Rethinking Shared Decision-Making in Prostate Cancer Screening

Kenneth Lin

Posted 2/28/12 on Common Sense Family Doctor 

Last October, the U.S. Preventive Services Task Force provisionally recommended against screening for prostate cancerusing the prostate-specific antigen (PSA) test, eliciting a variety of reactions from medical and patient advocacy groups. The New England Journal of Medicine published one of the most thoughtful responses by Mary McNaughton-Collins and Michael Barry, two physicians who have done a great deal of research on the psychological and physical harms related to false-positive tests, an all-too-common occurrence in men who receive periodic PSA testing. They respectfully disagreed with the USPSTF’s “D” (don’t do) rating for this preventive service, arguing that the rating should have instead been a “C” (don’t do routinely):

Continue reading “Rethinking Shared Decision-Making in Prostate Cancer Screening”

PSA and the Presidential Physical

Kenneth Lin

Posted 11/04/11 on Common Sense Family Doctor

Earlier this week, the White House released the results of President Obama’s periodic physical examination. Pronounced “fit for duty” by his personal physician, the President, who turned 50 earlier this year, had an unremarkable examination and normal blood sugar and cholesterol levels. Also, it seems that he’s finally managed to stop smoking – good for him. Interestingly, President Obama went against the advice of the U.S. Preventive Services Task Force and chose to receive a screening prostate-specific antigen test (which was normal), but, perhaps in recognition of the Task Force’s recent finding that the PSA’s harms outweigh its benefits, his physician felt it necessary to note in parentheses that this was an “informed patient request.” There’s no indication whether or not the President used any shared decision aids (such as this one from the Family Medicine department at Virginia Commonwealth University) to decide to undergo screening, but given the lengths his Administration went to prevent the new prostate recommendations from being released in the first place, this surely represents a small victory of science over politics.

Here’s what I wrote on March 1, 2010 about the President’s previous physical examination. Continue reading “PSA and the Presidential Physical”