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LETTERS: Jeremy L Menage You have to put your finger in BMJ 2008; 336: 232-a-233-a [Full text]

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A finger in a mesh.

Jean-Claude GRANGE   (3 February 2008)

A finger in a mesh. 3 February 2008
Jean-Claude GRANGE, GP Mantes-la-Jolie, 78200,FRANCE Send response to journal: Re: A finger in a mesh.	Sir, It is obviously uneasy to convince a man presenting with lower urinary tract symptoms that doing digital rectal (DRE) examination and prostate specific antigen dosage (PSA) are false issues to address prostate cancer worrying. No evidence-based arguments are available to give weight for managing such patient with DRE / PSA combo. Nevertheless we are not only two human people in the surgery: media and urologist associations are the shadow guests of our relationship and they force the patient to believe that a “good” GP is a DRE / PSA supporter (in France Regulatory authorities, ie HAS do not recommend such an attitude (1) but l'Association Française d’Urologie est pour). So, don’t forget that if you give in you will be forced to repeat each year the same PSA dosage and you should endure the patient stress before, during and after the result. DRE / PSA combo do not predict “invasive carcinoma” as you write it and you are now ready to do the same with asymptomatic patients. Sincerely yours, JC GRANGE, GP 1 - Opportunité d’un dépistage systématique du cancer de la prostate par le dosage de l’antigène spécifique de prostate. ANAES, mai 1998, pp115 http://www.has-sante.fr/portail/upload/docs/application/pdf/psa3.pdf Competing interests: None declared