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4 - Principle of Patient Autonomy

Published online by Cambridge University Press:  25 February 2010

By
David Lambert
Edited by
John Spandorfer ,
Charles A. Pohl ,
Susan L. Rattner  and
Thomas J. Nasca
David Lambert
Affiliation:
Senior Associate Dean for Medical Student Education University of Rochester School of Medicine and Dentistry
John Spandorfer
Affiliation:
Jefferson Medical College, Philadelphia
Charles A. Pohl
Affiliation:
Jefferson Medical College, Philadelphia
Susan L. Rattner
Affiliation:
Jefferson Medical College, Philadelphia
Thomas J. Nasca
Affiliation:
Jefferson Medical College, Philadelphia
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Summary

PATIENT AUTONOMY – PRIMARY CARE

An eighty-seven-year-old man wants prostate cancer screening despite his family physician's recommendation that such screening is not warranted. He has not had any change in urinary symptoms over the past five years. His past medical history is significant for chronic atrial fibrillation, hypertension, and advanced osteoarthritis. His medications include warfarin, diltiazem and acetaminophen. He has no family history of prostate cancer.

A Perspective from a General Internist

Clinical Background

Screening for prostate cancer is done through palpation during a digital rectal examination (DRE) and measurement of the level of prostate specific antigen (PSA) in blood serum. Digital rectal examination allows for palpation of only a portion of the prostate gland. PSA measurement is used to augment the digital rectal examination in screening. PSA levels are known to rise as the prostate volume increases, even in the absence of cancer. The recommendations for initiation and frequency of prostate cancer screening are controversial. The presence of new urinary or sexual symptoms should prompt an evaluation to exclude the presence of prostate cancer.

Further testing for prostate cancer takes place if the DRE is abnormal with marked asymmetry, presence of a nodule or nodules, or a hard consistency. PSA levels that are within the normal range but rise more rapidly than expected are also an indication for further testing.

Type
Chapter
Information
Professionalism in Medicine
A Case-Based Guide for Medical Students
 , pp. 154 - 188
Publisher: Cambridge University Press
Print publication year: 2009

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