Posted by Bjorn Lundquist on June 02, 1999 at 15:52:26:
I have been reviewing some of the discussions on this page, and the one on PSA is really a good one. Although we do see a lot more of CaP in Sweden, we still have exactly the same dilemma. SInce I do many andology workups including endocrine evaluation, and because this might lead to testosterone replacement therapy, I want to have a PSA to guide me in the case I should refrain from HRT. So I gained quite some experience of PSA (more or less) screening. And we also have a PSA screening study going in Sweden. There is a vast discussion among lay people. People are well educated in health issues in Sweden, and there is an increasing demand from the public to have PSA tests, in the absence of symtoms, as a screening. I believe one of the important things is not to do PSA in a patient you can't expect to understand what goes down if there is a slight elevation, and all the mess with negative biopsies proving nothing you can get yourself and the patient into.
We had task forces really indulging themselves into PSA issues for several years, and we still haven't managed to develop a consensus.
What happens in Sweden, is that the judgement of each MD is crucial, an that every one has to find his or hers (we have a small number of female urologists) way of coping with the entire issue. Which as you point out doesn't help alot if your friendly neighbour colleague does a PSA on the patient, you just told it was not indicated in...