Basic Knowledge
I. What are the causes of prostate cancer?
The risk factors for prostate cancer are not yet clear, but some of them have been identified. One of the most important factors is heredity. If an immediate family member (brother or father) has prostate cancer, his or her own risk of developing prostate cancer is doubled. Exogenous factors can influence the progression from so-called latent prostate cancer to clinical prostate cancer. A diet high in animal fat is an important risk factor. Other risk factors include low intake of vitamin E, selenium, lignans, and isoflavones. In Asia, where prostate cancer is low, green tea consumption is relatively high and green tea may be a preventive factor for prostate cancer.
How many stages of prostate cancer are there?
The staging of prostate cancer is based on the clinical examination results to determine the extent of cancer development, which helps to understand the extent of the lesion, judge the prognosis and formulate the treatment plan.
1.T indicates the local situation of primary tumor of prostate cancer, which is mainly determined by DRE and MRI. The number and site of positive biopsy by prostate puncture, pathological grading of tumor and PSA can assist in staging.
There is no accurate basis for the primary tumor of prostate cancer.
Clinically occult tumors that cannot be palpated by rectal palpation and cannot be detected by imaging.
Incidental tumor volume tumor volume less than 5% of the resected tissue.
Incidental tumor volume is greater than 5% of the resected tissue.
Tumors detected by prostate puncture biopsy (e.g., due to elevated PSA).
Tumors that are confined to the prostate gland.
Tumors limited to 1/2 of a single lobe of the prostate.
Tumors that exceed 1/2 of a single lobe but are limited to that single lobe (1/2-1).
Tumor invades both lobes.
Tumor breaks through the prostate envelope.
Tumor invades the prostatic envelope (on one or both sides).
Tumor invades the seminal vesicles.
The tumor fixes or invades other adjacent tissue structures other than seminal vesicles, such as bladder neck, external urethral sphincter, rectum, anal levator and/or pelvic wall.
2. N represents local lymph node invasion of prostate cancer. N stage is important for patients who are ready for radical therapy. Patients with stage below T2, PSA <20ng/m1 and Gleason score <6 have less than 10% chance of lymph node metastasis and are feasible for preserved lymph node dissection.
Local lymph node metastasis is unknown.
No local lymph node metastasis.
There is local lymph node metastasis.
3, M represents the distant metastasis of prostate cancer, mainly for skeletal metastasis, bone scan, MRI and X-ray are the main examination methods.
Distant metastasis cannot be evaluated.
No distant metastasis.
There is metastasis.
There are lymph node metastases other than regional lymph nodes.
Bone metastasis (single or multiple).
Other distant organ metastases (with or without bone metastases).
Histopathologic grading score is considered the best grading method because it not only takes into account the inherent heterogeneity of prostate cancer, but also has an important prognostic value. The primary and secondary patterns (if both range from 1-5) are used and yield an overall score with a possible range of 2-10 (if a single focal point of the lesion is found, it should be reported as two scores, e.g., if a single focal point of a Gleason 3 lesion is found, it should be counted as 3 + 3) Ungradable well-differentiated (mild interstitial) (Gleason2-4) moderately differentiated (moderate interstitial) ( Gleason5-6) Poorly differentiated or undifferentiated (significant interstitial changes) (Gleason7-10) Clinical staging period.
Stage I.
Stage II.
Stage III.
How long can I live with prostate cancer?
It depends on the condition, treatment effect and care.
4. Can young people get prostate cancer?
Autopsy results show that the incidence of prostate cancer increases with age, and the more extensive the histological examination, the higher the incidence. It occurs mainly in men over 50 years old, but occasionally in young people and even children.
Prostate cancer diagnosis
I. What are the early symptoms of prostate cancer?
Urinary disorders: difficulty in urination, thin urine stream or skewed urine stream, or bifurcation of urine stream, prolonged urination, frequent urination, urgent urination, painful urination, feeling of incomplete urination, etc. In severe cases, urine dripping and urinary retention may occur.
Pain in the lumbar, sacral, hip and hip areas, pelvic and sciatica pains are common and severe.
Metastatic symptoms are very common in patients with prostate cancer. About 1/3 or even 2/3 of patients have lymph node metastasis at the time of first visit, mostly in the intra- and extra-skeletal areas, lumbar area and groin. It can cause swelling of lymph nodes and lower limbs in the corresponding areas.
As the pain affects the diet, sleep and spirit, the general condition of the body becomes weaker and weaker, with progressive anemia, cachexia or renal failure.
If you find the above symptoms, you should go to a regular hospital for examination and early treatment, otherwise, the consequences of delaying the disease are quite serious.
What tests are needed to confirm the diagnosis of prostate cancer?
Rectal examination is the first step to diagnose prostate cancer, which is a simple and easy method with an accuracy rate of over 80%. In advanced cases, the cancer may occupy both lobes and extend to the bladder base, seminal vesicles and intestinal wall. However, rectal examination cannot make the diagnosis alone.
Prostate-specific antigen (PSA) is a highly specific and sensitive tumor marker, and its diagnostic value is currently considered to be higher than that of PAP. It can be used as a predictor for pathological classification of prostate cancer, monitoring before and after treatment, and early diagnosis.
Ultrasound is a special circular ultrasound probe inserted into the rectum that traces the extent of the lesion in a cross-section of the prostate. The size of the tumor, whether it is beyond the envelope, adhesions to surrounding organs, and metastases can be determined.
Radionuclide scans are often used to diagnose bone metastases from prostate cancer. With radionuclide 99Tc, whole-body scintigraphy can be performed by gamma photography. Currently, radionuclide 99Tc scan is an accurate method to detect bone metastasis of prostate cancer and is particularly sensitive to occult bone metastasis.
In contrast to MRI, CT can detect abnormal prostate morphology and determine the extent of prostate infiltration. MRI can show the extent of lesions in the prostate and surrounding tissues.
Prostate puncture biopsy can provide a basis for cytological diagnosis and is important for the diagnosis of early prostate cancer. Commonly used methods include: puncture, aspiration, transurethral and trans-perineal incisional biopsy, etc. Prostate biopsy and transrectal puncture have become the most commonly used methods, and their diagnostic accuracy rate can reach 80-95%. Transurethral resection biopsy is suitable for cancer of the anterior lobe, latent cancer with prostatic hyperplasia and those with clinical suspicion of cancer but negative biopsy by puncture or aspiration.
3. Is prostate cancer examination painful?
For those who have nodules in the prostate and whose PSA value is significantly elevated, a multi-point puncture through the rectum or perineum under the guidance of rectal ultrasound can be performed to obtain biopsies and then perform pathological examination for a definite diagnosis. This test is the only way to confirm the diagnosis of prostate cancer. Currently puncture is performed in 10 or more points according to the volume of the prostate and the subdivisions on the ultrasound image. Because of the different prostate volume and irregular prostate morphology, although multiple points of puncture are taken, sometimes the cancer lesion is small and the tissue of the cancer lesion may not be obtained in one puncture and the pathological diagnosis does not find tumor cells. Therefore, elderly men whose pathology is benign after the first prostate puncture biopsy should also have their PSA tested regularly to observe changes in PSA. If PSA continues to be elevated, a second, third or more prostate biopsies are recommended. Prostate puncture biopsy is an invasive test, and there is a risk of hematuria, urinary retention, fever and infection after the test, as well as the possibility of rectal bleeding via rectal puncture. However, the incidence of these post-test complications is very low, and the doctor will take measures to prevent them before and after the test.
4. Does a high PSA mean prostate cancer?
Prostate-specific antigen (PSA) is a protein enzyme secreted by prostate epithelial cells, of which 85% exists in complex form and only 15% exists in free form in serum (i.e. F-PSA). The normal reference value for PSA is currently considered to be 0-4ng/ml (ng/ml). The detection of serum prostate-specific antigen and free PSA is influenced by a number of factors, such as: ① prostatitis: after 6 weeks of acute and chronic prostatitis, serum PSA can only be reduced to the basic value; ② prostatic hyperplasia: about 23% of patients with prostatic hyperplasia have a serum PSA greater than 4ng/ml and 5% greater than 10ng/ml; ③ prostate cancer: serum PSA is significantly elevated and is progressively and continuously elevated; The PSA may increase after acute urinary retention, urinary retention, bowel movement, and ejaculation, and it has been reported that the PSA value decreases to the basal value only after 6 weeks of acute urinary retention and 2 days after ejaculation; ⑤ rectal examination and prostate massage may increase 1-fold and decrease to the basal value after 3 days of prostate massage; ⑥ cystoscopy may increase 4-fold and decrease to the basal value after 3 weeks of cystoscopy; ⑦ prostate puncture or transurethral resection (7) Prostate puncture or transurethral resection of the prostate (TURP) can increase 53 to 57 times, and after 3 weeks of puncture biopsy can be reduced to the base value; (8) Age factor: age and PSA are positively correlated, and the PSA values of BPH patients in China are 0 to 1.5 ng/ml at the age of 40, 0 to 3.0 ng/ml at the age of 50, 0 to 4.5 ng/ml at the age of 60, 0 to 5.5 ng/ml at the age of 70, and 0 to 5.5 ng/ml at the age of 70. 5.5 ng/ml, 0 to 8.0 ng/ml for those older than 80 years old.
Will prostate puncture biopsy aggravate prostate cancer or cause metastasis?
In most cases, prostate cancer patients must undergo prostate puncture biopsy to obtain prostate cancer tissue for pathological examination in order to clarify the pathological diagnosis of the disease. During the puncture procedure, a thin biopsy needle is used and the cancerous tissue is removed inside the syringe. Therefore, it can be assumed that prostate puncture biopsy itself will basically not lead to the spread of prostate cancer cells.
What should I do if I have been diagnosed with prostate cancer?
You should go to a regular hospital oncology department or urological specialist to further clarify the stage so that a treatment plan can be formulated.
Adjuvant treatment
I. What is chemotherapy for prostate cancer?
Chemotherapy for prostate cancer is one of the common treatment methods, using chemical drugs to help inhibit and kill cancer cells and control symptoms, especially for post-operative adjuvant treatment, which can help reduce the occurrence of post-operative complications and reduce the chance of recurrence and metastasis. However, chemotherapy for prostate cancer has certain side effects, and attention should be paid to the patient’s ability to tolerate them during the treatment process.
Second, which prostate cancer patients should undergo chemotherapy?
In advanced metastatic prostate cancer, chemotherapy can be used after the failure of endocrine therapy or radiation therapy. Chemotherapy, as an integral part of prostate cancer treatment plan, is used to eliminate potential small, currently undetectable lesions after the application of surgery or radiotherapy to remove local lesions. Studies have shown that those whose metastatic prostate cancer progressively worsens despite endocrine therapy can significantly improve both objective indicators and subjective symptoms with the use of chemotherapy drugs. Although chemotherapy alone cannot cure the primary lesion, it can prolong the postoperative survival of patients with an efficiency of 20% to 40%. Although chemotherapy as a treatment is not as effective as endocrine therapy and radiotherapy for prostate cancer, as an adjuvant treatment, it can often play a role that endocrine therapy and radiotherapy cannot replace.
What are the chemotherapy drugs for prostate cancer? What is the general treatment plan?
Single-agent chemotherapy can be used as follows: methotrexate, prednisone repeated every 3 weeks, or other drugs such as cyclophosphamide, estramustine phosphate, Tysol, Adriamycin, epirubicin, cisplatin, mitomycin, 5-Fu, etc.; Tysol is repeated weekly, with a 2-week break after 6 consecutive weeks, and 8 weeks is one course of treatment.
Combination chemotherapy: Combination chemotherapy has been shown to be superior compared to single agent chemotherapy. Currently considered the most effective is the combination of estramustine with vincristine sulfate or etoposide or tylosin.
Estramustine vincristine 4mg/m2/week for 6 weeks, followed by 2 weeks off.
IV. What is the efficacy of chemotherapy for prostate cancer?
Prostate cancer is not very sensitive to chemotherapy. The combination of mitoxantrone and prednisone significantly improves patients’ quality of life and has been considered the standard of care for hormone-non-dependent prostate cancer for the past decade or so, but does not improve overall patient survival. Recently, two randomized controlled studies demonstrated that docetaxel combined with prednisone or estramustine improved survival and reduced PSA in metastatic prostate cancer resistant to endocrine therapy with significantly better efficacy than mitoxan 25 percent. Therefore, docetaxel as the core chemotherapy regimen is currently the treatment of choice for hormone-non-dependent prostate cancer.
V. What are the toxic side effects of chemotherapy for prostate cancer?
1. Some drugs can affect fertility and cause malformations. Male patients should be abstinent during chemotherapy for prostate cancer.
2. Prostate cancer chemotherapy drugs that have toxic effects and adverse reactions on the respiratory system can cause acute chemical pneumonia and chronic pulmonary fibrosis, and even respiratory failure. Therefore with pulmonary toxic drugs (i.e. chemotherapy drugs that are toxic to the respiratory system), such as scramblomycin, the lungs should be checked regularly during the use of the drug, and follow-up visits should also be paid attention to after discontinuing the drug. If pulmonary toxicity is found, stop chemotherapy for prostate cancer immediately.
3. Inhibit the bone marrow hematopoietic system, mainly the decline of white blood cells and platelets. If the number of white blood cells is lower than (2.5-3) x 109/liter and platelets (50-80) x 109/liter, chemotherapy should be temporarily stopped and the drugs to raise blood cells should be used as prescribed by the doctor.
4. When intravenous injection of chemotherapy drugs for prostate cancer, inadvertent leakage of the drug may cause local tissue necrosis and embolic phlebitis. Therefore, health care workers must be very careful to prevent this.
5.It can damage the liver cells to different degrees, resulting in increased glutamate transaminase, rising bilirubin, hepatomegaly, pain in the liver area, jaundice, etc. In serious cases, it can cause liver cirrhosis and impaired coagulation mechanism, so it is necessary to check the liver function before and during the drug administration to detect the problems and solve them in time, and stop prostate cancer chemotherapy if necessary. 6.The hair loss and skin reactions that occur in prostate cancer chemotherapy are not common in all Even if they do occur, there is no need to worry too much, because generally the hair will grow back after the drug is stopped, and the erythema, rash and pigmentation of the skin will also improve or disappear.
Some prostate cancer chemotherapy drugs have toxic effects on the cardiovascular system, and heart failure can occur in severe cases. Therefore, electrocardiogram should be checked before and during the use of drugs, and abnormalities should be stopped immediately for timely treatment. Patients with heart disease should avoid using prostate cancer chemotherapy drugs that have toxic effects on the heart.
Among the systemic reactions of prostate cancer chemotherapy, the toxic effects and adverse reactions of the digestive system are the most troublesome for patients, such as nausea, vomiting, loss of appetite, abdominal pain, diarrhea, oral mucosal ulcers, pharyngitis, etc. 9. Toxic effects and adverse reactions of the urinary system include proteinuria, oliguria or anuria, and in some cases, hematuria. In order to have a clear understanding of kidney function, it is necessary to check regularly both before and during the use of drugs to detect problems and treat them in time.
VI. How to prevent and care for the toxic side effects of chemotherapy?
Local toxicity: ADM, DDP, PYM, etc. have low PH value, thus stimulating the intima and causing phlebitis, while the input of more alkaline solution increases the permeability of blood vessels and makes it easy to leak and cause tissue damage. ADM, CTX, 5-FU, MMC, DDP, etc. are easy to cause allergic reactions, increase the permeability of blood vessels and extravasation of drugs. The technical skill of injection, the quality of scalp needle and catheter, as well as the long injection time can also cause extravasation. CTX is not easy to dissolve, but it should not be heated to promote its dissolution because it loses its activity at >37°C. NH2 is the most unstable, temporary configuration (3 minutes). Do a good job of explanation, highlighting the irritation of the drug, the patient should be informed of the consequences of drug extravasation, when injecting the drug should ask the patient how the local feeling, whether there is pain or abnormal sensation, if there should be immediately informed to the nurse, not to force the uncomfortable, so as to cause tissue necrosis. Prevent drug extravasation: For drugs with strong irritation, administer them from the central vein as much as possible. The order should be NS-chemotherapy drug (the patient should be asked about the local sensation when pushing, so as to avoid needle slipping out of the blood vessel and drug extravasation)-NS flushing, so as to reduce the stimulation of drug to the blood vessel wall. Treatment of drug extravasation: stop the infusion, retain the needle, and connect the syringe to draw back. Close with lidocaine + dexamethasone to block and dilute extravasated drug. Local cold compress (except platinum oxalate) with 50% MgSO4 wet compress for at least 24h to make vasoconstriction and reduce drug diffusion to surrounding tissues. Alternatively, alternate the compresses with gold and Xylazine. Raise the affected limb and report to the physician. Clinically, wet reactions, severe pain, ulcer formation, and even extensive invasion of muscle health and ligaments leading to irreversible damage are often seen in 1 to 2 weeks after ADR leakage.
Alopecia: Due to rapid growth of hair follicle epithelium, it is sensitive to chemotherapy. Hair loss is commonly associated with the application of ADM, MTX, CTX, and vincristine. It should be explained to the patient well before treatment to eliminate the patient’s mental stress. Ice or chemical refrigerants, ice caps are available to prevent hair loss. Put on the ice cap 5-10 min before drug administration and maintain it for 30-40 min after drug injection to reduce the amount of drug entering the scalp, and protect the ear and the back of the neck with a dry towel to prevent frostbite. ADM, CTX often cause severe hair loss, generally 1 to 2 weeks after a dose of hair loss, 1 to 2 months to peak. It often causes great mood swings in patients. Therefore, it should be explained to the patient that it is caused by chemotherapy and is a reversible complication. Female patients with hair loss can wear a cap or wig, which does not affect the aesthetics.
Cardiac, hepatic and renal toxicity: ADM has obvious cardiotoxicity. 5-FU, CTX, etc. can also appear cardiotoxic. Mainly ECG abnormalities, which are generally reversible, should be done before, during and after drug administration for routine ECG examination. Permanent cirrhosis of the liver can occur after long-term use of MTX. Most antitumor drugs are excreted by the kidneys. When applied in large doses, it is easy to form yellow precipitate in acidic environment due to poor solubility of its metabolites. In addition, due to the rapid disintegration of tumor tissues after chemotherapy, it is easy to produce hyperuricemia, and in serious cases, uric acid crystals can be formed, blocking the renal tubules and leading to renal failure. Therefore, patients with high-dose chemotherapy should be kept hydrated and alkalized to reduce the burden on the kidney. The daily intake is maintained at more than 5000ml, so that the urine volume is above 3000ml. And give sodium bicarbonate. The pH should be measured after each urine, and the PH value should be lower or equal to 6.5-7.0. If it is lower than 6.5, the sodium bicarbonate dosage needs to be increased. Properly record the amount of in and out, if the amount of intake has been sufficient and the urine volume is still low, give diuretics. ctx has been excreted in its original form, if the amount of intake is insufficient, it is easy to cause hemorrhagic cystitis, therefore, it is contraindicated in patients who are dehydrated. To build up the confidence of overcoming the disease, have an attitude of actively cooperating with the treatment, fully understand their disease, and not be daunted by chemotherapy, they can selectively read novels, poems and the deeds of anti-cancer stars to improve their thinking and develop their horizons. When receiving chemotherapy, learn the knowledge about chemotherapy, make patient explanation to patients, tell them some side effects of chemotherapy, and propose to family members to pay attention to dietary patterns and induce patients to eat with the color, aroma and taste of food.
Allergic reaction: paclitaxel (PTX) is a new anti-cancer drug, and the incidence of allergic reaction is 39%, among which the incidence of serious allergic reaction is 2%. They manifested as bronchospasm, croup, pruritus, rash, flushing, angioedema, limb pain, anxiety, and hypotension. Almost all reactions occur within the first 10 min of drug administration, and severe reactions often occur within 2 to 3 min of drug administration. To prevent the development of allergic reactions, patients receiving PTX should be given prophylactic medication beforehand. Usually, DXM 20mg is given orally 12 and 6h before PTX, and Benadryl 50mg is given intramuscularly 30-60min before PTX.
What is radiation therapy for prostate cancer?
Radiation therapy for prostate cancer is the application of high-energy physical rays to treat prostate cancer.
Which prostate cancer patients should be treated with radiotherapy?
Radiation therapy for prostate cancer patients has good efficacy, wide indications and few complications, and is suitable for patients at all stages. Radical radiation therapy for early stage patients (T1-2, N0M0) has a local control rate and 10-year disease-free survival rate similar to radical prostate cancer surgery. The principle of treatment for locally advanced prostate cancer (T3-4, N0M0) is based on adjuvant radiotherapy and endocrine therapy. Palliative radiotherapy is feasible for metastatic cancer to relieve symptoms and improve quality of life. In recent years, three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) have been gradually applied to prostate cancer treatment and become the mainstream radiotherapy techniques. Radiation therapy plays an important role in all stages of prostate cancer treatment.
For early stage prostate cancer with low risk of recurrence, external irradiation or brachytherapy with isotope insertion and particle implantation can be used; for intermediate stage prostate cancer with moderate risk of recurrence, external irradiation plus brachytherapy or postoperative supplemental radiotherapy can be used; for advanced stage prostate cancer with high risk, palliative and decompensated radiotherapy of the prostate area or metastatic lesions, combined with depot endocrine therapy or chemotherapy can be used.
Can prostate cancer be treated with molecular targeted therapy?
Molecular targeted therapy has good applications in other tumors such as slow-grain, non-small cell lung cancer, colorectal cancer, gastrointestinal mesenchymal tumor, breast cancer, etc. However, there is no evidence to support the use of molecular targeted therapy in prostate cancer. However, there is no evidence to support the use of molecularly targeted therapy in prostate cancer.
X. What are the molecularly targeted therapeutic agents for prostate cancer?
The molecularly targeted therapeutic agents currently under clinical trials include drugs against prostate-specific membrane antigen (PSMA) and prostate stem cell antigen (PSCA), anti-angiogenic drugs, anti-tumor cell signaling drugs and COX-2 inhibitors.
XI. Can prostate cancer be treated with Chinese medicine?
Prostate cancer is the most common malignant tumor in the male genital system, and the principle of Chinese medicine treatment for prostate cancer is to support the righteousness and dispel the evil. The treatment of prostate cancer is based on the principle of supporting the righteousness and dispelling the evil, i.e. to improve the body’s ability to resist disease and enhance the immune function.
What are the advantages of traditional Chinese medicine in treating prostate cancer?
The treatment of prostate cancer by TCM should follow the principle of diagnosis and treatment of TCM, based on the patient’s symptoms and signs, the western treatment methods used, the different treatment stages, as well as the patient’s post-illness qi and blood strength and weakness and yin and yang of the internal organs, and then propose the corresponding treatment plan.
Chinese medicine has a strong holistic concept. TCM can often consider the characteristics of the patient’s whole body rather than just limiting to the cancer lesion itself. Secondly, TCM is less harmful to healthy cells, and generally does not cause new damage to physical strength due to the treatment itself, and while the cancer is improving, physical strength will be gradually restored and immunity will be gradually strengthened.
Chinese medicine reduces the toxic side effects of the “three axes”. Surgery, radiotherapy and chemotherapy are the three axes of conventional treatment for prostate cancer, and the cooperation of Chinese medicine can produce special effects in reducing the toxic side effects of these three axes, which can greatly improve the survival period and quality of life of patients.
Which prostate cancer patients are suitable for TCM treatment?
Chinese medicine can only play an adjuvant role in the treatment of prostate cancer, but it can reduce the side effects of patients after surgery and radiotherapy and chemotherapy, increase the immunity of patients, and improve the quality of survival.
Chinese medicine treatment is not yet the primary means of treatment for prostate cancer, and he can target patients with milder symptoms. In fact, patients should take the auxiliary role of TCM in treatment, because TCM can reduce the side effects of radiotherapy and chemotherapy after surgery, reduce patients’ pain, improve patients’ immunity, and have good helpful effects for the eradication.