PSA test - how much?

[Lacessit]

Have benign prostatic hyperplasia. Just wondering how much a PSA blood test should cost at the hospitals ( Chiang Mai )

Thanks for responses in advance.

[lopburi3]

Understand this is not Chiang Mai or current but as no reply will post last had in December 2015 and cost 1,100 baht at Vejthani Hospital in Bangkok (90 minute).

[rott]

Private blood test clinic in Pattaya charges 700.

 

They do 4 tumour markers for 2,000, 1,100 sounds a bit steep I am aware of govt hospitals (not Chang Mai) charging 500.

[Sheryl]

About 800-900  baht at a private lab such as https://www.brianet.com/en/news-update/brialab-chiangmai-openning/

 

At a hospital, more and you'll also have a doctor fee (another 750 - 1,500 depending on doctor and hospital) unless it is done as part of a checkup package. 

[spornb]

Srinakarin KhonKaen, govt teaching hospital, long list of blood tests including PSA about 1200 bhatt, guess PSA element 360 bhatt

 

Will be a guide no doubt for other govt hospitals

 

Half the cost of any KK private hospital

 

Test done at 8.30 am results can be collected two hours later, two locations for blood tests

 

Need to be registered there and get doctors form for tests, we use form from Chulalongkorn BKK and generally they will accept this

Edited December 5, 2019 by spornb

[spornb]

4 hours ago, spornb said:

Srinakarin KhonKaen, govt teaching hospital, long list of blood tests including PSA about 1200 bhatt, guess PSA element 360 bhatt

 

Will be a guide no doubt for other govt hospitals

 

Half the cost of any KK private hospital

 

Test done at 8.30 am results can be collected two hours later, two locations for blood tests

 

Need to be registered there and get doctors form for tests, we use form from Chulalongkorn BKK and generally they will accept this

REDUCING BLOOD TEST COSTS FURTHER additional observations

I need regular blood tests has been every three months, now, every six, so as to keep costs done I use quality colour photocopies of lab order and avoid the doctors costs each time

I then check results myself and so long as no significant movement since previous one do not need to consult doctor

I also have trends over a lengthy period

My PSA is of particular interest, after some surgery, it dropped three years ago to nearly zero, now it is well within the accepted levels but the tests show the speed it is increasing at is going up, a sign that all is not well

Blood test prices.pdf

[TerryLH]

30 minutes ago, spornb said:

"...and avoid the doctors costs each time..."

The doctors fee at Srinagarind Hospital in KK is 50 baht.

Terry

[spornb]

1 hour ago, TerryLH said:

The doctors fee at Srinagarind Hospital in KK is 50 baht.

Terry

Also avoids waiting time, which can at Srinakarin be substantial,  sometimes 2 hrs plus, sometimes not long, actually use the form from Chulalongkorn

 

Sometime invoices add nursing charge even if none, I have many many 200 plus invoices from both Chulalongkorn and Srinakarin, and paid a big sum in medical, maybe 1.5 M !!

Saving waiting time also good

We have our own parking space at Srinakarin !, disabled by new building almost always available

[BritManToo]

San Sai government hospital charged me 300bht for a PSA blood test earlier this year.

Plus 50bht for hospital services (inc doctor and nurse).

 

@OP, but you're already taking medication, which as far as I know invalidates the PSA test.

Edited December 5, 2019 by BritManToo

[canopus1969]

2 hours ago, spornb said:

My PSA is of particular interest, after some surgery, it dropped three years ago to nearly zero, now it is well within the accepted levels but the tests show the speed it is increasing at is going up, a sign that all is not well

Blood test prices.pdf 1.55 MB · 0 downloads

What did you have to cause it to drop that low, a prostatectomy ?

[tweedledee2]

I had a CMP blood draw including PSA and the cost was under 1100 baht. The drs fee was 400 baht. Done at the private hospital in Surin.

[spornb]

4 minutes ago, canopus1969 said:

What did you have to cause it to drop that low, a prostatectomy ?

I had holep surgery in India, centre of prostate removed,  3 1/2 yrs ago, then cancer found, in prostate and else where, three months chemo and radiation at Chulalongkorn, all cancer gone but returned six months later, at present all quiet, but prostate continues to grow slowly, at 75 probably not a big deal, PSA back to 2.5 but doubling every six months, I was 72 when operated on, should have had prostate removed, but Thailand  said no cancer there,  chose to have no more chemo, and not have colostomy bag reversal, I will talk by PM to anyone who has these problems

 

Thailand very good on some cancers but way behind India on Prostate, I also pay all my own bills, and am cost conscious so long as it does not compromise quality

[sfokevin]

Go to the Red Cross on the River (down river from US Consul) ... Just walk-in and go to 2nd floor - they do a number of blood tests... They will email you results... PSA 550 baht...

 

[spornb]

Very interesting, some interesting competitive prices being exposed, many scream and shout about extortionate costs here, but personally I have had some very very excellent care at very affordable costs, I pay my own bills, I would say no insurance you need to be able to raise very quickly 1.0 m, my failsafe is still back to UK and say catch

 

Some minuses wait often 2/3 hrs for appointment, and same day but then UK 2/3 months if lucky, results from last MRI copy disc they will not post have to wait 4 days so wife has to go KhonKaen BKK and KhonKaen, inconvenient yes, but still overal very good

 

PLAN FOR THE WORST and hope for the best, AND HAVE A PLAN

[rott]

On 12/4/2019 at 11:51 AM, Sheryl said:

About 800-900  baht at a private lab such as https://www.brianet.com/en/news-update/brialab-chiangmai-openning/

 

At a hospital, more and you'll also have a doctor fee (another 750 - 1,500 depending on doctor and hospital) unless it is done as part of a checkup package. 

It so happened (after my earlier post) that I was going to the Lifestyle Clinic for a 4 tumour marker test today, not expecting any problems.

And it comes back OK except for the CEA which was through the roof.

So I will be going to the Pattaya Memorial tomorrow, can you advise what the procedure will be from here please? Will the first step be a colonoscopy? And after that biopsy? Or MRI.?

 

Any advice/information gladly accepted Sheryl.

Edited December 5, 2019 by rott

[Sheryl]

10 hours ago, rott said:

It so happened (after my earlier post) that I was going to the Lifestyle Clinic for a 4 tumour marker test today, not expecting any problems.

And it comes back OK except for the CEA which was through the roof.

So I will be going to the Pattaya Memorial tomorrow, can you advise what the procedure will be from here please? Will the first step be a colonoscopy? And after that biopsy? Or MRI.?

 

Any advice/information gladly accepted Sheryl.

 

It will depend on your medical history and symptoms if any.

 

CEA is a very non-specific test and definitely not recommended for use in screening. I don't know what other tumour marker tests you had but most of these probably are not. either. Tumor markers are used in people with diagnosed cancer  whose cancer is associated with elevation of that marker. Sometimes also in conjunction with other tests but, except  for PSA,  not as a screening tool (and there is some debate around that one). The results are very non-specific and often lead to unnecessary invasive tests.  They can also lead to a false sense of complacency. The truth is that there are only a few tests of any proven value in screening for cancer and most of these are not blood tests.

 

Are you a smoker? As CEA is often elevated in smokers.  It is also elevated in various infections, inflammatory bowel disease and yes, several cancers (though also  possible to have those cancers without elevation of CEA).

 

All that said, if you are over 50 and have not had a colonoscopy then you should have one in any case even without an elevated CEA. If you are under 50. no bowel symptoms and no family history of GI cancers then it is a much harder call.

 

If you are a heavy smoker or have been in the past 15 years then  a low dost CT scan screening is indicated (again even without an elevated CEA). I doubt Memorial can do this.

 

Would help to know exactly what the level was.  Elevations due to smoking alone won't usually exceed 5 ng/ml.

 

[rott]

Thanks for the quick response Sheryl, the reading was 21.9.

 

I had a colonoscopy 7 years ago at the Srisawan hospital in Nakhon Sawan (I know you don't rate private provincial hospitals) that showed one haemorrhoid, numerous diverticuli but nothing else. I haven't smoked for over 30 years and not much then.

 

Radiotherapy for prostate cancer 11 years ago (current level 0.233), a daily statin for the last 8, and that's about it.

Edited December 6, 2019 by rott

[canopus1969]

18 hours ago, spornb said:

I had holep surgery in India, centre of prostate removed,  3 1/2 yrs ago, then cancer found, in prostate and else where, three months chemo and radiation at Chulalongkorn, all cancer gone but returned six months later, at present all quiet, but prostate continues to grow slowly, at 75 probably not a big deal, PSA back to 2.5 but doubling every six months, I was 72 when operated on, should have had prostate removed, but Thailand  said no cancer there,  chose to have no more chemo, and not have colostomy bag reversal, I will talk by PM to anyone who has these problems

 

Thailand very good on some cancers but way behind India on Prostate, I also pay all my own bills, and am cost conscious so long as it does not compromise quality

I had a prostatectomy (was only 68) here and am very happy with my Doctor

The PSA reading was naturally close to zero but seems a little left as now up to 0.2.

My Doctor has said he does not want it over 1.0 and will start me on a course of Eligard should the PSA reading start getting near - maybe talk to your Doctor and ask him ?

[Sheryl]

4 hours ago, rott said:

Thanks for the quick response Sheryl, the reading was 21.9.

 

I had a colonoscopy 7 years ago at the Srisawan hospital in Nakhon Sawan (I know you don't rate private provincial hospitals) that showed one haemorrhoid, numerous diverticuli but nothing else. I haven't smoked for over 30 years and not much then.

 

Radiotherapy for prostate cancer 11 years ago (current level 0.233), a daily statin for the last 8, and that's about it.

 

21.9 is indeed high enough to be a worry.

 

And history of a prior cancer also increases the concern, survivors of one type of cancer are in general at higher risk of another new cancer than are people who have never had cancer. The risk is not huge, but it is more than if you had never had a cancer. 

 

Prostate cancer cells are not usually CEA-expressing so this is not likely to be due to metastasis of prostate cancer cells though there are exceptions noted in the literature.

 

Diveritculi per se would not elevate CEA but inflammation of diverticuli (diverticulitis) could. you would be symptomatic (pain, fever, nausea etc) if this were the case. 

 

I have a general rule of thumb that whenever lab results are unexpected and don't seem to fit the clinical picture the first thing to do should be to get a repeat level. Even when the most reliable of labs was involved.  SO I suggest you do that first. Lab errors do happen.

 

When you say "Lifestyle Clinic" did you mean Lifecare Labs?

 

Do you have the CD of your prior colonoscopy? if not, get it. This is important. I have known upcountry private hospitals to miss obvious things on colonoscopy.

 

In short, with you first order of business should be: (1) repeat the CEA test.(2) If still elevated have a colorectal specialist review the CD of the colonoscopy.  For that I really recommend taking the time to travel to Bangkok to see Prof. Chucheep, best specialist in Thailand and a really nice man to boot. He has private hours at Bangkok Christian Hospital on I think Mondays and at Bumrungrad one Thursday evenings. Can also be seen at the colorectal clinic at Chulalongkorn (government hospital) but will take longer and be less convenient. He will advise if he thinks a repeat colonoscopy is indicated and I would trust his judgement on that.

 

An ultrasound or scan of the liver might also be advised, again only if repeat CEA still elevated over 10.

 

https://www.bch.in.th/find-doctor/doctor-profile/?smid=4581

 

https://www.bumrungrad.com/doctors/Chucheep-Sahakitrungruang

 

For Bumrungrad need appt which you can make online,. BCH (which costs  less) no need appointment  but arrive early to register and get in the queue.

 

[rott]

Thank you again Sheryl, I will repeat the CEA and if needs be contact Prof Chucheep.

Yes it was Lifecare.

[spornb]

4 hours ago, Sheryl said:

Prof. Chucheep, best specialist in Thailand and a really nice man to boot

For colorectal probably one of the best in the world, there is a utube video of him, an exceptionally nice man, I am seeing him at Chula again next Thursday, for routine follow up and generally at this time of the year I take him a nice bottle of malt whiskey.

 

I was operated on by him and his team, for 13 hrs at Chula two years ago, all done through keyhole surgery, no big scars, first met him three years ago, when he referred me to a top oncologist, for radiation and chemo, at Chulalongkorn.

 

Dr Chucheep is a professor at the teaching hospital and earns little when working at Chula, he is of a much forgotten type, wishing to do his very best and achieve excellence, at the expense of earning high monetary rewards, a true caring professional, sadly not so common these days

 

My cancers colorectal and prostate, appeared to go after the radiation and chemo, to the amazement of all the doctors,  but they came back, 9 mths later,  Dr Chucheep gave me the option of being operated on at the Bumrungrad or Chula, I asked him where the facilities gave him the chance of doing the best job, he said no difference, I was admitted within two weeks! to Chula, GodBless the UK NHS I wonder how long. would have been the wait there !

 

Dr Chucheep also told me due to my large size and weight it would be very challenging operating on me, but he liked a challenge, we both survived !, we always joke a lot when we meet, I think he likes me, or maybe its my young wife! which helps, and also understands my bad english humour

 

This saved me very very substantial sums by going to Chula, I pay my own bills, I had a private room on the 23 floor of the new building overlooking lumpini park

 

I first met him at Bangkok Christian hospital, my wife went there at 4.00 am to queue for a 1.00 pm appointment, and God helps those who help themselves, we just turned up no referral and said we would like to see him, I had a summary and copy MRIs

 

He has a colleague Dr Hirachani at Bangkok Hospital in Phuket  they qualified together a while ago, who I took a second opinion from and he gave me an estimate ten times greater, but gave me an hour and a half discussing matters, and when I enquired how much he said no charge, he just said give my kindest regards to my friend Dr Chucheep

 

At Chula he normally has a few beautiful female trainees following him round, and I always comment he is not only a good surgeon but the best dressed man at Chula, he smiles as do his student who also adore him.

 

I was exceptionally lucky to wind up with him and his team, several well qualified post grad doctors, looking after me, as a foreigner Chula is difficult to get into, and by going to Bangkok Christian first maybe one finds a backdoor into Chula

 

I doubt if I could have found better anywhere in the world, and I say thank you to all who helped me achieve this

 

He will also personally do a colonoscopy, on a no pain two shot anaesthetic, at the specialist colonoscopy clinic at Chula

 

I will willingly communicate either by PM or phone if any one needs more specific detail

 

Remember Christmas is coming and there are some excellent Doctors in thailand, at very affordable costs, just be careful, I also have a long list of horror stories, CHECK OUT YOUR DOCTOR FIRST

 

God Bless stay positive, AND HAPPY CHRISTMAS

[sunnyboy2018]

My company clinic started giving warnings about the efficacy of the PSA tests as they led to too many innacurate results leading to unesseccary life changing surgery. Regarding the price: Im pretty sure most hospitals have an online price list.

[Lacessit]

On 12/5/2019 at 3:08 PM, BritManToo said:

San Sai government hospital charged me 300bht for a PSA blood test earlier this year.

Plus 50bht for hospital services (inc doctor and nurse).

 

@OP, but you're already taking medication, which as far as I know invalidates the PSA test.

I'm taking saw palmetto as a precaution, for urination. Perhaps Sheryl can clarify whether that affects a PSA result.

Also take Codiovan and Somac.

[lopburi3]

4 minutes ago, sunnyboy2018 said:

Regarding the price: Im pretty sure most hospitals have an online price list.

It appears we posters have not found them.  Have you links you can provide us?  

[Sheryl]

13 hours ago, Lacessit said:

I'm taking saw palmetto as a precaution, for urination. Perhaps Sheryl can clarify whether that affects a PSA result.

Also take Codiovan and Somac.

 

not known to

[Lacessit]

15 hours ago, sunnyboy2018 said:

My company clinic started giving warnings about the efficacy of the PSA tests as they led to too many innacurate results leading to unesseccary life changing surgery. Regarding the price: Im pretty sure most hospitals have an online price list.

Point taken. I'd be having surgery in Australia if necessary, and double-checking the PSA there beforehand.

I'd assume false negatives are far less frequent than false positives.

[ThaiBunny]

15 minutes ago, Lacessit said:

Point taken. I'd be having surgery in Australia if necessary, and double-checking the PSA there beforehand.

I'd assume false negatives are far less frequent than false positives.

Most men with prostate cancer die with the cancer not of the cancer

[Sheryl]

4 hours ago, Lacessit said:

Point taken. I'd be having surgery in Australia if necessary, and double-checking the PSA there beforehand.

I'd assume false negatives are far less frequent than false positives.

 

It is a value along a scale so doesn't give a positive or negative result as such. It  can be elevated by a  number of things besides prostate cancer, most notably benign prostatic hypertrophy (BPH) which most older men have to some degree, and also prostatitis.  If prostatitis is present should always treat first and repeat PSA later, PSA result while there is inflammation/infection is unreliable. 

 

PSA needs to be interpreted in conjunction with the patient's age, history and physical exam (digital exam of the prostate - its size and contours.  Also, change over time is significant...the elevations due to BPH will not change rapidly so in  the absence of infection/inflammation, a noticeable increase in  PSA is suggestive of cancer as are really high values (over 20).  Values over 30 are almost always cancer, over 20 the positive predictive value is about 70-75% but then it drops considerably.

 

Equally important, rapid increases  in absence of infection/inflammation are suggestive of the more aggressive type of prostate cancer which is what is of most importance to detect in an older man.

 

The difficulty comes when there is an enlarged prostate without obvious irregularity in shape and a mildly to moderately elevated PSA (e.g. >4 to about 10),  all of which are pretty common findings in older men. 3/4 of such patients don't have cancer, about 1/4 do and deciding in that situation whether to proceed t biopsy can be difficult. Especially in a much older man, some urologists would opt to just monitor closely for a while and see what the levels do.

 

And yes, it is possible to have prostate cancer with a normal PSA level. Though most patients with prostate cancer will have elevation, some don't. The negative predictive value is 85% i.e. 15% of men with normal PSA level nonetheless  have cancer.

 

These various considerations are why the controversy over PSAs. Personally I think they are useful as long as used and interpreted sensibly.

 

While it is true that more men die with prostate cancer than of it, it is also true that prostate cancer is one of the leading causes of cancer deaths in men worldwide. Some forms can be aggressive, others much less so, it is a not a uniform disease.

[delboy]

PSA test at Suan Dok hospital in Chiang Mai was 460 baht for me last Sunday (8 Dec 2019)

Edited December 11, 2019 by delboy

[rott]

Sheryl and spoorn, many thanks for the advice and support. A second blood test gave a reading of 20.4. I have seen Dr Chucheep at BCH and he has me down for a CTH of chest and abdomen a week tomorrow. So we (or I) will see.