Australian men seeking treatment for Prostate-Specific Antigen (PSA) testing may suffer unless an active approach to help GPs manage this testing issue is introduced, according to an article published in the latest edition of the Medical Journal of Australia.

Dr Carole Pinnock, Chair of The Australian Prostate Cancer Collaboration (APCC), says the debate over PSA testing for prostate cancer has been prolonged, public, and sometimes acrimonious.

Dr Pinnock outlines effective communication strategies to support shared decision-making between doctor and patient.

"There is a pressing need to support and resource GPs to assist men in making an informed choice about prostate cancer testing.  We need to detail how patients make these decisions, discuss medicolegal issues, and provide access to decision support resources," Dr Pinnock said.

"A community education program on men's prostate or reproductive health will help to reduce the burden on the GP as the sole agent responsible for community and patient understanding of the issues."

The APCC convened a workshop on informed choice for prostate cancer testing as part of the Conjoint 4^th National Prostate Cancer Symposium and the 5^th Annual APCC Meeting held in 2003.  The workshop comprised urologists, GPs, nurses, members of non-government cancer organisations, patients and consumers.

Speakers at the meeting reported a climate of anger, frustration and, increasingly, litigation, resulting from lack of understanding of the issues at the point of testing.

Most evidence-based guidelines produced to date state that 'individuals considering a test should be fully informed about the pros and cons and make their own decisions'.  Dr Pinnock, however, says none of these guidelines addresses the issue of how to ensure such "informed choice".

Barriers that prevent men from being fully informed include:

• time constraints for the GP;
• lack of knowledge of complex issues;
• need to understand medicolegal obligations;
• wide variations in patient awareness
• need to understand how to communicate the complex areas of risk  and uncertainty to the patient.

Workshop participants also highlighted that "informed refusal" is as important as "informed consent" - a patient needs to be made aware that there is information he should consider before deciding not to have a test.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT:      Carole Pinnock, 08 8275 1169 (B/H); 0416 226 249 (A/H)
                    carole.pinnock@rgh.sa.gov.au

                    Judith Tokley, AMA Public Affairs         0408 824 306