Interpretation of the 2022 Guidelines for Prostate Cancer Screening, Early Diagnosis and Treatment in China (Part 1)

*Only for medical professionals to read and reference to interpret the epidemiology, disease types, risk groups and early screening recommendations of prostate cancer in China
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Prostate cancer is one of the most common malignant tumors in the male reproductive system, and its incidence is increasing year by year in China
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Due to the lack of specific symptoms of early prostate cancer, it is easy to be confused with benign prostatic hyperplasia
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Therefore, early diagnosis is very important for the timing of prostate cancer treatment and the selection of programs [1]
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In order to promote the standardization, quality and homogenization of prostate cancer screening services in China, and to provide scientific and operational guidance on prostate cancer screening for screening-related staff, domestic experts and scholars have formulated the "Prostate Cancer Screening in China" Guidelines for Early Diagnosis and Early Treatment (2022, Beijing)" (hereinafter referred to as "Guidelines") [2]
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The first half of the "Guidelines" will be explained in detail below, that is, the epidemiology of prostate cancer in China, disease types, risk groups, and early screening recommendations
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Interpretation of the epidemiological characteristics and related risk factors of prostate cancer The disease burden of prostate cancer in China is relatively heavy.
In 2015, the number of prostate cancer cases in the country was about 72,000, accounting for 3.
35% of all new cases of malignant tumors in men.
The incidence of prostate cancer in urban areas higher than that in rural areas [3]
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The study showed that compared with 1990, the number of men with prostate cancer, the number of deaths, the standardized incidence rate and the standardized mortality rate all increased significantly in China in 2013, the number of incidence increased from 13,800 to 81,400, an increase of 490.
27%; the number of deaths It increased from 5,800 to 17,800, an increase of 206.
86%; the standardized incidence rate increased from 4.
48/100,000 to 13.
33/100,000, an increase of 197.
54%; the standardized mortality rate also increased from 2.
26/100,000 to 3.
32/100,000, an increase 46.
9% [4]
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Moreover, there is a gap between the 5-year survival rate of prostate cancer patients in China and developed countries and regions such as Europe and the United States [2]
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Prostate cancer-related risk factors include: age, family history of prostate and breast cancer, smoking, obesity, prostatitis, benign prostatic hyperplasia, excessive intake of milk or related dairy products, calcium, and zinc
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Intake of green tea and soy foods may reduce the risk of prostate cancer [2]
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Interpretation of pathological types and grades of prostate cancer Pathological types of prostate cancer include acinar adenocarcinoma, intraductal carcinoma, ductal adenocarcinoma, urothelial carcinoma, squamous cell carcinoma, basal cell carcinoma, and neuroendocrine tumors, which are currently the most widely used The grading method is the Gleason scoring system, which divides prostate cancer tissue into major morphological grading areas and secondary morphological grading areas.
Prostate cancer can be divided into 5 different groups according to the Gleason total score and disease risk
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The "Guide" recommends using the 8th edition of the American Joint Committee on Cancer TNM staging system to group the prognosis of prostate cancer into stages I, II, III and IV.
Show [2]
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Table 1.
American Joint Committee on Cancer Prostate Cancer TNM Stage and Prognosis Group Correspondence Table Potential Negative Effects of Prostate Cancer Screening Potential Negative Effects of Prostate Cancer Screening Psychological influence [2]
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False-positive screening: Prostate-specific antigen (PSA)-based screening for prostate cancer may result in false-positive screening, with false-positive screening results from a randomized European prostate cancer screening study showing false positives in men ≥70 years of age The false-positive rate was 20.
6%, with a false-positive rate of 14.
5% for men aged 65-69, 11.
1% for men 60-64, 6.
4% for men 55-59, and a false-positive rate for men <55 The positive rate was 3.
5% [5]
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Overdiagnosis: Analysis of 11 randomized controlled trials collected by the German Institute for Quality and Efficiency of Health Care showed that the reported overdiagnosis rate in randomized controlled trials of PSA-based prostate cancer screening was 0.
7%-6.
0%[6]
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Overtreatment: Overdiagnosis is often accompanied by overtreatment, which often results in long-term urinary, reproductive, and bowel symptoms due to the proximity of the prostate to the bladder, penis, and rectum [7]
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Associated Psychological Effects: Screening may lead to over-detection and treatment of less severe prostate cancer, resulting in increased healthcare costs, increased adverse effects and complications, and increased patient anxiety
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The specificity and sensitivity of PSA testing are not high, and false-positive results will lead to patient anxiety and increase unnecessary diagnostic operations [8]
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All high-risk groups of prostate cancer The "Guide" points out that men with a life expectancy of more than 10 years and one of the following conditions are high-risk groups of prostate cancer [2]: 1) Age ≥ 60 years old, 2) Age ≥ 45 years old and have prostate cancer Family history of cancer, 3) carrying BRCA2 gene mutation and age ≥40 years old
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All men other than the above-mentioned high-risk groups are a general-risk group.
The "Guideline" recommends that men aged 45 years and older with a family history of prostate cancer be informed in detail about the known and potential harms and benefits of screening, which can then be combined with specialist physicians.
It is recommended to decide whether to proceed with prostate cancer screening [2]
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Interpretation of prostate cancer screening frequency and stop time "Prostate Cancer Screening Chinese Expert Consensus (2021 Edition)" pointed out that for those who need prostate cancer screening, serum PSA testing should be performed every 2 years.
When <4 μg/L, follow-up every 2 years is recommended; when the subject’s PSA is ≥4 μg/L, the subject or his family should be notified in time, and the subject should be referred to the hospital for treatment Further diagnosis, treatment and follow-up [9]
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The "Guide" takes into account the large population base in China and the relatively tight medical and health resources, as well as the operability of prostate cancer screening in medical and health institutions at all levels, and points out that men who have undergone screening and have a life expectancy of more than 10 years, Serum PSA testing is recommended every 2 years[2]
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Regarding the timing of screening discontinuation, the Canadian Urological Association recommends that the age at which prostate cancer screening is discontinued should be based on baseline PSA levels and life expectancy: men aged 60 years with PSA <1.
0 ng/mL, consider discontinuing PSA screening; life expectancy <10 years men, stop PSA screening [10]
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This "Guide" integrates relevant international guidelines and recommends that men aged 60 and over with a PSA test level of <1.
0 ng/mL stop screening, and those with a life expectancy of less than 10 years are recommended to stop screening [2]
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The "Guide" combines the practice of prostate cancer screening in China and the high incidence of the age group over 70 years old, and recommends that men aged ≥ 75 years choose whether to stop screening according to their personal health status [2]
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Summary The "Guide" is based on the research progress of prostate cancer screening at home and abroad, expert consensus, guideline specifications, screening project experience and China's actual national conditions, focusing on the characteristics and screening of prostate cancer in China.
Recommendations for prostate cancer screening
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References: [1] Liang Chaochao, Zhou Jun, Zhang Li.
Current status and future of prostate cancer diagnosis and treatment [J].
Journal of Clinical Urology, 2014, 29(8): 657-660.
[2] He Jie, Chen Wanqing, Li Ni , Cao Wei, Ye Dingwei, Ma Jianhui, Xing Nianzeng, Peng Ji, Tian Jinhui, China Prostate Cancer Screening and Early Diagnosis and Early Treatment Guidelines Development Expert Group, China Prostate Cancer Screening, Early Diagnosis and Early Treatment Guidelines Development Working Group.
Prostate Cancer Screening in China Guidelines for early diagnosis and early treatment (2022, Beijing)[J].
Chinese Journal of Oncology,2022,44(1):29-53.
[3]Zheng Rongshou, Sun Kexin, Zhang Siwei, Zeng Hongmei, Zou Xiaonong, Chen Ru, Gu Xiuying, Wei Wenqiang, He Jie.
Analysis of the prevalence of malignant tumors in China in 2015 [J].
Chinese Journal of Oncology, 2019, 41(1): 19-28.
[4] Qi Jinlei, Wang Lijun, Zhou Maigeng, Liu Yuning, Liu Jiangmei, Liu Shiwei, Zeng Xinxin, Yin Peng.
Analysis of the disease burden of prostate cancer in Chinese men from 1990 to 2013 [J].
Chinese Journal of Epidemiology, 2016, 37(6): 778-782.
[5] Kilpeläinen TP, Tammela TL, Roobol M, et al .
False-positive screening results in the European randomized study of screening for prostate cancer.
Eur J Cancer.
2011;47(18):2698-2705.
[6]Paschen U, Sturtz S, Fleer D, Lampert U, Skoetz N, Dahm P.
Assessment of prostate-specific antigen screening: an evidence-based report by the German Institute for Quality and Efficiency in Health Care.
BJU Int.
2021;10.
1111/bju.
15444.
[7]Vickers AJ.
Redesigning Prostate Cancer Screening Strategies to Reduce Overdiagnosis.
Clin Chem.
2019;65(1):39-41.
[8] Yang Jinyi.
Importance and potential harm of PSA screening for prostate cancer [J].
Modern Health, 2009, 25(7):1-2.
[9]Prostate Cancer Group of the Chinese Anti-Cancer Association Urogenital Tumor Professional Committee.
Chinese Expert Consensus on Prostate Cancer Screening (2021 Edition)[J].
Chinese Journal of Cancer,2021,31 (5):435-440.
[10]Ricardo AR, Ross JM, Karim M, et al.
Canadian Urological Association recommendations on prostate cancer screening and early diagnosis[J].
Can Urol Assoc J, 2017, 11(10): 298-309.
This material is supported by AstraZeneca and is for reference only by healthcare professionals Approval Number: CN-93249 Valid until April 23, 2022This material is supported by AstraZeneca and is for reference only by healthcare professionals Approval Number: CN-93249 Valid until April 23, 2022This material is supported by AstraZeneca and is for reference only by healthcare professionals Approval Number: CN-93249 Valid until April 23, 2022