: 240
Joined: May 2007

LRP
$30K HOSPITAL
$18K-SURGEON--I paid 16k out of my pocket.

Lion1

hopeful and opt...
Posts: 1360
Joined: Apr 2009

there is a very experienced doctor, (I'm not home now and I don't remember his name) who does davinci surgery. He only accepts cash. Since I had my biopsy at uc irvine, I was referred to him. The cost last march was 500 for a consult, 5000 for a prostate with no complication, and 6500 for one where there was nodule involvement. The hospital costs were separate. I did not use him, but he has performed lots of surgeries. If you need to know his name, I have the information at home, you can contact me at this site, or irakaget@yahoo.com, simply mention prostate in the subject line, so I do not delete.

Ira

ps by the way I believe that a davinci is a robotic assisted laprioscopic

pps: how many cores were positive and what was the involvement?

hopeful and opt...
Posts: 1360
Joined: Apr 2009

Thomas e. ahlering...............714 456- 6068 appt.

KJN
Posts: 6
Joined: Jan 2010

Thanks to all of you for looking up those figures, and the phone number. Wow! Those prices are as bad as I had feared. Doing it in the US may not be possible for me. I'll keep looking around, and check out Irvine. I've heard that it may be possible to negotiate with some hospitals for the insurance company price. I'll see what I can come up with. Do any of you know if the price your insurance company paid was lower than the price that you quoted to me?

I had my biopsy done in Bangkok. They took 24 cores. The right lobe showed no cancer, and the left showed cancer in 9 out of 12, but I don't know the percentage in each. The slides just arrived at Johns Hopkins yesterday for a second opinion.

The urologist surgeon in Bangkok who did my biopsy does robotic assisted surgeries. He's done 180. He is supposed to have the most in Thailand, and he says he's got more than the leader in Singapore. I'm hearing that over 250 is a better bet. When I read of surgeons doing 1800 in the US, it sounds much better to me.

142
Posts: 169
Joined: Dec 2009

You are correct that there is a difference in cost. In my case there were things that the insurance would not pay, but were written off up front (mine only pays 6 biopsy cores, the Dr. won't do less than 12, and the lab has an agreement with the Dr. that helps cover the difference).
There were a number of items considered "not covered" that were written off or reduced with some polite conversations (I have found some amazingly considerate people out there).
The insurance companies in general also have fixed price or fixed percentage agreements for a long list of procedures with "in-network" providers and hospitals, which may not be the closest or the one you are familiar with.
I can't say in detail what rules apply - I couldn't make sense of how some numbers were arrived at, but I would say the insurance company spent about $18,000, while I spent something over $5,000 (in respect to the hospital & doctors).
If I had not been extraordinarily careful about selecting doctors and facilities that were within the insurance company's network, my part would have been at least $12,000, perhaps much more. This level of attention had to be kept up at every point I signed anything.

And I pay a significant insurance premium, which can't be ignored in the total "cost".

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

I am very lucky with the company I work for has pretty good insurance. My annual maximum out of pocket is only $950. Since I met that with all the doctors seen since discovered in Oct 09 I wanted to get the operation done in 09 thus avoiding the additional $950 I'd be spending immediately after the Operation if I choose to wait and do in Jan or Feb. My entire operation cost will cost me $0 all covered 100% by insurance...however the doc's and hospital will not be getting at all what they billed. For example just got what the Insurance covered of the $26,015.00 hospital bill...insurance on paid them $10,997.15 making the provider eat the rest....right now I am loving my job and thank God for the insurance the company has - Anthem Blue Sheild Blue Cross. Can't wait to see the Dr's bills and see how the insurance denies them thousands...it's simply rediculous the cost charged on some line items. Now the surgeons...getting rid of my cancer...that is priceless and if forced to I would pay just about any amount...somehow.

Randy in Indy

hopeful and opt...
Posts: 1360
Joined: Apr 2009

Remember that you get only one prostate operation, so you want the best....

I have medicare and a bluecross suppliment.........i notice that the various doctors that I saw ask more than what they accept thru these coverages..........so I think that you might be able to negotiate.....check out a few docs for price.

As far as dr ahlering.........At a support group, I spoke with a physician who had the operation with him, and asked for a professional discount//////he did not receive it......

What other countries are you considering for an operation, israel, austraila (sp), taiwan, etc

Where are you from in the US, do you have a support group and a place to stay?

ira

KJN
Posts: 6
Joined: Jan 2010

Hopeful and Opt...

I work in Japan and spend part of the year in Thailand with my wife who is from there. I have insurance in Thailand that will pay for an operation there, but I haven't found a surgeon with very high numbers there. That same insurance will reimburse me for surgery in any other country except the US. I'd still have to come up with the cash, but could get it back from them if I could get it pre-authorized.

So, I could do it free in Thailand, but maybe with a less experienced surgeon. Doesn't sound too appealing. I could do it in the US, where it sounds like the best surgeons are, but I will have to pay for it all. Still, I want to do this right.

Another option is doing it in some other country where I can find a high volume surgeon, pay for it up front, and hopefully get a refund. That would be great. But finding a surgeon that I can trust in an unfamiliar country is an overwhelming task. I'm looking into it, but just scratching the surface at this point. Japan isn't looking too promising.

I grew up in northern California, but don't have family there any more. I have siblings in the Seattle area and the outskirts of New york City, so I have places to stay, there. I am looking around the New York area, because there are many famous hospitals there and in neighboring states. My sibling there is a cancer survivor (8 years). That is my support group in the states at the moment.

hopeful and opt...
Posts: 1360
Joined: Apr 2009

however in nyc there are top doctors, there are two robotic surgeonsthat are supper stars in NYC........I not home now, so I will have to get back to you

Ira

hopeful and opt...
Posts: 1360
Joined: Apr 2009

ashutosh k. tewari, md

bdhilton
Posts: 759
Joined: Jan 2010

From my perspective, the numbers you are stating above for the "experienced" di Vinci surgeon in Thailand are not high. No matter what procedure you get from my perspective you want a doctor with experience and excellent provable stats….

I am having Open Surgery up in Chicago soon but Dr. Shah out of Atlanta is an excellent di Vinci surgeon with about 1200 under his belt + CNN did a piece on him back in 2006 (you can google it)…best of luck in this thought process

SeattleJ
Posts: 32
Joined: Mar 2011

The Seattle Cancer Care Alliance (Fred Hutchinson Cancer Research Center & University of Washington Medical Center)was recently ranked as 5th best cancer center in the US by US News & World Report. It is listed as one of the top 10 cancer centers in the US by all rating services that I've checked. I had an open procedure done there on March 11, 2011 by Dr. William Ellis, but he is also considered one of the top robotic surgeons. My wife also had her breast cancer treated at the same center, so we can both verify the excellent quality of care provided there. The website is http://www.seattlecca.org/. Good luck in your search.

John
Seattle, WA

macguy's picture
macguy
Posts: 18
Joined: Nov 2009

You might want to check out cryosurgery. Although this method is not all that popular on this site it's suppose to be less expensive than surgery. www.upmccancercenters.com/cancer/prostate/cryosurgery.html

2ndBase's picture
2ndBase
Posts: 220
Joined: Mar 2004

Surgery is not the only option you have. Radiation can kill all the cancer in the prostate. I was 52 with psa of 24 and Gleason of 9 and only had radiation and I have no cancer in my prostate today. There are less side effects this way also. Hope this helps.

KJN
Posts: 6
Joined: Jan 2010

2ndBase

What type of radiation treatment did you have? I have heard that some can cost more than surgery.

macguy's picture
macguy
Posts: 18
Joined: Nov 2009

21 Century Oncology in Clarkston, MI told me my share of the $80,000 to $100,000 costs for Intense modulated radiation therapy would be $8,000 and Medicare would pickup the rest. I believe medicare will reduce their invoice somewhat. I am waiting for the Henry Ford Hospital costs to come in.

KJN
Posts: 6
Joined: Jan 2010

Yeah, that's what I was afraid of. I have to pay for anything in the US out of pocket. Johns Hopkins has quoted me surgery at around $21,000. Surgery in Sydney, Australia is around the same price. If I can come up with that amount, that's probably the route I will go. Right now, I am still trying to see if I can pull that amount together. It's a struggle at this point. This was all a big surprise, of course, as I'm sure it was for everyone here.

macguy's picture
macguy
Posts: 18
Joined: Nov 2009

Henry Ford Hospital in Detroit gave me an approximate quote that my share of the costs with medicare would be $4,600 for 43 treatments and now I have an appointment at Beaumont Hospital in Troy, MI for another quote. Apparently it pays to shop around.

macguy's picture
macguy
Posts: 18
Joined: Nov 2009

Henry Ford Hospital in Detroit gave me an approximate quote that my share of the costs with medicare would be $4,600 for 43 treatments and now I have an appointment at Beaumont Hospital in Troy, MI for another quote. Apparently it pays to shop around.

jminnj's picture
jminnj
Posts: 129
Joined: Nov 2009

Just had my robotic 2 weeks ago. The surgeons bill was about 25K, and then 43K for the hospital. Of course, with HMO they are not getting anywhere near those amounts and I am responsible for about $1,200 of the total costs.I live in Northern New Jersey.

HIFUgal
Posts: 58
Joined: Sep 2009

My gosh, you are 52, I'm guessing you haven't heard of HIFU (high intensity focused ultrasound) it comes with a verrrry low risk of any side effects, and incontinence is virtually unheard of.

There's a wonderful HIFU center in Japan, it costs $14,000. which even includes a couple nights in the hospital, which is only given because of the language barrier. HIFU is a two-three hour procedure, and then you are fine, you need a supra pubic catheter, which is no big deal, for 2-3 weeks.

read my thread here: http://csn.cancer.org/node/177783

And go to http://en.wikipedia.org/wiki/HIFU for an explanation of the treatment. My husband had HIFU over a year ago, he had no troubles, no pain ~ or even discomfort, no side effects at all. We've sent in more than a dozen men all report being thrilled with the outcome.

Here's the site for Japan, Dr. Uchida is very well known and very respected all over the world. He's been treating men with HIFU for 9 years. http://www.hifu-jp.org/

MCK
Posts: 2
Joined: Mar 2011

KJN....my husband is 54 and also works overseas, as a teacher. Thus, we do not have health insurance either. He came home to the USA for a medical consultation this week with a urologist/surgeon and received a diagnosis of protate cancer, gleason rating 6. The urologist/surgeron recommended robotic removal of the prostate.

The doctor and the billing department at the American hospital were not able to offer any approximation of the cost. The billing department kept repeating 'it depends on how they code it'

Were you able to verify costs of the surgery, and can you offer any type of financial or medical advice? I am not sure if we should stop with this one recommendation from the urologist, or if we should consult an oncologist as well. I also dont know what kind of financial help might be available to someone without insurance, with income above the poverty level, but an income in a teacher's salary level who cant pay the total cost of surgery in the 40 to 75 thousand range I see predicted on this blog

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

MCK,

I am truly sorry that you find yourself in this difficult strait. I don't understand your situation completely or why being an overseas teacher made you ineligible for insurance unless you decided to opt out of coverage your employer may have offered.

Treating prostate cancer without insurance can be extremely expensive as you're starting to realize. I think your estimate of $40-75K for surgery and associated hospital costs is probably on the conservative side but it varies greatly across the country. Other treatment options are likely to be in the same price range but it is extremely difficult to get exact estimates in advance of treatment.

While I understand that cost is a major factor in your decision process today I strongly urge you to first consider the best treatment for your husband's condition and it very well may not be robotic surgery as the first urologist suggests. Most men who go through this process seek multiple second opinions and only knowing a Gleason 6 score is simply not enough information to give you much advice based on experience other than very general guidelines.

In general, a Gleason 6 score is considered less threatening that higher Gleason grades but much depends upon the PSA history, physical symptoms, the size of the prostate, the PSA density and velocity, other health conditons, whether or not there were any bumps felt on the DRE, how many cores were positive, and how much cancer was in each biopsy core.

Many of us who have had a prostate cancer diagnosis seek second opinions from radiologists and oncologists who specialize in prostate cancer. Second opinions obviously aren't free (my experience is that they cost anywhere from $500-$1500 each) but they are critical to gaining a full understanding of the scope of your husband's disease and the full range of options open to him for treatment.

A second opinion on the biopsy is also strongly encouraged as reading the Gleason score is a highly subjective process and other pathologists may have differeing opinions and I urge you to have your slides read by a leading pathology center such as Johns Hopkins or Bostwick Labs where they have specialists in recognizing prostate cancer patterns in biopsy slides.

At this point your husband needs to be educating himself on the various treatment options available to him, their potential side effects, and gaining an understanding on the progress of this disease and how it will affect his quality of life. You're fortunante to have (at least at this point) a less threatening diagnosis which affords you some time to research your options.

As you may know, the new health care law prohibits denial of coverage for pre-existing conditions so it may be useful to you to also start researching medical plans available from your husband's overseas employer or private insurance options. Some doctors offer steeply discounted services for patients with special financial needs but I'm afraid I can't offer you any suggestions on how to seek out such doctors and institutions.

It seems to me that the most prudent course is to conduct some research, gather second opinions, and figure out what the optimum treatment for your husband is and then figure out how you might pay for it. At this point I don't believe you should be making a decision entirely on cost alone.

If you do follow the advice of your urologist and pursue robotic surgery, please make sure you seek out a surgeon with a lot of experience. Many studies have shown that robotic surgeons do not gain proficiency in this procedure until hundreds of surgeries have been performed and patients with less experienced surgeons are much more likely to experience adverse side effects that will impact your husband's quality of life for decades.

Best wishes to you and your family for finding a suitable solution for your situation.

K

MCK
Posts: 2
Joined: Mar 2011

thank you very much for your kind and informative response. We are just getting started and we will consider everything you suggested very carefully. We wish you continued good health.

balasu
Posts: 1
Joined: Nov 2011

Try the Asian Heart Institute, Mumbai a very good facility which has the Da Vinci Robotic facility. The surgery is done by Dr. Mani Menon of the Henry Ford Medical Centre, Detroit. He is one of the top Robotic surgeons. He visits this facility to do surgeries. The cost would be much less.

tarhoosier
Posts: 189
Joined: Aug 2006

delete

poston8
Posts: 1
Joined: Feb 2011

I highly reccomend you read INVASION OF THE PROSTATE SNATCHERS before you do anything. It reports the latest thinking in prostate cancer management.

Washburn4
Posts: 5
Joined: Mar 2013

Hi KJN,

I was diagnosed two years ago - PSA of 4.2, Gleason 6.  Given that is considered "low risk" and "slow growing," I did active surveillance.  However, last November I had another biopsy that showed one sample at Gleason 7, so I decided to move to treatment.

For two years I researched my options and decided that HIFU (high intensity focused ultrasound) was my treatment of choice and that, if and when I had it done, I wanted it done by Dr. Stephen Scionti, who has now done more than 1,000 such treatments.

HIFI is common in Europe, Canada, and Asia (including Japan) but not yet approved by the FDA so it is generally not covered by US insurance.

Yesterday evening we returned from Bermuda after having Dr. Scionti do the procedure on Saturday.

It was all I had hoped for.  In spite of having some cancer in the apex of my prostate, Dr. Scionti was able to work around it leaving everything intact.  I was told here that, with surgery or radiation, I had a 50-50 chance of incontinence and a 70% probability of impotence.  The numbers for Scionti's patients are 1-2% incontinence, and 10-20% impotence.  Much depends on the man's health before the procedure.  I was told I would be as good going out as I was going in.  Scionti brought two of his nurses from the States and other nursing staff was from the King Edward VII Memorial Hospital in Hamilton, Bermuda.  Everyone was absolutely superb and I can't imagine how I could have gotten better care in the States.

However, the price of treatment is $25,000 (not including airfare and hotel) which, in your case, may be cheap compared to the other options.  I don't know and am just now researching the cost of different treatments so maybe I can recoup some of my costs.

But, given that you are only at a Gleason 6 (low risk) I have a few thoughts.

- Get another opionion.  My first urologist kind of pushed me toward seeds but grudgingly agreed that I was a good candidate for surveillance, with the understanding that I would rethink it if the cancer progressed.

-Take time to do your own research.  Remember that urologist = surgeon so surgery is generally what they will recommend.  I haven't met a doctor here, other than my "new" urologist, who has heard of HIFU.  They don't practice it because they'd have to learn something new.

- Get a copy of Dr. Mark Scholz' Invasion of the Prostate Snatchers.  In spite of the clever title it's a very serious work.

- Get a copy of Dr. Colon Campbell's book The China Study.  Two years ago we (my wife and I) went on a (mostly) vegan diet and the general condition of our health has improved greatly.  Low cholesterol, fantastic blood work, etc.  Also, my PSA stayed flat (the last one was 4.1) and my prostate actually shrank from 39 to 31, which also helped with  the treatment.

- Take a look at Dr. Stephen Scionti's web site.  It's all there.  

Anyway, I've gone on longer that I planned but you are where I was a couple years ago.  And I've seen so much damage done to friends and relatives by the "standard" surgery and radiation.  Granted, there are lots of success stories too.

One more thing.  HIFU is repeatable should the cancer ever return, surgery and radiation are not.  But HIFU also needs to be done while the cancer is still in relatively early stages.  It's not for advance cancer that has gotten outside the prostate.  Mine hadn't

So now I am looking forward to 2-3 weeks of this catheter bag, then the catheter comes out and I plan to be normal.

I hope this is helpful.  Let me know if you have any questions.

Good luck,

Mike Miller

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Mike, if Dr. Scionti told you that there was a 50/50 chance of incontinence and a 70% chance of impotence for either radiation or surgery then you were sorely mislead.  Egregiously so.  While i am not an advocate of surgery for the risks of incontinence and impotence, the typical recovery rates are much, much higher than what you (or what your doctor told you) indicate.  In my own case of chosing SBRT radiation for a low risk diagnosis, the statistics for my treatment are less than 4% urinary problems that usually clear within a few weeks and almost no incidences of complete incontinence.  85% of men who are potent before treatment remain potent afterward.  Other radiation treatments have similar statistics.  

I do agree with the books you mentioned but hope patients seek second opinions with specialists in several treatment methods.

 

K

Washburn4
Posts: 5
Joined: Mar 2013

I should have been more clear.

In paragraph #5 when I say "I was told here," "here" is home in Minneapolis and the are figures I was given were by my urologist, not Dr. Scionti.  And the figures I gave "here" were only for me personally given that I had  Gleason 7 cancer in the apex of my prostate right on the edge and my urolologist said he doubted, with robotic (DaVinci) surgery, that he would be able to spare the nerves on that side.  That was what dropped the, as far as I know correct, figures you gave to the ones from me.

Dr. Scionti was not troubled by the cancer in the apex in terms of being able to spare the nerves in question.  

 

Washburn4
Posts: 5
Joined: Mar 2013

After a couple hours of "recovery" (coming out from under the anesthesia) we returned to the hotel, had a bite, a good night's sleep, and flew home the next day (yesterday).  And today has been a very normal, quiet day for a 72 year old in Minnesota.  Just lots of water and a few pills.

One more thing.  Like a previous person noted, Japan has been doing HIFU for 12+ years.  Just be sure, as with any treatment, to get a doctor who does lots of them and has good stats on his own patients.

Mike Miller

yankeefan
Posts: 69
Joined: Mar 2013

amount billed (not necessarily amount paid, due to insurance considerations) rounded to nearest hundred dollars:

surgeon: $6,300.00

anesthesiologist: $1,400.00

hospital (OR cost, one night room & board, etc): $6,600.00

Total: $14,300.00

I am lucky, I have good insurance. My total out of pocket cost for all of this is $300.00 

I will add that, if the statements my insurer sent me are accurate, the surgeon and the anesthesiologist didn't receive nearly what they billed.

I will also note that my surgery was the retropubic, i.e. open variety, not the robotic assisted. I don't have the numbers for the robotic surgery, but my sense is that it costs significantly more than the open procedure. There are those that argue that the added cost doesn't translate into improved results...but that's another discussion.......

Note, I just had this surgery last month, so these are up to date amounts; also for comparison purposes, my surgery was done at John's Hopkins, in Baltimore, MD. 

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