Prostate Cancer is the second leading cause of cancer death to men, behind lung cancer. An estimated 233,000 new cases of prostate cancer are diagnosed each year with approximately 30,000 deaths. The common screening test is the PSA.
If you have a suspiciously high PSA test number, and your doctor believes that a prostate biopsy is appropriate, ask to have an MRI guided biopsy of the prostate. Just one year ago MRI guided biopsies accounted for 1 percent of the 1 million prostate biopsies performed each year. Then, there were only 20 centers nationwide to offer the procedure. Now, almost every city in the nation hosts a center with this capability.
Medicare and most private insurers will pay for the biopsy procedure however they may NOT pay for the MRI (which can cost $600-$2000). Insurers are sometimes reluctant to pay for the MRI until there has been a confirmed diagnosis of cancer.
A prostate biopsy, without MRI guidance, is a painful procedure in which doctors remove 12 or more randomly chosen tissue samples from the walnut sized gland and send these to a lab for testing. The results can be inconclusive and may need to be done again. In addition the results can be misleading.
In approximately 50% of cases, doctors either misdiagnose low grade cancer as high grade or high grade cancer as low grade. This may lead to debilitating surgery for the man with low grade (risks: incontinency, impotency) or death for the man who did not undergo surgery because of the low grade misdiagnosis.
The MRI guided biopsy allows the physician to more accurately hone in on the most suspicious area to biopsy. This increases the probability that high grade cancer will be properly identified. The procedure has been tested to reduce the misdiagnosis of high grade as low grade or low grade as high grade from 50% to 20%.
The procedure is still considered somewhat investigational, hence the reluctance from insurance carriers to pay the whole freight for the MRI and biopsy combined. But, given the increased diagnostic benefits, it is a procedure that should nonetheless be requested. Since it is a rather new procedure make sure it is performed by a urologist who has experience with the procedure.
Tony Baratta is a trial attorney in Huntingdon Valley, PA who represents clients who have been seriously injured. Tony is the founding partner of Baratta, Russell, & Baratta and a member of the Pennsylvania Brain Injury Association (BPIA). Tony is on the board for the Philadelphia VIP, a member of the Million Dollar Advocates Forum for trial attorneys and voted one of Philadelphia’s Super Lawyers 2008-2014.
