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Update in General Internal Medicine
- Wendy Levinson, MD;
- Keith Roach, MD;
- Diane Altkorn, MD; and
- Scott Stern, MD
- 1998-99 Series; John Roberts, MD, Editor From the University of Chicago, Chicago, Illinois. Requests for Reprints: Wendy Levinson, MD, Section of General Internal Medicine, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637. Current Author Addresses: Drs. Levinson, Roach, Altkorn, and Stern: Section of General Internal Medicine, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637.
The advances in general internal medicine that occurred in 1997 are too numerous to describe in a single article; selecting the advances considered here required a careful assessment of both the clinical relevance and the strength of the evidence. This assessment was done by members of the Section of General Internal Medicine at the University of Chicago, who met biweekly during 1997 to review major medical journals for articles that might affect a general internist's practice. Priority was given to articles that addressed problems that general internists manage frequently. After completing this initial screening, we solicited advice from generalist and subspecialty colleagues and from the editors of ACP Journal Club.
The results of this process are summarized in Table 1. Because general internal medicine is so broad, many of the articles addressed in this Update will be discussed in more depth in the other papers in the 1998-1999 Update series.
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Cancer Screening
Testing for prostate-specific antigen (PSA) is controversial but common. We still do not fully understand the benefits and risks of this practice. Because no prospective trials have assessed the benefits and harms of PSA testing, we must draw on indirect evidence.
One important component of our understanding is the natural history of prostate cancer. In Johansson and colleagues' 15-year cohort study [1], 223 of 642 men with prostate cancer had localized disease and were given no treatment initially. The 15-year survival rate among these 223 men was 81%; this rate did not differ from the rate among 77 men who did receive initial treatment. About two thirds of the tumors were well differentiated, and about half were diagnosed incidentally in men undergoing transurethral resections. The findings therefore may not be generalizable to men undergoing PSA testing. Nonetheless, Johansson and colleagues' study is the longest study of the …
