The numbers are stark. According to the United States Preventive Services Task Force, for every man whose death from prostate cancer is prevented through PSA screening, 40 become impotent or suffer incontinence problems, two have heart attacks and one a blood clot. Then there’s the psychological harm of a “false positive” test result, which is 80 percent of all “positive” tests. They lead to unnecessary worry, follow-up biopsies, physical discomfort and even harm. Final grade: D.
Three men close to me have been diagnosed with prostate cancer late in life. Each was around 70. My dad, already in throes of advancing Alzheimer’s disease, did what the doctor ordered (actually, I suspect my mom told my dad to do what the doctor ordered). He had surgery. And for the last six years of his life, which until his final three months was at home, she cleaned up after him because of his incontinence. My neighbor made the same choice. He quietly admitted to me one day that he suffers from similar symptoms, but he is grateful because he believes his life was saved by the operation. And my friend Arnie? I’ve written about him in this space before. He was diagnosed at 70, and being a psychiatrist with a strong sense of his own sexual being, understood the potential tradeoffs. He decided to forgo treatment. He died a few years ago at 90. I never learned the cause.
So what does it mean that PSA testing gets a D rating? If you want the test, or your doctor performs it routinely, your insurance company may not pay for the test. It won’t have to since the Affordable Care Act says prevention services must be rated either A or B to warrant automatic coverage. Yet I wouldn’t worry if you’re a symptomless man who is hellbent on getting this unnecessary test. Three insurers told the Washington Post yesterday that they will continue to pay for the test if it is ordered by a physician. I can’t imagine Medicare cutting off payment, either. The wary bureaucrats at CMS have no interest in wading into a fight with the “Evidence? We don’t need no stinkin’ evidence” crowd.
I predict that you’ll see no change in clinical medical practice from this pronouncement by USPSTF. Physicians in community practice will continue to routinely screen men between 50 and 75. Millions will continue to receive unnecessary treatment. A few thousand lives each year will be saved. Will that justify the harm — including premature deaths — caused by the false positives? We’ll never know. Because those who experience those harms will suffer in silence. After all, they’re men.Did you like this? If so, please bookmark it, RSS feed.