Curmudgeon's Corner

PSA Tests After 50?

Posted by Al Campbell on Oct. 7, 2011

U.S., Healthcare, Political, Quality of Life

I am particularly tuned into things about prostate cancer and, therefore, the testing using PSA work-ups that are used to identify the protein counts that might indicate a cancerous situation.  I wrote a long time ago about ‘My Friend John’ discussing my friendship with a cigar smokin’ buddy named John who died from prostate cancer at an early age.  I am also a male of increasing age.

I read, in the morning Journal Sentinel, of a study done by the United States Preventive Services Task Force (a group of physicians recruited by the Feds to study various things relating to cost control initiatives).  The article discussed the recommendation that PSA tests be eliminated for men over the age of 50 since it can lead to “more tests and treatments that needlessly cause pain, impotence and incontinence”.  Among the reasons given was that most forms of prostate cancer are slow growing.  (John’s was not slow growing and he had a PSA level of over 1,600 at the time of his death when the norm is in the range of 2 to 5 as I recall.)

I was very concerned with this study and found a more complete report of it on the Huffington Post.  That report discussed the same study but also included the information that this related to men of 75 years of age or older, and went on to discuss the abuses of excessive tests being ordered by physicians who feared law suits if they didn’t order the testing and were subsequently sued.

Prostate cancer is the leading cancer diagnosed in men.  This is the rough equivalent of breast cancer in women.  I believe I recently read that prostate cancer causes a higher rate of death amongst men than does breast cancer amongst women.  I am not trying to equate one to the other in terms of suffering and humiliation.

Back to the point of all this:  There is a major difference between the New York Times piece, which the Journal Sentinel published, and the more detailed report from the Huffington Post site.  If the government were to limit the use of PSA testing, it would save very little money since that is part of a standard blood test.  What causes the expense is the follow-up that physicians prescribe when a count has increased significantly from one test to another.  That is why the test is important since a benchmark is established and then monitored to watch whether or not there is a significant increase in the count that might point to a problem.

Among my issues is the legal system that promotes the expensive follow-up testing and surgical procedures by physicians to protect themselves from suit.  I’ll wager that we could cut our medical test costs simply by reforming the legal system that thrives on the lucrative suits enabled.  Maybe it involves the burden of bearing the expense if a suit is not successful.  Maybe it involves setting new guidelines concerning the proper testing protocol and subsequent decision-making recommendations at various ages by sex.  With that in place, the government might better be able to control excessive testing since that seems the direction this study was taking. 

I’d like to have the PSA test performed so that I would be aware of my situation.  I have often said that if diagnosed with prostate cancer from now on I would very seriously consider doing nothing given its typical slow growth rate and the likelihood that I’d expire from some other cause given my age.  But, I like being in the mix of decision makers regarding my own health.

I am concerned also that this might well be a precursor to the future control of the practice of medicine given government’s encroachment in that area.  This isn’t a ‘death panel’ but it sure looks as though it’s findings could promote such a panel or prompt some other arm of the federal system to use the findings as the basis for other decisions.

Would I change my mind if I were diagnosed with prostate cancer following my next physical?  I don’t know the answer to the question and won’t know the answer until I am diagnosed, if ever.  Would I fight having the PSA tests removed from protocol for men over 50?  Absolutely!  If the test is done, I have a right to the information that results…good or bad.  Could I tolerate the test being removed from protocol for men over the age of 75?  I could if there were other medical conditions known that could be used to help weigh the question, but not simply because of the attained age

Our government has, and has had for some time, enormous leverage over the practice of medicine in America.  This article only served to remind me of the implications, and the fact that we are in the implementation cycle for the Patient Protection and Affordable Care Act (PPACA) reminded me that significant changes to what we’ve known could be coming down the road.

As you can see from this blog, I am conflicted as I imagine most would be.  I can theorize when I don’t know the people involved, but it gets really personal when I do know the people involved or when that person is me or my immediate family.