Coffee & Coverage: Prostate Cancer Screenings and Medicare

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Prostate cancer is a leading cause of cancer death in men, second only to lung cancer. There is a test available to get regular screenings to determine if you are at risk.

What is the PSA test?

The PSA test is a blood test that measures the amount of the prostate-specific antigen in the blood. However, it’s important to note that high levels of the PSA antigen don’t necessarily mean that cancer is present. A high PSA test result could simply be due to age, irritation, infection, or other factors.

Factors that can raise PSA levels:

  • Enlarged prostate
  • Inflamed or infected prostate
  • Age

Factors that can lower PSA levels:

  • Drugs to treat an enlarged prostate or urinary conditions
  • Chemotherapy
  • Obesity
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Digital rectal exam

The prostate-specific antigen (PSA) test is usually performed in conjunction with a digital rectal exam (DRE) in which the doctor examines the prostate glands to see if there are any abnormalities or lumps.

If either the PSA test or the DRE displays abnormalities, a doctor will order a transrectal ultrasound of the prostate or a prostate biopsy to check if it is indeed cancer.

An important note: some prostate cancers are not threatening to a man’s health or survival in his lifetime. In this case, cancer would just be watched. A doctor would not order treatment so as not to put the man at risk for other health problems that could result from treatments such as chemotherapy or radiation.

What Medicare covers

Medicare covers the PSA test and the digital rectal exam once a year for men 50 and older (starting the day after you turn 50). For the PSA test, you pay nothing unless your particular doctor does not accept Medicare assignment. For the rectal exam, you will pay 20 percent while Medicare will cover 80 percent of the cost. The Part B deductible and any copayments apply.

Medicare will also cover any additional diagnostic prostate cancer screenings as ordered by your doctor. For diagnostic screenings, you will pay 20 percent while Medicare will cover 80 percent of the cost.

Risk factors and symptoms

If you are over the age of 50, African-American, have a family history of close relatives with prostate cancer or have a diet high in fatty foods, it’s a good idea to get routine prostate cancer screenings. In addition, if you experience any of the following symptoms, you should get screened:

  • Difficulty urinating or weak stream
  • Frequent urination at night
  • Pain while urinating
  • Blood in the urine or semen
  • Painful or difficult ejaculation
  • Consistent pain in the pelvic area or lower back

What to know

If your PSA levels are found to be high, you still only have about a 25 percent chance of having prostate cancer. If prostate cancer is detected early, there is a very high chance of successful treatment. Talk with your doctor about your options for prostate cancer screening.

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