Prostate Health Screening

For men over 50 years old with no family history of prostate cancer, a PSA (prostate specific antigen) blood draw + digital rectal examination once a year is enough； If an immediate relative (father, brother) has had prostate cancer, the screening age should be advanced to 45 years old ； Not everyone needs to undergo prostate MRI or biopsy, and there is no need to assume that they have cancer as soon as they see an increase in PSA.

Last week, I met a 48-year-old brother in the clinic. His father was diagnosed with prostate cancer when he was 60 years old. He read several alarmist popular science articles. The physical examination showed that PSA was 4.2ng/ml. He had been suffering from insomnia for half a month and could not eat. The first thing he said when he came in was "Doctor, please give me a puncture quickly, I must have cancer." As a result, he was given a digital examination and the prostate was very smooth. The free PSA ratio was also checked, which was 0.25, which is much higher than the safety threshold of 0.16. He just asked him to have a reexamination in six months. The eldest brother slapped his thigh on the spot and said, "If I had known better, I wouldn't have thought about it. I have suffered in the past half month."

In fact, there have been two different views in the academic circles regarding the scale of prostate screening. Preventive medicine organizations in Europe and the United States, such as the USPSTF, proposed a few years ago that men over 70 years old and with a life expectancy of less than 10 years do not need routine screening. The reason is that most prostate cancers are indolent and develop extremely slowly. Many men do not know they have the disease until they die. Screening out the disease will easily lead to over-treatment, surgery and radiotherapy, which will affect the quality of life. To put it bluntly, "If you have to dig out a small mole that is not causing trouble, it will leave a big scar." However, most experts in the domestic urology field are more inclined to relax the age limit. After all, the early diagnosis rate of prostate cancer in our country is too low. Almost 60% of patients are already in the middle and late stages when diagnosed, missing the best opportunity for treatment. As long as there are no serious underlying diseases in the body and men over 70 are expected to live for more than 10 years, it is still recommended to check once a year. There is no harm.

Talking about the examination itself, I also know that many people are resistant to digital rectal examination. After all, you have to take off your pants and lie on your side, and the doctor puts his fingers in to touch it. It is really embarrassing. Every time I ask for a digital examination in the outpatient clinic, eight out of ten people's first reaction is to shrink back. Some people directly ask, "Doctor, can I spend more money to do an MRI? Don't do this to me." I really can’t do it. This test only costs a few dozen dollars. A skilled doctor can complete it in 10 seconds. You can directly feel the texture of the prostate and whether there is any induration. In the past few years, I have encountered at least 3 patients whose PSA was completely normal, but abnormality was detected during the digital examination. In the end, early-stage prostate cancer was found. If they skip this step, the diagnosis may be missed.

Let’s talk about the elevated PSA that everyone is most likely to panic about. It’s really either a high or a cancer. You stayed up late the day before the test, drank half a pound of liquor, rode a shared bicycle for half an hour, or even just had sex, which may lead to a transient increase in PSA. There was a 32-year-old young man who rode a shared bicycle 20 kilometers over the weekend for a physical examination. His PSA was found to be 8ng/ml. When he came with the report, his eyes were red and he said that he had cancer before he was married. I asked him to go back and rest for a whole week without doing any strenuous exercise. Then I checked again and found that the PSA dropped directly to 1.8, nothing happened. If the total PSA is really found to be in the "gray area" of 4-10ng/ml, don't rush to do a puncture. First look at the ratio of free PSA to total PSA. It's basically fine if it's greater than 0.16. If it's less than this value, consider a non-invasive prostate MRI. If there's an abnormality, go to the puncture step. There's no need to suffer the consequences of an invasive examination.

There are also many young men in their twenties and thirties who come to ask if they should do routine prostate screening. It is really unnecessary. The probability of prostate cancer under the age of 30 is lower than that of winning the 5 million lottery. If you have symptoms of frequent urination, urgency, and uncomfortable urination, just check for prostatitis first. Don’t waste money on screening.

In fact, to put it bluntly, prostate screening should not be taken too seriously, nor should you be led astray by anxious marketing on the Internet. Just choose the appropriate program based on your age, family history, and physical condition. If you are really unsure, it is much more effective to take a look at the urology department of a regular hospital than to spend a night watching short videos and wondering.