I can’t begin to count the number of times patients have asked me questions like these:
- “Why isn’t focal laser ablation covered by Medicare or insurance?”
- “My urologist said he won’t do my follow-up if I have focal laser ablation. Do you know a laser-friendly urologist in my area who will work with me?”
- “How come expensive treatments like robotic surgery and proton beam radiation are what patients hear about first when focal treatment could save so many medical dollars?”
There is no simple answer, but I’m aware that many of my patients believe that there are powerful profit-motivated “interests” that spend a lot on marketing in order to “drive patients” to certain treatments. I think this is oversimplifying. Change in medicine comes slowly, and the majority of researchers, especially those in the public sector such as investigators with the National Institutes of Health, are not led by a desire for personal gain.
An important nonprofit review body is the US Preventive Services Task Force (the Panel that recommended against broad PSA screening was a subgroup of the USPSTF). According to Wikipedia, “Recommendations are based solely upon evidence of medical benefit to the patient, no matter how expensive it is.”[i] Furthermore, “American health insurance groups are required to cover, at no charge to the patient, any service that the USPSTF recommends, regardless of how much it costs or how small the benefit is.”[ii]
How would you like to influence the USPSTF by telling them about the importance of focal therapy as a middle ground between active surveillance and radical treatment? Now is your chance!
This group has issued a call for public input on their new Draft Research Plan regarding PSA screening and where it leads. Check it out at http://www.uspreventiveservicestaskforce.org/Page/Document/draft-research-plan/prostate-cancer-screening1
When you go to the link, you will see a diagram of what the proposed research is looking to study, followed by a more detailed outline. Notice that focal therapies are not mentioned.
What follows their outline is a survey on individual items in the proposed study. Here is where you have an opportunity to bring to their attention that multiparametric MRI should precede a biopsy decision, that mpMRI targeted biopsies are more accurate and patient-friendly, and that focal therapy controls cancer without damaging quality of life.
I encourage you to take action. We need to get the attention of the USPSTF. If enough of us take 15-20 minutes to express our conviction, it will help tip the scales toward eventual widespread acceptance and even insurance coverage for FLA.
[i] https://en.wikipedia.org/wiki/United_States_Preventive_Services_Task_Force
[ii] Ibid.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
