PSA (prostate specific antigen) is one way we can monitor prostate health. PSA velocity refers to the amount of change in a PSA from year to year. When doctors see a rise in PSA, they often order a biopsy. Granted, many prostate biopsies do turn out to be negative for cancer. But right now, there is no other way to determine if prostate cancer — whether it’s aggressive or non-aggressive — exists without a tissue diagnosis through biopsy.

The best way to determine whether or not a biopsy is necessary is by measuring PSA.  Waiting for a patient to exhibit symptoms of prostate cancer or to be able to detect a nodule by digital rectal exam equates to a later diagnosis, and if the patient does have cancer, it may be more advanced.

A similar problem exists for women and mammograms. In late 2009, the United States Preventive Services Task Force recommended shifting the age to start mammograms from 40 to 50, to reduce false positives that can lead to biopsies. A huge uproar ensued, leading to the American Cancer Society, among other organizations, continuing to recommended mammograms at age 40.

What’s lost in the uproar is this stark fact: These two cancers cause the second most common cancer-related deaths in men and women, and the only way we can ever hope to drop those alarming statistics down is by screening and catching those cancers early.  PSA is not perfect (nor is mammography), but both of those tests are the best means for detecting and intercepting potential problems.

Until something better comes along, it is in the best interest of potential cancer victims to implement screenings.  Not screening will result in the loss a huge number of lives.  Is it worth the cost savings of cutting back on biopsies?

One thing we can all agree on is that survivors of most cancers owe it to only one thing — “early” detection and treatment.

I have to add that on the medical malpractice side, the most common reason for damages is delay in diagnosis and treatment.  Juries will rarely be sympathetic to medical practitioners when all they see are delays that allow treatable cancers to become untreatable.

We have  to find better ways to screen and to do so affordably. Surely in 2011, we have the means to do that.

1. Prevention
2. Full disclosure about costs upfront
3. Spread out the costs over time (different calendar years0
4. Check out area dental school clinics

Read the whole article here.

– Posted by Cyndi Hughes

– Dr. David Himmelstein, when asked about the health care reform bills in Congress

Dr. Himmelstein is an associate professor of medicine at Harvard Medical School who  he helped write major studies finding that medical bills were a leading contributor to personal bankruptcies in the United States.

Read the whole article in the New York Times here.

So for any of you still trying to make sense of health care reform, check those out.

– Posted by Cyndi Hughes

– CH

“Our health care system is engineered, deliberately or not, to resist change. The people who pay for it — you and I — often don’t realize that they’re paying for it. Money comes out of our paychecks, in withheld taxes and insurance premiums, before we ever see it. It then flows to doctors, hospitals and drug makers without our realizing that it was our money to begin with.”

“… health care will cost the typical household roughly $15,000 this year, including the often-invisible contributions by employers. That is almost twice as much as two decades ago (adjusting for inflation). It’s about $6,500 more than in other rich countries, on average.

“We may not be aware of this stealth $6,500 health care tax, but if you take a moment to think, it makes sense. Over the last 20 years, health costs have soared, and incomes have grown painfully slowly. The two trends are directly connected: employers had to spend more money on benefits, leaving less for raises.

“In exchange for the $6,500 tax, we receive many things. We get cutting-edge research and heroic surgeries. But we also get fabulous amounts of waste — bureaucratic and medical.”

Read the whole story here.

–Posted by Cyndi Hughes

More thoughts on this to follow!

Then in April, the American Urological Association issued new guidelines lowering the age recommended for prostate-specific antigen (PSA) screening from 50 to 40 years.

Peter R. Carroll, professor of medicine and chair of the Department of Urology at the University of California, San Francisco, and chair of the AUA guidelines committee on PSA screening, said: “There is no patient for which there is no risk. … The new guidelines not only allow for earlier detection of more curable cancers, but also allow for more efficient, less frequent testing. . . . Evidence shows that the PSA test is more accurate in younger men. …

“The single most important message of this statement is that prostate cancer testing is an individual decision that patients of any age should make in conjunction with their physicians and urologists.” Dr. Carroll said. “There is no single standard that applies to all men, nor should there be at this time, and the AUA does not recommend a single PSA threshold at which a biopsy should be obtained.”

This is a great step forward for those of us who are promoting early detection and treatment of prostate and all other cancers.  The AUA not only urges screening at age 40, bu also cites changes in the PSA of .4 (rather than .75 as before) as a sign of potential prostate cancer and indication for further evaluation.

For a long time, doctors and guidelines have gone with the 50-plus threshold, contending that earlier screenings often result in unnecessary procedures that can be harmful. They also cite the chance of  false positives, which is an initial diagnosis that seems to confirm the disease when it turns out that it’s not cancer. False positives, many claim, cause patients stress. Yet many of us believe that more men will die with this disease than of it.

But these arguments distract from the fact that cancer of the prostate remains the second most common cancer related death in males. Without screening at all, many men will suffer a horrible death and regret not having had the disease detected early just because they were considered statistically insignificant or because medical professionals didn’t want to risk coming up with a false positive.

The good news is that with the simple PSA test and a digital exam, prostate cancer, like most cancers, can be detected early and successfully treated. Treatment consists of removing the prostate and/or radiation; in cases where the cancer is felt to be nonaggressive, the cancer is merely observed. Undoubtedly, any complications from the treatments can be directly attributed to the skill set of the treating physician. Many urologist have very low complication rates.  Unfortunately, the converse is also true.

I can’t say this enough: Early detection is our best position in treating cancers and most other diseases.  We cannot catch a disease like prostate cancer early enough to treat it if we screen only men 50 and older or not at all. As we design new health care strategies we must always keep the following question in mind:  Are we saving money or are we saving lives?

Physicals do not have be administered exactly every 12 months.  There is nothing wrong with getting checkups every 15 to 18 months — a process I call “straddling.” For instance, last year many of my patients came for physicals in October, November or December, and if they were healthy, we will not schedule their next physical until early 2009. Yet only 13 to 16 months have transpired between physicals, allowing the patient to “straddle” two calendar years — 2007 and 2008 — with only one deductible payout (in 2007).

Lab tests can run in the hundreds of dollars. Again, with some thought and research, there are ways to save. For instance, for patients who are covering costs for bloodwork, we use the services of HealthCheckUSA, a nationwide company that offers discounted lab services at a savings of sometimes more than 50 percent. A complete health profile blood test valued at $530 only costs $200 at HealthCheck.

Another way to save on bloodwork is to have all basic tests run before the physical. That way, your doctor will have the test results in hand for the appointment, saving both of you the time and expense of a follow-up visit to review test results.

Your doctor can also shop around for lower costs. For tests like chest x-rays, which I always recommend for physicals, I refer patients to outpatient radiology facilities in San Antonio like South Texas Radiology, O’Neill and Associates and M&S Imaging San Antonio, where x-rays and a radiologist’s interpretation of them can be as low as $60. That’s considerably cheaper than at a hospital, where x-rays alone can run $125, and the radiologist’s interpretation could be $25 to $35 more.

These facilities are often cheaper for other tests as well. For patients who can pay with cash at the time of the test, many facilities will discount their fees. Ask your doctor for recommendations.

For women 40 and up, I recommend pelvic sonograms, which are noninvasive, safe and are cost effective. I ask the radiologist to examine the pelvis and provide additional views of the kidneys, which can give us valuable information about other organs. This type of sonogram has led to the early diagnosis of liver and kidney cancers as well as ovarian cancer well before the cancers could manifest. Insurance usually covers pelvic sonograms, especially if a woman has symptoms in the pelvic region.

I recommend colon cancer screening with a 60-inch scope for patients in their 40s.  However, most insurance covers only flexible sigmoidoscopies (24-inch scope) before age 50; that test is cheaper than a full colonscopy because it is performed without sedation in the specialist’s office rather than a surgical center. I get around this by asking the colon specialist to use the longer scope in the under-50 patients.  With the longer scope, he can perform a more thorough exam. The cost of around $150 is much less than $800 for the full colonoscopy.

If costs are a concern, don’t hesitate to have a frank talk with your doctor. Remember, your doctor is your advocate. He can shop around for cost savings and refer you to labs he uses regularly for discounts. Many doctors will often lower their own fees to their patients to help make healthcare affordable. After all, his goal is the same as yours: to ensure your health.