You may be surprised to learn what the insurance carriers don't seem to know especially when they tell your doctor it is experimental.   

Here are the top 3:

Proton therapy was FDA approved for use in the U.S. in 1988—24 years ago

Berkeley Radiation Laboratory treated the first patient with protons in 1954.

Medicare and about 180 private insurers consider proton therapy an established technology, and have been reimbursing for proton therapy for more than 20 years.

​​Aetna Owes $26M Over Denied Cancer Treatment, Jury Says
Law360 (November 8, 2018, 6:33 PM EST)

An Oklahoma jury this week slammed Aetna with two verdicts totaling nearly $25.6 million, finding the insurer willfully acted in bad faith when it repeatedly refused to cover proton beam therapy recommended for a woman’s cancer.   The Oklahoma City jury returned on Monday with a liability and compensatory damages verdict in favor of plaintiffs Ron Cunningham and the estate of his deceased wife, Orrana Cunningham, and on Tuesday found in their favor after a second-phase trial on punitive damages, according to the case docket.

The plaintiffs had alleged that Aetna Life Insurance Company had acted in bad faith in refusing to cover proton beam therapy — a type of targeted radiation treatment — recommended by the doctors treating Orrana Cunningham’s nasopharynx squamous carcinoma, a cancer located in the upper part of the throat near the base of the skull.

After deliberating for roughly three hours following a 12-day trial, the jury on Monday awarded $15 million to Orrana Cunningham’s estate and $500,000 to Ron Cunningham for emotional distress, and roughly $92,000 for their out-of-pocket spending on the cancer treatment, according to Cunningham attorney Doug Terry of Doug Terry Law. On Tuesday the jury awarded $10 million in punitive damages, according to Terry. The verdict forms were not available on the case docket as of Thursday.

“The people of Oklahoma county spoke loudly to send a message to the insurance industry that they’re not going to put up with insurance companies that recklessly disregard the rights of their policyholders, and we hope the verdict will help other people dealing with that in the future,” Terry told Law360 on Thursday.

Aetna had rejected coverage of the proton therapy — recommended because Orrana Cunningham’s cancer was so close to her brain — because the therapy was purportedly experimental, but that the evidence showed that the Aetna doctors who made those decisions spent less than an hour evaluating the case, Terry said.

“They were unqualified medically to be making these decisions, they were untrained in how to properly investigate and evaluate an insurance claim, they were overworked because they were handling way too many claims,” he said.

In a company statement, Aetna said its sympathies were with the Cunninghams, but that the public court record showed it had followed the proper procedures in the case. Aetna covered “proven safe and effective” radiation therapy, but the Cunninghams chose to instead pursue the proton beam therapy, for which there is a lack of clinical data, according to the statement.

Aetna’s denial was upheld through two levels of internal appeal, as well a review by an independent radiation oncologist — a review that was not permitted to be used at trial, according to the statement.

Aetna’s statement said it had no comment on “juror motives” or a potential appeal, but wanted to be clear that it followed the proper steps in denying the coverage.

The Cunninghams filed their suit on May 18, 2015, alleging that Aetna owed coverage under Ron Cunningham’s policy, which he obtained as an Oklahoma City firefighter. Orrana Cunningham was receiving treatment at Houston’s M.D. Anderson Cancer Center, and the doctors there recommended the proton beam treatment, according to their complaint.

Ron Cunningham mortgaged the farmhouse he had built with his wife in Meeker, Oklahoma, to obtain the roughly $90,000 he needed to pay out-of-pocket for the proton beam therapy, and after receiving the treatment his wife was improving and was released from the hospital, according to Terry.

On May 30, 2015, Orrana Cunningham died at age 54 of a viral infection that entered her brain and caused her brain stem to rupture, according to Terry.

The plaintiffs are represented by Doug Terry of Doug Terry Law and Justin D. Meek and Tom Paruolo of DeWitt Paruolo Meek.

Aetna is represented by John B. Shely and Laura Trenaman of Hunton Andrews Kurth LLP, Leasa M. Stewart of GableGotwals and Frederick P. Santarelli, Stewart J. Greenleaf Jr. and Sherine N. Bedlako of Elliott Greenleaf PC.

The case is Ron Cunningham et al. v. Aetna Life Insurance Company, case number CJ-2015-2826 in the District Court of Oklahoma County, State of Oklahoma.

Thank you to Law360
--Editing by Alanna Weissman.
Share us on:    By Daniel Siegal
https://www.law360.com/trials/articles/1100324/aetna-owes-26m-over-denied-cancer-treatment-jury-says

Special Reports > A Patient's Journey
MedPage Today.com
Men, Beware of Biopsies for Prostate Cancer Dx
Physicians often downplay the risks

​Source LA Times
By MELISSA HEALY
MAY 08, 2018 | 8:00 AM
  
Experts have new advice on prostate cancer screening. Here's why they put it back on the table

In a shift that puts early detection of prostate cancer back on the agenda of middle-aged men and their doctors, a federal panel of experts is recommending that men ages 55 to 69 weigh the potential harms and benefits of prostate cancer screening and judge whether getting tested feels right to them.

A recommendation issued Tuesday by the U.S. Preventive Services Task Force judged the "net benefits" of screening these men for prostate cancer to be small. But the panel said the prostate-specific antigen, or PSA, test should be offered to them "based on professional judgment and patient preferences."

For men 70 and older, the task force stuck with an earlier recommendation against routine prostate cancer screening.

The new guidance for men in late middle age is an unusual reversal of advice the panel offered in 2012. At that time, the task force suggested that for most men at any age, getting screened for prostate cancer just wasn't worth the risks — including anxiety, infection, erectile dysfunction and incontinence — of the unnecessary treatment that too often came with it.

Since then, the ledger of risks and benefits has changed on both sides.

As large studies have followed men for longer periods of time, researchers have seen that the PSA test can save lives — at least a few more lives than earlier believed — when used to screen men in their late 50s and 60s.

In a European clinical trial, periodic testing was initially found to prevent seven deaths for every 10,000 men screened. But with four years of additional follow-up, researchers have discovered the number of lives saved per 10,000 men screened is closer to 13. And mathematical models suggest that number will likely rise further as the men in the trial get older.

The increase "is not a big number," said Dr. Alex H. Krist, vice chairman of the task force, an independent group that operates under the auspices of the federal Agency for Healthcare Research and Quality. But the new data gave his panel "a little bit more confidence that fewer men would die" when more were screened before age 70.

At the same time, the responses of both doctors and patients to a prostate cancer diagnosis have undergone a significant shift.

In 2012, 90% of men who had their diagnosis confirmed with a biopsy were quickly ushered into surgery or treated with radiation, despite growing evidence that many of these cancers would never become dangerous.

Now, no more than 60% of such men proceed directly to treatment. The rest begin a process of "active surveillance" in which surgery or radiation is used only if the cancer progresses.

Meanwhile, urologists are using genetic testing, more precisely targeted biopsy procedures and improved imaging techniques to identify the more aggressive prostate tumors that warrant quick action.

Despite efforts to improve prostate cancer treatment, surgery and radiation therapy still exacts a high toll on patients: two out of three men will experience long-term erectile dysfunction, and about 20% of those who undergo radical prostatectomy will experience urinary incontinence.

But as more men "watch and wait," fewer men are exposed to the negative effects of treatment that might never have been necessary in the first place.

"That has changed the math of risks and benefits for screening," said Dr. David Penson, who chairs the Department of Urologic Surgery at Vanderbilt University in Nashville and was not involved in the new task force recommendation. "Take that small benefit and then reduce the harms of screening, and suddenly, the equation looks quite different."


In the United States, a man's risk of being diagnosed with prostate cancer at some point in his life is 13%, but his risk of dying of the disease is just 2.5%. Without screening, many men would never even know they had the disease, which can grow slowly for years. One-third of men who died in their 70s of other causes were found to have had prostate cancer.

For men between 55 and 69, the evolution of both knowledge and medical practice have made the question of whether to get the PSA test a potentially complex judgment call.

"This is what's called a preference-sensitive decision," said Ruth Etzioni, a biostatistician at Seattle's Fred Hutchinson Cancer Research Center who crunched the numbers from two of the largest clinical trials on prostate cancer screening but was not directly involved in setting the new guidelines. "It means the benefits and harms of the decision are going to be different for different people. Screening might be a good decision for you, but your friend may come up with a different decision."

Race would likely be a factor in those deliberations: African American men are nearly twice as likely to die of prostate cancer as white men.

A family history of prostate cancer, and of cancers called adenocarcinomas (which include breast, ovarian, pancreatic and colorectal cancer), also might nudge a man toward regular screening. Smoking, too, is linked to a higher risk of death from prostate cancer.

The task force cautioned, however, that there is insufficient evidence on the role of race and family medical history to draft separate recommendations for subgroups.

"My typical prostate cancer consultation used to be 30 minutes," said Dr. Inderbir S. Gill, chairman of USC's Department of Urology. "Now it's become a one-hour, 15-minute consult, and we're not finished. That's the price of our evolving knowledge."

A man's decision should also take into account such intangibles as his tolerance for uncertainty and his willingness to act in response to an ambiguous threat to his health.

"Don't ask the question if you're not sure what you'll want to do with the result," said Dr. Christopher Saigal, the vice chair of urology at UCLA's Geffen School of Medicine who studies how doctors and patients make decisions about prostate cancer treatment.

Saigal, who was not involved in the task force's deliberations, said he remains convinced that for most men in the designated age group, PSA screening is a sensible choice.

"This is still the most common solid cancer in men, and it's treatable," he said.

But some men are skeptical of screening's value, and others are anxious that any possible threat to their health should be reckoned with head-on. Some have family histories of cancer, and others have so many health issues that a long-term threat like prostate cancer takes a back seat to more immediate concerns.

"The key thing is talking to the man before you draw his blood," Saigal said. Such nuanced discussions take time, and in modern medicine, time is in short supply. "We're moving into an era in which personalized medicine and shared decision making is going to come to the forefront. The data is too complex, and people are too complex, for one model to fit everyone."

The new task force recommendations are in line with those of the American Urological Assn., which specify that men ages 55 to 69 with a life expectancy of more than 10 to 15 years be informed of screening's benefits and harms. The AUA notes that successive screening tests should be performed at least two years apart.

USC's Gill praised the new recommendations. But he added that the task force was not wrong in issuing its earlier, more skeptical views on prostate screening.

"This group very rightly said in 2008 and 2012, 'You urologists are hurting far more patients than you're helping, and the whole rigamarole starts when you take the PSA,'" Gil said.

"They have certainly stirred soul-searching in the urological community. They have certainly prodded urologists into acknowledging that yes, not every prostate cancer needs to be treated. They have done a great service."

SOURCE
melissa.healy@latimes.com
@LATMelissaHealy

http://www.latimes.com/science/sciencenow/la-sci-sn-prostate-cancer-psa-20180508-story.html

Download a printable PDF copy of the "Top 10 Myths about Proton Therapy for Prostate Cancer."
Myth #1  Proton therapy is experimental and investigational. It is a new, untested science. Learn the truth.

Myth #2  Proton therapy is significantly more expensive than conventional radiation treatments. Learn the truth.

Myth #3  Proton therapy is no better than advanced forms of conventional photon (X-ray) radiation treatment, such as IMRT, IGRT, CyberKnife, TomoTherapy or RapidArc. And, there may be more rectal damage with proton. Learn the truth.

Myth #4  Proton therapy is not recommended for patients with a high Gleason score. Click here to learn the truth.

Myth #5   If you have surgery and it fails, you can always have proton afterward. But if you have proton first and it fails, you cannot have surgery. Click here to learn the truth.

Myth #6  My doctor tells me that the only way to be sure I’m cured is to have the prostate removed from my body. With proton therapy, the prostate is left behind, so my chance of a recurrence is higher. Click here to learn the truth.

Myth #7  There is no data/statistics available to support the success of proton therapy. Click here to learn the truth.

Myth #8  Proton is radiation, and that means I am at risk for secondary cancer from proton treatment later in life, just as I am with IMRT. Click here to learn the truth.

Myth #9  If protons were so good, than [fill in name of prestigious institution] would have a proton center. Learn the truth.

Myth #10  I can't afford to take the time away from work and family required for proton therapy. I can get my treatment locally in a much shorter time and expect the same results. Learn the truth.

Bonus Myth  My urologist tells me I’m not a good candidate for proton therapy because I’m a young guy and that young men should have their prostate taken out surgically. Learn the truth.


Proton therapy has been under attack, often by practitioners of competing modalities, and the best way to set the record straight is with the facts. We encourage you to share these "mythbusters" with others and save them for future use. Click here for the PDF version.

Clearly, there is understandably immense concern about prostate cancer. In 2014, 3,102 Australian men died from the disease, making it the second leading cause of cancer death in males after lung cancer (4,947 deaths).

Media reporting about prostate cancer testing has long emphasised screening as highly sensible. This is consistent with other early-detection cancer-control messages about “finding it early”.
However, news reports often neglect to mention or minimise adverse consequences of interventions following the surgery and radiation that can follow a positive screening test, like long-term sexual impotence and incontinence.

Read more: Most people want to know risk of overdiagnosis, but aren’t told

There’s also a pitch to gender equity (“women have their cancer tests, and men have this one”). Those questioning testing have been vilified, and epidemiological details framed as an inferior form of knowledge than clinical experience.

Ten years ago, a study of Australian media reports found 10% of a large sample of statements in news reports were inaccurate or misleading and concluded:

Despite near universal lack of support for prostate cancer screening of asymptomatic men by leading international and Australian cancer control agencies, Australians are exposed to an unbalanced stream of encouragement to seek testing. This coverage includes inaccurate information which ignores scientific evidence and the general lack of expert agency support.

Since we published our book, many men have contacted me thanking us for writing it. But I’ve also been taken aside by others with this message: “Look, I know about all the controversy about prostate cancer testing but my husband had the test and his doctor said he was so lucky that they found it early because it was very advanced and if they’d left it any longer, he’d have almost certainly died from it.”

I reply that I of course have no idea what the test and subsequent biopsy showed and so I could not possibly comment. In some cases, this will be true, but as we shall see, in many more cases it won’t be.

Why are men unlikely to question advice?People who have been told by a specialist urologist that they are at serious risk of death are naturally unlikely to question what they are told. Having climbed on board the testing, biopsy and radical treatment “train” and being still alive to tell their story, they have what is often called “survivor joie de vivre”.

They are utterly convinced that the cancer discovery and radical intervention (surgical prostate removal or radiation therapy) has saved their lives. They can be evangelical about their luck, even when 77% live with sexual impotence three years after surgery. As some will tell you, “you can’t have sex in a coffin”.

But such accounts do not tell us whether testing and subsequent intervention really save lives. Here, the evidence needs to come from longitudinal studies of men who are found to have elevated prostate specific antigen (PSA) test results (including men who have not been tested) and who are then randomised into different treatments (including no treatment).

Seven years after we summarised available knowledge on this in our 2010 book, we now have results from two recent clinical trials to help us make even stronger informed decisions: the Prostate Testing for Cancer and Treatment (ProtecT) – 10 years of follow-up - and Prostate Cancer Intervention versus Observation Trial (PIVOT) – 20 years of follow-up.

Read more: Latest research shows surgery for early stage prostate cancer doesn’t save lives

Two Australian oncologists, Ian Haines and George Miklos, have given us an important, excoriating summary of these two studies.
They conclude the data:
… completely undermine the stratospheric spin associated with prostate cancer being a death sentence. They are unambiguous in their implications … The bottom line? Men with early stage abnormalities of the prostate who do not undergo surgery or radiation treatment, but whose condition is monitored for any progression of the cancer, live just as long as men who opted for complete removal of the prostate and who now live with its immediate consequences, including incontinence, intimacy issues, bowel problems and intervention regret.

What do the data say?The Australian Institute of Health and Welfare (AIHW) collates all incidence and mortality data for all cancers. This figure shows the median age of death in men from various cancers and all causes of death combined for 2014, the latest available year.


This shows that prostate cancer is very clearly a disease that mostly kills very late in life. The average age of death for prostate cancer in Australia is 82 years, while the median age for all male cancers combined (other than prostate cancer) is 75 – considerably younger.

Sixty percent of men who die from the disease are aged 80 or over with 87% aged 70 or more. Just 2.1% (65 men) who died from the disease were aged under 60, and three (0.1%) were aged under 50.
Significantly, the average age of death (from all causes combined) for an Australian man in 2014 was 78 years.

So men who die from any cause after that time – prostate cancer included – are already living longer than average. Prostate cancer is one disease in the Grim Reaper’s quiver at the end of our lives. As we all must will die from some cause, it’s worth reflecting on why so much attention should be given to a disease that stands out so obviously as one that kills most very late in life.
In 2014, prostate cancer killed 3,102 males out of 78,341 deaths from all causes (4%). It’s long been remarked that far more men die with prostate cancer than from it. We know from autopsy studies that around 40% of men in their 40s will have signs of prostate cancer, with this increasing to about 60% of men in their 60s. Clearly then, the great majority of men who develop prostate cancer will not die from it but from something else.

Yet the drive to promote prostate testing continues unabated, which is causing massive anxiety, intervention and significant decrements to the quality of life of men who are treated unnecessarily. Haines and Miklos point the finger at financial reasons for this over-treatment.

It will be even more difficult to dislodge early PSA testing, particularly in countries such as the United States, where it has now become deeply entrenched in a belief-based or business enterprise. After all, given the huge investments in proton-based radiation facilities (where it costs in excess of $300 million to just build a proton beam facility), or in robotic surgery machines, the financial incentives to repay the investment and to move to a for-profit situation are huge. A constant supply of patients is obligatory, and an increasing supply is preferable.

Many male doctors do not have PSA tests themselves. As more information emerges that challenges the wisdom of the promotion of prostate testing, we need to ask whether this bubble is near to bursting.

Original Posted at The Conversation 
theconversation.com/prostate-cancer-testing-has-the-bubble-burst-82260

​August 9, 2017 2.03am EDTAuthor

1. Simon Chapman
2. Emeritus Professor in Public Health, University of Sydney

What not to do before a PSA test includes a list of things to avoid doing before a PSA test because they can affect your results. To preserve and maintain prostate health, men are urged to get a PSA (prostate specific antigen) screening test. PSA testing is just one tool men can choose to help them check up on their prostate health.

Although the PSA test can be very helpful, it is not a perfect test.

Currently, the medical community has not reached a consensus on which PSA levels are “safe,” “suspicious,” or “dangerous.” Even though different experts and reputable organizations, including the American Cancer Society, the American Urological Society, Memorial Sloan-Kettering Cancer Center, and the US Preventive Services Task Force, all have slightly different recommendations as to when men should undergo PSA testing, they all agree on one thing: men need to have their prostate checked regularly, especially if there is any personal or family history of prostate problems. Exactly when a man should have his first PSA test and how often thereafter is a topic each man needs to discuss with his healthcare provider. Despite differing opinions, everyone can agree what not to do before a PSA test.

That said, there are some things a man should not do before having a PSA test. This list of  “don’ts” will help ensure your test results are as accurate as possible.

Don’t:

• Participate in vigorous exercise and activities that stimulate or “jostle” the prostate, such as bike riding, motorcycling, and riding a horse, ATV, or tractor, or getting a prostatic massage for 48 hours before your test.
• Participate in sexual activity that involves ejaculation for 48 hours before your test. Ejaculation within this time frame may affect PSA results, especially in younger men.
• Schedule your PSA test to be done for at least six weeks after undergoing any of the following procedures: prostate biopsy, transurethral resection of the prostate (TURP) for BPH, urethral catheter, cystoscopy, or any other procedure that involves the prostate. If you are in doubt about the possible impact of any procedure on your PSA test, talk to your doctor.
• Schedule a PSA test if you have a urinary tract infection. A bacterial infection in the urinary tract can cause PSA levels to rise temporarily. If you are not sure if you have a urinary tract infection, have a urine test before your PSA test to make sure. If you do have a urinary tract infection, you should wait at least six weeks after you have completed your antibiotic treatment before you have your PSA test.
• Schedule a digital rectal examination (DRE) before your PSA test. Although a DRE should not have an impact on PSA levels, having the PSA test first is a precaution.

Don’t forget to tell your doctor:

• If you undergoing chemotherapy, as these drugs can cause an elevated PSA level
• If you are taking any medications, especially statins, nonsteroidal anti-inflammatory drugs, or medications that control urinary problems such as dustasteride or finasteride. All of these substances have the potential to affect PSA levels.
• If you are taking any supplements. Some sports and nutritional supplements, such as carnitine, fenugreek, pomegranate, and tribulus terrestris, can cause PSA levels to rise.
• If you have undergone urinary tract or prostate surgery recently, or if you have suffered a pelvic injury or sports injury.
• If you have prostatitis or BPH.

http://prostate.net/articles/what-not-to-do-before-a-psa-test

About the Prostate
The more you know about the normal development and function of the prostate, where it’s located, and what it’s attached to, the better you can understand how prostate cancer develops and impacts a man’s life over time—due either to cancer growth or as a result of treatments.
Read More Here

Prostate Cancer Risk Factors
https://www.pcf.org/c/prostate-cancer-risk-factors/

Prostate Cancer Symptoms
https://www.pcf.org/c/prostate-cancer-symptoms/

Understanding PSA
https://www.pcf.org/article_external_tag/understand-psa/

Prostate Cancer Prevention
https://www.pcf.org/c/prevention/

Prostate Cancer - early detection and screening
https://www.pcf.org/c/early-detection-and-screening/

​Prostate Cancer - Newly Diagnosed
https://www.pcf.org/c/newly-diagnosed/

You’ve had the PSA test – or more likely, several of them – plus the digital rectal exam, and one or both of these suggested that you needed a Biopsy.  The biopsy was not fun, but you did it, and then you waited for a Pathologist to look at the tiny, needle-sized cores of tissue removed from your prostate.  Maybe you managed to forget about it while you were waiting – maybe you feel perfectly healthy, and this all seemed surreal.  Or maybe you let some dark thoughts creep in, and you started thinking about cancer and remembering everyone you ever know who has had cancer and not done very well. The waiting’s over now. Your doctor has just given you the news:  there’s cancer in there.  What are you going to do?