This cancer "very lazy" does not have to be ignored? Missing the timing of treatment is also tricky

The urology expert team of the First Hospital of Guangdong Medical College is in surgery.

The incidence of prostate cancer ranks second in the world's male malignant tumors, and even ranks first in some developed countries in Europe and the United States that endanger men's health. Although the incidence of prostate cancer in Asia is much lower than in Europe and the United States, it has also shown an upward trend in recent years.

Multiple studies have shown that after radical treatment, the 10-year survival rate of early prostate cancer can be as high as more than 85%. But early prostate cancer usually has no obvious clinical symptoms. How can I detect and treat it early? Experts recommend that men over the age of 50 or men over the age of 45 with a family history of prostate cancer increase prostate-specific antigen (PSA) screening for annual physical examinations. Once prostate cancer-specific antigen abnormalities are detected, even if there are no symptoms of urination discomfort, it should not be careless, and a professional doctor should be consulted as soon as possible to further check whether there is a potential prostate cancer risk.

Text, photo/ Guangzhou Daily all-media reporter Weng Shuxian Correspondents Ru Zhina and Han Wenqing

Medical Guidance/Professor Zeng Guohua, Vice President of the First Affiliated Hospital of Guangzhou Medical University and Leader of Urology, Professor Liu Yongda, Director of Urology, and Chief Physician Gu Di, Deputy Director of Urology

Case: The septuagenarian patient received focal treatment and was successfully discharged from the hospital the next day after surgery

Jiang Bo (pseudonym), 75, attended a free community prostate cancer screening led by the Department of Urology of the First Hospital of Guangdong Medical University a few months ago, and doctors found that his prostate-specific antigen (PSA) was 5.63 ng/ml (ng/ml). Normal reference values for PSA are: 0 to 4.0 ng/ml, and greater than 4.0 ng/mL suggests the presence of prostate cancer. Although Jiang Bo found PSA abnormalities, there were no abnormal symptoms of urination. After 3 months of re-examination, the Results of Jiangbo PSA were still abnormal, and the indicators were further increased to 6.58 ng/ml.

Goody, deputy director of the Department of Urology at the First Hospital of Guangdong Medical College, suggested that after undergoing PROST MRI and puncture tests, he was diagnosed with prostate acinar carcinoma. "Due to the timely discovery, the tumor is still in the early stages, combined with Jiang Bo's age and pathological stage, our team decided to use irreversible electroporation technology to treat him with prostate cancer focal points after detailed discussion." Goody introduced.

Faced with an unknown operation, Jiang Bo and his family are very worried. Unexpectedly, on the day of the operation, the urology team of the First Hospital of Guangdong Medical College took only more than 30 minutes to successfully complete the treatment of prostate cancer focal points for Jiang Bo. After the operation, Jiang Bo only retained one urinary catheter, and after 4 hours, he resumed his diet and was able to get out of bed and move, and he was successfully discharged from the hospital on the 2nd day.

After being discharged from the hospital, Jiang Bo returned to the hospital for follow-up, and the relevant indicators returned to normal and his physical condition was good.

Judgment: How "inert" is prostate cancer? Grading assessments give answers

Clinically, some patients are very anxious when they find prostate cancer, afraid of surgery and other treatments; some patients will find information on the Internet to "strengthen their guts", thinking that prostate cancer progresses slowly, is "inert cancer", the mortality rate is not high, do not have to pay attention.

"Neither of these extremes is advisable." Professor Liu Yongda, director of the Department of Urology of the First Hospital of Guangdong Medical College, said that at present, the treatment of prostate cancer is increasingly emphasizing individualization, and doctors will optimize the treatment plan according to the patient's pathological grade and personal physical tolerance.

The most widely used grading method for prostate adenocarcinoma in the world is the Gleason scoring system. "It is divided into five levels according to the degree of danger from low to high." Goody added that the higher the score, the greater the danger. The first degree is the so-called "indolent carcinoma", which may not metastasize for life, but may still progress to the second or third degree. Grades four and five, bone metastases can occur without active intervention, resulting in poor quality of life in the later stages and most likely death from prostate cancer.

"The key is to screen early and diagnose early, so that we can assess whether it is 'inert' or easy to progress and high risk based on the results, and develop an appropriate treatment plan accordingly." Goody said.

Treatment: more and more means More and more precise and minimally invasive

"With the advancement of medical technology, more and more means of treating prostate cancer, and the trauma can be made smaller." Goody analyzed that for the elderly, if the assessment results are very low-risk or low-risk, they can be actively monitored without surgery. A specialist physician may also be consulted to determine whether "focal therapy" is appropriate.

"This treatment does not require the entire prostate to be removed, and the local lesion can be accurately eliminated." Liu Yongda said that the development direction of surgical surgery is also becoming more and more minimally invasive. For example, the irreversible electroporation ablation focal treatment received by Jiang Bo is mainly a kind of "micro-invasive" treatment for early prostate cancer, using voltage difference to induce irreversible electroporation and apoptosis of tumor cells, while stimulating the body's immune system. Compared with other focal treatments such as radiation exposure, cryotherapy, and physical ablation, it is less invasive, safer, less complication, and more accurate protective.

"For patients at high risk and with marked local progression, more aggressive treatment should be taken and radical surgery considered." Zeng Guohua said. With the advancement of technology, robot-assisted laparoscopic radical prostate cancer resection has gradually become the mainstream surgical method, and patients no longer need to bear the pain and risks caused by traditional surgical large incisions. At present, the Department of Urology of the First Hospital of Guangdong Medical University has been able to carry out more difficult single-hole robot surgery, and patients with good physical condition can be discharged from the hospital the next day after surgery. Of course, follow-up follow-up and comprehensive treatment must also be adhered to in order to achieve better results.

Reminder: Asymptomatic PSA abnormalities in the early stages of prostate cancer are not careless

"Many male patients have a misunderstanding that there must be no prostate problem without urinating symptoms. In fact, for patients with elevated prostate-specific antigens (PSAs), even if there are no symptoms of discomfort with urination, they need to pay attention. Professor Zeng Guohua, vice president of the First Affiliated Hospital of Guangzhou Medical University and leader of the department of urology, explained that because early prostate cancer usually has no obvious clinical symptoms. Of course, a significant increase in PSA does not necessarily mean that it is prostate cancer, it may also be affected by other factors, such as prostatitis, benign prostatic hyperplasia can cause it to rise, but these latter two conditions are often accompanied by symptoms of urination, prostatic hyperplasia common urinary frequency, urgency, increased nocturia (2 times and more) and other symptoms, prostatitis common painful urination and even pelvic area pain or discomfort and other symptoms, but prostate tumors are often no symptoms in the early stage. Therefore, it is even more careless when the PSA test results are elevated and there are no symptoms of urination.

In addition, in contrast, the clinical elevation of PSA in patients with prostate cancer is more pronounced and persistently elevated. Jiang Bo is a typical example, after the first detection of PSA abnormalities, every three months the review indicators not only did not drop, but also further increased. Therefore, even if there are no symptoms, it is still necessary to consult a professional doctor to consider whether it is necessary to do a prostate MRI or even a prostate puncture biopsy to further investigate the cause.

Recommendation: Men over the age of 50 should do this screening annually

"Early screening, early diagnosis, and early treatment are effective ways to improve the 5-year survival rate of tumor patients." Goody said that the same is true for prostate cancer, and it cannot be delayed until obvious symptoms appear and early treatment is missed. It is recommended that men over the age of 50 or men over the age of 45 with a family history of prostate cancer have increased prostate-specific antigen (PSA) screening by taking blood from annual physical examinations. In addition, it is also necessary to develop good living habits every day, quit smoking and limit alcohol, eat less high animal fat diet, avoid long-term sedentary, etc., which will help protect the prostate.

According to reports, since April 2019, the Department of Urology of the First Affiliated Hospital of Guangzhou Medical University has cooperated with the China Prostate Cancer Alliance to explore the public welfare screening of prostate cancer in the mode of hospital and community linkage under the cooperation of 35 community health service centers in Yuexiu District, Haizhu District and Liwan District of Guangzhou. At present, the project has screened more than 40,000 cases, found nearly 200 cases of early prostate cancer patients, and the prognosis is good after the timely radical prostatection surgery for prostate cancer.