Prostate Cancer May Be Deadlier for the Uninsured

Study found they were more likely to have a higher PSA test score, advanced disease and shorter survival

By Kathleen Doheny

HealthDay Reporter

TUESDAY, May 7 (HealthDay News) -- Men who are uninsured or underinsured get advanced prostate cancer at nearly four times the national average and don't survive as long as other men with advanced disease, a new study says.

"We've identified a group of advanced prostate cancer patients who do not do well," said Dr. Jeffrey Reese, a clinical professor (affiliated) at Stanford University School of Medicine. He's also chief of urology at the Santa Clara Valley Medical Center, a county hospital serving a large underinsured population in San Jose, Calif.

"They come in invariably because they [are] having symptoms of metastatic disease," he said, which is when the cancer has spread to other parts of the body.

Of all men diagnosed with prostate cancer at the medical center from 1998 through 2008, Reese found 71 men, or more than 14 percent, had advanced prostate cancer. That's more than three times the national average of 4 percent who have advanced cancer at the time of diagnosis.

Even though the men were offered all available treatments, their five-year survival rate was also well below the national average, Reese found.

He is due to present the findings Tuesday at the annual meeting of the American Urological Association (AUA), in San Diego.

Testing for PSA measures the blood level of PSA, thought to be a key marker for prostate cancer. "A PSA of 4 is sort of the cutoff" before doctors begin doing other tests, Reese said. Some begin testing, such as a biopsy, even sooner, at 2.5 nanograms per milliliter (ng/mL).

In the study, the 71 men with advanced cancer all had prostate specific antigen (PSA) levels above 100 ng/mL. The median PSA in the men was nearly 400.

None of the 71 men -- whose average age was 66 -- had been tested for PSA before at the Santa Clara hospital, and Reese said he suspects most or all had never had a PSA test anywhere.

Under new, less stringent guidelines issued at the meeting, the AUA suggests PSA testing be discussed by men and their doctors, especially those aged 55 to 69, weighing the pros and cons of screening. The association says the best evidence of benefit from screening is among those men aged 55 to 69 screened every two to four years.

Survival of the men in the study was lower than the national average for men with advanced prostate cancer, Reese also found. The median survival was 18 months -- half of the men lived longer -- and less than 10 percent lived three years past the diagnosis.

In comparison, 29 percent of men with advanced disease, overall, live at least five years after diagnosis, Reese said.

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COPD May Be Over-Diagnosed Among Uninsured

Patients thought to have lung condition were re-evaluated in small study

By Alan Mozes

HealthDay Reporter

WEDNESDAY, May 22 (HealthDay News) -- Roughly four in 10 uninsured patients who have been diagnosed with chronic obstructive pulmonary disease (COPD) actually do not have the lung disease, a small new study suggests.

At issue: Faulty diagnoses were made based on an evaluation of symptoms, rather than by means of the so-called "gold standard" disease test known as spirometry, which shows how well a patient's lungs are working by measuring the amount of air they can exhale and how long that takes.

The study is scheduled for presentation Wednesday at the American Thoracic Society annual meeting in Philadelphia. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

COPD is a progressive disease that makes it hard to breathe. Symptoms include coughing, wheezing, shortness of breath and chest tightness, according to the U.S. National Heart, Lung, and Blood Institute. Cigarette smoking is the top cause of COPD.

"While there have been many studies of the under-diagnosis of COPD, there has not been a U.S.-based study that has quantified the problem of over-diagnosis," Dr. Christian Ghattas, a second-year medical resident at Saint Elizabeth Health Center in Youngstown, Ohio, said in a society news release. "And yet, the cost of treating someone for COPD is high."

How high? The study team cited statistics suggesting the cost exceeds $4,100 per year.

The researchers re-evaluated 80 patients, average age 53, being treated at a federally funded health center based in Akron, Ohio, that is designed to offer medical care to the uninsured and Medicaid patients. All the patients had been diagnosed in 2011 or 2012 as having COPD or as needing an inhaler device often given to treat COPD.

Investigators found that less than 18 percent of the patients had undergone spirometry testing, despite a Global Obstructive Lung Disease recommendation that COPD not be diagnosed without such a test.

Once conducted, spirometry testing revealed that nearly 43 percent of the patients did not have any obstruction that could be construed as COPD.

What's more, another quarter of the patients had a reversible condition that is more typical of asthma than COPD.

"We were shocked at the percentage," Ghattas said. He noted that, overall, probably half the patients were misdiagnosed.

"Although the number of patients in our study was small, I believe this study is representative of an uninsured and underserved patient population," he added. "However, the findings might be different among patients who are insured. They might be higher or lower. We simply don't know," Ghattas said.

But, "it is obviously detrimental to be on medications that won't work for you," Ghattas cautioned. "You won't feel better -- and that by itself can take a psychological toll -- and you may experience side effects that can compromise other aspects of your health."

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