Decision support only. Not medical advice. Consult a licensed clinician before initiating or changing therapy.

Patient 008

71y·male·white·ASCVD 9.3% · HbA1c 5.9%

2 active reversal flags

  1. OncologyCritical

    PSA screening in men aged 70+

    Why flagged

    PSA screen ordered for male patient age 71; USPSTF 2018 Grade D recommends against screening at age 70+ due to overdiagnosis and treatment harms outweighing benefit.

    1. Prior guidance2012

      Routine annual PSA screening for all men beginning at age 50 (ACS/AUA early 2000s).

    2. ERSPC/PLCO2009

      High rates of overdiagnosis (20-50%); minimal absolute mortality reduction (1.3 deaths prevented per 1,000 screened); severe treatment morbidity (incontinence, erectile dysfunction).

    3. Reversal2018

      Guidelines updated

    4. Current recommendation

      USPSTF (2018): Grade C (individualized shared decision) for men aged 55-69. Grade D (do not screen) for men >= 70 years.

  2. EndocrinologyHigh

    Intensive glucose control in Type 2 diabetes

    Why flagged

    T2DM patient age 71 on insulin/sulfonylurea with HbA1c 5.9 < 7.0%; intensive control in elderly reversed by ACCORD 2008 (increased mortality).

    1. Prior guidance2008

      Universal tight glycemic control targeting HbA1c < 7.0% or < 6.0% for macrovascular risk reduction (ADA, pre-2008).

    2. ACCORD2008

      Intensive target (< 6.0%) increased all-cause mortality (HR 1.22; 95% CI 1.01-1.46) and cardiovascular mortality (HR 1.35; 95% CI 1.04-1.76) compared to standard control (7.0-7.9%).

    3. Reversal2025

      Guidelines updated

    4. Current recommendation

      ADA (Current Standards of Care): Individualized HbA1c goals. Generally < 7.0%, but less stringent targets (< 8.0%) strictly recommended for older adults with extensive comorbidities or high hypoglycemic risk.