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medpundit |
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Wednesday, December 03, 2003In a survey of 7,889 men, researchers found that 32.5 percent of men over 75 received PSA blood tests an estimated 1.5 million men a year. Medicare typically pays $25.70 for the lab work, federal officials said, suggesting that more than $38 million a year is spent on those tests for older men. Federal officials said more than $90 million was paid out last year for PSA tests for Medicare recipients of all ages. "Most patients with an elevated PSA do not have prostate cancer," said Yao. Even if prostate cancer is first detected in a 75-year-old, the chances are very high that the patient will die of some other disorder before the slow-growing cancer could cause death, he said. Why is that a big deal? Because chasing down those false positives gets even more expensive (and much more invasive) than the test itself: The PSA test does not detect cancer directly. Instead, it determines, in effect, whether a patient has too much prostate tissue. That excess tissue can be caused by inflammation, by enlargement common to older men, or by cancer. A positive PSA test has to be followed up with a biopsy or other procedures before cancer can be confirmed. It always has been an imperfect test, but the media and interest groups (such as the professional societies of urologists) have made it a central aspect of men's wellness. As a result, conveying the nuances of the test is very difficult in the context of an office visit which has in all likelihood already been devoted to a host of other issues - complaints that need to evaluated, concerns that need to be addressed. Which is why this isn't surprising: Among the elderly men who participated in the survey, 88 percent said they got the PSA test at the advice of their doctor, but only 66 percent of those who got the test recall a discussion with the doctor about the risks and benefits of the test. For a test of questionable value, Yao said virtually all the doctors should have frank discussions with patients. Those frank discussions aren't happening because many doctors have in the back of their mind that if they don't order the test and the patient comes down with prostate cancer in a few years, which is certainly in the realm of possibility given its prevalence rate in elderly men, the doctor's going to get the blame - and the malpractice suit. On the other hand, if he does the test and the patient goes through urological consults and invasive testing the patient's going to be grateful that his doctor was "thorough." (And actually more than 66% probably had discussions with their doctors, they just might not recall them because they've been obscured by other, more pressing aspects of their visits.) And one more thing. It isn't at all surprising that more men have PSA levels done than fecal occult blood testing to screen for colon cancer. The PSA is a simple blood test. The fecal blood test requires the patient handle his own stool. Understandably, it has a notoriously high non-compliance rate. UPDATE: A reader reminds me that there are over-the-counter test kits to screen for blood in the stool that don't require handling excrement. I'm not sure how their sensitivity compares to the traditional testing methods, but they're better than doing nothing, I'm sure. posted by Sydney on 12/03/2003 07:46:00 AM 0 comments 0 Comments: |
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