Prostate health check methods

The core first-line screening combination for prostate health examination currently has the highest consensus among the global urological community: "digital rectal examination + prostate specific antigen (PSA) test + urinary prostate ultrasound (including residual urine measurement)". The combination of these three types of examinations can cover more than 90% of the screening needs for common prostate diseases. In special circumstances, other items can be added as needed.

Everyone knows that digital rectal examination is a "social death scene" for many men. I often meet young men in their twenties and thirties in my clinic. When they hear that they are going to undergo a digital examination, they take half a step back and ask if they can change it to something less painful. There are actually different opinions in the academic community as to whether digital examination is a routine must. The American Urological Association's guidelines updated in the past few years mentioned that low-risk people under the age of 50 who have no urinary abnormalities and no family history of prostate cancer can communicate with the attending doctor to evaluate the necessity. After all, it is an invasive examination and the experience is indeed not good. It may also stimulate the prostate and cause a transient increase in PSA, which will interfere with subsequent test results. But if you are over 45 years old, have a family history, or have symptoms of thin urine flow or incontinence, don’t be pretentious. The examination can be completed in 30 seconds and can directly detect whether there is induration in the prostate and the degree of hyperplasia. I just saw a 48-year-old business executive last month. Abnormal induration was detected during a routine physical examination. It was further found to be very early-stage prostate cancer. After minimally invasive surgery, he has returned to work normally.

After talking about the digital diagnosis that everyone is most resistant to, let’s talk about PSA, which can be done with just a tube of blood. This indicator is quite interesting. Do you think it is accurate? Riding a bicycle for half an hour the day before, just having sex, or even having prostatitis recently can make it rise several times. There was a young man who had just graduated. His PSA was 3 times higher during the physical examination at work. He came to register crying and said that he had cancer. After questioning for a long time, he said that he had just cycled 30 kilometers around the island with his friends the day before. He took a rest for two weeks and then checked again. All the indicators were normal. Precisely because of the high false positive rate, many experts now do not recommend that people under the age of 40 without symptoms routinely check PSA, which can easily increase anxiety. However, for people with high-risk factors, this item must be checked every year. After all, it is one of the few non-invasive indicators that can early indicate the risk of prostate cancer.

Let’s talk about the ultrasound that everyone is most familiar with. Most of the routine physical examinations are transabdominal ultrasound, which can be done while holding back urine. Although it is convenient, the accuracy of detecting the prostate is limited. If the PSA is abnormal or there are problems with digital examination, doctors will generally recommend a transrectal prostate ultrasound. The probe is inserted into the rectum and placed against the prostate to see whether there is hyperplasia and nodules. Of course, the experience is similar to that of digital examination, and you don’t have to be too resistant. It will be done in a minute or two. Don’t forget to add a residual urine test, that is, do an ultrasound after urinating to see how much urine is left in the bladder. Many patients with benign prostatic hyperplasia feel that urination is smooth, but in fact the residual urine is already hundreds of milliliters. Holding it in for a long time will damage the bladder function and even reflux and damage the kidneys. I met a 60-year-old man before who usually got up two or three times at night. He thought it was normal for his age. When the residual urine was 150ml, he quickly took medicine and intervened to avoid the trouble of inserting a urinary catheter.

If there are abnormalities in the first three screening tests and the risk of prostate cancer is suspected, further multi-parameter magnetic resonance imaging of the prostate or even prostate biopsy is needed. Nowadays, some private medical examination institutions use magnetic resonance imaging as a routine prostate screening item, charging more than 1,000 per time. In fact, it is completely unnecessary. The consensus in the academic community is that only high-risk groups need to do it. Ordinary people can do the first three items for routine screening, and there is no need to spend this unnecessary money.

Finally, let me mention a few common pitfalls. The "prostate self-examination kit" that sells for hundreds of dollars online claims that prostate problems can be detected by checking urine or pressing a few acupuncture points. It is all IQ tax and has no clinical reference value; some people think that doing a urine routine You can just check the prostate. No, a urine routine can only check whether there is a urinary tract infection. If you want to check for prostatitis, you need to do a separate prostate fluid massage test. This is not a routine screening item. It only needs to be done when symptoms of prostatitis such as frequent urination, urgent urination, and perineal swelling occur.

I have been in the urology department for almost 10 years, and I have seen too many people who delayed their illness because they were too embarrassed to do examinations. I have also seen people who are overly anxious and take health supplements every day because of a small abnormality. I have a practical suggestion for everyone: people over 50 years old without high-risk factors should do the core three tests once a year. If there is prostate cancer If you have a family history, you should reach the age of 45 earlier. If you have symptoms of urinary discomfort or perineal swelling, go directly to the urology department of a regular hospital. Don't blindly search for the right one, and don't hide from the examination because you are shy. Most prostate problems are more effective if they are intervened early. If you wait until they become serious, you will still suffer.