According to Medicare.gov, men over 50 qualify for prostate cancer screenings every 12 months. You can get prostate screening as early as the day after your 50th birthday. Medicare covers two prostate screening options:
- Digital rectal exam – the doctor inserts a gloved, lubricated finger (“digit”) into your rectum.
- PSA blood test – measures the amount of prostate-specific antigen (PSA) in your blood.
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American Cancer Society recommends you talk with your doctor to “make an informed decision” before deciding to get tested for prostate cancer.
Talk with Your Doctor Before Testing
Screening for prostate cancer has benefits and risks. Prostate cancer is the second leading cause of death in American men, behind lung cancer. Thus, screening and early treatment can prevent cancer from spreading and save your life!
However, “most men diagnosed with prostate cancer do not die from it.” Furthermore, prostate screening has possible harms, such as:
- False Negative – the test does not find anything, but you do have cancer. Risk is “extremely low, but not negligible.“
- False Positive – the test says you might have cancer, but you actually don’t. The chance of a false positive is higher.
Thus, discussing these benefits and risks with your doctor can help you decide whether to screen for prostate cancer.
PSA Cancer Screening
The PSA blood test measures the amount of prostate-specific antigen (PSA) in your blood. The Mayo Clinic says, “high levels of PSA may indicate the presence of prostate cancer.” However, “many noncancerous conditions can increase PSA level.” Thus, PSA “doesn’t provide precise diagnostic information about the condition of the prostate.”
In addition to PSA, your doctor will usually do a digital rectal exam.
Digital Rectal Exam
During a digital rectal exam, your doctor inserts a lubricated, gloved finger into your rectum. Then the health care provider feels the prostate for any abnormal lumps or hard areas. According to Mayo Clinic, “Neither a PSA test nor digital rectal exam provides enough information for your doctor to diagnosis prostate cancer.”
Thus, if you have positive test results, your doctor may recommend a biopsy to remove a sample of your prostate. The biopsy results may determine whether you have cancer or not.
Medicare Prostate Cancer Screening Costs
Medicare covers two prostate cancer screening tests: the PSA blood test and Digital Rectal Exam. Original Medicare pays 20% of the yearly digital rectal exam cost and 100% for the PSA test, as long as the doctor accepts Medicare assignment. Furthermore, you must pay the Part B deductible before Medicare covers the digital rectal exam.
In addition to cancer screening, Medicare covers cancer treatment for hospital inpatient, outpatient, and chemotherapy drugs.