In my urology clinic, two recent cases of advanced prostate cancer were caused by inattention to prostate cancer screening, which is deeply distressing and regrettable.
Example 1: Poor urination for more than 2 years, but advanced bone metastases
This is an 83-year-old man with a son and a daughter who have both emigrated to work abroad. The patient had dyspareunia for more than 2 years, with nocturia 4-5 times/night. The patient thought that it was a common disease in the elderly because he had no children around to take care of him, so he did not pay attention to it and simply dispensed medication at the community health center.
In the past 2 months, the dyspareunia has increased significantly and acute urinary retention has occurred, so the patient had to be placed in a hospital with an indwelling catheter. The first time I saw the patient, I was able to find out that the patient had been in the hospital for a long time. Prostate cancer with pelvic lymph node metastasis was considered by enhanced MRI of the prostate; nuclear bone imaging suggested multiple bone metastases. The prostate cancer was diagnosed pathologically by ultrasound-guided prostate puncture biopsy, with a Gleason score of 4+5=9 (no less than 8 is a high-risk prostate cancer).
The final diagnosis was advanced prostate cancer with bone metastases and pelvic lymph node metastases, which is now treated with endocrine therapy.
Example 2: hematuria was not taken seriously until he developed hematuria, but also advanced bone metastases
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This is a 63-year-old man who recently presented with 2 episodes of painless hematuria of the naked eye, and came to our hospital with ultrasound findings of a significantly enlarged prostate and no tumor in the bladder. The patient’s blood pressure was reduced to 537 ng/mL, and the prostate was examined on rectal examination. The prostate was considered as prostate cancer by enhanced MRI, and no pelvic lymph node metastasis was seen; nuclear bone imaging suggested multiple bone metastases. The patient was diagnosed with prostate cancer by ultrasound-guided prostate puncture biopsy pathology, with a Gleason score of 4+4=8 (a high-risk prostate cancer).
The final diagnosis was advanced prostate cancer with bone metastases, which is now treated with endocrine therapy.
The experience of the above 2 patients is saddening because they had advanced prostate cancer at the onset. When asked about their medical history, both patients refused to have a rectal exam and PSA examination every year, missing the opportunity for early detection of prostate cancer.
In the screening of prostate cancer, rectal exams and PSA are simple and easy to perform. The PSA test only requires a small amount of blood to be taken for a preliminary determination of the possibility of prostate cancer.
About the PSA test:
- In the late 1960s, Hare et al. found a semen-specific protein with a molecular weight of about 34,000 in prostate fluid and semen during their research on immunocontraception;
- This protein was extracted and purified from prostate tissue in 1979 and named prostate-specific antigen, or PSA, because it was found only in prostate tissue.
Elevated PSA is usually seen in 3 conditions: significant prostate enlargement, prostatitis, and prostate cancer. It is not always the case that a patient with prostate cancer will have an elevated PSA, but a significant elevation of PSA can prompt your doctor to further determine if you have prostate cancer.
The above cases also reveal that there are still many shortcomings and problems with prostate cancer screening in China. For example:
- Many patients lack a proper understanding of their disease and often underestimate the severity of their condition.
- Many physicians are not sufficiently aware of PSA and neglect to screen older male patients for PSA.
- Many patients are more reluctant to have a rectal exam, mistakenly believing that a single exam and several days of pain will result in refusal of the exam.
Therefore, it is important for people to identify and correct these misconceptions and behaviors in their daily routine, especially middle-aged and older men, to take prostate cancer screening seriously and undergo regular rectal finger exams and PSA blood tests so that prostate cancer can be detected and treated early, prolonging survival and improving quality of life.