It may be appropriate to offer prostate cancer screening to carefully selected men with a previous history of colorectal cancer. However, the risks and benefits of establishing the diagnosis in this setting need to be considered and discussed with them.
Once a patient has been appropriately educated by an informed healthcare provider about the possible benefits of PSA screening, then patient preference as part of shared decision making regarding PSA screening should be considered in all cases.
Not all patients with colorectal cancer are candidates for such screening, however, as a remaining life expectancy of at least 10 years is generally required in order for PSA screening to yield a significant mortality benefit.
The facts presented about screening should be tailored to the patient’s exact situation, and the patient’s values should be used to guide the final decision. For younger, healthy men, PSA screening should continue to be strongly considered.
The Task Force’s recommendation against PSA screening for prostate cancer is based on the best available science and the knowledge that, while we all want to prevent suffering and death from prostate cancer, PSA screening simply does not get us there.
Researchers have now identified a 3-gene signature that could indicate whether a particular early-stage prostate cancer is indolent. The test relies on a tissue sample, a PSA test, and a histology assessment.
Nancy Dawson, MD discusses PSA dynamics: the significance of PSA levels and PSA doubling time—the marker which currently provides the most information—and their usefulness in predicting metastatic disease and in counseling patients on their prognosis.