What are the items in prostate health examination?

At present, the core items of routine clinical health screening for the prostate are digital rectal examination, prostate-specific antigen (PSA) blood test, and prostate ultrasound. When abnormal indications appear, targeted examinations such as prostate magnetic resonance imaging, prostate biopsy, and routine prostate fluid will be added.

Last week, I accompanied my 46-year-old Zhou Zhou for a screening. He has been up at night two or three times in the past six months, and occasionally has urine bifurcation. He was afraid that there was a problem with the prostate. As soon as he arrived at the clinic, he asked if he wanted to do the most expensive test. The doctor smiled and said that he would do the basics first. The first thing he did was a digital rectal examination. Zhou Zhou was still squirming at the beginning, saying it hurt when he heard it. The doctor said just relax and wear it. It takes about 1 minute to insert a lubricated latex glove into the anus and touch it. Lao Zhou later said that he felt a little bloating but no pain at all. This examination can directly touch the size and texture of the prostate and whether there are hard nodules. At a cost of tens of dollars, it can screen out most obvious hyperplasia and suspicious tumor nodules. It can be done in grassroots hospitals and is extremely cost-effective.

However, digital examination could only touch the side of the prostate close to the rectum, and deep lesions could not be touched, so the doctor then prescribed a PSA blood test, and drew 2 ml of venous blood. The results would be available in the afternoon. By the way, there is still some controversy over the frequency of PSA screening in the academic community: some European and American guidelines now recommend that people over 55 years old and with family history should be screened every year. Those without high-risk factors can be screened every 2-3 years to avoid unnecessary anxiety and subsequent invasive examinations caused by false positive results. ； Domestic clinical consensus still recommends that men over 50 years old should undergo routine screening every year, and those with a family history of prostate cancer can be screened as early as 45 years old. Lao Zhou's result came out to be 3.8ng/ml, which is just stuck at the critical value (generally normal is below 4ng/ml, 4-10ng/ml is a gray area, and if it exceeds 10, you should be highly alert to the possibility of malignancy), so the doctor suggested a transrectal prostate ultrasound.

Different from the usual abdominal urination ultrasound, the transrectal ultrasound probe is closer to the prostate and can be seen more clearly. The specific volume of the prostate, whether there are calcifications, cysts, and suspicious hypoechoic nodules can be clearly seen. Lao Zhou’s ultrasound results The results showed that the prostate volume was slightly larger than normal, with a small calcification of 0.3cm, and no suspicious nodules. The doctor said that there was no big problem. He should stay less sedentary and drink less alcohol. A PSA recheck every six months would be enough. There was no need to do more expensive tests.

If there are abnormalities in these three basic examinations, such as PSA continues to rise, hard nodules are detected on digital examination, or suspicious lesions are seen on ultrasound, the next step is usually to do a multi-parameter magnetic resonance imaging of the prostate. This examination can score the malignancy of the suspicious lesions and is much more accurate than ultrasound. If the magnetic resonance also indicates the possibility of malignancy, a prostate scan is needed. Puncture biopsy is the gold standard for diagnosing prostate cancer. Last year, my distant cousin’s PSA was found to be 11.7ng/ml. A hard nodule was felt on the right side during digital examination. The MRI score was 4 points. The final puncture showed that it was early-stage prostate cancer. It has been almost a year since radical surgery. The reexamination indicators are all normal and it does not affect life at all.

Oh, by the way, if you are a young man around 30 years old who has no abnormal urination and is just doing a routine physical examination, usually a prostate ultrasound of the abdomen to hold back urine will be enough. If you have long-term symptoms of frequent urination, urgent urination, and perineal swelling, and if you suspect prostatitis, the doctor will also do a routine examination of prostate fluid. Massage the prostate and take a little secretion test to determine whether there is a bacterial infection. Symptomatic medication is enough. You don’t have to go to the hospital to do expensive examinations, which is a waste of money.