The Adult Well-Male Examination

 

The adult well-male examination should provide evidence-based guidance toward the promotion of optimal health and well-being. The medical history should focus on tobacco and alcohol use, risk of human immunodeficiency virus and other sexually transmitted infections, and diet and exercise habits. The physical examination should include blood pressure screening, and height and weight measurements to calculate body mass index. Lipid screening is performed in men 40 to 75 years of age; there is insufficient evidence for screening younger men. One-time screening ultrasonography for detection of abdominal aortic aneurysm is recommended in men 65 to 75 years of age who have ever smoked. Screening for prostate cancer using prostate-specific antigen testing in men 55 to 69 years of age should be individualized using shared decision making. Screening for colorectal cancer should begin at 50 years of age for average-risk men and continue until at least 75 years of age. Screening options include fecal immunochemical testing, colonoscopy, or computed tomography colonography. Lung cancer screening using low-dose computed tomography is recommended in men 55 to 80 years of age who have at least a 30-pack-year smoking history and currently smoke or have quit within the past 15 years. Immunizations should be updated according to guidelines from the Advisory Committee on Immunization Practices.

The goals of the adult well-male examination are to provide evidence-based guidance toward the promotion of optimal health and well-being, to screen for and potentially prevent premature morbidity and mortality from chronic diseases, and to provide age-appropriate cancer screening and immunizations. Most primary care guidelines come from the U.S. Preventive Services Task Force (USPSTF) and have been adopted by the American Academy of Family Physicians (AAFP).1,2 Some subspecialty guidelines offer additional guidance but may have conflicting recommendations. Currently, there is no accepted guideline for frequency of adult well-male examinations, although many private health insurance plans and Medicare recommend annual examinations.

WHAT IS NEW ON THIS TOPIC

The life expectancy of U.S. men in 2015 was 76.3 years, a slight decrease from previous averages and five years lower than that of women.

The U.S. Preventive Services Task Force found insufficient evidence to recommend for or against lipid screening in any risk group younger than 40 years.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Men should be counseled about healthy lifestyle habits, including:

Smoking cessation

A

7

Limiting alcohol intake

B

8

Receiving age-appropriate immunizations at recommended intervals

C

75

Recommended screening in men includes:

Human immunodeficiency virus infection in all men

A

13

Hypertension in all men

A

25

Diabetes mellitus in men 40 to 70 years of age who are overweight or obese

B

31

Dyslipidemia in men 40 to 75 years of age

B

33

Prostate cancer in some men 55 to 69 years of age, based on shared decision making

C

55

Colorectal cancer in average-risk men 50 to 75 years of age, using fecal immunochemical testing, colonoscopy, or computed tomography colonography

A

57

Lung cancer in men 55 to 80 years of age who have at least a 30-pack-year smoking history and currently smoke or have quit within the past 15 years

B

59


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Men should be counseled about healthy lifestyle habits, including:

Smoking cessation

A

7

Limiting alcohol intake

B

8

Receiving age-appropriate immunizations at recommended intervals

C

75

Recommended screening in men includes:

Human immunodeficiency virus infection in all men

A

13

Hypertension in all men

A

25

Diabetes mellitus in men 40 to 70 years of age who are overweight or obese

B

31

Dyslipidemia in men 40 to 75 years of age

B

33

Prostate cancer in some men 55 to 69 years of age, based on shared decision making

C

55

Colorectal cancer in average-risk men 50 to 75 years of age, using fecal immunochemical testing, colonoscopy, or computed tomography colonography

A

57

Lung cancer in men 55 to 80 years of age who have at least a 30-pack-year smoking history and currently smoke or have quit within the past 15 years

B

59


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

In 2007, men 15 to 65 years of age were significantly less likely than women to seek

The Author

JOEL J. HEIDELBAUGH, MD, is a clinical professor in the Departments of Family Medicine and Urology at the University of Michigan Medical School in Ypsilanti.

Address correspondence to Joel J. Heidelbaugh, MD, University of Michigan, Ypsilanti Health Center, 200 Arnet, Ste. 200, Ypsilanti, MI 48198 (e-mail: jheidel@umich.edu). Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

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