1. What are the surgical treatment methods for benign prostatic hyperplasia? The patient is sixty or seventy years old, except for prostate enlargement, other health conditions are better, long-term medication is economically unbearable, or after taking medication, symptom control is still not satisfactory, you can choose surgical treatment, surgical treatment includes open surgery and transurethral electrodesection of the prostate. If the prostate is particularly large, or accompanied by bladder stones, bladder diverticulum, etc., open surgery is appropriate, if the patient’s prostate is only I to II degree enlargement, or only the middle lobe hypertrophy, you can take transurethral resection of the prostate, the surgical procedure compared with the traditional open surgery, less damage, less bleeding, less surgical risk, short hospital stay, and the treatment effect and open surgery, is recognized as the “gold standard” of prostate enlargement. The procedure is a gold standard for the treatment of prostate enlargement. What should I pay attention to after transurethral resection of the prostate? Self-care is crucial during this period. (1) Prevention and treatment of urinary tract infection After surgery, the inner surface of the patient’s “eggshell” is large and exposed, and there are necrotic tissues and blood clots that have not been completely shed, which may become a good culture medium for bacterial growth. bleeding, then delayed bleeding is formed. Therefore, patients should take oral antibiotics excreted via urine, such as levofloxacin, within 2 to 3 weeks of discharge, and take care of rest and drink more water. (2) Prevent bleeding In addition to the infection factors mentioned above, bleeding is mainly caused by direct stimulation to the trauma, such as dry stools, strenuous activities especially cycling and other sports that directly stimulate the prostate fossa, and also, sexual intercourse and alcohol consumption can cause local congestion and increase the risk of infection and bleeding. (3) To improve temporary incontinence after benign prostatic hyperplasia surgery many patients will have varying degrees of urinary incontinence, possibly due to decreased resistance of the posterior urethra, uninhibited contraction of the bladder forcing muscle that manages bladder urination, infection in the prostate fossa, etc. Of course, true incontinence caused by damage to the external urethral sphincter is very rare. Patients should develop the habit of urinating regularly, which can enhance the compliance of the bladder forcing muscle and increase the amount of urine carried by the bladder, aided by the use of drugs that increase the compliance of the bladder forcing muscle such as sernitin can also play a certain effect. In addition, pelvic floor muscle contraction training, i.e., doing anal lift training, is also very important, and oral promethazine, etc., can also help, by enhancing the tone of the urethral sphincter and pelvic floor muscles to achieve the purpose of controlling urinary incontinence. If the patient still has urinary incontinence after one year, he should go to a specialist hospital for further treatment to determine whether it is true incontinence. (4) Pay attention to nutrition and combine work and rest In addition to the above-mentioned drinking more water and eating more fruits and vegetables, you should pay attention to the deployment of dietary nutrition and recipes that are nutritious and easily absorbed by the elderly. 3. Is it possible for all prostate enlargement patients to undergo transurethral resection of the prostate? Since all prostatic hyperplasia occurs in elderly patients, one should first assess the functional status of the patient’s heart, lungs, kidneys, liver and other important organs, and find out if there is coagulation dysfunction, and make an estimate on whether the patient can tolerate the surgical blow. Next, the following factors should be considered: ①The larger the prostate volume, the greater the amount of tissue to be removed, the greater the blood loss, the longer the operation time, and the greater the likelihood of various complications. ② Larger bladder stones or bladder diverticula coexist with prostatic hyperplasia. 4.Will prostate enlargement become prostate cancer? The process of occurrence and development of prostate cancer is divided into two steps: that is, the existence of pathological prostate cancer first, and then the transformation from pathological prostate cancer to clinical prostate cancer. Dihydrotestosterone in the local tissues of the prostate is responsible for triggering the development of BPH and clinical prostate cancer, however, hyperplasia and cancer are two completely different pathological processes. To date, there is only evidence that androgens can contribute to the transformation of pathological prostate cancer to clinical prostate cancer, and there is no evidence that they contribute to the development of new prostate cancer or the transformation of BPH to prostate cancer. The pathologic anatomy revealed that BPH occurs in the prostate tissue surrounding the urethra, whereas prostate cancer is most often seen in the peripheral tissues of the prostate. This suggests that the two are distinctly different in their mechanisms of occurrence and that there is generally no interconversion between the two. The actual fact is that a lot of patients with prostate enlargement have prostate cancer in combination, which makes it easy to misdiagnose and miss the diagnosis clinically. And the good site of prostate cancer is in the peripheral zone, which means that prostate cancer will still be born after prostate removal. So, despite the relief of urinary symptoms, the risk of prostate cancer still exists. The majority of prostate cancer can be detected by anal finger examination and serum prostate specific antigen test, so patients who have undergone prostate surgery should still cooperate with their doctors during medical checkups. 6.How to detect prostate cancer as early as possible? When older men experience urinary symptoms, most of them think of benign prostatic hyperplasia, which is a familiar disease to older people, but little is known about prostate cancer. Prostate cancer usually develops after the age of 50, and 95% of the cases occur in older men over the age of 60, and the incidence continues to increase with age. Prostate cancer is usually asymptomatic in its early stages, and even if there is discomfort, it is not enough to attract the patient’s attention. When the tumor enlarges and compresses the urethra, it is often confused with prostate enlargement. In China, about 80% of patients first find distant metastatic lesions before prostate cancer is discovered. At this time, the lesion is already in advanced stage and the prognosis is poor. How can prostate cancer be detected early? First of all, rectal examination is the simplest, most economical and practical method. In layman’s terms, by touching the prostate with the doctor’s index finger, many asymptomatic prostate cancer patients can be detected and can have a chance for early diagnosis and radical treatment. If a prostate nodule is found, the possibility of prostate cancer is suspected and one should further undergo a prostate puncture biopsy to confirm the diagnosis. The next test performed is the serum prostate-specific antigen (PSA) test. PSA is not high in the blood under normal conditions (no higher than 4ng/ml) and is elevated when prostate cancer and other prostate disease states are present and is currently the most sensitive tumor marker to screen for prostate cancer. Patients should avoid tests or operations that stimulate the prostate gland and cause PSA elevation before examination, such as prostate massage, cystoscopy, catheterization, transrectal ultrasound, prostate puncture biopsy and transurethral resection of the prostate gland. If the PSA is elevated, it should be rechecked once. If it is still elevated and if it is ruled out that it is obviously due to inflammation or other influencing factors, the possibility of prostate cancer is suspected and a prostate puncture biopsy should be performed. The third is transrectal ultrasound, which is an ultrasound probe that is placed into the rectum like a rectal exam, without any damage and only minor discomfort. This test has an elevated effect on serum PSA and should therefore be performed after a blood draw. Patients with nodules on rectal exam, elevated serum PSA, or suspicious lesions on ultrasound should undergo a transrectal prostate puncture biopsy. This is the ultimate means of confirming the diagnosis of prostate cancer. By organically combining the three steps of rectal finger examination, serum PSA and rectal ultrasound, most prostate cancers can benefit from early or early detection and have a chance for radical treatment. 7.Why should the testicles be removed for prostate cancer? Since the prostate is an androgen-dependent organ, most prostate cancers are androgen-dependent, which means that androgens in the body can contribute to further progression of prostate cancer, and elimination of androgens in the body can bring about significant relief of prostate cancer lesions and symptoms. Bilateral orchiectomy can control the progression of prostate cancer by reducing androgens in the body to a large extent. This procedure is less invasive, has fewer complications, and has some efficacy. For some patients who do not want to undergo orchiectomy, luteinizing hormone-releasing hormone stimulants such as Norethindrone or Norethindrone can be used to reduce the concentration of androgens in the blood to the level of orchiectomy, i.e. “medication for orchiectomy”. It should be noted that if “drug testicular excision” is used, flutamide (Fuzeol) should be applied first for 2 weeks and then treated with inhibition or Norad to prevent rebound and increase of tumor in a short period of time. 8. Do prostate cancer patients still need to take drugs after testicular removal? Most of the androgens in the prostate gland originate from the testes and can be effectively and safely removed by surgical or pharmacologic removal of the testes, but a small portion is from the adrenal glands. Flutamide (Fuzeol) binds to the androgen receptors of prostate cancer cells, blocking androgen uptake and/or preventing androgen binding to the nucleus, and has potent anti-androgenic effects. Combined with surgical debulking or pharmacological debulking, flutamide (Fuzil) can completely block androgenic effects in the testes and adrenal glands. Compared with single anti-androgen therapy, the combination therapy can block the effect of androgens on the prostate gland to the maximum extent, thus causing rapid apoptosis of prostate cancer cells and appropriately prolonging the survival of patients. 9.What should I do if prostate cancer patients have urinary obstruction? Transurethral resection of the prostate is often used to treat bladder neck obstruction caused by prostate cancer. Since 97% of prostate cancers are located in the peripheral area and infiltration of the envelope can occur early, transurethral resection of the prostate can only remove part of the prostate tissue or cancerous tissue. Therefore, it is not a radical procedure and is not curative. However, it can prevent uremia and improve the quality of survival of patients with advanced prostate cancer, and is the best procedure to reduce bladder neck obstruction caused by the prostate. Transurethral resection of the prostate is mainly used for patients with bladder neck obstruction caused by stage C or higher prostate cancer. 10.How should I follow up my prostate cancer patients? Most patients have elevated serum prostate-specific antigen (PSA) levels, and it is now recognized that this indicator reflects the effectiveness of treatment. In general, a decrease in PSA levels to 50% or less of preoperative levels by week 8 after endocrine therapy in patients with advanced prostate cancer is indicative of a better clinical outcome. For patients whose PSA has been controlled, a rebound often indicates that the lesion has progressed to hormone-non-dependent and the outcome is not promising. In addition, because drugs such as flutamide (Fuzeol) are toxic to the liver, patients need to have their liver function tested monthly. For patients who underwent radical resection or radical radiotherapy for prostate cancer, PSA follow-up is also important because, in theory, in patients without metastasis and recurrence, the postoperative blood PSA level should be less than 0.2ng/ml , and if PSA is elevated, the possibility of recurrence and metastasis should be considered and other treatment options should be used early. In addition, during the follow-up, one should find out whether there are bone and lung and liver metastases and do the corresponding examinations, such as isotope bone scan, ultrasound, etc.