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As the saying goes, the breast tissue in women and the prostate in men are the most troublesome areas. For instance, this pea-sized prostate has a frighteningly high likelihood of developing cancer.
In Western countries, prostate cancer has the highest incidence rate among male cancers. In our country, although the incidence rate of prostate cancer is relatively lower than that of Western nations, it is rising annually due to an aging population, improved economic conditions, and changes in dietary habits.
Prostate cancer is a very insidious disease that exhibits no symptoms in its early stages and is often referred to as the “silent killer.” By the time a patient experiences pain, obstruction, and difficulties in urination due to prostate cancer, it is often already in the advanced stage.
So, what examinations can be conducted to detect this “silent killer” early?
Digital Rectal Examination
The Digital Rectal Examination (DRE) is the primary method for diagnosing early prostate cancer. The male prostate is located at the pelvic floor, in front of the rectum, allowing the physician to assess the general condition of the prostate through digital examination.
Under normal circumstances, the prostate felt during a digital rectal examination measures about 3cm by 4cm and has a soft consistency. In cases of prostate enlargement, the size of the prostate gland can be noted to increase, but its consistency will not change; if the prostate feels very hard and its surface is not smooth, there is a high suspicion of prostate cancer.
Transrectal Ultrasound Examination
Transrectal ultrasound (TRUS) involves the insertion of an ultrasound probe, allowing for the observation of any abnormal nodules in the prostate, assessment of tumor volume, and evaluation of invasion into the prostate capsule and potential metastasis.
Therefore, transrectal ultrasound can complement the deficiencies of the digital rectal examination, primarily used for auxiliary examinations of small, centrally located cancerous nodules in the prostate.
Currently, transrectal ultrasound is an essential method for the early clinical diagnosis of prostate cancer.
Prostate-Specific Antigen Test
Prostate-specific antigen (PSA) is currently the most sensitive tumor marker for prostate cancer. Although PSA can be detected in the blood of healthy individuals, the levels are very low and do not exceed 4ng/ml. If PSA levels exceed 10ng/ml, prostate cancer should be highly suspected.
However, conditions like prostatitis and benign prostatic hyperplasia can also lead to elevated PSA levels. How can one differentiate between these and prostate cancer?
Although benign diseases such as prostatitis and benign prostatic hyperplasia can cause PSA levels to rise, the increase is typically not significant, usually limited to the range of 4ng/ml to 10ng/ml, and after symptomatic treatment, PSA levels gradually return to normal within a month.
However, PSA levels in early prostate cancer may also be lower than 10ng/ml. Thus, how to distinguish whether the PSA elevation is due to prostatitis, benign prostatic hyperplasia, or prostate cancer requires examining the free PSA (fPSA) levels. This is because patients with benign prostate diseases tend to have higher fPSA concentrations compared to cancer patients. A ratio of fPSA/PSA of 0.16 is generally considered the critical standard; the lower the ratio, the more likely it indicates prostate cancer.
If PSA levels remain elevated (greater than 10ng/ml) and imaging examinations and digital inspections by a physician indicate a possible presence of prostate cancer, a prostate biopsy can be performed for confirmation.
