Prostate cancer mortality in Asia rises, how to prevent it?

no thumb

At the 2019 Annual Meeting of the Urinary Male Genital Oncology Committee of the China Anti-Cancer Association on November 30, Professor Jun Hyuk Hong from South Korea introduced us the differences in the incidence and mortality of prostate cancer in China, South Korea, and European and American countries.Suggestions are given to reduce the risk.According to GLOBOCAN 2018 data, from a global perspective, prostate cancer is the second most common malignancy in men, with the fifth highest mortality rate, far lower than lung cancer.Judging from regional disease control data, the incidence and mortality of prostate cancer in East Asian countries are low, which are 13.9% and 4.9%, respectively.Moreover, the age-standardized incidence (ASR) of East Asian countries is also lower than that of European and American countries, especially China.In East Asia as a whole, the incidence of prostate cancer in Japan has been curbed, albeit at a high level, but it has been curbed in South Korea, but it has entered a plateau. The incidence in Hong Kong is plateau. The prostate cancer in three regionsIncidence rates were significantly higher than in mainland China (except Hong Kong).The incidence in China (except Hong Kong) is gradually increasing, with an annual growth rate of 8.92%.In the United States, prostate cancer is the most common malignancy in men, with the second highest mortality rate after lung cancer.Since the US Food and Drug Administration (FDA) approved serum prostate specific antigen (PSA) as a screening indicator for prostate cancer in 1991, the diagnosis and treatment of prostate cancer has entered the “PSA era”.After the advent of PSA screening, the incidence of prostate disease in the United States has skyrocketed.Although the incidence has declined in the United States since then, it is still significantly higher than in the years without PSA screening.PSA testing plays an extremely important role in early detection of prostate cancer.Because of the high detection rate of prostate cancer, older men in Europe and the United States attach great importance to PSA screening.However, with the emergence of the results of ERSCP and PLCO in two large-scale randomized clinical trials of PSA screening in Europe and the United States, a great deal of controversy has arisen in the academic community.The ERSPC study conducted a 1: 1 control screening of 160,000 elderly men aged 55 to 69 in 7 European countries. After 13 years of follow-up, PSA screening reduced prostate cancer-specific mortality by 20%.There was no difference in total mortality.In the same period, the PLCO study performed approximately the same tests on 76,000 55- to 74-year-old men in the United States. After 15 years of follow-up, American researchers found that PSA screening did not help reduce prostate cancer deaths.Based on the above results, in 2012 the United States Preventive Services Task Force (USPSTF) issued a “Not Recommended PSA Screening” statement.As a result, the guidelines and consensus statements of European and American countries have also revised the serum PSA test recommendations.At the meeting, Professor Hong showed us the changes in the early detection of prostate cancer in clinical guidelines in Europe and the United States since 1992.In 1992, AUA (American Society of Urology) & ACS (American Chemical Society): annual PSA test and digital rectal examination of high-risk men aged> 50 and 40-50 years; 2002, ACS: only life expectancy> 10Early detection of patients in 2008; USPSTF in 2008: PSA screening is not recommended for men> 75 years of age; AUA & EUA (European Urological Society) in 2009: initial PSA testing can be as young as 40 years of age; 2013Years, AUA: Early PSA testing is not recommended for men with a life expectancy of <10-15 years.Asian population differs from Europe and the United States, prevention strategies should not be copied. As more and more studies related to race and genes have been introduced, scholars in the field of urology have found that the incidence and mechanism of prostate cancer in Asian and European and American populations cannot be ignoredThe difference.The recommendations of the European and American guidelines for PSA screening are not necessarily completely suitable for Asians, especially Chinese.According to a report by Professor Dingwei Ye from the Cancer Hospital Affiliated to Fudan University at this year's CSCO academic conference, we know that although prostate cancer death rates in South Korea and Japan are high, they have been curbed; while in mainland China, prostate cancer death rates have risen significantly, with an annual growth rate.It reached 13.37%.In addition, the baseline PSA levels of all age groups in North America are higher than those of the Chinese and Asian populations.If diagnosis and treatment are performed according to Western PSA standards, a large number of Chinese prostate cancer cases may be masked, delaying diagnosis and treatment.In addition, the staging composition and cure rate of prostate cancer in China are significantly different from those reported in Europe and the United States: only 7.9% of prostate cancer patients in the non-screening group in the European screening study had metastasis, and the mortality rate of prostate cancer patients was only 9%;The metastasis rate of cancer patients is 70%, and the long-term survival rate is only 30%.At the meeting, Professor Hong from South Korea showed us several sets of data.Compared with the incidence of prostate cancer in the rural population, the incidence in China's urban population is more than double.Professor Hong pointed out in the report that this is related to the PSA screening conducted by urban health institutions.In Korea, the incidence of prostate cancer is also rising.This is also mainly related to PSA screening.Professor Hong pointed out that the annual cancer report released by the South Korean government in 2019 shows that with the continuous improvement of screening, diagnosis and treatment technology, even if the incidence is increasing, the 5-year survival rate of patients with prostate cancer has gratifying results.Koreans, Caucasians, and African Americans have significantly different pathological stages, and survival rates at different stages of prostate cancer are also significantly different.The "Asian Prostate Cancer White Paper" released in 2017 shows that the staging data when the Asian population is diagnosed with prostate cancer shows that the number of cases at the time of diagnosis is already in the middle and late stages.The main reasons for this result are the differences in PSA detection rates between regions and the low awareness of detection.Therefore, Professor Hong called on the government and doctors to promptly inform patients with prostate risk factors to conduct serum PSA testing in a timely manner.In addition, according to the "Asian Prostate Cancer White Paper" data, by 2030, the number of prostate cancer deaths in major Asian countries will double.According to Professor Hong, there are two main reasons for the significant increase in mortality: one is the problem of population aging in Asia, and the estimated ageing population will reach 932 million by 2050; the other is that urbanization and industrialization have exacerbated Asia.The occurrence and development of prostate cancer in the population include factors such as more animal fat intake, less physical exercise and more serious environmental pollution.Asian countries should attach importance to PSA screening for prostate cancer in men in Asia. Compared with European and American countries, PSA has its own characteristics.Although the incidence is lower than in European and American countries, it may be because the PSA screening is not in place and the incidence is currently increasing.Because of population aging, urbanization and industrialization, and other factors, mortality rates remain high.Pathologically, the staging of prostate cancer is later in the Asian population, and the Gleason score is higher, suggesting a worse to solve this problem?Different countries place different emphasis on PSA screening, and nationals have different opportunities for early diagnosis, which can lead to differences in morbidity and mortality.In South Korea, because prostate cancer has a lower mortality rate than lung cancer and breast cancer, the government has not paid enough attention to PSA screening, and a nationwide screening defense system has not yet been established.But we are actively working to add PSA screening to the national medical examination program.Professor Hong called, "I hope that governments and medical institutions in Asia will strengthen men's PSA screening and education about their pros and cons.To prevent cancer, in addition to strengthening screening, you can start by changing bad eating habits. A study of Asian immigrants has shown that a "westernized" lifestyle has led to an increased incidence of prostate cancer.For example, compared with the native Chinese population, the incidence of frontline cancer among Chinese people living in the United States has increased by 16 times. Professor Hong reminded that these eating habits increase the risk of prostate cancer: Excessive intake of red meat, bad fat, dairy products and eggsOverweight and obesity; smoking and drinking; ingestion of daidzein and isoflavones (common in soy products). These eating habits can reduce the risk of prostate cancer: eat more fish; increase vegetables, fruits, soy products, dietary fiberIntake of green tea or coffee; Strengthen physical exercise in moderation.Finally, Professor Hong concluded that Asians and European and American populations have different characteristics, and Asian countries should cooperate with each other to establish their own statistical centers for prostate cancer registration.In addition, traditional prognostic factors such as PSA, Gleason score, and clinical stage are not sufficient, and new genetic markers targeting Asians have yet to be discovered.The above content is only authorized by for exclusive use, please do not reprint without authorization of the copyright party.


The author ouyangshaoxia