Prostate Cancer (PC) is regarded as the most common form of cancer that is a second leading cause of death in American men. Recent reports suggest that each year, approximately 233,000 men are diagnosed with this malignancy. About one in six men in the US will be diagnosed with this condition in their lifetime and nearly 35 will die of it. This condition is mostly found in older men above 65 years or more.
There are different signs and symptoms connected with this syndrome and they may differ from one person to another. Several factors such as age, genetics, dietary habits, prostate inflammation, obesity and other lifestyle habits may increase the risk of developing this condition. As per recommendations from the American Cancer Society, men should undergo cancer screening tests at an early age (right from their early 50s or sooner). The major goal behind these tests is to identify this condition early enough so that it can be treated more effectively. Regular and standard tests help to recognize the correct disease symptoms and thus promote early treatment without any complications.
Although there is no regular screening program suggested for this cancer type, urologists often recommend men to be screened for this condition with tests such as digital rectal exam (DRE), prostate-specific antigen (PSA) test, cystoscopy or bladder scope test in order to confirm whether they have this condition.
Why Diagnosis of Prostate Cancer Is Challenging
Accurate and definitive diagnosis of this disease is often a challenging task for physicians. Appropriate risk stratification for men diagnosed with this syndrome is an initial step in diagnosis. The risk intensity (whether low-risk of death or high-risk of death or re-occurrence) will help to determine the specific treatment modality to be chosen.
In many cases decision making and timing related to the type of treatment approach to be opted for this disease is often complex and it is acknowledged that many patients may be over treated which in turn may cause unnecessary burden for them. Better diagnosis and risk stratification of high-risk men helps in more informed decision-making.
Medicare coverage is offered for annual preventive prostate cancer screening (PSA) test and DRE once every 12 months for all male beneficiaries aged 50 years or above. Healthcare providers can bill for the different therapies they provide that are reimbursable. Accurate diagnostic and procedural codes are to be reported on the claims to receive on-time and adequate reimbursement.
For e.g., ICD-9 code V76.44 indicates “Screening for malignant neoplasms of prostate.”
No Adherence to PSA Screening Guidelines – Finds a New Study
A recent survey shows that important guidelines related to prostate cancer screening across the United States are not being properly adhered to, particularly the recommendations made against screening older men. The study results were published in a research letter (published online on September 1, 2014) in JAMA Internal Medicine. Researchers said that they could not locate any particular data related to the current status of PC screening in the US and this prompted them to do this study.
As part of the survey, researchers examined data from the 2012 Behavioral Risk Factor Surveillance System (a joint initiative of the Centers for Disease Control and Prevention and the states) and analyzed data collected between January 2012 and February 2013. They found that the male respondents aged 50 years or more and without a history of PC or other related problems were reported as undergoing prostate-specific antigen (PSA) testing within the previous year.
The key findings of the survey are mentioned below –
- More than half of the men (48.5% of men aged 70-74 years and 48.4% men aged 65-69 years) who participated in the survey had undergone PSA testing.
- It was found that overall 37.1% men had been tested. However, when compared to younger men, older men had taken more testing.
- 45.7% of men aged above 75 years had taken a routine PSA test about 4 years back (even when the US Preventative Services Task Force (USPSTF) had specifically warned against routine PSA screening for people in this age group).
In October 2011, the USPSTF put forward a draft guideline recommending against conducting routine tests related to this disease at any age. The recommendation was accepted and finalized in May 2012 (while the survey was being conducted). However, the American Cancer Society and the American Urological Association still held the view that there was a strong need for men in the age group 50-74 years to carry out routine PSA testing with their physicians. Further, it was found that only 25% of men belonging to that age group were tested. Researchers say that if the hypothesis is that routine and standard tests have potential benefits, it is the younger men who will get benefited than older men.
The survey results also highlight a wide geographic variability in PSA screening across various states in the US. While adjusting prominent factors such as age, physician access and socio demographic factors the occurrence of PSA testing was recorded highest – 59.4% in Hawaii and lowest – 24.5% in New Hampshire. Moreover, this regional variation was more visible with mammography for breast cancer or colorectal cancer screening. The survey results signify the limited effect of national guidelines on clinical practice among healthcare providers.
September Observed as National Prostate Cancer Awareness Month
Recent reports suggest that about 910,000 cases of cancer of the prostate gland were reported globally (in the year 2008) and this number is expected to increase to 1.7 million by the end of 2030. These figures signify the need to create more awareness among people about this syndrome. The month of September is observed as National Prostate Cancer Awareness month in the United States. The main focus behind this celebration is to increase public understanding of the disease including its prevalence, treatment options and approaches to screening, diagnosis and prevention.