Prostate Cancer Screening and Management: Two Men in Their Mid-70s Consider Their Path to Treatment

Introduction. In a 3-week period, two men present to the office asking for advice regarding prostate cancer screening and evaluations they have undergone in recent weeks. 

Patient histories. The first patient is a 76-year-old man who has undergone prostate biopsy, which has revealed well-differentiated adenocarcinoma in several biopsy cuts with Gleason score 3/4. Imaging is negative for any spread. He is a healthy, vigorous man with no major medical diagnoses. He is medically sophisticated and after a long career of teaching had obtained a license for physical therapy assistant.

The second is a 75-year-old man who in recent weeks had "routine" prostate-specific antigen (PSA) testing incidentally as part of his yearly Medicare exams. There had been no new symptoms, and no signs of change in his urinary pattern. His test showed PSA of 3.9 ng/dL, and then 2 weeks late, 5.3 ng/dL. He, too, is otherwise an essentially healthy person whose only past medical history is recent years is atrial fibrillation. He has undergone two ablation procedures and been atrial fibrillation free for more than 1 year, such that his only residual medication is rivaroxaban daily. He will be seen by a urologist shortly and is concerned that these PSA readings indicate a cancer diagnosis. The situation very much worries him.

Both men are asking what these test scores mean to them regarding future therapy, prognosis, and management.