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A new law came into effect last month compelling health insurers to cover the costs of routine screening for prostate cancer, a move to encourage more men to consider the benefits of the screening test.
New York is the only state in the country to have passed a law that supports full coverage of the prostate specific antigen (PSA) blood test, which helps determine the risk of prostate cancer.
The new law is the result of a coalition of New York urologists and patient advocacy organizations who not only felt the law was needed, but who, during 39, a period of two years, justified the adoption of this measure to the legislators of Albany.
"With respect to physician practices, we were leading," said Dr. Deepak Kapoor, president of Advanced Urology Centers, which has offices in Long Island and New York. "It's something that has been done for the public good.
"We had lawmakers on both sides of the aisle who really tied their arms for this to happen," said Kapoor, a long-time advocate for PSA screening. "That's what happens with bipartisanship. It was also an excellent example of close collaboration between the private sector and non-profit organizations with legislators to achieve this. "
The Hewlett-based Long Island Breast Cancer Coalition on 1-9 is one of the leading advocacy groups for the cause, Kapoor said.
With regard to insurance coverage, New York now combines prostate screening in men with routine mammography, which under the Affordable Care Act is now fully covered in the country since the adoption of the law in 2010. ACA officials have not paid the same attention to the PSA. , despite the prevalence of prostate cancer in the United States and roughly similar costs for both forms of cancer screening.
A PSA exam costs an average of between $ 60 and $ 80, while a mammogram can cost between $ 75 and $ 250, but usually costs around $ 100, according to several local and national patient advocacy organizations.
"It's about removing barriers," Kapoor said of the law.
Some men may have avoided screening because their insurance company required a co-payment. According to Kapoor, others may have hesitated to test because of false information about the reliability of the PSA.
Despite criticism of the test, the PSA in recent decades has radically changed the trajectory of care by offering screening, early detection and prostate cancer management, Kapoor said.
"PSA is part of our therapeutic arsenal," he said of tools to reduce the risk of prostate cancer. "It's a gateway test. It's not perfect and no one will say that the PSA alone is a perfect instrument. But it's a tool from a qualified vendor to determine if additional tests are 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 each year.
Although no cancer screening is 100% accurate, Kapoor said the PSA has been controversial for years.
The US Task Force on Preventive Services discouraged screening in 2012, but reversed somewhat last year. Seven years ago, the committee – an independent committee of health experts made up of representatives from the US Department of Health and Human Services – awarded the PSA a D score.
In 2018, panelists made their final recommendation, assigning the PSA a grade of C for men aged 55 to 69, noting that these men should discuss with their doctor the pros and cons of testing before being tested. Committee members advised against screening for men 70 years of age and over with a grade of D.
For older men, they concluded that the benefits of the test did not outweigh the "disadvantages", defined as the anxiety produced by the additional test required in case of a positive result. Older men are more likely to have slow-growing tumors that will not lead to their deaths.
Middle-risk men should consider screening as early as age 50, while African-American men and anyone with a family history of the disease should consider screening at age 40. Men of all ages should discuss this with their doctor.
Kapoor – and other doctors – say it's better to know your status than to stay in the dark.
"I'm totally on his side about this," said Dr. Aaron Katz, chairman of the urology board at the NYU Winthrop Hospital in Mineola.
"I was trained as a urologist at a time when there was no way to detect prostate cancer. I remember men coming up with extreme bone pain, "Katz said of the pain caused by prostate cancer that had spread to the patients' bones at the time of cancer recognition.
"We have to be smart about it," he said about screening. "We should not put our heads in the sand."
Katz pointed out that the fact that a patient has a high PSA level does not mean that he has cancer. And even if a cancer is detected, the malignancy could grow slowly and require what doctors call active surveillance, a strategy in which the tumor is monitored over time.
Some of Katz's patients have been under active surveillance for 15 years.
Kapoor also supports active surveillance, a strategy in which the PSA also plays a role.
"The value of PSA is how you use it over time," said Kapoor. "There are different ways to use it. If you have an abnormal PSA, this is an invitation to other tests. The patient undergoes an additional evaluation and we only perform a biopsy when it is justified. "
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