Tumor markers are magical things, abnormal elevation may be cancer, cancer treatment after a period of time again climbed, may be recurrence. Although pathological examination is the "gold standard", tumor markers are also a weather vane for monitoring recurrence after treatment. Of course, it cannot be said that tumor markers rise = recurrence, but recurrence exclusion is required.
Mr. Sun, who participated in this multidisciplinary consultation, found that the tumor marker PSA was elevated in the physical examination 3 years ago, and then found that it was prostate cancer on in-depth examination, and immediately underwent heat ablation of prostate cancer.
Three years after the operation, no abnormalities were seen, but an elevated PSA was found at the end of 2021, and it was suspected that the tumor had relapsed. Go to the hospital for a prostate puncture biopsy and magnetic resonance examination to confirm that it is a malignant degeneration of prostate cancer.
Prostate cancer recurrence
Recurrence invades the seminal vesicle glands
Prostate cancer recurrence after surgery, how to treat it? And see what kind of treatment plan will be formulated for the International Multidisciplinary Consultation Expert Group.
Consultation notes
International multidisciplinary consultation, for patients to develop a "one person, one plan", its rationalization and personalized diagnosis and treatment can improve patient survival rate, shorten the patient diagnosis and treatment waiting time, while avoiding the cost and burden of multiple consultations and repeated examinations.
At the beginning of the consultation, the participating experts comprehensively and completely understood the patient's medical records, images and other information, listened carefully to the questions and demands raised by the patients and their families, and then, in view of the patient's condition and demands, dozens of medical teams from the Department of Oncology, Radiotherapy, Imaging, Physicists, Technicians, Nursing Staff and other dozens of people from China and abroad opened the multidisciplinary consultation.
Patient medical records
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Initial diagnosis
Prostate cancer, T3bN0M0, stage IIIB, histological grade 2
Introduction to the condition
Patient, male, 67 years old
3 years ago, the physical examination found that the PSA was high (patients complained about 7-8ng/ml), and then went to the hospital to diagnose prostate cancer, perform prostate heat ablation, and then regularly review the prostate without abnormalities, the specifics are unknown.
At the end of 2021, an elevated PSA was found, with 2021-12-3 PSA 11.646ng/ml and fPSA 1.116ng/ml. 2021-12-17 Prostate MRI: central band of the prostate with left posterior lobe nodule (2.2 cm), high possibility of malignancy, quasi-PI-RADS 4, biopsy recommended. Prostate cancer puncture, pathology: 1 prostate acinar carcinoma, GLEASON score 3 + 4 = 7 points, accounting for about 30%, 11 remaining prostate tissue suggest chronic inflammation of the prostate interstitial. 2021-12-28Thocular CT, bradycardia, emphysema with infection. Abdominal ultrasound, no abnormalities were seen. Bone scan, no abnormalities.
Past history: previous diagnosis of "hypertension" and currently unmediated.
History of allergy: previous streptomycin allergy.
History of Alcohol and Tobacco: None.
Family history: Father diagnosed prostate cancer.
Moments of discussion
Is there a family history? Need genetic testing?
According to the Chinese Society of Clinical Oncology (CSCO) Prostate Cancer Diagnosis and Treatment Guidelines 2021:
The patient's immediate family also has prostate cancer, he has a family history, according to the guideline's I. recommendation, genetic testing is recommended.
How is it treated after a relapse?
This patient is divided into stages T3bN0M0, stage IIIB, histological grade 2, postoperative recurrence is recommended salvage radiotherapy combined with endocrine therapy.
Prostate cancer is a tumor that is sensitive to radiation therapy. Radiation therapy is relatively small due to trauma, most elderly patients can tolerate, the safety is relatively high, and the efficacy is reliable, has always been one of the important treatment options for elderly prostate cancer patients.
As a hormone-dependent tumor, prostate cancer is an endocrine treatment for the recurrence of prostate cancer, which can delay the progression of the disease.
Conclusion of the consultation
After a detailed discussion, the consultation experts gave the following opinions:
Patients with a family history of tumors are recommended for genetic testing; salvage radiation therapy plus endocrine therapy is indicated.
Tumor markers can be used as one of the reference indicators for whether a tumor has recurred, but continuous monitoring is generally required, and if it shows a straight rise, recurrence or metastasis is very likely.
Hu Qiaoying
Director of the Department of Radiotherapy, Shanghai MeizhongJiahe Cancer Clinic
Wen Amin
Radiologist at Shanghai Meizhongjia and Cancer Clinic
U.S.-China-Ka and international multidisciplinary consultation expert team
Professor Fu Shen
Leader of the International Multidisciplinary Consultation Team
U.S.-China-Ka and international multidisciplinary consultation
Multidisciplinary consultation (MDT) is a method of discussing and discussing experts from multiple disciplines to develop a personalized diagnosis and treatment plan for patients, especially for the diagnosis and treatment of complex diseases such as tumors. It is the first diagnosis and treatment method advocated and promoted by MD Anderson Cancer Center in the United States, which is effective in improving the treatment effect of patients.
Meizhongjia International Multidisciplinary Consultation brings together the expert resources of Shanghai Meizhongjiahe Cancer Clinic, Guangzhou Taihe Cancer Hospital, Singapore Taihe International Hospital, etc., and is committed to providing professional, rigorous and high-quality personalized diagnosis and treatment programs for cancer patients.