Prostate cancer and the PCP: The screening dilemma

Abstract

The primary care provider (PCP) is in a difficult position with the myriad of recommendations regarding the screening of prostate cancer. New guidelines suggest that testing the general population lacks evidence whereas others state that it is appropriate in the correct patient. Universally all of the recommendations state that the PCP should involve the patient in a 'shared decision process' with whichever guideline they chose to follow. Regardless of the provider's belief or agreement with any of the guidelines one must question the feasibility of this process. Time and lack of urologic education are both obstacles for the PCP who is the gatekeeper for patient evaluation. In this perspective piece, the origin of the prostate-specific antigen (PSA) test is explored along with what the value truly means. The implementation of shared decision making is objectively reviewed as well as the ramifications of the entire process. In an endeavour to simplify screening for prostate cancer a logically based algorithm is offered.