Near the end of 2015, CMS (Centers for Medicare and Medicaid Services) proposed a measure that would penalize doctors who ordered PSA tests. It would be an economic penalty, in some form of a fine. Aside from being a harsh measure, it would reinforce a trend already noted in published studies: since the US Preventive Services Task Force (USPSTF) recommended against PSA screening for prostate cancer (PCa), there is an increase in patients being diagnosed with higher Gleason scores and bulkier disease because they weren’t screened. A new study reveals early but compelling evidence that the reduction in PSA screening starting in 2013 is already leading to an increase in diagnosing men with bulkier and more aggressive PCa because they weren’t screened earlier.
CMS has backed down from the proposal, thank goodness. Much credit for this goes to a coalition of PCa patient advocacy organizations. The coalition is called PCPC3, which stands for the Patient-Centered Prostate Cancer Coalition. You may recognize one or more of the current member organizations:
- National Alliance of State Prostate Cancer Coalitions (NASPCC)
- Prostate Advocates Aiding Choices in Treatments (PAACT)
- Prostate Cancer International (PCaI)
- Prostate Conditions Education Council (PCEC)
- Prostate Health Education Network (PHEN)
- Us TOO International
All of the above groups, with the exception of PAACT, issued detailed formal statements of opposition. They joined their “patient power” with that of the American Urological Association to point out the potential harm involved with depriving men of a simple and inexpensive test. No one doubts that PSA is imperfect as a PCa biomarker, or that it has led to much overdiagnosis and overtreatment. But until a better biomarker comes along (and until men with suspicious PSA results routinely have access to noninvasive 3T multiparametric MRI before biopsy) the data shows us the consequences of halting broad screening: men being diagnosed when it may be too late for a local cure.
It is inspiring when collective action brings a poorly informed policy movement grinding to a halt. In fact, the USPSTF is taking a second look at its 2012 recommendation against PSA screening. PCPC3 has issued a statement that they are pleased by the withdrawal of the penalty proposal, and they appreciate the work of the USPSTF to revisit their original determination. My own feeling is that the researchers who began tracking the impact of reduced screening starting in 2013 brought to light a situation that needs to be reversed as soon as possible, and the power of grassroots influence brilliantly reinforced the message.