The short version
| Cancer | Who (average risk) | Verdict |
|---|---|---|
| Colorectal | Ages 45–75 | Screen |
| Lung | Ages 50–80 with a heavy smoking history | Screen |
| Prostate (PSA) | Ages 55–69 (start the conversation at 45, or 40 if higher risk) | Discuss |
| Skin | Everyone: know your skin; exams if higher risk | Situational |
| Testicular | No routine screening; know the symptoms | Awareness |
| Multi-cancer blood tests | Not yet proven to reduce deaths | Not yet |
| Full-body MRI | Not recommended for screening | Skip |
Colorectal cancer
Colorectal cancer is one of the most common cancers in men, and one of the most preventable. Most start as polyps that take years to turn cancerous, and screening can find and remove them first. Rates in adults under 50 have been rising, which is why the U.S. Preventive Services Task Force lowered the starting age from 50 to 45 in 2021.
| Test | How often | Worth knowing |
|---|---|---|
| Colonoscopy | Every 10 years | Finds and removes polyps in the same procedure. Requires bowel prep and sedation, so you'll need a ride home. |
| FIT (fecal immunochemical test) | Every year | A simple at-home stool kit. Cheap and effective, but only if done every year. |
| Stool DNA-FIT (e.g. Cologuard) | Every 1–3 years | At home. More sensitive than FIT alone, but more false positives. |
| CT colonography | Every 5 years | A "virtual colonoscopy." Still needs bowel prep, and polyps found need a real colonoscopy. |
| Flexible sigmoidoscopy | Every 5 years | Examines only the lower colon. Less commonly used today. |
The best test is the one you'll actually do. If you're putting off a colonoscopy, a yearly FIT kit is far better than nothing. But any positive stool test or CT result means you need a follow-up colonoscopy. Skipping it defeats the purpose.
Start earlier, typically at 40 or 10 years before your relative's age at diagnosis (whichever comes first), if a parent, sibling, or child had colorectal cancer or advanced polyps. Inflammatory bowel disease and some inherited syndromes also mean earlier and more frequent screening. Between 76 and 85, whether to continue depends on your health and past results.
Prostate cancer & PSA
Prostate cancer is the most common cancer in American men, but most cases grow slowly, and many men die with it rather than from it. That's what makes PSA screening a genuine judgment call.
PSA (prostate-specific antigen) is a blood test. A higher level can signal cancer, but also an enlarged prostate, inflammation, recent ejaculation, or a long bike ride.
The case for testing
- ✓Large trials show PSA screening modestly reduces deaths from prostate cancer, and reduces cancers found only after they've spread.
- ✓Aggressive cancers found early are much more treatable.
The case for caution
- ✕False positives lead to anxiety and biopsies.
- ✕Overdiagnosis: finding slow cancers that would never have caused harm. Treating them risks erectile dysfunction and urinary incontinence.
What the guidelines say
- USPSTF: for men 55–69, the decision to screen should be an individual one made with your doctor. It recommends against routine screening at 70 and older.
- American Urological Association: suggests offering a baseline PSA at 45–50, and starting at 40–45 for men at higher risk, then repeating every 2–4 years through age 69.
- Higher risk means Black ancestry (about twice the risk of dying from prostate cancer), a father or brother with prostate cancer, or inherited gene mutations like BRCA2.
Why the trade-off has improved
Two changes have shifted the balance toward testing in recent years. First, an MRI before biopsy helps avoid unnecessary biopsies and targets suspicious areas. Second, active surveillance, meaning monitoring low-risk cancers instead of treating them right away, is now standard, which greatly reduces overtreatment. If you get a low-risk diagnosis, ask about it.
PSA on TRT
Testosterone therapy doesn't appear to cause prostate cancer, but it can make an existing cancer grow and it can raise PSA somewhat. So Endocrine Society guidelines recommend, for men 40 and older (and 55–69 in particular):
- A PSA and prostate check before starting TRT.
- A repeat PSA at 3–12 months, then following standard screening guidance.
- A urology referral if PSA rises by more than about 1.4 ng/mL within the first year, or is confirmed above 4 ng/mL.
A TRT provider that skips baseline PSA testing is cutting a corner. Compare providers in our directory →
Lung cancer
Lung cancer kills more men than any other cancer, and it's usually found late. Yearly low-dose CT scanning reduces lung cancer deaths in people at high risk. The USPSTF recommends it for adults who:
- Are 50 to 80 years old, and
- Have a 20 pack-year smoking history (e.g. one pack a day for 20 years, or two packs a day for 10), and
- Currently smoke or quit within the past 15 years. The American Cancer Society goes further and recommends screening regardless of how long ago you quit.
Fewer than 1 in 5 eligible Americans get screened. If this describes you, ask your doctor. The scan takes minutes and uses a low radiation dose. Quitting smoking is still the single biggest thing you can do for your lungs, at any age.
Skin cancer
Men over 50 are more likely than women of the same age to develop and die from melanoma, in part because men get fewer skin checks and are more likely to have cancers on hard-to-see spots like the back and scalp. The USPSTF says there isn't enough evidence to recommend routine full-body skin exams for everyone, but awareness matters:
- Check your skin monthly, using a mirror or a partner for your back and scalp. Look for the ABCDEs: Asymmetry, irregular Borders, multiple Colors, Diameter larger than a pencil eraser, and Evolving size, shape, or color. Also look for any "ugly duckling" spot that looks different from your others.
- See a dermatologist for any new, changing, bleeding, or non-healing spot, and consider regular exams if you have many moles, fair skin, a history of bad sunburns, or a personal or family history of skin cancer.
- Sunscreen, hats, and shade reduce your risk.
Testicular cancer
Testicular cancer is uncommon but is the most common cancer in men aged about 15 to 35. It's also one of the most curable, even when it has spread. Routine screening isn't recommended for men without symptoms, but knowing what's normal for you helps you notice changes.
See a doctor promptly for:
- A painless lump or swelling in either testicle
- A feeling of heaviness in the scrotum
- A dull ache in the lower abdomen or groin
- A noticeable change in the size or firmness of a testicle
A note for men on TRT: testosterone therapy commonly makes the testicles shrink somewhat, because the body's own production slows. That's expected. A new lump or hard area is not, and should be checked.
Multi-cancer blood tests & full-body scans
Multi-cancer early detection blood tests Not yet
Tests like Galleri look for DNA shed by tumors in the blood and claim to detect dozens of cancer types from one draw. They're sold directly to consumers for around $900–$1,000. The appeal is obvious, but:
- ✕They're not FDA-approved, and no study has yet shown they reduce cancer deaths. Large trials are still underway.
- ✕They miss many early-stage cancers, which are the ones screening is supposed to catch. A negative result doesn't mean you're cancer-free.
- ✕A positive result can lead to extensive imaging and procedures, sometimes without finding anything.
If you choose to take one, treat it as an add-on, never a replacement for colorectal, lung, or other proven screening.
Full-body MRI scans Skip
Direct-to-consumer whole-body MRI services (often $1,000–$2,500) promise to find cancer and other problems early. No major medical organization recommends them for people without symptoms. There's no evidence they improve outcomes, and they frequently turn up incidental findings, like small cysts, nodules, and benign spots, that lead to more scans, biopsies, and worry. They also miss some cancers that proven screening tests catch.
Symptoms not to ignore
Screening is for people without symptoms. If you have any of these, see a doctor, whatever your age or screening history:
- !Blood in your stool or black, tarry stools, or a lasting change in bowel habits. Colorectal cancer is increasingly found in men under 50.
- !Blood in your urine or semen, or new trouble urinating.
- !A cough lasting more than a few weeks, or coughing up blood.
- !Unexplained weight loss, persistent fatigue, or night sweats.
- !A new lump anywhere, including the chest. Men can get breast cancer, too.
- !A sore in the mouth that doesn't heal, or trouble swallowing.
- !A new or changing skin spot.