Important cancer screenings for men

As men age, good health takes effort. For most men, good health is being physically and mentally able to work and play with little to no limitations so they can be the best versions of themselves.

Good health includes understanding risk factors for male-specific prostate and testicular cancer and what you can do to minimize those risks. June is Men's Health Month and a good time to make sure you're taking care of yourself.

To ensure you have the most up-to-date information, we spoke with Christian Paul Pavlovich, a professor of urology at the Johns Hopkins School of Medicine and director of the Prostate Cancer Active Surveillance Program. Here's what he says that every man should know about today's screening guidelines:

Prostate cancer: Age-specific screening guidelines

When should you start getting screened for prostate cancer? The answer depends on multiple factors, including your age and family history.

Prostate cancer screening, ages 40 to 54

Your doctor will consider many factors before suggesting when to start prostate cancer screening, but the first recommendation will likely be a PSA test. The standard for prostate cancer screening for 30 years, a PSA test measures how much of a particular protein (called prostate-specific antigen) is in your blood.

While the general guidelines recommend starting at age 55, you may need PSA screening between the ages of 40 and 54 if you:

• Have at least one first-degree relative (father, brother, or child) who has had prostate cancer
• Have at least two extended family members who have had prostate cancer
• Are African American, a racial category that has a higher risk of developing more aggressive cancers

Prostate cancer screening, ages 55 to 69

Men between 55 and 69 will benefit the most from screening. That's because this is the time when:

• Men are most likely to get cancer
• Treatment benefits outweigh any potential risk of treatment side effects

Most men will get prostate cancer if they live long enough. Some prostate cancers are more aggressive; others can be slow growing. Doctors will take your age and other factors into consideration before weighing the risks and benefits of treatment.

You should ask your doctor how often he or she recommends you get screened. For most men, every two to three years is enough.

Depending on the results of your first PSA test, your doctor may recommend you get screened less (or more) frequently.

Decoding a PSA test

Doctors will consider your age and the size of your prostate when determining what your PSA score means. In general:

• For men in their 40s and 50s, a PSA score greater than 2.5 ng/ml is considered abnormal. The median PSA for this age range is 0.6 to 0.7 ng/ml.
• For men in their 60s, a PSA score greater than 4.0 ng/ml is considered abnormal. The normal range is between 1.0 and 1.5 ng/ml.
• A PSA score also may be considered abnormal if it rises a certain amount in a single year. For example, if your score rises more than 0.35 ng/ml in a single year, your doctor may recommend further testing.

An abnormal PSA test: What comes next?

If your PSA score is in the abnormal range, your doctor may recommend you repeat the PSA test. If your levels are still high, your doctor might recommend one of the newer prostate cancer screening tests available today.

These tests can help better assess your risk for prostate cancer and determine whether a biopsy is necessary. Only a prostate biopsy can definitively diagnose prostate cancer.

For individualized recommendations that suit you, ask your doctor about:

• What age you should start prostate cancer screening
• New blood, urine, and imaging tests that are available
• Improved biopsy techniques, if applicable

Testicular self-exam: Advice from a Johns Hopkins urologist

Testicular cancer is one of the most common cancers among young men, yet many are unfamiliar with the disease and how easily they can play a role in detecting it. To help, testicular cancer expert Philip Pierorazio—an associate professor of urology at the Johns Hopkins School of Medicine and director of the Division of Testis Cancer—explains how and why you should perform regular self-checks.

Why should I check my testicles for cancer?

Some experts doubt the usefulness of testicular self-exams, but these checkups can help men catch testicular cancer early. Although survival rates for all stages of the disease are relatively high, patients diagnosed later often undergo chemotherapy and radiation, which have unpleasant side effects. You should perform self-exams to spot cancer so it can be removed with surgery alone.

How do I perform a testicular self-exam?

Before you start, get to know your anatomy. Here are two things to keep in mind:

• Don't worry if one testicle is bigger than the other or hangs lower. That's normal.
• It's easy to mistake the epididymis for an unusual mass. The epididymis is a coiled set of tubes that lines the back and top of each testicle. It's the portion of the reproductive system where the sperm "mature" or learn to swim. It will feel softer and bumpier than the testicle it's attached to.

Here's how to perform a self-exam:

Set aside five minutes while you're in the shower. A warm shower will relax the scrotum and the muscles holding the testicles, making an exam easier. Starting with one side, gently roll the scrotum with your fingers to feel the surface of the testicle.

• Check for any lumps, bumps, or unusual features. Contrary to what many assume, cancerous tumors typically aren't painful.
• Make note of any changes in size over time. While the most common symptom of testicular cancer is a painless mass, some men experience swelling of the testicles and scrotum.
• Be aware of any dull soreness or heaviness.
• Switch sides and check the other testicle.

What should I do if I find something?

See your doctor as soon as you can. On average, men wait four to six months to make an appointment, a time delay that could allow the cancer to spread. There's no reason to feel embarrassed about discussing your testicles. Your doctor has seen plenty before, and the conversation could save your life.

Your physician will perform a quick exam, ask about your symptoms, and send you to get an ultrasound, which is a painless, radiation-free diagnostic procedure.

How often should I check?

It's recommended that you perform a self-exam once a month. By checking regularly, you'll have an easier time noticing when something has changed. If you feel something abnormal, seek a professional opinion right away.

What else could a testicular lump be?

Any change or irregularity in the scrotum or testicles requires a visit to your doctor. Fortunately, most testicular masses are not cancer. While benign, the following testicular conditions can cause intense discomfort and threaten fertility:

• Cysts (can form in the testicle, epididymis, or structures around the testicle)
• Infection
• Injury
• Varicocele (abnormally dilated veins)
• Hydrocele (collection of fluid around the testis)

Remember that Work Stride: Managing Cancer at Work is an employer-sponsored benefit program that provides comprehensive information and personal support from nurse navigators to help all Johns Hopkins employees and managers understand and navigate the cancer journey continuum including those dealing with a cancer diagnosis, caring for someone with cancer, or wanting to be proactive in preventing cancer.

Your Johns Hopkins workplace oncology nurse navigator can answer your cancer-related questions, including what screenings are available to you; early detection and prevention; managing known cancer risk factors; and navigating treatment or caregiving while continuing to work. Contact the program at 844-446-6229 or managecancer@jh.edu.