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Prostate canceris the most common cancer among men and the second most common after lung cancer. TheAmerican Cancer Societyestimates that nearly 250,000 men in the United States will be diagnosed with prostate cancer in 2021.
While prostate cancer rates increased sharply in the late 1980s and early 1990s due to increased screening with the prostate-specific antigen (PSA) blood test, incidence rates stayed steady from 2013 to 2017.
The average age of diagnosis is 66, and it rarely occurs in those younger than 40. And the number of new cases diagnosed in African American men is nearly 80% higher than the number of new cases diagnosed in Caucasians.
According toYousef Al-Shraideh, MD她是OSF HealthCare的泌尿肿瘤医生，早期发现是良好结果的关键。
Most prostate cancers are found at the local or regional stage when the disease is confined to the prostate or locally advanced, which involves nearby organs, mainly theseminal vesicles.
The good news
The five-year survival rate for most people with local or regional prostate cancer is nearly 100%, and the 10-year survival rate is 98%. According to the ACS, there are more than 3.1 million prostate cancer survivors in the United States today.
如何诊断、分级和观察前列腺癌?
“前列腺癌的诊断主要是通过直肠局部麻醉，超声引导下的前列腺活检。通常情况下，患者的耐受性很好。”“它也通过融合(Uronav)活检进行，这或多或少是相同的技术。与此不同的是，该技术将超声图像与MRI图像融合，以精确定位MRI检测到的可疑病变。”
Prostate cancer is classified depending on the risk, which is usually the product of the PSA value, clinical exam/MRI, and the Gleason score (grading system of the tumor cells under the microscope that ranges from 6-10).
Low risk
It’s low risk when the cancer is still confined to the prostate and has a PSA of less than 10 ng/ml or a Gleason score (a grading system for tumors that ranges from 6 to 10) of 6.
“In this case, the cancer can be watched by a protocol called active surveillance, which entails checking PSA every six months, having a digital rectal exam every year and a repeat MRI or prostate biopsy 12-18 months after diagnosis,” Dr. Al-Shraideh said.
Intermediate risk
You’re at an intermediate risk when cancer is still confined to the prostate and you either have a PSA of 10-20 ng/ml or a Gleason score of 7.
Al-Shraideh博士说:“在这种情况下，首选的选择是通过治疗癌症来治愈疾病，尤其是对于预期寿命超过10-15岁的男性。”
Surgery and radiation are the two main ways to treat intermediate prostate cancer.
“We do the robotic surgical removal of the prostate at OSF with excellent results of tumor cure, early urinary control for full urinary continence and erectile functionality,” Dr. Al-Shraideh said. “The other modality of cure is through radiation.”
High risk
When cancer goes through the prostate capsule (locally advanced), spreads out (metastasizing to bone or solid organs) or has a PSA of more than 20 ng/ml or a Gleason score between 8-10, it is considered high-risk.
According to Dr. Al-Shraideh, the treatment of cancer at this stage depends on many factors, including tumor stage and grade, life expectancy and functional status of the patient.
“Locally advanced cancers could still benefit from attempts to cure by either surgery or radiation,” Dr. Al-Shraideh said. “However, cancer that has spread is treatable but difficult to cure, and it usually requires androgen hormonal therapy and additional second-line treatment of chemotherapy, hormonal therapy or immunotherapy.”
Screening recommendations
“建议40-54岁的男性如果患前列腺癌的风险较高，就进行筛查。我不建议40岁以下的男性进行筛查，”Al-Shraideh博士说。“高危人群包括非裔美国人，以及那些有严重致命癌症家族史的人，如前列腺癌、乳腺癌、卵巢癌或胰腺癌，尤其是那些受影响的人是直系亲属或在较年轻时患过癌症的人。”
For men ages 55-69 years, you should talk to your primary care provider to weigh the benefits of reducing prostate cancer metastatic disease and death. However, this age group would get the greatest benefit from screening.
不建议70岁以上的男性进行PSA检查，除非他们健康状况良好，预期寿命超过10-15年。
How to get proper screening
Proper screening consists of two tests: the digital rectal exam and the PSA blood test.
“Most people are aware of the rectal exam because many men find it uncomfortable and embarrassing, and it makes for an easy premise in a comedy movie or television show,” Dr. Al-Shraideh said. “But it only takes 10 seconds with mild discomfort.
“基本上，及早发现有风险的男性可以避免重大损害。”
PSA血检检查是否存在前列腺特异性抗原。通常情况下，PSA只有在前列腺结构出现问题，导致抗原泄漏到血液中时才会被发现。
“If you have an elevated or rising amount of PSA in your blood, it’s a sign something might be wrong in the prostate, and cancer could be one of those things,” Dr. Al-Shraideh said.
Al-Shraideh博士说，两种检查都是必要的，因为其中一种可以发现另一种可能遗漏的问题。在直肠检查中，你的医生可能会发现一个可疑的结节，而血液检查显示正常。同样地，血液检查可以显示你血液中PSA的存在，而直肠检查却不能显示任何东西。
So, talk toyour doctor关于定期前列腺检查。它可能会救你的命!