如何早期发现前列腺癌

不久前,美国的鲍威尔将军成功地进行了前列腺癌手术,康复后很快便回到了国务卿的岗位上,这完全得益于早期发现前列腺癌的先进理念与技术.纵观当今世界,前列腺癌是造成患者死亡最多的癌症之一,其中不乏政界要人和社会名流,例如法国前总统密特朗和伊朗宗教领袖翟梅尼,均是因此而失去了生命.     

前列腺癌盆腔淋巴结转移的诊治:新手段和新策略

<正>盆腔淋巴结是前列腺癌播散的常见部位,不同于骨骼、肺和肝等远处脏器,盆腔淋巴结转移的前列腺癌仍然归类为区域性(regional)病变,介于局限性(local)和远处播散性(distant)病变之间。与此同时,针对盆腔淋巴结转移的前列腺癌的诊治也有着:应当积极进行局部治疗,还是以姑息内分泌治疗为主的学术争论?本文针对这一难题做些初步探讨,总结近年来的文献数据,提出指导临床实践的新手     

前列腺癌放射治疗

放射治疗目前不仅用于早期局限性前列腺癌的根治性治疗，亦逐渐应用于局部晚期前列腺癌的治疗、手术后的辅助性治疗以及与内分泌联合治疗。除外照射放射治疗外，组织问插植放射治疗，3-D适形放射治疗等技术也愈来愈多地应用于前列腺癌的治疗。该文重点讨论各种放疗技术在前列腺癌治疗中的适应证、疗效与副反应。     

AMACR在前列腺癌中的表达和应用

前列腺癌是一种常见的恶性肿瘤。统计数据表明，美国男性每年有179000人被诊断为前列腺癌，40000人死于前列腺癌。我国不是前列腺癌高发区，但随着人均寿命的延长，膳食结构的改变和诊断技术的提高，前列腺癌的发病率正在逐年升高。     

前列腺癌阴茎转移三例报道并文献复习

世界范围内前列腺癌发病率在男性恶性肿瘤中位居第2位 [1].亚洲前列腺癌发病率远低于欧美国家,但近年来我国发病率逐年升高,晚期前列腺癌预后差,仍是目前治疗的难点 [2].前列腺癌主要经骨转移,经阴茎转移罕见,国内外报道较少,且多为个案报道.阴茎转移患者多合并多器官转移,多数生存期≤1年.成都市第二人民医院2011年至2...     

前列腺癌诊断方法研究进展

前列腺癌潜伏期较长，转移较慢，有些甚至终生不被发现。探寻新的诊断方法以协助前列腺癌的早期诊断，一直是人们研究的热点。经过数十年的临床研究，前列腺癌的诊断方法取得了重大进展。近年，人工智能的加盟及蛋白质芯片表面增强激光解吸电离一飞行时间一质谱技术的应用更加加速并拓宽了前列腺癌诊断技术的发展。     

Hepsin和前列腺癌

Hepsin是一种Ⅱ型跨膜丝氨酸蛋白酶,其过度表达于前列腺癌中并促进其发展和转移。Hepsin对前列腺癌（Pca）的诊断,预后和治疗具有重要作用,因此深入探讨Hepsin的结构,作用及与Pca的关系具有重要意义。本文对Hepsin的结构,作用及与Pca的关系作扼要综述。     

Prostate cancer diagnosis,staging and survival

Prostate cancer is the most common malignancy in men and the second most common cancer related death. Through research, we have found that African–American men and men with a family history of prostate cancer have a significantly higher risk of prostate cancer. In the 90's the mortality rate from prostate cancer decreased, presumably due to PSA testing. Patients with organ-confined tumors, particularly if they have a moderate Gleason score have an excellent chance of long-term survival with radical prostatectomy or external beam radiation therapy. Advances in detecting micrometastatic disease are needed to further impact on this disease.     

Prostate volume and adverse prostate cancer features: fact not artifact

PurposeA recent prostate cancer finasteride chemoprevention trial showed a higher rate of sextant biopsy-detected high grade prostate cancer (HGPCa) in finasteride exposed men, whose prostates were significantly smaller than those of controls. We investigated the association between prostate size and prostate cancer grade and stage in a large (n = 3412) single center radical prostatectomy cohort, which was unexposed to any form of hormonal manipulation.MethodsLogistic regression models were used.ResultsSmall prostates were associated with higher rate of HGPCa at biopsy and at radical prostatectomy (both p < 0.001), with higher rate of extracapsular extension (p < 0.001), seminal vesicle invasion (p < 0.001) and with tumor volume >3.4cc, after accounting for age, PSA, clinical stage and year of surgery.ConclusionsOur findings demonstrate that prostate cancers located in small glands are fundamentally more aggressive than those located within larger glands. In consequence, prostate cancer detection and treatment strategies should account for prostate volume.     

Prostate cancer as a first and second cancer: effect of family history

Background:

Diagnosis with prostate cancer has been reported to increase the risk of subsequent tumours. However, specific data on individuals with a parental history are not available so far.

Methods:

On the basis of the nationwide Swedish Family-Cancer Database including 18,207 primary invasive prostate cancers, standardised incidence ratios (SIRs) were used to estimate the relative risks of subsequent tumours after prostate cancer in the general population and among individuals with a parental history of cancer.

Results:

A significantly increased SIR of colorectal cancer was found among prostate cancer patients with a parental history of colorectal cancer (2.26, 11 cases). The SIRs of parental concordant (same site) tumours after prostate cancer were also increased for urinary bladder cancer (4.42, 4 cases) and chronic lymphoid leukaemia (38.0, 2 cases).

Conclusion:

A higher than additive and multiplicative interaction was observed between the individual history of prostate cancer and parental history of colorectal and urinary bladder cancers, although the number of cases did not permit the rejection of any interaction model. The results suggest that the occurrence of second tumours, for example bladder after prostate or prostate after bladder tumours, is mostly related to shared genetic and non-genetic risk factors rather than treatment of first cancer.     

中国前列腺癌筛查与早诊早治指南（2022，北京）

前列腺癌是好发于老年男性的生殖系统恶性肿瘤。前列腺癌高风险人群筛查与患者的早诊早治对提高前列腺癌治愈率至关重要。制定符合中国国情的前列腺癌筛查与早诊早治指南,将促进中国前列腺癌筛查的同质性和规范性,提高前列腺癌筛查的效果。《中国前列腺癌筛查与早诊早治指南(2022,北京)》受国家卫生健康委员会疾病预防控制局委托与指导,由国家癌症中心发起,联合多学科专家,根据《世界卫生组织指南制定手册》的原则和方法,整合近年来国内外在前列腺癌筛查与早诊早治方面的新进展,同时考虑中国前列腺癌筛查的实际经验,针对前列腺癌筛查对象、技术、流程、质量控制等15个关键问题给出了详细的循证推荐,旨在规范前列腺癌筛查与早诊早治实践,提升中国前列腺癌防控效果。     

Clinical Outcomes from Dose-Reduced Radiotherapy to the Prostate in Elderly Patients with Localized Prostate Cancer

Radical treatment of localized prostate cancer in elderly patients may lead to unacceptable treatment-associated toxicities that adversely impact quality of life without improving survival outcomes. This study reports on a cohort of 54 elderly (>70 years) patients that received 4000–5000 cGy of palliative external beam radiotherapy (EBRT) as an alternative to androgen deprivation therapy (ADT). The primary outcome of interest was the period of ADT-free survival, and secondary outcomes included overall survival (OS) and metastases-free survival (MFS). Kaplan–Meier regression was used to estimate survival outcomes. Thirty-six (67%) patients achieved a break in ADT post-radiotherapy, with a median time to ADT reinitiation of 20 months. Common Terminology Criteria for Adverse Events (CTCAE) were limited to low-grade gastrointestinal (GI) or genitourinary (GU) toxicities, with no skin toxicities observed. Grade 1 GI toxicity was observed in 9 (17%) patients, and grades 1 and 2 GU toxicities were observed in 13 (24%) and 3 (6%) patients, respectively, with no higher-grade toxicities reported. Five-year MFS and OS were 56% and 78%, respectively. In summary, the treatment regimen was well-tolerated and achieved durable ADT-free survival in most patients. Dose-reduced EBRT appears to be a viable alternative to ADT in elderly patients with localized prostate cancer.     

Prostate cancer in systemic lupus erythematosus

Our research objective was to estimate prostate cancer risk in systemic lupus erythematosus (SLE), relative to the age-matched general population. A progressive literature review was performed to identify SLE cohort studies with cancer registry linkage for cancer ascertainment. Data were pooled from four studies of large SLE cohorts who met these criteria. The total number of prostate cancers observed was derived by pooling the incident cases across all studies. The total expected number of prostate, derived from applying appropriate general population cancer incidence data to the observed number of patient-years of follow-up for each study, was similarly determined. The parameter of interest was the standardized incidence ratio (SIR), the ratio of observed to expected malignancies. The four studies together provided a pool of 6,068 male SLE patients observed for a total of 38,186 patient-years (mean 6.3 years). Within these subjects, 80 prostate cancers were observed. In each contributing study, the number of cancers expected far exceeded that observed. The pooled SIR estimate for prostate cancer risk in males with SLE, compared to the general population, was 0.72 (95% CI 0.57, 0.89). These data suggest a decreased risk of prostate cancer in SLE; more definite conclusions require additional data. As alterations in androgen pathways can potentially alter prostate risk, a lower risk of prostate cancer in SLE could possibly be due to low hypoadrenergic states which some believe may occur in men with SLE; underlying genetic factors could also be at play. Further study of these issues in large cohorts is needed.     

Impact of socioeconomic status on prostate cancer diagnosis,treatment, and prognosis

BACKGROUND:

The objective of the current study was to evaluate the impact of socioeconomic disparities on prostate cancer presentation, treatment, and prognosis in Geneva, Switzerland, in which healthcare costs, medical coverage, and life expectancy are considered to be among the highest in the world.

METHODS:

This population‐based study included all patients diagnosed with invasive prostate cancer among the resident population between 1995 and 2005. Patients were divided into 3 socioeconomic groups according to their last known occupation. Compared were patient and tumor characteristics and treatment patterns between socioeconomic groups. Cox multivariate regression analysis was used to assess and explain socioeconomic inequalities in prostate cancer‐specific mortality.

RESULTS:

Compared with patients of high socioeconomic class, those of low socioeconomic class were more often foreigners, were found less frequently to have screen‐detected cancer, were found to have a more advanced stage of disease at diagnosis, and less often had information regarding disease characteristics and staging. These patients underwent prostatectomy less frequently and were more often managed with watchful waiting. The risk of dying as a result of prostate cancer (hazards ratio [HR]) in patients of a low versus high socioeconomic status was increased 2‐fold (95% confidence interval [95% CI], 1.5‐2.6). After adjustment for patient and tumor characteristics and treatment, the mortality risk was no longer found to be significantly increased (HR, 1.2; 95% CI, 0.8‐1.6).

CONCLUSIONS:

In the current study, patients of low socioeconomic class were found to be at increased risk of dying as a result of their prostate cancer. This increased mortality is largely attributable to delayed diagnosis, poor diagnostic workup, and less invasive treatments in these individuals. Cancer 2009. © 2009 American Cancer Society.     

前列腺癌的适形和调强适形放疗

适形和调强适形放射治疗已经广泛地应用于治疗前列腺癌.适形放疗或调强适形放疗技术能够提高靶区的照射剂量,改善前列腺癌的无生化失败生存率和总生存率.调强适形技术可使高剂量分布区与靶区三维形状的适合度大大提高,显著减少周围正常组织和器官的受照射体积,在照射剂量提高的同时并未增加直肠和膀胱的毒性反应.适形和调强适形放疗的治疗体位宜选择仰卧位.临床靶区需要包括整个前列腺.对于有高危因素的病人临床靶区还需要包括精囊和盆腔淋巴结.