Did you know men are less likely than women to visit their doctor on a regular basis? The Centers for Disease Control and Prevention conducted a study that states, “Women were 33 percent more likely than men to visit a doctor”. According to Dr. Robert Macmillan at Sterling Primary Care, an affiliate of TriStar Centennial Medical Center, when health-related problems are identified early on through regular screenings and visits, they are easier to treat and can often times make the difference between life and death. He shares with HCA Today the top six screenings all men need to know and be proactive about in order to keep their health in check.
If we catch prostate cancer early before it spreads beyond the prostate, the patient has over a 90 percent cure rate. If cancer spreads outside that prostate the rate decreases significantly. I recommend, for most men, screening beginning at 40 years of age. Now, there are limited exceptions to that. If a patient has a family history of an early prostate cancer diagnosis in a first degree relative, meaning a father or brothers, then we may start screening ten years before the age of diagnosis. For example, if a patient’s father got diagnosed with prostate cancer at 45, we would start screening that patient at 35.
There are two main options for screening for prostate cancer. There is the DRE, or digital rectal exam, which is the one that some men feel nervous about. Then there’s the PSA, or prostate-specific antigen screening, which is essentially a blood test. Each one of those has its proponents and its detractors. I tend to lean more towards starting with the PSA and if it’s elevated at all, then doing either a DRE or having that patient see a urologist depending on the circumstances. I recommend doing a PSA yearly and a DRE every two to three years. The bottom line is that it is an individual choice to be made by each patient with their doctor based on the doctor’s recommendations.
My baseline recommendation for screening is a colonoscopy, which is a scope that looks at the entire colon. A lot of people are reluctant to have it because they’ve heard horror stories about the preparations that they have to do the day before. But truthfully, they’ve made a lot of great advances in those preps; it’s no longer handing a patient a gallon jug of something that tastes terrible to drink. It’s a quart of Gatorade and a few pills. If we catch colon cancer early, it is very treatable through surgically removing that section of the colon; and the survival rate is fantastic. If it spreads, the survival rate decreases.
For colon cancer, I recommend starting to screen at 50 years of age for most males. Again, if there is a relative with an early diagnosis, we may start earlier; but that’s an individual decision on a case-by-case basis. If they had no other major risk factors and a normal colonoscopy that doesn’t show polyps or anything like that at 50 years of age, I recommend screening again in ten years. Now, there may be a shorter interval if the gastroenterologist doing the test sees a polyp or legions on the inside of the colon.
A lot of men enjoy being outside and unfortunately, over a few decades, that can take its toll on the skin; and skin cancer can result. Now, there are several different kinds of skin cancer, but the one we fear the most is melanoma. It is the only skin cancer that can spread and can be potentially fatal.
Patients should take a proactive approach to skin cancer protection and also detection – looking for legions, or darkened spots on the skin, that are greater than a centimeter or, in a real-world equivalent, greater than the diameter of that pencil eraser when looked at head-on. Other characteristics to watch out for are legions that are developing jagged borders, legions with color variability, and legions that are increasing in size. I tell patients frequently: “You look at the front of you; have your significant other look at the back of you.” It is a chance for them to do something before they ever get to the doctor.
I have had patients with melanoma in their mid-20s on and so, I recommend doing regular skin cancer screenings during the annual physical.
The range of testicular cancer is 25 to 35 years of age, with the average age at diagnosis being 33, and that’s unusual because most cancers, the chances go up as you get older. But testicular cancer is not that way. What I recommend for my male patients in that age range is that they do a monthly testicular cancer self-exam.
Hypertension screening measures blood pressure. The goal should be less than 140 for the systolic, or the top number, and less than 90 for the diastolic, which is the bottom number. It’s important that both of those numbers are at goal. Once it reaches above 140 for the systolic or 90 for the diastolic, the risk for cardiovascular disease, meaning heart attack or stroke, goes up. This is not something where male patients have to be paranoid, checking their blood pressure three times a day; but having it checked at the doctor’s office once a year, especially after 30 is a good idea. I recommend starting hypertension screening in their 20s every other year during their physical and then yearly once they reach 30 years of age.
Blood pressure and cholesterol are the two biggest things that impact cardiovascular disease. Cholesterol screening is done through a simple blood test. If it comes back elevated, there are some lifestyle changes patients can make; but, in some cases, it may mean they just need to go on medicine for it. I recommend having a cholesterol screening done at least once in their 20s and then basically yearly when patients reach 30 years of age. There may be some variation in that depending on other risk factors.
Dr. Robert D. Macmillan is family practice physician with HCA Healthcare’s Physician Services Group (PSG). He practices at Sterling Primary Care, an affiliate of TriStar Centennial Medical Center, in Nashville, Tenn. If you or a loved one have questions about screening, call askSARAH – a dedicated helpline from Sarah Cannon, the Cancer Institute of HCA Healthcare, designed to answer your cancer-related questions. Call (844)-482-4812.