The American Urological Association (AUA) recently urged Congress to
pass the Medicare Preventive Benefit Improvement Act of 1997, which would
provide coverage for annual prostate cancer screening for Medicare-eligible
men over the age of 50. The screening procedures covered would include
prostate-specific antigen (PSA) blood tests and digital rectal examinations.
In testimony before the House of Representatives Subcommittee on Health
of the Ways and Means Committee, AUA Secretary William R. Turner, Jr, md,
a urologist at the Medical University of South Carolina, said that the
PSA test has greatly enhanced the ability of urologists to diagnose prostate
cancer at an early stage when the chances of successful treatment are high.
"Like most cancers, early diagnosis improves treatment outcomes
and increases treatment choices," Dr. Turner told subcommittee members.
"There is now evidence that early detection is beginning to have
an impact," Dr. Turner continued. "Prior to the use of PSA, only
30% to 40% of prostate cancer cases were diagnosed at an early stage. Among
men getting annual PSA tests, early stage disease is diagnosed 70% to 85%
of the time."
He stated that recent studies are demonstrating a declining prostate
cancer death rate, suggesting that early diagnosis and improved therapy
may be paying dividends. "If these trends continue, it may be possible
to conclude that efforts at early detection and treatment have resulted
in decreased death rates," Dr. Turner said.
Screening Costs Deemed a Good Investment
In addressing the issue of the costs to the Medicare system that would
occur if the bill were enacted, Dr. Turner testified: "The American
Urological Association urges you to weigh carefully the costs of enactment
against the savings that will stem from avoidance of costly palliative
therapies and the loss of productive life. We can think of few better investments
for this Congress than passage of this bill."
During his testimony, Dr. Turner said that nothing could be further
from the truth than the attitude that prostate cancer is not a serious
disease that usually needs no treatment and only requires observation.
In calling prostate cancer a killer, he cited American Cancer Society estimates
that prostate cancer will be diagnosed in more than 334,000 American men
during 1997 and that it will result in more that 40,000 deaths in the United
States during that year. He pointed out that prostate cancer is the second
leading cause of cancer death in American men and the most commonly diagnosed
"While prostate cancer is a disease found more frequently in older
men, and some who have the disease diagnosed later in life would not be
candidates for treatment, it also occurs in younger men whose life is dramatically
shortened," Dr. Turner said. "Furthermore, the disease in its
terminal stages causes untold pain and suffering due to bone metastasis
and major organ involvement."
The AUA also provided subcommittee members with a copy of the AUA policy
on the early detection of prostate cancer. The policy states that all men
over the age of 50 should get an annual PSA test along with a digital rectal
examination. It also advises men at high risk--those with a family history
of prostate cancer and African-Americans--to begin this process at 40 years
In addition to addressing PSA blood tests and digital rectal examinations,
the proposed legislation also proposes that Medicare pay for other preventive
services, such as colorectal cancer screening.