AUA's Response to the OTA Study on Prostate Cancer Screening for Elderly

The American Urological Association, representing 10,000 urologistsworldwide, is encouraged that the Office of Technology Assessment(OTA) has issued a report that concludes that "prostate cancerscreening could indeed be as cost-effective as other disease screeningservices already covered by Medicare."

OTA's report, "Preventive Services Under Medicare: Costsand Effectiveness of Prostate Cancer Screening Among Elderly Men",concludes that "Given the state of current knowledge aboutprostate cancer, it may be reasonable for Medicare to considerreimbursement of the screening test. Reimbursement could be seenas ensuring that out-of-pocket screening expenses (however small)not impede well-informed discussion and decision making betweenphysician and patient."

The AUA says that it is vitally important that all men have accessto PSA surveillance. As the OTA observes, men who have eitherprivate insurance or the means to pay for the PSA are obtainingthis test. Economically disadvantaged men may be foregoing earlycancer detection. This could prove detrimental to African-Americanmen who not only experience the highest incidence of the disease,but also experience a more rapid progression of the cancer.

OTA raises questions about the efficacy of currently availabletreatment. While it is true that certain men of advanced age andpoor health will not benefit from therapy for prostate cancer,younger men in good health, especially those with a family historyof the disease, can be spared a premature death. Concerns of theOTA regarding the value of treatment are based at least in parton medical literature reflecting the value of treatment beforethe availability of PSA testing. Patients in the older studieswere primarily diagnosed by DRE alone, and had a more advancedstage and extent of prostate cancer at the time of their diagnosisand treatment. Outcomes of the treatment, therefore, cannot beexpected to equal those being achieved now that prostate cancer-- through PSA testing-- can be diagnosed at an earlier, potentiallycurable stage.

Data from more recent studies indicating a clear advantage totreatment over "watchful waiting" were forwarded toOTA by the AUA with advice from the AUA's Committee to Establishthe Efficacy of the Treatment for Prostate Cancer.

Emerging information regarding current prostate cancer treatmentfollowing early detection through PSA and DRE will confirm thevalue of aggressive treatment. It is the position of the AmericanUrological Association that all men have access to PSA testing.The AUA urges Congress to enact legislation that will provideMedicare coverage for this important service.