There are several treatment methods for prostate cancer, and the choice of which treatment method depends mainly on the tumor stage and the patient’s physical condition.
1.Close monitoring
Patients with prostate cancer are monitored and not treated for prostate cancer, and then treated if monitoring reveals prostate cancer progression that threatens the patient’s health. The basis of this program is that some prostate cancers do not affect the patient’s life and health throughout life, and treatment will instead increase the patient’s pain and financial burden. Close surveillance is a recommended treatment option for patients with low-grade malignant early-stage prostate cancer. However, current screening methods cannot determine very accurately which patients belong to low grade malignancy, therefore, there is a risk of delaying patient treatment.
2.Surgical resection (radical prostate cancer surgery)
It is one of the most commonly used treatment methods for limited stage prostate cancer. Depending on the surgical method, it can be divided into open radical prostate cancer surgery, laparoscopic radical prostate cancer surgery, and robotic-assisted radical prostate cancer surgery. Regardless of the type of surgery used, the entire prostate is removed, the lymph nodes in the pelvis are cleared or not depending on the condition chosen, and the bladder and urethra are then anastomosed.
Possible complications of radical prostate cancer surgery include bleeding, urinary incontinence, and impotence.
(1) Open radical prostate cancer surgery
A surgical incision of about 10-15 cm in length is made in the lower abdomen to remove the entire prostate gland. Depending on the condition, the lymph nodes in the pelvis are selected to be cleared, and then the bladder and urethra are anastomosed. Open radical prostate cancer surgery is a traditional surgical approach that has accumulated a large number of cases and experience with positive results. It is still a widely used surgical approach at home and abroad.
(2) Laparoscopic radical prostate cancer surgery
Compared with traditional open surgery, there is no need to make a long incision in the abdomen. Generally, 4-5 small incisions of button size are made in the lower abdomen, and the prostate gland is removed completely through special laparoscopic instruments, and the lymph nodes in the pelvis are cleared or not according to the condition, and then the bladder and urethra are anastomosed. Laparoscopic radical prostate cancer treatment has nearly 20 years of experience and mature technology. However, there are limitations of laparoscopic equipment, and in foreign countries, this procedure has been used less frequently due to the wide application of robotics.
(3) Robotic-assisted radical prostate cancer surgery
Robotic-assisted radical prostate cancer surgery is based on traditional laparoscopic radical prostate cancer surgery, which is a product of the combination of high technology and medicine, and generally involves making 4-6 small button-sized incisions in the lower abdomen, and the surgeon operates on the patient by controlling the “robot arm”. Compared to traditional laparoscopic surgery, robotic surgery is more precise, easier for the surgeon to operate and easier to learn and master. It is a widely used surgical method for radical prostate cancer surgery in Europe and America, but robotic surgery equipment is expensive and cannot be widely carried out in China at present.
3.Radiotherapy
Radiation therapy is a treatment method that uses radiation to kill prostate cancer cells, and it is also one of the most common treatment methods for prostate cancer. The other type of radiation therapy is brachytherapy, also known as internal radiation, which involves implanting radioactive particles directly into the prostate gland to treat tumors.
Radiation therapy can be used not only to treat prostate cancer that is confined to the prostate or pelvis, but also to treat pain when prostate cancer metastasizes to the bone or other parts of the body.
Radiation therapy may bring some complications or side effects to patients, such as erectile dysfunction, urinary incontinence, fecal urgency, blood in the stool, frequent urination, and urgent urination. With the progress of radiotherapy equipment and improvement of technology, the complications of radiotherapy have been significantly reduced.
4.Cryotherapy
4-8 cryo needles are inserted into the patient’s prostate gland through the skin and freeze the prostate gland to the temperature of cell death to achieve the purpose of treating prostate cancer. This is a minimally invasive, non-surgical incision and non-radiation damage treatment. The patient’s hospital stay is short, and in foreign countries, hospitalization is not even required. With the development of freezing equipment and improved technology, the treatment range and temperature control are more precise, thus obtaining similar tumor control results as surgery and reducing complications. However, compared with surgery and radiation therapy, the incidence of postoperative impotence is high with cryotherapy.
5.Endocrine therapy
Endocrine therapy is all aimed at stopping the stimulating effect of androgens (testosterone) on the growth of prostate cancer cells. One method is to reduce the level of androgens in the blood by removing the testicles or using drugs to inhibit the production of androgens; another method is to block the binding of androgens to the androgen receptors in the body through drugs.
6.Chemotherapy
Chemotherapy refers to the use of cytotoxic drugs to kill cancer cells. Chemotherapy drugs are usually infused into the patient’s bloodstream through a vein, and the drugs flow throughout the body with the blood, so chemotherapy has the effect of killing cancer cells in all parts of the body (except the brain). Chemotherapy drugs cannot cure prostate cancer, but they can keep the disease under control for a period of time.
Different treatment modalities are adapted to patients with different stages
Stage I: close monitoring, surgery (open, laparoscopic, robotic-assisted radical prostate cancer surgery), radiation therapy, cryotherapy
Stage II: follow-up, surgery (open, laparoscopic, robotic-assisted radical prostatectomy), radiation therapy, cryotherapy
Stage III: radiation therapy with or without endocrine therapy, some patients are suitable for surgery or cryotherapy
Stage IV: endocrine therapy, some patients are suitable for endocrine therapy combined with radiotherapy, surgery or cryotherapy