From the Guidelines
Age is the primary factor to consider when recommending prostate cancer screening for this 55-year-old male patient, as the benefits of screening may outweigh the potential harms in this age group. For men at average risk of prostate cancer, screening with prostate-specific antigen (PSA) testing typically begins at age 50-55, making this patient an appropriate candidate for discussion about screening 1. The incidence of prostate cancer increases significantly with age, with the majority of cases diagnosed in men over 65. However, starting discussions about screening at age 55 allows for earlier detection of aggressive cancers while balancing the risks of overdiagnosis.
Key Considerations
- The patient's age places him in a category where the benefits of screening may outweigh the potential harms, as suggested by the American Cancer Society guideline published in 2018 1.
- The American Urological Association recommends shared decision-making for men aged 55-69 years considering PSA screening, taking into account individual life expectancy and risk factors 1.
- The patient's lack of family history of cancer is a factor, but not the primary consideration in this case, as age is a significant risk factor for prostate cancer.
Screening Approach
- Screening involves a simple blood test (PSA) and possibly a digital rectal examination, with further testing if abnormalities are detected.
- The patient should be engaged in shared decision-making, discussing the benefits and harms of screening, as well as his individual values and preferences.
- The Prostate Cancer Prevention Trial (PCPT) Prostate Cancer Risk Calculator can be used to estimate the patient's overall risk of prostate cancer and high-grade prostate cancer, aiding in decisions about biopsy and other treatments 1.
From the Research
Factors to Consider for Prostate Cancer Screening
When recommending prostate cancer screening for a 55-year-old male with no family history of cancer, several factors should be considered:
- Age: The patient's age is a significant factor, as the risk of prostate cancer increases with age 2, 3, 4.
- Life expectancy: The patient's life expectancy should also be considered, as screening may not be beneficial for those with limited life expectancy 2, 3.
- Comorbid medical conditions: The presence of comorbid medical conditions should be taken into account, as they may affect the patient's life expectancy and the potential benefits of screening 2.
- Patient values: The patient's values and preferences regarding screening and treatment should be considered, including their willingness to undergo screening and treatment 2, 3.
- PSA levels: The patient's PSA levels should be considered, as well as the percentage of free PSA, which can help predict the risk of clinically significant prostate cancer 5.
Benefits and Harms of Screening
The benefits and harms of screening should also be considered:
- Benefits: Screening may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened, and may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened 2.
- Harms: Screening may result in frequent false-positive results, psychological harms, and harms from treatment, including erectile dysfunction, urinary incontinence, and bowel symptoms 2, 6.