Medicare should stop paying for prostate cancer screening in men over the age of 75....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.
1. The good doctor seems to base his decision on facts not in evidence. As I have noted here and elsewhere, see my book on Prostate Cancer Genomics, the studies detailed in NEJM had fatal flaws. Thus the conclusion reiterated in the statement is itself flawed.
2. PSA tests should be Bayesian in nature. Namely if there is a family history then they should be used cautiously. If a first degree relative died of an aggressive form of PCa then thet should be watched very carefully.
3. Genetic tests are slowly evolving yet not yet there. However they do present an option.
4. Some small percent of PCa is highly aggressive and early detection does have a positive effect. Most cases are indolent and slow growing, yet we still have no clear test other than family history to determine this.
5. Allowing the patient to pay themselves is an option. If the test is indicative, doe this young man suggest that the biopsy should also be charged to the patient, what if the PCa is Gleason 6, should the operation also be charged to the patient.
6. Is he suggesting that old men have no value? That seems to be the consensus of this group.
Shame on the Times! But I guess everyone tries to throw grandpa over the cliff, the Democrats want to save just grandma!
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