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Men More Likely to Be Screened for Prostate Cancer Than for Colorectal Cancer

Despite lack of evidence for mortality benefit, 75% of men older than 50 have undergone PSA screening.

Colorectal cancer screening is supported by clinical trial data and practice guidelines; in contrast, direct evidence to support prostate cancer screening is not available yet. Thus, one would assume that colorectal cancer screening is more prevalent than prostate cancer screening. To test that assumption, researchers examined data from a U.S. telephone survey in which nearly 50,000 men (age, 40) were asked whether they had undergone screening with prostate-specific antigen (PSA) tests, fecal occult blood tests (FOBT), sigmoidoscopy, or colonoscopy.

Men who were 50 or older were significantly more likely to report that they had undergone prostate cancer screening than colorectal cancer screening at least once (75% vs. 63%). The prevalence of "up-to-date" screening (for prostate cancer, PSA testing during the previous year; for colorectal cancer, FOBT during the previous year or an endoscopic test during the previous 5 years) was also higher for prostate cancer screening. In only 1 state -- Minnesota -- were men significantly more likely to report recent colorectal screening than prostate screening.

Comment: Primary care clinicians will not be surprised by these findings: PSA testing is easier and more convenient to perform than are any of the colorectal tests, and many men worry more about prostate cancer than about colorectal cancer. These screening patterns likely will persist unless results of randomized PSA screening trials, which are underway, show no mortality benefit for early prostate cancer detection.

— Allan S. Brett, MD

Published in Journal Watch General Medicine April 8, 2003

Citation(s):

Sirovich BE et al. Screening men for prostate and colorectal cancer in the United States: Does practice reflect the evidence? JAMA 2003 Mar 19; 289:1414-20.

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