If no prostate mass is found during a routine color ultrasound examination, can prostate cancer be ruled out?

Many middle-aged and elderly men are very concerned about prostate diseases. Among them, the most concerned issue is whether prostate cancer can be prevented?

The prostate is an important organ in the male reproductive system. It is chestnut-shaped, located below the bladder, surrounding the urethra, and adjacent to the rectum on the dorsal side. Malignant tumors that grow in this area are prostate cancer.

In my country, prostate cancer patients are mainly in the middle and late stages. More than half of the patients have already developed local invasion when they are discovered, and some have already developed distant metastasis. Early detection can improve the efficacy of tumor treatment and prolong the patient's survival time.

What are the main symptoms of prostate cancer ?

Patients with early prostate cancer may have no special clinical manifestations, or they may show symptoms of benign prostatic hyperplasia, such as dysuria. In the middle and late stages of prostate cancer, severe cases may cause urinary retention, urinary incontinence, hematuria, etc. When bone metastasis occurs, it may cause symptoms such as bone pain and pathological fractures.

Through physical examinations and regular screening of high-risk groups, early and localized prostate cancer can be detected, allowing patients to receive timely treatment and improve survival rates. Most patients with early and localized prostate cancer can be cured through surgery or radiotherapy.

Who are at high risk for prostate cancer ?

The "Guidelines for Prostate Cancer Screening, Early Diagnosis and Treatment in China" states that people at high risk of prostate cancer are defined as

(1) Age ≥ 60 years;

The incidence of prostate cancer in men over 60 years old can reach 13%, and these patients should also undergo regular prostate screening.

(2) Aged ≥45 years and with a family history of prostate cancer;

If there is a direct relative with prostate cancer, such as a brother or a father, then prostate cancer screening is recommended after the age of 45.

(3) Carrying BRCA2 gene mutation and aged ≥40 years.

Men with a life expectancy of more than 10 years who meet one of the conditions can decide whether to undergo prostate cancer screening based on the advice of a specialist after fully understanding the benefits and harms of screening.

What are the screening methods for prostate cancer?

(1) Rectal examination

Digital rectal examination (DRE), also known as anal examination, is performed by the doctor wearing sterilized gloves on his right hand and using his fingers to feel whether there are any tumors or nodules on the surface of the prostate, and to determine the size, texture, and mobility of the tumors and nodules.

Digital rectal examination (DRE) alone is not recommended for prostate cancer screening. DRE is recommended as an auxiliary examination when the initial PSA test is positive.

The sensitivity of rectal examination is low for early prostate cancer or prostate cancer originating from the peripheral zone.

(2) PSA is recommended as the first choice for prostate cancer screening

Prostate-specific antigen (PSA) is a glycoprotein secreted by prostate acinar epithelial cells and is detected by blood draw. It is currently the preferred marker for diagnosing prostate cancer and is divided into total prostate-specific antigen (T-PSA) and free prostate-specific antigen (f-PSA).

The normal value of T-PSA is 0-4 ng/ml. After excluding factors that may affect the increase of T-PSA, such as urinary tract infection, indwelling urinary catheter, DRE, sexual life, etc., and continuous testing of serum PSA for two times>4.0 ng/ml, it is recommended that a urologist guide further clinical examination and intervention.

If serum PSA is ≤4.0 ng/ml, regular monitoring (every 2 years) is recommended.

(3) The use of positron emission tomography (PET-CT), ultrasound, or magnetic resonance imaging alone for prostate cancer screening is not recommended.

Tips:

(1) If a routine color Doppler ultrasound does not reveal a prostate mass, prostate cancer cannot be completely ruled out.

(2) It is recommended that male patients with abnormal DRE, abnormal imaging, or related manifestations such as bone pain, fracture, etc. should undergo PSA testing.

(3) Men over 50 years old who have symptoms of lower urinary tract obstruction, such as difficulty urinating and painless hematuria, must undergo early screening for prostate cancer.

(4) Prostate puncture biopsy is required for diagnosis.

Can prostate cancer be prevented?

To reduce the incidence of prostate cancer, it is recommended to:

1. Healthy diet:

Eat a low-fat diet, eat more fresh fruits and vegetables, including soy foods rich in plant protein, drink green tea in moderation, and supplement vitamin E;

Eat more white meat and less red meat, and avoid eating raw, cold, spicy and other irritating foods;

2. Do not smoke or drink alcohol;

3. Keep exercising and maintain a regular work and rest schedule;

4. Drink plenty of water and urinate frequently in your daily life, avoid holding urine and sitting for long periods of time;

5. Promoting standardized screening and promoting early diagnosis and treatment are important means of detecting prostate cancer.