Latest ERSPC, NEJM

[urologologist]

Hey there,

So needless to say we are all aware of the current debate, the AUA's stance against the task force recommendations and now the most recent update to the ERSPC trial out on the NEJM this week. I don't want to talk about the future medical consequences but rather, the other part that's behind it. $$$

Basically, I'd like to hear some opinions regarding the financial impact that the current recommendations (against PSA screening, in case you are living under a tree) you believe will have on the field of Urology and your practice in general. (primarily stone guys can try and avoid the "well, my business is mostly stone based")

Thanks,

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[urologologist]

Hey there,

So needless to say we are all aware of the current debate, the AUA's stance against the task force recommendations and now the most recent update to the ERSPC trial out on the NEJM this week. I don't want to talk about the future medical consequences but rather, the other part that's behind it. $$$

Basically, I'd like to hear some opinions regarding the financial impact that the current recommendations (against PSA screening, in case you are living under a tree) you believe will have on the field of Urology and your practice in general. (primarily stone guys can try and avoid the "well, my business is mostly stone based")

Thanks,

A follow up question.

2. If the situation is as follows
Prostate Cancer -> Mostly ignored
ED -> Mostly medically treated
BPH -> Mostly medically treated

Whats our new bread and butter?

 

[DocEspana]

Every other field out there ignores the task force recommendations. They are made solely to keep costs down rather than actually save lives.

If everyone was honest with themselves, it should lower the rate of PSA testing. The urologist I talk to all (n=4) admit that PSA is a rather pointless test unless there is high clinical suspicion of prostate cancer and it does lead to unnecessary and damaging procedures done for results alone, rather than clinical indications.

But everyone is not honest with themselves. And for that reason they will do as the gynecologists, breast surgeons, and internists do and flip the bird to the task force recommendations and continue to get full reimbursement for what they have always done thanks to the specialty society recommendations being in line with the status quo.

It should have little effect on anything.

 

[Sol Rosenberg]

A follow up question.

2. If the situation is as follows
Prostate Cancer -> Mostly ignored
ED -> Mostly medically treated
BPH -> Mostly medically treated

Whats our new bread and butter?

No way will prostate cancer be mostly ignored. Someone showed me this article (from a newspaper, so this is not something that I'm presenting as a top tier of evidence or anything like that) and it pretty much lays the issues out:

http://galvestondailynews.com/story/270466/

Urologists will still do plenty of prostates. I didn't quite understand what you were getting at in your first post, but some might argue that stones were the bread and butter of urology anyway. Whatever the case, the general urologist who does a good mix of stones, prostates, office, medical, and some "big" cases like kidneys will still be plenty busy, and plenty compensated. MAYBE that mix will change a little based on the new recs, but I agree with DocEspana that most of the recs will be ingored anyway. It'll just take a couple of people being diagnosed with metastatic prostate cancer that were never screened with PSA suing their PCP to re-change the standard of care (if it ever changes in the first place.) My personal hope is that something pans out from all the research that is being done into alternate markers for prostate cancer and that, ultimately, we will have a better screening test.