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TECHNOLOGY: PSA tests unnecessary, but it’s typical for Medicare?

Medpundit points to a new study that questions the use of the PSA prostate test among the elderly.  As I learned via Family Medicine Notes, of positive PSA tests, some 7 in 10 are false positives (or at least don’t mean that the person concerned has cancer).  In the study, roughly 1/3 of 75 year olds got the PSA test, 88% because their doctor told them to get it. Meanwhile a substantial number of men die with but not from prostate cancer. In other words if you’re 75 and have no history of prostate cancer, what your PSA is doesn’t matter. Not only is the test a waste of money but chasing down the false positives causes more tests, costs and incoveniences down the road.

Medicare for ever has just paid  for procedures that are of dubious medical justification in its age group. Way back when there was a clinical trial of CABGs among men under 65, but very quickly and with no trial in the relevant age group, Medicare was paying for CABG’s in its population particularly in those over 75. The provision of kidney dialysis to the very old is another example of where age is not taken into account, although it is in the UK.  Whatever the moral rights and wrongs, the tradition of excessive care of the soon to-be-dead continues and there has been no debate about it. This is a classic case of where Medicare should change its payment mechanism to encourage the right behavior.  But it won’t.

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So what do you with older men with prostate cancer?