Health Screenings Men Need - When & Why

    Dr. Paul Siami, Deaconess Clinic Urology


     Health screenings help doctors and other providers detect conditions at earlier, more treatable stages.  Whether we’re screening for blood glucose (for diabetes), cholesterol (for heart disease) or PSA (for prostate cancer), the goal of all screenings is to bring attention to a problem or a developing problem.
     
    Recommendations for PSA (prostate specific antigen) and other screening tests can be confusing. To add to that confusion, there has been some recent PSA controversy as a result of a recommendation by the US Preventative Services Task Force. The Task Force indicated concerns about the use of PSAs as screening tests for ALL men over the age of 40. They said that some of the negative effects of the PSA screening is that it may lead to unnecessary and sometimes costly treatment.

    However, as a member of the American Urological Association, we disagree with the Task Force recommendation to halt all PSA testing. We feel there is significant improvement in health outcomes as well as survival in men who are screened appropriately.


    Appropriate PSA screening
    Here are my recommendations on who should be screened for PSA.

    • Men who have family history of prostate cancer (uncle, father, grandfather, brother)
    • Men of any age who are likely to survive 10 years beyond the time of screening. (Meaning, if cancer is detected, the patient is likely to benefit from treatment options.)
    • Any man who is concerned about his prostate health and wants to monitor changes.
    • Men who have urinary symptoms such as slow stream, delay or interruption in starting stream, urgency and frequency, excessive nighttime urination, etc.

    Who should NOT be screened for PSA
    I want to note that I also have recommendations on who should NOT have a PSA screening, which I regularly share with my primary care colleagues when I see their patients for consultation.

    In the U.S. Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, the U.S. investigators report no life-extending benefit from combined screening with PSA testing and digital rectal examination during an average follow-up of 7 years.

    In the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial, the European investigators report that PSA screening without digital rectal examination was associated with a 26% relative reduction in the death rate from prostate cancer at an average follow-up of 11 years. This means a reduction of about 9 men dying of prostate cancer per 10,000 men screened.

    THEREFORE, at the present time, data does not support PSA screening for prostate cancer in men whose 10 year survival is questionable.

    In my practice and in communication with my colleagues, I do not recommend any more PSA testing for patients who:

    a. do not have any obstructive urinary symptoms (such as slow or interrupted stream) or

    b. there is no significant evidence that prostate cancer screening will improve his quality of life.
     
     
    Other recommended screenings
    I also want to share some recommendations regarding other health screenings men need at different ages.

    These are joint recommendations from the American Cancer Society, American Heart Association and American Diabetes Association.  I’ll break them out by decades of age.
     
    At age 20-29 years AND 30-39 years

    A man needs to have his BMI (body mass index), and blood pressure screened annually/at each routine healthcare visit.
    Cholesterol (lipid profile) should be checked every 5 years, or more often if abnormal.

    Blood glucose and colon cancer testing is only needed if the man is at an above average risk. If not, no additional testing is needed at this time.

    Most insurance companies will cover screening tests as recommended by your physician.
     
    At 40-49 years

    A man needs to have his BMI (body mass index), and blood pressure screened annually/at each routine healthcare visit.

    Cholesterol (lipid profile) should be checked every 5 years, or more often if abnormal.

    Blood glucose should be checked every three years beginning at age 45; more often or earlier if indicated by doctor.

    Colon cancer testing is only needed if the man is at an above average risk. If not, no additional testing is needed at this time.

    Prostate cancer screening (for all African American men and also all men with close family members with prostate cancer) should be discussed with a health care professional early in this decade. Age 40 is recommended by the American Urological Association.

    Most insurance companies will cover screening tests as recommended by your physician.
     
    At 50-64 years


    A man needs to have his BMI (body mass index), and blood pressure screened annually/at each routine healthcare visit.

    Cholesterol (lipid profile) should be checked every 5 years; more often if abnormal or under treatment for high cholesterol, or if recommended by your doctor.

    Blood glucose should be checked every three years; more often or earlier if indicated by doctor.

    Colon cancer testing should begin at age 50; maybe earlier if the man has significant risk factors or family history. Talk with your doctor about which tests are best for you (fecal occult, colonoscopy, etc.) and how frequently the tests should be done.

    Prostate cancer testing: Talk with your doctor about the potential benefits and limitations of testing to decide what tests are right for you, and when they should be performed.

    Most insurance companies will cover screening tests as recommended by your physician.
     
    At 65 and older
     
    The guidelines are the same as for ages 50-64. However, a great thing is that all these screening services are now covered by Medicare!
     
    Posted: June 20, 2014 by Jessica Gerlach

    Tags: health, men, screening

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