Ahmad Risk <[log in to unmask]> writes
>I agree. Another example: men with prostate symptoms. I don't do a
>PR. I do PSA and refer. If I am going to refer anyway, why do PR?
I couldn't let this throw away line go unchallenged!
Why do a PSA in this circumstance? The value of a "screening" PSA,
which this is, is very frugal. We are contemplating stopping GP access
to this test unless assessing for disseminated malignancy!
The PSA is a poor predictor in an essentially normal population (30-40%
of older men have "prostate symptoms"). There is scant evidence that
treating prostatic malignancy with radical prostatectomy as opposed to
watchful waiting confers benefit, at least in 15 years.
PSA can be normal in the presence of cancer and raised in the presence
of prostatic hypertrophy.
We have just had an excellent seminar on the subject, which is why I'm
venturing into this territory!
Jon Rogers Tel: 44 117 950 7100
Southmead Health Centre Fax: 44 117 944 5498
Bristol BS10 6DF UK e-mail: [log in to unmask]
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