PSA Test Gets a Controversial Downgrade

Posted in Across the Nation, Cancer Care by ACCCBuzz on May 22, 2012

Matt Farber, MA, Director of Economics and Public Policy, ACCC

The United States Preventative Services Task Force (USPSTF) has once again come out with a recommendation that is sure to stir controversy in the field of oncology. On May 21 the USPSTF gave the prostate-specific antigen (PSA) test a grade of “D,” essentially saying that the test may not be appropriate as it is being used currently. This recommendation runs counter to what has become common practice in many primary care, urologic, and oncologic offices across the country.

This is not the first time that the USPSTF has made a recommendation that created waves. In recent years, the panel made a recommendation related to the use of mammograms to test women for breast cancer. The recommendations were not highly received, and the panel endured a great deal of criticism. The pushback was so forceful that no major payers or practitioners changed their common practices.

This time around, the panel expressed its belief that, after reviewing two large studies, PSA tests save the life of just one man out of 1,000. In addition, the panel believes that for every man saved by PSA testing, another one will develop a blood clot, two will have heart attacks, and another 40 will develop incontinence or impotence due to unnecessary treatments.

A Closer Look at What It All Means
The big question that many people will ask is: Will this recommendation change how this test is given and how it is paid for? The answer to the first part is that practice will likely change very little due to this recommendation. Many men currently are given the option to take the PSA test, and many will opt for it. Men with lower risk factors may delay the test, perhaps; however, it is safe to say that the PSA test is not one that will disappear any time soon. As for the second half of the question, that is a trickier answer.

Most insurers will not do anything right away to change their policies. Large insurers have already come out to say that while they will review the data from the studies, they believe that PSA testing is still an important part of prevention of prostate cancer. They may eventually put some limitations based on risk factors or age on the test, but doing so will take some time. Medicare coverage is also tricky. Because of the Affordable Care Act, patients can receive preventative tests at no cost to them if the tests have a positive recommendation from the USPSTF. With this change, it is possible that PSAs will not be eligible for this coverage. Medicare will still likely cover the test, but the test would fall out of the preferred category.

Only time and more studies will tell if this decision has a major impact on the practice of medicine. Stay tuned to ACCC for more information.

ACCC’s Center for Provider Education has developed resources for community cancer programs to help develop prostate–specific cancer services in their home communities as well as measure progress or success of their prostate–specific cancer service line.

2 Responses

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  1. Richard Reiling, MD, FACS said, on May 22, 2012 at 8:53 pm

    As before we need to know the background of the task force and to what extent they had discussed the issue with those of us who care for cancer patients, including patients dying or cured of prostate cancer that was first detected by elevated PSAs.
    The real concern that many of us have toward the report is that the average lay person will misinterpret the recommendations that the PSA is no longer of any value and at the same time fail to get a surveillance exam.
    The best judgement for any man is to discuss with his physician! This is especially true for African-American men who have a high incidence of prostate cancer.
    Remember, that despite the recommendations, men still suffer greatly and die from prostate cancer!

  2. […] Matt Farber’s treatment of the subject is here. […]

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