What health screenings are recommended for men?

Health Screenings for Men

Men should undergo age-appropriate, risk-stratified screening that prioritizes cardiovascular disease prevention, cancer detection (particularly colorectal and prostate), and abdominal aortic aneurysm surveillance, with shared decision-making central to prostate cancer screening decisions. 1

Cardiovascular Screening

Blood pressure should be checked at every clinical encounter regardless of age. 2

Lipid screening is recommended for men aged 40-75 years; there is insufficient evidence to support routine screening in younger men unless specific risk factors are present (family history of premature cardiovascular disease, diabetes, hypertension, or BMI ≥25 kg/m²). 3, 2

Diabetes screening with hemoglobin A1C should be performed if BMI ≥25 kg/m² with additional risk factors including first-degree relative with diabetes, high-risk race/ethnicity, hypertension, HDL <35 mg/dL, or triglycerides >250 mg/dL. 3

Cancer Screening

Prostate Cancer

Prostate cancer screening with PSA testing requires shared decision-making and should begin at age 45-50 for average-risk men, age 45 for high-risk men (African Americans and men with first-degree relatives diagnosed before age 65), and age 40 for very high-risk men (multiple first-degree relatives diagnosed before age 65). 1

The 2018 NCCN Guidelines recommend baseline PSA screening starting at age 45 and continuing through age 75, with biopsy consideration when PSA >3.0 ng/mL. 1 The US Preventive Services Task Force (2018) recommends providing information about potential benefits and harms for men aged 55-69 years, while recommending against screening for men ≥70 years. 1

Key considerations for PSA screening:

• Screening should not occur in men with less than 10-15 year life expectancy. 1
• A baseline PSA <1.0 ng/mL at age 60 predicts <0.3% likelihood of prostate cancer death, allowing less frequent screening. 1
• Risk factors requiring earlier screening discussions include African American ethnicity, family history, and germline mutations (especially BRCA1/2). 1
• Alternatives to routine biopsy for elevated PSA include serum biomarker testing (PHI, 4Kscore) and multiparametric MRI. 1
• Active surveillance is appropriate for low-risk cancers detected through screening. 1

Common pitfall: Do not perform PSA testing in men under age 40-45 or those with limited life expectancy, as this provides no benefit and leads to unnecessary anxiety and procedures. 3

Colorectal Cancer

Colorectal cancer screening should begin at age 45 for average-risk men and continue until at least age 75. 3, 2 Screening options include fecal immunochemical testing, colonoscopy, or CT colonography. 2

Lung Cancer

Lung cancer screening with low-dose CT is recommended for men aged 55-80 years with at least a 30-pack-year smoking history who currently smoke or quit within the past 15 years. 2

Testicular Cancer

Testicular examination should be performed as part of cancer-related checkups, though evidence for routine screening by physician or self-examination is insufficient. 3

Abdominal Aortic Aneurysm

One-time screening ultrasonography for abdominal aortic aneurysm is recommended in men aged 65-75 years who have ever smoked. 2

Age-Specific Screening Algorithms

Young Men (Under 40)

• Blood pressure at every visit 2
• Lipid screening only if risk factors present 3
• Diabetes screening if BMI ≥25 kg/m² with additional risk factors 3
• No PSA testing 3
• No colorectal cancer screening 3

Middle-Aged Men (40-54)

• Blood pressure at every visit 2
• Lipid screening beginning at age 40 2
• Diabetes screening if indicated 3
• PSA screening discussions starting at age 45 (age 40 for very high-risk men) 1
• Colorectal cancer screening starting at age 45 3, 2

Older Men (55-75)

• Blood pressure at every visit 2
• Lipid screening 2
• PSA screening with shared decision-making (ages 55-69 per USPSTF; through age 75 per NCCN) 1
• Colorectal cancer screening 2
• Lung cancer screening if smoking history meets criteria 2
• One-time AAA ultrasound if aged 65-75 and ever smoked 2

Men Over 75

• Blood pressure at every visit 2
• Continue colorectal cancer screening based on prior screening history and life expectancy 2
• Discontinue PSA screening (USPSTF); consider only in highly selected healthy men with minimal comorbidity (NCCN) 1
• Discontinue lung cancer screening after age 80 2

Critical Barriers to Address

Men face specific barriers to screening including fear of disease diagnosis, low risk perception, heterosexual self-presentation concerns, avoidance of perceived femininity, and lack of time. 4 The partner's role is the most effective facilitator for increasing screening participation. 4 Primary care physicians play a key role in drawing men's attention to preventive measures, particularly for those who have not previously participated in screening programs. 5