A man comes in with symptoms of prostatism
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A man comes in with symptoms of prostatism. What about prostate specific antigen testing then? Let’s say you decided that you are not necessarily offering testing to all of your patients. But if a man comes in with prostatism, what should you do? Well, I’m sure all of you know that if you referred that patient to a urologist, which is becoming less frequent, at least in my practice, they would do prostate cancer screening on a careful basis. But if you are sitting with a man and you decide you are going to start them on an alpha blocker therapy, titran, should you also, as part of your evaluation, include a PSA test? The PSA in men with benign prostatic hypertrophy is much less, the specificity drops. So you are going to deal with more false positive tests in this population. In the AHCPR guidelines for how should you work up men with prostatism, they do not recommend PSA testing. I happen to do it. I do it especially with my patients saying … let me tell you the discussion that I do, and the real point of this discussion is; there are a lot of patients who are going to develop these problems. It’s unclear, should we screen them. You are supposed to elicit the patient values as to whether you should do the test or not. My discussion with men is to say, “There’s this test I can do that can find out whether you have prostate cancer. If you have a positive test, I’m not sure you’ve got it, but what I would recommend you undergo is a biopsy to see if you have the disease. If you undergo a biopsy and it is positive, it is still not clear whether we should do anything about it. What we do is we look at it under the microscope, and it looked like an angry tumor, we would recommend either radiation therapy or surgical resection. But I’ll tell you, if it looks sort of calm and is just sitting there, we might recommend that we do nothing at all. Now how would you feel if we went through this workup and I looked at you and said, ‘the best treatment may be to do nothing, or to do x-ray therapy, or to do surgery?’ is this still something you want to do?” And that’s actually my way out of the discussion. A surprising number of men still say, “I’d rather know than not know.” A surprising number of men say, “Never mind. Let’s not do it.” But I actually do that discussion with all men. Canadian viagra online.
With my patients who are women between the ages of 40 and 50, I say, “The American Cancer Society recommends that you undergo a mammogram every one to two years. However, the data I read suggested that it won’t necessarily help you live longer by doing that. If you were at standard risk for breast cancer, this decision is really up to you. What would you like to do?” And you need to document that you had that kind of discussion. Because, by the way, you in risk management, meaning malpractice hell, if you at least have a document of such discussion with the patient.