JustCare

Tag: PSA

  • Should you be screened for prostate cancer?

    Should you be screened for prostate cancer?

    Prostate cancer is one of the leading causes of cancer death in the US. It is also the most common cause of cancer among men, according to the Centers for Disease Control. That said, most men survive prostate cancer. Virtually all men survive for several years, with 98 percent surviving for 10 years, and 96 percent surviving for at least 15 years. The five-year survival rate falls to 29 percent for men with prostate cancer that has spread to other parts of the body. Should you be screened for prostate cancer?

    Should you get a prostate cancer screening?

    The US Preventive Services Task Force (USPSTF) advises that men between the ages of 55 and 69 should decide for themselves whether to get a prostate-specific antigen (PSA)-based screening for prostate cancer. They should consult with their physicians about the risks and benefits and factor in their preferences in their decision.

    The USPSTF says that screening offers a small possible benefit of lowering the risk of death from prostate cancer for men between 55 and 69. It also says that screening can cause many harms, including extra testing and perhaps prostate biopsy, as well as overtreatment. Overtreatment can lead to incontinence and erectile dysfunction.

    As a result, the USPSTF gives the prostate cancer screening a “C” grade, meaning that there is “at least moderate certainty that the net benefit is small.” And, for men who are 70 or older, it gives the screening a “D” grade, recommending against it because “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits..”

    Why shouldn’t I get a prostate cancer screening?

    The Prostate-Specific Antigen (PSA) blood test cannot differentiate between cancers that will be aggressive and benign cancers that are slow-growing and will never produce symptoms. Even so, most people with prostate cancer (aggressive or otherwise), never have symptoms. Invasive treatments for prostate cancer, like chemotherapy and radiation, in people with a benign slow-growing form are likely to cause significant harm.

    The Prostate Cancer Foundation reports that as many as two in five men treated for prostate cancer had tumors that would never have presented a risk to their health or lives. But, the radiation treatment many men opt for can cause incontinence and erectile dysfunction. And, hormone therapy treatment can lead to depression and osteoporosis.

    On the other hand, screening could reduce the chance of death from prostate cancer. The medical community recommends shared decision-making around screening. Individuals should weigh the risks and benefits of screening and make an informed decision on whether to proceed.

    What does Medicare cover?

    If you decide to proceed with a prostate cancer screening, Medicare covers a prostate screening each year, including a Prostate-Specific Antigen (PSA) blood test and a digital rectal exam (DRE). If you have traditional Medicare and your doctor takes assignment, the PSA test is covered in full. If you are enrolled in a Medicare Advantage plan, it is also covered in full if you see an in-network doctor. You will be responsible for coinsurance or a copay with the digital rectal exam.

    Medicare covers these tests more frequently for people whose doctors say they are medically necessary for diagnostic purposes.

    Here’s more from Just Care:

  • When to avoid preventive care services

    When to avoid preventive care services

    Medicare covers a wide array of preventive care services, which can offer tremendous benefits. But, some preventive care services may cause more harm than good for people towards the end of life. Liz Szabo reports for Kaiser Health News on when to avoid preventive care services.

    Mammograms and cervical cancer screenings: Experts say that people with terminal cancers of the lung, colon and pancreas generally should not be getting a mammogram or cervical cancer screening. Similarly, people in their late eighties and older with multiple chronic conditions usually do not need these services. The risks of harm outweigh the benefits.

    Experts further say that people with severe dementia and other chronic conditions near the end of life also do not need mammograms. Not only will a mammogram not improve their quality of life, it may lead to unnecessary surgeries.  It may also lead to painful hormonal therapies that can increase risk of stroke. Moreover, a mammogram is unlikely to identify a deadly disease. The research shows that only one woman in a thousand who gets a mammogram over a lifetime does not die because the cancer was  detected before it spread.

    Prostate cancer screenings: Experts also say that older people who already have a deadly cancer or who are at grave risk of dying within ten years are not likely to be helped by prostate screenings, PSA tests. PSA tests tend to identify tumors that are extremely slow-growing and do not need to be treated. And more than two in three prostate cancer screenings find something that does not need to be found. The follow-up biopsy causes infections in about 6 percent of men, 1 percent of whom end up in the hospital. These screenings have been deemed “low value” in men 75 and older. Research shows that men who receive surgery or radiotherapy for prostate cancer are no more likely to live ten years than men who receive active monitoring.

    Colonoscopies: Colonoscopies can lead to intestinal tears. And, people 75 and older are more likely to get a tear than younger people. Colonoscopies can also lead to dehydration and fainting in older adults.

    Skin cancer removal: People in their late eighties and older also might want to avoid removing skin cancers that are not life threatening. Caring for the skin after the cancer is removed can be problematic. And wounds may not heal. More than 25 percent of people report problems with their wounds healing.

    In sum, if you are wondering why some people should avoid these “harmless” tests, it is that the tests can lead to false positives, stress, and unnecessary invasive procedures as well as medical complications.

    Here’s more from Just Care: