The cancer screenings men need

Think about all of the men in your family—fathers, grandfathers, brothers, uncles. Statistically, 1 out of every 9 of them will be diagnosed with prostate cancer at some point in his life. The good news is, with the right cancer screenings, nearly all of them will survive. When prostate cancer is diagnosed during the early stages—that is, before cancer has spread to a far part of the body—the survival rate is nearly 100%, according to the SEER (Surveillance, Epidemiology, and End Results) database, maintained by the National Cancer Institute (NCI).

In fact, many cancers have high survival rates when doctors catch them early. That is why the NCI recommends cancer screening for men for the most common cancers at certain ages. 

Who should get cancer screenings?

“All men should be screened for prostate cancer, colon cancer, and testicular cancer,” says Anjali Malik, MD, a radiologist and cancer expert in Washington, DC. “Men who are high risk, such as smokers or people with a family history, should also be screened for lung cancer and skin cancer. And people with certain genetic syndromes, taking certain medications, or who have a family history of pancreatic cancer should be screened for that as well.”

But what if you are otherwise healthy and you have no cancer risk factors?

“Screening examinations are for asymptomatic patients, so even those in good health need regular screenings per the NCCN guidelines,” says Dr. Malik. NCCN is the National Comprehensive Cancer Network. Its guidelines are recognized as the standard for clinical practice and cancer care.

When should men be screened for cancer?

Each cancer type has its own age-related risk factors. Follow this guide to cancer screening for men by age and cancer type, or use the links below to skip to a section.

• Prostate cancer
• Testicular cancer
• Colorectal (colon) cancer
• Other cancers

Prostate cancer

Prostate cancer screening age: “Annual screenings should begin at age 40 for men with a first degree relative who had prostate or breast cancer,” says Dan Sperling, MD, the medical director for the Sperling Prostate Center in Delray Beach, Florida. “For African American men with no other risk factors, and for men with all other risk factors the age to start screening is 45, and age 50 for all men.” He notes that the Centers for Disease Control and Prevention (CDC) guidelines suggest dropping prostate tests for men at age 70 if they are in otherwise good health. But since older men tend to have a more aggressive disease if they are diagnosed late in life, Dr. Sperling recommends continuing the annual tests as long as the man has at least 10 years of life expectancy. 

Risk factors: “Early prostate cancer has virtually no symptoms,” says Dr. Sperling. “So men with the following risk factors should have an annual PSA blood test starting at age 45: family history of prostate or breast cancer; ethnicity (African American men appear to be at greater risk, though this has been questioned as an artifact of economics and geography); age (prostate cancer risk increases as men age); exposure to toxic substances like Agent Orange, etc.; poor lifestyle habits linked with obesity, inflammation, and diabetes.”

How to reduce your risk: Most prostate cancer risk factors are beyond your control. However, it may be possible to reduce your risk of developing cancer by eating a low fat, high fiber diet, exercising regularly, and maintaining a healthy body weight.

Screening test: Prostate cancer screenings can include one or more of the following tests: 

• PSA (Prostate-specific antigen) blood test: detects elevated levels of PSA in the blood, which may signify prostate cancer.
• Digital rectal exam (DRE): A doctor inserts a gloved, lubricated finger into your rectum to manually feel your prostate for lumps or enlargement.
• Prostate MRI (magnetic resonance imaging): Imaging that uses a powerful magnet to show a picture of your prostate. 

Dr. Sperling tells us that in the past, screenings were done only by PSA blood tests and DRE, which led to an “overdetection” of prostate cancer. This is because the substance detected by PSA tests is also present in men who simply have an infection or inflammation of the prostate. And an enlarged prostate is sometimes caused by benign prostatic hyperplasia, which is not cancerous.  

He recommends that men receive an annual PSA test. If the test results are high, the PSA test should be repeated. If the repeat is still suspicious, Dr. Sperling recommends a multiparametric MRI (mpMRI) to avoid misdiagnosis.

“This type of imaging is at least 95% accurate in detecting potentially dangerous tumors that may require further treatment,” says Dr. Sperling. “In turn, this can be diagnosed by an MRI-guided targeted biopsy, which uses minimal needles directed into the suspicious area for maximum diagnostic accuracy. If positive for cancer, a treatment tailored to the individual’s needs can be planned.”

People who are being treated with testosterone supplementation for hypogonadism are also closely screened for prostate cancer. 

RELATED: Prostate cancer treatment and medications

Testicular cancer

Testicular cancer screening age: Testicular physical examination should begin at age 15 and should occur annually at every man’s well visit. However, the CDC says that there isn’t sufficient evidence that screenings reduce death to recommend regular screening.

Risk factors: According to the NCI, testicular cancer is very rare. It is most commonly found in men and boys between the ages of 15 and 34. White men are four times more likely than black men to have this type of cancer. Having an undescended testicle is also a risk factor. 

How to reduce your risk: There is no way to truly reduce your risk for testicular cancer, which is why annual screening exams are so important. Testicular cancer is usually curable, even if it is detected at a late stage.

Screening test: There is no “official” screening test for testicular cancer. However, your doctor should examine your testicles at your annual physical exam, feeling for any suspicious lumps. Often testicular cancer is first detected by the men themselves, either by chance or during a self exam. 

Colorectal (colon) cancer

Colon cancer screening age: “Colon cancer screening should begin no later than age 50, however, many professional societies are starting to recommend screening earlier [age 40] as we are seeing younger and younger cases of colon cancer,” says Rebecca Berens, MD, a family physician and owner of Vida Family Medicine in Houston. 

The CDC recommends screening beginning at age 50. Though, the decision to begin screening for any cancer should be individualized based on personal risk factors. In high risk people for colon cancer, the screening is recommended to start earlier. Men should receive the fecal immunochemical test annually. Colonoscopies are recommended upon receiving abnormal fecal test results, or every 10 years if all test results are normal. “If the colonoscopy shows any polyps, it may need to be repeated more frequently,” says Dr. Berens. “Colon cancer screening is recommended until age 75, but may be continued after the age of 75 based on an individualized discussion between the patient and his doctor.”

Risk factors: The main risk factors for colon cancer are age, genetics, family history, and a personal history of inflammatory bowel disease. “Poor diet (especially a diet low in fiber/fruits and vegetables and high in processed foods), limited physical activity, tobacco use, and alcohol consumption also increase risk of colon cancer,” says Dr. Berens.

How to reduce your risk: Eat a fiber-rich diet containing lots of fruits and vegetables and very little processed foods to reduce your risk of colon cancer. Exercise, stay active, and avoid tobacco and alcohol. Limiting red meat also helps in reducing colon cancer incidence.

Screening test: There are a few options for colon cancer screening. A colonoscopy and a fecal test are the most common. When you get a fecal test, the doctor collects a stool sample to look for tiny streaks of blood in your stool. If there is any blood at all, your doctor should order a colonoscopy. The colonoscopy sounds scary to some people, but it is actually painless. During this test, your doctor inserts a long, flexible instrument into your rectum and all the way through your large intestine. This will transmit an image of the inside of your colon so the doctor can examine it for abnormalities.  

Other cancers

Most men will only need regular screenings for prostate, testicular, and colon cancers. However, you should do annual well visits with your primary care physician and ask if you have any special risk factors that may necessitate screenings for other cancers, such as skin, lung, or pancreatic cancer. 

Risk factors for some cancers include:

• Smoking
• Alcohol use
• Family history
• Poor diet
• Genetics
• Certain medications
• Obesity
• Certain diseases

This is not an exhaustive list. Discuss your health needs with your primary care physician.

RELATED: 9 things you can do to prevent cancer

How much do cancer screenings cost?

Medicare, Medicaid, and most insurance plans cover cancer screenings that are recommended based on your age and other risk factors. But even if you don’t have insurance coverage, there are options for receiving free cancer screenings. 

“Free PSA/digital rectal exams are periodically available in most communities,” says Dr. Sperling, referring to free cancer screenings at state and local health departments. Many health departments also offer free colon and testicular cancer screenings. Check with your own health department to find out if they offer screenings. 

You can also find free prostate cancer testing sites from the nonprofit Zero: The End of Prostate Cancer, and free colon cancer screenings at Stop Colon Cancer Now.