Prostate Prevention without a PSA Test
A recent review of the prostate cancer screening process by the US Preventive Task Force has patients and providers questioning how often the PSTA test should be used. While some are advocating for less testing, prostate cancer among U.S. men persists. Although American black males face the highest incidence rates of prostate cancer in the world, they are less likely to get the prevention and care they need. In the U.S.,
black males are more likely to die from prostate cancer than any other population. Health centers that serve large populations of uninsured and minority populations may have fewer patients getting their recommended screenings. 
*Map generated by Community Commons
Exposure to harm during the screening process may outweigh the benefit of being screened. Therefore, health centers have to develop additional ways to control disease and mortality rates. Fortunately, through the Affordable Care Act and the increase of patient-centered care and accountable care organizations, disease rates among the most vulnerable populations should decrease. The focus on prevention and wellness has helped health centers tackle several health issues at once. Prevention strategies employed at health centers include nutrition assistance, insurance enrollment, educational programs, counseling and mental health services, as well as self-management programs.
Health centers have unique features that can maximize the patient experience. An example is Mary’s Center, a health center program located in Washington, DC. Mary’s Center serves over 20,000 patients each year with a large population of minority patients. Additional health services include health promotion and disease prevention specific to cancer and cancer testing. The senior center and the health center partnered to provide programs and resources to the aging community. Through this partnership, the senior center is able to offer older adults various ways to manage their health through:
- Use of the teaching kitchen
- Personal nutritional counseling
- Increased physical activity at the gym
- Group exercises classes
- Attention to spiritual health through Bible study
Health centers are able to receive reimbursement from Medicare when they provide services to patients who are at risk for prostate cancer or if they treat patients who have prostate cancer. During the initial primary medical visit, patients receive a full medical exam and are surveyed about their medical history as well as. Medicare covers annual wellness visits which can serve as a comprehensive exam period, including prostate cancer screening and additional prevention services. Patients are not required to pay for services during the medical visit unless they receive a digital rectal exam (DRE) (payment is 20% of the cost).
For older adult patients receiving drug therapy for their prostate cancer, health centers may have the ability to provide medication at little to no cost. Pharmacy services may be in house at health centers like Variety Care in Oklahoma or may be provided through collaborations with other organizations such as Centro du Salud La Fe (partner: University of Texas at El Paso Cooperative Pharmacy Program). Cancer medication may be more affordable for older adults who use their Medicare Part D benefits due to changes in the Affordable Care Act. Changes include discounts of almost 50% for brand-name prescription drugs once patients enter the coverage gap and faster time through the coverage gap.
Health care providers should educate patients on ways to protect their health including making the right decision as to the whether they need a prostate cancer screening (See Take Time to Decide Infographic by the Centers for Disease Control and Prevention). Patients who are not at risk for such health conditions may not need a prostate cancer screening as those who have a family history of prostate cancer, are from a racial or ethnic minority group, or are 50 or older. Early prevention such as control over one’s diet, regular exercise, as well as a general healthy lifestyle can decrease the risk of prostate cancer in men.
,2 Centers for Disease Control and Prevention. 2013. Prostate Cancer. Retrieved from http://www.cdc.gov/cancer/prostate/basic_info/screening.htm