Uninsured With Prostate Cancer Diagnosed With More Advanced Disease

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Patients on Medicaid also more likely to have more severe cases
Friday, Sept. 17 (HealthDay News) -- Prostate cancer patients who are uninsured or on Medicaid at the time of their diagnosis tend to have more severe disease, likely because they have less access to medical care, U.S. researchers report.

They analyzed National Cancer Database records of 312,339 prostate cancer patients diagnosed between 2004 and 2006 to compare insurance status and measures of disease severity: prostate-specific antigen (PSA) levels; Gleason score (a higher score means more aggressive cancer and a poorer prognosis); and tumor stage.

Compared to patients with private insurance, those who were uninsured or Medicare-insured had higher PSA levels and Gleason scores, and were more likely to be diagnosed with advanced cancer.

The five-year relative survival rate for men with advanced prostate cancer is 30.6 percent, compared with 100 percent for patients diagnosed with localized or regional prostate cancer, according to the American Cancer Society.

"Strong associations between insurance and disease severity are likely related to lack of access to preventive services such as PSA screening and barriers to timely medical evaluation of urologic symptoms," American Cancer Society epidemiologist Stacey A. Fedewa said in a press release from the cancer society.

"Although there are unresolved questions about risks and benefits of PSA screening, it is important that all men have the opportunity to be informed about this option as well as access to other preventive health services and primary care," she continued. "In addition, it highlights the importance of continued research to reduce uncertainties about the prevention and early detection of prostate cancer, prognostic factors and improved treatment."

While new research suggests that older men with low PSA levels may not benefit from further prostate cancer testing, the cancer society recommends that men aged 50 and older talk with their doctors about the risks and benefits of baseline screening. Black men and men who have a close family member diagnosed with prostate cancer before age 65 should start talks about screening at age 45, and men with multiple family members affected by the disease before age 65 should discuss screening by age 40, according to cancer society guidelines.

The study appears online in the journal Cancer Epidemiology Biomarkers and Prevention.



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