From the Guidelines
Prostate-Specific Antigen (PSA) screening is recommended for men aged 55-69 after discussing benefits and risks with their healthcare provider, while Colorectal Cancer (CRC) screening should begin at age 45 for average-risk individuals with several options available, including colonoscopy every 10 years, flexible sigmoidoscopy every 5 years, CT colonography every 5 years, fecal immunochemical test (FIT) annually, or stool DNA testing every 3 years, as recommended by the American Cancer Society 1.
PSA Screening Guidelines
The standard PSA threshold is 4.0 ng/mL, with values above this level potentially requiring follow-up with prostate biopsy, as suggested by the American College of Physicians 1. Men with initial normal PSA results should be rescreened every 2-4 years, while those with family history of prostate cancer or African American men may begin screening earlier at age 40-45.
CRC Screening Guidelines
For CRC screening, average-risk individuals should begin at age 45, and high-risk individuals, including those with family history of CRC, personal history of inflammatory bowel disease, or certain genetic syndromes, should begin screening earlier and may need more frequent surveillance, as stated in the 2018 ACS guideline 1. Positive results from non-colonoscopy tests require follow-up colonoscopy, which is a crucial step in completing the screening examination, as emphasized by the American Cancer Society 1.
Follow-Up Procedures
Following polyp removal during colonoscopy, surveillance intervals range from 1-10 years depending on the number, size, and type of polyps found, as recommended by the American Cancer Society 1. These screening guidelines aim to detect cancer at earlier, more treatable stages, significantly improving survival rates while balancing the risks of unnecessary procedures and complications.
- Key considerations for PSA screening include discussing benefits and risks with healthcare providers, using a standard PSA threshold of 4.0 ng/mL, and rescreening every 2-4 years for men with initial normal PSA results.
- Key considerations for CRC screening include starting at age 45 for average-risk individuals, using several available screening options, and following up positive non-colonoscopy test results with colonoscopy.
- High-risk individuals may require earlier and more frequent screening for both PSA and CRC.
From the Research
Guidelines for Prostate-Specific Antigen (PSA) Screenings
- The prostate-specific antigen (PSA) test is used to detect prostate cancer at an early stage when treatment options are greater and outcomes may be improved 2.
- Screening via PSA testing may lead to a small reduction in prostate cancer-specific mortality, but it can cause significant harms related to false-positive test results, unnecessary biopsies, overdiagnosis, and overtreatment 3.
- Most guidelines recommend screening every 2 to 4 years in men 55 to 69 years of age at average risk 3.
- After a positive PSA test result, the test should be repeated, and if the PSA level is still elevated, next steps include multiparametric magnetic resonance imaging, assessment of urine or blood biomarkers, and referral to urology 3.
Guidelines for Colorectal Cancer (CRC) Screenings
- Screening colonoscopy can detect colorectal cancers in asymptomatic patients and reduce the rate of complications after brachytherapy 4.
- It is recommended to perform screening colonoscopy for men who have not had CRC screening within the 3 years preceding prostate cancer diagnosis before radiation therapy 4.
- Colorectal cancer is one of the deadliest malignancies, and its incidence is projected to more than double by 2035, especially in underdeveloped countries 5.
- Early detection and diagnosis of CRC are difficult due to its asymptomatic nature, and significant advancement has been made in the treatment of colorectal cancer, including surgery, chemotherapy, radiation therapy, and cryotherapy 5, 6.
Follow-up Procedures for PSA and CRC Screenings
- Three monthly PSA measurement is usually recommended for the first year after primary treatment for prostate cancer, and subsequently less frequent testing is required 2.
- A PSA rise after primary treatment usually indicates biochemical recurrence and often the need for further therapy 2.
- For CRC, multidisciplinary treatment is needed to cure the disease completely, and recent advances in surgical treatment, including laparoscopic and robotic surgery, have been made 6.
- Active surveillance is increasingly accepted as the preferred standard of care for patients with newly diagnosed low-risk prostate cancer, as it is associated with similar long-term survival and better quality of life than curative treatment 3.