Prostate cancer is a very complex problem. It requires a medical professional to evaluate and analyze it, and personally, I feel that it is best to find a university hospital or a doctor with a high profile, and even then, each patient goes to a different doctor with a variety of answers. Even so, the answers given by different doctors can be very confusing to the patient. The most crucial criteria for the diagnosis of prostate cancer are: 1. PSA (prostate specific antigen): the normal value of PSA is less than 4, 4-10 is the gray area, and more than 10 should be punctured to exclude prostate cancer. In addition, PSA ratio is also important, that is, free PSA/total PSA, if the total PSA is more than 10 and this value is less than 0.1, the possibility of prostate cancer is more than 50%. MRI (Magnetic Resonance Imaging): CT has low diagnostic value for prostate cancer and is not recommended, but MRI can accurately diagnose prostate cancer and stage and grade prostate cancer, therefore, MRI should be preferred for prostate cancer screening. 3.Prostate puncture biopsy: Neither PSA nor MRI can replace puncture biopsy in the diagnosis of prostate cancer. The Gleason score of the puncture biopsy specimen can help doctors effectively determine the prognosis of the patient. 4. ECT bone scan: Whether prostate cancer is accompanied by bone metastasis determines the treatment, especially whether it can be surgically cured or not. Therefore, bone scan is necessary. 5.PET: Positron spin emission can clarify whether there is substantial organ metastasis by functional science, but it is too expensive, each PET-CT examination costs about 10,000 RMB, so it can only be used selectively. The choice of prostate cancer treatment methods is the most headache for patients, because there are many methods and each of them has good efficacy. It is impossible to figure out what are the advantages and disadvantages of these methods even if you are not a professional doctor. 1.Destructive + anti-androgen therapy. The so-called debridement is the use of external means to remove the patient’s reproductive function, including the use of drug debridement and surgical debridement. With regard to the choice of debulking method, we should be clear that drug debulking (including goserelin, leuprolide and treprostinil) and surgical debulking (that is, bilateral orchiectomy) have similar efficacy and similar survival rates. To date, no single drug has been shown to be more effective than bilateral orchiectomy. In terms of treatment cost, drug denervation requires about 2,000 RMB per month (the lowest price is Goserelin 3 months, about less than 1,800 RMB per month), while surgical denervation requires only one surgery to maintain the denervation status for life, which is relatively inexpensive, but not easily accepted by patients in terms of concept. As for anti-androgen drugs, the most mainstream ones are flutamide and bicalutamide, both of which are effective against androgen receptors, and the price is basically similar, about 1000-1400 RMB/month. However, bicalutamide should be preferred at this time due to the fact that it only needs to be taken orally once a day (flutamide is taken orally 3 times) and its efficacy is considered superior to that of flutamide. Debulking + antiandrogen therapy can be effective in controlling prostate cancer, and many prostate cancer patients can achieve a long survival with just debulking + antiandrogen therapy. Moreover, even if antiandrogenic therapy fails, second-line antiandrogenic drugs can be used. For example, abiraterone. 2.Surgical treatment: This surgery refers to radical prostate cancer surgery. First of all, what kind of patients are suitable for radical prostate cancer surgery? Our current guidelines in China do not clearly answer this question, therefore, there are various answers to this question. My personal opinion is that as long as a clean cut can be guaranteed, surgery can be performed. So what kind of patients can be guaranteed to have a clean cut? The most famous prediction model is the Partin’s table and Kattan prediction model researched by Prof. Alan W Partin in the United States, according to which we can make accurate prognosis judgment and prediction of prostate cancer (Partin’s table also has an Apple version, which can be downloaded for free using an Apple phone or iPad). (Partin’s table is also available in Apple version, which can be downloaded for free using Apple phone or iPad). In general, for patients with a PSA greater than 30, we can determine that there is a high probability that the tumor has invaded the envelope and surgery cannot achieve a curative effect. Therefore, for patients with PSA greater than 30, surgery is generally not preferred. （The main reason for this controversy is that the pathological examination in China is not qualified. The most important reason for this is that the pathology in China is not up to par. Only a few hospitals in China have carried out formal ink experiments on radical specimens of prostate cancer, so there is no clear answer from the pathology in China as to whether the tumor is out of the envelope or not after radical surgery for prostate cancer. (The study by Professor Partin then set the upper limit of PSA at 20, above which there is a high probability of tumor invasion of the pericardium). In terms of surgical approach, whether it is laparoscopic, open surgery or robotic-assisted radical prostate cancer surgery, there are no advantages or disadvantages to these three surgical approaches, and both the short-term complications of surgery and the long-term prognosis are largely similar. Therefore, doctors skilled in open surgery will do open surgery, doctors skilled in laparoscopy will do laparoscopy, and doctors skilled in robotics will do robotics. For the current situation in China, the charge for laparoscopic surgery is about 1.5-2 times that of open surgery, and the charge for robotic surgery is about 10 times that of open surgery, so for the vast majority of patients, they should choose between open surgery and laparoscopic surgery. 3.Radiotherapy: This radiotherapy includes external radiation and internal radiation (that is, radioactive particle internal implantation for prostate cancer). The advantage of external radiation is that it is simple and easy to perform, and there are many hospitals that perform it. However, we need to clarify some problems of external radiation. First of all, radiotherapy for prostate cancer must be above 78Gy to achieve the best efficacy. As for domestic external radiation, the lack of suitable prostate fixation method leads to the prostate constantly drifting during radiotherapy, therefore, radiotherapy brings greater side damage to the bladder and rectum, resulting in a small total dose of radiotherapy. In general, hospitals, at most, are willing to give patients up to 70Gy, and according to Campbell Urology’s records, the efficacy of 70Gy is much less than that of 78Gy. Therefore, the efficacy of domestic external radiation needs to be discounted. In contrast, the radiation dose of internal radiation is relatively much higher, generally reaching 140Gy or more. Moreover, only proliferating tumor cells are the most sensitive to radiation, and external radiation can only irradiate for about 20-30 minutes per day, while internal radiation can guarantee 24-hour continuous irradiation. However, internal radiation requires special equipment and specially trained personnel, and fewer hospitals in China are able to perform it. The cost is about 1.5 times higher than that of external radiation. Meanwhile, internal radiation is not recommended for patients with bone metastases. 4.Chemotherapy: chemotherapy drugs represented by docetaxel also have good efficacy for prostate cancer. However, chemotherapy is often the last line of defense in the hands of doctors, usually after prostate cancer has reached the point where second-line anti-androgen and other means have failed.