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 curable stage.
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.
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