PREPARE FOR 50 YEAR OLD CHECK UP: MALE  

Dear patient:

This packet contains important information that you need to know about your health. Your upcoming “annual visit” with your doctor is a time for you and your doctor to look at your health since your last visit.  It is also a time to see if you are at risk for any health problems and to decide what steps you need to take to stay healthy. This packet will help you prepare for your annual visit.#

WHAT TO EXPECT AT YOUR ANNUAL VISIT:
                               

• A review of your health history to see if anything has changed since your last visit
• A complete physical examination
• A talk about behaviors that can affect your health, such as diet, exercise, alcohol use, and smoking
• An update of your shots
• A talk about tests you may need to screen for some cancers

1) YOUR HEALTH HISTORY

Changes in Your Health:  It is important for your doctor to know about any changes in your health since your last visit. Do not think that a change in your health is just part of “getting older.” A change in your health could be a sign of a problem that can be easily treated.

Medicine:  Your doctor will want to review your medicines with you.  It is helpful if you come ready to do this.  Look at the list of your medicines that is included in this packet.

• Cross off the ones you no longer take.
• Add any new ones that are not on the list. This should include over-the-counter medicines (like aspirin, allergy medicine, or pain medicine), vitamins, supplements, and any herbal medicines.
• Make sure the dose on the list matches what you take. If it is different, write down the dose you take.  
• Ask your doctor to give you an updated list of your medicines before you leave your visit.

Family History:  Your doctor will ask if there have been new health problems in your family. It is important that you find out what health problems affect your parents, grandparents, brothers, sisters, aunts, uncles and children. Your risk for some health problems, like diabetes, breast cancer, colon cancer, glaucoma, and depression, may be related to your family history. Your doctor may suggest that you have certain tests based on this information.

2) COMPLETE PHYSICAL EXAM

A physical exam helps to see if you are at risk for certain health problems. The goal is to find problems at an early stage so they can be taken care of. Your physical exam will include:

• Blood pressure  
• Weight
• Skin exam
• Show your doctor any new or changed moles. Moles that have grown in size, or have changed shape or color may need to be looked at more carefully.
• Rectal exam
• A rectal exam is done to see if there are any problems with your prostate or rectum. If the exam is not normal, more tests will be done. Even if the exam is normal, your doctor will still talk about cancer screening tests with you.  There is more information about this in the “Cancer Screening” section that starts on page 4.
• Your doctor might also check your heart, abdomen, blood flow, and joints. 

3) YOUR HEALTH HABITS

Some things you do may increase or decrease your risk for certain diseases. For example, smoking increases your risk for lung and mouth cancer, heart disease, and stroke. On the other hand, regular physical activity can decrease your risk for heart problems and diabetes.

If there are lifestyle factors that could be improved, you and your doctor can discuss possible changes. You should think about the following questions:

• Am I ready to change this behavior?
• What is preventing me from changing this behavior?
• If I have tried to change before, what did I learn from that experience?

Your doctor can give you some ideas about how to get started with changing a behavior. In addition, your doctor has written information about:

• Quitting smoking                      
• Decreasing alcohol intake  
• Starting an exercise program
• Eating healthy              
• Losing weight                                      

4) UPDATE ON YOUR SHOTS

Your annual visit is a good time to see if you need any vaccinations. Many adults think that vaccinations are only for kids. Not true!

• Tetanus is a serious illness, also called “lockjaw” that can be caused when the tetanus bacteria gets into a wound. Although the disease is very rare, there are still almost 50 cases a year in the United States. People over 60 are at highest risk for dying from the disease. 

A tetanus vaccine is recommended every ten years.

• Influenza, or “the flu,” is a virus that can cause serious complications. In a typical year, about 10 in every 100 people get the flu. People who are over 65 years, have lung problems like asthma or emphysema, have diabetes, or have heart problems like congestive heart failure are at increased risk of a serious complication from the flu. About 36,000 people die each year from complications of the flu.

If you have lung problems, heart problems, or diabetes, you should get a flu shot every year. If you live with a person with any of these problems, it is a good idea for you to get a flu shot.

• Pneumonia is a serious infection of the lungs often caused by the pneumococcal bacteria. About 5 out of 100 people who get pneumonia will die. A vaccination is available to prevent serious problems from pneumonia.

In general, people over 65 and those with the same medical problems that make flu shots a good idea should be vaccinated. Unlike the flu shot, this vaccine protects you for many years. Some people may need a second "booster" shot after 5 or more years.

If you have lung problems, heart problems, or diabetes, you should get a pneumonia vaccine.

• Hepatitis B is a virus that is spread by contact with blood or through sexual activity. Adults at high risk of hepatitis B infection should get a full set of vaccinations.  This involves 3 shots over 6 months.

People at risk for hepatitis B include:

• sexually active heterosexual adults with more than 1 sex partner in the past 6 months or with a history of a sexually transmitted disease
• men who have sex with men
• people who inject illegal drugs
• health care workers and people who work with the developmentally disabled
• household and sexual contacts of persons with chronic hepatitis B infection

If you are at risk for hepatitis B infection, you should get vaccinated.

5) CANCER SCREENING 

Cancer is the number 2 cause of death in the United States (heart disease is number 1). For men, the most common causes of cancer death are:

1. Lung cancer
2. Prostate cancer
3. Colorectal cancer

The biggest risk factor for lung cancer is smoking. The best way to prevent dying from lung cancer is to quit smoking! Currently, there are no proven tests to detect early lung cancer and prevent death from lung cancer. However, the use of x-ray tests known as CT scans is being studied. These tests are not recommended until more information is available. If you want to learn more about lung cancer screening, ask your doctor for written information.

Prostate cancer is the most common cancer in men (besides skin cancer), and the number 2 cause of cancer death in men (lung cancer is number 1). About 28,000 men die of prostate cancer each year. However, many men who are diagnosed with prostate cancer have very few problems from the cancer.
The current test that is available for prostate cancer screening is a yearly blood test, called the Prostate Specific Antigen (PSA) test. Not all doctors agree about the PSA test.
Why doctors do not agree:  The PSA test has not been studied as much as other screening tests (such as for colon or breast cancer). On one hand, PSA tests can identify prostate cancer at an early stage, when treatment can often cure you. Also, there are few symptoms of prostate cancer so you might not ever know you have the disease until it has already spread to other parts of your body.
On the other hand, PSA tests result in many false alarms and needless biopsies. Also, many slow growing prostate cancers detected by PSA tests would have remained silent throughout the patient’s life. By discovering them, the patient is subjected to the side effects of treatment.
More information about the Prostate Cancer and the PSA test can be found on the next page.

Colorectal cancer is cancer of the large intestine. Almost 6 out of 100 Americans will get this cancer at some point in their lives.
Colorectal cancer starts as a small growth, or polyp, in the intestine. These polyps will cause no symptoms. Luckily, there is good evidence that finding colorectal cancer early and treating it lowers the risk of dying from this cancer. Doctors screen for colorectal cancer by looking at the inside of your colon with a tiny camera that is inserted into your rectum. 
More information about colorectal cancer and screening tests used to find it is on page 6.

WHAT YOU NEED TO KNOW ABOUT PROSTATE CANCER SCREENING

 
The prostate is a walnut-sized gland that makes the fluid that carries sperm. It is below the bladder and goes around the tube that carries urine from the bladder to outside the body. When men age, the prostate tends to get bigger. An enlarged prostate can cause problems with urination, such as difficulty starting or stopping urination, urinating more frequently or urinating more often at night. Some men worry that these symptoms could be due to prostate cancer. However, prostate cancer usually does not cause these symptoms.

• About 3 out of 100 men will die from prostate cancer.
• Most men with prostate cancer die from something else, like heart attacks, strokes or another cancer.
• Prostate cancer is more common in men whose fathers or brothers have had it.
• African American men are at higher risk to be diagnosed with prostate cancer than other racial groups, and they have a higher death rate from prostate cancer.
• Most prostate cancers in older men will never cause problems because they usually grow slowly. The younger a man is, the more likely his prostate cancer will cause him trouble. Luckily, prostate cancer is less common in younger men.

Doctors can use a blood test to find some cancers of the prostate gland. This is called the Prostate Specific Antigen (PSA) test. The PSA test detects a protein that the prostate makes. Prostate cancers detected by the PSA test are more likely to be limited to the prostate gland. This is when the cancer is believed to be most treatable.
The PSA is usually high when a person has prostate cancer, but:

• you can have a normal PSA but still have prostate cancer.
• you can have a high PSA but not have prostate cancer.  You may just have an enlarged prostate.

In fact, about 75 out of 100 men who have a mildly elevated test will not have cancer on biopsy.

A doctor cannot tell you how much a PSA test will reduce your chance of dying from prostate cancer. This is what makes the choice so hard. Because most prostate cancer grows slowly many doctors feel that for men in their 70's and 80's, a PSA test is not useful. However, at any age, the best judge of whether to get a PSA test is you, the patient.
You should get as much information as you need to help make the decision. For some men, the comfort of a normal test or the anxiety about not having the test are reasons to get a PSA test. For other men, the decision to not get the test is based on the uncertainty of the recommendation and the desire to avoid invasive tests.
You may feel that your doctor should make the decision about prostate cancer screening. However, since the medical studies are not conclusive, the decision rests more on your personal preferences than on your doctor’s medical knowledge.

WHAT YOU NEED TO KNOW ABOUT COLORECTAL CANCER SCREENING

• Colorectal cancer is one of the most commonly diagnosed cancers in the United States.
• 2 to 3 out of 100 men will die from colorectal cancer.
• The death rate has been going down for the past 15 years. One reason is that there are fewer cases. Another reason is that more cancer is being found earlier when it is easier to treat.
• The risk of developing colorectal cancer goes up with age. More than 90 out of 100 cases occur in people over 50.
• Most people who have colorectal cancer do not have a family history of this cancer. However, if a parent or sibling has had colorectal cancer, you are at higher risk for developing it and you may need more screening than other people.
• Other risk factors include lack of regular physical activity, poor diet (low fruit and vegetable intake, and a low-fiber and high-fat diet), obesity, heavy use of alcohol, and tobacco use.

There are several tests to detect and remove colorectal polyps and cancer. Your doctor suggests one of the following plans:

A sigmoidoscopy every 5 years and a stool blood test every year

During a sigmoidoscopy, a doctor places a flexible, lighted tube with a camera on it into the rectum to look at the inside of the rectum and the about half of the colon. Sigmoidoscopy does not require staying in the hospital, or getting anesthesia. Most people find the test uncomfortable, but not painful. The test usually takes less than 15 minutes. You will usually get the results right away.
Since sigmoidoscopy can miss polyps or cancers in the rest of the large intestine, a stool blood test should be done every year. For this test, you use a home kit to collect samples of stool. You mail the samples to your primary care doctor’s office where it will be checked for hidden traces of blood.
If either of these tests is not normal, your doctor will recommend that you have a colonoscopy. You can also do the colonoscopy as a screening test right from the start.

• A colonoscopy every ten years

A colonoscopy is a longer version of the sigmoidoscopy that lets the doctor see the entire colon. You will get intravenous medication to help you relax. You will be sleepy but not unconscious. You may feel some cramping, but most of the time there is little or no discomfort. The test takes about 30 minutes. Because of the medicine you get during the test, you will need a family member or friend to take you home.

Most experts feel that the colonoscopy is the more complete test and that this is the preferred method. However, the colonoscopy involves a more extensive preparation (the preparation involves a gallon of laxative the day before the test versus about 16 ounces of laxative for the sigmoidoscopy) and it involves intravenous sedation. Also, your insurance may not cover all the screening tests. If you are paying for the tests yourself, the sigmoidoscopy is less expensive.

WHERE TO FIND MORE HEALTH INFORMATION

Information about the PSA test, colorectal cancer screening tests, and any of the other topics in this packet, is available at the Blum Patient and Family Learning Center at Massachusetts General Hospital.  The staff at the Blum Center can help you find the health information you are looking for.

In addition to written information, the Blum Center has videos and DVDs about many health topics.  These programs are designed to help you make better, more informed decisions about some health care and screening options available to you.  You can request a copy of a video or DVD when you visit or call the Blum Center.   

The Blum Center is located on the first floor of the White Building.  You can also access the Blum Center online at http://www.massgeneral.org/pflc/ or by phone at 617-724-PFLC (7352).

Please remember to complete the form enclosed in this packet. This will assist your doctor in focusing on your most important concerns and health issues.