What are the recommended health screenings for men based on age?

Health Screening Recommendations for Men by Age

Men should begin prostate cancer screening discussions at age 50 for average risk, age 45 for African Americans or those with a first-degree relative diagnosed before age 65, and age 40 for those with multiple affected first-degree relatives, with screening discontinued at age 70 for most men. 1

Prostate Cancer Screening by Age Group

Ages 40-44 Years

• Obtain baseline PSA testing only for men with multiple first-degree relatives diagnosed with prostate cancer before age 65 1, 2
• Baseline PSA above the median at age 40 is a stronger predictor of future prostate cancer risk than family history or race alone 2, 3
• Early PSA measurement provides more specific results because prostatic enlargement is less likely to confound interpretation 2

Ages 45-49 Years

• Initiate shared decision-making discussions for African American men 1, 2
• Begin screening discussions for men with one first-degree relative diagnosed with prostate cancer before age 65 1, 2
• Baseline PSA levels at ages 45-49 strongly predict future prostate cancer death, with 44% of deaths occurring in men in the highest tenth of PSA distribution 2, 3
• A single PSA test before age 50 predicts subsequent prostate cancer up to 30 years later with robust accuracy (AUC 0.72-0.75) 2, 3

Ages 50-54 Years

• Initiate screening discussions for average-risk men with at least 10 years life expectancy 1, 2
• The US Preventive Services Task Force does not recommend routine screening in this age group, but other organizations including the National Comprehensive Cancer Network recommend beginning at age 45 1
• Shared decision-making is mandatory before any PSA testing 1

Ages 55-69 Years

• This is the age group with the strongest evidence for screening benefit 1, 4
• Screening may prevent approximately 1.3 deaths from prostate cancer per 1,000 men screened over 13 years 4
• Screening may prevent approximately 3 cases of metastatic prostate cancer per 1,000 men screened 4
• All major guidelines recommend shared decision-making for men in this age group 1

Ages 70-74 Years

• Individualize screening decisions based on health status and prior PSA values 1
• Continue screening only in very healthy men with minimal comorbidity, prior elevated PSA values, and life expectancy >10-15 years 1, 2, 3
• Consider increasing the PSA threshold for biopsy to reduce overdiagnosis 1

Ages 75 and Older

• Recommend against routine PSA screening 1
• Men aged 75 or older with PSA <3.0 ng/mL are unlikely to die from prostate cancer and may safely discontinue screening 1, 2
• The harms of screening outweigh benefits in this age group due to increased false-positive results, biopsy complications, and treatment harms 4

Screening Intervals After Initiation

Risk-stratified intervals based on PSA results are superior to fixed annual testing: 2, 3

• PSA <1.0 ng/mL: Repeat every 2-4 years 2, 3
• PSA 1.0-2.5 ng/mL: Repeat annually to every 2 years 2, 3
• PSA ≥2.5 ng/mL: Screen annually with consideration for further evaluation including biopsy 2, 3

Screening every 2 years reduces advanced prostate cancer diagnosis by 43% compared to every 4 years, though it increases low-risk cancer detection by 46% 1, 2

Other Age-Based Screening Recommendations

Cardiovascular Screening

• Blood pressure screening should be performed at every clinical encounter 5
• Lipid screening is recommended for men ages 40-75 years 5
• There is insufficient evidence for lipid screening in men younger than 40 years 5

Abdominal Aortic Aneurysm Screening

• One-time screening ultrasonography is recommended for men ages 65-75 years who have ever smoked 5

Colorectal Cancer Screening

• Begin screening at age 50 for average-risk men and continue until at least age 75 5
• Screening options include fecal immunochemical testing, colonoscopy, or CT colonography 5

Lung Cancer Screening

• Screen men ages 55-80 years with at least a 30-pack-year smoking history who currently smoke or quit within the past 15 years 5
• Use low-dose computed tomography for screening 5

Common Pitfalls to Avoid

• Never proceed with PSA testing without informed decision-making discussion 1, 3
• Avoid screening men with less than 10 years life expectancy regardless of age 1
• Do not continue routine screening beyond age 70 in men with average health status 1, 2
• Avoid using fixed annual PSA screening intervals for all men rather than risk-stratifying based on baseline results 2, 3
• Do not screen men aged 75 and older with PSA <3.0 ng/mL, as they are unlikely to benefit 1, 2

Pre-Test Preparation for PSA Screening

• Avoid ejaculation for 48 hours before testing 3
• Refrain from vigorous exercise, particularly cycling, for 48 hours before testing 3
• Be aware that 5-alpha reductase inhibitors (finasteride, dutasteride) lower PSA levels by approximately 50% 3