Posted on: Tuesday, February 13, 2018
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Watchful waiting and prostate cancer
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Question

I just read a question from another veteran about a diagnosis of prostate cancer. The situation was similar to my own and the vet was concerned about the possibility of benefits being stopped because of an initial diagnosis with two subsequent negative biopsies.

I have just received notification that my benefits will be reduced from 100% to 10%. I was initially diagnosed with prostate cancer, received no treatment, opted for watchful monitoring and had two subsequent negative biopsies. The diagnosis remains "SC Prostate Cancer. Inactive. Managed by watching full waiting and surveillance.

No functional limitation". The only concern I would have is the inclusion of "Inactive" but since the diagnosis of Prostate Cancer still stands surely that should be immaterial since it could become active at any time. Do you have advice for conducting my appeal at this point?

Jim's Reply

I'm not sure I understand the sequence of events? Prostate cancer is often diagnosed by a rise in the PSA and then a subsequent positive DRE (Digital Rectal Exam) that leads to a prostate biopsy and subsequent medical or surgical treatment. The success or failure of treatment is usually monitored by the PSA and any further prostate biopsies are deferred as unnecessary.

After the first biopsy, if the veteran patient chooses watchful waiting (sometimes called active surveillance), the disease progress is monitored by PSA and other non-invasive tests to determine whether the disease has metastasized.

You report 2 subsequent biopsies after you elected watchful waiting.

That's very unusual. That the first biopsy was positive and subsequent biopsies were negative isn't terribly unusual. When we consider that the prostate is smaller than the average plum and that the cancers in the prostate are similar in size to a BB, accurately tapping into a single cancer nodule isn't a sure thing. Because of this some researchers believe that MRI is a more accurate way to diagnose prostate cancer https://tinyurl.com/glkq2ao

I'd like to understand why you had the 2 extra biopsies? You are not required to have invasive procedures to continue the diagnosis of prostate cancer. Once diagnosed by biopsy, the disease doesn't just go away and subsequent biopsies are rare.

The only question now is whether or not you still have cancer? I can't imagine how you don't have prostate cancer since it was diagnosed and not treated. Prostate cancer doesn't simply go away. If you have cancer, your rating is required to be at 100% with future exams scheduled. If you don't have cancer, the 10% rating is incorrect.

I've never heard of an "inactive" prostate cancer and a quick Google search tells us that the term isn't used in health care dialogues. A cancer is active until it is cured...even cancers said to be in remission are the result of therapy.

The bottom line is that VA does a terrible job of managing service connected prostate cancer benefits in veterans who choose watchful waiting. I deal with one or two cases like yours every week.

The VA schedule for rating disabilities

https://www.benefits.va.gov/warms/bookc.asp  makes no allowance for active surveillance and VA will continue to insist that you're cured so they can drop your benefits. Your history is one of the more egregious I've come across and I have a lot of questions about the extra biopsies. If you were told you had to have additional biopsies for those for benefits, there is a real problem.

 

Jim

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