Specific elements and misunderstandings of prostate cancer?

In the past 20 years, the incidence of prostate cancer in my country has increased dramatically, and it has become a major "killer" threatening the life and health of elderly men in major cities such as Beijing, Shanghai and Guangzhou. With the popularization of prostate cancer-related knowledge in all walks of life, people have also gained a certain understanding of the new term "prostate-specific antigen PSA". However, in daily clinical work, we found that many patients have a biased understanding of PSA, which has led to many misunderstandings in the diagnosis and treatment of prostate cancer, and even serious consequences.

PSA is the abbreviation of prostate-specific antigen, which is the most widely used tumor indicator in the diagnosis and treatment of prostate cancer. In most cases, when a patient has prostate cancer, the PSA in the blood will increase (the normal value is 4ng/ml), and when prostate cancer is effectively treated, the PSA level will decrease to varying degrees. Therefore, PSA is not only an important tool for diagnosing prostate cancer, but also a good indicator for detecting the effect of prostate cancer treatment.

The PSA test is performed by drawing blood, and the results are usually available on the same day. The method is simple and inexpensive, and whether or not you have eaten before the blood draw will not affect the test results. This test was first used clinically in China in 1994. Today, many units have included this indicator in their annual physical examinations for employees over the age of 50. With the increasing clinical use of PSA, how should you interpret your PSA test results? In clinical work, we have summarized two major "misunderstandings" that are worth noting.

Misunderstanding 1: Lack of vigilance and delay of opportunity

Like many other malignant tumors, prostate cancer needs to be diagnosed early to get better treatment results. Radical surgery or radiotherapy for early prostate cancer can have a 5-year overall survival rate of nearly 100%, but once it reaches the late stage, the 5-year survival rate is only 28%. PSA plays a vital role in the early diagnosis of prostate cancer. In fact, it is precisely because of the PSA test that the diagnosis rate of early prostate cancer in China has been greatly improved.

In many underdeveloped cities and regions, PSA has not become a routine physical examination item, which requires people to understand the importance of this examination. Once they reach the appropriate age (over 50-55 years old), every man should go to the hospital for this examination. Once the PSA value exceeds the normal value (4ng/ml), you must go to a regular hospital for further diagnosis to rule out prostate cancer.

It is regrettable for us clinicians that even in developed cities like Shanghai, many prostate cancer patients are already in the middle and late stages when they are diagnosed (national data show that this proportion is as high as 50%). Moreover, some of these patients even found that their PSA levels were elevated 2-3 years ago, but they just thought to themselves, "I don't have any problems with urination, so it must be okay." Therefore, they did not pay enough attention to it. It was not until the PSA level was "scary" (tens or even hundreds) that they were brought to the doctor by their relatives. However, at this time, the best treatment period for prostate cancer had been lost. Such things can be encountered almost every day in clinical work, which fully shows that we still have a lot of work to do in popularizing science education on prostate cancer.

Myth 2: Over-disturbing, seeing enemies everywhere

Contrary to the first misconception, some patients attach too much importance to the results of PSA tests and become worried by an abnormal PSA test value. They mistakenly equate "elevated PSA" with "prostate cancer" in their minds, which results in restlessness all day long and even symptoms of general discomfort.

Can an elevated PSA confirm prostate cancer? The answer is of course no. Prostate cancer can only be confirmed by finding cancer cells through "prostate puncture". In fact, when PSA is in the range of 4-20ng/ml, the positive rate of prostate puncture for finding cancer cells is only 20-30%. Even with the new targeted puncture technology we have developed, the positive rate is only about 40%.

In many patients, the elevated PSA is not caused by prostate cancer. For example, prostate hypertrophy, urinary tract infection, prostate inflammation, etc. can also cause elevated PSA. When a single PSA test finds an elevation, the best solution is to take the test results to a regular hospital's urology department as soon as possible. The doctor will have more ways to help you determine the cause of the elevated PSA. Don't worry or be afraid, or even avoid seeing a doctor. This will only increase the psychological burden on yourself and your family, and will do more harm than good to your health.

For prostate cancer, early diagnosis and early treatment are undisputed, but for the PSA test, you must pay attention: don't let your guard down and let it go, and don't be overly disturbed and endure unnecessary worries and doubts. Only with the help of urology experts can you give the most accurate interpretation of your PSA test results. This is the correct way to treat PSA testing. Clinical scientists are also working tirelessly to find better diagnostic indicators and strategies for prostate cancer. For example, some new indicators such as fusion genes and SNPs discovered by our team in the early stage have shown good auxiliary effects in early clinical applications, making the interpretation of the meaning of PSA indicators more accurate. In the near future, I believe that such new diagnostic strategies will definitely bring great benefits to prostate cancer patients.