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O exame bem masculino adulto

JOEL J. HEIDELBAUGH, MD e MICHELLE TORTORELLO, MD
Universidade da escola médica de Michigan, Ann Arbor, Michigan

O exame bem masculino adulto deve incorporar orientaço ã baseada em evidências para a promoço ã de tó ima
saúde e bem-estar, incluindo testes mostrados para melhorar os resultados de saúde de rastreio. u Q ase um terço do
relatório de homens, não tendo um médico da atenço ã primária. A história médica deve incluir o uso da
substância; fatores de risco para sexualmente trans - mitted infecçeõ s; hábitos de dieta e exercício; e os sintomas
da depressão. Exame físico deve incluir a pressão arterial e corpo triagem de n í dice de massa. Homens com
sustentado pressão arterial maior u q e 135/80 mm Hg devem ser selecionados para diabetes mellitus. aR streio de
lipídios é garantida em todos os homens 35 anos e mais velhos, e nos homens 20 a 34 anos de idade u q e têm fatores
de risco cardiovascular. Triagem de ultra-som para aneurisma da aorta abdominal deve ocorrer entre 65 e 75 anos de
idade nos homens u q e nunca fumaram. Há evidências de insufcient para recomendar a triagem de homens para o
câncer de pele ou osteoporose. A força de tarefa de serviços preventivos dos EUA
provisoriamente recomendou contra próstata-específico antígeno-com base de triagem
para câncer de próstata porque os danos de testes e overtreatment são superiores aos
potenciais benefícios. Triagem para câncer colorretal deve começar aos 50 anos de idade
em homens de risco médio e con-continuar até pelo menos 75 anos de idade. aR streio deve
ser realizado por sangue occult fecal alta sensibilidade, testando todos os anos, exible
sig-moidoscopy a cada cinco anos combinada com pesquisa de sangue oculta fecal teste a cada
três anos, ou colonoscopia cada 10 anos. O EUA Preven - tiva Services Task Force recomenda
contra o rastreio para o cancro testicular e doença pulmonar obstrutiva crônica.
Imunizaçeõ s devem ser recomendadas de acordo com as diretrizes do Comitê Consultivo

ILUSTRAÇÃO POR JENNIFER E. FAIRMAN

em práticas de imunizaço ã dos centros de controle e prevenço
ã de doenças. (

Sou médico de Fam. 2012; 85 (10): 964-971.

Copyright © 2012 American Academy de médicos de família.)

T
Ver editorial relacionado
²

na página 956.
objetivos do exame bem masculinoentre 15 e 65 anos de idade foram signi -
adulto são fornecer orientaçeõ s cativamente menos provável do que as
Informações do
²

baseadas em evidências para a mulheres a procurar pre-ventive cuidados de

paciente: um folheto sobre a promoço ã da saúde ideal um médico da atenção primária (15 por
saúde dos homens, escrito
cento contra 44 por cento, respectivamente,
pelos autores do presente e bem-estar, para evitar prematuro mor-
4

artigo, é fornecido na bidity e mortalidade de doenças crónicas e para fornecer em percentagem do totais
em três homens relatórios não tendo visitas). Quase um
página 972. vacinas e seleçeõ s apropriadas à idade. A principalnenhum fonte médico da atenção primária,
de orientaçeõ s de cuidados preventivos é o EUA Preven em comparaç
5 ão com uma em cinco
- tiva Services Task Force (USPSTF), que mulheres.
Controle e Dados
programa dos decentros
prevençpara doença
ão (CDC)
1 que uma percentagem substancial dos
informa as condiçeõ s clínicas da homens têm subopti-mal estado de saúde,
Academia Americana de méd2 icos de fatores de(Tabela
risco e seguro
1).
6

família. Orientaç
produzido por eõespecialidade
s grupos podem oferecer
orientaço ã addi-cional, mas podem fornecer História
recomendaçeõ s conicting. Atualmente, não há O histórico médico de machos adultos
consenso sobre a frequência ideal de exames bem deverão incluir histórias médicas e
masculinos adultos. cirúrgicas, como bem como o atual uso de
Socialização masculina, juntamente com medicaçoã e alergias. História familiar de
chal-Quisera no acesso aos serviços de saúde, câncer e doenças crônicas deve ser obtida.
problemas de cre-ates signicativa para História social deve centrar-se sobre os riscos
homens em saber quando acessar 3 cuidados do estilo de vida que contribuem para o
preventivos. Em 2007, os homens prematura morbidade e mortalidade, incluindo
Baixado do site da Web de médico de família americano em www.aafp.org/afp. Copyright © 2012 AmericanaAcademy
substânde
ciamédicos de família. Para o privado, Pussy - médico de família americano
964mercial uso de um usuário individual, do site da Web. Todos os direitos reservados. Contate copyrights@aafp.org para questões85,
Volume de núdireitos
mero 10 autorais15
e/ou
desolicitaç
maio õedes de permissão. www.
2012
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Exame bem masculino
TIPO: RECOMENDAÇÕES-CHAVE PARA A PRÁTICA

Provas
Recomendação clínica classificação Referências

Os
machos
adultos
devem
ser
aconselhados
sobre
hábitos
de
vida
saudáveis,
incluindo
seguinte:
o padrões de consumo podem satisfazer os
critérios de dependência do álcool e
Cessação do tabagismo A 17 aumentar o risco de morbidade associada e
Limitar a ingestão de álcool B 7 mortal-dade de doença e acidentes. 7 A
Reduzindo o risco de infecçeõ s sexualmente transmissíveis C 13-15 gaiola
ques-tionnaire (sentindo a necessidade de
Triagem para vírus do immunodeciency humano em A 15
homens risco aumentado
cortar, irritado pela crítica, culpado sobre
Dislipidemia, triagem em homens 35 anos e mais velha, A 23
beber e a necessidade de uma r" evelaço
ã " de
e em homens mais jovens com fatores de risco cardiovascular manhã) é o mais popular teste de triagem
Começando em 50 anos de rastreio de cancro colo-rectal A 42 para detecçoã de abuso de lá cool ou
de idade e continuando até pelo menos 75 anos de idade dependência nos18 cuidados primários.
Imunizações e intervalo-idade, C 64 Para os homens, bebendo arriscado
é dened como mais de 14 doses por
incluindo um toxoide tetânico, difteria reduzida
tetânico e impulsionador de pertussis acelular semana, ou mais de quatro drinques 7por
(dTpa), independentemente do tempo desde o reforço anterior ocasião.
INFECÇÕES SEXUALMENTE TRANSMISSÍVEIS
A = provas centradas no doente consistente, de boa qualidade; B = inconsistente ou
limitada-qualidade provas centradas no doente; C = consenso, evidência de doença,
Fatores de risco para DSTs (por exemplo, vários
ã de provassexo
habitual prac-tice, peritagem ou série de casos. Para obter informaçeõ s sobre a classificaço parte-ners,
tipo sys-tem, relaço
ã desprotegida, homens
vá para http://www.aafp.org/afpsort.xml.
que fazem sexo com homens) deve ser
determinadas para selecionar candidatos
adequados
13-15
Empara tela-ing.
homens de risco aumentado, alta-
uso, fatores de risco para doenças sexualmente transmissíveis (DSTs),intensidade de aconselhamento comportamental para prevenir DST
e hábitos de dieta e exercício atuais (Tabela 22,7-17 ). demonstrou para ser eficaz se realizada em vários grupo
ses-Sion mais de três a nove horas; n ú ica sessões
USO DE SUBSTÂNCIAS duram menos de 30 minutos foram encontradas 19 para ser
Homens devem ser perguntados sobre tabaco e álcool ineficaz. Triagem
para o immunodeciency humano infecço ã de vírus
usam em cada visita; evidência é insufcient para deve ser realizada rotineiramente em pessoas que relatam
recomendar triagem para uso de7,10,17 drogas
O ilí"5c-A"
itas.comportar - sem fatores de risco individuais, mas são vistas em
ioral quadro de aconselhamento é recomendado para se envolver ambientes clínicos de alto risco ou alta prevalência (por
pacientes em discussões sobre cessação do tabagismo: exemplo, clínicas STI, estabelecimentos prisionais,
(1) perguntar sobre o uso do tabaco; (2) aconselhar o abrigos, clínicas de tuberculose, clínicas de saúde para
paciente a sair através de mensagens claras e adolescentes com uma elevada15prevalência de ist, clínicas
personalizadas; (3) avaliar a vontade do paciente para que servem os homens que têm sexo com homens). Um
eresumo
recomendaç eõ s do CDC para rastreio de STI está
encerrar; (4) ajudar o paciente a desistir; e (5) organizar o disponível do USPSTF
17 em
acompanhamento
uso indevido podeeidentificar
apoio. Triagem para o
com precisã álcool
os homens cujo http://www.aafp.org/afp/2008/0315/p819.html.
montante e
DEPRESSÃO

Embora as mulheres têm taxas mais altas de depressão

Tabela
Estatí
1. sticas
atuais
sobre
saú
abem-estar
dee masculino com - pared com homens, muitos homens permanecem
sem diagnóstico, devido à falta de vontade de procurar
ajuda e discutir
3 seus sintomas. Fatores que aumentam o
48%nãoseenvolvemregularmenteematividadesfísicas*33porcentosãoobesos risco de depressã o
incluem concomitantes transtornos psiquiátricos
† (incluindo o abuso de lá cool e drogas), história familiar
32
por
cento
tiveram
cinco
ou
mais
bebidas
alcoólicas
bebidas
emum
dia
pelo
menos
umavez
no
passado
ano
* de depressão, condiçeõ s médicas crônicas,
desemprego e menor status8 socioeconômico.
31 por cento tem hipertensão †
22 por cento fumaça * Exame físico
20porcentodehomensmaisjovens,de65anosnãotêmsegurodesaúde
Componentes baseados em evidências do adulto
12% taxa de sua saúde geral como justo ou pobres *
masculino bem phys ical exame incluem triagem de
índice de massa (IMC) de
11,20pressão arterial
(Tabela 11,20-29
3 ).e corpo
* 18 anos e mais velhos.
† 20 anos e mais velhos. TRIAGEM DE PRESSÃO ARTERIAL
Informações de referência 6. A hipertensão é dened como uma pressão arterial
sistólica de 140 mm Hg ou mais, ou uma pressão arterial
diastólica de
15 de maio de 2012 Médico de família americano 965
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Exame bem masculino
Tabela 2. Diretrizes de triagem para riscos de estilo de vida em homens

Risco USPSTF/AAFP recomendação (classificação de evidências *) Comentários

Álcool oferecem
Tela
e aconselhamento
comportamental
intervençpara
õereduzir
s abuso
o álde
cool
(B). Inquirir sobre o consumo de álcool para identificar os
uso indevido 7 homens que consomem mais de 14 doses por semana ou
mais de quatro drinques por ocasião; Recomendamos não
mais do que dois drinques por ocasião.

Depressão Todos os homens da tela quando sistemas de suporte de

cuidados estão em vigor (B); Não tela rotineiramente
8 quando eles não são (C).

Dieta saudável Fornecer intensiva dietéticas comportamental para aconselhamentoO departamento U.S. de saúde e serviços humanos
adultos com hiperlipidemia e outros fatores de risco para recomenda-se que adultos diminuem sua ingestão diária
doenças crônicas cardiovasculares e relacionados com a dieta 2(não avaliado).
de gordura saturada, colesterol, sódio e açúcar adicionado.
9

Drogas ilícitas Evidêninsufcient

cia
é para
balancear
benefícios
prejudica
e de
triagem
de
rotina
(I).
Use 10

Obesidade Tela de todos os homens para a obesidade e oferecer Incentive

perda
a depeso
gradual
sustentada
e em
pessoas
cujo
peso
exceda
ideal
o para
sua
altura.
aconselhamento intensivo e intervenções comportamentais
para promover a perda
11 de peso sustentada (B).

Física A AAFP reconhece que a atividade física é desejável, mas a O departamento U.S. de saúde e serviços humanos
atividade eficácia do aconselhamento médico e aconselhamento é incerta. recomenda-se que os homens participem em pelo menos
2 150 minutos de exercício aeróbio de intensidade moderada
por semana, bem como pelo menos duas vezes por 12 semana de fortalecimento

Sexualmente Tela e fornecer alta intensidade comportamentais O Centers for Disease Control and Prevention
transmitidos aconselhamento para homens com alto risco de recomenda a todos os homens de rastreio de 64 anos
infecções sexualmente transmissíveis infecções (B), sífilis (A) e infecção pelo vírus doe immunodeciency
mais jovens humano
para a (A).
infecção de vírus do
13-15 immunodeciency humano pelo 16 menos uma vez, independentemente de fator
Evidência é insufcient para avaliar o equilíbrio de vantagens
e prejudica de aconselhamento comportamental para
evitar sexualmente transmissíveis em adultos que não estão no risco aumentado (I).
13

Evidência é insufcient para avaliar o equilíbrio de vantagens

prejudica
e de
triagemde
homensassintomáticos
para
gonorreiaou
clamídia,
mesmonaqueles
de
alto
risco
(I).

Uso de tabaco Inquirirsobreousodotabacoefornecerintervençõesdecessação(A). Farmacoterapia e sessões de aconselhamento

17 comportamental curto são eficazes no aumento da proporço ã
de fumantes que desistir e permanecer em abstinência por um ano com sucesso.

AAFP = academia americana de médicos de família; USPSTF = força de tarefa de serviços preventivos dos Estados Unidos.
* Provas classificações: A = a USPSTF recomenda o serviço; Há alta certeza que beneficiar o líquido é substancial. B = a USPSTF recomenda o
serviço; Há alta segurança que não beneficiar o líquido é moderada ou moderada certeza que beneficiar o líquido é moderada a substancial.
C = a USPSTF recomenda contra rotineiramente prestação do serviço; pode haver considerações que suportam a prestação do serviço em um
paciente individual; Há pelo menos moderada certeza que beneficiar o líquido é pequena. D = a USPSTF recomenda contra o serviço; há certeza
moderada ou alta, que o serviço não tem nenhum líquido beneficiar ou que os danos superam os benefícios. Eu = o USPSTF conclui que a
evidência atual é insufcient para avaliar o equilíbrio de benefícios e prejuízos do serviço; evidência é inexistente, de má qualidade, ou conicting, e o equilíbrio entre benefícios e danos n

Informações de referências 2 e 7 a 17.

90 mm Hg ou mais. Deve ser diagnosticada somente em homens de 20 anos e mais velhos que não foram
depois de dois ou mais elevadas leituras são obtidas pelo diagnosticados com doença cardiovascular ou diabetes.
menos dois vis - seu sobre um período de uma25 a várias
semanas.
afirma que,Oem pacientes com hipertensão, o risco global de RASTREIO DE IMC
USPSTF
doença cardiovascular (tabagismo, diabetes melli-tus, dislipidemia,
Medições de peso e altura devem ser obtidas em cada
idade, sexo, vida sedentária e obesidade) deve ser considerado visita.
na Os mé
11 dicos também podem considerar a

tomada de decisões de tratamento. 20 medição ncia da cintura abdominal em alguns homens;

circunferê
A calculadora de risco de Framingham (disponível em medida-mentos superiores a 40 polegadas (101,6 cm)
http:// hp2010.nhlbihin.net/atpiii/calculator.asp) pode ser estã o associados com um risco aumentado de diabetes
usada
para determinar o risco de 10 anos de eventos tipo 2, dislipidemia, hipertensão arterial e doença
cardiovasculares cardiovascular em homens com
966 Médico de família americano
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 Well Male Examination
Table 3. Screening Guidelines for Chronic Diseases in Men

Disease USPSTF/AAFP recommendation (evidence level*) Other guidelines

Abdominal aortic Screen once with ultrasonography in men 65 to 75 years of NA

aneurysm age if they have a family history or have smoked at least
100 cigarettes in their lifetime (B).21
No recommendation for or against screening in men
65 to 75 years of age who have never smoked (C).
21

Chronic obstructive Do not screen adults with spirometry (D).22 NA

pulmonary disease

Dyslipidemia Screen men 35 years and older (A), and men 20 to The National Cholesterol Education Program–
34 years of age who have cardiovascular risk factors (B).23 Adult Treatment Panel III recommends
screening with a fasting lipoprotein profile
24 once every five years.

Hypertension Screen men 18 years and older; evidence is lacking on The Seventh Report of the Joint National
optimal20 screening interval (A). Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood
Pressure recommends screening every two
years in patients with a blood pressure less than
120/80 mm Hg, and every year in those with a
blood pressure of 120/80 to 139/89 mm25Hg.

Obesity (body mass Screen all men and offer intensive counseling and behavioral NA
index greater than interventions to promote sustained weight11loss (A).
30 kg per m2) Evidence is insufficient to recommend for or against counseling
with behavioral interventions to promote sustained weight loss
in men with body mass index of 25 to 30 kg per m2 (I).11

Osteoporosis Evidence is insufficient to assess the balance of benefits
and harms of screening (I); men most likely to benefit
from screening would have 10-year risks for osteoporotic
fracture equal to or greater than those of 65-year-old white
women who have no additional risk factors. 27
The National Osteoporosis Foundation
recommends performing bone mineral
density testing in all men 70 years and older,
and in men 50 to 69 years of age who have
additional risk factors.26

Type 2 diabetes Screen men with a sustained blood pressure greater than
mellitus 135/80 mm Hg (B). 28
Evidence is insufficient to assess the balance of benefits and
harms of screening in asymptomatic men with a blood
pressure less than 135/80 mm Hg (I). 28
The American Diabetes Association recommends
screening all men 45 years and older, or older
asymptomatic men with a body mass index
greater than 25 kg per m2 and cardiovascular
risk factors.29

AAFP = American Academy of Family Physicians; NA = not available; USPSTF = U.S. Preventive Services Task Force.
*—Evidence ratings: A = the USPSTF recommends the service; there is high certainty that the net benefit is substantial. B = the USPSTF recommends
the service; there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. C =
the USPSTF recommends against routinely providing the service; there may be considerations that support providing the service in an individual
patient; there is at least moderate certainty that the net benefit is small. D = the USPSTF recommends against the service; there is moderate or high
certainty that the service has no net benefit or that the harms outweigh the benefits. I = the USPSTF concludes that the current evidence is insufficient to assess the ba

Information from references 11, and 20 through 29.

BMIs of 25 to 34.9 kg per m . 30 In men with BMIs of 2 cardiovascular risk equivalent because it confers an ele-
35 kg per m or greater, waist circumference has limited 2 vated 10-year risk.28 The American Diabetes Association
additional predictive power of cardiovascular disease risk defines diabetes as an A1C level of at least 6.5 percent; a
beyond that of BMI alone. In Asian
30 and black men, fasting plasma glucose level of at least 126 mg per dL
waist circumference may be a better indicator of cardio- (6.99 mmol per L); a plasma glucose level of at least 200
vascular risk than BMI. 31 mg per dL (11.10 mmol per L) two hours after ingesting a
75-g glucose load; symptoms of uncontrolled hypergly-
Screening for Chronic Diseases cemia (e.g., polyuria, polydipsia, polyphagia); and a ran-
DIABETES dom plasma glucose level of at least 200 mg per dL. 29The
Thirteen million U.S. men 20 years and older (nearly USPSTF recommends screening for diabetes in men with a
one in eight) have diabetes. Diabetes
32 is considered a sustained blood pressure of at least 135/80 mm Hg.

May 15, 2012 ◆ Volume 85, Number 10 www.aafp.org/afp American Family Physician 967
Well Male Examination

DYSLIPIDEMIA a dietary intake of 1,000 mg of calcium and 600 IU of

Men 35 years and older, and men 20 to 34 years who have vitamin D3 daily, whereas men 71 years and older should
additional cardiovascular risk factors, should be screened consume 1,200 mg of calcium and 800 IU of vitamin D
for dyslipidemia. 23The fasting lipoprotein profile is the daily, using supplements if dietary intake falls short of
preferred screening test.23,24 For nonfasting samples, total these goals. 39
cholesterol and high-density lipoprotein cholesterol levels
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
are recommended. The optimal interval for screening
23
is not known, and no age has been established at which The USPSTF recommends against screening adults for
physicians should stop screening. chronic obstructive pulmonary disease using spirome-
try.22Men with this condition, including those with mild
ABDOMINAL AORTIC ANEURYSM or moderate illness, will benefit from smoking cessation
Abdominal aortic aneurysm (AAA) occurs in 5 to 10 and annual influenza vaccination. Although moderate
percent of men 65 to 79 years of age. 33
The mortal- evidence suggests that influenza vaccination reduces
ity rate after dissection and rupture approaches 80 per- exacerbations of chronic obstructive pulmonary disease,
cent for men who reach the hospital and 50 percent for no studies have assessed whether spirometry leads to
men who undergo emergent surgical repair.33 Risk fac- increased influenza vaccination rates.40
tors include smok-
ing, hypertension, Cancer Screening
Nearly one in three men dyslipidemia, family The USPSTF recommends against screening for testicu-
reports having no primary history, and athero- lar cancer in adolescent and adult males 41 (Table 4 41-49).
care physician, compared with one in five women.
sclerosis. Smoking is Because the incidence is low and treatment is often effec-
the risk factor most tive even in advanced stages, the benefits of earlier detec-
strongly associated tion are minimal and are likely outweighed by the harms
with AAA (odds of false-positive results and unnecessary work-ups for
ratio = 5.1) and accounts for 75 percent of all aneurysms benign conditions. 41There is insufficient evidence to
at least 4.0 cm in diameter.34Twelve to 19 percent of first- assess the balance of benefits and harms of a
degree relatives of men with an AAA will develop an whole-body skin examination by a primary care
aneurysm. 35 Only 30 percent of asymptomatic AAAs are clinician or patient skin self-examination for the early
discovered on physical examination, with sensitivity and detection of48skin can- cer in men.
specificity of 68 and 75 percent, respectively.36,37
The USPSTF recommends a one-time ultrasound PROSTATE CANCER
screening for AAA in men 65 to 75 years of age who have Significant controversy exists about prostate cancer
ever smoked,21because randomized trials have shown screening in primary care. 45-47 The prostate-specific
that the benefits of screening and surgical repair in this antigen (PSA) serologic assay is the most commonly used
high-risk group outweigh the harms. One trial found a test for detection of prostate cancer, but the pro- portion
number needed to screen of 349 to prevent one AAA- of clinically significant prostate cancer detected is
related death over 4.3 years.38 unknown. The lifetime risk of prostate cancer is 16
percent, and the lifetime risk of dying from the disease is
OSTEOPOROSIS 3.4 percent. A subgroup analysis of a single large
46,50
Although the USPSTF found insufficient evidence to randomized controlled trial suggested that PSA screen-
recommend screening for osteoporosis in men, it states ing may decrease mortality (number needed to screen to
that if the relative benefits and harms of therapy for prevent one prostate cancer–related death = 1,410). 51
osteoporosis are similar in men and women, the men The USPSTF recently released a draft recommendation
most likely to benefit from screening would have against PSA-based screening in men of all ages, based on
10-year risks for osteoporotic fracture equal to or its conclusion that the harms from screening and over-
greater than those of 65-year-old white women who treatment outweigh potential benefits.45,52,53 Expert opin-
have no addi- tional risk factors. The National Osteoporosis Foun-
27
ion from the American Urological Association and data
dation recommends bone mineral density testing in all from an uncontrolled trial suggest that if prostate cancer
men 70 years or older and in men 50 to 69 years of age screening is performed, it should combine digital rectal
who have additional risk factors.26The Institute of Med- examination and the PSA test, which improves detection
icine recommends that men 19 to 70 years of age aim for compared with either test alone.46,54

968 American Family Physician www.aafp.org/afp Volume 85, Number 10 ◆ May 15, 2012
 Well Male Examination
Table 4. Cancer Screening Guidelines for Men

Type of USPSTF/AAFP recommendations (evidence

cancer rating*) Other guidelines

Colorectal Begin screening at 50 years of age in men The American College of Gastroenterology endorses colonoscopy as the
of average risk, and continue until 75 years preferredscreeningtest,anddoesnotrecommenddouble-contrastbariumenema.
of age; offer fecal occult blood testing every 43

year, flexible sigmoidoscopy every five years Recommendations from the American Cancer Society are the same as
combined with fecal occult blood testing those of the USPSTF and AAFP, but include the options of computed
every three years, or colonoscopy every 10 years (A).
tomographic colonography every five years, fecal immunochemical testing every year, or
42 44

Prostate PSA-based screening should not be The American Urological Association recommends offering PSA testing and
performed at any age because the digital rectal examination to well-informed men beginning at 40 years of age and continui
harms outweigh the benefits (D; draft recommendation). 46

45
Men older than 75 years should not be
screened because the harms outweigh
the benefits (D).45
The American Cancer Society recommends discussing the risks and benefits of
screening with men 50 to 75 years of age, and initiating screening at 45 years
of age in black men and in those with a first-degree relative who was diagnosed with pros
47

Additional screening options, including age-adjusted PSA values, free PSA

levels, PSA velocity, and doubling time, have been suggested. No current evidence sugges

Skin There is insufficient evidence to assess the balance

NA of benefits and harms of whole-

body skin examination or patient skin

self-examination for the early detection of skin cancer (I; 2009).
48

Testicular Do not routinely perform clinical screening or self-examination

The National Cancer
(D). Institute states that screening would result in unnecessary diagnostic
41 49

AAFP = American Academy of Family Physicians; NA = not available; PSA = prostate-specific antigen; USPSTF = U.S. Preventive Services Task Force.
*—Evidence ratings: A = the USPSTF recommends the service; there is high certainty that the net benefit is substantial. B = the USPSTF recommends the service;
there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. C = the USPSTF recommends
against routinely providing the service; there may be considerations that support providing the service in an individual patient; there is at least moderate certainty
that the net benefit is small. D = the USPSTF recommends against the service; there is moderate or high certainty that the service has no net benefit or that the
harms outweigh the benefits. I = the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service; evidence
is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. Information from references 41 through 49.

COLORECTAL CANCER but did not reduce all-cause mortality. Fecal immuno-60
Colonoscopy is increasingly becoming the preferred chemical testing and guaiac-based FOBT have similar
screening test for colorectal cancer, but there are no sensitivity (82 percent versus 62 percent, respectively),
randomized controlled trials comparing colonoscopy, but both modalities have poor sensitivity in the detec-
flexible sigmoidoscopy, and fecal occult blood testing tion of adenomas (30 percent versus 41 percent, respec-
(FOBT) with a definable outcome of cancer-specific or tively).61Fecal DNA testing yields more false-positive
all-cause mortality. 42,55,56 No randomized trial has com- results compared with FOBT (16 percent versus 5 per-
pared colonoscopy with other screening modalities or cent).62Computed tomographic colonography has an
no screening, and observational studies suggest that the 88 percent specificity in classifying results as negative, but
incremental benefits of colonoscopy compared with otherit does not detect one out of 25 advanced lesions. 63 The
modalities may be exaggerated, given the increased harmsUSPSTF recommends beginning screening for colorec- tal
associated with the procedure and sedation. 57,58
A cancer at 50 years of age and continuing until at least 75
study evaluating colorectal cancer detection rates esti- years of age, using high-sensitivity FOBT every year,
mated that if 10,000 persons were screened, sigmoidos- flexible sigmoidoscopy every five years combined with
copy would detect 168 with advanced neoplasms versus FOBT every three years, or colonoscopy every 10 years.42
191 using colonoscopy.59
A meta-analysis revealed that FOBT offered a 13 per- Immunizations
cent relative reduction in colorectal cancer mortality Current immunization guidelines from the CDC’s
with a number needed to screen of 833 over 12 years, Advisory Committee on Immunization Practices are

May 15, 2012 ◆ Volume 85, Number 10 www.aafp.org/afp American Family Physician 969
Well Male Examination

available online (http://www.cdc.gov/mmwr/preview/ 8. U.S. Preventive Services Task Force. Screening for depression in adults.
http://www.uspreventiveservicestaskforce.org/uspstf/uspsaddepr.htm.
mmwrhtml/mm6104a9.htm). Annual influenza vac- cination is May 15, 2011.
Accessed
strongly encouraged for all adults. For men younger than 65
9. U.S. Department of Agriculture, U.S. Department of Health and
years, tetanus toxoid, reduced diphthe- ria toxoid, and Human Services. Dietary guidelines for Americans, 2010.
acellular pertussis (Tdap) vaccination is recommended, http://www.cnpp.
usda.gov/publications/DietaryGuidelines/2010/PolicyDoc/PolicyDoc. pdf. Accessed Octob
regardless of the time since the previous booster. Tdap is
also recommended over tetanus and 10. U.S. Preventive Services Task Force. Screening for illicit drug use.
64
http://www.uspreventiveservicestaskforce.org/uspstf/uspsdrug.htm. Accessed May
diphtheria toxoids (Td) vaccination for adults 65 years 21, 2011.
and older who will be in contact with children younger 11. U.S. Preventive Services Task Force. Screening for obesity in adults.
http://www.uspreventiveservicestaskforce.org/uspstf/uspsobes.htm. Accessed May
than one year. 14, 2011.
12. U.S. Department of Health and Human Services. 2008 Physical activ-
Data Sources: We reviewed the U.S. Preventive Services Task Force, ity guidelines for Americans. http://www.health.gov/paguidelines.
Cochrane, Agency for Healthcare Research and Quality, DynaMed, Essen- Accessed October 28, 2011.
tial Evidence Plus, and National Guideline Clearinghouse databases.
13. U.S. Preventive Services Task Force. Behavioral counseling to prevent sex-
A Medline search was conducted using the key words men’s health, guidelines,
ually transmitted infections. http://www.uspreventiveservicestaskforce.
sexually transmitted infections, hypertension, blood pressure screening, abdominal
org/uspstf/uspsstds.htm. Accessed May 21, 2011.
aortic aneurysm, diabetes mellitus, dyslipidemia, obesity, osteoporosis, chronic
14. U.S. Preventive Services Task Force. Screening for syphilis infection.
obstructive pulmonary disease, prostate cancer, colorectal cancer, testicular http://www.uspreventiveservicestaskforce.org/uspstf/uspssyph.htm.
cancer, Accessed May
skin cancer, and immuniza- tions. Search dates: April, May, and October 2011. 21, 2011.
15. U.S. Preventive Services Task Force. Screening for HIV. http://www.
uspreventiveservicestaskforce.org/uspstf/uspshivi.htm. Accessed May
21, 2011.
The Authors
16. Branson BM, Handsfield HH, Lampe MA, et al.; Centers for Disease
JOEL J. HEIDELBAUGH, MD, FAAFP, FACG, is a clinical associate professor Control and Prevention. Revised recommendations for HIV testing of
of family medicine and urology, and is the clerkship director in the adults, adolescents, and pregnant women in health-care settings.
MMWR
Depart- ment of Family Medicine at the University of Michigan Medical School, Ann Recomm Rep. 2006;55(RR-14):1-17.
Arbor.
17. U.S. Preventive Services Task Force. Counseling and interventions to
prevent tobacco use and tobacco-caused disease in adults and preg-
MICHELLE
TORTORELLO,
MD,
third-year
ais family
medicine
resident
the
University
at of
Michigan
Medical
School. nant women. http://www.uspreventiveservicestaskforce.org/uspstf/
uspstbac2.htm. Accessed May 21, 2011.
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1984;252(14):1905-1907.
Ypsilanti Health Center, 200 Arnet, Ste. 200, Ypsilanti, MI 48198 (e-mail: jheidel@umich.edu). Reprints are not available from the authors.
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sexually transmitted infections: a systematic review for the U.S. Preventive
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