Prostate Health Checkup Program

The core basic items of routine prostate health examination are digital rectal examination (DRE), prostate-specific antigen (PSA) testing, and urinary prostate ultrasound. If there are abnormalities or clear symptoms of discomfort, additional items such as prostate fluid routine, urinary flow rate, pelvic MRI, and even needle biopsy can be added as needed. There is no need to blindly pursue a full set of high-end examinations.

Xiao Zhang, a 38-year-old Internet practitioner who received a consultation last week, had frequent urination for half a month and swollen perineum after sitting for a long time. After registration, he asked for a full set of prostate examinations. He even wanted to arrange a PET-CT. In fact, it is completely unnecessary. For most ordinary people's physical examinations, completing the first three basic items is enough to cover more than 90% of the screening needs for common prostate problems.

Let me first talk about digital rectal examination, which is frowned upon by many people. Many people find it embarrassing and uncomfortable, and would rather spend several times more money for an examination than do this. I can understand it. If it is done quickly in clinical practice, it can be completed in 10 seconds. The doctor can directly feel the size and texture of the prostate, whether there is any hardness, and whether there is any pain when pressing through the digital examination. The primary screening effect for prostatitis, prostatic hyperplasia and even early prostate cancer cannot be replaced by other examinations. I met a 47-year-old man before. His PSA test every year was within the normal range. Last year, during his physical examination, he felt a hard nodule on his right side. He underwent further puncture and was diagnosed with early-stage prostate cancer. He underwent radical surgery and has now returned to normal life. Of course, there is also controversy in the industry about the routine screening of this project. One group of people believes that men under 40 years old who have no obvious urinary discomfort and no family history of prostate cancer do not need to undergo routine screening. After all, the probability of cancer in young people is extremely low, and digital massage may actually aggravate the symptoms of ongoing prostatitis. ； The other group believes that early screening is no small matter, even if the probability is only one in ten thousand, it will be more reassuring after checking, and everyone can choose based on their own acceptance and actual situation. To be honest, I skip digital examination during my annual physical examination. It’s not useless, but it’s really a bit social. However, if you have symptoms of frequent urination and perineal swelling, you still have to do it.

The PSA test, which can be done by drawing a tube of venous blood, is currently recognized as the most sensitive indicator for early screening of prostate cancer. It does not require fasting and is very convenient to draw at any time. However, I would like to remind you that before checking this, it is best not to have sex for 3 days in advance, do not ride a bicycle for a long time, and do not hold urine for too long, otherwise the value will easily rise falsely and cause an own error. Last month, a 27-year-old man's work unit physical examination showed a total PSA of 6.3ng/ml. He was so scared that he went to the emergency room all night. After asking, he found out that he had just lived with his girlfriend the night before the physical examination. He was asked to go back and rest for 10 days before reexamining. The value dropped directly to 0.9ng/ml, which was a false alarm. There are currently differences in the guidelines for PSA screening in different regions. The American Urological Association recommends routine screening after the age of 55. The incidence of prostate cancer among young people in our country has increased in recent years. Therefore, the Chinese Urology Guidelines recommend that men over 45 years old with a family history of prostate cancer can be screened once a year. You can refer to it.

There are also two types of urological ultrasound that everyone is most familiar with, which are divided into transabdominal and transrectal. For routine physical examination, the transabdominal one will suffice. You can do it by holding back some urine. You can clearly see the size of the prostate, whether there are cysts, whether there are calcifications, and whether there are space-occupying lesions. Many physical examination reports will see the diagnosis of "prostate calcifications." Don't panic. These are equivalent to "small scars" on the prostate. Most of them are caused by calcium salt deposition after prostatitis has been suffered before. If there are no uncomfortable symptoms, there is no need to treat it. If there are abnormalities in PSA or digital examination, doctors will generally recommend a transrectal prostate ultrasound, which is more than three times more clear than transabdominal ultrasound and can see millimeter-level nodules. However, it is a bit embarrassing just like digital examination, and the acceptance rate is not high.

If abnormalities are found in these three basic items, or if you already have obvious symptoms such as frequent urination and urgency, difficulty urinating, perineal pain, and hematuria, you need to add other items as needed. For example, if you suspect prostatitis, you can do a routine prostate fluid test to see if there is an increase in white blood cells. ； If you have difficulty urinating, you can do a urinary flow rate test to see if the urethra is blocked by an enlarged prostate. ； If the PSA is high and there are suspicious nodules on digital examination or ultrasound, a multi-parameter MRI of the prostate or even a needle biopsy may be needed to clarify the nature. There was a 52-year-old uncle who had a total PSA of 12ng/ml. No abnormalities were found during digital examination, and no clear nodules were seen on ultrasound. At that time, the opinions of the doctors in our department were divided into two groups. One group recommended direct puncture. After all, a PSA higher than 10 is an indication for puncture. The sooner it is confirmed, the sooner it is reassured. ； The other group suggested doing an MRI first and using the PI-RADS score to assess the risk. If the score was low, follow up first to avoid a puncture in vain. Finally, after discussing with the family, the uncle chose to do an MRI first, and the score was 2, which was considered low risk. After that, the PSA was reviewed every 3 months. Now the value has been stable between 2-3 for two years, without any puncture, and his life has not been affected at all.

To be honest, many men are overly anxious about prostate examinations. They think they are going to get cancer when they urinate frequently, so they need the most expensive examination.； Either he didn't take it seriously at all, and he never had a PSA test when he was over 60 years old. He waited until he couldn't urinate before coming to the hospital. The test revealed that he had advanced prostate cancer, which is really a pity. In fact, the three basic items add up to less than 200 yuan. If you are over 40 years old, you can check it once a year. It doesn’t take much time to nip most prostate problems in the early stages. Why not?