Do you know how to diagnose prostate cancer?

When PSA screening finds abnormalities, we need further examination measures:

1. Rectal examination:

Digital rectal examination of the prostate is an effective method for diagnosing prostate cancer. Prostate cancer often occurs in the posterior lobe of the prostate and the edges of the two lobes. The lesions are hard, so the rectal finger position can touch the nodules. Digital examination shows enlarged glands, hard nodules, uneven heights, and disappearance of the central groove.

2. Transrectal ultrasound examination:

The typical sign of prostate cancer is low-echo nodules in the peripheral zone, and ultrasound can be used to preliminarily determine the size of the tumor (the prostate volume is the product of the three diameters of the prostate divided by 2, and the tumor volume is the product of the three diameters of the tumor divided by 2).

However, finding a hypoechoic lesion in the prostate does not necessarily mean prostate cancer. It may also be a normal prostate, a hyperplastic nodule caused by benign prostatic hyperplasia, PIN (prostatic intraepithelial neoplasia), acute or chronic prostatitis, prostate infarction, etc. In addition, sometimes prostate tumors appear as isoechoic and cannot be found on ultrasound.

Prostate puncture biopsy: Prostate puncture biopsy is the most reliable test for diagnosing prostate cancer. Therefore, systematic prostate puncture under the guidance of transrectal B-ultrasound is recommended.

3. Other imaging examinations for prostate cancer

(1) Computed tomography (CT) examination: The purpose of CT examination for prostate cancer patients is mainly to assist clinical physicians in clinical staging of tumors.

(2) Magnetic resonance imaging (MRI/MRS) scan: MRI examination can show whether the prostate capsule is intact and whether it has invaded the tissues and organs around the prostate. MRI can also show the invasion of pelvic lymph nodes and bone metastasis lesions. Therefore, the most important role of MRI is also reflected in the staging of tumors.

(3) Whole-body radionuclide bone scintigraphy (ECT): The most common distant metastasis site of prostate cancer is the bone. ECT can detect bone metastases 3 to 6 months earlier than conventional X-rays. Once the diagnosis of prostate cancer is established, whole-body radionuclide bone scintigraphy is recommended (especially in cases with PSA>20ng/ml and Gleason score>7, which helps determine the accurate clinical stage of prostate cancer.

To summarize the above content, PSA, rectal digital examination, and transrectal ultrasound can indicate prostate cancer, but to confirm prostate cancer, a prostate puncture biopsy must be performed. CT and MRI are mainly used to determine whether the prostate capsule is intact and whether there is pelvic lymph node enlargement. Whole-body bone scan is used to determine whether there is bone metastasis. These three examinations are mainly used to guide staging after prostate cancer is confirmed.