Forbes article: Guys: You Don't Want That PSA Test For Prostate Cancer

Even in the shared decision making model, which I think we do agree is where we need to get to, the doctor(s) still serve as "subject matter experts", to borrow a term from my professional life. No matter how much we read, we study, we question, we will never be the experts.

Let me pose the question this way: What IS the consulting physician's responsibility to the patient? Here's my view:

To provide information, and make sure the patient (and the family members involved) understands what the information is saying. This involves more than having a pamphlet rack in the exam room and telling the patient to pick out the ones they need.

To create a space where actual discussion is possible. The physician who puts on the paternalistic "don't ask, don't tell" attitude needs to be left in the dust. Mostly this requires the physician to make time--actual time--and to allow themselves to get connected to the patient at some level.

Depending on the situation (and this goes beyond PC), the physician needs to be willing to tell a patient who is hell-bent on an inappropriate treatment that they won't do it. And explain why.

Want to stop overtreatment? Then get the physicians to stop recommending it (and doing it).

Chask said...
This kind of promotion really annoys me.

The article says "There is convincing evidence that PSA-based screening leads to substantial over-diagnosis of prostate tumors. Many tumors will not harm patients, while the risks of treatment are significant."

The problem (IF there is a problem) is not over diagnosis, but over treatment of men without sufficient exploration of all options.

That problem, I believe is the fault of over zealous medicos who promote their own brand of treatment.

I know that was the case for me. Diagnosed by a Urologist, the only option offered was immediate surgery. Knowing no better and not being exposed to the kind of information available through this forum, I accepted his "advice". I now have significant permanent SE's which may have been avoided with a more considered treatment plan.

But compared with the outcome if I hadn't been diagnosed - just doesn't bear thinking about.

Hey Chask, Looking at the G9 Biopsy & T3 staging in your signature...... what other treatment plan would you have pursued?

Redwing57 said...
.......Sorry, feeling a bit grumpy tonight.

Its 'cause the Wings play their last game at the Joe tonight. I understand, bro.


As for the topic at hand...since prostate cancer is the number 2 cancer killer of American men, those side effects get put into perspective right quick for me. I would rather have all of the ****** side effects than die of prostate cancer.

My Gleason 7 (4+3) was "very aggressive" and "extremely dangerous". It went from unfindable to virtually exploding from out my prostrate in 11 months. My only clue was those continual pesky PSA tests every year. If it weren't for those, the PCa would have eaten my bladder and colon (it was working on them) and gone stage 4.