The Medical Screenings All Men Need, And When

No matter how fast medicine moves us towards treatments, preventive medicine will always be the most effective and cheapest way to keep healthy. Yesterday, we went over the most common screenings for women. Today we'll look at men's health screenings, when you should get them, and what kind of experience you're in for.

Not surprisingly, men and women can look forward to different screening tests throughout their lifetime. In today's case we can solidly notch a point in the "better to be a man" column: There is only one recommended screening test for men of average risk (i.e. with no personal or family medical history).

That, of course, excludes routine things checked during your annual primary care visit (blood pressure, cholesterol, blood sugar, urinalysis, abdominal circumference, physical exam, etc) or behaviour related screenings (STIs, lung cancer). Those tests are all absolutely critical to maintaining your health -- don't skimp on them just because you think heart disease doesn't seem as scary as bowel cancer. But in terms of recommended screening for cancer and other diseases, you pretty much have a fecal test or a colonoscopy to look forward to. Sad, I know.

As always, final decisions about your personal care should be made after a conversation between you and your physician. Not after a quick perusal of the internet.

Bowel Cancer Screening

What is it? Most people associate bowel cancer screening with colonoscopies -- a multipurpose test that can screen for bowel cancer, ulcers, polyps, and bleeding. There are actually a few methods of testing for bowel cancer, each with a different screening recommendation. The unique advantage of the colonoscopy is that it visualises the entire colon and allows for tissue sampling and removal of polyps as appropriate.

There are also several screening tests that look for blood in the stool, a possible sign of bowel cancer.

What does it feel like? I had to outsource this question. For the colonoscopy and sigmoidoscopy prep, the almost universal responses were either "I don't want to talk about it. There's just so much poop." For the colonoscopy itself, most people are sedated so you will have no memory of the experience. Because the sigmoidoscope does not travel as far up the digestive tract, patients are awake through the procedure. This was described "like someone is snaking a pipe...only it's your rectum."

For the faecal occult blood screening test (FOBT), the Cancer Council advises that the test involves taking samples from two or three bowel motions using a test kit. This is painless, but kind of gross. These are analysed at a pathology laboratory, and if blood is detected, further tests may be required.

When Should I Get It? The Cancer Council recommends a non-invasive test for low risk men. In all cases, if a test is positive, further exam via colonoscopy is required. Doctors recommend screening every two years, beginning at age 50. Free test kits can be sent to patients at age 50, 55, 60, 64, 65, 70, 72 or 74 years of age, with these increments changing to every two years, starting in 2020. The Cancer Council states that their preferred screening test for polyps and cancer is a colonoscopy, for people with a higher risk of developing bowel cancer.

Prostate Cancer Screening

What is it? Traditionally, men would regularly receive a digital rectal exam (DRE) and Prostate Specific Antigen (PSA) test to screen for prostate cancer in patients without symptoms. During the DRE, the doctor inserts a gloved, lubricated finger into your rectum to feel for growths or bumps. The PSA is a blood test that looks for a protein produced by the prostate that may be elevated in cases of cancer.

What does it feel like? The doctor will typically have you bend over the table (there are other possible positions if you are are unable to stand that way) and insert their gloved finger into your rectum, probing around for any masses or anything out of the ordinary. The test will usually last under a minute -- you may feel some mild discomfort but there shouldn't be any pain. Awkward small talk may be involved. While they're up there, many doctors will follow the exam with a FOBT to look for blood in your stool (a possible signifier of other non-prostate cancer problems)

The PSA is a blood test, so that feels like a finger prick.

When Should I Get It? Previously, PSAs have been recommended yearly after 50 years of age and for those with a family history of cancer. More recently however, experts have recognised that the harms of this testing may outweigh the benefits. The PSA test may deliver falsely positive results (level elevated but no cancer), leading to unnecessary anxiety and additional testing. A positive PSA test may also find small tumours that are not causing symptoms, but this may not reduce the chances of dying from prostate cancer. The resulting overtreatment, which may include surgery or radiation, can result in potential harmful side effects and complications.

The Cancer Council recommends that people discuss the possible risks and benefits of testing with their doctor before making any decisions on testing. The discussion should start at age 50 for men of average risk, age 45 for men of high risk, and age 40 for those of very high risk. Screening is repeated annually or every 2 years, depending on the results.

Penile Cancer Prevention

This last one is prevention rather than screening, but many parents don't realise that their children are eligible for the HPV vaccine so I want to mention it here. There are vaccines that protect against the cancer and genital wart causing strains of HPV. While earlier vaccination is ideal (it is recommended after age 11), the vaccine is recommended for women through the age of 26. This is a vaccine that prevents cancer. Man, woman, boy, girl -- if you're eligible and don't have it, go get it.

Regular screening and early treatment of common medical conditions remains your best bet for reaching (or outliving!) the average Australian lifespan of about 82 years (if you don't live in Austrlaia, your average life expectancy can be found here).

Most importantly, if you have any concerns or have a family history of cancer, we highly recommend that you discuss it with your doctor, or call the Cancer Council on 13 11 20 for more information.

Title illustration by Sam Woolley. Photos by the US Navy and the NIH Image Gallery.


    Looks like your american to australian conversion failed again, in australia patients are sedated for colonoscopies

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