Annual physical exams were once standard practice. The yearly physical provided reassurance to those who were well while serving as a warning bell for those who showed signs of some unseen problem. It was a chance to air complaints and concerns as well as an opportunity for doctors to ask patients about vaccinations, family history, and changing personal behaviors, like smoking, alcohol use, diet, sexual health, and exercise. The once traditional visit also helped doctors and patients bank needed rapport required for more serious discussions during times of illness.

Today, the yearly exam has been abandoned with most men preferring to monitor their own health and decide on specific screenings tailored to personal needs. Although it has its downside, the current approach speaks to independence and may better address individual requirements. Generally speaking, though, all men as they age need to think about three screenings above all else.

The Silent Killer

Prostate cancer, which usually occurs in older men, forms in tissues of the prostate — a gland in the male reproductive system found below the bladder and in front of the rectum. In 2013, the National Cancer Institute estimates there will be 238,590 new cases and 29,720 deaths from prostate cancer in the U.S. In short, not counting some forms of skin cancer, prostate cancer is the most common cancer in American men and second only to lung cancer in number of cancer deaths. Every year, more than 200,000 men are diagnosed with prostate cancer, and more than 25,000 men die from it.

There is no way to know for sure who will get prostate cancer, but among the risk factors is age. Men who are 50 years old or older are at greater risk of the disease. Until recently, many doctors and professional organizations suggested a yearly PSA screening for men beginning at age 50. Now, though, the U.S. Preventive Services Task Force (USPSTF) recommends against prostate-specific antigent (PSA)-based screening for men that do not have symptoms.

The Centers for Disease Control and Prevention (CDC) encourages men to talk with their doctors to learn the nature and risk of prostate cancer, to understand the benefits and risks of the screening tests, and to make decisions consistent with their preferences and values. After all, the potential benefit of prostate cancer screening is early detection of cancer, which often leads to better outcomes. Two tests are commonly used to screen for prostate cancer.

The digital rectal exam (DRE) consists of a doctor, nurse, or other health care professional placing a gloved finger into the rectum to feel the size, shape, and hardness of the prostate gland. The prostate specific antigen test (PSA) measures the level of PSA, a protein that is produced by the prostate gland, in the blood. PSA may be higher in men who have prostate cancer, however other conditions, such as an enlarged prostate, prostate infections, and certain medical procedures, also may increase PSA levels.

Bottom line? Medicare provides coverage for an annual PSA test for all eligible men age 50 and older. Many private insurers cover annual PSA screening as well.

The Symptomless Cancer

Colorectal cancer, often referred to as colon cancer or rectum cancer, occurs in the large intestine or large bowel or the passageway that connects the colon to the anus. According to the CDC, colorectal cancer is the second leading cancer killer in the U.S. In 2009, 136,717 people, including 70,223 men, were diagnosed with colorectal cancer, and 51,848 people, including 26,806 men, died from it. More than 90 percent of all colorectal cancers is found in people who are 50 and older. For this reason, the American Cancer Society recommends check-ups for this cancer beginning at age 50. Those who are at a higher risk, such as those who have colon or rectal cancer in their families, may need to begin testing when they are younger.

The number one reason to get tested is that if the cause of colorectal cancer is found, it can often be prevented. Colorectal cancer almost always begins with a small growth called a polyp, an abnormal, precancerous growth in the colon or rectum. If a polyp is found early and removed early — often during the colonoscopy itself — colorectal cancer will be stopped before it even begins. The second best reason for getting screened for colorectal cancer is it is often highly treatable. If it is found and treated early, survival rates are excellent.

Finally, Heart Health

For middle-aged men, the most important screening is for cardiovascular risk, and this would entail yearly blood pressure and blood sugar checks along with a cholesterol profile. Most men will develop cardiovascular risk factors at some point during their life, and two out of three of those who find themselves at risk will develop cardiovascular disease in their lifetimes. "That usually gets a man's attention," said Dr. Michael Blaha of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. He refers to cardiovascular disease as "a disease of lifestyle" and notes that in most cases, it is preventable.

"Some men with a family history of heart disease might benefit from a coronary artery calcium scan, a new test for early buildup of plaque in the heart arteries," said Blaha. Comparatively speaking, this test is easy; patients lie in a scanner machine for about 10 minutes while it takes pictures of the heart. The pictures will show whether or not specks of calcium or calcifications have formed in the coronary arteries. Over time, calcifications can harden or rupture, which may lead to blocked blood flow, the most common cause of a heart attack.

Cardiovascular risk screening, then, is relatively simple and can also provide an opportunity for other conversations. "A visit to your doctor is also a great time to discuss any erectile difficulties, because they could be a sign of more serious problems," said Blaha.