Am I the only one who had to back peddle, apologize, and try to explain the nightmare web of "what the heck am I supposed to do" with your patients all week?

So I get a ton of med alerts in my email and on my phone. I'm sure by now everyone has seen the PSA debacle. i personally told me Patients that I was going to continue to trend PSA because I am a trender and when our building finally publishes guidance - I'll do whatever that is. Until then, business as usual for me and tracking PSA on my old duddes.

I work nephrology so many of my pts PSA levels are elevated. What's the deal?

New recommendations against using PSA for prostate cancer screening d/t low reliability of current tests, for those who haven't seen them yet:

http://www.uspreventiveservicestaskforce.org/uspstf/uspsprca.htm

Am I the only one who had to back peddle, apologize, and try to explain the nightmare web of "what the heck am I supposed to do" with your patients all week?

So I get a ton of med alerts in my email and on my phone. I'm sure by now everyone has seen the PSA debacle. i personally told me Patients that I was going to continue to trend PSA because I am a trender and when our building finally publishes guidance - I'll do whatever that is. Until then, business as usual for me and tracking PSA on my old duddes.

Personally haven't had a huge problem with this ... but I also don't rely PSA to determine w/u or treatment. It can be helpful with decision making when it's off the charts, but there is such a huge gray area with the results/trends/influencing factors that most of the time it's a meaningless number.

What do you say to patients? That you follow the latest evidence-based medicine, and it is starting to suggest that this test is unreliable. You can still bring it into consideration when weighing w/u and treatment options, but you shouldn't solely rely on PSA levels.

Yep. I include my patients in the process. I tell them what the latest thoughts are PSA and that we have to agree on the plan. Some have said "I really want it done" some say "whatever". I also tell PTs (on pretty much all big topics) "I just read stuff and put the info out there - utlimately it's up to you - it's your life".

I still trend it but I explain to patients that a PSA level means nothing without a prostate exam, and VICE VERSA.

Velocity over level should be the focus. The USPTF recommendation does not recommend AGAINST (for men younger than 75). It makes no recommendation for or against testing.

I must say that I do routinely test men over 75 too. However I look for those that show what I would expect to be a life expectancy > 10 yrs. Some 80 y/o's are healthier than some 60 y/o's. So drawing a line between CHRONOLOGICAL age and BIOLOGICAL age is not that difficult when you see the person as a whole and not as a number.