PSA screensand consent
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Uncertainty surrounds the ultimate medical benefit of PSA screening.
"Until we have definitive information," says urologist Gerald Chodak,
MD, of the University of Chicago, "I am looking for an interim solution."
His answer: "In my practice, no one without cancer or a history of
abnormal PSA gets a PSA screen unless he signs a consent form."
The consent form provides such information as consequences of
an abnormal test; information about the biopsy, including complication
rates and how many needles are inserted; and how many men get multiple
followup biopsies. "Once you get on this train, you are going to
the end of the track," Dr. Chodak says. The form also gives success
rates and complications of therapies.
Some clinicians argue that full disclosure would deter men from
undergoing PSA testing. But Dr. Chodak finds that 80 to 85 percent
of men in his practice choose testing after reading the consent.
He also thinks a written consent saves clinicians time.
Dr. Chodak persuaded the editor of the journal Urology
to solicit several two-page commentaries on consents, which appeared
in the January 2003 issue (vol. 61, pp. 2-22). "My goal is ultimately
to have a consensus committee create a model consent form," he says.
Urologist Peter Scardino, MD, of Memorial Sloan-Kettering Cancer
Center, has a different view. "My feeling is that there is enough
paperwork in medicine," he says. "I can have a careful conversation
with a patient and dictate a note in the chart. It is part of a
trusting relationship between doctor and patient. I don’t need the
patient to sign a consent form."