The diagnosis of prostate cancer should include two aspects, one is qualitative, that is, to determine what the disease is; the other is quantitative, that is, to what extent it has developed. The diagnosis of prostate cancer also includes these two aspects. Specifically, there are five diagnostic techniques: tumor markers – serum PSA, rectal examination, prostate puncture, pelvic MRI, and whole-body bone scan. The first three techniques are qualitative, i.e., to determine if it is prostate cancer; the last two techniques are quantitative, i.e., to determine the extent of prostate cancer progression. The following are some specific points. 1.Serum PSA. one drop of blood can diagnose many kinds of diseases is the desire of the people and also the direction of medical doctors’ efforts. tumor markers are specific markers, generally antigens or antibodies, detected from blood to diagnose various kinds of tumors. The tumor marker for prostate cancer is the serum PSA. Because it is mainly secreted by the prostate gland, it becomes a good marker for the diagnosis of prostate cancer. It is clinically recommended that patients over the age of 50 with prostate enlargement should be routinely tested for serum PSA, and various medical screening centers also recommend this test for men over the age of 50. We all know that PSA over 4-10ng/ml should be suspected of prostate cancer, so many people are nervous. In fact, like most tumor markers, PSA values are not so absolute. PSA is secreted by the prostate gland epithelium, so the larger the prostate volume, the more it is secreted. it is not difficult to understand that PSA is also elevated in huge prostates and often exceeds the normal range, so some people suggest using PSA per unit of prostate volume to help diagnose, i.e. PSAD, the normal value is recommended at PSAD <0.15< span = "">. In addition, PSA secretion is influenced by many factors, such as holding urine, ejaculation, such as inserting a catheter, or performing a rectal exam. All of them can make PSA elevated. Therefore, for patients with PSA > 4ng/ml, who are younger and not willing to have a prostate puncture biopsy, you can test PSA regularly, for example once every 3 months, to see if there is a rising trend in PSA, which creates another indicator – PSAV, which refers to the rate at which PSA rises. The normal value of PSAV should be less than 0.75ng/ml.y. There are also places that measure free PSA and compare the ratio of free PSA to total PSA to assist in the diagnosis of prostate cancer, which also has some significance. Therefore, the tumor marker of prostate cancer, PSA, and its derivatives PSAD, PSAV, and the ratio of free PSA to total PSA are all helpful in diagnosing prostate cancer, and if more than two of them are abnormal, then a prostate puncture biopsy is highly recommended. 2. Rectal palpation. Since prostate cancer mostly occurs in the periphery of the prostate tissue, once the tumor is formed, most of the hard nodes in the prostate can be touched from the anal fingering. This is a basic skill for clinicians to diagnose prostate cancer. If it is prostate cancer, it will usually show as hard nodes on the surface of the prostate with hard texture, fixed position and poor mobility of the prostate. 3.Prostate puncture. This test is the gold standard to determine if it is prostate cancer. Also, it can grade the malignancy of prostate cancer. A transrectal puncture is usually chosen, but there are also punctures through the perineum. Although it is theoretically less painful and easier to perform, there have been reported cases of death due to the spread of bacteria in the rectum after puncture, so nowadays it is usually required to be performed in hospital in case there are serious complications that can be dealt with in time. Moreover, it is now mostly recommended that prophylactic oral antibiotics should be given for 3 days before puncture. The tissue obtained after the puncture is sent to the pathology department for examination, and immunohistochemistry is used to give a pathological grade. This is commonly referred to as the Gleason score. Due to the variability of adenocarcinoma structure in different areas, separate scores are given by major and minor grading areas and then the two are added together to give a total score. The level of the score is informative for the choice of treatment modality. 4. Pelvic MRI, i.e. pelvic magnetic resonance, is generally chosen as the wave spectrum examination. MRI examination can show whether the prostate envelope is intact, whether the tumor invades the tissues and organs around the prostate, and also shows the invasion of pelvic lymph nodes and bone metastatic lesions. MRI is a quantitative examination to assess the degree of disease development after the diagnosis of prostate cancer, but it needs to be done before the qualitative examination, i.e. prostate puncture, so that the hematoma after the puncture does not affect the display results. MRI itself does not have much positive rate in terms of confirming the diagnosis of prostate cancer. 5. Bone scan. Since the metastatic site of prostate cancer firstly targets the bone and bone metastasis is more frequent. Therefore, bone scan is often performed after the diagnosis of prostate cancer is confirmed. Whether there is bone metastasis is related to the degree of tumor malignancy. Generally speaking, high-risk prostate cancer, such as PSA> 20ng/ml and Gleason score> 7, is more likely to form bone metastasis. However, it does not mean that low-risk patients do not have the possibility of bone metastasis, so this is also a routine test. Treatment of prostate cancer Almost all treatments for malignant tumors include the following options: surgery, chemotherapy, radiotherapy, biotherapy, immunotherapy. Nowadays, targeted drug therapy has been added. Prostate cancer has its special features, namely endocrine therapy and oncologic radiotherapy, which are more effective for prostate cancer and are different from other tumors. Because of the variety of treatments, the treatment of prostate cancer is described in detail in clinical guidelines in various countries, far more than in textbooks. Even some clinicians are confused. In fact, the choice of treatment modality for prostate cancer is based on the development of the disease. As long as the prostate cancer is accurately staged and graded based on the aforementioned diagnosis, then the choice of treatment modality is not a challenge. Basically, it can be divided into the following three areas. 1. Prostate cancer primary, without metastasis. That is, patients are often concerned about whether it is early or late stage. At this time, prostate cancer is confined to the prostate envelope, there is no local infiltration or metastasis, and there is no distant metastasis to other tissues and organs. The available treatment options include: radical surgery, radical radiotherapy, endocrine therapy, brachytherapy (i.e. particle implantation), cryotherapy, high energy focused ultrasound therapy, radiofrequency ablation and other methods. 2.Locally progressive prostate cancer, also known as locally advanced stage, means that although prostate cancer has metastasis, the scope is not large and only limited to the prostate envelope and seminal vesicles, or other tissues outside the seminal vesicles. Surgery, radiotherapy, endocrine therapy, brachytherapy, etc. are also options. 3.Distant metastasis of prostate cancer. At this time, prostate cancer has metastasized to the pelvic lymph nodes or even further to other organs such as bones or lungs, liver, etc. At this time, it is not suitable for surgery, and only palliative treatment options are available, including: endocrine therapy, palliative radiotherapy, or some of them need chemotherapy. 4. Endocrine therapy for prostate cancer. From these treatment options, it is easy to see that endocrine therapy is applicable to all stages of prostate cancer. Endocrine therapy for prostate cancer has a history of more than 70 years, and is the most reproducible and longest used treatment modality among the various treatments for prostate cancer and has been used to date. Endocrine therapy consists of two aspects: anti-androgen therapy, which resists the effects of androgens on prostate cancer, and the reduction of androgen production, known as depot therapy. For the past 50 years, androgen depot has been the cornerstone of treatment for patients with metastatic prostate cancer. This can be done by surgical removal of the testicles for depotting or by injectable drugs for depotting. Both methods can reduce androgen production by more than 95%. Although drug debulking is more acceptable to patients, it must be acknowledged that surgical debulking has fewer complications than drug debulking, with studies showing a 23% reduction in fractures; a 35% reduction in peripheral arterial disease, and a 26% reduction in cardiac complications. Patients treated with pharmacologic debulking for more than 35 months had the greatest risk of fracture, peripheral artery disease, venous thromboembolism, cardiac complications, and diabetes. Precision medicine for prostate cancer In January 2015, President Barack Obama proposed the “Precision Medicine Initiative” in his State of the Union address. In fact, our ancestors in Chinese medicine have long proposed “treating patients according to their diseases”. There is also precision medicine for prostate cancer. A new blood test that is still in the experimental stage can help make personalized medical decisions and determine the treatment plan for individual prostate cancer patients. The new non-invasive “liquid biopsy” technology presents different cancer cells in the blood and analyzes their appearance and genetic makeup to determine whether the patient would benefit from hormone therapy. If this monitoring technology can be used in the clinical setting through the pilot phase, it will actually help clinicians make decisions about treatment options and select a more effective treatment for their patients. This is done by detecting what are called circulating tumor cells (CTCs). The types of CTCs vary greatly from patient to patient. The test technique places a blood sample on a slide, stains it with a special stain to distinguish normal cells from CTCs, and then a machine scans it to analyze the size, shape and other characteristics of CTCs. Researchers can also collect individual cells and harvest them from slides to analyze genetic abnormalities. The more diverse a patient’s CTC shape and genetic makeup, meaning a higher heterogeneity score, the less likely they are to respond to hormone therapy. These techniques are still in the research phase and are expected to lead to precision medicine for prostate cancer patients in the future.