The cardiovascular basics

Cardiovascular disease is the leading cause of death in men in most high-income countries, and its risk factors are silent. Three measurements do most of the work.

  • Blood pressure — checked at least every one to two years for adults with normal readings, and more often if elevated. Home measurement adds a great deal.
  • Lipid panel — periodically from young adulthood, with intervals set by risk. Ask for non-HDL cholesterol alongside LDL.
  • Blood glucose or A1C — screening from around age 35 for adults with overweight or obesity, and earlier with other risk factors such as family history.

Alongside these, ask for an estimated ten-year cardiovascular risk. It converts three numbers into a decision about what, if anything, to do next.

Cancer screening

Recommendations vary by cancer, and some are shared decisions rather than routine offers.

  • Colorectal cancer — screening from age 45 for average risk, by colonoscopy or stool-based testing at recommended intervals. Earlier and more frequently with family history or inflammatory bowel disease.
  • Lung cancer — annual low-dose CT for adults in the eligible age range with a significant smoking history who currently smoke or quit within the past 15 years.
  • Prostate cancer — PSA testing is recommended as an individual decision after discussing benefits and harms, typically from around age 55 to 69, and earlier for Black men and those with a family history.
  • Skin — no routine whole-body screening is recommended for average-risk adults, but report changing or new lesions.
  • Testicular — routine screening is not recommended; report any lump or change promptly.

The prostate conversation, honestly

PSA screening is genuinely uncertain, which is why guidelines frame it as a shared decision rather than a recommendation for or against.

The potential benefit is detecting aggressive prostate cancer earlier, which can reduce prostate cancer deaths in screened populations, though the absolute effect is modest.

The potential harms are substantial. PSA can be raised by benign enlargement, infection, and other causes, leading to biopsies that carry their own risks. And screening detects cancers that would never have caused symptoms — overdiagnosis — which can lead to treatment with real side effects including urinary and sexual dysfunction.

  • Discuss it from around 55 to 69, and earlier for Black men and those with a family history.
  • Ask what happens next if the result is raised.
  • Ask about active surveillance, which is now standard for many low-risk cancers.
  • Deciding not to test is a legitimate, evidence-consistent choice.

Other checks and often-missed items

Several recommendations get overlooked because they do not fit the usual mental model of a check-up.

  • Abdominal aortic aneurysm — a one-time ultrasound is recommended for men aged 65 to 75 who have ever smoked.
  • Hepatitis C — one-time screening is recommended for adults, with repeat testing for ongoing risk.
  • HIV — at least once for adults, more often with ongoing risk. Other sexually transmitted infection screening depends on risk.
  • Depression — screening is recommended for adults; men are less likely to raise it themselves.
  • Alcohol and tobacco — brief screening and counselling are effective and recommended.
  • Bone density — not routine for men, but considered with steroid use, low body weight, or a fragility fracture.
  • Vision, hearing, and dental — regularly, and more importantly with age.

Making appointments useful

Men in many countries attend primary care less often and delay seeking help for symptoms — a pattern that shows up in later-stage diagnoses. The practical fix is structural rather than motivational: schedule appointments in advance and prepare for them.

  • Book the next preventive visit before leaving the current one.
  • Bring a written list of the top three concerns.
  • Bring a complete medication and supplement list.
  • Document family history: relative, condition, age at diagnosis.
  • Ask directly what is due now and what is due next year.
  • Mention mood, alcohol, sleep, and sexual health explicitly; erectile difficulty in particular can be an early vascular signal worth evaluating.