At 05:31 PM 9/9/96 +0100, you wrote:
>Further to this thread, I had a rather chastening experience today. A
>70+year old man has seeing me on + off over the years anxious about his
>prostate. I did a PR and PSA in 1992-recorded the PR as normal and the
>PSA came back as 6.9,the lab normal range up to 10.Reassurance all
>round.This year he said things were a bit worse-could I reassess?
>Gladly-Again I recorded a PR as "moderately enlarged,benign" and the PSA
>now 10.9. The lab. had by this time decided that their normal range went
>up to 4-i.e. the 1992 result could have been viewed as mildly
>abnormal.Today a letter back from the urologist who feels the prostate
>has a possibly malignant nodule on examination.Re-examining him I can
>see what he means.The point is-do we as GPs feel enough malignant
>prostates on examination to be confident enough to exclude a Ca?
>Best wishes,--
>Peter Glover
>Church View Surgery
>Rayleigh,Essex
I could only confidently say that I have diagnosed a Ca Prostate on PR exam
once in the last 5 years. All the others have had a high PSA but the
prostate felt normal. With a patient who has a high PSA, I now arrange an
ultrasound scan before I refer them to a Urologist, but really biopsy is the
final arbiter.
Regards, Chris Collins :)
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Dr Christopher T.G. Collins, M.B.B.S. F.R.A.C.G.P. Voice (wk) +61 74 957077
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