Information

The main diagnostic methods for the prostate are:

• PSA - prostate-specific antigen
• Rectal palpation of the prostate - digital rectal examination
• Transrectal ultrasound
• Prostate biopsy

Tumor marker - Prostate-Specific Antigen (PSA)

PSA is an indicator of the condition of the prostate. The most commonly tested markers in everyday practice are total PSA and free PSA. The free fraction of PSA is secreted only by benign prostate tissue. The value of the free fraction should be as high as possible and should represent a larger percentage of the total PSA. The ratio of free PSA to total PSA indicates suspicion of prostate cancer or points toward benign hyperplasia - BPH. It is important to know that this ratio is a clinical conclusion, not a laboratory reference range, as is stated on the laboratory report form.

Interpretation of PSA is the responsibility and duty of the urologist. Conclusions are determined by the urologist's knowledge and experience.

Digital rectal examination - examination of the prostate by palpation through the rectum

When diagnosing any organ of the human body, it is necessary for it to be examined by the physician. One method is palpation - feeling the surface of the organ directly or through the abdominal wall. The prostate gland is accessible for examination through the rectum. The purpose of the examination is to assess the surface, firmness, demarcation from the surrounding tissues, and tenderness of the prostate. The examination is not performed to determine the exact size of the gland, but it does determine an approximate degree of enlargement - not enlarged, mildly, moderately, or significantly enlarged gland. This assessment is also necessary for comparison at subsequent examinations or for tracking changes in the condition of the gland.

The diagnostic conclusion from this examination is based exclusively and solely on the urologist's personal experience.

Transrectal ultrasound - TRUS

Transrectal ultrasound - an examination of the prostate using an endorectal high-frequency transducer - scans the prostate through the rectum and provides a clear image of the gland's structure. Areas suspicious for cancer or inflammation of the gland can be seen, and its boundaries relative to the surrounding tissues are determined more precisely. The method is particularly useful in the diagnosis of prostate cancer. Prostate biopsy is also performed using this method. In performing the prostate biopsy, the urologist builds personal experience regarding what they see and what they biopsy, as well as what result is obtained from the biopsy.

Interpretation of the TRUS is based on the urologist's personal experience.

Prostate biopsy

Prostate biopsy is the only method that provides definitive proof of prostate cancer. There is no other method that provides such proof. The methods presented above - PSA, digital rectal examination, and TRUS - are diagnostic and point toward one or another diagnosis of the prostate. When prostate cancer is suspected, a biopsy is offered and performed to confirm or rule out these suspicions. Modern biopsy is predominantly transrectal, and less commonly perineal. Transrectal needle biopsy is an established method in international practice, and its possible complications have been well described. These are minor in scope and are treated conservatively. The described major, life-threatening complications occur in very elderly men - over 75-80 years of age. In these patients, as a rule, the decision to perform a biopsy must be carefully considered. There is no evidence that prostate biopsy leads to the spread of cancer.

Prostate biopsy is well described in international practice, but its performance is an individual experience for each urologist, with an individual assessment of indications and contraindications, individual results, and individual interpretation of those results. Prostate biopsy must be performed with subsequent treatment in mind. The information obtained from the biopsy determines the course of action afterward - treatment or monitoring. Rich, detailed information from the biopsy leads to a clearer and better-motivated choice of course of action or treatment. An uninformative biopsy makes the correct choice of treatment, or the rationale for monitoring, difficult.

The choice of treatment is a judgment made by the urologist, based on their knowledge, practical experience, and familiarity with as many treatment methods as possible. These factors make it possible to reach an individual decision for each patient.