What are the essential components and screenings to address in a male annual physical, considering factors such as medical history, lifestyle, and risk factors, for men of different age groups and health statuses?

Essential Components of the Male Annual Physical Examination

The male annual physical examination should be structured around age-specific, evidence-based screenings rather than a comprehensive "head-to-toe" examination, focusing on cardiovascular risk assessment, cancer screening based on age and risk factors, metabolic disease detection, and targeted history-taking for modifiable risk factors.

History Components

Lifestyle and Risk Factor Assessment

• Tobacco use history including current smoking status, pack-years, and readiness to quit should be documented at every visit 1, 2.
• Alcohol consumption patterns, quantifying drinks per week and screening for alcohol use disorder 1, 2.
• Sexual history including number of partners, condom use, and risk factors for sexually transmitted infections including HIV 2.
• Diet and exercise habits with specific attention to frequency, duration, and intensity of physical activity 1, 2.
• Family history focusing on premature cardiovascular disease (men <55 years, women <65 years), diabetes, and cancers particularly prostate cancer diagnosed before age 65 3.

Medication and Supplement Review

• Document all prescription medications, over-the-counter drugs, and supplements as these may affect screening test interpretation 3.
• Review for medications affecting sexual function if erectile dysfunction or decreased libido is present 4.

Physical Examination Elements

Vital Signs and Anthropometrics

• Blood pressure measurement at every visit, targeting <120/80 mmHg 3, 1, 5.
• Height and weight to calculate body mass index (BMI), targeting <25 kg/m² 3, 1, 2.
• Waist circumference measurement, targeting <40 inches for men, as an independent cardiovascular risk marker 3, 5.

Focused Physical Examination

• Cardiovascular examination including heart auscultation and peripheral pulse assessment 3, 2.
• Abdominal examination with palpation for masses, organomegaly, and abdominal aortic aneurysm in appropriate age groups 3, 2.
• Skin examination for suspicious lesions during the cancer-related checkup 3, 5.
• Thyroid palpation as part of routine examination 3, 5.
• Testicular examination including measurement and palpation of testes, checking for masses, and assessment for varicocele 3.
• Digital rectal examination is controversial for prostate cancer screening and should not drive screening decisions, as PSA is the primary tool 5.

Laboratory Screening by Age Group

Men Ages 18-39

• Lipid profile (total cholesterol, LDL, HDL, triglycerides) every 5 years, or every 2 years if risk factors present (family history, diabetes, smoking) 3, 1.
• Fasting glucose or hemoglobin A1C every 5 years, or every 2 years if BMI ≥25 kg/m² with additional risk factors 3, 1.
• HIV screening at least once for all adults, more frequently based on risk factors 2.

Men Ages 40-49

• Lipid profile on non-fasting samples to assess cardiovascular risk 1, 2.
• Hemoglobin A1C for diabetes screening, especially if BMI ≥25 kg/m² with risk factors (first-degree relative with diabetes, high-risk race/ethnicity, cardiovascular disease, hypertension, HDL <35 mg/dL, triglycerides >250 mg/dL) 1.
• Baseline PSA and digital rectal examination at age 40 for men at appreciably higher risk (multiple family members with prostate cancer before age 65) 3.
• PSA discussion beginning at age 45 for African American men or those with a first-degree relative diagnosed with prostate cancer before age 65 3, 1.

Men Ages 50-64

• Complete blood count (CBC) with differential to screen for anemia, infection, and blood disorders 1.
• Comprehensive metabolic panel (CMP) to assess kidney and liver function and electrolyte balance 1.
• Lipid profile continuing assessment 1, 5.
• Hemoglobin A1C with repeat testing every 3 years if normal, yearly if prediabetes (A1C 5.7-6.4%) 1.
• Urinalysis with albumin-to-creatinine ratio to screen for kidney disease 1.
• Colorectal cancer screening beginning at age 45 with options including: annual fecal immunochemical test (FIT), multitarget stool DNA test every 3 years, colonoscopy every 10 years, CT colonography every 5 years, or flexible sigmoidoscopy every 5 years 1, 2.
• Prostate cancer screening discussion at age 50 for average-risk men, using shared decision-making to weigh benefits against harms 3, 1.
• PSA testing annually for men who choose screening after informed decision-making, with PSA <2.5 ng/mL allowing screening intervals extended to every 2 years 3.
• Lung cancer screening with low-dose CT for men 55-64 years with ≥30 pack-year smoking history who currently smoke or quit within past 15 years 2.

Men Ages 65-75

• One-time abdominal aortic aneurysm screening with ultrasonography for men who have ever smoked 2.
• Colorectal cancer screening continuation until at least age 75 if life expectancy >5 years 5, 2.
• Prostate cancer screening only for men ages 65-69 with >10-year life expectancy after explicit discussion of modest benefit (preventing 1.3 deaths per 1,000 men screened over 13 years) versus harms 5.
• Lung cancer screening continuation until age 80 if meeting smoking criteria 2.

Men Over 75

• Individualized screening based on life expectancy and functional status 5.
• Discontinue prostate cancer screening if life expectancy <10 years 5.
• Continue colorectal cancer screening only if life expectancy >5 years 5.

Prostate Cancer Screening Algorithm

For men choosing PSA screening after shared decision-making:

• PSA <2.5 ng/mL: Screen every 2 years 3.
• PSA 2.5-4.0 ng/mL: Screen annually and consider individualized risk assessment incorporating age, race, family history, DRE findings, and prior biopsy history 3.
• PSA ≥4.0 ng/mL: Refer for further evaluation or biopsy 3.
• PSA >10 ng/mL: Proceed to TRUS-guided 12-core biopsy regardless of other factors (>67% likelihood of cancer) 3.

Immunizations

• Annual influenza vaccination for all adults 5, 2.
• Tetanus-diphtheria booster every 10 years 5, 2.
• Update all immunizations according to Advisory Committee on Immunization Practices guidelines 2.

Critical Pitfalls to Avoid

• Do not delay colorectal cancer screening beyond age 45, as guidelines have lowered the starting age from 50 1.
• Do not screen for prostate cancer without informed decision-making discussing overdiagnosis, false positives, and treatment complications 3, 5.
• Do not perform PSA screening in men with <10-year life expectancy regardless of age 3, 5.
• Do not fail to confirm abnormal lipid or glucose results before making a diagnosis 1.
• Do not rely on digital rectal examination alone for prostate cancer screening; PSA is the primary tool 5.
• Do not order comprehensive laboratory panels without evidence-based indication, as this leads to unnecessary testing and patient harm 2, 6.