Guidelines — not always an easy answer
CMAJ 1999;160:983
In response to: J. Goertzen
James Goertzen's letter describes a serious concern among physicians attempting to interpret conflicting scientific evidence about the usefulness of a test or procedure. In the case of PSA testing for prostate cancer screening, discernment is yet more difficult, given that even the so-called "experts" disagree on use of this test.
To clarify our recommendations in the Clinical Basics article, some background is in order. One of us (N.F.) is a practising urologist with training in epidemiology, and the other (R.G.) is an epidemiologist. Fleshner would have preferred a direct recommendation for screening; Gallagher would have preferred a recommendation against screening. From our different perspectives, each of us felt that his own recommendation was correct, Gallagher because he feels there is little evidence that PSA screening reduces mortality rates, Fleshner because even in the absence of benefit in terms of mortality rates, early diagnosis and treatment with curative intent is the best way of ensuring cure and long life, particularly in a patient known to be at high risk for the disease. After much discussion, we compromised by simply stating the position of the American Urological Association.1
Unfortunately, this type of controversy is likely to become even more common in the future, as physicians attempt to practise evidence-based medicine.
We think that, ultimately, the answer for the practising physician is to describe to the patient the pros and cons of the test, find out what is important to the patient and — perhaps of more value in such a decision — what is not important to him, and then allow him to make the decision for himself.
Richard Gallagher, PhD
Cancer Control Research Program
British Columbia Cancer Agency
Vancouver, BC
Neil Fleshner, MD
Department of Surgery (Urology)
University of Toronto
Toronto, Ont.
HRoscoe@bccancer.bc.ca
 |
Send a letter to the editor Envoyez une lettre à la rédaction |
Reference
- American Urological Association. Early detection of prostate cancer [policy statement]. Baltimore: The Association; 1997. Available: auanet.org/pub_pat/policies/uroservices.html#Early detection of prostate (accessed 8 Mar 1999).
