Patients' requests for unnecessary medical tests erode health care quality for all. Commentary by G. Caleb Alexander, MD Mr. Mansion, 69, has a history of poorly controlled hypertension, obesity, and a 30-year, pack-a-day smoking habit. During a visit with his primary care physician, Dr. Lal, for a routine annual examination, Mr. Mansion's physical examination is within normal limits with the exception of the conditions noted above. After the examination is over, Mr. Mansion questions Dr. Lal

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... out having a PSA (prostate specific antigen) test as a screening for prostate cancer. He says that his wife read that PSA screenings can save lives and he wants one. After several questions, Dr. Lal determines Mr. Mansion is not experiencing any symptoms related to his prostate. However, his patient's concern for having this test done is clear. Dr. Lal explains the test is nonspecific, and elevated results can be an indication of any number of prostate conditions, from prostate cancer to benign prostatic hypertrophy. Even prostate cancer, if confirmed after a costly work-up, is not necessarily a terminal condition. All in all, Dr. Lal advises, it's fine to rely on the office exam unless Mr. Mansion experiences symptoms that indicate prostate problems.