My Journey Begins, Cancer and Medicare, Maybe this will help some others one day

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Jul 10, 2012
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16,422
Location
North Carolina Coast
(long read but those interested might find it useful)
Well, after beating the most serious part of a family history of diabetes and heart disease (I still have some arterial disease, genetic) but no intervention of even drugs are needed unlike all the males in my family which were a train wreck and had heart by-passes 20 years before my current age. Being the youngest I decided to not let that happen to me and I pretty much beat it, even though I have High LipoProtein A which nothing can be done about. I made sure to eat healthy. I also avoided diabetes (so far)

So, what do you know? since 2017 I have had very high PSA levels it started at a 4.7 and ended 7 years later at higher and way higher than 10___. Multiple MRI's and 4 Biopsies the first 3 over the years turned up nothing the last one in Sept 2024 turned up cancer.
Out of 12 samples taken only 2 came back, that was good and most likely because I was very aggressive on insisting on Biopies. One core showed a 3/3 which really doesnt call for action at that point. The other was a 3/4 which would be considered intermediate risk. This to me was VERY early stage and I wanted it gone.

So my regular urologist calls me up to see what I want to do. Watchful waiting, Radiation or Surgery. He clearly thought Surgery was not at all called for (but read on) I couldnt make up my mind, so there was a 4th option. A referral to Duke University Cancer Clinic almost one of the top 10 in the USA. We (my wife and I) got an appointment a few days before Thanksgiving 2024 to meet with 3 specialists who spent hours with us, just for us, just to review my case and get the options, individually one on one. One Oncology Radiologist, One Surgeon and One Medical Oncologist
My wife and I made the 3 hour trip and stayed in a hotel for the meeting the next day. FREAKING wonderful experience. The entire 5th floor devoted specifically to prostate and other cancers involving that area and we were there. Just for me.

Throughout ALL of this my Medicare ADVANTAGE plan paid for everything, not one hiccup not one objection, no stipulations.

Sadly all 3 specialists were very concerned. It caught my wife and I off guard. Here I was so happy that I found out about this cancer so quickly and being so proactive, almost insisting my Dr do a biopsy. But they explained to me, even though my PSA was down to 11.5 it had to be doubled to a PSA of 23 because of a drug I was on. I found out that all three doctors were to label me "High Risk" and bumped me up from a 7 to more like 8 to 10 (10 being the worst) with favorable outcome.
Also I found out if I wanted surgery it might not be successful do to heavy scarring from an appendectomy I had in the 4th grade that couldnt be closed up at the time, I was septic and almost died. So the surgeon said if I want surgery, robotics is out and he will do it by incision but a 20% chance I will wake up only to find out he cut me open and could not proceed. I was almost relieved in the sense that radiation and drug therapy was making more sense.

Based on the 3 doctors, they ordered a PSMA PET SCAN the latest state of the art scan to see if prostate cancer spread in my body. They were very concerned on how my PSA can be 23 and only 2 cores showing cancer, they felt something great must be going on. However the earliest available appt was Jan 2nd so they offered if I could get one sooner near where I live by all means do it. I told them I want to be treated there, they offered there are many doctors good near me and mentioned one name in particular of a Radio Oncologist that they love and wanted him up at Duke that is within 1 hour from me. I arraigned though the new doctor closer to me AND instant response of the doctors at Duke to get a PSMA SCAN ordered closer to me on Dec 20th and follow up with the new doctor near me on Dec 30th. So thanks to Duke within 2 hours the order for a PSMA PET SCAN arrived at a place closer to me. I was so impressed and also impressed with the staff at what will become my new doctor. All this time, unknown to me and handled by their offices approval was needed by my Advantage Plan, I only found out because I got a letter in the mail it was approved. Once again, no hiccups at all from my plan. The retail cost of this scan was $19,000 and it was determined as far as the scan can tell, the cancer has not spread to any other part of my body.

SO that ends my journey with my medicare advantage plan 2024/ NOT ONE QUESTION, NOT ONE HOLD UP. EVERYTHING PAID FOR.
With that said the current Advantage Plan wasnt being offered in the New Year 2025 and I could care less, I just pick a new one on line on the government website and as soon as you click, you are covered for 2025.

HOWEVER since the provider had decided (Aetna) not to offer this plan for 2025 I also had the right to go into standard Medigap Plan with NO underwriting and guaranteed acceptance. SO here I am with cancer and after thinking about it for a month or so ( I knew way ahead of time) I decided for 2025 to go into private Medigap Plan N which includes Government A and B plus private plan D for drugs. The cost is only $135 extra a month and of that, they will pay a gym cost of up to $110 a month! Net would be $25 including the drug plan so why not? Here I was about to battle cancer and there would not be much to think about.

Why did I decide to go to Medigap from an Advantage plans I so loved for 3 years? Simple, chances are it will cost me less for the year and to be honest, since I am new to the area I wouldnt have to worry about who is in network. I will say, after 2025 I plan but on going back to Advantage C if this all resolves itself. But I honestly do not know right now, though as of right now my Drs are in the Advantage Plan I would choose if I did there seems to be a little turmoil from year to year. The reason for this post is I read stories about Medicare and it's a wonderful system if you take advantage of it and use it, educate yourself right on the https://www.medicare.gov/ website, you can read of days and study.

So the decision was made. Fantastic doctor here on the coast who my wife and I liked very much and they like him up at Duke that they wanted him to move up there, he didnt want too.
I am to undergo radiation and drug therapy. This doctor changed my threat designation a little bit. But he explained it means the same. From high risk favorable outcome to intermediate risk unfavorable outcome.

Yesterday, Wed, the drug was delivered to my house. I am to take one pill a day for 6 months. The drug cost is up to $3000 a month x 6 months roughly $18,000 but can be as little as $14,000 my cost is $2000 thanks to the new medicare drug out of pocket limit for 2025 or it would have been $8,000. My life as I know it will change for the next 6 months and I am not looking forward to it because of the drug but I want to live and make sure this thing is knocked out. The side effects are not going to be pleasant. However they are being aggressive in the sense they use this for high risk cases and in cases where it has spread.

Next week I am going to spend over another half day, meeting with two specialists (one of which is my new doctor) arranging and going over what will be my radiation schedule coming up which will be 5 days a week for 5 weeks as well as MRI and CT scan. This past Monday my regular urologist implanted 3 gold markers inside my body that the computer will use as markers in order to deliver the radiation to the proper area and avoid other areas as much as possible. My doctor tells me the survival rate is 90% for 15 years.

Prostate cancer sucks. The possible side effects of surgery or radiation are different but both can suck. Though immediate side effects for me with radiation will be almost none, 3 years down the road it POSSIBLY can rear its ugly head and even expose you in the future to cancers because of the radiation itself. My hope is, as time goes on medicine advances. One reason how far we have come was surgery was always preferred as late is 2006 now radiation is much more focused and that trend is almost reversed DEPENDING ON YOUR CASE>

SO FOR ALL OF YOU, MAKE SURE YOU ARE GETTING REGULAR CHECK UPS, DONT BE AFRAID OF YOUR DOCTOR, SURE EDUCATE YOURSELF, READ UP BUT ONLY SO YOU CAN TALK TO YOUR DOCTOR AND UNDERSTAND THE CONVERSATION. DO NOT RELY ON INTERNET FORUMS AND WHAT OTHER PEOPLE SAY. YOUR DOCTOR IS THE KEY. MY POST IS ABOUT BEING PRO ACTIVE IN DOING SO, DONT BE AFRAID OF TESTS, IF YOUR DOCTOR GIVES YOU THAT OPTION, TAKE IT, DONT PUT IT OFF.
From the sound of my cancer (they are all different in aggressiveness) I am so glad I was almost insistent on my 4th biopsy when my doctor gave me the choice to wait another six months or do it now.

As far as Medicare Advantage C plans and Medigap Plans plus D plan it comes down to cost and what you want and what you are willing to pay and possibly give up depending on the area you live. I loved my Advantage C plans but given the chance to go back (at least for now) Medicare A, B and private Medigap N plus private Plan D makes everything thoughtless for the extra monthly premium.

Medigap costs are pretty much fixed where the Advantage C plan can get pricey if your copays add up to many thousands and you have to stay in network. So right now, yeah, I am happy to be in Medigap the purpose of my post is to highlight my personal experience. Im sure the end result would be the same with my Advantage Plan. However should your Advantage C plan not be offered the following year, the system once again worked perfect. In the mist of a cancer diagnosis I got an unconditional acceptance into Medigap because my plan wasnt being offered and that gave me the option of choosing anything I wanted. If my plan was still offered I would think NO WAY would I have been accepted into Medigap and that is something each individual needs to know. Once you are in Advantage c you can only get out in the 1st year for guaranteed acceptance. UNLESS your Advantage C plan is no longer offered.
The system works and works very well, I am thrilled that I live in the USA and can get this latest technology, latest drug therapy that even my regular urologist never prescribed before. People trash our health care system, well, you will be thankful in cases like mine.
I was able to consult with a total of 5 specialists plus my regular urologist (who is specialist in his own right) and my cost was pennies. Making educated decisions is up to you, get opinions.
 
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(long read but those interested might find it useful)
Well, after beating the most serious part of a family history of diabetes and heart disease (I still have some arterial disease, genetic) but no intervention of even drugs are needed unlike all the males in my family which were a train wreck and had heart by-passes 20 years before my current age. Being the youngest I decided to not let that happen to me and I pretty much beat it, even though I have High LipoProtein A which nothing can be done about. I made sure to eat healthy. I also avoided diabetes (so far)

So, what do you know? since 2017 I have had very high PSA levels it started at a 4.7 and ended 7 years later at higher and way higher than 10___. Multiple MRI's and 4 Biopsies the first 3 over the years turned up nothing the last one in Sept 2024 turned up cancer.
Out of 12 samples taken only 2 came back, that was good and most likely because I was very aggressive on insisting on Biopies. One core showed a 3/3 which really doesnt call for action at that point. The other was a 3/4 which would be considered intermediate risk. This to me was VERY early stage and I wanted it gone.

So my regular urologist calls me up to see what I want to do. Watchful waiting, Radiation or Surgery. He clearly thought Surgery was not at all called for (but read on) I couldnt make up my mind, so there was a 4th option. A referral to Duke University Cancer Clinic almost one of the top 10 in the USA. We (my wife and I) got an appointment a few days before Thanksgiving 2024 to meet with 3 specialists who spent hours with us, just for us, just to review my case and get the options, individually one on one. One Oncology Radiologist, One Surgeon and One Medical Oncologist
My wife and I made the 3 hour trip and stayed in a hotel for the meeting the next day. FREAKING wonderful experience. The entire 5th floor devoted specifically to prostate and other cancers involving that area and we were there. Just for me.

Throughout ALL of this my Medicare ADVANTAGE plan paid for everything, not one hiccup not one objection, no stipulations.

Sadly all 3 specialists were very concerned. It caught my wife and I off guard. Here I was so happy that I found out about this cancer so quickly and being so proactive, almost insisting my Dr do a biopsy. But they explained to me, even though my PSA was down to 11.5 it had to be doubled to a PSA of 23 because of a drug I was on. I found out that all three doctors were to label me "High Risk" and bumped me up from a 7 to more like 8 to 10 (10 being the worst) with favorable outcome.
Also I found out if I wanted surgery it might not be successful do to heavy scarring from an appendectomy I had in the 4th grade that couldnt be closed up at the time, I was septic and almost died. So the surgeon said if I want surgery, robotics is out and he will do it by incision but a 20% chance I will wake up only to find out he cut me open and could not proceed. I was almost relieved in the sense that radiation and drug therapy was making more sense.

Based on the 3 doctors, they ordered a PSMA PET SCAN the latest state of the art scan to see if prostate cancer spread in my body. They were very concerned on how my PSA can be 23 and only 2 cores showing cancer, they felt something great must be going on. However the earliest available appt was Jan 2nd so they offered if I could get one sooner near where I live by all means do it. I told them I want to be treated there, they offered there are many doctors good near me and mentioned one name in particular of a Radio Oncologist that they love and wanted him up at Duke that is within 1 hour from me. I arraigned though the new doctor closer to me AND instant response of the doctors at Duke to get a PSMA SCAN ordered closer to me on Dec 20th and follow up with the new doctor near me on Dec 30th. So thanks to Duke within 2 hours the order for a PSMA PET SCAN arrived at a place closer to me. I was so impressed and also impressed with the staff at what will become my new doctor. All this time, unknown to me and handled by their offices approval was needed by my Advantage Plan, I only found out because I got a letter in the mail it was approved. Once again, no hiccups at all from my plan. The retail cost of this scan was $19,000 and it was determined as far as the scan can tell, the cancer has not spread to any other part of my body.

SO that ends my journey with my medicare advantage plan 2024/ NOT ONE QUESTION, NOT ONE HOLD UP. EVERYTHING PAID FOR.
With that said the current Advantage Plan wasnt being offered in the New Year 2025 and I could care less, I just pick a new one on line on the government website and as soon as you click, you are covered for 2025.

HOWEVER since the provider had decided (Aetna) not to offer this plan for 2025 I also had the right to go into standard Medigap Plan with NO underwriting and guaranteed acceptance. SO here I am with cancer and after thinking about it for a month or so ( I knew way ahead of time) I decided for 2025 to go into private Medigap Plan N which includes Government A and B plus private plan D for drugs. The cost is only $135 extra a month and of that, they will pay a gym cost of up to $110 a month! Net would be $25 including the drug plan so why not? Here I was about to battle cancer and there would not be much to think about.

Why did I decide to go to Medigap from an Advantage plans I so loved for 3 years? Simple, chances are it will cost me less for the year and to be honest, since I am new to the area I wouldnt have to worry about who is in network. I will say, after 2025 I plan on going back to Advantage C if this all resolves itself. The reason for this post is I read stories about Medicare and it's a wonderful system.

So the decision was made. Fantastic doctor here on the coast who my wife and I liked very much and they like him up at Duke that they wanted him to move up there, he didnt want too.
I am to undergo radiation and drug therapy. This doctor changed my threat designation a little bit. But he explained it means the same. From high risk favorable outcome to intermediate risk unfavorable outcome.

Yesterday, Wed, the drug was delivered to my house. I am to take one pill a day for 6 months. The drug cost is up to $3000 a month x 6 months roughly $18,000 but can be as little as $14,000 my cost is $2000 thanks to the new medicare drug out of pocket limit for 2025 or it would have been $8,000. My life as I know it will change for the next 6 months and I am not looking forward to it because of the drug but I want to live and make sure this thing is knocked out. The side effects are not going to be pleasant. However they are being aggressive in the sense they use this for high risk cases and in cases where it has spread.

Next week I am going to spend over another half day, meeting with two specialists (one of which is my new doctor) arranging and going over what will be my radiation schedule coming up which will be 5 days a week for 5 weeks as well as MRI and CT scan. This past Monday my regular urologist implanted 3 gold markers inside my body that the computer will use as markers in order to deliver the radiation to the proper area and avoid other areas as much as possible. My doctor tells me the survival rate is 90% for 15 years.

Prostate cancer sucks. The possible side effects of surgery or radiation are different but both can suck. Though immediate side effects for me with radiation will be almost none, 3 years down the road it POSSIBLY can rear its ugly head and even expose you in the future to cancers because of the radiation itself. My hope is, as time goes on medicine advances. One reason how far we have come was surgery was always preferred as late is 2006 now radiation is much more focused and that trend is almost reversed DEPENDING ON YOUR CASE>

SO FOR ALL OF YOU, MAKE SURE YOU ARE GETTING REGULAR CHECK UPS, DONT BE AFRAID OF YOUR DOCTOR, SURE EDUCATE YOURSELF, READ UP BUT ONLY SO YOU CAN TALK TO YOUR DOCTOR AND UNDERSTAND THE CONVERSATION. DO NOT RELY ON INTERNET FORUMS AND WHAT OTHER PEOPLE SAY. YOUR DOCTOR IS THE KEY. MY POST IS ABOUT BEING PRO ACTIVE IN DOING SO, DONT BE AFRAID OF TESTS, IF YOUR DOCTOR GIVES YOU THAT OPTION, TAKE IT, DONT PUT IT OFF.
From the sound of my cancer (they are all different in aggressiveness) I am so glad I was almost insistent on my 4th biopsy when my doctor gave me the choice to wait another six months or do it now.
Absolutely - read up! -
So, I was going to MD Anderson - had two Doctors that had a flock of Interns in tow … Got to know one well enough that during a consultation - asked if I could play Doctor. I was spot on and he turned to the youngsters and said you might need to schedule time with him 🫢
 
Best of luck with your treatment. My dad was diagnosed I believe 5 years ago and his GP wasn't budging on treatment selection, which was complete removal via the DaVinci robot at Toronto General Hospital. He's been cancer free now (PSA of 0) for 4 years and side effects, beyond having to learn to pinch off his bladder, were minimal (still has use of).

It really sucks that laparoscopic surgery wasn't an option for you, as the precision afforded by the DaVinci robot is incredible, which means a considerable reduction in the risk of side effects and a much higher likelihood of all the cancer being removed.

Because my dad, his uncle and several men in his family have had prostate cancer, I've already started to get my PSA checked at the behest of my urologist. As you note, a lot of the time you have to be your own advocate, though I've been lucky in that respect.
 
You and I have had a history of differences in our analysis of senior healthcare plans, but none of that matters now.

I'm really glad for you that things have worked out well, and I do hope that things will continue to be positive for you getting this health crisis paid for and successfully resolved.

I'm pulling for you!
 
(long read but those interested might find it useful)
Well, after beating the most serious part of a family history of diabetes and heart disease (I still have some arterial disease, genetic) but no intervention of even drugs are needed unlike all the males in my family which were a train wreck and had heart by-passes 20 years before my current age. Being the youngest I decided to not let that happen to me and I pretty much beat it, even though I have High LipoProtein A which nothing can be done about. I made sure to eat healthy. I also avoided diabetes (so far)

So, what do you know? since 2017 I have had very high PSA levels it started at a 4.7 and ended 7 years later at higher and way higher than 10___. Multiple MRI's and 4 Biopsies the first 3 over the years turned up nothing the last one in Sept 2024 turned up cancer.
Out of 12 samples taken only 2 came back, that was good and most likely because I was very aggressive on insisting on Biopies. One core showed a 3/3 which really doesnt call for action at that point. The other was a 3/4 which would be considered intermediate risk. This to me was VERY early stage and I wanted it gone.

So my regular urologist calls me up to see what I want to do. Watchful waiting, Radiation or Surgery. He clearly thought Surgery was not at all called for (but read on) I couldnt make up my mind, so there was a 4th option. A referral to Duke University Cancer Clinic almost one of the top 10 in the USA. We (my wife and I) got an appointment a few days before Thanksgiving 2024 to meet with 3 specialists who spent hours with us, just for us, just to review my case and get the options, individually one on one. One Oncology Radiologist, One Surgeon and One Medical Oncologist
My wife and I made the 3 hour trip and stayed in a hotel for the meeting the next day. FREAKING wonderful experience. The entire 5th floor devoted specifically to prostate and other cancers involving that area and we were there. Just for me.

Throughout ALL of this my Medicare ADVANTAGE plan paid for everything, not one hiccup not one objection, no stipulations.

Sadly all 3 specialists were very concerned. It caught my wife and I off guard. Here I was so happy that I found out about this cancer so quickly and being so proactive, almost insisting my Dr do a biopsy. But they explained to me, even though my PSA was down to 11.5 it had to be doubled to a PSA of 23 because of a drug I was on. I found out that all three doctors were to label me "High Risk" and bumped me up from a 7 to more like 8 to 10 (10 being the worst) with favorable outcome.
Also I found out if I wanted surgery it might not be successful do to heavy scarring from an appendectomy I had in the 4th grade that couldnt be closed up at the time, I was septic and almost died. So the surgeon said if I want surgery, robotics is out and he will do it by incision but a 20% chance I will wake up only to find out he cut me open and could not proceed. I was almost relieved in the sense that radiation and drug therapy was making more sense.

Based on the 3 doctors, they ordered a PSMA PET SCAN the latest state of the art scan to see if prostate cancer spread in my body. They were very concerned on how my PSA can be 23 and only 2 cores showing cancer, they felt something great must be going on. However the earliest available appt was Jan 2nd so they offered if I could get one sooner near where I live by all means do it. I told them I want to be treated there, they offered there are many doctors good near me and mentioned one name in particular of a Radio Oncologist that they love and wanted him up at Duke that is within 1 hour from me. I arraigned though the new doctor closer to me AND instant response of the doctors at Duke to get a PSMA SCAN ordered closer to me on Dec 20th and follow up with the new doctor near me on Dec 30th. So thanks to Duke within 2 hours the order for a PSMA PET SCAN arrived at a place closer to me. I was so impressed and also impressed with the staff at what will become my new doctor. All this time, unknown to me and handled by their offices approval was needed by my Advantage Plan, I only found out because I got a letter in the mail it was approved. Once again, no hiccups at all from my plan. The retail cost of this scan was $19,000 and it was determined as far as the scan can tell, the cancer has not spread to any other part of my body.

SO that ends my journey with my medicare advantage plan 2024/ NOT ONE QUESTION, NOT ONE HOLD UP. EVERYTHING PAID FOR.
With that said the current Advantage Plan wasnt being offered in the New Year 2025 and I could care less, I just pick a new one on line on the government website and as soon as you click, you are covered for 2025.

HOWEVER since the provider had decided (Aetna) not to offer this plan for 2025 I also had the right to go into standard Medigap Plan with NO underwriting and guaranteed acceptance. SO here I am with cancer and after thinking about it for a month or so ( I knew way ahead of time) I decided for 2025 to go into private Medigap Plan N which includes Government A and B plus private plan D for drugs. The cost is only $135 extra a month and of that, they will pay a gym cost of up to $110 a month! Net would be $25 including the drug plan so why not? Here I was about to battle cancer and there would not be much to think about.

Why did I decide to go to Medigap from an Advantage plans I so loved for 3 years? Simple, chances are it will cost me less for the year and to be honest, since I am new to the area I wouldnt have to worry about who is in network. I will say, after 2025 I plan but on going back to Advantage C if this all resolves itself. But I honestly do not know right now, though as of right now my Drs are in the Advantage Plan I would choose if I did there seems to be a little turmoil from year to year. The reason for this post is I read stories about Medicare and it's a wonderful system if you take advantage of it and use it, educate yourself right on the https://www.medicare.gov/ website, you can read of days and study.

So the decision was made. Fantastic doctor here on the coast who my wife and I liked very much and they like him up at Duke that they wanted him to move up there, he didnt want too.
I am to undergo radiation and drug therapy. This doctor changed my threat designation a little bit. But he explained it means the same. From high risk favorable outcome to intermediate risk unfavorable outcome.

Yesterday, Wed, the drug was delivered to my house. I am to take one pill a day for 6 months. The drug cost is up to $3000 a month x 6 months roughly $18,000 but can be as little as $14,000 my cost is $2000 thanks to the new medicare drug out of pocket limit for 2025 or it would have been $8,000. My life as I know it will change for the next 6 months and I am not looking forward to it because of the drug but I want to live and make sure this thing is knocked out. The side effects are not going to be pleasant. However they are being aggressive in the sense they use this for high risk cases and in cases where it has spread.

Next week I am going to spend over another half day, meeting with two specialists (one of which is my new doctor) arranging and going over what will be my radiation schedule coming up which will be 5 days a week for 5 weeks as well as MRI and CT scan. This past Monday my regular urologist implanted 3 gold markers inside my body that the computer will use as markers in order to deliver the radiation to the proper area and avoid other areas as much as possible. My doctor tells me the survival rate is 90% for 15 years.

Prostate cancer sucks. The possible side effects of surgery or radiation are different but both can suck. Though immediate side effects for me with radiation will be almost none, 3 years down the road it POSSIBLY can rear its ugly head and even expose you in the future to cancers because of the radiation itself. My hope is, as time goes on medicine advances. One reason how far we have come was surgery was always preferred as late is 2006 now radiation is much more focused and that trend is almost reversed DEPENDING ON YOUR CASE>

SO FOR ALL OF YOU, MAKE SURE YOU ARE GETTING REGULAR CHECK UPS, DONT BE AFRAID OF YOUR DOCTOR, SURE EDUCATE YOURSELF, READ UP BUT ONLY SO YOU CAN TALK TO YOUR DOCTOR AND UNDERSTAND THE CONVERSATION. DO NOT RELY ON INTERNET FORUMS AND WHAT OTHER PEOPLE SAY. YOUR DOCTOR IS THE KEY. MY POST IS ABOUT BEING PRO ACTIVE IN DOING SO, DONT BE AFRAID OF TESTS, IF YOUR DOCTOR GIVES YOU THAT OPTION, TAKE IT, DONT PUT IT OFF.
From the sound of my cancer (they are all different in aggressiveness) I am so glad I was almost insistent on my 4th biopsy when my doctor gave me the choice to wait another six months or do it now.

As far as Medicare Advantage C plans and Medigap Plans plus D plan it comes down to cost and what you want and what you are willing to pay and possibly give up depending on the area you live. I loved my Advantage C plans but given the chance to go back (at least for now) Medicare A, B and private Medigap N plus private Plan D makes everything thoughtless for the extra monthly premium.

Medigap costs are pretty much fixed where the Advantage C plan can get pricey if your copays add up to many thousands and you have to stay in network. So right now, yeah, I am happy to be in Medigap the purpose of my post is to highlight my personal experience. Im sure the end result would be the same with my Advantage Plan. However should your Advantage C plan not be offered the following year, the system once again worked perfect. In the mist of a cancer diagnosis I got an unconditional acceptance into Medigap because my plan wasnt being offered and that gave me the option of choosing anything I wanted. If my plan was still offered I would think NO WAY would I have been accepted into Medigap and that is something each individual needs to know. Once you are in Advantage c you can only get out in the 1st year for guaranteed acceptance. UNLESS your Advantage C plan is no longer offered.
The system works and works very well, I am thrilled that I live in the USA and can get this latest technology, latest drug therapy that even my regular urologist never prescribed before. People trash our health care system, well, you will be thankful in cases like mine.
I was able to consult with a total of 5 specialists plus my regular urologist (who is specialist in his own right) and my cost was pennies. Making educated decisions is up to you, get opinions.
How old are you? Yes-it's pertinent.
 
16 yrs after being told the lump in my right breast was cancer. Cut ,poisoned and nuked, a 9 month process. I take a pill that cost about $4 a month. My cancer isn't cured, but is very well maintained. Worst long term side effect has been neuropathy in my feet and fingers from the chemo. Again, I am lucky, I caught it pretty early, twice. I went through some changes in attitude about things and adopted gratitude as a mantra. YMMV.
 
How old are you? Yes-it's pertinent.
I am 68,
At age 46 = .92 (psa)

Screenshot 2025-01-16 at 2.08.03 PM.webp


Screenshot 2025-01-16 at 2.07.06 PM.webp


My PSA history there was a drop in late 2023 and stayed that way in 2024 due to the drug I was prescribed when the Duke doctors informed me that is all well and good but you have to double those numbers for the true PSA while taking that drug and they told me the 8/2024 numbers where closer to 23 not 11.8

OK SO I AM CURIOUS WHY @CKN is asking my age!!?!?!? *LOL*
 
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I am 68,
At age 46 = .92 (psa)

View attachment 259141

View attachment 259142

My PSA history there was a drop in late 2023 and stayed that way in 2024 due to the drug I was prescribed when the Duke doctors informed me that is all well and good but you have to double those numbers for the true PSA while taking that drug and they told me the 8/2024 numbers where closer to 23 not 11.8

OK SO I AM CURIOUS WHY @CKN is asking my age!!?!?!? *LOL*

Because if you were ten years older the treatment may not be as extensive. They may not worry about the issue as much....if you get my drift.
But best of luck on your treatment.
So much good info for those who put down Medicare Advantage Plans-excellent info.
 
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Really great message to take care of your health and some awesome knowledge on your health journey/medicare experience. I sincerely wish you the best in this endeavor.

I am a Radiation Therapist by trade, if you have questions or want to talk anytime, feel free to PM me 🙏
I'll keep that in mind! Thanks and I also appreciate your post. Yes, we were really careful in seeking multiple thoughts and opinions. It's why I wanted to post, many do not know they have options to seek further advice from other medical facilities and doctors. I got lucky and was offered it from my primary urologist. I honestly did not even really think much about it.
SO far I have consulted a Radiation Oncologist, surgeon and medical oncologist at Duke.

Now consulted with a new what is now my radiation oncologist more local and
I have an appointment next week for another medical oncologist with the health network I chose to be treated closer to my home since I am now taking Orgovyx based on Dukes recommendation. My regular urologist never prescribed this drug before (he only prescribes Lupron) but he wrote the prescription and the health network I go to arranged to get me the drug through their Specialty Pharmacy while also have me following up with the local medical oncologist. Im thrilled and actually very surprised how well all these doctors and their offices worked with me and very quickly.

SO since you are a radiation therapist next week I think you will get this ...

I have an appointment with the new Medical oncologist which I don even have to keep now that I have the drug I wanted but we are keeping it because information and consultation is good and since my urologist is not familiar with the drug I think prudent to see him.

After that appointment I am meeting with my radiation oncologist (GREAT GUY, he spent sooooo much time with my wife and I, also introduced his nurse to me and as she entered into the system the course of treatment I was going to take had me with them to make sure everyone was on the same page.

After that they are doing a "Radiation Oncology Simulation" I assume that is when they set up my programming?
After that appt I am getting a CT scan and MRI

Im feeling really good about this, some of it very surreal, I never had any type of illness in my life and all of a sudden when it is you, only then can you imagine what people go through, all of a sudden my life is changed.

For others though, options are good, talk to doctors, no right or wrong. I can say none of the 6 doctors I have saw (actually 5 and one more next week) pushed me to be treated by them or pushed me to accept a treatment plan. They all laid out my options on which direction to go.

Thanks again, I will keep you in mind!
 
Because if you were ten years older the treatment may not be as extensive. They may not worry about the issue as much....if you get my drift.
But best of luck on your treatment.
So much good info for those who put down Medicare Advantage Plans-excellent info.
Oh... yeah, I get it, what bothered doctors most was such a high PSA for such a small amount of cancer found. Either way, no way was I going to live with it, correct at my age.
 
I am 68,
At age 46 = .92 (psa)

View attachment 259141

View attachment 259142

My PSA history there was a drop in late 2023 and stayed that way in 2024 due to the drug I was prescribed when the Duke doctors informed me that is all well and good but you have to double those numbers for the true PSA while taking that drug and they told me the 8/2024 numbers where closer to 23 not 11.8

OK SO I AM CURIOUS WHY @CKN is asking my age!!?!?!? *LOL*
They seem to be more concerned with the rate of increase than the actual number.
 
Keep punchin' @alarmguy, You are helping a lot of us with your courage and "can do" attitude.
You da man!

FYI, my father was diagnosed with advanced prostate cancer; his Doctors here felt it was too far advanced. We sent him to Quebec, Canada where he was treated with flutamide. Flutamide was not yet approved in this country. He lived another 35 years.
 
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Are you getting the proton radiation or the "regular"? My MiL had regular radiation. It was not fun. Primarily, because the radiation facility was in a city hospital that was 15 miles from her house in traffic and forced valet parking. Hopefully, you have a local facility with easy parking and a stress-free drive. Luckily, my wife's employer arranged for a driver.

What drug are they giving you?

Wishing you the best and please keep us updated.
 
I'll keep that in mind! Thanks and I also appreciate your post. Yes, we were really careful in seeking multiple thoughts and opinions. It's why I wanted to post, many do not know they have options to seek further advice from other medical facilities and doctors. I got lucky and was offered it from my primary urologist. I honestly did not even really think much about it.
SO far I have consulted a Radiation Oncologist, surgeon and medical oncologist at Duke.

Now consulted with a new what is now my radiation oncologist more local and
I have an appointment next week for another medical oncologist with the health network I chose to be treated closer to my home since I am now taking Orgovyx based on Dukes recommendation. My regular urologist never prescribed this drug before (he only prescribes Lupron) but he wrote the prescription and the health network I go to arranged to get me the drug through their Specialty Pharmacy while also have me following up with the local medical oncologist. Im thrilled and actually very surprised how well all these doctors and their offices worked with me and very quickly.

SO since you are a radiation therapist next week I think you will get this ...

I have an appointment with the new Medical oncologist which I don even have to keep now that I have the drug I wanted but we are keeping it because information and consultation is good and since my urologist is not familiar with the drug I think prudent to see him.

After that appointment I am meeting with my radiation oncologist (GREAT GUY, he spent sooooo much time with my wife and I, also introduced his nurse to me and as she entered into the system the course of treatment I was going to take had me with them to make sure everyone was on the same page.

After that they are doing a "Radiation Oncology Simulation" I assume that is when they set up my programming?
After that appt I am getting a CT scan and MRI

Im feeling really good about this, some of it very surreal, I never had any type of illness in my life and all of a sudden when it is you, only then can you imagine what people go through, all of a sudden my life is changed.

For others though, options are good, talk to doctors, no right or wrong. I can say none of the 6 doctors I have saw (actually 5 and one more next week) pushed me to be treated by them or pushed me to accept a treatment plan. They all laid out my options on which direction to go.

Thanks again, I will keep you in mind!


That is amazing that you have a team that is professional, thorough and appears to treat you as a person; not as a cog in the wheel. Truly makes all the difference in the world during a challenging time in life.

For the Simulation; they will "set you up" in the position that they will utilize for your daily treatments. Often times you will get a few small tattoos (size of freckle), and they might do a CT scan that day (for treatment planning). There's a lot of nuances to these appointments depending on their practices. But generally, it's pretty straightforward and fairly quick. Those seeds that you mentioned will be used for daily alignment via xray or CBCT (small CT scan). That whole process is done by the Therapist to localize the treatment area and deliver treatment with incredible accuracy.

My favorite part of this job is getting to know people since they are with you for 3-7 weeks or so. I feel blessed to be able to help in anyway I can, and people in general are just amazing.
 
That is amazing that you have a team that is professional, thorough and appears to treat you as a person; not as a cog in the wheel. Truly makes all the difference in the world during a challenging time in life.

For the Simulation; they will "set you up" in the position that they will utilize for your daily treatments. Often times you will get a few small tattoos (size of freckle), and they might do a CT scan that day (for treatment planning). There's a lot of nuances to these appointments depending on their practices. But generally, it's pretty straightforward and fairly quick. Those seeds that you mentioned will be used for daily alignment via xray or CBCT (small CT scan). That whole process is done by the Therapist to localize the treatment area and deliver treatment with incredible accuracy.

My favorite part of this job is getting to know people since they are with you for 3-7 weeks or so. I feel blessed to be able to help in anyway I can, and people in general are just amazing.
I missed my calling, I find your field fascinating. Yes, from what I understand told to my wife and I, gone will be any markings on my skin, that the new scan guided treatment is going to reliably solely on the gold balls they injected. (that injection wasnt fun. 3 needles must have been 10 inches or more long *LOL* (the entire thing, not just the needle but the plunger too or whatever you call it) after 4 biopsies, 3 awake this was at least over a lot faster!

PS yeah, they also want what seems to be an updated MRI
Screenshot 2025-01-16 at 3.18.44 PM.webp


Screenshot 2025-01-16 at 3.20.10 PM.webp


but first this, after meeting with the medical and radiation oncologist Radiation is 5 weeks, 5 days a week if I didnt mention it. Got to log out right now.
 
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