The incidence of prostate cancer in China is growing rapidly
With the improvement of China’s economic level and people’s living standard, the per capita life expectancy has increased, and the incidence of prostate cancer in China is increasing year by year, becoming the primary problem affecting the health of middle-aged and elderly men in China.
In 2009, the incidence of prostate cancer in China was 9.92 per 100,000. The incidence of prostate cancer is higher in first-tier cities, with 19.30/100,000, 32.23/100,000 and 17.57/100,000 in Beijing, Shanghai and Guangzhou, respectively.
The 2015 China Oncology Annual Report data show that prostate cancer is one of the six cancers with increased incidence in men in China, ranking 9th among the top 10 malignant tumors in humans and 6th among malignant tumors in men, and it is estimated that the number of new cases of prostate cancer in China in 2015 was 60,300.
Most patients with initial prostate cancer diagnosis in China are in the middle to late stages
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In addition, the clinical staging of patients with primary prostate cancer in China differs significantly from that of developed Western countries:
- In the United States, for example, clinically limited cases account for 81% of patients with initially diagnosed prostate cancer, lymph node metastases account for 12%, and distant metastases account for only 4%.
- In contrast, a multicenter study in China showed that only one-third of patients with initial prostate cancer had clinically limited prostate cancer, and most patients were already in the mid- to late-stage at the time of initial diagnosis, resulting in a much poorer overall prognosis for prostate cancer patients in China than in the western developed world.
Thus, screening, early diagnosis, and treatment of high-risk populations are the most effective means of improving the overall survival of prostate cancer patients in China.
Domestic study shows that PSA screening greatly improves prostate cancer detection rates
There are few studies on prostate cancer screening in China, and there are no reports of large-scale prostate cancer screening based on serum prostate specific antigen (PSA) testing in community populations, and only a few single-center studies have been reported. For example:
- PSA testing in 5,341 healthy men aged 32 to 87 years at a hospital found that 123 (2.30%) men had PSA>4 μg/L, and prostate cancer was diagnosed in 8 (0.15%) by prostate puncture biopsy;
- Serum PSA testing in 5 632 healthy men over 50 years of age at a hospital found that 473 (8.40%) men had PSA>4 μg/L, 194 of whom underwent prostate puncture biopsy, and 38 (0.67%) were diagnosed with prostate cancer.
This shows that serum PSA screening (defining PSA>4 μg/L as the threshold for abnormality) has a very high positive predictive value, and since the detection rate of prostate cancer in men in China is much higher than in Western developed countries, serum PSA testing can effectively screen a large number of people at high risk for prostate cancer.
In addition, middle-aged and older men in China generally lack knowledge of the relevant science, and tend to avoid symptoms such as urinary obstruction. In addition, the Chinese Cancer Society organized a discussion with urological oncologists and reached a consensus on prostate cancer screening.
The main recommendations of the consensus are summarized below:
What is the significance of prostate cancer screening?
Increasing the detection rate of prostate cancer and detecting early prostate cancer.
What methods are used for prostate cancer screening?
- Regular serum PSA testing is recommended;
- PCA3, P2PSA, 4K score, Prostate Health Index, and MRI are not recommended as routine screening for prostate cancer.
Who should be screened for prostate cancer?
Who should be screened for prostate cancer?
- Prostate cancer screening based on PSA testing for men in good health with a life expectancy of 10 years or more;
- Serum PSA testing every 2 years, with termination of PSA testing based on the patient’s age and health status;
- Serum PSA testing should be performed as early as possible for those at high risk for prostate cancer, which include.
- Men age >50 years;
- Men age >45 years with a family history of prostate cancer;
- Men age >45 years with a family history of prostate cancer;
- Men aged >40 years with baseline PSA>1 μg/L.
- Men age >50 years;
- Men age >45 years with a family history of prostate cancer;
- Men age >45 years with a family history of prostate cancer;
- Men aged >40 years with baseline PSA>1 μg/L.