What has your doctor told you about PSA testing?


According to a recent article in the Annals of Family Medicine, about 64 percent of 3,400 men aged between 50 and 74 years of age who participated in a survey conducted in 2010 stated that they had never had a conversation with their doctor about the pros and cons of PSA testing.

There is already a nice summary of this paper available on the HealthDay web site, and we see little point in repeating the same information here. The full text of the original paper by Han et al. is also accessible on line.

The bottom line is perhaps best encapsulated in some comments made by Dr. Robert Ferrer, the vice chair for research in the department of family and community medicine at University of Texas Health Science Center at San Antonio, as follows:

  • Doctors have “a duty to help patients understand in situations where there are competing benefits and harms.”
  • “The PSA decision is no more complex than many other health care decisions.”
  • The medical profession needs to find ways to educate patients even if doctor visits are brief and cluttered with other tasks.
  • Clinicians have a responsibility to help patients make decisions consistent with their preferences.

Now that sounds like one of the most sensible sets of comments we have heard about PSA testing in the past 20+ years!

The article by Han et al. is, in fact, just one of four articles dealing with PSA testing that are available in this issue of the Annals for Family Medicine. They are, probably, all worth reading together as a group:

There is a real value to the patient community of being well aware of research and discussion like this that is going on within the primary care community. It can be balanced against the more dogmatic “guidelines” issued by everyone from the U.S. Preventive Services Task Force to the American Urological Association.

3 Responses

  1. FERRER & GILL EDITORIAL ECHOES UNCRITICAL ACCEPTANCE OF USPSTF RECOMMENDATION AGAINST SCREENING, AND ACCEPTS PROFOUNDLY FLAWED SCREENING DATA FROM ERSPC AND PLCO (IMPLICIT)

    I’ve read the editorial, and I find their comments on shared decision making thoughtful. However, I feel they are poorly informed about the key flaws in the Task Force recommendation and the studies upon which it was based, which have been discussed numerous times here.

    I hope to read the other references above.

  2. Dear Jim:

    I don’t think we have a clue how well or poorly Drs. Ferrer and Gill are informed about how the USPSTF reached its conclusions. They are very careful to not comment on the appropriateness of the USPSTF recommendation!

  3. I got annual PSA tests since I was about 40 I believe. When my PSA doubled in one year from 2.9 to 5.4 my GP recommended a urologist and a biopsy. However, being on finasteride for BPH my PSA was more like double the reported number. So I have Gleason 9 prostate cancer and after an RP I was stage pT3b. So I wish I had a biopsy years earlier before it had spread. Due to biochemical recurrence (PSA rose to 0.3) 8 months post-op, I’ve since had ADT and SRT and my PSA is undetectable.

    Who knows if I have prostate cancer anymore?

    Bob

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