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Shared Decision Making and PSA Screening

January 23, 2013

PSA article screenshot“Should men get PSA tests to screen for prostate cancer?”

The Wall Street Journal posed the question in an informal, online poll last September. An accompanying article featured a debate between Richard Ablin, who’d discovered the prostate-specific antigen (PSA) in 1970, and an oncologist, Oliver Sartor. Ablin argued that the PSA test should be used only to screen men with a family history or active symptoms. For all other men, he said, a coin toss would be as effective. Sartor countered that the test finds cancers that can be treated early, acknowledging that for most men surveillance instead of active treatment is appropriate. Ablin retorted, “If we really could determine which cancers need treatment and which don’t, we wouldn’t be having this debate.”

The passage above is from this month’s AJN Reports by Joy Jacobson, “Navigating the PSA Screening Dilemma.”

The article gives a great overview of one of the big screening debates of the moment. Many of these debates are driven by changes in guidelines along with a dawning awareness in the medical community that certain tests we’ve assumed to be wholly beneficial, wholly necessary for most patients, may in fact be more harmful than not for many patients, leading to unnecessary treatment, anxiety, and waste of valuable resources.

The article also incorporates a discussion of the role being envisioned for “shared decision making” in helping patients make informed choices that are right for them. Let us know your take as a nurse or a patient, or both.—Jacob Molyneux, senior editor

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