Today’s Managing Health Care Costs Number is $3 billion
This shows impact of prostate cancer screening on patients. The data source is a Cochrane Collaborative review in 2013.
Hot on the heels of yesterday’s report showing that mammography appeared not to lower breast cancer death in the overall population, a urologist has an unreferenced op-ed in today’s New York Times advocating the return to widespread screening for prostate cancer. Deepak Kapoor, the past president of the trade association of large urology groups, points out that urologists have individualized their approach to Prostate Specific Antigen (PSA) testing, and they can test for derivatives, test for serum binding of PSA, and do genetic tests of the urine.
Kapoor suggests:
…Men should not wait for a government agency to tell them what’s best. My own strongest recommendation is that men insist on a baseline PSA test while in their 40s. From this baseline, a personalized screening regimen that considers risk factors and other indicators can be developed.
And warns:
No increase in cancer mortality has been observed, but that may be a matter of time; aggressive cancers are less treatable. One study concluded that annual prostate cancer deaths may increase as much as 5 percent, for the first time in more than 20 years.
Not likely. If we weren’t able to show any decrease in prostate cancer mortality with two decades of aggressive PSA testing, it’s not likely that withdrawal of that testing will lead to an increase in mortality over the entire population. Yes – there will be anecdotal cases of aggressive late stage prostate cancers which might have been picked up earlier as we (eventually) cease doing indiscriminate screening. But there will also be people who won’t die of postoperative complications of unnecessary radical prostatectomies. We just won’t know who those people are.
Richard Ablin, the scientist who discovered prostate specific antigen (PSA) wrote in the NY Times in 2010
I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A. screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments.
The prostate industrial complex represented over $9 billion of cost in 2010, before we had so many different variations of prostate specific antigen to choose from, and before substantial use of new expensive prostate cancer pharmaceuticals. Abandonment of screening represents billions of dollars of lost revenue to pathologists, radiologists, urologists, hospitals and others.
Urologists are sincere in their belief that PSA testing and its successors offers genuine benefit to their patients. They see patients dying of metastatic disease, and they know that their good work has helped the patients they deeply care for. They think of the self-referral opportunities in care of prostate cancer only in their subconscience, although urologists are among the highest paid physicians, and lead the medical community in self-referral conflicts of interest.
If you’re seeking good advice about whether to get screened for prostate cancer, don’t ask a urologist. And if the urologist pens an op-ed in the New York Times proclaiming new, better tests and strong willingness to promote watchful waiting after a slow-growing prostate cancer is found, ask them for published, peer-reviewed evidence.
