"We wanted to make sure that it was highlighted that men really need to be screened, and it should be covered by insurance," says Adam Murphy, MD, MBA, MSCI.
In this video, Adam Murphy, MD, MBA, MSCI, discusses the advocacy surrounding PSA screening recommendations at the 2023 AUA Summit, where he was part of the discussion "Breaking Down Barriers to PSA Screening". Murphy represented R. Frank Jones Urological Society at the Summit, and he is currently an assitant professor of urology at Northwestern University's Feinberg School of Medicine in Chicago, Illinois.
PSA screening as a whole went down after the US Preventive Services Task Force gave PSA screening a D grade. That was because they thought that the risks of the tests actually outweighed its benefits. There was some data behind that for them that made that recommendation possible. They really focused on level 1 evidence and clinical trials. We didn't really have a lot of great data in that space, because the trials had been contaminated in the control arm. Those trials showed that up to 83% of the people in the control arm had screening. We had to go with data that the US Preventive Services Task Force doesn't usually use, which is retrospective data that they don't consider.
The other thing that happened in the time that that decision happened was we were not using active surveillance and monitoring approaches for prostate cancer. We can surveil people and avoid overtreating them with surgery and radiation by a lot. Now, 43% of people are getting active surveillance instead of active treatment, so that risk/benefit ratio should be skewed towards much more benefit towards screening now. We're in a different day, different era. I think has been reevaluated with urologists involved. That grade that is provided by the US Preventive Services Task Force, it's now a C. That's C still means that insurances can either cover that test or not.
One thing that I highlighted in my presentation was that I go out to the community and do screening in the community on Chicago's south and west side. Even with me showing up with my team with a free PSA test, it's hard for me to reach people to get them to do this test. We bring out giveaways, and other health materials are provided, food is provided sometimes, and still men won't get it because it's not ranking high on their priorities of things to do. We often serve people who are uninsured, underinsured, or even if they're insured, only about 38% of them will get a PSA screening in a given year.
So given all that, we wanted to make sure that it was highlighted that men really need to be screened, and it should be covered by insurance. The C grade makes it hard for folks. It's pretty much covered in men 55 to 69, based off The US Preventive Services Task Force recommendation. But it is not covered for aged 40 to 54 routinely, and that's a time when men with family history and Black men with African ancestry are at increased risk of cancer compared to whites for having prostate cancer. Our purpose was really to tell Congress that we need men with high risk for prostate cancer to be treated as if they had an A or B grade on their PSA screening so that insurances will be forced to cover the tests without a copay going to the patients, which will discourage many men from actually participating in PSA screening, even high risk men, who just are not aware of the benefits of it.
This transcription has been edited for clarity.