Tips To Choose A Hospital Overseas For Prostate Cancer Treatment
- Select a JCI-certified hospital that has been catering to the needs of international patients.
- Ask for the profile of the doctor. Check the background of the doctor, his experience, and education before choosing one.
- Check if the treatment is covered by insurance and check with the hospital if they accept the insurance provider.
- Seek clear information on the cost of treatment, the estimated duration of stay, and the expected outcomes.
- Choose a hospital that provides visa assistance by sending a visa invitation letter directly to the embassy.
- Choose a hospital that is willing to provide additional services such as airport and hotel pickup and drop, overnight stay arrangement for the attendant, and translator services.
Are Prostate Biopsies Safe
One of the main issues with prostate cancer screening tests is that they can lead to misdiagnosis and as a result, overtreatment.
Even if you take many samples, a biopsy can still sometimes miss cancer. This occurs if none of the biopsy needles pass through the rights areas. Thus, the biopsy will have a false-negative result.
How Does The Procedure Work
Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes. By measuring these echo waves, it is possible to determine how far away the object is as well as the object’s size, shape and consistency. This includes whether the object is solid or filled with fluid.
In medicine, ultrasound is used to detect changes in the appearance of organs, tissues, and vessels and to detect abnormal masses, such as tumors.
In an ultrasound exam, a transducer both sends the sound waves and records the echoing waves. When the transducer is pressed against the skin, it sends small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off internal organs, fluids and tissues, the sensitive receiver in the transducer records tiny changes in the sound’s pitch and direction. These signature waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on the monitor. One or more frames of the moving pictures are typically captured as still images. Short video loops of the images may also be saved.
A computer processes the signals and creates a series of images, each of which shows a thin slice of the body. These images can be studied from different angles by the radiologist.
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How Much Does A Prostate Biopsy Cost
If you were recently screened for prostate cancer and your PSA test or digital rectal exam showed abnormal results, your doctor may recommend a prostate biopsy to investigate further.
Amino found that the median network rate for a prostate biopsy is $877. Keep in mindthis is an estimate for what you and your health insurance company might pay together for the biopsy.
Read on to learn more about what a prostate biopsy is and who might need to have one.
Comparison With Existing Evidence
Our estimates of costs and effectiveness for no screening and PSA screening are broadly similar to estimates from the MISCAN model . Both models were calibrated to the ERSPC trial and used the same health state values , while the costs for treatment of advanced cancer were 41,683 for Sweden compared with 12,276 for the Netherlands . The MISCAN model does not explicitly model for the PSA value, requiring stronger assumptions about how the test characteristics vary by screening interventions. The Prostata natural history model was calibrated to contemporary Gleason score-specific incidence and survival, which are critical for any evaluation of the S3M test.
Our cost-effectiveness analysis between the S3M test and PSA is broadly comparable with an evaluation of the Prostate Health Index . Note, however, that it is difficult to directly compare the test characteristics for PHI and S3M due to differences in populations and study design.
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When Is A Psa Test Needed
If you are age 50 to 74, you should discuss the PSA test with your doctor. Ask about the possible risks and benefits.
Men under 50 or over 75 rarely need a PSA test, unless they have a high risk for prostate cancer.
- You are more likely to get prostate cancer if you have a family history of prostate cancer, especially in a close relative such as a parent or sibling.
- Your risks are higher if your relative got prostate cancer before age 60 or died from it before age 75. These early cancers are more likely to grow faster.
- If you have these risks, you may want to ask your doctor about getting the PSA test before age 50.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
The Test Is Often Not Needed
Most men with high PSAs dont have prostate cancer. Their high PSAs might be due to:
- An enlarged prostate gland.
- Recent sexual activity.
- A recent, long bike ride.
Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. But most of these cancers do not cause problems. It is common for older men to have some cancer cells in their prostate glands. These cancers are usually slow to grow. They are not likely to spread beyond the prostate. They usually dont cause symptoms, or death.
Studies show that routine PSA tests of 1,000 men ages 55 to 69 prevent one prostate cancer death. But the PSA also has risks.
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Should Mri Be Used To Diagnose Prostate Cancer
Improved magnetic resonance imaging may aid detection of prostate cancer. Until recently, most professionals have been skeptical that magnetic resonance imaging could be used on a widespread basis to diagnose or stage prostate cancer with any degree of reliability, and therefore help with making treatment decisions.
Isnt A Psa Test Enough
The prostate specific antigen test is a common screening test for prostate cancer. PSA is a protein that comes from the prostate gland. The test measures the amount of PSA in your blood. Its a simple blood test, and for some men, it turns out to be a lifesaver.
On the other hand, its value as a diagnostic tool is fairly limited. High PSA levels may be a sign of prostate cancer, but its not enough to diagnose the disease with certainty. Thats because there are other reasons your PSA levels could be high, including urinary tract infection and inflammation of the prostate.
Also, a single abnormally high PSA test result cant tell you if the high level is temporary or rising over time.
Low PSA levels cannot definitively rule out prostate cancer, either. The fact is that PSA tests can result in both false positives and false negatives.
PSA tests can be useful during and after treatment for prostate cancer. Rising PSA levels may signal that treatment is not effective or there is a recurrence of the cancer. If your PSA levels are decreasing, your current treatment is probably doing its job.
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A Movement Toward Transperineal Biopsies
About two million American men undergo transrectal biopsies each year to diagnose prostate cancer or to monitor low-risk and favorable intermediate-risk prostate cancers for active surveillance .
Men on AS, like me, who have undergone routine transrectal biopsies may be warned that we face a 1-3% risk for sepsis infections in which nasty microbes from the rectum are spread to the bloodstream and wreak havoc. Many are not warned at all.
But it gets worse: A number of these men die or suffer disability from sepsis from transrectal biopsies, according to Richard Szabo, MD, a clinical associate professor of urology at the University of California Irvine.
Based on Norwegian figures, one in 1,000 men die from transrectal biopsies. This translates to roughly 2,000 American men per year, according to Truls Bjerklund Johansen, MD, a urology researcher at Oslo University Hospital.
The use of powerful antibiotics likely has kept the death rate down but portends long-term danger as antibiotic resistance grows and is expected to cause an additional death toll.
The True Toll of Transrectal Biopsies
The old maxim holds that doctors bury their mistakes. In the case of deaths by transrectal biopsies, mistakes often may be buried under a misleading cause listed on death certificates. Doctors don’t often link deaths from septic shock to transrectal biopsies performed a few days earlier.
Misunderstood Risks of Transrectal Biopsies
How Is A Prostate Biopsy Used To Detect Prostate Cancer
Tissue samples from the prostate biopsy are examined under a microscope for cell abnormalities that are a sign of prostate cancer. If cancer is present, it is evaluated to determine how quickly its likely to progress and to determine your best treatment options. A prostate biopsy is used to detect prostate cancer.
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How Painful Is A Prostate Biopsy
During the procedure, your consultant will apply a local anaesthetic to your perineum, where the biopsy needle will enter, to reduce any discomfort.
Most men experience only mild discomfort after the procedure, but some men find a prostate biopsy painful. If you need to, you can take over-the-counter painkillers such as paracetamol if you need to and your consultant hasnt told you not to for any reason. If the pain doesnt go away, speak to your doctor.
Controversies And Misconceptions Surrounding Prostate Biopsies
The PSA test measures the levels of PSA proteins in the body, and when it was first developed, it was quickly implemented by many physicians as a screening test for prostate cancer. The thought was that since PSA proteins are only produced by the prostate, elevated levels could be an indication of prostate cancer. As a result, most men with an abnormal PSA test underwent a prostate biopsy.
The increase in biopsies resulted in the number of advanced, untreatable prostate cancers decreasing significantly because more prostate cancers were caught earlier, when the disease is easier to treat. But the problem with many patients being diagnosed sooner was that some patients were being aggressively treated when they should have been monitored instead.
Though many in the field of urology believe it was flawed, a controversial study attempted to assess the benefits of the PSA test as a screening tool for prostate cancer, and its results led to the recommendation that most men shouldn’t get the test because it didnt appear to improve mortality rates from prostate cancer. This, combined with growing awareness that many cases of prostate cancer were being treated unnecessarily or prematurely, led to a reduction in prostate biopsies. This controversy led to a reduction in prostate cancer screening and an increase in the number of diagnoses of advanced prostate cancer.
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Nice New Prostate Cancer Guidelines
The National Institute for Health and Care Excellence highly recommends the use of mpMRI scanning as a first-line test for patients with suspected clinically localised prostate cancer. Multiparametric MRI scan before biopsy is also recommended for patients with clinically significant prostate cancer since it helps to locate the cancer and to target it directly.
More information about NICE Prostate Cancer Guidelines
High Deductible High Costs: How Much Does A Prostate Biopsy Cost
We got this note from a friend:
I am a small business owner, both employer and employee. The employee in me pines for my old health insurance plan. The deductible was low enough that it was always met. The in-network co-pays were fixed and affordable. My costs were my costs no matter what doctors billed my insurance carrier or what they were ultimately paid. Blissful ignorance. Well, maybe not blissful, but I just didnt really care.
The employer in me, though, was paying over $2,000 a month for my family of three and also covering the full cost of insurance for most of my staff. Our rates had risen 12 to 19 percent annually for five years running which was, in a word, unsustainable. So last year, facing another double-digit rate increase, I switched to a high-deductible plan. This lowered my insurance bill considerably, but meant that my family would not receive any coverage or reimbursement unless and until we spent over $5,700 in network.
My education began quickly. An annual physical in January revealed an elevated PSA score, which sent me back to a urologist who had been treating me over a year for a persistent prostate infection. Now he felt a biopsy was the prudent course, and my primary care provider agreed.
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French Urology Association Guidelines
Using magnetic resonance imaging as an initial test for suspected prostate cancer patients is now recommended by the French Urology Association.
Biopsy naive patients should have systematic biopsies when their MRI is negative, while the ones whose MRI is positive should undergo systematic biopsies combined with targeted biopsies. Regarding patients with prior biopsy, the performance of a multiparametrical MRI before another biopsy session is recommended.
Addressing Challenges To Adopting Mri For Prostate Cancer Screening
3D illustration of prostate cancer cells. Image credit: Shutterstock
Magnetic resonance imaging may not be the best diagnostic choice universally for all men suspected of having prostate cancer, according to researchers at Weill Cornell Medicine and NewYork-Presbyterian. While recent studies have demonstrated that MRI is more accurate in detecting tumors than other diagnostic procedures, there are barriers that prevent the techniques widespread use.
In an editorial published Sept. 13 in JAMA Oncology, Dr. Jim Hu, the Ronald P. Lynch Professor of Urologic Oncology at Weill Cornell Medicine and director of the LeFrak Center for Robotic Surgery at NewYork-Presbyterian/Weill Cornell Medical Center, argues that significant limitations including cost and radiology expertise stand in the way of fully implementing MRI as the primary diagnostic tool for prostate cancer.
What we want people to understand is that there are significant challenges to accepting wholesale that MRI should be the new standard of care, Dr. Hu said, and the benefit of MRIs increased diagnostic capabilities needs to be balanced against those costs.
Working within these limitations is critical to the future of prostate cancer diagnosis, Dr. Hu said. Scaling up prostate MRI capabilities at hospitals throughout the country will take time and significant expense. In the meantime, we need to look at this in the wider context of what is available to us right now.
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Other Treatment Options For Prostate Cancer
There are several other prostate cancer treatment options that are available for the patients. Chemotherapy is one of the other popular treatment modality that may be used after surgery for patients with the cancer of the prostate.
The following table highlights the average cost of chemotherapy for prostate in some of the top medical tourism destinations in the world:
- Hormone therapy
- External beam radiotherapy
Thus, the total cost of prostate cancer treatment varies greatly from one individual to another, depending on the individual medical case.
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What Are The Limitations Of Ultrasound
A biopsy can only show if there is cancer in the samples taken, so it is possible that cancer in unsampled areas of the prostate might be missed.
For MRI-guided biopsies, high-quality images are assured only if you are able to remain perfectly still while the images are being recorded. If you are anxious, confused or in severe pain, you may find it difficult to lie still during imaging, and the resulting images may not be of sufficient quality to be useful as a diagnostic tool.
Likewise, the presence of an implant or other metallic object sometimes makes it difficult to obtain clear MR images. A person who is very large may not fit into the opening of certain types of MRI machines.
MR imaging cannot always distinguish between cancer tissue and inflammation or the presence of blood products within the prostate, which sometimes occurs related to a prostate biopsy. To avoid confusing the two on imaging, prostate MR imaging may be performed six to eight weeks after prostate biopsy, if possible, to allow any residual bleeding to resolve itself.
MRI typically costs more and may take more time to perform than other imaging methods. Talk to your insurance provider if you have concerns about the cost of MRI.
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How To Get The Most For Your Money
Even if your insurance does cover some or most of your prostate biopsy, youll likely pay a portion of the total cost out-of-pocket. To make sure youre getting the most care for your money:
Ask your insurance company about your costs, like co-insurance, copays, and deductibles.
Utilize your Health Savings Account , Flexible Spending Account , and Health Reimbursement Account to cover out-of-pocket expenses.
Use Amino to compare prices for different doctors.
Have a conversation with your doctor. This is especially important if you dont have insurance and are paying for the full cost of the biopsy yourself. Some doctors will offer a discount or an interest-free payment plan if they know youre shouldering the cost on your own.
What Will I Experience During And After The Biopsy
If you receive IV contrast for the MRI-guided procedure, you may feel coolness and a flushing sensation for a minute or two when the contrast material is injected. The intravenous needle may cause you some discomfort when it is inserted and you may experience some bruising once it is removed.
Rarely, patients may experience side effects from the MR contrast material, including nausea and local pain, hives, itchy eyes or other reactions. If you experience allergic symptoms, a radiologist or other physician will be available for immediate assistance.
When the ultrasound probe or endorectal coil is inserted into the rectum, you will feel pressure and may have some temporary discomfort.
You will hear a clicking noise when the biopsy needle samples the prostate, and you may feel a stinging or burning sensation in the area.
Some patients find it uncomfortable to remain still during MR imaging. Others experience a sense of being closed-in . Therefore, sedation can be arranged for those patients who anticipate anxiety.
If you feel heating on your skin at any time during MR imaging, the MR technician should be notified so that they can perform a closer examination of the area.
Some patients experience a small amount of bleeding from the rectum or perineum immediately after the biopsy procedure. If this occurs, it will cease with gentle pressure.
You may feel pain and discomfort in the area of the prostate for a day or two after the biopsy, particularly when you are seated.
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