What are the items in prostate health examination?

For daily prostate health screening, the core basic items are digital rectal examination, prostate-specific antigen (PSA) blood test, and prostate ultrasound. Only when abnormal and suspicious abnormalities are found in these three items, additional advanced examinations such as prostate magnetic resonance imaging and needle biopsy are needed.

Last week, I saw a 42-year-old Internet programmer who skipped prostate-related physical examinations every year. Recently, he had been up three or four times at night for half a month. He still felt that his urine was not clean when urinating, so he came to see a doctor. When he came to see him, he asked if he could just do a blood test to check his PSA. He felt that digital examination and transrectal ultrasound were too embarrassing. I can just take advantage of this situation to say a few words. There are indeed different opinions in the academic community on whether low-risk groups should routinely undergo digital rectal examination. Some scholars believe that for men under 40 years old, with no urinary discomfort, and no family history of prostate cancer, a PSA + transabdominal ultrasound is enough. The invasive nature of digital examination will dampen everyone’s enthusiasm for screening. Others believe that digital examination can detect nearly 30% of early-stage prostate cancer patients with normal PSA values. As long as it is acceptable, it is recommended. Just like the 52-year-old Uncle Zhang who came for a review last month. His PSA during last year's physical examination was only 4.3ng/ml, which was just at the critical value. He thought he was fine at first, but the physical examination doctor insisted on doing a digital examination and felt a hard nodule on the left side of the prostate. He further performed MRI and puncture and was diagnosed with very early-stage prostate cancer. After minimally invasive surgery, all indicators are now normal and there are no sequelae. If he had missed the digital examination at that time, metastasis might have occurred in a year and a half.

Let’s talk about the PSA test that everyone is most familiar with. Don’t scare yourself when you see an increase in the value. Last week, there was a 28-year-old young man who had just slept with his girlfriend the day before. The next day, the PSA test at the work unit soared to 8ng/ml. He took the report and asked sadly if he had cancer. I asked him to go back and take a rest. Rest for two weeks, don't ride a bicycle, and don't sit for a long time. When you check again, it will return to the normal level of 1.2ng/ml. Therefore, before checking PSA, you should pay attention to not having sex within 24 hours, not riding a bicycle, and it is best not to do a digital rectal examination first. Otherwise, squeezing the prostate will cause the value to falsely increase, which will be in vain.

There are two types of prostate ultrasound: transabdominal and transrectal. For routine physical examination, just choose transabdominal ultrasound. After holding back urine, scan across the abdomen, and there will be no discomfort. If you already have obvious frequent urination, urgency, urinary obstruction, or there are abnormalities in PSA and digital examination, it is recommended to do transrectal ultrasound. The probe is inserted into the anus to be closer to the prostate, so you can see it more clearly. Many small calcifications and nodules will not be leaked.

If abnormalities are indeed detected in the basic three items, such as PSA that continues to be higher than normal, hard nodules detected by digital examination, and abnormal echoes seen on ultrasound, then a multi-parameter magnetic resonance imaging of the prostate will be recommended. This examination has a much higher resolution than ultrasound and can initially determine the benign and malignant tendencies of the nodules. If the magnetic resonance also indicates a high risk, prostate biopsy will be the last step. This is the gold standard for diagnosing prostate cancer and is an invasive examination. It is generally not performed at the beginning unless necessary.

Speaking of this, some people may ask, I don’t feel any discomfort at ordinary times, so do I need to do these tests? In fact, it is enough for men over 50 years old to do three basic tests every year. Those with a family history of prostate cancer can start screening as early as 40 years old. There is no need to choose expensive examinations, and don’t miss necessary items because you are shy. Whether it is hyperplasia or cancer, prostate problems generally have no specific symptoms in the early stage. Waiting for blood in the urine or complete inability to urinate before checking again, it is often delayed.