first contact

xNTP

Well, I've started inquiring locally ("A") and away ("B").  A/B, first post.  Locally I'm having problems on getting an office quote for cash where basically we do some kind of exam, DRE, PCA3 and draw a 4Kscore blood test ($395 for 4K's lab in NJ itself, $xxxx for a blood draw instead of $xx ???).   My order of battle is to first get these tests at reasonable cost, second a better mpMRI, and then select the biopsy option.  Biopsy is necessarily after the 4Kscore  and mpMRI.

mpMRI quotes are from $3500 (A) to under $1000 (B).   I've decided that I want to get the DRE and molecular information now, done in A, and will go all out for advanced physics and physical procedures in B, perhaps in 2 weeks.  My biggest delay(s) could be getting this initial workup done for "A" reasonable price.

Basically I need them to co-operate on my script for an initial consultation, exam and draws.  I've had some bad experiences with oncologists before. Although I am usually the least aggressive person in the room, I can go hypercritical (and supercritical) about technical currency, bias and conflicts of interests with doctors.  A doctor who tries to channelize me without contributory better information when I'm trying for best, is done. 

Anyone who can describe or point out detailed first office visit stories and costs would be much appreciated and helpful.  Ditto stories on advanced blood tests and the mpMRI (in any of the different flavors).  

AUA    NCCN    PSA-DRE screening chart

 

VascodaGama

Costs

You may find some ideas on costs in HeallingWell forum. Here is a link;

http://www.healingwell.com/community/default.aspx?f=35&m=1949852

VG

Max Former Hodgkins Stage 3

Costs

A CT where I live costs MORE than a PCa biopsy.

A DRE is available as a GP office visit, with a copay of $40.

I still guess that a biopsy would be cheaper than any of the other stuff you posit in Approaches A or B, but I have not scrutinized this with either hypercriticality or supercriticality (at least I think not, having no idea what either is). 

Plus, the biopsy is the only one of these tests you MUST have.  Use a bit of logic (I tutored formal and mathematical logic for years in college). This exapmle is prima facie and inductive, not deductive.

P.1  (Premise 1):  You want to save money.

P.2:  Of the tests you list, only one, the biopsy, is both manditory (to receive treatments) and definitive (all of the other tests are neither).

Conclusion:  The biopsy is the only rational test to currently spend money on.

Q.E.D.

max

xNTP

my point of view

Thanks, Max. It's Place A and Place B, not "plan" or "approach A or B"

In Place B, a 3T mp-MRI is **much less** than a 12 core biopsy in Place A.  Papers raise a question how much a biopsy done first alters the MRI.  

If I'm really fortunate, our insurance may pay for all of that done in Place B, but I don't count on insurance in a hurry for advanced care or without successful prior experience. For Nov-Dec in Place A, there's no realistic chance of getting insurance benefit in 2016.

Now at this belated point, I realize that our insurance industry - govt conventional wisdom on PSA testing (2012) is totally wrong for me.  Working the issue, I would have desired PSA+fPSA or PHI for my age, back then a few years ago, before the 4 panel test was available, which now may should be the gold standard.

Now, going forward, I especially want the best dataset reasonably possible.  At this moment, I want a dataset that I find most useful whether dx'd for prostatitis, BPH, low Gleason PCa, indolent PCa, PCa aggressive to varying degrees, or metastatic PCa, with some respect to the weighted odds of a PSA ~8.   I am hopeful that the four kallikreins can be a useful set of data for any scenario.  Especially if I am dealing with the worst case, I want more biomarkers and monitoring options independent of prostate biopsy.  

At most, I'll lose 1-3 weeks on the earliest possible biopsy if it's advanced or aggressive PCa. Even this might be gained back on starting tx sooner with alarms made sooner from 4Kscore, PCA3, or in Place B with availability of extra opinions and followup diagnostics.   I'm already thinking about interim chemistry for next week.