What health screenings are recommended for a male older than 65?

Health Screening Recommendations for Men Over 65

Men over 65 should undergo one-time abdominal aortic aneurysm screening if they have ever smoked, annual blood pressure and BMI assessment, colorectal cancer screening until at least age 75, and individualized prostate cancer screening discussions only until age 69, after which PSA screening should be discontinued. 1, 2

Cardiovascular Screening

• Blood pressure measurement should be performed at every clinical visit to screen for hypertension, which remains a critical modifiable risk factor in this age group 3
• Lipid profile assessment (total cholesterol, LDL, HDL, triglycerides) should continue to assess cardiovascular risk, particularly in men with life expectancy exceeding 5-10 years 3, 4
• One-time abdominal aortic aneurysm (AAA) screening with ultrasonography is strongly recommended for men aged 65-75 years who have ever smoked, as this prevents approximately 81% mortality risk associated with rupture 2, 5
• For men aged 65-75 who have never smoked, AAA screening should be selectively offered based on individual risk factors and shared decision-making 2

Cancer Screening

Colorectal Cancer

• Colorectal cancer screening should continue until at least age 75 in men with life expectancy greater than 5 years 6, 4, 5
• Screening options include: colonoscopy every 10 years, annual fecal immunochemical test (FIT), CT colonography every 5 years, or flexible sigmoidoscopy every 5 years 6, 5
• The choice between modalities should be based on patient preference, comorbidities, and test availability, with colonoscopy remaining the gold standard 6

Prostate Cancer

• For men aged 65-69 years, prostate cancer screening with PSA requires shared decision-making that weighs the modest benefit (preventing 1.3 deaths per 1,000 men screened over 13 years) against significant harms including false positives, overdiagnosis, and treatment complications 7, 1
• PSA screening should NOT be performed in men 70 years and older, as the harms definitively outweigh benefits due to increased false-positive rates, biopsy complications, and treatment-related morbidity in this age group 1
• Treatment complications are substantial: 1 in 5 men develop long-term urinary incontinence and 2 in 3 experience permanent erectile dysfunction after radical prostatectomy 1
• Screening should only occur after explicit discussion of these risks, and should be avoided entirely in men with less than 10-year life expectancy 7

Lung Cancer

• Low-dose CT screening is recommended for men aged 65-80 with at least 30 pack-year smoking history who currently smoke or quit within the past 15 years 5

Metabolic Screening

• Fasting glucose or hemoglobin A1C testing should be performed to screen for diabetes, particularly in men with BMI ≥25 kg/m² or other cardiovascular risk factors 3
• Calculate BMI and measure waist circumference to assess for central obesity, an independent mortality risk factor 3

Immunizations

• Annual influenza vaccination is essential for all adults over 65 3, 8
• Pneumococcal vaccination should be administered according to current ACIP guidelines 8
• Tetanus-diphtheria booster every 10 years 3

Physical Examination Components

• Skin examination for concerning lesions should be performed as part of the cancer-related checkup 7, 3
• Thyroid examination and consideration of thyroid function testing 3
• Digital rectal examination remains controversial and should not drive screening decisions, as PSA is the primary prostate cancer screening tool 7, 3

Critical Pitfalls to Avoid

• Do not perform PSA screening in men over 70 years - this causes net harm through unnecessary biopsies and treatment complications without mortality benefit 1
• Do not continue cancer screening in men with less than 5-year life expectancy - the lead time required for screening benefit exceeds their expected survival 4
• Do not miss AAA screening in former smokers aged 65-75 - this is one of the few screening tests with clear mortality benefit in this specific population 2
• Failing to incorporate functional status and comorbidities into screening decisions leads to overscreening in frail elderly men who will not benefit 4