Transrectal Ultrasound Accuracy for Prostate Health

Transrectal Ultrasound Examination of the Prostate

Hello, doctor.
I apologize for asking again, but I would like to inquire about the accuracy of transrectal ultrasound examinations for the prostate.
I previously underwent a transrectal ultrasound at Wan Fang Hospital, where the doctor mentioned that there were some calcifications in my prostate, possibly due to past inflammation.
However, the ultrasound did not indicate any malignant tumors, leading to the conclusion of prostatitis.
Can this confirm that the elevated PSA is not caused by prostate cancer? Is there a possibility that malignant tumors could be undetectable by transrectal ultrasound? Additionally, I would like to ask another question: I have a history of urinary stones, and I wonder if issues like urinary stones or other urinary tract diseases or inflammation could also lead to elevated PSA levels, or if PSA levels are solely influenced by the prostate itself.
Thank you!

People troubled by high PSA levels, 30~39 year old female. Ask Date: 2010/09/20

Dr. Xu Weikai reply Urology

All tests are merely references and not absolute.
For most individuals, they can serve as reference values, but they may not necessarily apply to everyone.
In other words, while the PSA levels for most people fall between 0 and 4, indicating benign conditions, some individuals with PSA levels greater than 4.0 may still be benign.
Conversely, there are patients with malignant tumors whose PSA levels are below 4.0.
Transrectal ultrasound is more accurate than standard ultrasound, but it is not definitive.
Some malignant tumors may appear identical to a normal prostate on ultrasound, making differentiation impossible.

Reply Date: 2010/09/20

More Info

Transrectal ultrasound (TRUS) is a commonly used diagnostic tool for assessing prostate health, particularly in the context of prostate cancer screening and evaluation of prostate-related conditions. The accuracy of TRUS can be quite high, especially when used in conjunction with other diagnostic methods, but it is not infallible.
In your case, the presence of calcifications in the prostate, which your doctor attributed to previous inflammation, is a common finding and often does not indicate malignancy. However, it is important to note that while TRUS can provide valuable information about the prostate's structure, it has limitations. Some cancers may not present with obvious abnormalities on ultrasound, leading to false negatives. This means that while your TRUS results did not show signs of cancer, it does not completely rule out the possibility of prostate cancer, especially if your PSA levels are elevated.

Prostate-specific antigen (PSA) is a protein produced by both normal and malignant cells of the prostate gland. Elevated PSA levels can be indicative of several conditions, including benign prostatic hyperplasia (BPH), prostatitis (inflammation of the prostate), and prostate cancer. Your doctor’s assessment that your elevated PSA is likely related to prostatitis is plausible, especially given your history of inflammation. However, it is crucial to understand that PSA is not a definitive marker for cancer; some men with prostate cancer may have normal PSA levels, while others with benign conditions may have elevated levels.

Regarding your question about urinary tract stones and their potential impact on PSA levels, it is indeed possible for other urological conditions to influence PSA levels. Inflammation or irritation in the urinary tract, whether from stones or infections, can lead to elevated PSA levels. Therefore, while the prostate is a primary source of PSA, other factors, including urinary tract health, can also play a role.

In summary, while TRUS is a valuable tool for assessing prostate health, it is not 100% accurate, and elevated PSA levels can arise from various conditions beyond prostate cancer. Continuous monitoring and follow-up with your healthcare provider are essential, especially if your PSA levels remain elevated or if you develop new symptoms. If there are concerns about the accuracy of the TRUS results or if your PSA levels continue to rise, further investigations, such as MRI or biopsy, may be warranted to ensure a comprehensive evaluation of your prostate health.
It is also advisable to maintain open communication with your healthcare provider about any symptoms you experience and to discuss the best follow-up plan tailored to your specific situation. Regular check-ups and monitoring are key components in managing prostate health effectively.

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