How is metastatic prostate cancer detected and treated in men over 70?
National guidelines on prostate cancer screening with the PSA test are set by the US Preventive Services Task Force (USPSTF).
使用 PSA 检测进行前列腺癌筛查的国家指南由美国预防服务工作组 (USPSTF) 制定。
This independent panel of experts in preventive and primary care recommends against screening for prostate cancer in men older than 70.
这个由预防和初级保健领域的独立专家小组建议不要对 70 岁以上的男性进行前列腺癌筛查。
Why?
为什么？
Prostate cancer tends to be slow-growing.
前列腺癌往往生长缓慢。
Men in this age group are more likely to die with the disease rather than from it.
这个年龄段的男性更有可能死于这种疾病，而不是死于疾病。
And in the view of the USPSTF, survival benefits from treating PSA-detected prostate cancer in older men are unlikely to outweigh the harms of treatment.
USPSTF 认为，治疗 PSA 检测到的老年男性前列腺癌的生存获益不太可能超过治疗的危害。
Still, that leaves open the possibility that men could be screened for prostate cancer only after their disease has advanced to symptomatic stages.
尽管如此，这仍然存在一种可能性，即男性只有在疾病进展到有症状阶段后才能进行前列腺癌筛查。
For a perspective on PSA screening and advanced prostate cancer treatment in older men, we spoke with Dr. Marc B.
为了了解老年男性 PSA 筛查和晚期前列腺癌治疗的观点，我们采访了 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。
Q.
问。
How often should men over the age of 70 be screened for prostate cancer?
70 岁以上的男性应该多久接受一次前列腺癌筛查？
Such testing is performed outside of guidelines, and generally following a discussion with the patient's physician.
此类测试是在指南之外进行的，并且通常是在与患者的医生讨论之后进行的。
It's not unusual for us to find advanced metastatic prostate cancer in older men flagged by a PSA test.
我们在老年男性中通过 PSA 检测发现晚期转移性前列腺癌并不罕见。
The disease might spread asymptomatically, but some men get a PSA test only after they have advanced prostate cancer symptoms such as trouble urinating, fatigue, or bone pain.
这种疾病可能会无症状传播，但有些男性仅在出现排尿困难、疲劳或骨痛等晚期前列腺癌症状后才进行 PSA 检测。
The USPSTF's PSA screening guidelines are long overdue for an update - they were last published in 2018.
USPSTF 的 PSA 筛选指南早就该更新了 - 它们上次发布于 2018 年。
And with life expectancy increasing overall for men over 70, we are all anxiously awaiting the new guidelines, which are generally updated every six years.
随着 70 岁以上男性的预期寿命总体增加，我们都在焦急地等待新的指导方针，该指导方针通常每六年更新一次。
Q.
问。
What sort of other tests follow after a positive result with PSA screening?
PSA 筛查结果呈阳性后，还需要进行哪些其他测试？
Typically, a prostate needle biopsy.
通常，前列腺穿刺活检。
And I also recommend a digital rectal exam (DRE) to feel for any abnormalities in the prostate gland.
我还建议进行直肠指检 (DRE)，以感觉前列腺是否有任何异常。
President Biden was having urinary symptoms at the time of his PSA test, and he was reported to have had a nodule noted on his DRE.
拜登总统在接受 PSA 检测时出现泌尿系统症状，据报道，他的 DRE 上发现了一个结节。
We do not know what his PSA score was.
我们不知道他的 PSA 分数是多少。
Recently, we've been moving toward magnetic resonance imaging scans of the prostate that provide more diagnostic information, and can serve as a guide to more precisely identify abnormalities in the prostate gland that we can sample with a biopsy.
最近，我们一直致力于前列腺的磁共振成像扫描，它可以提供更多的诊断信息，并可以作为更精确地识别前列腺异常的指南，我们可以通过活检取样。
Q.
问。
How do we know if the cancer is likely to spread aggressively?
我们如何知道癌症是否可能积极扩散？
The more aggressive tumors have cells with irregular shapes and sizes that can invade into adjoining tissues.
更具侵袭性的肿瘤具有形状和大小不规则的细胞，可以侵入邻近的组织。
A time-honored measure called the Gleason score grades the two most common cancer cell patterns that pathologists see on a biopsy sample.
一种名为“格里森评分”的历史悠久的衡量标准对病理学家在活检样本上看到的两种最常见的癌细胞模式进行了分级。
That system has now undergone some labelling changes.
该系统现在已经进行了一些标签更改。
To simplify matters, doctors developed a five-tier grading system that ranks tumors from Grade Group 1 - the least dangerous - to Grade Group 5, which is the most dangerous.
为了简化问题，医生开发了一个五级分级系统，将肿瘤从危险性最低的 1 级到危险性最高的 5 级。
These Grade Groups still correlate with Gleason scores.
这些等级组仍然与格里森分数相关。
For instance, a Gleason score of 3+3=6 correlates with Grade Group 1 for low-risk prostate cancer, whereas a Gleason score of 4+5=9 for high-risk disease correlates with Grade Group 5.
例如，对于低风险前列腺癌，3+3=6 的格里森评分与 1 级相关，而对于高风险疾病，4+5=9 的格里森评分与 5 级相关。
We can also evaluate how fast cancer cells are dividing - this measure is called mitotic rate - or order genetic tests that provide additional information.
我们还可以评估癌细胞分裂的速度 - 这种测量称为有丝分裂率 - 或进行基因测试以提供更多信息。
We know that men who test positive for inherited BRCA1 and BRCA2 gene mutations are at risk for more aggressive disease, for instance.
例如，我们知道，遗传性 BRCA1 和 BRCA2 基因突变检测呈阳性的男性面临罹患更具侵袭性疾病的风险。
BRCA test results also have implications for family members, since the same mutations elevate risks for other inherited cancers including breast cancer and ovarian cancer.
BRCA 检测结果对家庭成员也有影响，因为相同的突变会增加其他遗传性癌症（包括乳腺癌和卵巢癌）的风险。
Q.
问。
How do you know if the cancer is metastasizing?
您如何知道癌症是否正在转移？
Traditionally, patients would get a computed tomography scan of the abdomen and pelvis along with a bone scan.
传统上，患者会接受腹部和骨盆的计算机断层扫描以及骨扫描。
These tests look for metastases in the lymph nodes and bones, but they are increasingly outdated.
这些测试寻找淋巴结和骨骼中的转移，但它们越来越过时。
These days, doctors are more likely to scan for a protein called prostate-specific membrane antigen (PSMA) that can be expressed at high levels on tumor cell surfaces.
如今，医生更有可能扫描一种称为前列腺特异性膜抗原（PSMA）的蛋白质，这种蛋白质可以在肿瘤细胞表面高水平表达。
A PSMA scan is much better at detecting prostate tumors in the body that are still too small to see with other imaging tests.
PSMA 扫描可以更好地检测体内前列腺肿瘤，这些肿瘤仍然太小而无法通过其他成像测试看到。
If the scans show evidence of metastatic spread, we classify men as having either high- or low-volume disease depending on the extent.
如果扫描显示转移扩散的证据，我们根据程度将男性分为高容量或低容量疾病。
Men with no more than three to five metastases are described as having oligometastatic prostate cancer.
转移灶不超过三到五个的男性被描述为患有寡转移性前列腺癌。
Q.
问。
What treatment options are available for metastatic prostate cancer?
转移性前列腺癌有哪些治疗方案？
We generally don't begin with a single drug.
我们通常不会从单一药物开始。
Men with low-volume metastatic prostate cancer typically get doublet therapy, which is a combination of two drugs that each starve tumors of testosterone, a hormone that prostate cancer needs to grow.
患有小体积转移性前列腺癌的男性通常会接受双重疗法，这是两种药物的组合，每种药物都会使肿瘤缺乏睾酮，睾酮是前列腺癌生长所需的激素。
One of the drugs, called leoprolide (Lupron), blocks testosterone production.
其中一种药物称为利奥普瑞林（Lupron），可阻止睾酮的产生。
The other drugs are drawn from a class of medications that prevent testosterone from binding to its cell receptor.
其他药物来自一类阻止睾酮与其细胞受体结合的药物。
Those drugs are called androgen receptor pathway inhibitors (ARPIs).
这些药物被称为雄激素受体途径抑制剂（ARPIs）。
They include enzalutamide (Xtandi), daralutamide (Nubeqa), apaludamide (Erleada), or another drug with a slightly different mechanism called abiraterone (Zytiga).
它们包括恩杂鲁胺 (Xtandi)、达拉鲁胺 (Nubeqa)、阿帕鲁胺 (Erleada) 或另一种机制略有不同的药物，称为阿比特龙 (Zytiga)。
If the cancer progresses on doublet therapy, then we can add chemotherapy to the mix.
如果双重治疗后癌症进展，那么我们可以添加化疗。
This is called triplet therapy (Lupron + ARPI + chemotherapy).
这称为三联疗法（Lupron + ARPI + 化疗）。
We may also recommend immediate triplet therapy depending upon the extent of the cancer spread.
我们还可能建议根据癌症扩散的程度立即进行三联疗法。
Some men are eligible for other treatments as well.
有些男性也有资格接受其他治疗。
For instance, men with PSMA-positive disease (meaning their cells express the protein in high amounts) can be treated with an intravenously-delivered therapy called Lutetium-177.
例如，患有 PSMA 阳性疾病（意味着他们的细胞大量表达这种蛋白质）的男性可以使用一种名为 Lutetium-177 的静脉注射疗法进行治疗。
Known as a radioligand, this type of therapy seeks out PSMA-expressing cells and kills them with tiny radioactive particles.
这种疗法被称为放射性配体，它寻找表达 PSMA 的细胞并用微小的放射性粒子杀死它们。
Some men are eligible for metastasis-directed therapy (MTD).
有些男性有资格接受转移导向治疗（MTD）。
In such cases, we treat metastatic deposits with highly focused beams of radiation delivered from outside the body.
在这种情况下，我们用从体外发射的高度聚焦的辐射束治疗转移性沉积物。
MTD is generally reserved for patients with oligometastatic prostate cancer.
MTD 通常适用于寡转移性前列腺癌患者。
Q.
问。
What happens if a patient is positive on a genetic test for prostate cancer?
如果患者前列腺癌基因检测呈阳性会怎样？
That opens up options for so-called targeted therapy - which is a term we use to describe treatments that target specific cell changes that cause tumors to grow.
这为所谓的靶向治疗提供了选择——我们用这个术语来描述针对导致肿瘤生长的特定细胞变化的治疗方法。
Patients with BRCA1 or BRCA2 mutations, for instance, can start on doublet therapy plus a targeted therapy called a PARP inhibitor.
例如，患有 BRCA1 或 BRCA2 突变的患者可以开始接受双重治疗加上称为 PARP 抑制剂的靶向治疗。
Two PARP inhibitors are approved for prostate cancer in BRCA-positive men: olaparib (Lynparza) and rucaparib (Rubraca).
两种 PARP 抑制剂被批准用于治疗 BRCA 阳性男性的前列腺癌：olaparib (Lynparza) 和 rucaparib (Rubraca)。
Men with a different gene mutation called microsatellite instability are eligible for a targeted drug called pembrolizumab (Keytruda).
患有微卫星不稳定性的不同基因突变的男性有资格使用一种名为派姆单抗（Keytruda）的靶向药物。
Q.
问。
How is the outlook for metastatic prostate cancer changing?
转移性前列腺癌的前景如何变化？
It's improving dramatically!
它正在显着改善！
Metastatic prostate cancer used to carry a very poor prognosis.
过去，转移性前列腺癌的预后非常差。
Today, it's not unusual for men to live 10 years or longer with the disease.
如今，男性患有这种疾病能活 10 年或更长时间已经很常见了。
We're even starting to treat cancer in the prostate directly - something we didn't do in the past since the cancer had already spread beyond the prostate gland.
我们甚至开始直接治疗前列腺癌——这是我们过去没有做过的，因为癌症已经扩散到前列腺之外。
More recent studies have shown improvements from delivering radiation to the prostate gland itself in patients with metastatic cancer.
最近的研究表明，对转移性癌症患者的前列腺本身进行放射治疗可以带来改善。
We're including these treatments more often now, which is something we wouldn't have considered before.
我们现在更频繁地采用这些治疗方法，这是我们以前不会考虑的。
I would advise men to undergo a cardiac evaluation prior to starting on hormonal therapy.
我建议男性在开始激素治疗之前进行心脏评估。
Hormonal therapies can exacerbate cardiovascular risk factors, so these should be addressed before and during treatment.
激素疗法会加剧心血管危险因素，因此应在治疗前和治疗期间解决这些问题。
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
As a service to our readers, Harvard Health Publishing provides access to our library of archived content.
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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