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As the saying goes, the breasts of women and the prostate of men are the most headache-inducing areas. For example, the probability of cancer in the walnut-sized prostate is frighteningly high.
In Western countries, prostate cancer has the highest incidence rate among male cancers. In our country, although the incidence of prostate cancer is relatively lower compared to Western countries, with the increasing aging population, improved economic levels, and changes in dietary habits, the incidence of prostate cancer is on the rise.
Prostate cancer in the early stages shows no symptoms, making it a very secretive disease known as the “silent killer.” By the time a patient feels the swelling, obstruction, and difficulty in urination caused by prostate cancer, it is often already in the advanced stage.
So, through which tests can this “silent killer” be detected early?
Prostate digital rectal examination
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, and a physician can understand the approximate condition of the prostate through a digital rectal examination.
In normal circumstances, a digital rectal examination can detect a prostate size of about 3cm*4cm with a soft hardness. In cases of prostate hyperplasia, an enlargement in prostate volume can be observed, but the hardness remains unchanged. If the examined prostate is very hard to touch, with an irregular surface, one should highly suspect the possibility of prostate cancer.
Transrectal ultrasound examination
Transrectal ultrasound examination (TRUS) involves inserting an ultrasound probe through the anus. This procedure not only allows for the observation of abnormal nodules within the prostate but can also determine the volume of tumors and assess whether the tumor has invaded the prostatic capsule and other areas.
Therefore, transrectal ultrasound examination complements the deficiencies of digital rectal examination. It is mainly used to assist in examining small cancerous nodules located in the central prostate region.
Currently, transrectal ultrasound examination is an essential method for the early clinical diagnosis of prostate cancer.
Prostate-specific antigen testing
Prostate-specific antigen (PSA) is currently the most sensitive tumor marker for prostate cancer. While PSA can be detected in the blood of normal individuals, the levels are very low and do not exceed 4ng/ml. If PSA levels exceed 10ng/ml, one should highly suspect the presence of cancer cells in the prostate.
However, prostate inflammation and enlargement can also lead to increased PSA levels. How then can prostate cancer be distinguished from benign conditions based on PSA levels?
Although benign conditions like prostate inflammation and enlargement can cause elevated PSA levels, the increase is not significant and usually remains within the range of 4ng/ml to 10ng/ml. After appropriate treatment, PSA levels gradually return to normal within a month.
In some cases, PSA levels in early-stage prostate cancer may be below 10ng/ml. To differentiate between increased PSA levels due to prostate inflammation, enlargement, or prostate cancer, one needs to consider the indicator of free PSA (fPSA). This is because patients with benign prostate conditions tend to have higher fPSA concentrations compared to cancer patients. Typically, a ratio of fPSA/PSA of 0.16 is considered as a critical threshold, with lower ratios indicating a higher likelihood of prostate cancer.
If PSA levels consistently remain elevated (above 10ng/ml) and after imaging studies and digital rectal examination by a physician confirm the possibility of prostate cancer, a prostate biopsy is usually recommended for a definite diagnosis.
In the United States, men over 50 years old generally undergo PSA testing. However, in our country, only a small minority of men over 50 years old undergo this examination.
Experts recommend that men in their fifties and sixties should include cancer screening in their physical examinations and get a PSA test. It is also advisable to check PSA levels when other prostate diseases are suspected.
If elevated PSA levels are detected, specialized medical professionals should be consulted for further understanding and additional tests. This approach increases the chances of early diagnosis and treatment for prostate cancer patients.
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Author’s Introduction
Dr. Hu Qingfeng
Department of Urology, Huashan Hospital, Fudan University
Bio: Doctor of Medicine from Fudan University, specialized in the early diagnosis and comprehensive treatment of urological tumors. Published over 20 professional papers as the first author, including 10 SCI papers. Currently working as an attending physician in the Department of Urology at Huashan Hospital, Fudan University, focusing on the early diagnosis and minimally invasive treatment of urological male reproductive system tumors, as well as the comprehensive treatment of advanced prostate cancer, kidney cancer, and bladder cancer.
Clinic Hours: Tuesday afternoon at the Main Huashan Hospital, all day Thursday at the North Huashan Hospital.
