The American Urological Association, representing 10,000 urologists
worldwide, is encouraged that the Office of Technology Assessment
(OTA) has issued a report that concludes that "prostate cancer
screening could indeed be as cost-effective as other disease screening
services already covered by Medicare."
OTA's report, "Preventive Services Under Medicare: Costs
and Effectiveness of Prostate Cancer Screening Among Elderly Men",
concludes that "Given the state of current knowledge about
prostate cancer, it may be reasonable for Medicare to consider
reimbursement of the screening test. Reimbursement could be seen
as ensuring that out-of-pocket screening expenses (however small)
not impede well-informed discussion and decision making between
physician and patient."
The AUA says that it is vitally important that all men have access
to PSA surveillance. As the OTA observes, men who have either
private insurance or the means to pay for the PSA are obtaining
this test. Economically disadvantaged men may be foregoing early
cancer detection. This could prove detrimental to African-American
men who not only experience the highest incidence of the disease,
but also experience a more rapid progression of the cancer.
OTA raises questions about the efficacy of currently available
treatment. While it is true that certain men of advanced age and
poor health will not benefit from therapy for prostate cancer,
younger men in good health, especially those with a family history
of the disease, can be spared a premature death. Concerns of the
OTA regarding the value of treatment are based at least in part
on medical literature reflecting the value of treatment before
the availability of PSA testing. Patients in the older studies
were primarily diagnosed by DRE alone, and had a more advanced
stage and extent of prostate cancer at the time of their diagnosis
and treatment. Outcomes of the treatment, therefore, cannot be
expected to equal those being achieved now that prostate cancer
-- through PSA testing-- can be diagnosed at an earlier, potentially
Data from more recent studies indicating a clear advantage to
treatment over "watchful waiting" were forwarded to
OTA by the AUA with advice from the AUA's Committee to Establish
the Efficacy of the Treatment for Prostate Cancer.
Emerging information regarding current prostate cancer treatment
following early detection through PSA and DRE will confirm the
value of aggressive treatment. It is the position of the American
Urological Association that all men have access to PSA testing.
The AUA urges Congress to enact legislation that will provide
Medicare coverage for this important service.