At 17:31 on 9/9/96, Peter Glover 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?
Be sensible, use the correct part of the brain.
If your reasoning is correct we should send all males to a urologist or all
people to the hospital when they cough, vomit, have a headache, etc, etc
It's not solved, still, what the best treatment is.
In elderly it could be correct to wait and see and start treating when
problems develop, no sooner.
How many man have prostaat cancer at the age of 80, 90 100 years of age? (
my memory tells me 80,90,100%) And how many of those age-groups are
treated.
What are the consequences of treating versus non-treating prostate cancer:
length of life, quality of life, cost.
Do we really know the result of that difficult equation?
(Remember that when one sees results of research it is allways done by
specialists with an interest (mentaly, career-wise, financialy) or funded
by pharmaceutical establisments with the same interests (but in an other
order)
There won't be much enthousiasm for research to prove that doing nothing in
many cases is a good option.
Research like this is a typical domain for GP's. But who will fund it?
Gerard Freriks,huisarts, MD
C. Sterrenburgstr 54
3151JG Hoek van Holland
the Netherlands (31) 174-384296/ Fax: -386249
ARS LONGA, VITA BREVIS
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