AUA Urges Congress to Mandate Medicare Coverage of Prostate Cancer Screening Tests

The American Urological Association (AUA) recently urged Congress topass the Medicare Preventive Benefit Improvement Act of 1997, which wouldprovide coverage for annual prostate cancer screening for Medicare-eligiblemen over the age of 50. The screening procedures covered would includeprostate-specific antigen (PSA) blood tests and digital rectal examinations.

In testimony before the House of Representatives Subcommittee on Healthof the Ways and Means Committee, AUA Secretary William R. Turner, Jr, md,a urologist at the Medical University of South Carolina, said that thePSA test has greatly enhanced the ability of urologists to diagnose prostatecancer at an early stage when the chances of successful treatment are high.

"Like most cancers, early diagnosis improves treatment outcomesand increases treatment choices," Dr. Turner told subcommittee members.

"There is now evidence that early detection is beginning to havean impact," Dr. Turner continued. "Prior to the use of PSA, only30% to 40% of prostate cancer cases were diagnosed at an early stage. Amongmen getting annual PSA tests, early stage disease is diagnosed 70% to 85%of the time."

He stated that recent studies are demonstrating a declining prostatecancer death rate, suggesting that early diagnosis and improved therapymay be paying dividends. "If these trends continue, it may be possibleto conclude that efforts at early detection and treatment have resultedin decreased death rates," Dr. Turner said.

Screening Costs Deemed a Good Investment

In addressing the issue of the costs to the Medicare system that wouldoccur if the bill were enacted, Dr. Turner testified: "The AmericanUrological Association urges you to weigh carefully the costs of enactmentagainst the savings that will stem from avoidance of costly palliativetherapies and the loss of productive life. We can think of few better investmentsfor this Congress than passage of this bill."

During his testimony, Dr. Turner said that nothing could be furtherfrom the truth than the attitude that prostate cancer is not a seriousdisease that usually needs no treatment and only requires observation.In calling prostate cancer a killer, he cited American Cancer Society estimatesthat prostate cancer will be diagnosed in more than 334,000 American menduring 1997 and that it will result in more that 40,000 deaths in the UnitedStates during that year. He pointed out that prostate cancer is the secondleading cause of cancer death in American men and the most commonly diagnosedcancer.

"While prostate cancer is a disease found more frequently in oldermen, and some who have the disease diagnosed later in life would not becandidates for treatment, it also occurs in younger men whose life is dramaticallyshortened," Dr. Turner said. "Furthermore, the disease in itsterminal stages causes untold pain and suffering due to bone metastasisand major organ involvement."

The AUA also provided subcommittee members with a copy of the AUA policyon the early detection of prostate cancer. The policy states that all menover the age of 50 should get an annual PSA test along with a digital rectalexamination. It also advises men at high risk--those with a family historyof prostate cancer and African-Americans--to begin this process at 40 yearsof age.

In addition to addressing PSA blood tests and digital rectal examinations,the proposed legislation also proposes that Medicare pay for other preventiveservices, such as colorectal cancer screening.