Screening and early diagnosis of prostate cancer

The incidence of prostate cancer in my country is increasing year by year. The symptoms of early and middle stage prostate cancer are similar to those of prostate hyperplasia, which are non-specific. When they are discovered, they are usually in the late stage, and the best time for treatment has been lost. Therefore, early diagnosis and treatment are particularly important. The most recognized early clinical diagnosis model for prostate cancer is the "three-step method":

①Prostate-specific antigen (PSA) and digital rectal examination (DRE).

② Depending on the specific situation, choose imaging examinations such as transrectal prostate ultrasound (TRUS) and magnetic resonance imaging (MRI) to complete the localization diagnosis of suspicious lesions.

③ Obtain pathological diagnosis through systematic prostate biopsy guided by transrectal ultrasound.

1. PSA test

1. Prostate-specific antigen (PSA), as a single detection indicator, has a higher positive diagnostic prediction rate for prostate cancer compared with DRE and TRUS. The normal value is 0-4.0ng/ml. The higher the PSA, the greater the possibility of prostate cancer. Data show that the PSA levels of men of different ages in my country are ≤2.15ng/ml for 40-49 years old, ≤3.20ng/ml for 50-59 years old, ≤4.1ng/ml for 60-69 years old, and ≤5.37ng/ml for 70-79 years old, all lower than those of men in Western countries.

⑴PSA test indications:

① Men over 50 years old with lower urinary tract symptoms need PSA testing;

② For men with a family history of prostate cancer, PSA testing should be advanced to 45 years old;

③Men with abnormal DRE or imaging examinations should also undergo PSA testing.

⑵PSA examination frequency:

① For those aged 45-49 years, with normal DRE and PSA>1ng/ml, PSA should be checked again every 1-2 years;

②For those with normal DRE and PSA ≤ 1ng/ml, re-examination at age 50;

③ If DRE is normal and PSA is normal in patients over 50 years old

⑶PSA is affected by many factors: Factors that affect blood PSA levels include mechanical compression of the prostate (such as DRE, urinary retention, cystoscopy, etc.) and urinary tract infection, hematuria and other factors. Therefore, PSA should be checked 24 hours after ejaculation, 48 hours after cystoscopy and catheterization, and 7 days after prostate digital examination. It is recommended to perform a routine urine test at the same time as PSA examination to rule out the influence of hematuria and/or inflammation.

2. Digital rectal examination (DRE) of the prostate is simple, easy and painless, and is an important means of early diagnosis of prostate cancer. The prostate of patients with prostate cancer is hard or as hard as a rock, and nodules and other changes can be felt.

3. Ultrasound: The typical sign of low-echoic nodules in the peripheral zone of prostate cancer is not common, and the diagnostic specificity is low. The value of MRI in the diagnosis of prostate cancer has been increasingly recognized in recent years, and it is also the best imaging examination for prostate cancer staging.) Localization diagnosis of prostate cancer Clinical diagnosis is required before treatment of prostate cancer. Systematic prostate puncture biopsy is the most reliable examination for diagnosing prostate cancer.

The following 4 situations require systematic prostate biopsy

1. Prostate nodules found during rectal examination, any PSA.

2. Abnormal images found by ultrasound, CT or MRI, any PSA.

3. PSA>10ng/ml.

4. PSA 4-10 ng/ml, f/tPSA 0.15, or PSAV>0.75

Transperineal or transrectal puncture biopsy under the guidance of rectal ultrasound is the standard puncture examination method. Our department has a dedicated rectal ultrasound instrument. I have performed hundreds of prostate puncture biopsies proficiently. The accuracy of puncture biopsy has been significantly improved, and the incidence of biopsy complications such as fever and hematuria is extremely low.