Screening for prostate cancer in asymptomatic men: clinical, legal, and ethical implications.
OBJECTIVE
To describe the opposing recommendations of the major medical organizations related to screening for prostate cancer and to explore the impact of these opposing recommendations on advanced practice nurses (APNs) who are in a position to decide who gets screened and when.


METHODS
Published medical, legal, and economic articles, published legal verdicts and settlements, case law, and news reports.


RESULTS
The national recommendations for screening for prostate cancer are conflicting and have legal, economic, and ethical implications for healthcare practitioners. Both the current early diagnostic tests, age- and race-based prostate specific antigen ranges, and the resultant treatment have significant problems and further contribute to the national controversy about whether to screen asymptomatic men. Lack of coverage for early detection of prostate cancer by many managed-care plans and Medicare also contribute to the dilemma practitioners face. However, electing not to screen "at-risk" men may subject APNs to charges of negligence or other legal theories.


CONCLUSIONS
Present recommendations by the leading national medical, cancer, and policy organizations related to prostate cancer screening are contradictory. Adding to this national quagmire is the lack of financial support from Medicare and most health maintenance organization plans to pay for early detection of prostate cancer. These conflicting recommendations place APNs in a legally and ethically precarious position. APNs and nurses with patient education responsibilities should individualize decision-making and counsel their asymptomatic patients who may be at risk for prostate cancer about the benefits and complications of screening.


CONCLUSIONS
Considering the multiple implications of the decision to screen for prostate cancer, counseling patients who may be at risk for the disease and involving them and their spouses may be the best approach in deciding whether to screen for prostate cancer in asymptomatic men.
Gerard
M J
MJ
College of Law, Northern Illinois University, DeKalb, USA.
Frank-Stromborg
M
M
D017677:Age Distribution; D000368:Aged; D004993:Ethics, Nursing; D006801:Humans; D015994:Incidence; D008297:Male; D008329:Managed Care Programs; D008403:Mass Screening / Q000331:legislation & jurisprudence / Q000379:methods*; D008875:Middle Aged; D009720:Nurse Clinicians; D009722:Nurse Practitioners; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000209:etiology; D012307:Risk Factors