How to Diagnose Prostate Cancer

Prostate cancer can be diagnosed comprehensively through digital rectal examination, prostate-specific antigen testing, imaging examinations, needle biopsy, and pathological examinations.

1. Digital rectal examination

The digital rectal examination is a common method for initial screening for prostate cancer. Doctors use gloved fingers to feel the prostate through the rectum to determine whether there are hard, asymmetrical nodules or abnormal bulges. This examination is simple and non-invasive, but it may miss the diagnosis of tumors that are small in size or in hidden locations, and need to be combined with other examination methods.

2. PSA test

The prostate-specific antigen test measures PSA levels in the blood through a blood draw. Abnormally elevated PSA values ​​may indicate prostate cancer, but prostatitis or benign hyperplasia can also cause PSA to rise. It is generally believed that if PSA exceeds 4ng/ml, further examination is required. Dynamic monitoring of the PSA change rate is more valuable as a reference.

3. Imaging examination

Transrectal ultrasound can clearly display the prostate structure and guide puncture, and multi-parameter magnetic resonance imaging can more accurately identify suspicious lesion areas. A CT or bone scan is used to evaluate for the presence of pelvic lymph node metastasis or bone metastasis, and these tests are critical for cancer staging and treatment planning.

4. Puncture biopsy

Under ultrasound or MRI guidance, prostate tissue samples are obtained through rectal or perineal puncture. Systematic 12-needle puncture is a standard operation, and targeted puncture can be added for suspected lesions found on imaging. Hematuria or transient fever may occur after biopsy, and most patients resolve spontaneously.

5. Pathological examination

After the puncture specimens are processed by the pathology department, the cell morphology and tissue structure are observed through a microscope. The Gleason scoring system is divided into grades 1-5 according to the degree of differentiation of cancer cells. The two main grades are added together to obtain a total score of 2-10. The higher the score, the higher the degree of malignancy. It also needs to be tested to see if the tumor has invaded nerves or blood vessels.

After prostate cancer is diagnosed, active surveillance, radical surgery, or radiotherapy should be selected according to the stage. It is recommended that men over the age of 50 undergo PSA screening every year, and those with a family history should be screened as early as 45 years old. Maintaining a low-fat diet and moderate exercise can help reduce the risk of the disease. Patients diagnosed with the disease need to strictly follow the doctor's instructions and regularly review PSA and imaging. If bone pain or difficulty urinating worsens, you should seek medical attention promptly to evaluate the progress of the condition.