FOR USA ONLY- PSA Testing Under Fire by CMS

Here is a newly emerged advocacy opportunity regarding the PSA test and Prostate Cancer in the USA. Malecare feels you should be empowered to participate in this national health policy issue.

CMS' Center for Medicare issued what is known as a Medicare Advantage Call letter. In the letter, the CMS signals to Medicare Advantage Plans that they will put a Healthcare Effectiveness Data and Information Set (HEDIS) "non-recommended PSA screening measure" as a display measure in 2018 and will consider it for the 2019 Star ratings. CMS is the US federal agency that administers Medicare, Medicaid, and the State Children's Health Insurance Program.

Here is the text of the CMS recommendation:

"Non-Recommended PSA-Based Screening in Older Men (Part C).

This measure (PSA) reflects the percentage of men age 70 and older who were screened unnecessarily for prostate cancer using the prostate-specific antigen (PSA) based screening. It excludes men in hospice, men with a prostate cancer diagnosis or dysplasia of the prostate. It also excludes those with a prior-year PSA test that was elevated (that is, a PSA in the current year is needed for monitoring) and excludes those who were dispensed prescriptions for 5-alpha reductase inhibitor (5-ARI) during the measurement year. CMS plans to report PSA on the 2018 display page and will consider it for 2019 Star Ratings."

There are several exclusions listed, but the recommendation does not account for comorbidities, individualized risk for prostate cancer, prolonged life expectancy past age 70 and patient preferences.

If you disagree with the CMS, you might suggest that exclusions should be provided for men at high risk, including African Americans, men with a family history of BRCA gene and those with a family history of prostate cancer. Or, that the CMS should wait until late 2017 or 2018 when the USPSTF issues it's revised recommendation regarding PSA testing.

The recommendation is focused on men age 70 and older. If you agree with the CMS, you might email your support because older men in the USA could face treatment that diminishes quality of life with little to gain in life longevity and that concern about prostate cancer in older men may distract attention from more life threatening issues.

Malecare encourages you to think about your own concerns about PSA testing for men over the age of 70 and to share them with the CMS. Comments might be made public, so avoid including specific confidential information. Comments must be received by March 3, 2017...please send yours, today.

Send your comments to: AdvanceNotice2018@cms.hhs.gov

Please feel encouraged to email me with any other questions or comments.

Best regards,

Darryl

Darryl Mitteldorf, LCSW

Executive Director

Malecare

darryl@malecare.org

5 Replies

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  • if a man expects to live ten years or more, he should be screened at least every 2 years according to the british study. The current psa recommendation is misguided and misunderstands the US study. There was no arm where people read in magazines that a psa test was not recommended by the USPSTF.

  • My urologist of 16yr. has his clinic partners displeasure about the CMS, posted in the waiting room. Some of you may not be aware that MEDICARE will only pay for ONE PSA test per year.

  • I cannot understand what they are even talking about doing. A 2019 star rating? But if they are thinking of continuing in any way the current USPSTF statement on PSA testing, I think that they are deranged.

  • I just emailed this to AdvanceNotice2018@cms.hhs.gov :

    I am a 73-yo athlete with projected lifetime expectation of 103 … unless you count my advanced metastatic (to my mediastinum, pressed against my L carotid artery) prostate cancer with a PSA of 52 and a doubling time of four months. I am just entering a custom-tailored, all-out ADT, chemotherapy, and antiangiogenesis assault on my cancer, with very frequent PSA monitoring as my primary metric of titration of the dozen or so drugs involved. I was notified just yesterday that Medicare will now only pay for one PSA per year (my state prohibits me from simply buying them).

    You want to deny me a few dirt-cheap test procedures requested by the Mayo Clinic, Fred Hutch Cancer Research Center's Seattle Cancer Care Alliance, and the Compassionate Oncology Medical Group of Los Angeles just to save a few lousy bucks … just as my VA PCP (I am a Priority 1 Viet Nam era veteran) did in 2015 when my PSA was passing through its most critical phase since my 2004 VA prostatectomy? This isn’t routine screening — like that which saved my life in 2004; it is part and parcel of my ongoing life-prolonging medical treatment.

    SHAME ON YOU!

  • Excellent