The incidence of prostate cancer is high in Western countries; in the United States, for example, prostate cancer has surpassed lung cancer as the number one tumor killer for men. The incidence of prostate cancer in China is not as high as in the United States, but with an aging population, the incidence has been increasing year by year in recent years.
So, what are the characteristics of prostate cancer incidence in China? What is the survival status of prostate cancer patients? What are the problems in diagnosis and treatment? In this article, we will review and introduce these issues in order to draw attention to prostate cancer disease, especially among men.
The incidence of prostate cancer is growing rapidly in China
There are significant regional and ethnic differences in the incidence of prostate cancer, with the Chinese having the lowest incidence, Europeans having the highest, Africa and Israel in between, and countries such as China and Japan having the lowest incidence of prostate cancer. In the United States, prostate cancer has become the number one tumor threatening men’s health, with approximately 160,000+ new cases and nearly 30,000 deaths from prostate cancer nationwide in 2018.
What is alarming is that although China has a low incidence of prostate cancer compared to Europe and the United States, the incidence of prostate cancer is increasing year by year as people’s standard of living improves and prostate screening technology becomes available. the incidence of prostate cancer in Chinese men increased from 3.52/100,000 in 1998 to 11.00/100,000 in 2008, an average annual increase of 12%. The incidence of prostate cancer has become the fastest growing malignancy in China.
The trend of increasing prostate cancer is particularly pronounced in large cities compared to rural areas. For example, the incidence of prostate cancer in Beijing has more than tripled from 5.53 per 100,000 in 2001 to 16.62 per 100,000 in 2010.
Prostate cancer is rare in men under 50 years of age, but occurs mainly in older men, and the incidence increases with age, with a peak incidence at age 75 and older.
With the widespread use of prostate-specific antigen (PSA) screening and increased national awareness of medical screening, the incidence and detection of prostate cancer in China is expected to increase further.
PSA screening is controversial internationally, but the benefits outweigh the harms in our current situation
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Since the 1980s, the United States has been using PSA testing to screen men over the age of 50 for prostate cancer, which has greatly improved the detection rate of prostate cancer; moreover, most prostate cancer patients diagnosed by PSA are in the early stages of prostate cancer, and most early prostate cancer is curable.
In China, most patients are seen only after prostate cancer has become locally enlarged causing symptoms of difficulty urinating, or after bone metastases have occurred causing pain, and most patients are already at an advanced stage when prostate cancer is detected, losing the best time for treatment. As a result, the overall prognosis for prostate cancer patients in China is poor compared to the United States.
There is a general lack of scientific knowledge about prostate cancer among middle-aged and older men in China and an avoidance of problems such as obstruction of urination or skeletal pain that have already occurred. Therefore, PSA screening is not as common in China as it is in the United States; at the same time, there are relatively few studies on PSA screening in China, and no studies have been conducted on serum PSA screening in the general population.
Theoretically, PSA screening can improve the early diagnosis of prostate cancer and improve the chances that some prostate cancer patients will be cured with early intervention. However, there are some problems with the screening process, such as the low accuracy of PSA screening, possible waste of medical resources, overdiagnosis, and overtreatment. These issues have been controversial, and in response to these controversies, two prospective studies were conducted in the United States and Europe, but the two large studies came to diametrically opposed conclusions, adding to the debate about the significance of PSA screening.
For PSA screening, although it has its own set of shortcomings and many controversies, in the current situation in China – where most prostate cancer patients are diagnosed at an advanced stage or have bone metastases – PSA as a screening tool for prostate cancer is still of great importance and has more advantages than disadvantages.
Many new drugs have not yet been introduced, affecting survival in patients with advanced disease
In terms of prostate cancer treatment, surgery, radiotherapy, and endocrine therapy are currently the mainstay in China. For early stage limited prostate cancer, radical prostatectomy and radiotherapy are still the recommended approaches. And for patients with biochemical recurrence and advanced prostate cancer, endocrine therapy (including surgery or pharmacological debulking, use of anti-androgen drugs such as androgen receptor antagonists) is the first line of treatment. However, the endocrine therapies and modalities adopted for this group of patients in China are still relatively single, and for many new endocrine drugs for prostate cancer, most hospitals have not yet introduced them, thus failing to maximize the overall survival of patients with advanced disease.
The diagnostic and treatment systems established in Europe and the United States are well established, including early diagnosis from PSA screening of prostate cancer, treatment, follow-up, recurrence detected during follow-up, further treatment after recurrence, treatment after entering the castration resistant prostate cancer (CRPC) stage, and The conditions for participation in clinical trials are very well established. In China, through the joint efforts of the Society of Urology and physicians, the level of prostate cancer diagnosis and treatment has also made great progress, and the screening rate and survival rate of patients have improved significantly, but there is still a gap with the systematic engineering in Europe and the United States.
“Overtreatment” reduces the quality of survival of prostate cancer patients
Overall, prostate cancer has a better prognosis than any other type of malignancy, and the 5-year survival rate for patients with limited prostate cancer is close to 100%. However, prostate cancer is also heterogeneous and is clinically classified into low-risk, intermediate-risk, and high-risk groups based on serum PSA, Gleason score, and clinical stage; the higher the risk level, the worse the prognosis. Also, the prognosis of prostate cancer patients is associated with the androgen dependence of the tumor.
There are many treatment options for prostate cancer, including active surveillance/watchful waiting treatment, radical surgery, radiation therapy, local therapy, endocrine therapy, and chemotherapy. Each treatment has corresponding side effects, such as surgery and radiation therapy may affect patients’ urinary control and sexual function, and endocrine therapy may lead to an increased incidence of cardiovascular disease and metabolism-related diseases, which can affect patients’ quality of life, and sometimes the harm caused by the treatment may even exceed that of prostate cancer itself.
In recent years, the medical community has become aware of the potential for “overtreatment” in prostate cancer. The survival and quality of life of patients with prostate cancer will be further improved.
Finally, I would like to urge all men to take their prostate health seriously and raise awareness of prostate cancer prevention.