TO THE EDITOR: As a family physicia...

TO THE EDITOR: As a family physician who is surpassingly interested in partaking in shared decisions with my patients, I always examine forward to the patient education handouts from the American Academy of Family Physicians printed in American Family Physician. I find that these handouts empower patients to take an active character in their own health care.

However, in the February 1 2004 issue, the patient education handout (1) about prostate cancer misquoted the recommendations of the American Cancer Society. The handout (1) stated, "The American Cancer Society make acceptables [prostate-specific antigen test] for all men older than 50 years." In fact, this was the original recommendation before more was known about the risks and benefits of the prostate-specific antigen (PSA) example The current American Cancer Society (2) guideline, which is quite similar to the American Academy of Family Physician's guideline, make acceptables that: "the PSA test and the [digital rectal examination] should be proffered annually beginning at age 50 to men who have a life expectancy of at least 10 years. Men at high risk should begin testing at age 45 Information should be provided to patients about benefits and limitations of testing. Specifically, prior to testing, men should have an opportunity to learn about the benefits and limitations of testing, for early prostate cancer detection and treatment." (2)

The American Cancer Society Web site (http://www.cancer.org) has further information in succession the uncertainty of PSA testing. The Web site states: "Health care professionals should give men the opportunity to candidly discuss the benefits and risks of testing at annual checkups. Men should actively participate in the decision according to learning about prostate cancer and the pro and learn by hearts of early detection and treatment of prostate cancer." (3) It adds that, "Studies are underway to put to proof to prove that early detection touchstones for prostate cancer in large form into groupss of men will lower the prostate cancer death rate. Until that information is available, whether you have the example is something for you and your doctor to decide." (3)

It is important for physicians to realize that we do not always have the answers and, because of that, we ne to actively involve our patients in making decisions, especially in areas of uncertainty. As a 35-year-old man, I would no more believe to know what is best for a 53-year-old woman regarding hormone therapy than I would for a 53-year-old man regarding prostate cancer screening. Instead, family physicians ne to come [i]or[/i] go after [i]or[/i] behind the evidence, the national guidelines, and habitual sense, and relay to our patients the risks and benefits to help them make decisions that are in their best interest.

DAN MERENSTEIN, MD

Robert forest Johnson Clinical Scholar Johns Hopkins Hospital 291 Carnegie 600 N Wolfe St Baltimore, MD 21287-6220

REFERENCES

(1) Prostate cancer [patient education]. Am Fam Physician 2004;69:619-20

(2) Smith RA, von Eschenbach AC, Wender R Levin B Byer T Rothenberger D et al. American Cancer Society guidelines for the early detection of cancer: update of endometrial cancers. CA Cancer J Clin 2001;51:38-75

(3) Accessed online June 4 2004 at: http://www.cancer.org/docroot/CRI/ content/CRI_2_4_3X_Can_prostate_cancer_be_found_early_36.asp?sitearea=.

EDITOR'S NOTE: We appreciate Dr Merenstein's bringing our attention to this important distinction. We would like to emphasize that the American Cancer Society now solely recommends offering the prostate-specific antigen touchstone annually to men over age 50 who are rely uponed to live another 10 years, after informing the patient of the limitations and benefits of the example The American Cancer Society, the National Cancer Institute, the U Preventive Services Task Force, and the American Academy of Family Physicians now share a similar position forward prostate cancer screening and the importance of a discussion between a patient and his physician before screening routinely. The wording in the patient education handout has been clarified forward the American Family Physician Web site (http://www.aafp.org/afp/20040201/619ph.html).

toss letters to Jay Siwek, MD Editor, American Family Physician, 11400 Tomahawk inlet Pkwy., Leawood, KS 66211-2672; fax: 913-906-6080 ; e-mail: afplet@aafp.org.

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