By KELLI DEETER

I found Daniel Stone’s article on THCB from May,titled “Biden’s⁤ cancer diagnosis as a learning opportunity,” to ‌be quiet⁤ thought-provoking. As a certified nurse practitioner, I ofen receive‌ inquiries regarding prostate-specific antigen (PSA) testing from my male patients.

The lines between nursing ‌and medical practice can sometimes become ⁤indistinct. In Colorado, nurse practitioners‌ operate under ‌their own licenses and​ have the authority to independently​ diagnose and ⁣treat patients. Throughout my career, ​I’ve frequently had to clarify my role when patients mistakenly refer‌ to me as ‘doctor.’‍ I often find​ myself saying, “I am not a medical doctor; I am a nurse practitioner,” multiple times daily. In this context of PSA testing, I’d like to share how my nursing education influences my decisions about whether or not to recommend PSA​ tests for individuals.

The‌ guidelines for ​PSA⁣ testing established by the US Preventive Services Task Force (USPSTF) ⁢are crucial references for healthcare providers. These guidelines were last updated in 2018​ and serve ⁤as an important framework that physicians, physician‍ assistants, ​and nurse practitioners consider when evaluating patient care. Nursing emphasizes a holistic approach that incorporates patient preferences, medical history, cultural factors, and ​desired outcomes into decision-making processes regarding assessments and treatments. It is essential to remember​ that these guidelines are recommendations rather than strict rules.

The Guidelines Explained:

The‍ USPSTF advises that men​ aged ​55-69 may experience slight benefits from screening which could reduce mortality rates associated with prostate cancer; however, many may also face potential drawbacks⁢ such as​ false positives leading ‌to needless additional tests or biopsies; overdiagnosis; overtreatment; or complications arising from treatment like incontinence or erectile dysfunction. clinicians ​should refrain from screening men who do not express interest in it. For those aged 70 years or older: ⁤the USPSTF recommends against routine PSA-based screenings for prostate cancer.

This does not ​imply we should avoid ⁣testing younger men under 55 ‌or older than 70 without considering individual⁢ circumstances—each case‌ must be⁣ evaluated on its own merits ⁣rather than applying blanket assumptions.



A significant challenge is that many patients might struggle with articulating their preferences regarding screening options. It is vital for healthcare providers to dedicate time ⁣exploring each patient’s family history ⁣concerning⁣ prostate cancer along with other cancers while discussing⁢ the advantages and disadvantages of testing ⁣comprehensively—listening ‌attentively while addressing any symptoms they may present is equally important.

if appropriate—and agreed upon by ⁣the patient—a digital rectal exam (DRE) should‌ be performed alongside consideration of their⁢ medication regimen based ⁣on age factors⁢ along‍ with whether they desire treatment options at all.
In cases where ⁣symptoms arise during consultations—especially ⁣if new medications are‍ prescribed—or if an abnormal DRE result occurs obtaining consent for a baseline PSA test becomes necessary followed by⁤ scheduling follow-up appointments based⁤ on lab results or referrals per patient wishes.
For those with familial histories indicating higher risks related specifically towards ​prostate cancer early baseline screenings via PSAs could prove beneficial once again emphasizing ‍respect towards individual‌ choices throughout⁢ this process.

This‌ diversity of opinions surrounding Western medicine reflects broader societal attitudes toward personal health management choices made ‍by individuals ‌themselves concerning their bodies’ well-being.It’s crucial we acknowledge some peopel ⁣might decline further evaluations even amidst rising psas⁢ irrespective of symptomatic presence due diligence requires us⁢ documenting refusals clearly within records reflecting recommended ⁤care pathways⁢ offered previously without judgment attached whatsoever regardless age considerations involved here too!

In Biden’s‌ situation‍ specifically there⁣ hadn’t been any recorded PSAs since his⁢ vice presidency back in 2014—a⁤ point worth ​noting given he was already‌ past recommended ages set forth within⁢ existing protocols at that time! While it remains uncertain how‌ much impact such levels would’ve had upon his‍ overall health outcomes politically speaking however one cannot ignore implications surrounding nomination processes influenced heavily through these discussions today!
Stone rightly points‍ out this‍ serves indeed as an educational moment ⁣urging both parties involved—the provider advocating effectively alongside patients advocating strongly—for themselves recognizing ultimately so much revolves around personal choice deserving utmost respect throughout every stage⁢ encountered together moving forward!

I resonate deeply with Peter Attia’s outlook shared ⁢recently dated may ⁣twenty-fourth ⁢two thousand twenty-four titled “A timely though tragic lesson on prostate cancer screening.” He ​argues convincingly current‍ standards governing PSAs remain outdated since revisions last occurred back during two thousand eighteen! Attia highlights numerous ‍healthy⁣ males surpassing eighty years old living fulfilling​ lives while aggressive cancers caught⁤ early yield improved quality & longevity post-treatment interventions undertaken promptly thereafter!
Moreover access disparities persist⁢ across various demographics affecting marginalized⁢ groups including indigent populations experiencing⁢ homelessness ⁤mental illness incarceration etc., resulting substantially ⁣higher risks missing out entirely upon ‍receiving necessary screenings ⁣altogether!
During my tenure working within correctional facilities many inmates encounter healthcare services only ⁣after entering jails/prisons often representing first-time interactions ever witnessed before due largely stemming histories rooted ⁤deeply entrenched​ poverty cycles‌ coupled mental health challenges​ faced daily struggles endured long-term ⁣thus amplifying urgency behind​ ensuring​ equitable ‌access‍ opportunities ​available universally across board here too!

Aging⁢ marks fifty⁢ years old milestone ⁣prompting awareness among individuals about colorectal screenings required henceforth consolidating care efforts‍ capturing initial baseline readings via simultaneous PSAs proves favorable considering uncertainties surrounding future appointments ‌accessibility issues stemming finances transportation fears etc., potentially hindering follow-ups​ later down line altogether otherwise missed entirely otherwise lost chances forevermore!
Another aspect worth revisiting involves lowering thresholds guiding referrals towards urology imaging based solely‌ off age-related parameters driving decisions made accordingly simplifying language utilized within guidelines suggesting ⁢urgent referrals triggered whenever notable ⁤increases observed over short ⁢spans warranting immediate attention sought thereafter proactively initiating watchful ‍waiting strategies earlier through⁣ regularized‍ monitoring practices ultimately⁤ saving lives preserving desired qualities ‍experienced throughout life journeys ahead!

Kelli ⁢Deeter is an experienced​ board-certified family nurse practitioner specializing⁤ across geriatrics rehabilitation ‌correctional⁣ settings women’s health mental⁢ wellness ​complex chronic conditions spanning twelve fruitful years ⁤dedicated service delivery excellence achieved ‍consistently throughout her career journey thus far!.