Risk communication is an essential precondition for shared decision making. To support patients in their decision for or against PSA-Screening physicians need high risk competency and the ability to explain statistical data corresponding to patients' needs. The following best practice example shows how future and experienced physicians can use risk talk and shared decision making in counseling a patient for or against PSA-testing.
When treating patients with prostate cancer, the use of androgen deprivation therapy may be associated with significant and serious risks for almost every organ systems which, particularly in patients suffering from concomitant cardiovascular and/or cerebrovascular diseases, may be fatal. Rather than using GnRH-agonists (former LHRH agonists), which are known to be particularly related to serious effects, instead, GnRH-antagonists (former LHRH antagonists), intermittent androgen deprivation, androgen antagonists, or bilateral orchiectomy may be selected for individual patients. For each of these options, further evaluation will be required with regard to benefits and suitability. Considering the risks associated, limiting the use of androgen deprivation to cases with clear indication is absolutely mandatory. In patients suffering from concomitat cardiovascular and/or cerebrovascular diseases, the ratio of therapeutic benefits and risks should be considered very carefully. Basically, androgen deprivation therapy may be avoided by applying early risk-adapted PSA diagnostics which allow successful diagnosis and treatment of prostate cancer prior to the development of metastases.
