Endorectal MRI

[PaulC]

I recently saw a radiation oncologist for a consultation after my primary treatment (RP) and secondary approach (clinical trial) both failed. His opinion is that radiation is unlikely to benefit -- from 6% to 40% likely, depending on which study you trust -- but since it's the only curative therapy, it should be considered.

It seemed reasonable to me that he ordered an endorectal MRI for two reasons:

• To see whether the cancer might have metastasized to the pelvis, which would rule out any need for radiation.
• To see whether there might be local hot spots that would need to be especially targed by the radiation.

But my insurance company, which has been remarkably cooperative in everything up till now, refuses coverage. The reason they provide is that there were no abnormal results seen on other recent imaging tests (CT of abdomen, X-ray of pelvis).

So my questions are these:

• Have I correctly understood the reasons for an endorectal MRI?
• Isn't it the case that an endorectal MRI is more sensitive than other tests, and can thus increase the likelihood-of-benefit of radiation therapy if no mets are found?
• How should I proceed, if the insurance company drags its heels in responding to my doctor's appeal and my appeal?