It is often said that men have a hard life, working hard and worrying about their careers, and taking care of their wives, children and children at home.
Even in physiological data, men’s suffering is well documented. According to the life expectancy list of countries released by the World Health Organization in May 2016, among the top 20 countries, the life expectancy of women is 3 to 6 years higher than that of men [1].
WHO 2015 list of life expectancy by country Image source: Wikipedia
In addition, men’s health often lights up red lights and endures some indescribable and unspeakable things. Since every October is Pink Ribbon Month, the world pays attention to women’s breast health and prevention of breast cancer. Then, in November, there should also be a healthy month for men – Movember.
Don’t think this is a spelling error, the new term is a combination of “Mustache” (beard) and “November” (November), which stands for “November” worldwide. Grow a Beard” charity campaign to raise awareness of men’s health and raise funds to fight men’s worst enemy – prostate cancer.
“Stop men dying too young” Image source: Global Prostate Cancer Foundation website i>
Why is prostate cancer increasing? Who is more likely to get prostate cancer? Today, let’s talk about the “number one killer” of old men who have been lurking in men for a long time.
1. 60% of Chinese prostate cancer patients are found to have advanced disease and cost at least 400,000 to 1 million
“The biggest problem with prostate cancer is that we catch it too late!”
Wang Zhihua, deputy chief physician of the Department of Urology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, pointed out the current situation of prostate cancer patients in my country.
In fact, prostate cancer is common in Western countries and has surpassed lung cancer as the number one malignant tumor in Northern Europe and the United States. According to estimates by the American Cancer Society, in 2009, there were nearly 200,000 new cases of prostate cancer and nearly 30,000 deaths in the United States. On average, 1 person was diagnosed every 3 minutes, and 1 in 9 American men was diagnosed [2].
What’s even more frightening is that many older men have cancer cells in their prostates, but they’re slow to detect. A survey showed that 50% of men aged 70 to 79 had cancer cells in their prostates, while among men aged 80 to 89, the proportion reached 67%, which may progress to life-threatening patients at any time [2].
Prostate cancer has become the fastest growing malignant tumor in my country. In 2015, there were about 60,300 new cases of prostate cancer in my country, and about 26,600 deaths [3]. Compared with rural areas, the growth trend of prostate cancer in big cities is particularly obvious. For example, the incidence of prostate cancer in Beijing has increased from 5.53/100,000 in 2001 to 16.62/100,000 in 2010, an increase of more than three times [4].
However, it is worth mentioning that, unlike European and American countries, Chinese patients with prostate cancer are often diagnosed at an advanced stage.
According to the “Prostate Cancer Screening Expert Consensus” issued by the China Anti-Cancer Association in 2017, nearly 81% of newly diagnosed prostate cancer cases in the United States are clinically localized prostate cancer, and the 5-year survival rate is close to 90% [5], while only 30% of new cases in my country are clinically localized patients, and the rest are locally advanced or extensively metastatic patients. These patients cannot receive local radical treatment, and the treatment effect is poor [6].
Wang Zhihua explained that this is because most early prostate cancers have no obvious symptoms. Even if the tumor grows to a certain volume and compresses the urethra, it will only cause some dysuria, frequent urination and urgency, similar to benign prostatic hyperplasia. The non-specific manifestations of prostate cancer have caused most of the newly diagnosed prostate cancer patients in my country to be in the middle and late stages.
“At present, the status of prostate cancer in my country is that 60% of the patients who come to the hospital for treatment are in the advanced stage (5% in developed countries in the United States and Europe), losing the opportunity for radical treatment and requiring lifelong Comprehensive treatment based on endocrine therapy (about 80,000 to 100,000 yuan per year).” Zhou Fangjian, director of the Department of Urology, Sun Yat-sen University Cancer Hospital, once said that based on the 5-10-year survival time of general advanced prostate cancer, the total medical cost of each patient is at least Among 400,000 to 1,000,000 patients, only 40% of prostate cancer patients belong to the early stage and can be treated with radical treatment [7].
2. Prostate cancer picks four types of people, so be careful!
The average annual incidence rate increases by 12%. Why is the incidence of prostate cancer increasing in China?
It starts with the risk factors for prostate cancer.
Age
This is the biggest risk factor for prostate cancer, and men over 50 have a significantly higher risk of prostate cancer than those under 50. The older a man with prostate cancer is at diagnosis, the less aggressive his prostate cancer is generally.
Image source: Zhanku Hailuo
Inheritance
Family members with prostate cancer are at higher risk for prostate cancer. If one of your immediate family members (father/son or brother) has been diagnosed with prostate cancer, your risk is 2 times higher than the average person, and if you have 2-3 immediate family members diagnosed with prostate cancer, this risk Will increase 5 to 11 times. Research has identified several inherited genes that may increase the risk of prostate cancer, but it is estimated that hereditary prostate cancer accounts for only 5 to 10 percent of all prostate cancer cases. [2]
Race
Black Americans have about 60% higher risk of prostate cancer than whites, and the degree of malignancy is generally higher, but the incidence of prostate cancer is very low in Asians and men living in Africa. The incidence rate increased sharply after the United States, which also suggested that prostate cancer is not only related to race, but also environmental factors such as high-fat diet and excessive consumption of red meat.
Diet
Research suggests that a high-fat diet may be a risk factor for prostate cancer. Prostate cancer is more common in countries where meat and dairy are the staple food compared to those where rice, soy products and vegetables are the basic diet.
In general, the increase in the incidence of prostate cancer in my country is related to an aging population and a westernized lifestyle. For example, obesity caused by a diet high in animal fat and lack of exercise is one of the important risk factors for prostate cancer.
Image source: Zhanku Hailuo
Therefore, eating more fruits and vegetables, maintaining a balanced and healthy diet, and exercising regularly are all excellent for preventing prostate cancer!
3. There are three “magic weapons” for catching prostate cancer. Our PSA screening awareness is too lacking!
As I mentioned earlier, prostate cancer likes to “latent” for a long time, and there may be no symptoms clinically. It is difficult to detect this “thief” based on personal subjective feelings, so how can we detect clues at an early stage? Woolen cloth?
Actually, there are quite a few diagnostic methods, but there are three main ones.
First, there is prostate-specific antigen (PSA) screening, the most sensitive prostate cancer tumor marker available. PSA screening has advanced the diagnosis of prostate cancer by 5 to 8 years. When the serum PSA concentration of normal healthy men is 10μg/L, most patients are diagnosed with prostate cancer.
Image source: Zhanku Hailuo
Secondly, it is digital rectal examination (yes, yes, you know…), which is the simplest and most commonly used method for diagnosing early-stage prostate cancer.
The prostate is close to the front of the rectum. The size of the prostate is about 4cm*3cm in normal digital rectal examination. It is soft in texture, smooth in surface, no nodules and symmetrical on both sides. Prostate increases in size but is not very hard, while prostate cancer is hard, like a rock.
Finally, we also have a method of transrectal ultrasonography, which is a sophisticated “radar” for prostate cancer and assists physicians in determining tumor size and clinical stage.
However, a few years ago, there was a debate about prostate cancer screening in China. The source came from a randomized controlled study in the United States and Europe. It was believed that PSA screening was insufficient, and patients The survival benefit is small and entails significant overdiagnosis and treatment [8][9][10].
Dr. Wang Zhihua introduced that after nearly 30 years of promotion and use, PSA screening for middle-aged and elderly men in Europe and the United States is mostly covered by medical insurance, and they have a full understanding of the early diagnosis of prostate cancer, while the domestic situation is quite different on this point. Differently, PSA is still difficult to popularize in my country. “A PSA screening costs about 160 yuan. Few units will actively participate in the physical examination of employees, and many patients are missed.“
In 2017, domestic experts also reached a consensus on prostate cancer screening: Age older than 50, older than 45 with a family history of prostate cancer, older than 40 with baseline PSA Serum PSA testing should be performed as soon as possible in men with >1 ng/ml and every 2 years [11].
OverallHe said that although prostate cancer is menacing, in fact, there is no need to worry too much. It belongs to the type with better treatment effect among all malignant tumors. The 5-year survival rate of patients with localized prostate cancer is close to 100%. The treatment also includes radical surgery, radiotherapy and chemotherapy. , endocrine therapy and other means, but at the same time prostate cancer also has certain heterogeneity, and the degree of risk is very different.
So, fellow eligible men, for your health, it’s time to schedule a PSA test!
*The content of this article is for the popularization of health knowledge and cannot be used as a specific diagnosis and treatment suggestion, nor can it replace the face-to-face consultation of a licensed physician, and is for reference only.
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