Joey Wahler (Host): It's often taken for granted. So, we're discussing men's health. Our guest is Dr. Anthony Witt. He's a family medicine physician with Woodlawn Health. This is Woodlawn Health Doc Talk. Thanks for joining us. I'm Joey Wahler. Hi, Dr. Witt. Welcome.

Anthony Witt, MD: Hi,Joey. Thanks for having me.

Host: Great to have you aboard. We appreciate the time. So first, tell us what are the routine screenings that men need regularly and starting at what age?

Anthony Witt, MD: Yeah. So when we talk about screenings, most people automatically jump to cancer screenings. That's usually what is being discussed. And so, the primary screenings for men would be colon cancer screening that's now at age 45. It used to be age 50, but we're seeing earlier cancers being diagnosed. So, that recommendation has been dropped to 45 for colon cancer screening. And prostate cancer screening is a little bit of a lengthier discussion that we'll touch on, but generally, depending on which society you prescribe to, can start anywhere from age 40, 45. Most people go by age 50 if you get screened. Lung cancer screening is not for everybody. It is only if you have a certain amount of smoking history. That generally starts around age 50 as well.

So, for men's cancer screenings, that's primarily what we're looking at. I also do like to touch on the yearly lipid or cholesterol screening, yearly diabetes screening and high blood pressure screening, which is just as it sounds, getting your blood pressure checked once a year. So, these are all things that don't really have a certain age to start. I just generally say it's best to see your primary care provider on a yearly basis in adulthood.

So, the moment you leave high school, you should already be seeing your pediatrician; then, you can see your adult family practice provider because all these screenings do change with time. And your primary care provider is your point person to keep you up-to-date on those screenings. So even if you're completely healthy, even if you are not yet 45 for the colon cancer screening, seeing a yearly provider is important for those other cholesterol, diabetes, high blood pressure screenings, and they can keep you apprised of any other changes in recommendations.

Host: Gotcha. So, what's the importance, generally speaking, of having annual blood tests And what are a few of the significant results they can yield?

Anthony Witt, MD: That's a question that comes up a lot of like, "Hey, I'm maybe young. I don't feel anything abnormal going on? Why do I need to have blood work done?" And not all insurances pay for wellness labs. Thankfully, most of them do. But sometimes patients get some surprise bills that we're not aware of.

I see a lot of importance in "wellness labs," And that means something slightly different per provider, because it gives us a baseline set of labs. So, one, it can absolutely identify something that we wouldn't have known otherwise. Like, a patient that's anemic, right? Their blood counts are low, that they weren't symptomatic to. So, it can alert us to an issue. And, you know, sometimes we catch diabetes just off screening labs, you know, screening yearly wellness labs. But it also gives us a baseline set of labs. So if you were to get ill in the next two to three years and you go into the hospital and your labs are all over the place because you're acutely ill, we'd have no way of knowing, you know, how far off are these labs from your normal, unless we have a baseline set in the last few years.

So, I change how frequent I do those labs for my patients based off their age. You know, somebody in their early 20s. If they're otherwise healthy, they probably don't need those every single year, but somebody in their 40s, yeah, at that point we should be screening their lipids every single year.

So, again, that's just the value of seeing your primary every year, because then you can develop that relationship with them and come up with the screening frequency that's appropriate for your situation.

Host: For men, getting a blood test typically means including PSA, especially as men age. How much of a difference does having your PSA regularly checked make in diagnosing possible prostate cancer, because it really could be the difference between life and death for some people, right?

Anthony Witt, MD: It could for some patients, yeah. The recommendation for prostate cancer screening is very complex depending on, as I said earlier, which society you follow, whether it's the American Cancer Society, or whether it's the Urological Society or Family Medicine Society. They all have different variations of what they recommend for prostate cancer screening.

The advice of everyone should go get a PSA drawn. It actually is a little bit more complex than that because you can get elevated PSA levels that are not clinically significant, but can lead to advanced testing and invasive procedures that have side effects that might not have been necessary in the first place.

That being said, I usually try to recommend for my patients to have a yearly PSA after the age of 50, but not all providers might feel that way, and it really just depends on that particular patient. Certainly, if you are awaiting for symptoms to develop, to alert you to the possibility of a cancer, then oftentimes that is potentially already metastatic depending on the type of prostate cancer you have. So, early identification is always the key. And that's regardless of the cancer, right? That's why we do colonoscopies before they have symptoms for colon cancer screening. That's why we do lung cancer screening for men that have a very strong smoking history before they develop a chronic cough or coughing up blood.

We try to identify these things earlier. That's where the value of the PSA comes in. Let's try to identify a potential cancer before it gets to the point where it's advanced and symptomatic. And an elevated PSA can suggest that possibility and then can lead to further followup.

Host: And, Dr. Witt, short of cancer, how important are regular prostate exams as men age, especially to address issues like an enlarged prostate? And when might an MRI come into play there? Because sometimes, of course, as men age, there are issues with urinary capability and other things as well.

Anthony Witt, MD: Sure. Yeah. You know, if you would've gone into a doctor's office 20 years ago, pretty standard that every man over a certain age is going to get a digital rectal exam for prostate cancer screening. And that's no longer recommended, to the relief of many men that go to see their primary doctor on yearly basis.

So, screening is almost exclusively through the blood test, the PSA. Where imaging comes into play is if we are having symptoms in which an exam would be appropriate in those cases, or we have an elevated PSA to a level that is concerning for possible malignancy, then we would like to get further imaging of that prostate, right? We want to know, is this an elevation in PSA that is something that we really need to be concerned about? Or are these symptoms something that we really need to be concerned about from a cancer perspective?

And so, thankfully, we have prostate MRI imaging that is available to us now that did not use to be as widely available, because used to it was an ultrasound. And there might still be indications for a prostate ultrasound, but they are becoming less widely used. And the MRI is kind of replacing them for the most part, which is much less invasive. The MRI is much less invasive testing and, honestly, a lot more accurate for identifying prostate cancer lesions, and then also ruling out what things might not actually be cancer without having to do further invasive testing. So, the MRI is becoming much more widely used and, again, to the relief of many men that might need advanced imaging, that they could go to an MRI instead of having to have the transrectal ultrasound, which was still used occasionally, but not as much now.

Host: And which I'm sure doctors didn't love doing either, right?

Anthony Witt, MD: Exactly. Yeah. So, it's a win-win all around.

Host: Absolutely. Switching gears a little bit, Doc, can you discuss how colon cancer screening, ideally with a colonoscopy, the gold standard there can also make the difference dramatically in terms of diagnosis. Because much like in the case of prostate cancer, colon cancer, if caught early, usually very treatable if caught later, sometimes not so much, right?

Anthony Witt, MD: And this was without prompting; I love that you dropped a gold standard for colonoscopy, because that's the exact verbiage that I use in the exam room. There are a few different ways to screen for colon cancer, but the two most common is the colonoscopy and then Cologuard, which everybody sees advertised on TV. That's the cute little box that gets mailed to your house, and you provide a sample and you send it back. So, both are good screening tests, but yes, the colonoscopy is definitely the gold standard. And I don't see that being replaced as the gold standard maybe ever. But I can't see that far into the future.

Direct visualization of the entire inside of the colon just cannot be beat, it can't be underestimated how important that is. I also like to explain to my patients that one thing many don't think about is it can actually not only screen for colon cancer, it can help prevent colon cancer because you can remove some of these polyps before they have a chance of even growing up into a cancer. Not all polyps equal future cancers. Most of them are not. But if you can remove one that could have become a cancer in the future, then you have prevented it before it even got to the clinical stage of a cancer.

But as you had mentioned, early detection is absolutely key. I already in my early career have a handful of patients that had gone for a routine screening colonoscopy, and identified an early colon cancer mass, which is still, you know, great that we catch it early. It's still a big deal, right? They still have to have part of their colon removed and potentially further treatments. But the survival rate is dramatically higher the earlier that you catch it. If you wait until you are having symptoms, oftentimes it's quite advanced at that stage.

Host: A couple of other things for you. One being why is it that men still, in 2026, avoid seeking medical care? There's still that machismo or ego or whatever it may be, right?

Anthony Witt, MD: Yeah, I would say, I think, that's slowly improving. You know, culture norm's slowly changing a little bit, but I still have quite a few men that are only brought in at the urging of their spouse or their significant other that is essentially making them come into the office.

I think you, you'd mentioned the machismo ideal set, you know, it's a weakness if you have to ask for help, it's a weakness if you're just going to go get screening. I kind of think of the old jokes about men driving for hours in circles in a parking lot, because they refuse to ask for directions to the next stop, right? If you have to ask for help, it is a failure and it's a weakness.

And so, I think that kind of sentiment creeps into other areas of life, including health. And this next point, not just unique to men, but both men and women, is the fear of what might be found if you do go, right? If you do go and get screened, we could find something. And then, they have to deal with that. Whereas ignorance is bliss sometimes, where if you just don't get screened, you don't know about it, which for obvious reasons is not the appropriate approach to healthcare.

So, I think it's those kind of two big factors that are still keeping men out of exam rooms, is they don't want to look like they need to rely on somebody else to help keep them healthy. And they maybe might be fearful of what we find if we do meet them in the exam room.

Host: And then, in summary here, kind of picking up on that thought, what are your general recommendations for men to keep in mind in order to stay healthy and remain being a once-annually patient for as long as possible? Because one advantage certainly that we haven't discussed is if there is something that you're hesitant about, seeing a doctor for may be embarrassed, uncomfortable, whatever the case may be, if you do see someone, whoever it is regularly, a lot of that goes away because there's a relationship there, right?

Anthony Witt, MD: Yeah. As you develop a rapport with your provider, even if you only see them once a year, you get more comfortable with that provider. And then, it's easier to come to them with a very personal concern that you wouldn't share with anybody else outside of an exam room. So, just going once a year just kind of helps break down that barrier a little bit.

 I think often and have these discussion with patients of, like, if I had to boil down all of medicine into what's the most important thing to be a healthy human, because everyone kind of wants that secret sauce, they want to know what the secret is, what the shortcut is, and it's the same boring stuff that we hear all the time of getting adequate sleep at night, getting exercise on a regular basis, and drinking plenty of water every day. And honestly, of the three of those, getting adequate sleep every night is what I always rank as number one.

Now, what adequate sleep is each night, it depends on your age and it depends on your gender, and it depends on various other things, and that's something to discuss with your primary provider. But starting from a young adult, if you want to stay healthy, and stay a once-a-year patient, not become a diabetic, and not have to rely on high blood pressure medications and all this kind of stuff, if it is lifestyle-driven—because there are genetic factors at play—but if it is lifestyle-driven, if you're getting adequate sleep every single night and being rested during the day, drinking plenty of water, and then exercising a regular basis, which is 150 minutes every week of moderate intensity activity, that's a pretty darn good start to a healthy life.

Host: Absolutely. Great advice indeed. Well, Folks, we trust you are now more familiar with maintaining good men's health. Dr. Witt, keep up all your great work and thanks so much again.

Anthony Witt, MD: Thanks, Joey, for having me. I appreciate it.

Host: Same here. And for more information, please do visit woodlawnhealth.org or call 574-223-3141. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler. And thanks again for being part of Woodlawn Health Doc Talk.