PSA Controversy

 Should You or Shouldn't You PSA Controversy?

Prostate Cancer

For the last 20 years PSA test have been suggested for all men over 50 years old. A PSA test is a blood test that is used to find the level of prostate-specific antigens in the blood stream. Abnormal amounts of this antigen can represent the onset prostate cancer. This practice has been the standard, but new data and research is showing that mass PSA testing doesn't have any effect on the death rate of men who have prostate cancer. The controversy with PSA testing is that they may result in overzealous treatment that can leave men infertile or impotent. Some findings also say that the cancers that are found through PSA might find slow growing cancer that takes decades to develop, and that most men within this age range would die of natural causes or some other disease before this slow growing prostate cancer will have time to develop. The new studies show that men who wait until they have actual symptoms of prostate cancer share the same exact mortality rate as men who have had routine PSA tests.

As a medical billing test this has direct implications. Insurance companies and HMO's may no longer pay for PSA testing and speculative biopsies. Urologist and Primary care Doctor's might have to stop suggesting these test and procedures for their patients because they will no longer be covered under future insurance plan. Getting doctors paid for these services will become difficult. The research behind these new findings followed over 70,000 men 50 years and older and this test are said to have very little use. One rebuttal to these findings might be the constant lower death rate from prostate cancer. Deaths from prostate cancer decrease an average of 4% every year. One might posit that PSA test might not help an aggregate of men, but the test is worth giving because it helps a small amount of men survive prostate cancer.

Instead of recommending PSA testing for all men, Doctors might want to start taking advantage of Digital Rectum Exams. These exams can be performed less frequently and will still provide early detection of tumor growth without all the false flags that PSA testing gives. Digital Rectum Exams will still be billable to insurance companies and HMO. The key is finding out what is best for the patient and secondly what the insurance companies and HMO's will actually pay for. It is unfortunate that health care is such a business, but medical billing services must know what they can actually bill. What we hope to see are a list of services, test, and procedures that physicians are allowed to give.

These changes have not yet been put in place, but many patients are doing their own due diligence and are learning about the unreliability of PSA test. There might also be a group of patients who demand these tests and procedures. The world of prostate screening is changes - not much for the better, but towards the truth. We hope to see new procedure that helps save more lives.