Anyone know about PSE Episwitch ?

Easy, as there is a lot of information available. It does not test the blood for cancer. Rather, it uses several different genetic markers to assign a probability of one having prostate cancer. The test has been approved for use by the FDA. However, CMS has not approved it for reimbursement, so no other insurance company or third party payor reimburses it. The direct cost is about $950 plus a couple of hundred dollars for the doctor drawing the blood and then reporting the findings.

Is it more accurate than PSA? Accurate for what? Diagnosing PCa? Neither do that, so neither are accurate for diagnosis. Only a direct microscopic examination of the tissue cells can diagnose PCA. Can it help in determining whether one should do more investigation? That is the purpose. Is it worth paying about $1,200 out of pocket? Only you can determine that.

When you asked your urologist about it, what did he say?

Yes, as of January 1, 2024, insurance providers can reimburse patients for the EpiSwitch Prostate Screening (PSE) test using the CPT PLA code 0433U. This code applies to Medicare, Medicaid, and private payors. The PSE test is a blood test that uses a whole blood sample to identify and measure five DNA biomarkers and prostate specific antigen (PSA) levels to predict the likelihood of prostate cancer. It can increase the accuracy of the standard PSA test from 55% to 94%.

This is what I see online as far as cost ..
I haven’t asked my URO yet
I get my PSA done again this Thursday and see him Friday
If my PSA is higher and he wants to do a biopsy I was going to ask for free PSA and MP MRI first , but then I saw this

CVC……Directly following approval by the FDA, the CMS (Centers for Medicare and Medicaid Services) assigns the reimbursement codes to be used. Then, the CMS embarks on a process to determine whether Medicare will reimburse and under what circumstances it will reimburse. Usually, all third party payors wait to see what CMS does and, if CMS decides to reimburse, then most all third party payors will then follow and provide reimbursement. This process usually takes more than a year to perform and often multiple years. Usually, new reimbursements are announced on a quarterly basis. It looks like the CMS codes were assigned late in 2023.

CMS reimbursement considers many factors including efficacy, medical necessity, cost and similarity to other available approved drugs and services. Basically, they won’t reimburse for anything that is not medically necessary and won’t reimburse for a drug that just does what some other drug already does, but costs considerably more. The PSE test has some real hurdles to get reimbursement, primarily cost. Medicare allows one PSA test per year for screening. The annual PSA test is free and not subject to the Part B deductible. Usually the full cost of a PSA test is around $100. When one has more tests due to diagnosis or treatment, then the tests are reimbursed under Part B and are subject to the deductible.

Since the PSE test costs closer to $1,200 and doesn’t profess to do more than the PSA test does, it is unlikely, in my opinion, to get similar treatment as the PSA test. The PSE test doesn’t detect cancer, rather it provides a probability of presence of cancer. So it is not diagnostic, rather it helps direct the investigation toward diagnosis, or not. For now, PSE appears to be self paying, unless some insurance company is reimbursing for it.

But …if let’s say my PSA is still at the number it is or even higher …and I ask for free PSA and MRI and they both show nothing
Would I be able to safely say let’s wait on the biopsy and monitor ?
And IF if either was a concern and I needed a biopsy , and I asked him to knock me out and he wouldn’t , how would I go about finding a URO that would in Syracuse or Rochester NY area ?
Thx guys !!!

Makes total sense . If my PSA hasn’t changed and the DRE is negative I assume he will monitor ? Guess we shall see

Nope , but I see that a jump that big in one year isn’t “ normal”, I’ve always read here that just because your PSA is below 4 what’s more important is the big jump !
I’m trying to prepare for my discussion with my URO after my retest ( PSA) on Thursday
I’ve seen this URO the past three years , my old URO passed away.
Again, if the PSA doesn’t increase this time ( 1 month since last ) and my DRE is negative , I’m “ assuming “ he will monitor instead of recommending a biopsy .
So here’s a question , if he does recommend a biopsy with what I just said, what would you do ?

Post Edited (cvc) : 7/15/2024 3:46:02 PM (GMT-8)

JNF said...
It remains that your PSA is in the normal range for your age, 3.5-4.5 for men from ages 60 to 70. Yes, it increased in the past year and bears investigating. It seems you are doing that by having more frequent PSA tests this year.

If your PSA goes up significantly again, then your urologist will take that into account. At that time does it warrant the MRI? I don’t know. That is for your urologist to determine. It also depends on the DRE impression. Understand that you appear to most of us to be doing the correct things with your doc.

Question , where did u see that 3.5 to 4.5 being “ normal” ? I’ve seen no higher than 4
Just curious

As Master Po said in Kung Fu, “have patience, Grasshopper”.

CVC, I looked at a number of different sites and see both numbers. The American Cancer Society shows what I used, 3.5-4.5 as normal range for ages 60-70. John’s Hopkins uses 4.0 as top of normal range for over 60. But your last reading was 3.63, within both ranges as normal. And remember, abnormal doesn’t necessarily mean cancer. It means something abnormal is occuring and could be excessive enlargement, infection, and/or cancer. All have to be investigated.

And while a yearly increase of 1.5 may appear to be abnormal, it would not necessarily be abnormal. Such an increase could be expected for a person with an infection (prostatitis) or enlargement (BPH). And, yes, it could be from cancer. All the reasons to investigate. First by monitoring PSA more frequently. If the trend continues upward that may indicate getting the MRI. If the trend stays steady, and/or, fluctuates a bit up and down, that may be more indicative of infection. Continued enlargement, common in men your age, would also cause your PSA to trend upward.

From many discussions with my urologist, when PSA is going up and the DRE is normal, he usually gives a course of Avodart for several months. This will reduce the size of the prostate and reduce the PSA significantly. Then he monitors PSA quarterly to see if it is still increasing. If it is, then it is more indicative of cancer. He then goes to MRI, and if warranted, then the biopsy. He has a positive biopsy rate of over 90%, so he is very careful about using the biopsy only when clearly indicated.

Here is to an acceptable PSA and less worry on Thursday. Stay vigilant.

Results 2.9 down from 3.63 in a month …
I’m wondering if the day I got it drawn at 3.63 I had been working out in extreme heat and riding a mower for over 2 hours
Could that have spiked it ?
I’ll hope my DRE tomorrow is negative
Thx again guys for all the insight .. I’m breathing easier seeing it go down instead of up

CVC, so happy for your good results. Wishing you smooth sailing (literally) on the DRE tomorrow and then you can relax.

Jim

DRE was good , he said “ I’d say your prostate is 60 grams , no lumps no bumps”
He said “ your anxiety is over the top”
Humm I don’t see that 😁

Post Edited (cvc) : 7/19/2024 4:11:36 PM (GMT-8)