Prostate Health Checkup Methods

Asymptomatic ordinary people after the age of 50 should undergo a digital rectal examination + prostate-specific antigen (PSA) test once a year for preliminary screening. Symptomatic or high-risk groups (with a family history of prostate cancer and a history of chronic prostatitis) should additionally undergo urinary tract ultrasound, routine prostate fluid, MRI or even needle biopsy as needed. There is no need to blindly undergo a full set of examinations, nor should you miss key screenings for fear of embarrassment.

Last week, I met a young man who works on the Internet at the outpatient clinic. He had frequent urination and distended lower abdomen for 3 months. He did some research on the Internet and asked for a full set of prostate MRI and puncture when he came in. He said he was afraid that he had prostate cancer. When I asked, I was only 32 years old. I had just had a PSA check-up at work in 23 years and it was completely normal. There was no family history. There was no need to do those expensive advanced tests. I was prescribed a routine prostate fluid test and abdominal ultrasound. In the end, it was ordinary aseptic prostatitis. I adjusted my work schedule and took some symptomatic drugs, and the symptoms were almost gone in less than a month.

Don’t underestimate the doctor’s gloved index finger. Digital rectal examination is the lowest cost among all prostate examinations and is most likely to be rejected by patients. Many people shake their heads like a rattle when they hear that they have to insert the anus for examination, saying it is too embarrassing and would rather not do it. In fact, the entire process of digital examination by a skilled urologist only takes about 10 seconds. At most, there will be a slight soreness, but no pain at all. Through digital examination, you can directly feel the size, texture, hardness, and tenderness of the prostate. Many early-stage prostate cancers are discovered only after abnormalities are detected through digital examination. Even if the PSA is normal, it cannot replace it. Oh, by the way, if you happen to have an anal fissure or an acute attack of hemorrhoids, tell your doctor in advance that you can choose other primary screening methods, so there is no need to force yourself.

Let’s talk about the PSA that you often see in physical examination reports, which is prostate-specific antigen. It should be mentioned here that the academic community has actually been controversial about the scope of application of this indicator: European and American guidelines generally use 4ng/ml as the critical value, and many domestic studies recommend 6ng/ml as the critical value for the Chinese population to avoid over-screening. ； There is also a group of scholars who believe that there is no need for routine PSA testing for asymptomatic people under the age of 40. After all, the incidence of prostate cancer in this age group is less than 0.1%. A slightly higher detection will only increase anxiety. The other group believes that prostate cancer is getting younger and younger, and early screening can identify high-risk groups in advance. Both sides have large sample data to support it. Currently, clinical practice generally recommends that people with a family history of prostate cancer advance the initial screening age to 45 years old, while the general population should start testing at the age of 50. In addition, I would like to remind you of a little detail that I have encountered many pitfalls. Do not have sex, ride a bicycle, or undergo a digital rectal examination 24 hours before the PSA test. These behaviors will temporarily increase the PSA. Last month, I met a 47-year-old brother who had just had sex the night before the physical examination. The PSA was found to be 6.7. I was so scared that I couldn't sleep. I avoided these taboos for a week before coming for a review, and the next check dropped to 2.8. It was just a false alarm.

As for ultrasound, conventional abdominal ultrasound is done by applying some coupling agent on the lower abdomen, which is convenient and painless, but the details inside the prostate are not as clear as transrectal ultrasound. This is also a point that has been debated clinically for several years: some doctors believe that as long as patients have abnormal urination, they should directly undergo transrectal ultrasound. It can be seen accurately and can directly see whether there are calcifications, nodules, and whether there is much residual urine. ； Another school of thought believes that it is enough to do an abdominal ultrasound for primary screening. After all, transrectal ultrasound has to go into the anus, and many patients have low acceptance. If there are problems found in the abdominal ultrasound, it is not too late to do an advanced one. I usually ask the patient's wishes first. If it is really objectionable, it is perfectly fine to do a preliminary abdominal ultrasound screening first. There is no need to force others to do it.

Oh, by the way, many people come to ask if they have serious prostate disease when they see "prostate calcification" on the B-ultrasound report. In fact, calcification is mostly scars left after prostatitis has healed before. If there are no symptoms, there is no need for special treatment. Regular review is enough. Don't be fooled by some irregular institutions into doing interventional treatment, which is a waste of money.

If a problem is really discovered in the initial screening, such as PSA exceeding 10ng/ml, or hard nodules are felt by digital examination, or suspicious hypoechoic nodules are seen on ultrasound, then you need to consider prostate MRI or even prostate biopsy. Many people are afraid of puncture as soon as they hear it. They think it will require many needles and it will be extremely painful. Nowadays, puncture is done under ultrasound guidance, with local anesthesia, and the whole process only takes about 20 minutes. As long as you pay attention to avoid infection after the operation, there is basically no major discomfort. Moreover, this is the gold standard for diagnosing prostate cancer, so don’t resist when it is really necessary.

I have been practicing urology for almost 12 years, and I have met too many patients who are frightened. They either ask for a full set of examinations when they have no symptoms at all, or they have difficulty urinating for half a year and still refuse to come for examinations out of fear of embarrassment. In fact, prostate examination is really not as complicated as everyone thinks, and there is nothing to be embarrassed about. We do dozens of digital examinations a day, and there will be no other ideas at all. If you really have symptoms such as frequent urination, urgency, lower abdominal distension, and difficulty in urination, or you have reached the age for screening, go directly to the urology department of a regular hospital. The doctor will choose the most appropriate examination items based on your situation. You can blindly check the data to compare, but it is easy to magnify small problems and scare yourself.