W#14 Health Promotion (replies)

Scenario E: Focus on Prostate Cancer Guidelines

Ivan is a 59-year-old Caucasian male in your office today for his annual exam. He has been reading about prostate cancer and the need to have some lab work done. His wife really wants him to get his PSA drawn, but he’s not so sure. Your physical exam of Ivan is “all normal.” When reviewing Ivan’s health assessment form, you see he smokes two packs of cigarettes a day and his only complaint is a chronic cough.

Chen is 76-year-old gentleman of Chinese descent. He is here today for an annual exam and a recheck of his blood pressure. Chen tells you he just heard from his brother that his PSA (Prostate Specific Antigen) is really high, and they are concerned he may have prostate cancer. Chen’s brother is from his father’s second marriage and he is only 59 years old. Chen is asking to have his PSA drawn to make sure he doesn’t have prostate cancer.

POST # 2 JAMIE

Prostate cancer is one of the most common types of cancer in men. Usually prostate cancer grows slowly and is initially confined to the prostate gland, where it may not cause serious harm. However other types can spread quickly and more aggressive (Mayo Clinic, 2019). Most prostate cancers are found as a result of screening with a prostate-specific antigen (PSA) blood test or a digital rectal exam (American Cancer Society, 2020).

In the first case scenario, Ivan is a 59-year-old Caucasian male in the office for his annual exam. He has been reading about prostate cancer and the need to have some lab work done. His wife really wants him to get his PSA drawn, but he is not sure. The physical exam of Ivan is "all normal." While reviewing Ivan's health assessment form, he smokes two packs of cigarettes a day and his only complaint is a chronic cough. According to the Prostate Cancer Foundation (2019), screening should begin at age 40 if the patient has a family history of it and age 55-69 to discuss with doctor. Because the patient is within the age range for prostate screening, he should be tested.     

In the second case scenario, Chen is 76-year-old gentlemen of Chinese descent. He is in the office for an annual exam and a recheck of his blood pressure. Chen states he heard from his brother that his PSA is really high, and they are concerned he may have prostate cancer. Chen's brother is from his father's second marriage and he is only 59 years old. Chen is asking to have his PSA drawn to make sure he does not have prostate cancer. As mentioned above, the Prostate Cancer Foundation does not recommend prostate screening for men above the age of 70, so Chen is not a candidate. Education needs to be provided to the patient in regard to family history. Chen's brother is not biologically related to him, so the concern with genes are low in this situation. However, it would be recommended for Chen to find out if his father had any past medical history with cancer because the genes can correlate with one another.

Although diagnosing options are the same for both patients, each of them are presenting with different backgrounds and family history. Ivan is within the proper age range for screening and should have the PSA test done. However, Chen does not have a known biological family history of prostate cancer and is above the recommended age range for screening. In this situation, as the APRN, I would not screen the second patient but instead provide education on the topic.

References

Prostate cancer - Symptoms and causes. (2019, April 17). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087

Should I Be Screened? (2019, December 10). Prostate Cancer Foundation. https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/the-psa-test/should-i-be-screened/

Tests to Diagnose and Stage Prostate Cancer. (2020). American Cancer Society. https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html#:%7E:text=Most%20prostate%20cancers%20are%20first,Screening%20Tests%20for%20Prostate%20Cancer.)