Prostate Cancer in Older Men

Dorothy A. Calabrese, MSN, RN, CURN, CNP

Disclosures

Urol Nurs. 2004;24(4) 

In This Article

Screening for Ca P in Older Men

Screening the general population is a controversial topic, and screening older people is a topic that can generate much discussion and disagreement. The question of screening the general male population for prostate cancer has never been answered definitively. Recommended screening consists of a yearly DRE and a PSA blood test. Evaluating changes in the PSA or DRE allow the health care practitioner to evaluate any variations and to make recommendations regarding the best course for the patient (continued monitoring vs. a prostate biopsy).

When screening for Ca P should stop has never been identified; it is generally felt that a person with a life expectancy of 10 years or less does not need screening since Ca P is generally a slow-growing cancer. The need for screening with its implications and/or stopping the yearly screening process should be discussed by the patient and his health care practitioner (Gerard & Frank-Stromborg, 1998).

Proponents of screening argue that this simple process allows Ca P to be diagnosed at an earlier state, a stage that is potentially curable. Since Ca P is such a prevalent diagnosis, early detection and cure can reduce the risk of metastatic disease. Opponents of prostate cancer screening argue that screening has not ultimately changed the outcome for patients with prostate cancer. They also feel that the emotional and financial costs of screening are unnecessary. Screening has resulted in anxiety for men and their partners as well as unnecessary procedures (for example, prostate biopsies and scans). Opponents also believe that older men found to have prostate cancer through screening may be treated unnecessarily. This can lead to significant sequelae that affect quality of life (Vaughn, 1998).

While a PSA is a "simple" blood test, the implications of testing should be discussed with the patient and his health care practitioner prior to the process. A patient with multiple medical problems and/or one who does not have a life expectancy of 10 years probably does not need to subject himself to this process. Many older men may fit into this category (Vaughn, 1998).

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