In the NY Times some upcountry physicians opine:
Nevertheless,
screening is a choice. Medicare should not penalize doctors for
ordering PSA tests, but it should make sure it is not giving the test
away free. Requiring men to bear the small cost of the test is not a
punishment, it’s a motivation for them to consider the screening
decision more carefully. Not only does the test have important
implications for adverse health outcomes in the near future, but it also
has near-term implications for some serious out-of-pocket costs from
potential follow-up care. Support
the process by rewarding doctors for taking the time to discuss the
trade-offs patients face. Medicare already requires, and reimburses for,
shared decision making for lung cancer screening; it should do the same
for prostate cancer screening.
PCa is a major killer or men in the US. Also is can be a significantly indolent disease, it just goes no where in almost all inflicted. Yet we do not know which men will be indolent and which will die a horrible death with collapsing spinal cords and the like. So the best course is to assume the worst and hope for the best. Not many other cancers are this way, although some DCIS may be of the same ilk, yet women would never allow that conversation. Men on the other hand just seem to let them be told whatever some "expert" deems appropriate.
So what should be done? The above suggestion is place a financial burden on the test. That is not at all unreasonable. But men should get a balanced discussion of the risks. Namely, we really do not have a great grasp on this disease. It is complicated and it defies many of the Bayesian rules we are told to follow.
But "Trust but Verify" may be the best path.
Posts
