Standards for prostate health

There is no subjective discomfort such as frequent urination, urgent urination, painful urination, or perineal swelling. The physiological functions related to urination and sexual function are not affected, and no pathological changes can be found in blood tests, B-ultrasound and other examinations. Don’t believe those single standards on the Internet that say “prostate size must be 4×3×2cm to be considered healthy.” They regard the group mean as a golden rule. The actual individual differences are much greater than many people think.

I have been working in the Department of Urology for almost 8 years, and I have seen too many people who were so frightened by the words "prostate is slightly larger" on the physical examination report that they checked Baidu all night. Last month, a 28-year-old Internet programmer came to the clinic. The B-ultrasound showed that his prostate was 4.2×3.3×2.1cm, which was a bit larger than the reference value. As soon as he entered the door, he panicked and asked if he needed surgery and whether it would affect fertility in the future. As a result, he was given a urine routine and PSA (prostate specific antigen) test, which were all within the normal range. I asked him if he felt any discomfort. He said that except for the occasional inability to urinate after working overtime for a long time, he just rested for two days and had no other problems. I just let him go back. The congestion caused by sitting still for 10 hours is not a disease at all. Standing up to get a glass of water and walking for two steps every hour after sitting is more effective than taking any health supplements.

Oh, by the way, speaking of the size of the prostate, it is actually the same as a person’s height. There is a rough reference range, but how can it be considered normal if everyone is stuck at 170cm? The prostate looks like an upside-down chestnut, just stuck at the outlet of the bladder, guarding the upper opening of the urethra. As long as it does not compress the urethra, cause inflammation, or abnormal hyperplasia, it is not a big deal if it is slightly larger or smaller. Young men in their twenties and thirties should not worry blindly that they have prostatic hyperplasia. This disease is basically a degenerative disease that only appears after the age of 50. The enlargement of the glands in young people is mostly temporary congestion and will disappear on its own after a while.

Nowadays, there are actually two different tendencies in the academic circles to judge prostate health. The traditional evidence-based medicine school believes more in objective examination results. Even if you occasionally have slight perineal soreness, as long as all indicators are normal, it is not considered a pathological problem. At best, it is considered a stress reaction caused by lifestyle. If you respond and adjust your work and rest, you can recover; the functional medicine school that has become popular in recent years pays more attention to subjective feelings. If you repeatedly experience swelling and incontinence after sitting for a long time, even if no abnormalities are found in all examinations, it will be judged as sub-healthy prostate. It is recommended to intervene in advance to avoid progression to organic diseases. Both opinions are reasonable. There is no need to argue about right or wrong. After all, your body is yours, and you know best whether it is comfortable or not.

Many people have very polarized perceptions of the prostate. I have met many old smokers in their 60s who wake up three or four times a day and have urinary lines as thin as if the faucet is not turned on. They all thought it was a normal phenomenon of old age. They did not come to check until the PSA exceeded 10ng/ml during a physical examination. It was already early-stage prostate cancer; I have also seen many men in their early twenties. Young man, when I occasionally have bifurcated urine, I search everywhere to see if I have prostatitis. I am so anxious that I can't sleep. It is purely because I am scaring myself. Bifurcated urine may just be the residual prostate fluid in the urethra after an erection, or the shape of the urethra has temporarily changed after holding in urine for too long. It has nothing to do with inflammation.

Oh, by the way, a few words about the PSA indicator. It is the prostate-specific antigen that is often seen in physical examinations. The normal reference value is less than 4ng/ml. It is currently the most commonly used primary screening method for detecting prostate cancer. However, a high level does not mean that you have cancer. For example, if you hold your urine for two hours before the test, or if you have blood drawn less than 48 hours after having sex, there may be a transient increase. Don't panic when you see an arrow on the report. Check again every two weeks. Most of the time it will fall back to the normal range.

There is another piece of trivia that many people don’t know: prostate health is closely related to smooth bowel movements. The organs in our pelvis are very close to each other, and the rectum is right behind the prostate. If you are constipated for a long time, hard fecal matter presses the prostate every day, which can easily lead to gland congestion. Many patients told me that after the constipation is cured, the slight incontinence of urination and the pain in the perineum disappear immediately, which is more effective than taking anti-inflammatory drugs.

The thing I usually tell patients who come for consultation the most is that there is no need to label yourself by looking at those rigid numerical values. If you usually urinate easily, don't have any inexplicable pain, and don't feel any discomfort during intercourse, even if the B-ultrasound is a little bigger, you don't need to take it seriously at all. On the contrary, for those who sit and play games every day, sit for four or five hours without moving, or eat spicy food and drink heavily every day, even if their current examinations are all normal, they are not far from having problems.

Of course, if you have begun to experience frequent and urgent urination that lasts for more than a week, a dull pain in the perineum or pubic area, or even pain during intercourse, then don’t bear it, and go to the urology department of a regular hospital to register as soon as possible. Don’t believe in the “glandular detoxification” and “infusion treatment” of private men’s hospitals. Simply paying IQ tax will harm your body.