College of American Pathologists
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PSA screensand consent

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March 2003

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."