Medicare should stop paying for prostate cancer screening in men over age 75

The following op-ed was published on June 1st, 2011 in the New York Times’ Room for Debate blog.

Medicare should stop paying for prostate cancer screening in men over the age of 75.

You may be surprised to hear that, especially coming from a primary care doctor. But evidence is mounting that screening for prostate cancer is not only ineffective in older men, but may actually be harmful.

The cornerstone of prostate cancer screening involves measuring the prostate specific antigen, or P.S.A., in the blood. But the test is notoriously inaccurate and cannot differentiate between prostate cancers that are dangerous and ones that aren’t. It’s a crucial distinction, since most American men diagnosed with prostate cancer won’t die from it.

Studies have been inconclusive about whether prostate cancer screening saves lives. What’s more certain are the harmful effects, including impotence and urinary incontinence, caused by unnecessary prostate procedures stemming from false positive P.S.A. tests. The U.S. Preventive Services Task Force updated their prostate cancer screening guidelines in 2008, and after careful deliberation of the evidence, recommended against screening older men.

But those guidelines continue to be ignored. This past March, the Journal of Clinical Oncology found that nearly a quarter of men aged 85 and older continued to receive P.S.A. screening tests.

Why is this?

One reason is that Medicare pays for annual prostate cancer screening in all men 50 years and older, with no upper age limit.

Another is that drug companies market aggressively, and profit from, the treatments born from prostate cancer screening, whether necessary or not. In fact, Richard J. Ablin, the immunobiologist who discovered P.S.A. in 1970, called P.S.A. screening a “hugely expensive public health disaster.”

Dr. Kenneth Lin, lead author of the U.S. Preventive Services Task Force’s prostate cancer screening guidelines, also blames the news media. In an email to me, he said “news shows invariably feature athletic septuagenarians on the golf range telling reporters that they don’t want some government panel taking their P.S.A. tests away. But most 75-year-old men are in much poorer health, and prostate cancer surgery has no survival benefits in men over age 65, much less 75.

About $3 billion annually is spent on P.S.A. testing alone, with a substantial portion paid for by Medicare. An upper age limit on prostate cancer screening not only would shave those costs, but more important, spare patients from the harms of unneeded prostate procedures.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitter, and LinkedIn.

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