Health in­sur­ers must cover PSA test

The Buffalo News - - SPORTS - NEWSDAY

A new law qui­etly went into ef­fect in Jan­uary that re­quires health in­sur­ers to cover the cost of rou­tine screen­ing for prostate cancer, a mea­sure aimed at en­cour­ag­ing more men to con­sider the ben­e­fits of be­ing tested.

New York is the only state in the coun­try to pass a law that sup­ports full in­sur­ance cov­er­age of the PSA (prostate-spe­cific anti­gen) blood test, which helps de­ter­mine prostate cancer risk.

The new law is the brain­child of a coali­tion of New York urol­o­gists and pa­tient ad­vo­cacy or­ga­ni­za­tions that not only saw a need for the leg­is­la­tion, but over a two-year pe­riod made a case for the mea­sure among leg­is­la­tors in Al­bany.

“As far as physi­cian prac­tices go, we were in the lead,” said Dr. Deepak Kapoor, pres­i­dent of Ad­vanced Urol­ogy Cen­ters, which has of­fices through­out Long Is­land and in New York City. “This is some­thing that was done for the pub­lic good.”

“We had law­mak­ers on both sides of the aisle who re­ally linked arms to­gether to make this hap­pen,” said Kapoor, a long­time ad­vo­cate of PSA screen­ing.

As far as in­sur­ance cov­er­age, New York now puts men’s prostate screen­ing on par with rou­tine mam­mog­ra­phy, which un­der the Af­ford­able Care Act be­came fully cov­ered na­tion­wide with the act’s pas­sage in 2010. Framers of the ACA didn’t ex­tend the same con­sid­er­a­tion to the PSA, de­spite the preva­lence of prostate cancer in the United States and roughly sim­i­lar costs for the two forms of cancer screen­ing. Hewlett-based 1 in 9 Long Is­land Breast Cancer Coali­tion was one of the lead­ing ad­vo­cacy groups to sup­port the law, Kapoor said.

A PSA exam costs an av­er­age of $60 to $80, while a mam­mo­gram can cost $75 to $250, but gen­er­ally runs about $100.

This is about re­mov­ing bar­ri­ers,” Kapoor said of the law.

Some men may have avoided screen­ing be­cause their in­sur­ance com­pany re­quired a co­pay. Oth­ers, Kapoor said, may have been wary of test­ing be­cause of mis­in­for­ma­tion about the PSA’s re­li­a­bil­ity.

De­spite crit­i­cism of the test, the PSA in the last few decades has dra­mat­i­cally changed the tra­jec­tory of care by of­fer­ing screen­ing, early de­tec­tion and prostate cancer man­age­ment, Kapoor said.

“It’s a gate­way test,” he said. “It isn’t per­fect and no one would say the PSA alone is a per­fect in­stru­ment. But it is a tool of a skilled provider to de­ter­mine if fur­ther test­ing is war­ranted.”

Prostate cancer is the sec­ond-lead­ing cause of cancer in men, with more than 240,000 new di­ag­noses and 28,000 deaths in the United States an­nu­ally.

While no cancer screen­ing is 100 per­cent ac­cu­rate, Kapoor said the PSA has been fraught with con­tro­versy for years.

The U.S. Pre­ven­tive Ser­vices Task Force – an in­de­pen­dent com­mit­tee of health ex­perts em­pan­eled by the U.S. De­part­ment of Health and Hu­man Ser­vices – seven years gave the PSA a grade of D. The com­mit­tee makes rec­om­men­da­tions on clin­i­cal pre­ven­tive ser­vices, par­tic­u­larly screen­ings. Panelists last year is­sued their final rec­om­men­da­tion, giv­ing the PSA a grade of C for men be­tween the ages of 55 and 69, not­ing those men should have a dis­cus­sion with their doc­tors about the pros and cons of the test be­fore un­der­go­ing screen­ing. Com­mit­tee mem­bers rec­om­mended against screen­ing for men 70 and older.

For older men, they con­cluded that ben­e­fits of the test do not out­weigh the “harms,” which were de­fined as the anx­i­ety pro­duced by ad­di­tional test­ing re­quired in the event of a pos­i­tive re­sult. Older men are more likely to have slow-grow­ing tu­mors that will not lead to their deaths.

Men at av­er­age risk should con­sider screen­ing, start­ing at age 50, Kapoor said, while African-Amer­i­can men and any­one with a fam­ily his­tory of the disease should con­sider screen­ing start­ing at age 40. Men of all ages should dis­cuss the test with their doc­tors.

Kapoor – and other doc­tors – say it’s bet­ter to know one’s sta­tus than to be left in the dark.

“I am to­tally in his camp on that,”

“I was trained as urol­o­gist at a time when there wasn’t a way to screen for prostate cancer. I re­mem­ber men com­ing in with ex­treme bony pain,” Katz said of pain caused by prostate cancer that had spread to pa­tients’ bones by the time the cancer was rec­og­nized.

“We have to be smart about (screen­ing),” said Dr. Aaron Katz, chair­man of urol­ogy at NYU Winthrop Hos­pi­tal in Mi­ne­ola. “We should not be putting our heads in the sand.”

Katz em­pha­sized that just be­cause a pa­tient has an el­e­vated PSA re­sult does not mean he has cancer. And even if cancer is found, he said, the ma­lig­nancy may be slow-grow­ing and re­quire what doc­tors re­fer to as ac­tive sur­veil­lance, a strat­egy in which the tu­mor is mon­i­tored over time. Some of Katz’s pa­tients have been un­der ac­tive sur­veil­lance for as long as 15 years.

“The util­ity of the PSA is in how you use it over time, Kapoor said. “There’s a va­ri­ety of ways to use it. If you have an ab­nor­mal PSA, that’s an in­vi­ta­tion for fur­ther test­ing. We have the pa­tient un­dergo ad­di­tional eval­u­a­tion and only when war­ranted do we pro­ceed with a biopsy.”

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