With the urbanization of China, the standard of living of the population is rising.
Prostate cancer cases are also on the rise. As our hospital, the number of prostate cancer cases received has increased from single digits per year to more than double digits per month, this increase in incidence is alarming but is the reality we have to face.
We started radical prostate cancer surgery in 1989, and in recent years, we have completed the transformation from open surgery to lumpectomy, effectively overcoming complications such as hemorrhage or urinary incontinence, and combining comprehensive treatment measures to maximize the life of the patient. Li Yining, Department of Urology, The Second Hospital of Fujian Medical University However, in daily work, it is often found that adequate communication with patients and family members is often not possible, which leads to a dead end in the treatment of some patients. Therefore, I am writing this article.1. Rejection of prostate puncture: When PSA is abnormal, nodules are palpated on anal examination, and nodules are found on imaging, these are the indications for which prostate puncture must be performed, and the puncture pathology report is also used as the only basis for the subsequent treatment when a special medical insurance is required.This routine prostate puncture, performed under inpatient conditions, has significantly reduced the risk. We perform prostate puncture hundreds of times a year.
(1) I once encountered a case of advanced prostate cancer, said to be from PSA 5.6ng/ml, and started to do observation, observation for 7 years, all the way to more than 200, bone metastasis was already obvious at the time of the visit. The family was asked why they were only observing and not dealing with it. The family said that every three months, an old specialist was called to do an anal examination and said that there was nothing wrong, so no treatment was done. If the puncture had been done in time and clarified, it might have been able to be treated earlier.
(2) Some cases are considered to be advanced, so puncture is not done: for example, elevated PSA is found, or there are metastatic foci. So no puncture is done. But there is always a clinical misdiagnosis. PSA is also found to be inflammatory and elevated; other types of cancer can also manifest metastases in the prostate. The lack of a puncture to obtain a pathological diagnosis may lead to a bias in treatment, and it is impossible to evaluate the effectiveness of treatment.
(3) Thinking that you are too old or in poor health to have a puncture: in fact, without the pathological report obtained by puncture, you may be blinded to the future treatment. 2. Dependence on endocrine therapy Prostate cancer, unless it is a low-risk case (indications for active surveillance 1. Very low-risk patients, PSA <10, GS ≤6 positive Biopsy index ≤3, clinical T1c- 2a with ≤50% of tumor per puncture specimen. 2a prostate cancer. 2. Younger patients with well differentiated or moderately differentiated clinical T1a prostate cancer with life expectancy >10 years. This type of disease requires close follow-up with PSA, TURS or prostate biopsy. 3. asymptomatic patients with well or moderately differentiated T1c-2a prostate cancer with a life expectancy of <10 years.) , or not, are always progressing. Endocrine therapy alone cannot completely control the progression of cancer, not to mention that endocrine therapy for prostate cancer may lose its efficacy about 2 years after treatment and turn into refractory prostate cancer for which endocrine therapy is ineffective, which is detrimental to the patient's long-term treatment. 3. Irregularity of endocrine therapy Many patients, because of symptom control or other reasons, use irregular endocrine therapy, which is actually extremely ineffective. Radical surgery can solve some cases, but for those with lymph node metastasis or protruding peritoneum or seminal vesicle infiltration, radical surgery is not all-powerful, and further treatment such as adjuvant endocrine therapy or remedial radiotherapy is needed after surgery. When entering non-hormone dependence, some doctors suggest using drugs such as Norelide and Inhibiton, in fact, it is often ineffective, because these drugs only work on the testicles, after orchiectomy, these drugs have lost their place of action, but because of the misunderstanding of such doctors, the result is that the patient used again.
Because of the high incidence of biochemical recurrence, intermittent endocrine therapy is now more recommended, but only under the guidance of a specialist.6. Status of radical surgery: Because radical surgery mastery is not yet too popular among doctors, some patients do not have access to doctors who can do radical surgery, and this leads to treatment bias.
What we talk about may also be very partial, welcome to discuss together.