Prostate cancer should be checked at age?

*Only for medical professionals to read and reference Professor Chen Wanqing interprets the latest prostate cancer screening guidelines for you! Prostate cancer is one of the common malignant tumors in the genitourinary system of elderly men.
Its morbidity and mortality ranks second and fifth respectively among male cancers in the world.
Among domestic male patients, its morbidity and mortality are Ranked 6th and 7th respectively [1]
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Compared with European and American countries, although the overall incidence of prostate cancer patients in China is lower and the average age of onset is higher, the incidence of patients has gradually shown an upward trend in recent years, and the proportion of patients diagnosed with advanced prostate cancer in China is higher
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Therefore, strengthening and improving the screening, early diagnosis and early treatment of prostate cancer in China is crucial to improving the survival benefit of prostate cancer patients
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Recently, the "China Guidelines for Prostate Cancer Screening, Early Diagnosis and Early Treatment (2022, Beijing)" (hereinafter referred to as the "Guidelines"), which was recently revised by the China Guidelines for Prostate Cancer Screening, Early Diagnosis and Early Treatment Guidelines Development Expert Group and Working Group, was released.

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The Medical Tumor Channel specially invited Professor Chen Wanqing from the National Cancer Center and the Cancer Hospital of the Chinese Academy of Medical Sciences to comment and interpret the update points of the 2022 edition of the Guidelines and the current status of prostate cancer diagnosis and treatment in China
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Who are at high risk for prostate cancer? The 2022 edition of the "Guidelines" clearly states that age, smoking, obesity, family history of prostate and breast cancer, prostatitis, benign prostatic hyperplasia, and excessive intake of dairy products are considered high risk factors for prostate cancer
.

Prof.
Chen said: "According to the 2016 National Cancer Registry data [2], the age of onset and the incidence of prostate cancer in China are generally positively correlated
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The incidence and mortality of prostate cancer are at a low level among people before the age of
55.

55 -In the 60-year-old population, the morbidity and mortality rates are on the rise
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Among people over 60 years of age, the incidence and mortality of prostate cancer increase rapidly, until reaching a peak in people over 85 years of age
.

"At the same time, data from multiple studies have shown that having a family history of prostate cancer and breast cancer or carrying a genetic history of BRCA gene mutations increases the risk of prostate cancer
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Therefore, the "Guide" defines the following groups as high-risk groups for prostate cancer: 1.
Age ≥ 60 years old; 2.
Age ≥ 45 years old, and have a family history of prostate cancer; 3.
Age ≥ 40 years old, and carry BRCA2 gene mutation Compared
with
 European and American countries, the proportion of patients with advanced prostate cancer in China is higher, and the 5-year relative survival rate is lower
.

Professor Chen said: "Like most tumor types, there are no obvious specific symptoms in the early stage of prostate cancer, so most patients It is in the middle and late stages after the onset of symptoms
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At the same time, relevant data show that the 5-year survival rate of localized prostate cancer patients in the United States in 2016 was nearly 100%, while the age-standardized 5-year survival rate of prostate cancer in China in 2015 only increased from 53.
8% in 2003 to 66.
4%
.

"How should people at high risk of prostate cancer be screened? Then, how should screening be carried out scientifically for people at high risk of prostate cancer? Considering the impact of prostate cancer screening on people's quality of life and length of life, and the condition of most prostate cancer patients The development is relatively slow, and the "Guidelines" recommend that for high-risk groups under the age of 75 and with a life expectancy of more than 10 years, the first screening test using serum prostate-specific antigen (PSA) test is performed every two years
.

As for the screening methods and results management, combined with PLCO, ERSPC and other studies [3,4] "Guide" recommends: 1.
PSA testing is recommended as the first choice for prostate cancer screening, and the critical value of PSA is 4.
0 ng/ml 2.
Serum PSA > 4.
0 ng/ml twice, after eliminating the interference of other factors affecting the PSA detection level, it is recommended to guide further clinical examination and intervention by a urologist; 3.
When serum PSA > 4.
0 ng/ml, it is recommended to periodically (every 2 years) monitoring once
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 A systematic review of 63 PSA-based prostate cancer screening studies published in JAMA showed that PSA screening can reduce the risk of death from prostate cancer
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However, there are also studies [6] that show that receiving a single PSA test is beneficial for the detection of low-risk prostate cancer, but does not reduce the mortality of prostate cancer.
Continuous screening can improve the detection sensitivity and facilitate subsequent treatment of diagnosed patients.
However, it should be noted that However, this leads to an increased risk of overdiagnosis in the clinic
.

At the same time, Professor Chen emphasized: "For men at general risk for prostate cancer (all men other than the high-risk groups mentioned above), mass screening is not recommended, nor is positron emission computed tomography (PET-CT) alone recommended.
), ultrasound, and magnetic resonance imaging (MRI) for prostate cancer screening
.

” Figure 1 How to avoid over-diagnosis in the prostate cancer screening process will be a key challenge for the popularization of prostate cancer screening in the future.
Currently, prostate cancer screening in China There are still many challenges and difficulties
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With the continuous improvement of people's awareness of prostate cancer, more and more new biomarkers such as serum predipeptide prostate-specific antigen (p2PSA), p2PSA percentage, and prostate health index (PHI) are familiar to the clinic.
A number of studies and consensuses at home and abroad do not support its use as an indicator for routine screening and detection of prostate cancer
.

Professor Chen said: "The detection of tumor-related biomarker levels in patients may be the best tumor screening method at present.
Therefore, a large number of studies are now exploring different tumor biomarkers, although there is no evidence to prove p2PSA, The specificity and sensitivity of p2PSA percentage and PHI in prostate cancer screening are higher than PSA detection, but with the advancement of technology, it is believed that more accurate and convenient new biomarkers can be found in the future
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” In addition, prostate cancer screening How to further develop and improve the popularization of the investigation is also a difficult problem to be solved urgently in the future
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Relevant American studies and scholars said that excessive screening work will bring about the drawbacks of "overdiagnosis" in clinical practice
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In this regard, Professor Chen said: "Since around 2000, the United States has no longer recommended and popularized prostate cancer screening for the population.
This has alleviated the over-diagnosis in clinical practice to a certain extent, but it has also led to new cases in the United States.
The proportion of patients with advanced prostate cancer has increased
.

" "At present, there are still many deficiencies in the screening of prostate cancer in China compared with developed countries in Europe and the United States, which is one of the reasons why the survival rate of patients with prostate cancer in China is lower than that in European and American countries.
Avoiding excessive diagnosis and treatment while making a prognosis, and implementing the advantages and disadvantages of popularizing prostate cancer screening to the public are the difficulties and challenges that China's prostate cancer screening-related staff must face in the future
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"Professor Chen finally added
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Expert Profile Professor Chen Wanqing Researcher, Ph.
D.
, Doctoral Supervisor National Cancer Center Director of Cancer Early Diagnosis and Treatment Office, Cancer Hospital, Chinese Academy of Medical Sciences, National Health Commission Outstanding Contribution Chairman of the Professional Committee of Screening, Early Diagnosis and Early Treatment, Vice Chairman of the Tumor Sample Integration Research Branch of the Chinese Anti-Cancer Association, Chairman of the Precision Prevention Professional Committee of the Beijing Association for Cancer Prevention and Treatment, Chairman of the Translational Medicine Professional Committee of the Beijing Society for the Prevention and Treatment of Breast Cancer Member of the Standing Committee of the Prevention and Control Branch, Deputy Head of the Tumor Group Deputy Chairman of the Professional Committee of Lung Cancer Prevention and Tobacco Control, Member of the Standing Committee of the Professional Committee of Oncology Epidemiology of the China Anti-Cancer Association, Expert of the Expert Committee of the Breast Cancer Prevention and Control Special Fund of China Health Promotion Foundation, Member of the Standing Committee of the Asian Cancer Registration Alliance The editor-in-chief of Cancer Epidemiology is responsible for a number of major national public health projects
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Lead a number of national scientific research projects
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He has published more than 300 academic papers as the first author or corresponding author, with a total of more than 700 SCI impact factors, and edited 15 monographs as deputy editor
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   References: 1.
Sung H, Ferlay J, Siegel RL, et al.
Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.
CA Cancer J Clin.
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Epub 2021 Feb 4.
PMID: 33538338.
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National Cancer Center.
2019 China Cancer Registration Annual Report [M].
Beijing: People's Health Publishing House, 2021.
3.
Andriole GL, Crawford ED, Grubb RL 3rd, et al.
Mortality results from a randomized prostate-cancer screening trial.
N Engl J Med.
2009 Mar 26;360(13):1310 -9.
doi: 10.
1056/NEJMoa0810696.
Epub 2009 Mar 18.
Erratum in: N Engl J Med.
2009 Apr 23; 360(17): 1797.
PMID: 19297565; PMCID: PMC2944770.
4.
Schröder FH, Hugosson J, Roobol MJ, et al.
Screening and prostate-cancer mortality in a randomized European study.
N Engl J Med.
2009 Mar 26;360(13):1320-8.
doi:10.
1056/NEJMoa0810084.