A 55-year-old man comes to the office after a friend was diagnosed with prostate cancer. He has no urinary symptoms and has never had prostate cancer screening. The patient has a history of hyperlipidemia, which is being managed with lifestyle modification. He takes no medications, exercises regularly, and does not use tobacco, alcohol, or illicit drugs. Screening colonoscopy at age 50 was normal, and the patient has no significant family history of cancer. Which of the following is a true statement that should be taken into consideration when counseling the patient regarding prostate cancer screening?

Question

A 55-year-old man comes to the office after a friend was diagnosed with prostate cancer.  He has no urinary symptoms and has never had prostate cancer screening.  The patient has a history of hyperlipidemia, which is being managed with lifestyle modification.  He takes no medications, exercises regularly, and does not use tobacco, alcohol, or illicit drugs.  Screening colonoscopy at age 50 was normal, and the patient has no significant family history of cancer.  Which of the following is a true statement that should be taken into consideration when counseling the patient regarding prostate cancer screening?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bfd4_61a9_8f63_1183162fd107_MD0005_00 Prostate cancer is common, with a lifetime incidence of up to 16% of men. However, it is often relatively indolent and has a long preclinical phase in which patients do not experience symptoms. Most men who develop prostate cancer die from other causes. Prostate-specific antigen (PSA) tests can be used for early detection of prostate cancer. However, because PSA commonly detects slow-growing tumors, up to half of all screening-detected cancers are overdiagnosed (ie, cancer that would not have become clinically significant during a patient's lifetime). Different professional societies have different screening guidelines, most of which emphasize the importance of counseling and individualization of recommendations. Prostate cancer is rare in men age <55, and routine screening in this age group is not recommended. Screening is also not recommended for men age ≥70 or for those with a life expectancy <10 years because the risks likely outweigh any mortality benefits for these patients (Choice D). For men age 55-69, PSA screening likely confers reduced prostate cancer mortality, but the absolute benefit is small and is at least partially offset by harms, including false-positive tests and adverse effects of treatment (eg, sexual dysfunction, urinary incontinence) (Choice E). Screening in average-risk men age 55-69 can be considered but should be performed only after appropriate patient education and shared decision-making. However, these screening recommendations do not apply to patients with increased prostate cancer risk (eg, African Americans, positive family history) or to diagnostic testing in symptomatic men. (Choice A) Digital rectal examination (DRE) is helpful in evaluating for possible prostate cancer in men with an elevated PSA. However, it has low sensitivity and specificity for screening and is generally not recommended for prostate cancer screening. (Choice C) Screen-detected prostate cancer is often localized and indolent. A "watchful waiting" approach may be preferable to aggressive treatment for these tumors and may reduce the harms resulting from screening. Educational objective: Prostate cancer is often indolent, and most men with prostate cancer die from other causes. Screening for prostate cancer with prostate-specific antigen can be considered for men age 55-69, but the absolute benefit is small. Screening is not recommended for those age <55 or ≥70 or with a life expectancy <10 years. References: Screening for prostate cancer: recommendation statement. (http://www.ncbi.nlm.nih.gov/pubmed/30277733)

A 55-Year-Old Man Comes to the Office After a Friend