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Difficulty: MediumPreventive Care and Screening

A 72-year-old male presents to the clinic for a routine wellness evaluation. He has a medical history of essential hypertension that is well controlled with amlodipine. He feels well and reports no weight loss, changes in bowel habits, or urinary symptoms. He is a retired teacher who has never smoked and consumes alcohol occasionally. There is no family history of cancer. A review of his electronic medical record shows that his last preventive colonoscopy was performed 10 years ago and was normal. During the visit, the patient asks if he should be tested for prostate cancer, noting that a friend of the same age recently had a prostate-specific antigen (PSA) blood test. Which of the following is the most appropriate next step in managing this patient's preventive care?

  1. Schedule a screening colonoscopy and advise against PSA testingAnswer
  2. B
    Schedule a screening colonoscopy and order a PSA test
  3. C
    Advise against both screening colonoscopy and PSA testing
  4. D
    Order a screening ultrasound of the abdominal aorta and advise against PSA testing
  5. E
    Order a low-dose computed tomography (LDCT) of the chest and a screening colonoscopy

Answer

Schedule a screening colonoscopy and advise against PSA testing
The correct decision schedules a colonoscopy and advises against PSA testing. The United States Preventive Services Task Force (USPSTF) recommends routine screening for colorectal cancer in all average-risk adults aged 45 to 75 years. Since this patient is 72 and his last normal colonoscopy was 10 years ago, he is due for repeat screening. Conversely, the USPSTF recommends against prostate-specific antigen (PSA) screening for prostate cancer in men aged 70 years and older (Grade D) because the potential harms of screening outweigh the benefits in this age group.

Step-by-Step Solution

1
Determine the patient's eligibility for colorectal cancer screening.
The patient is 72 years old and is 10 years out from his last normal colonoscopy. He is due for screening.
USPSTF guidelines recommend routine screening for colorectal cancer in all adults aged 45 to 75 years.
2
Determine the patient's eligibility for prostate cancer screening.
The patient is 72 years old, so PSA testing should be discouraged.
USPSTF recommends against PSA-based screening for prostate cancer in men aged 70 years and older (Grade D).
3
Evaluate the need for other risk-specific screenings based on history.
The patient has never smoked.
Screenings for abdominal aortic aneurysm (AAA) and lung cancer require a significant smoking history, which this patient lacks.

Key Concept

Age-appropriate cancer screening guidelines and upper-age cutoffs (USPSTF)
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Topics

Preventive Care and Screening

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