Low Grade Prostate Cancer–What Will Happen Under Obamacare?

Anyone who follows my Facebook page will know that I have grave concerns over the Affordable Care Act and that I ultimately think it will fall flat on its face.  But my reasons may be different than most.

With all the research I read through and post articles about, it should be abundantly clear that our system of medicine is incredibly expensive and incredibly ineffective for today’s burden of chronic diseases.  We waste more money on stupid stuff like statins, blood pressure medications and countless surgeries.  More on this later.

On to this particular study.

There has certainly been controversy in the past few years on the dangers of overtreating breast and prostate cancers from aggressively pursuing screenings like PSA testing and mammography.  It has become clear that there is a significant harm from finding and aggressively treating cancers that never would have created a problem (the old adage about dying WITH prostate cancer instead of dying FROM prostate cancer.

To this end, researchers looked at treating low grade prostate cancer (prostate-specific antigen level <10 µg/L, stage ≤T2a, Gleason score ≤3 + 3) with brachytherapy, intensity-modulated radiation therapy, or radical prostatectomy and compared this treatment with observation.

Here’s the details:

  • Active surveillance is a more frequent form of observation, including regular PSA tests, digital exams, ultrasounds and biopsies to keep an eye on whether the cancer is progressing.
  • Watchful waiting is much less intense, relying more on the development of symptoms or less frequent PSA testing.
  • Compared with active surveillance, watchful waiting provided 2 additional months of  life expectancy (9.02 vs. 8.85 years) at a savings of $15,374 ($24 520 vs. $39 894) in men aged 65 years.
  • The life expectancy was the same in 75 year old men with a smaller cost savings of $11,746.
  • As far as treatment, brachytherapy (the use of radiation implants) was the most effective and least expensive initial treatment.
  • If a treatment was known to lead to a more dramatic reduction in prostate cancer death (in other words, if a treatment was known to add lots of years of life rather than just a few months or a year), then treatment  became more effective than observation.
  • Active surveillance became as effective as watchful waiting in 65 year old men when the there was at least a 63% chance of the man progressing to treatment (basically, if the man was at a relatively higher risk, active surveillance was a better approach).
  • Active surveillance became as effective as watchful waiting when the quality of      life was 4% higher in men aged 65 years or 1% higher in men aged 75 years.
  • Watchful waiting remained least expensive in all analyses.

Overall, watchful waiting or active surveillance were more effective as well as FAR cheaper under a variety of clinical scenarios that can be laid out for the patient.

So how does this apply to Obamacare?  For a long time now, we US citizens have wanted our healthcare and we want it now.  Damn the evidence.  If a 40 year old woman wants her mammogram, she’s going to get it.  If a 65 year old male has a PSA of 8, he wants his prostate destroyed with radioactive seeds or have it taken out altogether.  If someone has a cholesterol of 230, he or she know, from the commercials, that they need a statin.

But as we gather evidence that suggests that a huge chunk of procedures that are currently done are not worth the cost and / or risk.

If Obamacare is going to be worth snot, it is going to have to deprogram us from our resource-heavy, benefit-low healthcare delivery system.  Most will view this as government getting it nose into our healthcare and making cuts, but the reality is that it is just good medicine.

Only time will tell how it all works out.


James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.