Prostate Health Checkup Methods

Men over 50 years old with no underlying diseases undergo a "digital rectal examination + serum prostate-specific antigen (PSA) test" once a year. Men with a family history of prostate cancer have the starting age for screening advanced to 45 years old. The total cost of these two examinations is less than 150 yuan, which can cover more than 90% of the risk of early prostate lesions.

Last week, I met a 48-year-old Internet programmer at the outpatient clinic. After sitting there for a long time, he complained that he had been urinating frequently and his lower abdomen was bloated recently. After watching a short video, he found that the symptoms of prostate cancer were consistent. When he came up, he asked for the most expensive prostate MRI. He said that he would have a thorough examination. I did not directly bill him, but first asked him to do these two basic screenings. The results showed that the prostate was only slightly enlarged by digital examination, and the PSA value of 2.3ng/ml was completely within the normal range. In the end, he was diagnosed with chronic prostatitis caused by sitting for a long time. He was prescribed medicine worth hundreds of dollars and was told to stand more and sit less. He got better in two weeks and saved more than a thousand MRI fees.

Don’t underestimate these two inspections, which are so cheap that they can almost be ignored. First, let me talk about the digital rectal examination, which many people frown upon hearing about. It is really not as embarrassing and uncomfortable as everyone thinks. The doctor wears sterile gloves and applies lubricant. If the operation is fast, it can be completed in 10 seconds. You can directly feel the size and texture of the prostate, whether there are hard nodules, and whether there is tenderness. There are indeed different academic opinions on this examination: some European and American scholars believe that the sensitivity of digital examination for early-stage prostate cancer is only about 20%. Many cancerous locations are not palpable inside the prostate. Routine examination will increase patients' anxiety, and there is no need to include it in basic screening. ； However, the consensus among most tertiary urological surgeries in China still regards it as a necessary option. After all, there is no additional trauma, no need to wait for reports, and zero additional cost. Even if it can only detect 20% of early abnormalities, it is much better than missing a diagnosis.

If a digital examination is when the doctor "touches" the surface abnormalities with his hands, then the PSA test is about drawing a tube of blood to check the "healthy thermometer" of the prostate - an increase in the value only indicates a stress reaction in the prostate, not necessarily cancer. Don't get weak when you see abnormal results. I met a 28-year-old cyclist last month. His PSA test at work was 8ng/ml (the normal range is 0-4ng/ml). He came crying with the report and said that he must have cancer. After asking carefully, he found out that he had just ridden a 30-kilometer long-distance bicycle the day before the physical examination. The pressure and congestion of the prostate caused the indicator to rise. After two weeks of rest, the recheck dropped to 2.7ng/ml. Nothing happened. In addition to riding for a long time, having just had sex or having a recent prostatitis attack, PSA will temporarily rise. Just avoid these situations before checking. There is also controversy about PSA screening: some European and American medical institutions believe that PSA can easily lead to over-diagnosis. Many people go for punctures because of high indicators, but are ultimately found to be benign lesions. They even recommend that men over 70 years old and asymptomatic do not need routine PSA testing. ； However, the incidence situation in our country is different from that in Europe and the United States. The age of onset of prostate cancer is 5-10 years earlier than in Europe and the United States, and more than 40% of patients are already in the late stage when diagnosed. Therefore, current domestic guidelines still recommend that men under the age of 75 include PSA in their annual physical examination.

If something really goes wrong with these two basic screenings, for example, if a hard nodule is felt during the finger examination, or if the PSA is higher than the normal range in two consecutive rechecks, it is not too late to go for further examination. The first choice is transrectal prostate ultrasound. If financial conditions permit, you can also do multi-parameter prostate MRI. Both of these can clearly see the internal structure of the prostate and whether there are any suspicious lesions. To be honest, the sensitivity of MRI is indeed high, but the price is hundreds or even thousands, so there is no need to use it as a routine physical examination. Ordinary people have no symptoms and basic screening is fine, but they still have to do it. It is a waste of medical resources.

If imaging examinations also reveal suspicious lesions, prostate biopsy is required, which is the gold standard for diagnosing prostate cancer. Don’t be frightened and wave your hands when you hear about puncture. Nowadays, transperineal puncture is commonly used. After local anesthesia, the pain is much less than the transrectal puncture in the early years, and the postoperative recovery is also faster. There is no absolutely unified standard for indications for puncture: some doctors think that puncture is necessary only when the PSA exceeds 10ng/ml, while others think that if PSA is in the gray area of ​​4-10ng/ml, puncture should be performed as long as there are suspicious signals on MRI. The specific judgment must be combined with age, family history, and imaging results, and just listen to the attending doctor.

Finally, I would like to mention a few common pitfalls. Don’t believe the “in vitro non-invasive prostate scan” and “early detection of prostate cancer with a drop of urine” promoted by private institutions. They are all IQ taxes. A patient previously spent more than 3,000 yuan to undergo a so-called "precision prostate screening" at a physical examination institution. The final report he received did not even have a PSA value. It just wrote "mild abnormality of the prostate", which has no clinical reference value at all. Don’t think that you don’t take it seriously just because you are young. The youngest prostate cancer patient I met last year was only 42 years old. He had a family history but had never been screened. When he came, he had bone metastases. It was a pity.

In fact, prostate examination is really not as complicated as everyone thinks, and it is not that difficult to ask. Don't put off the examination because you are shy, and don't scare yourself into having random examinations because you have frequent urination. Spending more than 100 per year on a digital examination and blood draw is more reliable than anything else.