Advances in the treatment of primary prostate cancer The ability to undergo radical prostatectomy for high-risk, very high-risk prostate cancer is inconclusive and controversial.Naveen Pokala et al. studied 75,416 patients with non-metastatic, GS score of 8-10 who underwent radical prostatectomy and found that their overall survival rates at 5, 10, 20 and 25 years were 94%, 80%, 38% and 18%, respectively, with corresponding tumor-specific survival rates of 94%, 88%, 68% and 64%. , 38% and 18%, with corresponding tumor-specific survival rates of 94%, 88%, 68% and 64%. In contrast, performing pelvic lymph node dissection did not significantly increase overall patient survival compared to radical prostate cancer surgery alone. A study from the Mayo Clinic showed that in 87 pT4 patients, 46% had lymph node metastases. Postoperatively, 88.5% and 36.8% of patients received adjuvant endocrine therapy and radiotherapy, respectively, with 5-year and 10-year tumor-specific survival rates of 91% and 70%, respectively, and a local recurrence rate of only 11.5%. Therefore, it is believed that radical prostatectomy should be used as part of the comprehensive treatment of locally advanced prostate cancer.Joseph Ischia et al. studied 565 patients with high-risk prostate cancer who underwent radical surgery and found that the use of radical prostatectomy as the only or primary treatment modality resulted in “cure” in approximately half of the patients , they concluded that radical prostate cancer surgery should be considered as one of the primary treatment modalities for high-risk prostate cancer. It is controversial whether and what adjuvant therapy should be applied to patients with extraperitoneal infiltration or seminal vesicle invasion with lymph node metastasis found after radical prostate cancer, Mehrdad Alemozaffar et al. found through a study of 253 patients who underwent radical prostate cancer pathologically diagnosed as pT3N+ that postoperative adjuvant endocrine therapy compared with postoperative adjuvant radiotherapy or observation , which improved recurrence-free survival but had no effect on tumor-specific survival or overall survival. Degarelix, an LHRH antagonist, is a new option for prostate cancer debulking therapy. Neal Shore conducted a meta-analysis of six randomized controlled studies comparing Degarelix with an LHRH agonist (LHRH-a) and found that Degarelix compared to LHRH-a in patients with musculoskeletal pain (9% vs. 12%, p= 0.0822), fractures (<1% vs. 2%, p=0.0411), and joint-related toxicities (4% vs. 6%, p=0.0116), and prolonged overall patient survival (98.3% vs. 96.7%, p=0.0329). They concluded that Degarelix resulted in better disease control compared with LHRH-a. Advances in the treatment of recurrent prostate cancer For patients with biochemical recurrence of prostate cancer after radical prostatectomy, endocrine therapy or radiotherapy is the commonly used treatment with good results, but the value of surgical treatment is not well studied. Alexander Winter et al. reported 12 patients with negative margins after radical surgery and no adjuvant therapy, with no evidence of local recurrence and distant metastasis at the time of biochemical recurrence , with PET-CT suggesting ≤3 lymph node metastases. Lymph nodes suspected of metastasis and peripheral lymph nodes were surgically resected. 10 cases were confirmed to have lymph node metastasis, 9 of which had a significant decrease in PSA, and 5 patients with only 1 lymph node metastasis had no recurrence (PSA < 0.2 ng/ml) after a mean follow-up of 38.8 months. They concluded that for such patients, PET-CT has some diagnostic value for lymph node metastasis and resection of metastatic lymph nodes has therapeutic value. The efficacy of salvage radiotherapy is related to the PSA value before starting radiotherapy, however, it is not clear at what minimum PSA level radiotherapy should be started.Roberto Muller et al. divided 286 patients with local recurrence after radical surgery into 4 groups, and the PSA values for starting radiotherapy were At a median follow-up of 48.6 months, 76 patients with failed salvage radiotherapy had better outcomes compared to those with PSA ≤1.0 ng/mL and >1.0 ng/mL before radiotherapy, while there was no significant difference in the outcome of patients with PSA ≤1.0 ng/mL. there was no significant difference in treatment efficacy in patients with PSA ≤1.0 ng/mL. Advances in the treatment of destructive-resistant prostate cancer Abiraterone is a new androgen synthesis inhibitor that may prolong overall survival in patients with metastatic destructive-resistant prostate cancer (mCRPC) who have failed docetaxel therapy. A further analysis of the ALSYMPCA study by Michael Tomblyn et al. reported that radium-223 not only prolonged the overall survival of patients with mCRPC, but also reduced pain, decreased opioid use and improve the quality of life of patients. Despite the emergence of new therapeutic agents with different mechanisms of action, docetaxel-based chemotherapy is still the main method of mCRPC treatment, and Sun Zhongquan et al. combined estradiol phosphate mustard with estradiol phosphate in 42 cases of mCRPC that progressed after docetaxel plus prednisone treatment, resulting in a PSA efficiency of 66.7% in 39 evaluable patients. Haruki Kume et al. suggested that the use of intermittent docetaxel regimens for mCRPC could reduce the toxic effects of treatment without affecting the efficacy compared with standard treatment regimens.