Prostate cancer is one of the most common male malignancies in Europe and the United States, with a mortality rate second only to lung cancer. With longer life expectancy and improved diagnostic techniques, the incidence is increasing year by year, and it is more likely to occur in the peripheral zone of the prostate. More than 80% of prostate cancer is hormone-dependent, and non-hormone-dependent type only accounts for a minority.
Diagnostic criteria
I. Clinical manifestations
(1) Prostate cancer generally develops slowly and most of them have no obvious clinical symptoms. It is detected by rectal examination, ultrasonography or preoperative PSA examination of prostate enlargement and biopsy of prostate system. Few of them are found incidentally in the specimen of prostate cancer enlargement.
(2) When prostate cancer is large, it may cause difficulty in urination, urinary retention, urinary incontinence, hematuria or hydronephrosis.
(3) In case of bone metastasis, crestal medullary compression nerve symptoms and pathological fracture may occur.
II. Auxiliary examination
(a) Rectal palpation: hard nodules of the prostate can be found, either as a single nodule or as a mass, hard as a stone.
(2) Serum PSA measurement: elevated PSA may have prostate cancer, which should be combined with imaging and prostate biopsy to make the diagnosis.
(c) Ultrasonography: Generally, transrectal ultrasonography can show whether the tumor is a hypoechoic area and whether it invades the peritoneum and seminal vesicles.
(4) CT and MRI: It can show the tumor in the prostate, its scope and morphology, and can detect the metastatic enlarged lymph nodes in the pelvis.
(E) Intravenous urography: When prostate cancer invades and compresses the ureteral orifice, it may cause hydronephrosis.
(6) Prostate biopsy: It is necessary to confirm the diagnosis of prostate cancer, and sometimes multiple biopsies are required to confirm the diagnosis.
(vii) Whole-body bone scan: It can reveal the whole-body bone metastases.
Treatment principles
Prostate cancer treatment can be divided into wait-and-see, radical prostatectomy, endocrine therapy, radiation therapy and chemotherapy, etc.
A. Wait and see: suitable for limited prostate cancer, patient’s predicted life expectancy <10 years, serum PSA measurement, rectal examination and ultrasound examination every 3 months.
II. Radical prostatectomy: suitable for patients with limited prostate cancer, etc., with predicted life expectancy >10 years.
Endocrine therapy: Endocrine therapy is one of the main treatments for prostate cancer, especially for patients with metastatic lesions. The methods are
(a) orchiectomy: It can make most prostate cancers recede or stabilize with simple surgery and good efficacy. However, it can cause penile erectile dysfunction (ED), etc.
(b) Gonadotropin analogue LHRH-A: such as leuprolide acetate (Suppressant), goserelin (Norelide), etc., which can reduce LH secretion by pituitary gland and testosterone synthesis, and can achieve the level of drug de-testosterone, with the same complications as orchiectomy.
(iii) Anti-androgen therapy: Flunitinamide (Flutamide), Casodex, etc. are commonly used.
(iv) Estrogen.
Radiotherapy can effectively control the local lesions of the prostate gland and relieve the pain of bone metastases and metastatic lymph nodes that are not treated with other treatments. Radiation therapy can be external irradiation or intra-tissue irradiation.
Chemotherapy: chemotherapy drugs such as Adriamycin, 5-Fu, cyclophosphamide, cisplatin can be used, but the efficacy is not very satisfactory.