Prostate Cancer Screening: Can the Government Get It Right?

Prostate Specific Antigen (PSA) tests are back in the news, as they are one entry point for the government to start micromanaging how it pays doctors in Medicare. To set the stage:

• Currently, Medicare pays for an annual PSA test for men 50 and older as “preventive care.”
• However, Obamacare does not consider an annual PSA test for men 50 and over as “preventive care.”
• The U.S. Preventive Services Task Force’s current guidelines (updated in 2012), recommend against PSA tests.
• PSA testing has declined significantly since the 2012 guidelines were updated.
• The American Cancer Society favors PSA tests for men over 50, and as early as 40 for men with more than one first-degree relative diagnosed with prostate cancer.

You can be forgiven for being confused. The issue, put most bluntly, is that 70 percent of prostate cancer deaths occur after age 70. Much medical opinion claims that testing men at 50 leads to false positive diagnoses, causing men to undergo treatment that is unnecessary, expensive, and has a high risk of serious side effects (including incontinence and impotence). Many of these men will die of other causes long before prostate cancer gets them, and the disease can always be diagnosed later if necessary.

This is not an issue to be taken lightly. The U.S. Preventive Services Task Force has re-opened the question, inviting input on a research plan that should lead to more risk-based guidelines. Further, Medicare has commissioned a consulting firm to develop quality measures (to be collected via electronic health records) that will have an impact on physicians’ pay: Those who order too many PSA tests will have their Medicare payments cut. (You can thank bipartisan super-majorities in the current Congress for this. They granted Medicare this power via the extremely flawed so-called “doc fix” passed last spring.)

There is a better way than giving the government the power to decide the value of PSA tests. Let’s accept that some physicians believe PSA tests are overused and that others disagree based on a different understanding of the evidence. Let’s accept that medical directors at some insurers believe PSA tests for 50-year olds are appropriate and some believe they are not.

Why not just allow individuals to choose doctors and insurers based on their own preferences? Researchers could conduct observational studies on the results. And we would get a lot closer to the truth than by giving the government the power to decide the question.

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For the pivotal alternative to Obamacare, please see the Independent Institute’s book, A Better Choice: Healthcare Solutions for America, by John C. Goodman.