How much does prostate surgery cost in the US?

KJN said:

Other countries, US state
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.

KJN said:

Other countries, US state
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.

Kongo said:

Tough Situation
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

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

Washburn4 said:

Prostate Cancer Treatment

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

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

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. 

MATA said:

Cost of robotic prostate surgery

I live in Panama and the total cost here including hospital, surgeon, everything is $20,000 in September 2015. I am signed up for Medicare A & B. Does anyone know much will I have to pay out of pocket for the surgery if I have it done in the U.S?

I had my DaVinci robotic surgery in Northern Virginia on June 3rd.  The total bill for my Urologist (performed the surgey), the hospital stay (4 days), the anesthesiologist and the actual cost of the procedure came in at almost $60,000.  The insurance company negotiated the price down to $23,00 for everything, my cost was $3,000.  I hope this helps.