2021 CCO CACA Guidelines: Screening and early diagnosis of prostate cancer patients

‍‍During the 2021 CCO conference, the intensive reading conference of "China Comprehensive Cancer Diagnosis and Treatment Guidelines (CACA) - Prostate Cancer" was held online
.

At the meeting, Professor Dai Bo of Fudan University Affiliated Cancer Hospital explained the CACA guidelines for prostate cancer screening and early diagnosis based on the guidance cases provided by Professor He Liru from Sun Yat-sen University Cancer Center
.

Let's take a look
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The case lead patient, a 68-year-old male, previously healthy, was admitted to the hospital with an elevated PSA detected on a community screening physical examination
.

PSA: 13.
6ng/ml
.

DRE: The prostate is large in degree III without obvious nodules
.

MRI: abnormal signal foci of left lobe of prostate, PIRADS 4 points
.

Prostate targeted biopsy: Prostate cancer was diagnosed, Gleason score was 4+3, 10/16 were positive, and the lesions were all located on the left side of the prostate
.

Robot-assisted radical prostatectomy: prostate cancer, Gleason score 4+3, negative margins, T2N0M0
.

Long-term follow-up: PSA <0.
006 ng/ml
.

The patient in this case was found to have increased PSA through physical examination screening, diagnosed early-stage prostate cancer through perfect examination, and timely selected radical prostatectomy to achieve the effect of radical prostatectomy.
It is a typical successful case benefiting from early diagnosis and early treatment
.

So, how can patients with prostate cancer achieve early diagnosis? Let's listen to Professor Dai Bo's interpretation of the CACA Guidelines for Prostate Cancer Screening and Early Diagnosis
.

Experts interpret the three early principles of prostate cancer prevention and treatment: early screening, early diagnosis, and early treatment
.

Early diagnosis: For suspected prostate cancer patients, the MDT to HIM strategy is adopted, and various diagnostic measures are comprehensively used to accurately diagnose early-stage prostate cancer patients
.

Early treatment: Curative treatment is given at an early stage of the disease so that the patient can be cured
.

Early screening of prostate cancer patients is an important means to detect early-stage prostate cancer patients.
quality
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The CACA guidelines refer to the 2021 Chinese Prostate Cancer Screening Expert Consensus Guidelines and recommend prostate cancer screening in the Chinese population
.

The guidelines recommend that medical institutions at different levels carry out prostate cancer screening in the Chinese population through modes such as service station screening, base screening, and outpatient screening
.

Prostate cancer screening has been carried out in various places using the screening model recommended by the CACA guidelines
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Taking the Shanghai area as an example, the results of prostate cancer screening in more than 3,000 high-risk groups show that screening can improve the detection rate of early-stage prostate cancer and change the staging composition of patients
.

A total of 3037 healthy men were screened in this study, and 42 were diagnosed with prostate cancer, of which 34 (81%) were early-stage prostate cancer
.

97.
66% of these patients received radical mastectomy and were cured
.

Based on the above evidence, the CACA guidelines recommend serum PSA testing every 2 years for high-risk groups of prostate cancer in China
.

High-risk groups include: men > 50 years old; men > 45 years old with a family history of prostate cancer; men > 40 years old and PSA > 1 ng/ml; men > 40 years old and carrying BRCA2 mutations
.

If the patient's PSA is greater than or equal to 4ng/ml, further diagnosis and treatment are required; if the patient's PSA is <4ng/ml, it is recommended that the patient be followed up every 2 years
.

Early diagnosis of prostate cancer Determining the clinical symptoms of prostate cancer is the key to early diagnosis
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The early symptoms of prostate cancer are not typical, mainly urinary tract symptoms such as frequent urination, urgency, dysuria, urination obstruction, and increased nocturia, which are indistinguishable from symptoms of benign prostatic hyperplasia
.

When the disease develops to the advanced stage, symptoms such as blood sperm, hematuria, impotence, etc.
caused by local invasion of the tumor will appear
.

With the further development of the tumor, distant metastases will cause symptoms of metastases, including lower extremity edema and bone pain
.

CACA guidelines recommend the following methods for the diagnosis of prostate cancer: digital rectal examination (DCE) in physical examination, PSA test in laboratory examination, magnetic resonance imaging (MRI), and needle biopsy
.

In recent years, MRI technology has advanced by leaps and bounds, making it the most important imaging method for prostate cancer
.

CACA guidelines recommend the use of multiparametric MRI techniques in prostate cancer MRI
.

Multiparametric MRI technology requires at least two new imaging techniques [diffusion-weighted imaging (DWI), dynamic enhanced imaging (DCE), spectral analysis imaging (MIS), etc.
] in addition to the conventional T1 and T2 signal sequence scans
.

Multiparametric MRI for prostate cancer is required because DWI and DCE images are required for PI-RADS scoring of peripheral prostate zone (PZ) tumors; PI-RADS for central glandular zone (TZ) tumors T2WI and DWI images are required for scoring
.

Clinicians perform PI-RADS scores based on the results of multiparametric MRI, and then select further treatment of patients based on different scores
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Prostate biopsy is recommended by CACA guidelines for the diagnosis of prostate cancer
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At present, the commonly used puncture examination methods include systematic puncture and targeted puncture
.

Systematic aspiration is a needle biopsy of all parts of the prostate
.

Targeted puncture can accurately puncture the lesions in the prostate under the guidance of medical images
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Compared with systematic puncture, the advantage of targeted puncture is that the positive rate of prostate cancer detection is high and the missed diagnosis rate is low; it can reduce the probability of detecting clinically insignificant prostate cancer
.

The CACA guidelines suggest that different puncture methods should be used according to different patient conditions
.

For patients with initial needle biopsy, if abnormal signals in the prostate are found by multiparametric MRI, targeted biopsy or targeted biopsy combined with systematic biopsy is required; if no abnormal signals are found on multiparametric MRI, systematic biopsy is recommended
.

For prostate cancer patients with repeated puncture, if abnormal signals in the prostate are found on multiparametric MRI, targeted puncture is recommended; if no abnormal signals are found on multiparametric MRI, systematic puncture is recommended
.

Prostate cancer biopsy can obtain the pathological diagnosis of prostate cancer in patients
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The CACA guideline recommends a clear Gleason grading (grade 1-5) for the pathological diagnosis of prostate cancer.

.

The higher the Gleason grade, the higher the malignancy of the tumor and the worse the prognosis of the patient
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On the basis of the Gleason grading, the Gleason score can be obtained
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Gleason score = primary component score + secondary component score
.

According to the ISUP Grading Groups system, the Gleason score is divided into 5 groups.
The higher the grading group, the worse the prognosis of the patient
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In addition, the CACA guidelines recommend TNM staging for prostate cancer staging, which is used to guide the follow-up treatment of patients and determine the prognosis of patients
.

For T staging, digital rectal examination and magnetic resonance imaging results are recommended as the basis for staging; for N staging, pelvic contrast-enhanced CT and magnetic resonance imaging results are recommended as the basis for staging; for M staging, bone scan or PET/CT is recommended for staging
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Conclusion Finally, Professor Ye Dingwei from Fudan University Affiliated Cancer Hospital made a summary of the above content
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Professor Ye pointed out that in the screening and early diagnosis of prostate cancer patients, first of all, we should emphasize popular science education, so that patients can realize the importance of early screening and early diagnosis, and work closely with the community; secondly, we should focus on localized screening, The first-level, second-level, and third-level hospitals are jointly linked, and finally the multidisciplinary collaboration and integration of MDT to HIM can be achieved, and the accuracy of screening and early diagnosis can be improved
.

Expert Introduction Dr.
He Liru, Chief Physician, Doctoral Supervisor Visiting Scholar at MD Anderson Cancer Center, USA Member of the Special Committee of the Urology Oncology Group of the Radiotherapy Branch of the Chinese Medical Association Member of the National Health and Health Commission Capacity Building and Continuing Education Oncology Special Committee Group Youth Member Vice Chairman of the Youth Committee of Urogenital Oncology of Guangdong Anti-Cancer Association Professor Dai Bo, Standing Committee Member of Radiation Oncology Branch of Guangdong Women Physician Association Professor Dai Bo, MD, Chief Physician, Doctoral Supervisor Director of Urology Department of Fudan University Affiliated Cancer Hospital China Secretary General of the Youth Committee of the Urology and Male Genital Tumor Professional Committee of the Anti-Cancer Association Member of the Standing Committee of the Laparoscopic and Endoscopic Surgery Branch of the China Association for the Promotion of International Exchanges of Health Care, a member of the Shanghai Association of Urology, and the editorial board of the following academic journals: "Chinese Journal of Urology", "Chinese Journal of Urology" "China Cancer Journal", "Journal of Southern Medical University", "Chinese Journal of Cancer Prevention and Treatment" for two sessions of "Chief Minimally Invasive Surgery Chief Surgeon Doctor" of China Anti-Cancer Association Urogenital Oncology Specialist Committee Committee "MDT Outstanding Physician" People's Good Doctor (Golden Camellia - Outstanding Contribution Award, Urology Oncology Field) Two-time Good Doctor Online "Good Doctor of the Year" Shanghai Urological Association Annual Person of the Year Benevolent Physician (Shanghai Outstanding Specialist Physician Award) Nomination Award) Outstanding Young Talents of Shanghai Health System Professor Ye Dingwei, Fudan University's Top Ten Medical Youth Executive Director of Cancer Society Deputy Head of Oncology Group of Urology Branch of Chinese Medical Association Chairman-designate of Asia Pacific Prostate Society (APPS) Editor: LR Reviewer: Mia Executive: XY‍‍