Can men hold off on treating recurring prostate cancer?
What happens if PSA levels start rising after surgery or radiation for prostate cancer?
如果前列腺癌手术或放疗后 PSA 水平开始上升，会发生什么？
Up to a third of men treated for the disease will eventually confront this problem.
多达三分之一的接受该疾病治疗的男性最终将面临这个问题。
If there's no accompanying evidence of cancer on imaging scans, then men have what's called a biochemical recurrence.
如果影像扫描没有伴随癌症证据，那么男性就会出现所谓的生化复发。
This means that PSA - the biochemical marker in this case - is flagging the presence of cancer cells that doctors are still unable to see.
这意味着 PSA（本例中的生化标记物）正在标记医生仍无法看到的癌细胞的存在。
Biochemically recurring cancer is asymptomatic, and it can take years for visible metastases to appear.
生化复发性癌症是无症状的，可能需要数年时间才会出现可见的转移。
Sometimes men live the rest of their lives with a rising PSA without ever developing metastases.
有时，男性在 PSA 升高的情况下度过余生，却从未发生转移。
Now, an ultra-sensitive scanning technology is raising new questions about biochemical recurrence and how to manage it.
现在，超灵敏扫描技术提出了有关生化复发及其控制的新问题。
This scan works by illuminating a protein on cancer cells called prostate-specific membrane antigen (PSMA).
这种扫描的工作原理是照亮癌细胞上一种称为前列腺特异性膜抗原 (PSMA) 的蛋白质。
A PSMA scan can reveal small tumors in the body that older, conventional imaging technologies, such as bone scans or magnetic resonance imaging, are unable to detect.
PSMA 扫描可以显示体内较旧的传统成像技术（例如骨扫描或磁共振成像）无法检测到的小肿瘤。
Doctors have coined a new term for this condition: (PSMA) + BCR.
医生为这种情况创造了一个新术语：(PSMA) + BCR。
When a man has biochemical recurrence as it's traditionally defined, with no evidence of cancer on conventional imaging, doctors base treatment decisions on additional factors, such as how fast PSA levels are rising.
当一名男性出现传统定义的生化复发时，且常规影像学上没有癌症证据，医生会根据其他因素做出治疗决定，例如 PSA 水平上升的速度。
If treatment is initiated, then a standard approach is to give drugs that block testosterone, a hormone that drives prostate cancer to grow and spread.
如果开始治疗，标准方法是给予阻断睾酮的药物，睾酮是一种促进前列腺癌生长和扩散的激素。
But doctors might also delay that treatment, since biochemical recurrence tends to proceed slowly, if at all.
但医生也可能会推迟治疗，因为生化复发往往进展缓慢（如果有的话）。
What if a man has (PSMA) + BCR?
如果一个男人有 (PSMA) + BCR 怎么办？
Then things get a bit more complicated.
然后事情就变得有点复杂了。
Since the scan does show metastases, many doctors are inclined to treat aggressively without delay, in some cases using powerful combinations of hormonal therapies that have considerable side effects.
由于扫描确实显示转移，许多医生倾向于立即积极治疗，在某些情况下使用具有相当大副作用的强大激素疗法组合。
However, some experts are calling for a more nuanced approach.
然而，一些专家呼吁采取更细致的方法。
"We've encountered situations where patients have small cancerous lesions on a PSMA scan that don't necessarily grow," says Dr. David Einstein, Disease Group Leader of the Genitourinary Medical Oncology Program at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School.
“我们遇到过这样的情况，患者在 PSMA 扫描中发现微小的癌性病变，但不一定会生长，”贝斯以色列女执事医疗中心泌尿生殖肿瘤医学项目疾病组组长、哈佛医学院助理教授 David Einstein 博士说。
That it's possible to hold off on treating PSMA-detected disease may be surprising to some busy doctors who lump such cases together with metastatic cancer.
对于一些忙碌的医生来说，推迟治疗 PSMA 检测到的疾病可能会感到惊讶，他们将此类病例与转移性癌症混为一谈。
But Dr. Einstein says doctors shouldn't lose sight of what's already known from studying patients with biochemical recurrence.
但爱因斯坦博士表示，医生不应该忽视通过研究生化复发患者已经了解到的情况。
Where metastatic cancer that shows upon conventional imaging is considered serious and aggressive (though progression varies from person to person), biochemical recurrence can be associated with a decade or more of survival, and that's likely true "for at least some PSMA-detected recurrences as well," Dr. Einstein says.
爱因斯坦博士说，传统成像显示的转移性癌症被认为是严重且具有侵袭性的（尽管进展因人而异），生化复发可能与十年或更长时间的生存有关，“至少对于一些 PSMA 检测到的复发来说，这可能是正确的。”
"Many, if not most, men" with PSMA-detected recurrence face "no imminent threat of morbidity or mortality from their prostate cancer," Dr. Einstein and his colleagues wrote in a paper last year.
爱因斯坦博士和他的同事去年在一篇论文中写道，“许多（如果不是大多数）患有 PSMA 复发的男性”不会面临前列腺癌发病或死亡的迫在眉睫的威胁。
Dr. Einstein says accelerated treatments for PSMA-detected recurrence may in some cases do little more than add years of toxic side effects to a man's life.
爱因斯坦博士说，在某些情况下，针对 PSMA 检测到的复发进行加速治疗可能只会给男人的生活增加多年的毒副作用。
There's still no evidence that treating biochemical recurrence actually improves survival, though it can delay progression and keep further PSA increases in check.
仍然没有证据表明治疗生化复发确实可以提高生存率，尽管它可以延缓进展并控制 PSA 的进一步增加。
Researchers are now studying the "natural history" of prostate cancers that reappear and are detected only with PSMA scans.
研究人员现在正在研究前列腺癌的“自然史”，这些癌症只能通过 PSMA 扫描才能重新出现和检测到。
This means they are looking at where and when the disease tends to spread and how it behaves over time, including responding to treatment.
这意味着他们正在研究疾病倾向于传播的地点和时间，以及它随着时间的推移如何表现，包括对治疗的反应。
They are also in the process of developing clinical trials for new treatments that might have longer-lasting benefits than hormonal therapies.
他们还正在开发新疗法的临床试验，这些新疗法可能比激素疗法具有更持久的益处。
In the meantime, Dr. Einstein says, decisions on how to handle recurring cancer spotted by PSMA scanning should take other factors into account: They include:
与此同时，爱因斯坦博士说，在决定如何处理 PSMA 扫描发现的复发性癌症时，应考虑其他因素：它们包括：
"The advanced technology of PSMA scanning that detects very small deposits of cancer has raised important treatment questions that are now being actively studied," says Dr. Marc B.
Marc B.
Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases.
加尼克是哈佛医学院和贝斯以色列女执事医疗中心的戈尔曼兄弟医学教授，也是哈佛医学院前列腺疾病指南的主编。
"Dr. Einstein's leadership is providing much needed guidance on how to manage prostate cancer recurrence detected by PSMA scanning," says Dr. Garnick.
“爱因斯坦博士的领导力为如何管理通过 PSMA 扫描检测到的前列腺癌复发提供了急需的指导，”加尼克博士说。
"Delaying or postponing treatments that would in the past have been given immediately is a strategy that is often embraced by our patients."
“推迟或推迟过去需要立即进行的治疗是我们患者经常接受的策略。”
C.W.
C.W.
Schmidt , Editor, Harvard Medical School Annual Report on Prostate Diseases
施密特，哈佛医学院前列腺疾病年度报告编辑
Marc B.
马克·B.
Garnick, MD , Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing
Garnick，医学博士，哈佛医学院前列腺疾病年度报告主编；哈佛健康出版社编辑顾问委员会成员
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作为为读者提供的一项服务，哈佛健康出版社提供对我们存档内容库的访问。
Please note the date of last review or update on all articles.
请注意所有文章的最后审查或更新日期。
No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
本网站上的任何内容，无论日期如何，都不应替代您的医生或其他合格临床医生的直接医疗建议。
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