Prostate cancer is the second leading cause of cancer death among men in the U.S. According to the American Cancer Society, more than 70% of all diagnosed prostate cancers are found in men ages 65 years or older. While trends suggest that prostate cancer death rates have decreased across all racial/ethnic groups, African American men still die from prostate cancer more often than any other racial/ethnic group (ACS, 2004).

All men are at risk for prostate cancer. However, a man is considered to be at higher risk if his father, brother, or son has a history of prostate cancer.

Medicare covers the two most common tests to detect prostate cancer. The screening Prostate Specific Antigen blood test, also known as the PSA test, measures the amount of PSA enzyme in the blood, a marker for prostate cancer. The PSA blood test is not perfect; while there is good evidence that PSA screening can detect early-stage prostate cancer, the evidence is mixed and inconclusive about whether early detection improves health outcomes. The Digital Rectal Examination (DRE) is the second test Medicare covers to detect prostate cancer.

What Medicare covers:

Medicare covers 1 PSA test every year AND 1 DRE test every year for Medicare beneficiaries ages 50 and older. There is no coinsurance or Part B deductible for the PSA test, but they both apply to the DRE test.

Other helpful information:

The U.S. Preventive Services Task Force has determined that that the evidence is insufficient to recommend for or against routine screening for prostate cancer using prostate specific antigen (PSA) testing or digital rectal examination (DRE). Prostate cancer screening is associated with possible harms. These include anxiety and follow-up procedures based on frequent false-positive test results, as well as the complications that may result from treating prostate cancers that, if left untreated, might not have affected the man's health.

Since current evidence is insufficient to determine whether the potential benefits of prostate cancer screening outweigh its potential harms, there is no scientific consensus that such screening is beneficial. The U.S. Preventive Services Task Force recommends that clinicians discuss the harms and benefits of prostate cancer screening with their patients before performing screening procedures.

If early detection through screening does improve health outcomes, those most likely to benefit would be men aged 50 to 70 who are at average risk for prostate cancer and men older than 45 who are at increased risk (African American men and men whose first-degree relatives have had prostate cancer are at increased risk). Benefits may be smaller among Asian Americans, Hispanics, and other racial and ethnic groups at lower risk for prostate cancer.

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Related Links Inside CMS
Medicare.gov "Preventive Services-Prostate Cancer Screening" Prevention - General Information
Related Links Outside CMS
U.S. Preventive Services Task Force Recommendations on Prostate Cancer Screening CDC--Prostate Cancer Information NCI--Prostate Cancer Information American Cancer Society--Prostate Cancer Information

Page Last Modified: 05/12/2008 7:40:08 AM
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