Prostate Health Checkup Program

The core basic items of routine prostate health examination are digital rectal examination, prostate specific antigen (PSA) testing, and urinary prostate ultrasound. If there is urinary discomfort, suspected inflammation or tumor lesions, advanced items such as urinary flow rate measurement, prostate fluid routine, and prostate biopsy can be added as needed.

Last week, I met a 38-year-old operation and maintenance man from an Internet company in the urology clinic. As soon as he came in, he clutched his cell phone and said that he had searched the symptoms and found that it was most likely prostate cancer, and he wanted to order the most expensive full-body examination. After asking for a long time, I found out that he had been busy with three projects in a row recently, sat for more than 12 hours a day, and had been urinating frequently for almost two weeks. He had no family history, painful urination, or hematuria. I directly prescribed him a routine urine test for 9 yuan and a urinary tract ultrasound for 120 yuan. The result showed that he had mild congestion caused by sitting for a long time. He just needed to adjust his schedule and drink more water. There was no need to waste money.

To be honest, digital rectal examination is a "social death item" for many men. When they hear that they have to take off their pants and the doctor reaches into the rectum to feel it, most people's first reaction is "Can I not do it?" ”. But don’t tell me, this project charges less than 30 yuan, and an experienced doctor can complete it in 30 seconds. He can directly feel the size, texture, and presence of induration of the prostate, as well as the degree of hyperplasia. It is the most cost-effective primary screening method. Of course, some scholars believe that if high-resolution ultrasound and PSA testing have been done, asymptomatic low-risk people can avoid digital examination to reduce discomfort. Currently, there is no unified requirement in the industry, and most hospitals will still use it as a routine primary screening item.

PSA, which can be done with just a tube of blood, is currently the core indicator for prostate cancer screening. There is still some disagreement in the industry about the screening age: The Domestic Urological Society recommends that men over 45 years old with a family history of prostate cancer should be screened once a year, and ordinary men should be screened every year after the age of 50. ； An article published by the UCLA research team in the United States last year also proposed that low-risk groups can postpone screening until the age of 55 to avoid excessive medical treatment. Another reminder, an elevated PSA does not mean it is cancer - recent cycling, prostatitis, or even just ejaculation may cause the indicator to temporarily rise. If an abnormality is detected, don't panic. Just recheck every 2 weeks and combine it with other tests to make a judgment.

Ultrasound is also a required option for primary screening, and is now divided into two types: transabdominal and transrectal. Generally, transabdominal screening is enough for primary screening. You can see it by holding down some urine. There is no discomfort. The disadvantage is that the small nodules inside the prostate are not well recognized. If the PSA is abnormal or a problem is detected during digital examination, the doctor will generally recommend a transrectal ultrasound. There is no need to hold in urine. The probe is only a few millimeters away from the prostate, and tiny nodules can be seen clearly. Although it feels a bit like a foreign body, most people can tolerate it.

If you already have obvious urinary frequency, urgency, incomplete urination, or dribbling, you will usually have a uroflowmetry test - that is, you urinate once into a special urine cup. The machine will automatically measure your urination speed and urine volume, and can intuitively determine whether there is urinary tract obstruction caused by prostate hyperplasia. The whole process is completely non-invasive, but you need to hold in your urine in advance until you have an obvious need to urinate. Only patients who are suspected of having bacterial prostatitis need to do a routine prostate fluid test. The doctor will take a little prostate fluid through rectal massage and test it to see if there is an increase in white blood cells. Many people will have some soreness and distension in the lower abdomen after the procedure, which will disappear in a day or two. Don’t worry too much.

As for the prostate biopsy, which many people have heard of, it is the gold standard for diagnosing prostate cancer. It is an invasive examination and is only needed when PSA continues to rise abnormally, suspicious nodules are found by ultrasound or magnetic resonance, or hard nodules are felt by digital examination. Regarding the indications for puncture, different doctors also have different judgment standards: some doctors think that puncture is needed only if the PSA exceeds 10ng/ml, and some will recommend puncture even if the imaging has seen clear suspicious nodules, even if the PSA is only 5ng/ml. The specific situation must be determined based on the individual situation, and there is no absolute right or wrong. Nowadays, punctures are performed under ultrasound guidance, which is very accurate. The probability of bleeding and infection is less than 1%, and there is no need to worry about the spread of tumors.

I have been a urological surgeon for almost 12 years, and I have seen too many patients who have gone to extremes: either a young man in his early twenties, who sat for two nights and had frequent urination, and had to undergo a full set of tests. In the end, it was found that nothing was wrong, but he frightened himself for half a month.； Or he is an old man in his seventies, who thinks that slow urination is a normal phenomenon of old age. If he does not have a check-up every ten years, he will be diagnosed with advanced prostate cancer and there is no chance of surgery. In fact, it is really unnecessary. There is no unified "package" for prostate examination. The doctor will prescribe it based on your age, symptoms, and family history. There is no need to be overly anxious about doing the examination, and don't put off the examination because you are embarrassed.

After all, this inconspicuous chestnut-sized gland controls two major functions: urination and reproduction. It is more prone to problems as you get older. Spending more than 100 per year on a basic screening is really more reliable than any health care product.