Wang Dad, 72 years old, found prostate-specific antigen (PSA) elevated in the physical examination of the unit tissue, multiple nodules in the prostate were seen in ultrasound B, and abnormal signals were seen in the peripheral band of the prostate with nuclear magnetic resonance (MRI). Director Zhou Qing and Deputy Director Zhou Xing of the First Department of Andrology led the team to carefully analyze the patient's condition, and finally performed transperineal prostate puncture biopsy under ultrasound guidance for Wang Dad. The operation was smooth, the intraoperative puncture was precisely taken, there was no obvious bleeding at the postoperative puncture, and the patient did not feel discomfort.
1. What is PSA?
PSA is a serine protease secreted by prostate duct epithelial cells that is produced only by the prostate epithelium and, because it is prostate-specific, is an important tumor marker for the diagnosis of prostate cancer. PSA levels can be affected by more factors, such as prostatitis, prostatic hyperplasia, sexual activity, finasteride drugs, etc. To rule out these factors, we recommend A PSA test 48 hours after catheterization or cystoscopy, 1 week after digital prostate rectal examination, 1 month after prostate puncture, and 24 hours after ejaculation.
Usually, the total PSA (tPSA) < 4 ng /ml is normal, the risk of prostate cancer increases when the tPSA > 10 ng/ml, and when the tPSA is located at 4 to 10 ng/ml, prostate cancer cannot be excluded, and it needs to be combined with other diagnostic indicators, such as fPSA/tPSA ratio, PSA density, PSA rate, etc.
2. The incidence of prostate cancer is increasing year by year
A Cancer Journal for Clinicians (CA) 2019 Global Oncology Yearbook shows that prostate cancer currently ranks first in male malignancy and second in mortality, and has become one of the major public health problems that seriously threaten men's health. In recent years, with the change of lifestyle and the aging of the population in China, the average annual increase rate of prostate cancer incidence is about 12.07%, which is the fastest growing tumor. Since there are no obvious clinical symptoms in the early stage of prostate cancer, most patients are diagnosed at an advanced stage, thus losing the best time for treatment. Therefore, early detection, early diagnosis and early treatment of prostate cancer are particularly important.
Men over the age of 50 are advised to have their PSA checked annually, and if there is a family history of prostate cancer, this age should be relaxed to 45 years old. What we need to know is that PSA and B ultrasound are only important means of early screening of prostate cancer, MRI is the most sensitive imaging test for prostate cancer, and the "gold standard" for the final diagnosis of prostate cancer is prostate puncture biopsy.
3. Learn about transperineal prostatic biopsy
There are two main pathways of common prostate puncture biopsies: transrectal and transperineal. Compared with traditional transrectal prostate puncture, ultrasound-guided transperineal prostatic biopsy has the following advantages:
1. Positioning is more accurate, sampling is more accurate;
2. There is no need for strict intestinal preparation before surgery;
3. High safety, less postoperative complications;
4. It is easy to detect tumors at the tip of the prostate
4. Who needs a prostate biopsy
The results of a prostate puncture biopsy survey conducted by the China Prostate Cancer Alliance (CPCC) show that compared with European and American countries, patients with prostate aspiration biopsy in China have the characteristics of high PSA, small prostate size, high Gleason score, and low positivity rate. The Expert Consensus on Prostate Puncture recommends that a prostatic biopsy be performed in the following settings:
(1) Digital rectal examination found suspicious nodules of the prostate, any PSA value;
(2) B ultrasound or MRI found suspicious lesions, any PSA value;
③tPSA＞10 ng/ml；
(4) tPSA4~10 ng/ml, fPSA/tPSA ratio or PSA density abnormalities;
Prostate biopsy is not appropriate if:
(1) In the acute infection period and fever period.
(2) Have a hypertensive crisis.
(3) In the period of cardiac insufficiency and decompensation.
(4) Diseases with a serious tendency to bleed.
(5) In the period of diabetic blood glucose instability.
(6) There are serious internal and external hemorrhoids, perianal or rectal lesions.
The "ultrasound-guided transperineal prostatectomy biopsy" carried out by the Department of Andrology of our hospital fills the gap of such technologies in our hospital, marking that the diagnosis and treatment of prostate cancer in our hospital has entered a new stage of practice. Taking the national natural science foundation of China's regional key project "Molecular Epidemiological Analysis of Prostate Cancer in Hunan Population and Intervention Research on Warm Kidney Blood Detoxification Method (U20A20408)" as an opportunity, Director Zhou Qing's research group has carried out a large number of integrated traditional Chinese and Western medicine research on prostate cancer, and mastered the diagnosis and treatment technologies of endocrine therapy, new endocrine therapy, chemotherapy, radiotherapy and other diagnostic and treatment technologies for prostate cancer patients. From the screening, diagnosis to treatment of prostate cancer, the whole process of prostate cancer patients has been managed, so that more and more patients can benefit from it, effectively improving the quality of life and long-term survival rate of prostate cancer patients.