The prostate cancer clinically detectable is the most common cancer in men over 50 years of age in the U.S., and the second leading cause of cancer death in men. Approximately 30% of men over 50 have asymptomatic foci of prostate cancer recognizable in the autopsy series. However, it is estimated that the risk of a man of 50 years to develop a clinically relevant prostate cancer has been estimated at about 10%, while the risk of dying from prostate cancer is approximately 3%.
Benign prostatic hyperplasia
Moreover, it should be noted that benign prostatic hyperplasia (BPH) is the most common benign tumor in men over 50 years, and the second cause of admission for surgery. It is therefore advisable to assess clinically, albeit brief, in this age group. In fact, 70% of patients over age 70 develop BPH, of whom between 35 and 40% suffer with prostate clinic due to cervico-urethral process.
The right candidate is a male between 50 and 70 years of age with good health and a life expectancy of at least 10-15 years. In cases of family history of prostate cancer suggests starting as an option at 40 years of age. Although it has been said that the prevalence of prostate cancer increases with advancing age, after 70 years of life expectancy decreases to less than ten years and the risk of death from other causes increases. Thus, although each case must be taken individually, do not recommend routine screening of men over 70 years without symptoms, except that the detection or treatment of prostate cancer affecting the quality of life of patients.
Of course The urologist should include an assessment visit in the prostate of any man with urinary symptoms.
What tests are performed on a prostate check?
was prompted by urinary frequency, by the existence of complaints or problems associated with it, hematuria (blood in urine) and so on. May also be given the IPSS ( International Prostatic Syptoms Score ), a scale of urinary symptoms and quality of life validated by WHO, which gives us an impression of the man's clinical situation quickly.
The application of digital rectal examination as part of routine screening is well established. However, some patients feel aversion for the exam and the lack of sensitivity and specificity of the test are the two limitations. Used alone, it has not succeeded in detecting prostate cancer at an early stage, potentially curable, but in combination with PSA has unquestionable value.
- Urinary sediment analysis: to distinguish urinary tract infections that can cause irritative symptoms similar to prostate patients and to identify the hematuria (blood in urine).
- Determination of plasma creatinine (allows an assessment of renal function), so this determination as the above are part of routine health checks, so it is common for patients to bring in the time of the visit to the urologist.
- The PSA is a protein produced by prostate epithelial cells and, among other circumstances, blood level increases with the presence of prostate cancer cells. The routine use of PSA in male patients older than 50 years has been recommended by the American Society of Cancer , the American Urological Association , among others, and the FDA also has approved it as a tool for early detection of prostate cancer. Although the standard reference values are between 0 and 4 ng / ml (Tandem E assay), have also been proposed age-specific levels, but have not enjoyed wide acceptance. The problem is that in any case, there is an overlap between the values of PSA in cancer patients and patients with benign prostatic hyperplasia. That is, it is not uncommon for patients with elevated (usually moderate, between 4 and 10 ng / ml) of this index is to make appropriate diagnostic tests and are not cancer cells, and conversely, not what is that other men have figures within the normal range and who suffer from prostate cancer. Therefore, it has been suggested the use of other tests (free PSA, PSA density, PSA velocity, etc.) to avoid this uncertainty, but this exceeds the purpose of a urological check and must be determined in subsequent visits if required .
is a test not required, but it is certainly a useful tool if there are significant micturition or other clinical circumstances so warrant. The measurement of waste (volume of urine left in the bladder after urination) may be sufficient in the context of a urological check. Although transrectal ultrasound is useful in the diagnosis of prostate cancer is not recommended as part of a routine by the lack of specificity and relative discomfort.
is a test easy to perform, devoid of hassles and reproducible. Its purpose is to obtain objective and quantifiable data on the patient's lower urinary tract, that does not always correlate with symptoms and the degree of obstruction. It consists of making urination in the flow meter device that measures the amount of urine output per unit of time and transforms it into a signal that can be digitized and sent to a polygraph.
In general, organizations that promote urological checkups recommend an evaluation combined, most often based on physical examination and PSA, although, as we have seen, may include other tests based on clinical findings.