Should You Be Getting a Digital Rectal Exam? And Other Screening Questions for Men
A screening test is defined as: “The examination of a group of usually asymptomatic individuals to detect those with a high probability of having or developing a given disease”. In other words, screening tests are done to assess risk, NOT for already symptomatic individuals.
A good screening test has the following attributes:
- Investigates an important health problem
- Effective and acceptable treatment is available
- The screening test itself is accurate and acceptable to patients
- Natural history of the condition should be adequately understood
- Overall benefits of screening outweigh harm
- Ensures informed choice, confidentiality and respect for autonomy for the patient
Chlamydia/gonorrhea (STI) testing [1]
WHAT: Urine test to measure the presence of sexually transmitted bacteria (commonly either chlamydia or gonorrhea
WHO: Sexually active males
WHEN: Currently, there’s not enough evidence to support routine testing for asymptomatic individuals
Testing recommended in people who’s sexual history presents new or persistent risk factors:
- New partner(s)
- More than 1 sexual partner
- Inconsistent condom use in non-mutually monogamous relationships
- Sexual partner with an STI
- Exchanging money for sex or drugs
Human Immunodeficiency Virus (HIV) testing [2]
WHAT: Testing for presence of the virus that is a risk factor for developing Acquired Immune Deficiency Syndrome (AIDS)
WHO: Age 15-65 year old
- Sexually active
- High risk populations e.g. men who have sex with men, active injection drug users, positive for other sexually transmitted infections (STIs)
- Increased risk populations: Unprotected vaginal or anal intercourse, sexual partners who fall under the high risk population category
WHEN: High risk populations = once a year
- Increased risk populations = every 3-5 years
- Routine re-screening not necessary in individuals who have not been at increased risk since testing HIV-negative
Digital Rectal Exam (DRE) and Prostate Specific Antigen (PSA) testing [3]
WHAT: Screen for prostate cancer risk. DRE involves palpation of the prostate through the patient’s rectum, while PSA is a blood test
WHO: Males aged 50-70
Men >45 who are at increased risk (African-American males and/or those with a family history of first degree relative with prostate cancer)
WHEN: Currently, there’s insufficient evidence to support routine testing, due to frequent false positive rates, along with mixed and inconclusive evidence whether early detection improves health outcomes
Lipid Screening Test [4]
WHAT: Cholesterol (total, HDL, LDL) and triglyceride levels in your blood
WHO: Men aged 35+ years old
Men aged 20-35 at increased risk for coronary heart disease (CHD), defined as having any of the following:
- Diabetes
- Previous history of CHD or non-coronary atherosclerosis
- Family history of cardiovascular disease before age 50 in male relatives or age 60 in female relatives
- Tobacco use
- Hypertension
- Obesity (BMI ≥30)
WHEN: The optimal screening interval is undermined, however it would be reasonable to suggest every 5 years, shorter intervals for those whose previous lipids levels were on the higher end, and longer intervals for those with repeated normal lipid levels
This is often done as part of your annual routine full-body check up
Blood pressure [5]
WHAT: Indirect measure of the elasticity of the arterial walls and the force of your heart contraction and relaxation through a heart beat
The top number represents your systolic pressure, while the bottom number represents your diastolic pressure measures presence or risk of hypertension (high blood pressure)
WHO: Aged 18+ years old
WHEN: Every 2 years in persons with blood pressure less than 120/80 mm Hg and every year with systolic blood pressure of 120 to 139 mm Hg or diastolic blood pressure of 80 to 89 mm Hg
One elevated measurement may prompt your doctor to recommend re-testing at an earlier interval
It takes at least 3 separate elevated measurements to be diagnosed with hypertension
Blood glucose levels (HbA1c) [6]
WHAT: This specific measurement of blood glucose levels gives your average over the last 3 months, which is done after an overnight fast. This differs from fasting blood sugar levels, which usually only measures your current blood sugar levels.
Screens for type II diabetes
WHO: Adults with untreated or treated elevated blood pressure (>135/80 mmHg)
WHEN: Although the optimal screening interval is unknown, the American Diabetes Association (ADA) recommends every 3 years.
However, it is a good idea for this to be done on an annual basis as part of your routine full-body check-up, regardless of elevated blood pressure. Chronically high blood glucose or insulin sensitivity can have damaging effects on your cardiovascular system, hormones, vision, immunity, and so much more
Naturopathic doctors are trained as primary healthcare professionals, meaning they are able to perform all of the screening tests above (besides sexually transmitted infections currently). Keep in mind that the above recommendations are listed as SCREENING exams, meaning the recommended testing for asymptomatic individuals.
Your doctor may perform tests outside of the above listed as individual to your health concerns and personal/family history. As always, the information listed on this website and article are not meant to replace the advice from your medical practitioner – please consult a healthcare professional for
The most important thing is to have a practitioner that you trust and are able to have open conversations with. This ensures you get the best of your visits, and that you receive a holistic approach to your health.
See my article about screening test in females here.
