RESPONSE DISCUSSION

1) Does the problem have professional significance?

2) Does the problem have potential or actual significance for society?

3) Does the problem have the potential to build or refine evidence-based practice?

DISCUSSION

Prostate cancer screening remains a contentious health issue even in the current decade. Several guidelines have been issued by bodies like the American Cancer Society (ACS), American Urological Association (AUA) and National Comprehensive Cancer Network (NCCN) among others (Araujo & Oliveira, 2018). These organizations provide the footprint on how healthcare providers should approach the use of Prostate Specific Antigen and Digital Rectal Examination (DRE) to detect early stages of prostate malignancy (Cuzick et al., 2014). Despite the much research work that has been put into these guidelines, there lacks a clear approach in terms of the age to start screening, risk stratification, and when to initiate treatment (Ilic et al., 2018). The nurse practitioner may thus encounter difficulties when educating the male patients about how, when, and which methods to use in malignancy screening.

The use of targeted questions in history taking (subjective approach) before ordering PSA studies can be used to improve the efficiency of prostate cancer screening. Nurses and other healthcare providers should have a routine of clerking male patients to stratify their risk before recommending a PSA test. This will ensure that there is no over-reliance on laboratory studies and that the screening guidelines are more effective. The subjective approach would also seem effective in harmonizing the various guidelines.

References

Araujo, F., & Oliveira, U., Jr (2018). Current guidelines for prostate cancer screening: A systematic review and minimal core proposal. Revista da Associacao Medica Brasileira (1992), 64(3), 290–296. https://doi.org/10.1590/1806-9282.64.03.290

Cuzick, J., Thorat, M. A., Andriole, G., Brawley, O. W., Brown, P. H., Culig, Z., Eeles, R. A., Ford, L. G., Hamdy, F. C., Holmberg, L., Ilic, D., Key, T. J., La Vecchia, C., Lilja, H., Marberger, M., Meyskens, F. L., Minasian, L. M., Parker, C., Parnes, H. L., Perner, S., … Wolk, A. (2014). Prevention and early detection of prostate cancer. The Lancet. Oncology, 15(11), e484–e492. https://doi.org/10.1016/S1470-2045(14)70211-6

Ilic, D., Djulbegovic, M., Jung, J. H., Hwang, E. C., Zhou, Q., Cleves, A., Agoritsas, T., & Dahm, P. (2018). Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. BMJ (Clinical research ed.), 362, k3519. https://doi.org/10.1136/bmj.k3519