Radiology: Volume 277: Number 3 - December 2015 Reviews and Commentary: Perspectives
Stella K. Kang, MD, MSc; Angela Fagerlin, PhD; R. Scott Braithwaite, MD, MSc
A 52-year-old man with mildly elevated prostate-specific antigen underwent a commercially available test for quantification of a gene fusion present in prostate cancer. The urologist later informed the patient of his test result – an approximate risk of 10% for high-risk (at least Gleason score 7) prostate cancer. The patient became frightened and immediately asked about further diagnostic measures. His doctor offered to order a prostate magnetic resonance (MR) imaging because he understood the test could probably exclude a clinically important prostate cancer. When the prostate MR imaging report described a lesion with “equivocal risk” for clinically significant tumor, the urologist incorrectly interpreted the posttest probability of high-risk cancer to be 50%, while the patient demanded that a “better” radiologist interpret the study and provide a more definitive interpretation for malignancy. Did the image test benefit the patient in this case? What role could the radiologist serve in such cases to support the patient’s decision-making?