What cancer screening tests should a 50-year-old male undergo?

Cancer Screening Tests for a 50-Year-Old Male

A 50-year-old male should undergo colorectal cancer screening with either annual fecal occult blood testing, colonoscopy every 10 years, or one of the other approved screening methods, and should have a discussion about prostate cancer screening with PSA testing and digital rectal examination. 1

Colorectal Cancer Screening

Colorectal cancer screening is strongly recommended for all average-risk adults beginning at age 50. The following options are available:

1. Annual high-sensitivity guaiac fecal occult blood testing (FOBT) or fecal immunochemical testing (FIT) 1
2. Flexible sigmoidoscopy every 5 years 1
3. Annual FOBT/FIT plus flexible sigmoidoscopy every 5 years (this combination is more accurate than either test alone) 1
4. Colonoscopy every 10 years 1
5. Double-contrast barium enema every 5 years 1
6. Computed tomography colonography every 5 years 1

The American Cancer Society and other organizations consider colonoscopy and annual FIT as first-tier screening tests due to their effectiveness in reducing mortality 2. If colonoscopy is declined, FIT should be offered as an alternative.

Important considerations:

• In-office single-panel guaiac FOBT using a stool sample collected during digital rectal examination is NOT recommended due to low sensitivity 1
• High-sensitivity guaiac FOBT or FIT should be used instead of older versions 1
• Earlier screening is recommended for those with risk factors such as family history of colorectal cancer or polyps 3

Prostate Cancer Screening

For prostate cancer screening at age 50:

• PSA blood test and digital rectal examination (DRE) should be offered annually to men with at least a 10-year life expectancy 1, 4
• Men should have an informed discussion about the benefits, risks, and uncertainties of prostate cancer screening before proceeding 1, 4
• For high-risk men (African Americans and those with a first-degree relative diagnosed with prostate cancer before age 65), screening should begin at age 45 1, 4
• For very high-risk men (multiple first-degree relatives diagnosed before age 65), screening should begin at age 40 4

PSA testing considerations:

• A PSA level of 4.0 ng/mL or higher typically warrants further evaluation 4
• Men with PSA levels < 1.0 ng/mL should be rescreened every 2-4 years 4
• Men with PSA levels between 1.0-2.5 ng/mL should be rescreened every 2 years 4
• Men with PSA levels ≥ 2.5 ng/mL should be rescreened annually 4

Cancer-Related Checkup

As part of a periodic health examination, a cancer-related checkup should include:

• Examination for cancers of the thyroid, testicles, lymph nodes, oral cavity, and skin 1
• Health counseling regarding tobacco use, sun exposure, diet and nutrition, risk factors, sexual practices, and environmental and occupational exposures 1

Other Important Considerations

• Lung cancer screening: Currently, there is ongoing evaluation of screening for lung cancer with low-dose computed tomography, but specific recommendations for average-risk individuals are not yet established 1

• Skin cancer awareness: While routine screening for skin cancer by primary care physicians is not universally recommended for average-risk individuals, awareness of skin changes and monthly self-examination are prudent 1

• Testicular cancer: Examination of testicles may be included as part of a cancer-related checkup, though routine screening has insufficient evidence for recommendation 1

By following these screening recommendations, a 50-year-old male can significantly reduce his risk of cancer-related mortality through early detection and treatment.