50 important tests to consider when you turn 50.

A campaign poster is not the same as a screening rule.

Prostate cancer awareness campaigns are useful because men often wait for symptoms, and early prostate cancer may cause none. But PSA testing is still a shared decision: useful for some, misleading for others, and best interpreted by age, baseline value, family history, ancestry, urinary symptoms, prostate size, infection risk, and trend.

No symptoms, normal-sized prostate, PSA 9.

A real age-50 check found PSA 9 despite no urinary symptoms and a normal-sized prostate. His father had prostate cancer, common but still relevant. Ultrasound and biopsy found medium-grade cancer involving about half the prostate; if left much longer, spread beyond the prostate was a serious concern.

Because it was caught in time, open nerve-sparing radical prostatectomy was possible. Incontinence and impotence were avoided, PSA has stayed zero for more than 23 years, and no radiotherapy or chemotherapy was needed. This does not make PSA mandatory for every man, but it shows why an informed PSA discussion at 50 can matter.

The prostate was removed before spread.

Contains graphic surgical image. Click to view.

This graphic operative image shows the author's prostate being removed. The practical point is not the photograph itself; it is the window of opportunity. A quiet PSA result led to diagnosis while curative surgery was still possible.

Normal kidney numbers are useful too.

A creatinine and eGFR baseline can be boring in the best possible way. It helps later when a person starts blood pressure medicines, diabetes medicines, anti-inflammatories, contrast scans, or becomes unwell and the clinician needs to know what normal used to look like.

A conduction pattern is a finding, not a whole diagnosis.

An ECG pattern such as left bundle branch block can be old and stable, or it can matter a lot if it is new, unexplained, or paired with chest pain, breathlessness, fainting, palpitations, or poor exercise tolerance. It usually needs comparison with prior ECGs and clinical assessment rather than machine-text panic.

A very low PSA can be reassuring.

For example, a PSA around 0.4 ug/L in the early 40s is generally a low baseline. That does not mean "never test again," but it can support a calmer, less frequent follow-up plan unless family history, symptoms, or risk changes.

Total cholesterol 7.8, LDL 5.4: not a heart attack, but actionable.

A lipid result such as total cholesterol 7.8 mmol/L, LDL 5.4 mmol/L, non-HDL 6.5 mmol/L, and triglycerides 2.4 mmol/L is high enough to deserve follow-up. It should usually trigger repeat/confirmation, cardiovascular risk calculation, family-history review, secondary-cause review, and discussion of diet, weight, alcohol, exercise, smoking, statin therapy, or other lipid-lowering treatment.

Borderline blood count changes need context.

One de-identified example: hemoglobin 133 g/L, RBC 4.22 x10^12/L, hematocrit 0.40, MCV 95 fL, MCHC 332 g/L, RDW 13.7%, platelets 213 x10^9/L, white cells 9.8 x10^9/L. The hemoglobin and RBC are just below that lab's male reference range, while platelets and total white cells are within range.

Next step is not panic. Consider prior baseline, bleeding, iron/B12/folate, kidney disease, inflammation, alcohol, medicines, recent surgery or illness, and repeat testing if unexpected or persistent.

A mild neutrophil pattern often reflects stress or inflammation.

Example differential: white cells 9.8 x10^9/L, neutrophils 8.0 x10^9/L, lymphocytes 1.3 x10^9/L, monocytes 0.5 x10^9/L, eosinophils 0.0 x10^9/L, basophils 0.1 x10^9/L. Mild neutrophilia with low-ish lymphocytes can occur with acute illness, inflammation, stress response, steroid effect, smoking, or recovery after a procedure.

Trend matters. Persistent, extreme, unexplained, or symptom-linked changes need clinician review rather than isolated interpretation.

Inflammation can settle, and the trend tells the story.

Example CRP: current CRP 2.0 mg/L with a reference of less than 5.0, after earlier elevated values above 20-70 mg/L. CRP is a nonspecific inflammation marker; infection, surgery, injury, inflammatory disease, and some cancers can raise it.

A normalizing CRP can be reassuring when the person is clinically improving. A high or rising CRP without a clear reason should be interpreted with symptoms, examination, cultures, imaging, and other blood tests.

Normal liver tests are useful after previous spikes.

Example current liver results: bilirubin 16 umol/L, alkaline phosphatase 62 U/L, ALT 29 U/L, GGT 11 U/L, protein 74 g/L, albumin 44 g/L, globulin 30 g/L. These sit within the displayed reference ranges.

Earlier spikes in ALT or GGT can follow alcohol, fatty liver, viral illness, medicines, supplements, bile-duct problems, muscle injury, or lab timing. The useful response is to repeat, review causes, and investigate persistent or severe abnormalities.

Very high LDL can point to inherited risk.

LDL around 5 mmol/L or higher, especially when persistent or combined with early heart disease in relatives, can suggest familial hypercholesterolemia. Next steps may include repeat fasting lipids, ApoB, Lp(a), thyroid and diabetes checks, secondary-cause review, and sometimes genetic testing or cascade testing for relatives.

Abnormal does not mean unexplained.

Lipids can be affected by diet, alcohol, weight, diabetes, thyroid disease, kidney disease, liver disease, pregnancy, medicines, and genetics. PSA can be affected by infection, inflammation, ejaculation, cycling, procedures, prostate size, and cancer. The pattern is the point.

Some wins are quieter than cancer treatment.

A colon polyp found and removed at 45 may prevent a future cancer, especially when follow-up colonoscopies stay clear. Barrett's esophagus after years of severe GERD/GORD reflux is another example: fundoplication can control reflux for selected people, but Barrett's still needs surveillance even after symptoms improve. See refluxsurgery.com.