A new law
quietly went into effect in January that requires health
insurers to cover the cost of routine screening for prostate
cancer, a measure aimed at encouraging more men to consider
the benefits of being tested.
New York is the
only state in the country to pass a law that supports full
insurance coverage of the PSA (prostate-specific antigen)
blood test, which helps determine prostate cancer risk.
The new law is
the brainchild of a coalition of New York urologists and
patient advocacy organizations that not only saw a need for
the legislation, but over a two-year period made a case for
the measure among legislators in Albany.
“As far as
physician practices go, we were in the lead,” said Dr.
Deepak Kapoor, president of Advanced Urology Centers, which
has offices throughout Long Island and in New York City.
“This is something that was done for the public good.
lawmakers on both sides of the aisle who really linked arms
together to make this happen,” said Kapoor, a longtime
advocate of PSA screening. “This is what happens with
bipartisanship. It was also a great example of the private
sector and nonprofit organizations working closely with
legislators to make this happen.”
in 9 Long Island Breast Cancer Coalition was one of the
leading advocacy groups to support the law, Kapoor said.
As far as
insurance coverage, New York now puts men’s prostate
screening on par with routine mammography, which under the
Affordable Care Act became fully covered nationwide with the
act’s passage in 2010. Framers of the ACA didn’t extend
the same consideration to the PSA, despite the prevalence of
prostate cancer in the United States and roughly similar costs
for the two forms of cancer screening.
A PSA exam
averages between $60 and $80, while a mammogram can cost
anywhere from $75 to as much as $250, but generally runs about
$100, according to several local and national patient advocacy
This is about
removing barriers,” Kapoor said of the law.
Some men may
have avoided screening because their insurance company
required a copay. Others, Kapoor said, may have been wary of
testing because of misinformation about the PSA’s
criticism of the test, the PSA in the last few decades has
dramatically changed the trajectory of care by offering
screening, early detection and prostate cancer management,
The PSA is part
of our armamentarium,” he said of tools to help lower the
risk of prostate cancer. “It’s a gateway test. It isn’t
perfect and no one would say the PSA alone is a perfect
instrument. But it is a tool of a skilled provider to
determine if further testing is warranted.”
is the second-leading cause of cancer in men, with more than
240,000 new diagnoses and 28,000 deaths in the United States
While no cancer
screening is 100 percent accurate, Kapoor said the PSA has
been fraught with controversy for years.
Preventive Services Task Force discouraged screening in 2012
only to somewhat reverse itself last year. Seven years ago,
the panel — an independent committee of health experts
empaneled by the U.S. Department of Health and Human Services
— gave the PSA a grade of D. The committee makes
recommendations on clinical preventive services, particularly
panelists issued their final recommendation, giving the PSA a
grade of C for men between the ages of 55 and 69, noting those
men should have a discussion with their doctors about the pros
and cons of the test before undergoing screening. Committee
members recommended against screening for men 70 and older,
giving it a letter grade of D.
For older men,
they concluded that benefits of the test do not outweigh the
“harms,” which were defined as the anxiety produced by
additional testing required in the event of a positive result.
Older men are more likely to have slow-growing tumors that
will not lead to their deaths.
Men at average
risk should consider screening, starting at age 50, Kapoor
said, while African-American men and anyone with a family
history of the disease should consider screening starting at
age 40. Men of all ages should discuss the test with their
Kapoor — and
other doctors — say it’s better to know one’s status
than to be left in the dark.
“I am totally
in his camp on that,” said Dr. Aaron Katz, chairman of
urology at NYU Winthrop Hospital in Mineola.
trained as urologist at a time when there wasn’t a way to
screen for prostate cancer. I remember men coming in with
extreme bony pain,” Katz said of pain caused by prostate
cancer that had spread to patients’ bones by the time the
cancer was recognized.
We have to be
smart about this,” he said of screening. “We should not be
putting our heads in the sand.”
that just because a patient has an elevated PSA result does
not mean he has cancer. And even if cancer is found, he said,
the malignancy may be slow-growing and require what doctors
refer to as active surveillance, a strategy in which the tumor
is monitored over time.
Katz’s patients have been under active surveillance for as
long as 15 years.
supports active surveillance, a strategy in which the PSA also
plays a role.
of the PSA is in how you use it over time, Kapoor said.
“There’s a variety of ways to use it. If you have an
abnormal PSA, that’s an invitation for further testing. We
have the patient undergo additional evaluation and only when
warranted do we proceed with a biopsy.”