Every primary care practice has the same Men’s Health Month problem. Men show up for sick visits, not wellness visits. And when they do come in, two of the highest-value screening conversations either get skipped or get botched: colorectal cancer screening, because the conversation almost always opens with the wrong question, and the prostate-specific antigen (PSA) test, because the clinical guidance is muddy enough that most providers avoid the topic entirely.

Both problems are fixable. The fix for one is a different opening line. The fix for the other is a four-minute script keyed to the patient’s age band. Neither requires more time. They require different time.

Stop Asking About Colonoscopies

For the 52-year-old man on your panel who has been refusing a colonoscopy for six years, the single most important workflow change your practice can make is to stop asking him about colonoscopies. The opening question that closes a colorectal cancer screening gap is not, “Are you up to date on your colonoscopy?” It is, “Have you ever done a stool test for colon cancer screening?”

The U.S. Preventive Services Task Force gives equal weight to several screening modalities for average-risk adults ages 45 to 75 — including the annual fecal immunochemical test (FIT) and the every-three-year FIT-DNA stool test, alongside colonoscopy every ten years [1]. For HEDIS purposes, the Colorectal Cancer Screening (COL) measure recognizes the same modality set, with each modality carrying its own look-back window [2]. A patient who completes a FIT this year is up to date. A patient who completed a FIT-DNA stool test in the last three years is up to date. A patient who had a screening colonoscopy nine years ago is up to date. The colonoscopy framing — and only the colonoscopy framing — fails the men least likely to schedule one.

The workflow change to support this is small and physical. Move the FIT kits from a back supply closet to a labeled bin at the front desk, alongside the patient education sheet. Train the front desk to offer a take-home kit to any eligible male patient who declines an in-office discussion of colonoscopy. The kit goes home with the patient that day, not after a referral, not after another visit. Documentation matters here, too: the chart should record the modality offered, the modality the patient chose, and the date the kit went home, so the same patient does not get re-flagged as a gap when he completes the test six weeks later. And the clinical follow-up matters — a positive stool test result requires a follow-up colonoscopy to complete the screening [2], which is a conversation worth previewing the day the kit goes home so the patient is not surprised.

The Four-Minute PSA Conversation Most PCPs Avoid

PSA testing is the opposite problem. The clinical guidance is not muddy — it is deliberately conditional, and the answer depends entirely on the patient’s age. The U.S. Preventive Services Task Force draws three lines [3]:

Men under 55 (average risk): Grade I — insufficient evidence to recommend routine PSA screening. For average-risk men in this band, the conversation is usually “not today.” The exceptions are men at higher baseline risk — most often Black men or men with a first-degree family history of prostate cancer — where some guidelines support starting the shared-decision conversation as early as age 40 to 45 [4].

Men ages 55 to 69 (average risk): Grade C — shared decision-making, individual choice. This is where the four-minute conversation lives.

Men age 70 and older: Grade D — do not screen routinely. The HEDIS measure titled Non-Recommended PSA-Based Screening in Older Men [5] rewards the practice for documenting the conversation and the choice — not for ordering the test.

Most providers skip the topic in the 55-to-69 band because there is no clean answer. Treat that as the feature, not the bug, and the conversation fits in four minutes. Open with what is known about prostate cancer in this age group. Name what is unknown about PSA testing alone. Walk through where a positive result leads — additional testing, possible biopsy, treatment with real quality-of-life trade-offs. Close by framing the patient’s choice and documenting it. The chart note should record that the conversation happened, what the patient elected, and the date. That documentation pattern protects the patient, the practice, and the chart — and, for men age 70 and older, it is what closes the HEDIS measure on documenting the discussion rather than ordering the test [5].

How the Practice Sees This Coming

Neither conversation happens unless the practice knows it is due before the patient walks into the room. CareEmpower®’s Chart Prep Tool surfaces open screenings, due labs, and a 12-month care timeline for each scheduled patient before the visit [6] — so an eligible male patient arrives with the open colorectal cancer gap and the eligible-for-shared-decision PSA prompt already on the chart. For the man who has not been seen in 18 months, Equality Health’s Care Specialists and Community Health Workers run telephonic and field-based outreach to reconnect him with the practice. The visit is the prerequisite for both screenings; the outreach is what makes the visit happen; the template is what captures the credit.

The Bottom Line for Men’s Health Month

The two screenings men skip are not skipped because the science is hard. They are skipped because the conversation defaults are wrong. A different opening line for colorectal cancer screening. An age-banded four-minute script for the PSA decision. A pre-visit briefing that tells the team which one applies to the patient on the schedule. A care team that brings the disengaged patient back in the first place. None of those four are new technology. All of them are within reach this month.

References

[1] U.S. Preventive Services Task Force. Colorectal Cancer Screening: Recommendation Statement. May 2021. uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening

[2] National Committee for Quality Assurance. HEDIS Colorectal Cancer Screening (COL) Measure Specifications. Referenced in Equality Health Colorectal Cancer Screening Quality Guide, February 2025. ncqa.org/hedis

[3] U.S. Preventive Services Task Force. Prostate Cancer: Screening — Recommendation Statement. May 2018. uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening

[4] American Urological Association. Early Detection of Prostate Cancer Guideline, 2023 amendment. auanet.org/guidelines-and-quality/guidelines/early-detection-of-prostate-cancer-guidelines

[5] National Committee for Quality Assurance. HEDIS Non-Recommended PSA-Based Screening in Older Men (PSA) Measure Specifications. ncqa.org/hedis

[6] Equality Health. CareEmpower® User Guide, February 2026 — Chart Prep Tool, p. 21.