What are the male preventive health check-up items?

Men's preventive health check-up has never been a fixed list that applies to everyone. The core is basic general items combined with personalized additions corresponding to individual circumstances. The priority completely depends on age, living habits, past medical history, and family genetic history. It is not at all the cookie-cutter "N-items that men must check" list posted online.

Just last week, a 32-year-old Internet programmer came to me to order a physical examination. He stays up until two or three o'clock every day. He has smoked for almost 10 years, has been sedentary for a long time and has a waistline of 94. He often eats takeaways heavy in oil and salt. In addition to the basic items such as routine hematuria, liver and kidney function, electrocardiogram, and abdominal ultrasound, I directly added prostate-specific antigen preliminary screening, Carotid artery ultrasound, Helicobacter pylori carbon 14 insufflation and glucose tolerance test. At first, he thought that he was young and did not need to spend hundreds of dollars more. It turned out that the fasting blood sugar had reached the critical value and Helicobacter pylori was also positive. Fortunately, it was discovered early. He could adjust his daily routine and diet and then kill the bacteria. If it continued, he might develop diabetes or chronic gastritis.

Many people's understanding of men's physical examinations is still that "it's enough to check the prostate more often". In fact, the screening focus of different age groups is not very different. Take men over 40 years old as an example. If they have a smoking history of more than 20 years, or if there is a direct relative in the family who has had lung cancer, low-dose spiral CT is a must-have item. Don’t just use regular chest X-rays to make up for it. I met a 51-year-old smoker before who had his chest taken every year for physical examination at work. The X-rays all showed normal. Last year, I was told to switch to low-dose CT, and a 6mm ground-glass nodule was directly detected. After the surgery, the pathology was early-stage carcinoma in situ. Now the recovery is no different from that of a normal person. By the time the chest X-ray can show abnormalities, it will basically be in the middle and late stages.

There is also a very controversial thing now, that is, many medical examination institutions prefer to prescribe a full set of tumor markers and even cancer genetic screening for several thousand yuan to young men in their early twenties with no underlying diseases or family cancer history. There are two schools of thought in the industry. One group believes that early screening will give you peace of mind, even if there is nothing wrong with the test. The other group believes that the incidence of malignant tumors in this age group is extremely low, and the false positive rate of these items is high. On the contrary, it is easy for young people to be overly anxious due to abnormal results, which is a waste of money and an undue burden.

If you often drink alcohol and have fatty liver during physical examination, don't just focus on the enzyme indicators of liver function every time. It is best to add liver elastography. Just like when you buy an apple, you can't just look at the smoothness of the skin. You have to pinch it to know whether there is chaff inside. This examination can directly see whether there are signs of liver fibrosis. Abnormal liver function is often already irreversible damage. There are also people who often go out to socialize and eat irregularly. Those over 45 years old must have a gastrointestinal endoscopy regardless of whether they have symptoms of stomach pain or acid reflux. Those with a family history of gastrointestinal cancer must have a gastrointestinal endoscopy earlier than the age of 40. Don’t feel that you have to suffer from a gastrointestinal endoscopy. If you wait until you have symptoms, it may be too late.

All said and done, there is really no unified standard answer to the physical examination. Don’t believe in the gimmicky must-check lists on the Internet. Before placing a bill, talk to the doctor about your living habits and whether there is any genetic history in your family. Tailor-made items are the most useful. Spending thousands on a bunch of useless screening items is better spent on examinations that truly suit your situation.