Just retired, it "started work"! Will prostatitis develop into prostate cancer? How should middle-aged and elderly men avoid it →

Because it is more common in people over 60 years old, which is the retirement age for most men, prostate cancer is also jokingly called "retirement cancer". In daily life, frequent urination, urgency, and incomplete urination... prostatitis and prostatic hyperplasia are troubles for many middle-aged and elderly men. But can the prostate gland become cancerous? Can prostatitis and prostatic hyperplasia turn into prostate cancer? How can we prevent it?

Case

Mr. Li, 59, is about to retire. He usually eats well, drinks well, sleeps well, has no worries, and feels healthy. Before the unit physical examination in January 2022, he did not notice anything unusual in his body, except for slight frequent urination. Soon, the physical examination report came out, and the prostate-specific antigen (PSA) was slightly elevated to 4.45ng/ml. At first, Mr. Li did not care too much. The doctor told him that there were many factors for the increase, and he could observe first and do regular check-ups. In May and September 2022, Mr. Li followed the doctor's advice for a follow-up examination, but the PSA value did not drop. In September, the PSA value increased to 5.77ng/ml. The prostate MRI examination indicated prostate hyperplasia, and no signs of tumors were found. However, considering that Mr. Li's PSA value continued to rise, and the amplitude was large. In order to further explore the cause, the doctor recommended a prostate puncture biopsy.

"The MRI examination was fine, I don't believe I have prostate cancer." At first, Mr. Li was reluctant to have a puncture biopsy, thinking that PSA testing is not only for prostate cancer, but also for prostatitis and prostate hyperplasia. After a detailed analysis of Mr. Li's condition, he finally agreed to a biopsy. According to the test results, Mr. Li was pathologically diagnosed with early prostate cancer and underwent radical prostatectomy in October 2022. After a period of recovery, Mr. Li's PSA value dropped to below 0.01ng/ml, and the treatment effect was good, achieving clinical cure.

Urinary system cancer with the highest incidence rate

The prostate is a gland that is specific to men and is located between the bladder and rectum. It can often be felt through a rectal digital examination. The prostate is generally the size of a chestnut and will increase in size with age.

The prostate gland can be divided into the peripheral zone, central zone, transitional zone and periurethral glandular area. Most of all benign prostate tumors, namely prostate hyperplasia nodules, occur in the transitional zone and periurethral glandular area. Prostate cancer refers to the malignant proliferation of prostate tissue cells under the influence of carcinogenic factors. These cancerous nodules often occur in the peripheral zone, and their cancer cells can spread to other parts of the body through the blood.

Prostate cancer is a common malignant tumor of the male urinary and reproductive system, and its incidence ranks second among all male malignant tumors worldwide. The incidence of prostate cancer is closely related to age. It usually occurs after the age of 50, and the incidence of prostate cancer increases exponentially after the age of 70. In recent years, with the arrival of an aging society, the improvement of living standards, and the enhancement of people's awareness of physical examinations, the incidence of prostate cancer has increased year by year, and it has now become the malignant tumor with the highest incidence rate in the urinary system.

Genetics, smoking, and a diet high in animal fats increase risk

The risk factors for prostate cancer are not yet fully understood, but the factors that have been confirmed include race, age, and genetic factors. Among them, the genetic factors of prostate cancer are very important. According to statistics, the brothers of prostate cancer patients have a three times higher risk of prostate cancer than other people, and are more likely to develop the disease at an early age.

Other possible factors include sex hormone levels, smoking, obesity, etc. Several studies and analyses have shown that smoking has the greatest relationship with lung cancer, followed by cardiovascular and cerebrovascular diseases, and smokers have a higher rate of prostate cancer.

In addition, prostate cancer has a certain relationship with diet. A high-animal fat diet can increase the risk of prostate cancer, and insufficient intake of vitamin E, selenium, etc. is also a risk factor.

There are usually no specific symptoms in the early stages, similar to prostate hyperplasia.

The symptoms of prostate cancer in the early stages of the disease are consistent with those of prostate hyperplasia, and the two can exist at the same time, so the early symptoms are not specific.

When the tumor compresses the urethra or invades the bladder or the end of the ureter, it can cause symptoms such as dysuria, hematuria, and hydronephrosis. Since prostate cancer can easily metastasize to bones through the blood, a considerable number of patients go to the hospital for bone pain. At this point, it is diagnosed as advanced prostate cancer. Therefore, early detection and timely treatment are very important.

Digital rectal examination combined with PSA is the best screening method

Prostate-specific antigen (PSA) is a protein that is highly specific to the prostate organ. By taking a blood test for PSA, combined with the patient's symptoms and other tests, early diagnosis of prostate cancer can be made and the progression of the disease can be tracked.

Under normal circumstances, 0~4ng/mL is generally used as the normal reference range for prostate cancer, but normal PSA does not exclude the risk of prostate cancer, it just means that the risk of cancer is relatively small. When PSA is between 4~10ng/ml, the risk of prostate cancer in the Chinese population is 25%. When PSA>10ng/ml, the risk of cancer increases exponentially, up to about 66%.

However, PSA cannot completely determine whether or not one has prostate cancer, as well as the severity of prostate cancer, because prostate hyperplasia, prostatitis, urinary retention, urethral manipulation, etc. can all lead to elevated PSA. Clinically, when the PSA value is abnormal, the doctor will perform a combined screening through a rectal digital examination, which is also recognized as the best method for early prostate cancer screening.

If the above methods are unable to make a preliminary diagnosis of prostate cancer, then a puncture biopsy is the gold standard for diagnosis.

Quit smoking and drinking, eat more tomatoes and soy products

Men over 50 are recommended to have a PSA test every year

From the perspective of the risk factors for prostate cancer, prevention can be achieved by quitting smoking and drinking, adjusting diet structure and habits, and changing living environment. Eat less spicy and irritating foods, eat more vegetables and fruits, and eat more bean products rich in plant protein. Studies have found that eating more tomatoes and bean products can effectively reduce the risk of prostate cancer, and green tea may also be a preventive factor; pay more attention to exercise and physical exercise; quit smoking and drinking, stay up less late, and develop good work and rest habits.

PSA is still the most important and effective means of detecting early prostate cancer. According to the 2019 CUA guidelines, it is recommended that the following groups undergo PSA testing and other related screening every year.

1. Males over 50 years old;

2. Men aged >45 years with a family history of prostate cancer;

3. Men aged >40 years with baseline PSA >1ng/ml.

Two questions about the prostate

1.Is prostate calcification the same as prostatitis?

No.

Normal urine contains a lot of crystalline salt components, such as calcium ions and sodium ions. During male urination or ejaculation, factors such as the contraction of the prostate and urethra muscles can cause urine to flow back from various openings into the prostate tissue. Over time, these crystalline salt components gradually precipitate to form small stones or crystals, which appear as calcification foci on color Doppler ultrasound. Prostatitis is divided into acute and chronic, and can be divided into bacterial and non-bacterial. The vast majority of patients, especially young and middle-aged patients, suffer from chronic non-bacterial prostatitis. Chronic non-bacterial prostatitis is an aseptic inflammation of the prostate area. Most people with prostate calcification will have chronic prostatitis, but the two are not the same thing. Prostate calcification generally does not require treatment. Chronic prostatitis can be relieved by promoting local blood circulation through warm water sitz baths or local hot compresses, and some Chinese patent medicines can also be taken orally for symptomatic treatment.

2. Will prostatitis develop into prostate cancer?

No.

Prostatitis can be divided into bacterial and non-bacterial according to the cause. It is more common in young people, especially drivers, teachers, office workers and other sedentary people. It is also common in teenagers who frequently masturbate and have uncontrolled sex. Most people have chronic non-bacterial prostatitis. From the perspective of pathogenesis, prostatitis is a sterile inflammation, similar to arthritis and gastritis. This chronic inflammation will not develop into a tumorous lesion. Therefore, friends with chronic prostatitis should not be too stressed, relax their minds, and follow the doctor's professional advice for treatment. The most important way to prevent prostate cancer is to conduct early PSA screening as mentioned above.

Source: Chongqing University Cancer Hospital

Author: Yuan Gangjun, attending physician of the Department of Urological Oncology, Affiliated Cancer Hospital of Chongqing University, Doctor of Medicine

Audit expert: Liu Nan

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