Kelli Deeter
In May, Daniel Stone’s work on THCB attracted me “Biden’s cancer diagnosis is teaching moment”. In my practice as a board-certified nurse practitioner, I often ask my male patients about prostate-specific antigen (PSA) tests.
Nursing practices and medical practices often become blurred or mixed together. In Colorado, nurse practitioners practice under their own license and can independently diagnose and treat patients. In some cases where I work, I find myself frequently correcting patients who call me a “doctor.” “I’m not a doctor, I’m a nurse practitioner,” I repeat multiples every day. In the discussion of PSA tests, I would like to share my decision based on my nursing training, or not order an individual PSA test.
It is important to quote PSA testing guidelines recommended by the US Preventive Services Task Force (USPSTF), by Journal of the American Medical Association (JAMA). The last update to the guidelines was in 2018. Remember, these are guidelines for using these guidelines when doctors, physicians, physician assistants and nurse practitioners consider patients. In nursing, a holistic and team approach to patient preferences, historical, cultural considerations, and expected outcomes are weighted in decisions for evaluation, testing, referral, and treatment. The guidelines are guides, not absolute guides.
Guidelines indicate that for patients aged 55-69: Screening offers small potential benefits for some men to reduce the chances of death from prostate cancer. However, many men experience potential harms of screening, including false positive results for additional tests and possible prostate biopsy; overdiagnosis and overtreatment; and treatment of complications such as urinary incontinence and erectile dysfunction… Clinicians should not screen men who do not express screening. For patients aged 70 and older: USPSTF recommends PSA-based screening for prostate cancer. This does not mean that we as providers should not test men under 55 years of age less than 70 years of age. We need to look at each patient case independently of each other, rather than bringing everyone together.
Furthermore, patients may not know how to “express preference screening”. There must be allocated time to explore their family history of prostate and other cancers, explain to them the benefits and risks of testing, listen and discuss their signs and symptoms, perform digital rectal examination (DRE) (DRE) (DRE) (DRE) (if appropriate), and agree to the patient’s medication regimen and consider their age and their age, and whether they need treatment. Of course, if they are symptomatic and are prescribing new medications for their symptoms, or if they are symptomatic and have an abnormal DRE obtained, PSA should be obtained in the patient’s approval to establish a baseline and follow-up appointments via a repeat laboratory or referral (if the patient needs it). If a family history of prostate cancer is present, it is best to have an early PSA screening test to establish baseline. Similarly, the preferences of the patient must be taken into account.
People feel differently about Western medicine and about what they want and their bodies. We must realize that just because someone is increasingly PSA with or without symptoms, they may not agree to DRE or referral to urology, surgery, or oncology. As a provider, we should refuse to recommend care. No matter how old you are, you don’t need to test, follow-up or treatment. As for Biden, there has been no PSA test during his vice president since 2014. There is no reason to be irrelevant fact, in 2014 he was 72 years old. The guidelines are not tested at the age of 70. If the extraction situation may not have his health outcomes or treatment, the PSA level may have affected the outcomes of his nomination for the presidency, thereby politicizing nursing and medical practices. Now pointing at the fingers has changed nothing in the past. I agree with Stone, it’s a teaching moment: advocate for yourself as a patient, advocate for your patients as a provider, and believe that most of these health is a personal choice and should be respected and protected.
I agree Peter Attia in a May 24, 2024 debate, this is a tragic lesson on prostate cancer screeningPSA screening guidelines are outdated; the last revision was in 2018. Attia said that many men stay healthy and live over 80 years old and will better benefit patients’ quality of life and time of life if arrested early and received aggressive cancer. I also think it is correct to screen early in life at 50. Access to health care is a problem for many in our society. Marginalized populations, such as poverty, homelessness, geriatric, mental illness, and incarceration experiences, are at a higher risk of missing any PSA tests altogether. In my job as a nurse practitioner in the correctional system, this is usually the first time they meet a health care provider for individuals entering jails and prisons. These people usually have a history of poverty, homelessness and/or mental illness. also, New cancer diagnosis is increasing and male; 29% of new cancer types are prostate.
For most people, 50 is a milestone and they know they should be screened for colorectal cancer at this age and other screening tests. Consolidating care by capturing PSA simultaneously will establish an early baseline; always guarantee that patients with health care access issues will return to reappointment due to financial, transportation, fear or other factors. Another consideration for modifying PSA filtering guidelines is to lower thresholds PSA level based on patient age Referrals for urology to imaging and simple language into the guideline, in order to triple PSA in 6-12 weeks, may be the possibility of an emergency referral to urology. Initiating early attention waiting for PSA screening has the potential to save more lives and maintain the desired traits of life.
Kelli Deeter is a board-certified family nurse practitioner with 12 years of experience in geriatric medicine, rehabilitation, corrections, women’s health, mental health and complex chronic care.
