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CT Scan Schedule for Pure Seminoma Stage 1a

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  • CT Scan Schedule for Pure Seminoma Stage 1a

    Stage 1a. Pure seminoma. I/O done in Feb 2018. No blood marker elevated before or after, Chose surveillance

    CT Scan in Feb 2018 + Chest X Ray: Clear. No blood marker
    3-month: CT Scan in May 2018: Clear No blood marker. Doc said we dont need blood tests since markers were never elevated.
    6-month: CT Scan in August 2018: Clear
    1-year: CT Scan in Feb 2019: Clear

    That's where my doc and the insurance are debating.

    My doc wants a CT Scan at 18 months (Sept 2019) while my insurance states the guidelines point to 24 months. If you read them it says 6 to 12 months and my insurance guideline says "once a year after the 12 month CT" not "a year later" but open for interpretation.

    As a side note I had a Chest X Ray on June 28, 2019 (Unrelated to TC< I had a persistent ear infection and post nasal drips) that was clear.

    I checked prices and cheapest out of pocket was $900. (My doc is at Stanford but they are WAY to expensive if not covered by insurance).

    I am torn because on one hand my Stanford urologist is my specialist and he should know what is best for me. On the other hand, that's another dose of radiation and a slightly aggressive schedule.

    Note that my Stanford doc had requested MRI instead of CT Scan but insurance denied (more expensive). Dont think I could afford one out of pocket.

    One additional insurance question. Typically in the US, can you get the insurance negotiated rates if the insurance is not actually paying for the procedure?

    Any insights welcome! My Stanford doc still has not done the peer to peer review with the insurance but so far he has never won that argument with them
    Last edited by lautreamont; 08-22-19, 04:53 PM.

  • #2
    For Stage I pure seminoma without any adjuvant treatment, you should be getting CT scans every 6-12 months through years 2 and 3 after diagnosis. Insurance of course will say "every 12 months",as that's cheaper. I think they mean the next scan should be at 24 months after diagnosis.

    For CT scan pricing, if you say up front that you're a "self-pay", they'll typically give you much CHEAPER rates than insurance billed rates. That ought to help out some. If you already have insurance but are considering paying for the extra scan out of pocket (which is what it sounds like), I'm not sure that it's worth it. It's a mental and peace of mind thing more than clinical necessity, otherwise they'd say every 6 months rather than every 6-12 months. If you feel like you really want to do the scan, then just do it, but otherwise 12 months is still fine. This is all based on mountains of clear CT scan CD's for tons of other stage I pure seminoma patients like yourself. When I look at the surveillance schedule for my Stage IIB with EPx4 chemo and RPLND follow up today vs what I went through back then and how many scans they've taken out, I almost want to cry a little. Lol. Every scan was an emotional rollercoaster. I'd rather have had a lot less, but it was all of my clear chest x-rays that helped them realize that all the chest x-rays weren't necessary for someone in my boat. So just some perspective....
    Young Adult Cancer Survivorship by Steve Pake
    April is Testicular Cancer Awareness Month!
    Feb 2011, Stage IIB, 4xEP, RPLND, PTSD
    My Survivorship Thread | All of my Blogs


    • #3
      Thank you. Yeah I will pay 100% out of pocket. I was just wondering what "most"people did in the past. At 18 or 24 months.. And are they alternative at 18 months (e.g. I got a chest X Ray, maybe I could add a blood test).. But like you say, the peace of mind of getting it done now (6 months after the 1 year) may just be right for me (pretty anxious type).


      • #4
        Outrageous what they are doing to you.

        Are you in a state where you are able to appeal it, ask request external review l? I have had success doing that in CT. Although might not be worth your while tue bureaucratic hassle for 900 USD - that’s the insurers game.

        Husband just relapsed with 1a seminoma on the 1yr scan. I think you do the right thing not wanting to wait a full year without scans.


        • #5
          I got my HR person to talk to our insurance rep and finally they approved the CT which will be 18 months from I/O (I had the one year in March 2019). I had the CT yesterday at Stanford. My urologist is out this week and my follow up is next week. Usually I get the results the same day so the wait is no fun. PS T 1 Sorry about the 1 year relap. I know the odds were already lower after a clear 3 months and 6 months. Is he going through BEP now? Pure seminoma can be very slow to grow so I am prepared for the possibility as well.