Preventive health for men

Author : Dr Jennifer Frank University of Wisconsin School of Medicine and Public Health Appleton, Wisconsin

2009-12-15

Preventive Health for Men : Find out what the "annual exam" is really all about.

Do you really need an annual "physical" at the doctor's office? Well, that is a matter of some debate, but there are some preventive health measures - things to keep you healthy and detect problems early - that you do need, especially if you are 50 years or older. Read below to find out what is essential and what is not.

Preventive Health Defined

Preventive health is widely defined, but basically refers to those things you do to keep yourself healthy.  This includes everything from getting your blood pressure checked to taking enough calcium.  Common areas of preventive health include: 

• Laboratory Studies:  These are tests that look for diseases (like diabetes or high cholesterol), infections (like Human Immunodeficiency Virus (HIV) or chlamydia), or screen for cancer (like stool cards checking for blood that can indicate colon cancer).
• Radiologic Studies:  These include xrays, ultrasounds, mammograms, and CAT scans that are done to screen (usually) for cancer, osteoporosis, or vascular disease. 
• Other diagnostic studies:  This may include an EKG looking for heart disease.
• Questions the doctor asks you about your personal and family history, symptoms you may be having, and lifestyle habits (like smoking, exercising, and calcium intake)
• Physical examination looking for signs of disease
• Immunizations to prevent you from getting diseases like influenza or pneumonia
• Counseling about ways to be healthier

How to figure out what you need

With all the testing listed above, it can be difficult to figure out what you need to have done, how often, and at what age.  While your primary care doctor can generally advise you what is needed and what is not, what follows is a quick guide to what is currently recommended.*

*One thing that makes all of this even more confusing is that different medical societies make different recommendations.  The recommendations I am outlining reflect what is recommended by the US Preventive Services Task Force, a national government organization that makes recommendations about preventive health care services.

Focus on Men

Men and women have many similar preventive health needs, but do have difference risks for things like cardiovascular disease or cancer.  Therefore, this knol focuses on what is currently recommended for men.

Immunizations

Immunizations for almost all men (18 and older)

• Tetanus is needed every 10 years.  There is a new vaccination called Tdap (Adacel is the brand name) that includes a booster immunization against pertussis.  Pertussis is whooping cough, which is annoying but generally not dangerous for adults.  However, it can be dangerous for unimmunized infants and children.  Since immunity fades after your childhood vaccine series, it is possible for adults to pass on whooping cough to children.  So, the Centers for Disease Control (CDC) recommends that all adolescents and adults (ages 11 - 64) receive a pertussis booster.  You can wait until you are due for your next tetanus booster, or just go ahead and get it now if it has been at least 2 years since your last tetanus booster.  It is particularly important to get the pertussis booster if you have contact with children under 1 year of age or work in a health care setting.

• Influenza vaccine is administered each fall.  It is recommended for all adults who are 50 years and older and younger adults who have certain chronic diseases (like asthma, diabetes, heart disease, kidney disease, cancer, or a problem with their immune system).  The influenza shot is given to people 50 years and older (as well as children and younger adults for whom the vaccine is recommended).  For adults younger than 50, an alternative is an influenza vaccine administered as a nasal spray.  You should check with your doctor or check out www.cdc.gov to find out whether you need the shot or can get the nasal spray. 
• Pneumovax is given to adults 65 years of age and older once to prevent a common form of pneumonia.  It is also given to younger adults with chronic health problems or smokers (and should be repeated after age 65 in these people).

Immunizations for some men

• Herpes Zoster (brand name Zostavax) is recommended for adults 60 years and older who have a history of chicken pox to prevent shingles (whether or not you have already had shingles).  This is a one time vaccine.

Immunizations to consider:

• Hepatitis A is a 2 part vaccination that you receive once in your lifetime to prevent a form of hepatitis that is transmitted usually by something you eat or drink that was touched by someone who has Hepatitis A.  It is now recommended for all kids and is a good idea for adults as well, particularly if you live in a high-risk area or have a high-risk condition (certain chronic diseases or lifestyle risks).
• Hepatitis B is a 3 part vaccination that you receive once in your lifetime to prevent a form of hepatitis that is transmitted by blood or sexual activity.  This is also now recommended for all kids and is a good idea for adults as well, particularly if you work in a health care setting, have risky sexual behaviors or are exposed to bodily fluids.
• Catch up vaccinations:  If you have never received MMR (measles, mumps, and rubella) or meningococcal vaccination or if you have not had either the varicella vaccination or chicken pox, you need to get "catch up" vaccinations.

Laboratory studies

The screening labs you need depend on your own personal health history, your family health history and your age.  Screening labs are different from diagnostic labs.  If you have a sore throat and go to the doctor to be seen, you may have a throat culture done.  The throat culture is done to diagnose strep throat.  A screening test is done to find out if you have a disease before you start having symptoms.  A good example would be a fasting blood sugar to see if you have diabetes, even if you don't have any symptoms of diabetes.

• Diabetes testing is done by checking your blood sugar to see if it is too high.  There are a few different ways to do this:
• Fasting blood sugar is checked after you've had nothing to eat or drink for 8-12 hours.  If the blood sugar is 126 or higher, you may have diabetes.  In order to be diagnosed with diabetes, you need to have a reading of 126 or higher on 2 separate occasions when you are in your usual state of health.
• 2 hour oral glucose tolerance test combines a fasting blood sugar (above) with another blood sugar check 2 hours after you have taken a very sugary drink.  If your 2 hour sugar level is 200 or higher, you have diabetes.
• A "random" blood sugar is checked whenever - without relation to when you last ate or drank.  If the sugar level is 200 or higher (and you have symptoms of diabetes like urinating a lot), you have diabetes
• Cholesterol is measured either randomly (without fasting) or after having nothing to eat or drink for 12 hours.  A cholesterol panel has several separate measurements.  I will describe the 4 that are looked at most closely below:
• Total Cholesterol level is just that - the total cholesterol number.  It is good to be 200 or lower.
• Triglycerides measure the "fat" in your blood.  It is good to be 150 or lower.
• HDL stands for high-density lipoprotein and is the "good" or Healthy cholesterol.  The higher the better.  Men should have levels of 40 or higher. 
• LDL stands for low-density lipoprotein and is the "bad" or Lethal cholesterol.  Your goal level changes based on your risk of heart disease.  People who have had a heart attack should have levels less than 70, whereas healthy young adults may be okay with levels 160 or higher.
• Thyroid function is checked with a test called the TSH which stands for thyroid stimulating hormone. 
• Occult blood in the stool is checked by testing stool samples you submit to the lab.  This is a screening test for colon cancer.
• Vitamin D Levels - Vitamin D deficiency is gaining increased attention.  While not often done, it is probably a good idea to have your Vitamin D levels checked (test is called 25 (OH) D level) if you are older (more than 65 years old), have dark skin, any problems with not absorbing nutrients from your gut, or do not get outside very often.

Cancer Screening

Cancer screening is done to look for a cancer that is treatable in people at risk for a cancer but who do not have symptoms.  We purposely do not screen for some types of cancer (pancreatic, brain, lung) because screening, on the whole, does not produce a benefit.  Cancer screening can include blood tests, pap tests, ultrasound, and physical exams.

Cancer screening for almost all men

• Skin cancer screening - the benefit of examining your skin all over on a regular basis is debatable.  But it is not too difficult to look at your skin from time to time to see if any moles are growing, bleeding, or changing colors.

Cancer screening for men at certain ages

• Colorectal cancer screening is recommended for average risk men starting at age 50.  It can be done in a variety of ways - colonoscopy, flexible sigmoidoscopy, stool test for blood, virtual colonoscopy, barium enema.  Recent recommendations promote colonoscopy as the "best" test to start with for most patients.  This is for several reasons:  colonoscopy allows direct visualization of the colon and the doctor can take a sample of anything abnormal that is seen, colonoscopy can pick up pre-cancerous lesions that can be removed before they even become cancer, the other tests, if abnormal, require colonoscopy for further evaluation.  
• Prostate cancer screening is recommended for men who choose to have it at about age 50.  It may start at age 40-45 if you are African-American or have a family history of prostate cancer.  There is a lot of debate and research about prostate cancer screening right now.  This is why:
• Prostate cancer is very slow growing, so even if you have it, it is not likely to kill you.
• Prostate cancer is very common, especially as you get older.  An old adage from medical school is that about 80% of men will have some degree of prostate cancer by age 80.  So, if almost all men get it if they live long enough, and you are not likely to die from it, is it worth looking for? 
• The treatment for prostate cancer can leave you with a lot of problems.  Most commonly, complications can include incontinence and impotence.  However, men can also be left with irritative voiding symptoms (pain or discomfort or even difficulty when you urinate).  So, if prostate cancer is common and unlikely to kill you, maybe the treatment is worse than the cure.
• We don't know who is most likely to benefit from early detection or treatment.  A lot of research is going on right now to figure out which men are most likely to benefit from finding and treating prostate cancer early.  But, at this point, we're just not sure who is most likely to benefit. 
• If you do decide to get prostate cancer, the best way to have it done is with a combination of a digital rectal exam (the doctor inserts a gloved finger into your rectum and gently feels your prostate gland for any lumps or nodules) plus a prostate specific antigen (PSA) test (a simple blood test).  If you have a prostate gland, your prostate will make some of the prostate specific antigen.  If your prostate is growing from cancer, the PSA level may be high.  The difficulty with both of these tests is:
• For the digital rectal exam, the doctor can only feel a part of the prostate gland.  So, the part the doctor can feel may feel normal but there could be a cancer growing in a different part.
• For the PSA test, the test can be high from other conditions (like benign prostatic hypertrophy (BPH) which is age-related enlargement of the prostate gland) or may be normal even if you have cancer. 

Other types of testing

• Bone density testing for osteoporosis is recommended for men if they have an increased risk of osteoporosis. 
• Ankle-brachial index is screening for blood vessel (vascular) disease and is recommended in men at high risk for vascular disease.
• Coronary calcium score is a newer test that goes by other names (cardiac CT, EBCT).  It is a CT scan of your heart that measures the amount of calcium deposited in the heart blood vessels.  It can help your doctor to find out if your risk for heart disease is higher or lower than what would be predicted based on your cholesterol results, personal history, and family history.  

Coronary CT Scan

• Ultrasensitive CRP is a blood test that measures something called CRP or C-Reactive Protein.  This protein is a marker of inflammation.  It will be high if you have an infection or some type of inflammatory condition like rheumatoid arthritis.  It also can be high in people who have increased inflammation for other reasons.  People with high ultrasensitive CRP values are at higher risk of having heart disease.
• Abdominal ultrasound is done to screen for a dilated blood vessel in your abdomen called a "triple A" or "AAA" which stands for Abdominal Aortic Aneurysm.  Currently, it is recommended for men ages 65-75 who have ever smoked.

Counseling Topics

Your doctor may talk to you about ways to be healthier or stay healthy.  These include:

• Stop smoking
• Get enough calcium and vitamin D. 
  Men should get between 1000-1200 mg of calcium each day.  A serving of yogurt, cheese or milk has about 250-300 mg of calcium.  If you don't get enough calcium in your diet, you should add a calcium supplement.  Since your body cannot absorb a lot of calcium at once, you shouldn't take more than about 600 mg of calcium at a time.  Vitamin D is an important part of bone health.  You should be getting about 800-1000 units per day, depending on how much sunlight exposure you get.
• Eat healthy. 
  This includes avoiding lots of high-fat, high-salt, high-cholesterol, or sugary foods.  Some good rules of thumb:
• Eat lots of fresh fruits and veggies (aim for at least 5 servings each day)
• Eat brown grains - whole wheat rice, breads, whole grains
• Eat lean proteins - nuts, fish, chicken, beans
• Exercise is really, truly good for you.  Get some exercise everyday.  The best initial approach is to just increase your activity by:
• Parking your car in the farther spot from the store (not a lot of competition for these spots)
• Use your feet instead of the remote control
• Stairs instead of the elevator
• Wear your seatbelt and bike/motorcycle helmet

Conclusion

    Part of staying healthy is preventing disease or finding it early.  One way to do this is to see your primary care doctor on a regular (usually every 1-2 years) basis.  The annual physical is nothing to be afraid of!

A Cool Tool:

If you would like to plan your next preventive health visit with your doctor, there is a great new tool available from the USPSTF and Agency for Healthcare Research and Quality.  The Electronic Preventive Services Selector will identify the preventive services you need based on your age, gender, and health habits.

Links:
The US Preventive Services Task Force Recommendations

Osteoporosis in Men

Coronary Calcium Score

Preventive Health in Men