Standards for prostate health

At present, the core of the universal judgment of prostate health in the clinical field of urology and men's medicine is the combination of "no subjective discomfort symptoms, normal urinary/reproductive function, and no pathological abnormalities in medical examination images." There is no single absolute gold standard, and the weight of doctors' judgments in different clinical directions will also be different.

I just saw a 28-year-old Internet operator last week. His face turned pale when he took the physical examination report. It clearly said "prostate calcification". When he came in, he asked if it was cancerous and whether he needed an operation. I performed an anal examination on him and found that the texture of his prostate was uniform and there were no nodules. The prostate-specific antigen (PSA) level was also within the normal range. I then asked him if he had frequent urination or urgency, perineal pain, or ejaculation pain during intercourse. He shook his head for a long time and said he felt nothing. In this case, I directly told him that there was no need to worry at all, as it was considered healthy.

Of course, there are different clinical views here: many doctors who focus on chronic diseases in the elderly will classify simple prostate calcification into the sub-health category of "degenerative changes" and recommend adjustments to lifestyle habits and follow-up. However, the mainstream consensus in urology and men's medicine is that calcification without accompanying symptoms is like a mole on the face. It is just that the scar left by the self-healing of asymptomatic prostatitis in the past does not require special intervention at all.

Speaking of this, some people may ask, I can’t just run to the hospital when I feel a little uncomfortable. How can I initially judge whether there is a problem at home?

You really don’t need to believe the nonsense on the Internet that “more than one night pee means your prostate is bad.” The night before, you held a watermelon and ate half of it, then showed off three bottles of cold beer. Isn’t it normal for you to urinate two or three times at night? Under the premise of eliminating these clear triggers, if you have frequent urination, urgency and inability to urinate for more than one week, or have a dull pain in the perineum or lower abdomen after sitting for a long time, there is a stinging sensation during ejaculation during intercourse, or there is even a little blood in the semen, then you really need to be vigilant. There are also details that many people tend to overlook: when urinating, the urine stream becomes thinner, and you have to hold your breath hard to urinate. Don’t think it’s because you are “tired recently.” If this happens under the age of 40, it is most likely due to edema and inflammation of the prostate.

As for the imaging indicators that everyone often looks at during physical examinations, don’t be frightened when you see abnormal arrows. The reference value of normal adult male prostate size under B-ultrasound is 4*3*2cm, but if it exceeds this number, it does not necessarily mean prostate hyperplasia - I met a 26-year-old young man before who worked overtime for a month and sat for 12 hours a day, and drank iced coffee every day. After staying up late at night, the B-ultrasound showed that the prostate was larger than normal and there was still a small amount of fluid. I took anti-inflammatory drugs for a week and adjusted my work and rest. After a follow-up check, everything was normal. It was just edema caused by inflammation, which is the same as when you make a cut on your hand and swell.

There is also the PSA that everyone is most afraid of. The normal value range is 0-4ng/ml. There has always been academic controversy in this area: some schools of thought believe that young people under the age of 35 should be wary of pathological changes if their PSA exceeds 2ng/ml. However, most clinicians will first investigate the triggers - I also picked up a 50-year-old brother last week. The local The PSA during the physical examination was 4.3ng/ml. The doctor said that prostate cancer could not be ruled out. He was so frightened that he could not sleep all night. When I asked him, he had just had a party with his old classmates the day before the examination and drank a pound of liquor and had sex with him. I asked him to eat lightly and abstain from sex for two weeks and then come back for a reexamination. The result dropped to 1.8ng/ml. Nothing happened. To put it bluntly, prolonged sitting, drinking, sexual intercourse, and urinary tract infection may all lead to a transient increase in PSA. You cannot draw conclusions based on one indicator alone.

To be honest, I have been working in outpatient clinics for so many years, and 90% of the young people who came in with the question "Is there something wrong with my prostate?" were frightened by anxiety marketing on the Internet. On the contrary, many elderly men thought that "frequent urination is normal in old age" and persisted, eventually causing serious problems. There used to be a 62-year-old man who suffered from frequent urination and incontinence for almost two years, which eventually progressed to the point where he could not urinate for half a day. When the urine was checked, there was 300ml of residual urine in the bladder. Prostatic hyperplasia had pressed the urethra until there was only a gap left. In the end, the only solution was surgery. This is a typical condition that has been out of the health category for a long time.

Finally, I would like to give you the most practical judgment method: As long as you don’t feel any persistent discomfort during urination, there is no abnormal pain during sexual intercourse, and the prostate B-ultrasound and PSA indicators of the annual physical examination do not indicate pathological abnormalities, don’t speculate that you have a prostate problem. If you really feel uncomfortable, go to a regular hospital for urology and men's examination. Don't believe the "Top Ten Standards for Prostate Health" compiled by those who sell health care products on the Internet. They are purely deceiving.