The incidence of prostate cancer in China is increasing year by year, and the symptoms of early to mid-stage prostate cancer are the same as those of prostate hyperplasia, which are non-specific. Therefore, early diagnosis and treatment are particularly important. At present, the more recognized clinical diagnosis model of prostate cancer is the “three-step approach”.
① Prostate-specific antigen (PSA) and rectal finger examination (DRE).
② Depending on the specific situation, transrectal prostate ultrasound (TRUS), magnetic resonance imaging (MRI) and other imaging examinations are selected to complete the localization and diagnosis of the suspected lesion.
③Pathological diagnosis is obtained by transrectal ultrasound guided biopsy of the prostate system.
I. PSA examination
1.Prostate specific antigen (PSA), as a single test, has a higher predictive rate for positive prostate cancer diagnosis compared with DRE and TRUS. The normal value is 0-4.0ng/ml. The higher the PSA, the higher the possibility of prostate cancer. There are data showing that PSA levels in different age groups of men in China are ≤2.15 ng/ml at age 40-49, ≤3.20 ng/ml at age 50-59, ≤4.1 ng/ml at age 60-69, and ≤5.37 ng/ml at age 70-79, which are lower than men in western countries.
(1) Indications for PSA testing.
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 of age;
③Men with abnormal DRE or imaging should also undergo PSA test.
(2) PSA test frequency.
①People aged 45-49 with normal DRE and PSA >1 ng/ml should have PSA rechecked 1-2 years;
② For those with normal DRE and PSA ≤1 ng/ml, repeat PSA at age 50;
(3) PSA review at age 1-2 years if DRE is normal and PSA <3 ng/ml and there is no indication for puncture above 50 years.
(3) PSA affects many factors: factors affecting the blood PSA level include mechanical extrusion of the prostate (such as DRE, urinary retention, cystoscopy, etc.) as well as urinary tract infection, hematuria, etc. Therefore, PSA should be examined 24 hours after ejaculation, 48 hours after cystoscopy, catheterization, and 7 days after prostate fingerprinting, and it is recommended that routine urinalysis be performed at the same time as PSA examination to exclude the effects of hematuria or/and inflammation .
Prostate rectal examination (DRE) is simple, easy and painless, and is an important test for early diagnosis of prostate cancer. The prostate gland of prostate cancer patients is hard or hard as stone, and nodules and other changes can be palpated.
The value of MRI in the diagnosis of prostate cancer has gained more and more widespread recognition in recent years and is also the best imaging test for prostate cancer staging) Localized diagnosis of prostate cancer requires clinical confirmation before prostate cancer treatment, and systematic puncture biopsy of the prostate is the most reliable test to diagnose prostate cancer.
Systematic puncture biopsy of the prostate is required in the following 4 cases
1.Prostate nodules found on rectal examination, any PSA.
2. Ultrasound, CT or MRI reveals abnormal images, any PSA.
3.PSA >10 ng/ml.
4, PSA 4-10 ng/ml, f/t PSA<0.15, or PSAD>0.15, or PSAV>0.75
Rectal ultrasound-guided transperineal or transrectal puncture biopsy is the standard puncture examination method. Our department has a special rectal ultrasound instrument, and I have skillfully performed hundreds of prostate puncture biopsies. The correct rate of puncture biopsies has increased significantly, and the incidence of biopsy complications such as fever and hematuria is extremely low.