What kinds of cancer screenings should men get as they age?
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Q. As a man in my 60s, I do screening tests for prostate and colon cancer. But I wonder if I should get other testing like a full body CT scan to look for early signs of other cancers?
A. First, let's discuss the big two you mentioned: prostate cancer and colon cancer. Please note that my comments will be related to men at average risk of these and other cancers.
Before choosing prostate cancer screening, men should have a discussion with their doctor about the pros and cons of blood testing for prostate-specific antigen (PSA). Since you have opted in for screening, I suspect that you are getting a PSA test done every year or two. Your doctor may also be doing a rectal exam to assess the prostate for any abnormalities, although this is optional. Now, doctors can also consider ordering newer urine DNA tests and prostate MRIs as additional methods that might improve the detection of aggressive prostate cancers that are important to diagnose and treat early.
Screening for colon cancer is the one I most strongly recommend to everyone beginning at age 45. Of the available methods, colonoscopy is my first choice because not only does it find early cancers, but during the procedure, the doctor can remove polyps before they become cancerous. Men who can't have a colonoscopy for any reason should do stool testing for colon cancer.
I sometimes get questions like yours about why doctors don't order periodic full body CT scans or MRIs to look for other early cancers. The main reason is that these imaging tests too often find suspicious spots that might be cancer, but most often are not. Because of the uncertainty, many people with these results undergo unnecessary additional testing, biopsies, and even surgery. Additionally, there is as yet insufficient evidence that universal imaging testing for people at average cancer risk improves their overall outcomes. Also, repeated CT scans mean additional radiation exposure, which increases cancer risk.
For people with a higher cancer risk because of a known genetic mutation, a medical condition linked to cancer, or a strong family history of a specific cancer, it's a different story. A CT or MRI scan with possible extra testing, often beginning at much younger ages than generally recommended, is definitely warranted.
That said, exciting scientific advancements in early cancer detection, such as blood testing for certain DNA mutations and specific tumor markers, may soon become more widespread.
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About the Author
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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