Less PSA Tests = less biopsies?

[WEBB PINKERTON]

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Wonder how many in-office urology labs will actually follow recommendations. Not many unless insurance companies force them. Might have to shut down the lab if they cant take all those unnecessary biopsies and order all those unnecessary stains.
Bet Bostwick Lab is nervous. They already lost a lot of revenue with Urovision reimbursement being slashed.

http://www.nytimes.com/2011/10/07/health/07prostate.html?_r=1

 

[2121115]

Wouldn't matter to my practice because Oppenheimer stole them all already. I hope they go to zero.

 

[KeratinPearls]

Wouldn't matter to my practice because Oppenheimer stole them all already. I hope they go to zero.

Why dont you help these guys set up an in office lab and maybe capture some of the PC? Better than losing everything.

 

[mlw03]

AUA is already coming out against these recomendations. Shocking. We're supposed to live in the age of evidence based medicine, and here we have a panel without a financial interest saying the evidence doesn't support the test, and the urologists immediately come out against it. Hard to believe their motivations are anything but the bottom line. And I'm sure plenty of GU pathologists (including one I have particuarly fond memories of from residency) will be similarly against the recommendations because they're so subspecialized that without 3 trays of prostate biopsies a day, they'll be hard pressed to justify their paychecks.

 

[2121115]

Why dont you help these guys set up an in office lab and maybe capture some of the PC? Better than losing everything.

There are not enough pathologists in our group to spare someone to leave and go sign out prostate biopsies everyday. Going off site basically takes you out of the normal work flow and there is not enough coverage to work it out. It is all economics right? You have to calculate whether the small amount of PC you would pick up would be enough to pay an additional pathologist for the practice.

 

[yaah]

They are just recommendations. Like how they came out with the limiting mammograms recommendation last year. There are tons of organizations out there - there have always been some that recommend against PSA screening, some that recommend it, and some that take no opinion. This is a comparatively large organization but it is by no means the only voice. There have always been lots of organizations that don't recommend it (I think one has been the family practice association).

For a lot of people (especially patients) it depends on your perspective and your priorities.

I don't think this is going to change much. There are already tons of men who don't go for screening. This provides more support to their decision but obviously isn't going to change it. And there remains a large number who will want it, regardless. And of course, remember that this recommendation is only for asymptomatic patients. I am not sure what % of biopsies are done on people without any symptoms whatsoever, but it's probably less than you think already.

There is also the complicating factor of active surveillance as an option after diagnosis. This still requires biopsy but treatment (and most of the complications) is deferred.

So are there men who have a doctor's appointment this month who will not get PSA screening who would have last month before the recommendations? Possibly, but it probably isn't a huge number.

 

[lipomas]

First off, you should be using "fewer" and not "less."

Second, this is a controversial area. So everyone is going to pick the recommendation that fits best with their own personal bias, be you a patient or be you a physician. If you're a patient who knows a few guys who died of PCA or who had surgery and are still alive, you might ignore that recommendation. If you know a few guys who had surgery and are now impotent and bitter then you might follow it. Of course, you probably would have followed that recommendation before it came out since there have already been other organizations with the same opinion.