Case 45: Jock Palmer

INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Provide and explain the appropriate information to Jock and answer any questions he has. You do not need to take any history or examine Jock.

The following information is on his summary sheet:

• Past medical history

• Nil significant

• Medication

• Nil

• Allergies

• Nil

• Immunisations

• Up-to-date

• Family history

• Nil significant

• Social history

• Business executive

• Divorced

• Non-smoker

• Alcohol—six standard drinks per week.

INSTRUCTIONS FOR THE PATIENT, JOCK PALMER

You are a 52-year-old executive. Your employer offers you annual screening tests. This year you received a letter informing you that the tests would include the prostate specific antigen (PSA). The company sent round an information letter but this left you confused. You trust your GP and want the GP’s opinion as to whether you should have this PSA test. You have made this appointment with your GP to discuss the PSA test.

You are well and have no urinary symptoms.

During the consultation you will ask the following questions:

1. What is the PSA test?

2. What are the advantages of having the test?

3. Is there any reason not to have the test done?

4. If the test is high, does that mean that I have cancer?

5. What would happen if the result was high?

6. Should I have the test?

The following information is on your summary sheet:

• Past medical history

• Nil significant

• Medication

• Nil

• Allergies

• Nil

• Immunisations

• Up-to-date

• Family history

• Nil significant

• Social history

• Business executive

• Divorced

• Non-smoker

• Alcohol—six standard drinks per week.

SUGGESTED APPROACH TO THE CASE

Re-establish rapport

Acknowledge that this is a complex and controversial issue

Question Jock about his understanding of PSA tests

Question Jock about his general health—exclude weight loss, fatigue, fever, bone pain, family history of prostate cancer

Specific questions

To exclude urinary symptoms

• — Frequency

• — Stream

• — Nocturia

• — Haematuria

• — Dysuria

Tailor explanation of PSA test to address Jock’s concerns

• — PSA comes from the prostate

• — Test has limited accuracy and can be affected by a number of conditions/scenarios

• — Low result does not mean that there is no cancer

• — Raised result does not mean that there is cancer

• — Trend of results provides some clinical ...