前列腺癌6大谜团
2012-08-26 11:12:29 来源：
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Six common myths about prostate cancer
前列腺癌6大谜团
When it comes to prostate cancer, there's a lot of confusion about how to prevent it, find it early and the best way - or even whether - to treat it. Below are six common prostate cancer myths along with research-based information from scientists at Fred Hutchinson Cancer Research Center to help men separate fact from fiction.
当涉及到前列腺癌时，关于如何预防、早期发现，以及最好的治疗方法或者是否需要治疗有很多困惑。以下是前列腺癌的六大常见谜团以及来自Fred Hutchinson癌症研究中心的科学家们关于前列腺癌以研究为基础的有关信息
Myth 1 Eating tomatobased products such as ketchup and red pasta sauce prevents prostate cancer. "The vast majority of studies show no association," said Alan Kristal, Dr.Ph., associate director of the Hutchinson Center's Cancer Prevention Program and a national expert in prostate cancer prevention. Kristal and colleagues last year published results of the largest study to date that aimed to determine whether foods that contain lycopene the nutrient that puts the red in tomatoes - actually protect against prostate cancer.
谜 团一——吃番茄酱和红粉意酱番茄类食品可以预防前列腺癌。Hutchinson 中心癌症预防计划和一个全国性的前列腺癌预防专家组副主任Alan Kristal博士说：“绝大多数的研究显示两者之间没有任何联系。” Kristal和同事们去年发表了一项迄今为止最大的针对含有番茄红素（一种使番茄呈红色的营养物）的食物是否真的能预防前列腺癌的研究结果。
After examining blood levels of lycopene in nearly 3,500 men nationwide they found no association. "Scientists and the public should understand that early studies supporting an association of dietary lycopene with reduced prostate cancer risk have not been replicated in studies using serum biomarkers of lycopene intake," the authors reported in Cancer Epidemiology, Biomarkers & Prevention. "Recommendations of professional societies to the public should be modified to reflect the likelihood that increasing lycopene intake will not affect prostate cancer risk."
通 过检测全国3500名男性血液中番茄红素的水平后他们发现没有任何联系。作者在Cancer Epidemiology, Biomarkers & Prevention杂志中指出“科学家和公众应该明白早期的有关膳食番茄红素和前列腺癌的风险降低之间有某种联系的研究不能再运用摄入番茄红素的血清生 物标记物在以后的研究中复制。”“专家对公众的建议应该修改为增加番茄红素的摄入可能不会降低患前列腺癌风险。
Myth 2 High testosterone levels increase the risk of prostate cancer. "This is a lovely hypothesis based on a very simplistic understanding of testosterone metabolism and its effect on prostate cancer. It is simply wrong," Kristal said. Unlike estrogen and breast cancer, where there is a very strong relationship, testosterone levels have no association with prostate cancer risk, he said. A study published in 2008 in the Journal of the National Cancer Institute, which combined data from 18 large studies, found no association between blood testosterone concentration and prostate cancer risk, and more recent studies have confirmed this conclusion.
谜 团二——高睾丸激素水平会增加前列腺癌的风险。Kristal说：“这是一个非常可爱的假设——基于对睾丸激素的代谢和对前列腺癌影响的非常简单的理解， 可惜是错的。”他说：不像雌激素和乳腺癌之间有很强的联系，睾丸激素水平和前列腺癌之间没有联系。一项2008年发表在国际顶级杂志Journal of the National Cancer Institute的研究整合了18个大型研究的数据发现血清睾丸激素的浓度和前列腺癌之间没有任何联系，并且最近的研究进一步证实了这一结论。
Myth 3 Fish oil (omega3 fatty acids) decrease prostate cancer risk. "This sounds reasonable, based on an association of inflammation with prostate cancer and the antiinflammatory effects of omega3 fatty acids," Kristal said. However, two large, welldesigned studies including one led by Kristal that was published last year in the American Journal of Epidemiology have shown that high blood levels of omega3 fatty acids increase the odds of developing highrisk prostate cance
谜 团三——鱼肝油（omega-3脂肪酸）降低前列腺癌风险。Kristal 说：“根据前列腺癌与炎症之间的联系以及omega-3脂肪酸的抗炎作用，这听起来很合理。”然而，两项大型的、设计良好的研究表明血液中高水平的 omega-3脂肪酸增加患前列腺癌的风险，其中的一项研究由Kristal领导，去年发表在《美国流行病学杂志》上。
Analyzing data from a nationwide study of nearly 3,500 men, they found that those with the highest blood percentages of docosahexaenoic acid, or DHA, an inflammation-lowering omega-3 fatty acid commonly found in fatty fish, have two-and-a-half times the risk of developing aggressive, high-grade prostate cancer compared to men with the lowest DHA levels. "This very sobering finding suggests that our understanding of the effects of omega-3 fatty acids is incomplete," Kristal said.
对 全国接近3500名男性的研究数据进行分析，他们发现血清中含有最高比例二十二碳六烯酸或者DHA的男性患侵袭性、高分期前列腺癌的比例是血清中最低比例 DHA的男性2到2.5倍。Krista说：“这项非常发人深省的发现表明我们对omega-3 脂肪酸作用的理解还不够。”
Myth 4 Dietary supplements can prevent prostate cancer. Several large, randomized trials that have looked at the impact of dietary supplements on the risk of various cancers, including prostate, have shown either no effect or, much more troubling, they have shown significantly increased risk. "The more we look at the effects of taking supplements, the more hazardous they appear when it comes to cancer risk," Kristal said. For example, the Selenium and Vitamin E Cancer Prevention Trial (SELECT), the largest prostate cancer prevention study to date, was stopped early because it found neither selenium nor vitamin E supplements alone or combined reduced the risk of prostate cancer. A SELECT followup study published last year in JAMA found that vitamin E actually increased the risk of prostate cancer among healthy men. The Hutchinson Center oversaw statistical analysis for the study, which involved nearly 35,000 men in the U.S., Canada and Puerto Rico.
谜 团四——膳食补充剂能够预防前列腺癌。几项大型的、随机的临床试验研究了膳食补充剂对各种癌症的影响，包括前列腺癌；结果表明要么没有影响、要么影响很 大。Kristal说：“当我们越期待膳食补充剂的效果时，它引起的肿瘤风险就显得危害越大。”例如：迄今为止最大的前列腺癌预防研究：硒和维生素E癌症 预防临床试验（SELECT）早些时候被叫停了，因为无论单独补充硒或者维生素E或者联合补充对减小前列腺癌的风险都没有作用。一项去年发表在JAMA的 选择性跟踪调查研究发现在健康男性中维生素E实际上增加了患前列腺癌的风险。Hutchinson中心审查了该项研究的数据分析，其中包括来自美国、加拿 大以及波多黎各的接近三万五千名男性。
Myth 5 We don't know which prostate cancers detected by PSA (prostatespecific antigen) screening need to be treated and which ones can be left alone. "Actually, we have a very good sense of which cancers have a very low risk of progression and which ones are highly likely to spread if left untreated," said biostatistician Ruth Etzioni, Ph.D., a member of the Hutchinson Center's Public Health Sciences Division.In addition to blood levels of PSA, indicators of aggressive disease include tumor volume (the number of biopsy samples that contain cancer) and Gleason score (predicting the aggressiveness of cancer by how the biopsy samples look under a microscope). Gleason scores range from 2-5 (low risk) and 6-7 (medium risk) to 8-10 (high risk).
谜 团五——我们不知道哪种通过PSA（前列腺特异性抗原）筛查的前列腺癌需要治疗，哪些不用管它。生物统计学家、Hutchinson 中心公共卫生科学系Ruth Etzioni 博士说：“事实上，我们对哪些类型的肿瘤不治疗是否容易进展有这很好的了解。”除了血清PSA的水平外，恶性疾病的指示物还包括肿瘤体积（活检样品有肿瘤 细胞的数量）和Gleason评分（通过显微镜下活检样品的组织形态预测肿瘤的侵袭性）。Gleason评分分为2-5分（低度恶性）、6-7分（中度恶 性）、8-10分（高度恶性）。
"Men with a low PSA level, a biopsy Gleason score of 6 or lower and very few biopsy samples with cancer are generally considered to be very low risk," Etzioni said. Such newly diagnosed men increasingly are being offered active surveillance watchful waiting approach rather than therapy for their disease, particularly if they are older or have a short life expectancy.
Etzioni说：“PSA低水平、活检Gleason评分为6分或低于6分以及活检中肿瘤细胞数量几乎没有的大体认为是低度恶性的。”这种新的诊断技术提供了一种新的积极的治疗方案-保守观察治疗，而不是对他们进行治疗，特别是老年人或者较短的预期寿命。
"The chance that these men will die of their disease if they are not treated is very low, around 3 percent," she said. Similarly, such men who opt for treatment have a mortality rate of about 2 percent. "For the majority of newly diagnosed cases of prostate cancer, giving initial clinical and biopsy information, we can get a very good idea of who should be treated and who is likely to benefit from deferring treatment."
她说：“如果这些患者不治疗，死于这种疾病的几率是很小的，大约3%。”同样地，如果这些患者选择治疗，死亡率大概为2%。“对于新近诊断的前列腺癌患者，提供刚开始的临床和活检信息，我们就能对哪些患者需要治疗以及哪些患者能从推迟治疗中受益有很好的了解。
Myth 6 Only one in 50 men diagnosed with PSA screening benefits from treatment. "This number, which was released as a preliminary result from the European Randomized Study of Prostate Cancer Screening, is simply incorrect," Etzioni said. "It suggests a very unfavorable harmbenefit ratio for PSA screening. It implies that for every man whose life is saved by PSA screening, almost 50 are overdiagnosed and overtreated."
谜 团六——只有五十分之一经过PSA检测的前列腺癌患者从治疗中受益。Etzioni 说：“作为欧洲前列腺癌筛查随机对照研究的初步结果，这一数字是不正确的。”“这提出了PSA筛查的一个非常不利的伤害比。这意味着从PSA筛查中受益的 人群中，几乎近50名是被过度诊断和过度治疗的。
"Overdiagnosis" is diagnosing a disease that will never cause symptoms or death in the patient's lifetime. "Overtreatment" is treating a disease that will never progress to become symptomatic or life-threatening.
“过度诊断”是一种诊断性疾病，在病人的一生中永远不会引起症状或者死亡。“过度治疗”是一种治疗性疾病，永远不会进展成有症状的疾病或者对生命有威胁。
The 50toone ratio is based on shorterm followup and "grossly underestimates" the lives likely to be saved by screening over the long term and overestimates the number who are overdiagnosed. "The correct ratio of men diagnosed with PSA testing who are overdiagnosed and overtreated versus men whose lives are saved by treatment long term is more likely to be 10 to one," she said.
50比1的比例是基于短期随访和“严重低估”了经过长时间筛查受益的患者以及高估了“过度诊断”的数量得出的。她说：经过PSA检测诊断的男性“过度诊断”和“过度治疗”的比例与经过长期治疗受益的男性比例正确的应该为10比1。
前列腺癌6大谜团
When it comes to prostate cancer, there's a lot of confusion about how to prevent it, find it early and the best way - or even whether - to treat it. Below are six common prostate cancer myths along with research-based information from scientists at Fred Hutchinson Cancer Research Center to help men separate fact from fiction.
当涉及到前列腺癌时，关于如何预防、早期发现，以及最好的治疗方法或者是否需要治疗有很多困惑。以下是前列腺癌的六大常见谜团以及来自Fred Hutchinson癌症研究中心的科学家们关于前列腺癌以研究为基础的有关信息
Myth 1 Eating tomatobased products such as ketchup and red pasta sauce prevents prostate cancer. "The vast majority of studies show no association," said Alan Kristal, Dr.Ph., associate director of the Hutchinson Center's Cancer Prevention Program and a national expert in prostate cancer prevention. Kristal and colleagues last year published results of the largest study to date that aimed to determine whether foods that contain lycopene the nutrient that puts the red in tomatoes - actually protect against prostate cancer.
谜 团一——吃番茄酱和红粉意酱番茄类食品可以预防前列腺癌。Hutchinson 中心癌症预防计划和一个全国性的前列腺癌预防专家组副主任Alan Kristal博士说：“绝大多数的研究显示两者之间没有任何联系。” Kristal和同事们去年发表了一项迄今为止最大的针对含有番茄红素（一种使番茄呈红色的营养物）的食物是否真的能预防前列腺癌的研究结果。
After examining blood levels of lycopene in nearly 3,500 men nationwide they found no association. "Scientists and the public should understand that early studies supporting an association of dietary lycopene with reduced prostate cancer risk have not been replicated in studies using serum biomarkers of lycopene intake," the authors reported in Cancer Epidemiology, Biomarkers & Prevention. "Recommendations of professional societies to the public should be modified to reflect the likelihood that increasing lycopene intake will not affect prostate cancer risk."
通 过检测全国3500名男性血液中番茄红素的水平后他们发现没有任何联系。作者在Cancer Epidemiology, Biomarkers & Prevention杂志中指出“科学家和公众应该明白早期的有关膳食番茄红素和前列腺癌的风险降低之间有某种联系的研究不能再运用摄入番茄红素的血清生 物标记物在以后的研究中复制。”“专家对公众的建议应该修改为增加番茄红素的摄入可能不会降低患前列腺癌风险。
Myth 2 High testosterone levels increase the risk of prostate cancer. "This is a lovely hypothesis based on a very simplistic understanding of testosterone metabolism and its effect on prostate cancer. It is simply wrong," Kristal said. Unlike estrogen and breast cancer, where there is a very strong relationship, testosterone levels have no association with prostate cancer risk, he said. A study published in 2008 in the Journal of the National Cancer Institute, which combined data from 18 large studies, found no association between blood testosterone concentration and prostate cancer risk, and more recent studies have confirmed this conclusion.
谜 团二——高睾丸激素水平会增加前列腺癌的风险。Kristal说：“这是一个非常可爱的假设——基于对睾丸激素的代谢和对前列腺癌影响的非常简单的理解， 可惜是错的。”他说：不像雌激素和乳腺癌之间有很强的联系，睾丸激素水平和前列腺癌之间没有联系。一项2008年发表在国际顶级杂志Journal of the National Cancer Institute的研究整合了18个大型研究的数据发现血清睾丸激素的浓度和前列腺癌之间没有任何联系，并且最近的研究进一步证实了这一结论。
Myth 3 Fish oil (omega3 fatty acids) decrease prostate cancer risk. "This sounds reasonable, based on an association of inflammation with prostate cancer and the antiinflammatory effects of omega3 fatty acids," Kristal said. However, two large, welldesigned studies including one led by Kristal that was published last year in the American Journal of Epidemiology have shown that high blood levels of omega3 fatty acids increase the odds of developing highrisk prostate cance
谜 团三——鱼肝油（omega-3脂肪酸）降低前列腺癌风险。Kristal 说：“根据前列腺癌与炎症之间的联系以及omega-3脂肪酸的抗炎作用，这听起来很合理。”然而，两项大型的、设计良好的研究表明血液中高水平的 omega-3脂肪酸增加患前列腺癌的风险，其中的一项研究由Kristal领导，去年发表在《美国流行病学杂志》上。
Analyzing data from a nationwide study of nearly 3,500 men, they found that those with the highest blood percentages of docosahexaenoic acid, or DHA, an inflammation-lowering omega-3 fatty acid commonly found in fatty fish, have two-and-a-half times the risk of developing aggressive, high-grade prostate cancer compared to men with the lowest DHA levels. "This very sobering finding suggests that our understanding of the effects of omega-3 fatty acids is incomplete," Kristal said.
对 全国接近3500名男性的研究数据进行分析，他们发现血清中含有最高比例二十二碳六烯酸或者DHA的男性患侵袭性、高分期前列腺癌的比例是血清中最低比例 DHA的男性2到2.5倍。Krista说：“这项非常发人深省的发现表明我们对omega-3 脂肪酸作用的理解还不够。”
Myth 4 Dietary supplements can prevent prostate cancer. Several large, randomized trials that have looked at the impact of dietary supplements on the risk of various cancers, including prostate, have shown either no effect or, much more troubling, they have shown significantly increased risk. "The more we look at the effects of taking supplements, the more hazardous they appear when it comes to cancer risk," Kristal said. For example, the Selenium and Vitamin E Cancer Prevention Trial (SELECT), the largest prostate cancer prevention study to date, was stopped early because it found neither selenium nor vitamin E supplements alone or combined reduced the risk of prostate cancer. A SELECT followup study published last year in JAMA found that vitamin E actually increased the risk of prostate cancer among healthy men. The Hutchinson Center oversaw statistical analysis for the study, which involved nearly 35,000 men in the U.S., Canada and Puerto Rico.
谜 团四——膳食补充剂能够预防前列腺癌。几项大型的、随机的临床试验研究了膳食补充剂对各种癌症的影响，包括前列腺癌；结果表明要么没有影响、要么影响很 大。Kristal说：“当我们越期待膳食补充剂的效果时，它引起的肿瘤风险就显得危害越大。”例如：迄今为止最大的前列腺癌预防研究：硒和维生素E癌症 预防临床试验（SELECT）早些时候被叫停了，因为无论单独补充硒或者维生素E或者联合补充对减小前列腺癌的风险都没有作用。一项去年发表在JAMA的 选择性跟踪调查研究发现在健康男性中维生素E实际上增加了患前列腺癌的风险。Hutchinson中心审查了该项研究的数据分析，其中包括来自美国、加拿 大以及波多黎各的接近三万五千名男性。
Myth 5 We don't know which prostate cancers detected by PSA (prostatespecific antigen) screening need to be treated and which ones can be left alone. "Actually, we have a very good sense of which cancers have a very low risk of progression and which ones are highly likely to spread if left untreated," said biostatistician Ruth Etzioni, Ph.D., a member of the Hutchinson Center's Public Health Sciences Division.In addition to blood levels of PSA, indicators of aggressive disease include tumor volume (the number of biopsy samples that contain cancer) and Gleason score (predicting the aggressiveness of cancer by how the biopsy samples look under a microscope). Gleason scores range from 2-5 (low risk) and 6-7 (medium risk) to 8-10 (high risk).
谜 团五——我们不知道哪种通过PSA（前列腺特异性抗原）筛查的前列腺癌需要治疗，哪些不用管它。生物统计学家、Hutchinson 中心公共卫生科学系Ruth Etzioni 博士说：“事实上，我们对哪些类型的肿瘤不治疗是否容易进展有这很好的了解。”除了血清PSA的水平外，恶性疾病的指示物还包括肿瘤体积（活检样品有肿瘤 细胞的数量）和Gleason评分（通过显微镜下活检样品的组织形态预测肿瘤的侵袭性）。Gleason评分分为2-5分（低度恶性）、6-7分（中度恶 性）、8-10分（高度恶性）。
"Men with a low PSA level, a biopsy Gleason score of 6 or lower and very few biopsy samples with cancer are generally considered to be very low risk," Etzioni said. Such newly diagnosed men increasingly are being offered active surveillance watchful waiting approach rather than therapy for their disease, particularly if they are older or have a short life expectancy.
Etzioni说：“PSA低水平、活检Gleason评分为6分或低于6分以及活检中肿瘤细胞数量几乎没有的大体认为是低度恶性的。”这种新的诊断技术提供了一种新的积极的治疗方案-保守观察治疗，而不是对他们进行治疗，特别是老年人或者较短的预期寿命。
"The chance that these men will die of their disease if they are not treated is very low, around 3 percent," she said. Similarly, such men who opt for treatment have a mortality rate of about 2 percent. "For the majority of newly diagnosed cases of prostate cancer, giving initial clinical and biopsy information, we can get a very good idea of who should be treated and who is likely to benefit from deferring treatment."
她说：“如果这些患者不治疗，死于这种疾病的几率是很小的，大约3%。”同样地，如果这些患者选择治疗，死亡率大概为2%。“对于新近诊断的前列腺癌患者，提供刚开始的临床和活检信息，我们就能对哪些患者需要治疗以及哪些患者能从推迟治疗中受益有很好的了解。
Myth 6 Only one in 50 men diagnosed with PSA screening benefits from treatment. "This number, which was released as a preliminary result from the European Randomized Study of Prostate Cancer Screening, is simply incorrect," Etzioni said. "It suggests a very unfavorable harmbenefit ratio for PSA screening. It implies that for every man whose life is saved by PSA screening, almost 50 are overdiagnosed and overtreated."
谜 团六——只有五十分之一经过PSA检测的前列腺癌患者从治疗中受益。Etzioni 说：“作为欧洲前列腺癌筛查随机对照研究的初步结果，这一数字是不正确的。”“这提出了PSA筛查的一个非常不利的伤害比。这意味着从PSA筛查中受益的 人群中，几乎近50名是被过度诊断和过度治疗的。
"Overdiagnosis" is diagnosing a disease that will never cause symptoms or death in the patient's lifetime. "Overtreatment" is treating a disease that will never progress to become symptomatic or life-threatening.
“过度诊断”是一种诊断性疾病，在病人的一生中永远不会引起症状或者死亡。“过度治疗”是一种治疗性疾病，永远不会进展成有症状的疾病或者对生命有威胁。
The 50toone ratio is based on shorterm followup and "grossly underestimates" the lives likely to be saved by screening over the long term and overestimates the number who are overdiagnosed. "The correct ratio of men diagnosed with PSA testing who are overdiagnosed and overtreated versus men whose lives are saved by treatment long term is more likely to be 10 to one," she said.
50比1的比例是基于短期随访和“严重低估”了经过长时间筛查受益的患者以及高估了“过度诊断”的数量得出的。她说：经过PSA检测诊断的男性“过度诊断”和“过度治疗”的比例与经过长期治疗受益的男性比例正确的应该为10比1。
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