From the Guidelines
Healthcare maintenance for a 50-year-old male should include education and anticipatory guidance on prostate cancer screening, with a discussion of the potential benefits and harms of screening using the prostate-specific antigen (PSA) test.
Key Points
- The American Cancer Society recommends that men at average risk receive information about the uncertainties, risks, and potential benefits of prostate cancer screening starting at age 50 years 1.
- The American College of Physicians (ACP) recommends that clinicians inform men between the ages of 50 and 69 years about the limited potential benefits and substantial harms of screening for prostate cancer, and base the decision to screen on the risk for prostate cancer, a discussion of the benefits and harms, the patient's general health and life expectancy, and patient preferences 1.
- The US Preventive Services Task Force recommends providing information about the potential benefits and harms of screening for men aged 55-69 years, and recommends against screening for men aged ≥70 years 1.
Screening Recommendations
- Men at average risk: Discuss screening with PSA test starting at age 50 years, with screening intervals of every 2 years for men with PSA levels less than 2.5 ng/mL, and yearly for men with PSA levels of 2.5 ng/mL or higher 1.
- Men at high risk: Discuss screening starting at age 45 years for African American men and men with a first-degree relative diagnosed with prostate cancer before age 65 years, and at age 40 years for men with multiple family members diagnosed with prostate cancer before age 65 years 1.
- Asymptomatic men older than 75 years or those with a life expectancy less than 10 years: Should not be offered prostate cancer screening due to substantial harms associated with screening and treatment relative to questionable benefits 1.
Education and Anticipatory Guidance
- Clinicians should educate patients about the potential benefits and harms of prostate cancer screening, including the risks of false-positive results, overdiagnosis, and overtreatment 1.
- Patients should be informed that the PSA test is not a definitive diagnostic test, and that further testing and treatment may be necessary if the test is positive 1.
- Clinicians should help patients weigh the potential benefits and harms of screening, and make an informed decision about whether to undergo screening 1.
From the Research
Healthcare Maintenance for a 50-year-old Male
The following healthcare maintenance is recommended for a 50-year-old male:
- Medical history focusing on tobacco and alcohol use, risk of human immunodeficiency virus and other sexually transmitted infections, and diet and exercise habits 2
- Physical examination including blood pressure screening, and height and weight measurements to calculate body mass index 2
- Screening for colorectal cancer using fecal immunochemical testing, colonoscopy, or computed tomography colonography 2
- Immunizations updated according to guidelines from the Advisory Committee on Immunization Practices 2
Education and Anticipatory Guidance
Education and anticipatory guidance are important components of healthcare maintenance, including:
- Risk assessment and early intervention 3
- Prevention, primary, secondary, and anticipatory 3
- Patient-centered approach, defining outcomes based on the patient's goals and preferences 4
- Shared decision making, particularly for screenings such as prostate cancer using prostate-specific antigen testing 2
Additional Recommendations
Additional recommendations for healthcare maintenance in older adults include: