The common prostate physical examination items are explained At present, the popularity of physical examinations is increasing, and because the physical examination items often include prostate examinations, many patients have prostate abnormalities detected. The following is a special explanation of prostate physical examination issues, mainly including the most common prostate finger examination, prostate ultrasound, prostate-specific antigen (PSA), hoping that readers will understand what these tests are, what value they have for diagnosis, and how to deal with any problems. The prostate gland can be divided into a central zone, a peripheral zone and a migratory zone. The most common area for prostatitis and prostate cancer is the peripheral zone; the migratory zone is the easy site for prostate hyperplasia; and the central zone is generally free from prostate cancer and prostate hyperplasia. before the 1960s, it was customary to divide the prostate into five lobes, namely the anterior, middle, posterior and two lateral lobes. the middle and lateral lobes are the good sites for benign prostate hyperplasia, but when the middle lobe is hyperplastic, the gland protrudes into the bladder. The size of the prostate gland palpated on rectal examination is not necessarily the actual size of the prostate gland, so rectal examination is flawed in patients with predominantly middle lobe hyperplasia. In addition, the descriptions of prostate enlargement are Ⅰ degree enlargement (2 times greater than normal), Ⅱ degree enlargement (2 to 3 times greater than normal), Ⅲ degree enlargement (3 to 4 times greater than normal), and Ⅳ degree enlargement (4 times greater than normal). A prostate finger test is the easiest and most necessary method to check for prostate enlargement. Generally, the doctor will note the anatomical boundaries of the prostate, its size, hardness and the presence of hard nodes. When there is prostate enlargement, it has a hard texture, a smooth surface, and a shallow or absent central groove. However, it is difficult to accurately describe the multiplicity of prostate enlargement on prostate finger examination, and it varies from individual to individual. The normal volume of the prostate varies in size, so prostate finger examination is not accurate in grading enlargement. Since prostate cancer mainly originates in the peripheral zone or posterior lobe of the prostate, prostate finger examination can theoretically detect prostate cancer earlier, usually with palpable nodular changes and a shallow or absent central sulcus. If the hardness of the prostate is increased, the surface is uneven, and there are suspicious hard nodes, further examination should be recommended to rule out prostate cancer, etc. ＞If you’re not sure if you’re a good candidate, you should have a prostate exam once a year. The actual prostate gland is a very good place for you to get a good deal of time and money. Some people have psychological and physical difficulties accepting prostate finger examination, so it is important to fully respect the patient’s wishes clinically, while operating gently and avoiding violent injuries. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. The most important thing is that you can find out if there are any abnormalities in the prostate gland, such as stones and cysts. Transrectal ultrasound: Transrectal ultrasound examines the size, shape and internal structure of the prostate more carefully than transabdominal ultrasound and can calculate the exact volume and weight of the prostate after laminotomy. It is also possible to obtain biopsy specimens through B ultrasound guidance and targeted puncture to obtain pathological diagnostic information. Transurethral ultrasound: The operation is complicated and for larger prostate enlargement, it is often difficult to insert the probe into the urethra, which is invasive and difficult for patients to accept. Trans-perineal ultrasound: Trans-perineal images are less clear and are rarely used. The prostate ultrasound can accurately assess the degree of prostate enlargement prostate ultrasound can measure the left and right diameter, upper and lower diameter and front and back diameter of the prostate, because the front and back diameter of the prostate enlargement increases and resembles a round or oval shape, so the volume of the round or oval shape is calculated by the formula: that is, the volume of the prostate = 0.52 x (the product of three diameters), and then multiplied by the specific gravity of the prostate 1.05 is the weight (g). The weight of the normal prostate is about 20 g. By calculating this, the degree of prostate enlargement can be assessed. The size of the prostate is not proportional to the symptoms, which means that even a mildly enlarged prostate may have severe symptoms, while someone with a severely enlarged prostate may have mild symptoms. The actual fact is that you can find out about prostate stones (calcification), prostate cysts prostate stones (calcification): prostate calcification is the scar left after the prostate had been inflamed and healed, which is the precursor of prostate stones. The prostate stones are divided into two categories: real and pseudo prostate stones, strictly speaking, prostate stones are primary or endogenous, real stones formed in the prostate alveoli and ducts. These stones mostly contain organic components such as protein, cholesterol, citric acid, etc. They are completely different from urethral stones and should not be confused. In some cases, prostate stones can penetrate the mucous membrane of the urethra in the prostate and enter the urethra, which should be distinguished from urethral stones. A prostate stone that originates in the urethra is a pseudoprostate stone. Prostate stones are often accompanied by chronic prostate inflammation, and prostate stones often hide a large number of bacteria, so they can often serve as the core of infection and store bacteria, while antibiotics that inhibit bacteria are difficult to enter the stones to work. Some patients are worried and afraid once they see a physical examination report suggesting stones in the prostate, but in fact prostate stones are different from kidney stones and ureteral stones. The majority of small, asymptomatic stones often do not require treatment, and for stones that are symptomatic but not seriously infected, prostate massage and antibiotics can be used to control symptoms. When stones are combined with prostatic hyperplasia, prostatectomy can be performed via the urethra to scrape out as many stones as possible at the same time. If the stones are large and numerous, sometimes it is necessary to do a transepithelial prostatectomy and stone removal, but simply doing a prostatectomy and stone removal often re-form stones in the prostate cavity, and should also give treatment for comorbidities, such as prostate stones with chronic prostatitis and vesiculitis, the main treatment is symptomatic, using hot water sitz baths, antibiotics and urinary tract antispasmodics to relieve the symptoms of posterior urethral irritation. Prostate cysts: are due to congenital or acquired causes of cyst-like changes in the prostate gland. Larger cysts can be palpated by anal finger palpation, and cysts protruding into the urethral cavity can be detected by urethroscopy. The main clinical symptom of prostatic cysts is difficulty in urination due to cyst compression of the urethra. In adults, most of the cysts are secondary, with slow onset and gradual onset of symptoms such as dyspareunia, dyspareunia and dyspareunia. When the cyst is large, it protrudes towards the bladder neck and rectum, and also compresses the rectum causing constipation and difficulty in defecation. PSA: the most specific indicator for early screening of prostate cancer PSA test has been widely used in clinical practice and has become one of the most important tools for early diagnosis and screening of prostate cancer, and is the most specific indicator for prostate cancer. PSA is a protein enzyme produced by prostate epithelial cells, which is rarely found in the blood when normal, but once prostate cancer is present, the PSA value will be high. However, since PSA is only a marker for prostate epithelial cells, not for prostate cancer cells, it is not very specific to screen for prostate cancer by using the normal range of PSA of 0-4 ng/mL, which is commonly used clinically. In addition to prostate cancer that can cause an increase in PSA level, benign prostate hyperplasia, inflammatory prostate lesions, prostate massage, etc. can all increase it. The majority of scholars now believe that when the total PSA level is between 4 and 10 ng/mL, the free PSA to total PSA ratio (F/T ratio) is important in identifying the benign and malignant prostate lesions and reducing the number of unnecessary biopsies. When the F/T ratio is between 0.1 and 0.25, a puncture biopsy should be performed; when the F/T ratio is >0.25, the possibility of prostate cancer is very small (<10%); when the F/T ratio is <0.1, the possibility of prostate cancer is very high (>80%) and a puncture biopsy of the prostate should be performed. Note that rectal examinations, cystoscopy and puncture biopsy can significantly increase free PSA and F/T ratio; therefore, these tests should be avoided until PSA is measured. Finasteride decreases serum PSA levels and can reduce serum PSA by up to 50% in those taking it for >12 months, which can affect the results and should be noted at the time of diagnosis. elevated PSA, what should I do next? Repeat PSA test: It is to rule out the chance of 1 test, except the elevation caused by other factors, it is recommended to repeat the test and observe the change of PSA level. ultrasound test: It is a non-invasive test method, which can detect the nodule-like changes in the prostate gland earlier and help to diagnose the prostate cancer at an early stage and observe the treatment effect continuously. There are trans-abdominal, trans-urethral and trans-rectal routes, among which trans-rectal examination is the most effective. The typical presentation of prostate cancer on ultrasound is a hypoechoic occupancy in the peripheral zone of the prostate. CT and MRI: both of them can show the anatomical relationship between the prostate gland and the surrounding tissues, but they are generally unable to make a qualitative diagnosis and are only used as a staging method. MRI shows the internal structure of the prostate and is valuable for differentiating prostate hyperplasia from prostate cancer, but it is expensive and takes a long time to perform, so it is not used as a routine test. MRI of prostatic hyperplasia mainly shows a significantly enlarged prostate, which is visible under the level of 2-3 cm above the pubic symphysis; a long T1 low signal shadow on T1-weighted images and equal or high signal shadow on T2-weighted images; the enlarged prostate compresses the surrounding tissue to form a low signal ring, resembling a pseudocapsule, diffuse hyperplasia and contraction of the bladder triangle to become shorter, with the neck retracted toward the urethra. It can also cause lower urinary tract obstruction, but the prostate is not large on rectal examination. The prostate system puncture biopsy: Ultrasound-guided transrectal or perineal prostate system puncture biopsy has become a routine clinical examination method. For patients with serum PSA levels >10 ng/mL, or between 4 and 10 ng/mL, and an elevated F/T ratio, or a suspicious rectal exam, puncture biopsy should be performed. Systematic biopsy can help to understand the extent of the tumor, the Gleason score of the tumor and determine the location of the prostate acinar tumor to avoid positive surgical margins, and the Gleason score is important in determining the patient’s prognosis. What is the next step to treat prostate cancer when it is diagnosed? If prostate cancer is diagnosed, treatment should be carried out in a regular hospital and appropriate measures should be taken according to the clinical stage of the tumor, Gleason score, PSA level, patient’s age and general condition. Treatment options include wait-and-see, radical resection, adjuvant endocrine therapy, radiation therapy, cryotherapy Author: Guo Jun Gao Qinghe, Department of Male Medicine, Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine