In the West, prostate cancer is the most common malignant tumor, and in China, prostate cancer has overtaken bladder cancer as the most common malignant tumor of the urinary system. The following information is extracted by me according to the 2014 edition of the Chinese Diagnostic and Treatment Guidelines for Urological Diseases.
I. Epidemiology of prostate cancer
According to the latest data from the National Cancer Center, prostate cancer has become the most prevalent tumor in the urological system since 2008.
②Patients with prostate cancer are mainly elderly men.
③Hereditary prostate cancer: for three or more family members with the disease, or at least two with early onset (before age 55).
④A diet high in animal fat is an important risk factor for the development of prostate cancer. Lycopene contained in tomatoes is a strong antioxidant and a potential protective factor for prostate cancer.
⑤ Sunlight exposure was negatively associated with prostate cancer incidence.
⑥Green tea may be a preventive factor for prostate cancer
II. Diagnosis of prostate cancer
① Rectal examination combined with PSA test is currently recognized as the best test for early suspected prostate cancer.
② Rectal examination: it shows a hard node with peripheral band. The rectal examination should be performed after the PSA test.
③The more consistent view in China is that a serum total PSA (tPSA) >4ng/m is abnormal.
④The positive rate of prostate cancer puncture puncture in serum total PSA 4~10ng/m is 15,9%.
⑤ Transrectal ultrasonography: typical prostate cancer presents as hypoechoic nodules in the peripheral zone.
(6) Ultrasound-guided transrectal prostate aspiration biopsy is recommended in the following cases.
(7) Magnetic resonance imaging (MR) of the prostate can show the integrity of the prostate envelope, whether the tumor invades the seminal vesicle gland, bladder neck and other periprostatic tissues and pelvic lymph node metastasis.
ECT can detect bone metastasis 3-6 months earlier than conventional X-ray, but the sensitivity of ECT is high but the specificity is poor.
The pathological diagnosis of prostate cancer: the Geason scoring system is recommended for the pathological grading of prostate cancer. The higher the score value, the more malignant the tumor is.
⑩ Risk factor analysis of prostate cancer.
III. Treatment of prostate cancer
(i) Wait-and-see (for patients with prostate cancer who are unwilling or too frail to receive active treatment).
(II) Radical prostatectomy (for potentially curable prostate cancer).
(i) Radical prostate cancer resection behind the pubic bone (open surgery: very traumatic, difficult and long operation time).
②Laparoscopic radical prostate cancer surgery (laparoscopic surgery. Advantages: less damage, clear anatomy, less complications).
③Robotic-assisted laparoscopic radical prostate cancer surgery (robotic surgery. Advantages: same as laparoscopic surgery, disadvantages: high cost)
There is no significant difference between laparoscopic surgery and robotic surgery in terms of the overall complication rate and positive surgical margin rate of postoperative complications.
(C) External radiation therapy for prostate cancer (radiotherapy)
(1) It is the radical treatment for prostate cancer.
②Compared with radical surgery: lower incidence of sexual dysfunction, urethral stricture and urinary incontinence.
③Disadvantages: easy to cause radiation damage to the rectum.
④Common complications of radiotherapy.
Early irritation symptoms: urinary frequency, urinary urgency, increased nocturia
Radiation cystitis: hematuria
Radiation proctitis: diarrhea, blood in stool, perianal erosion
(IV) Endocrine therapy of prostate cancer
①Concept: The progression of prostate cancer is closely related to androgen (testosterone), and any treatment to remove or inhibit androgen activity can be endocrine therapy.
②Two terms of endocrine therapy.
Denervation: Removal of testosterone producing organs (surgical denervation: bilateral orchiectomy) or inhibition of testosterone production (pharmacological denervation, mainly luteinizing hormone-releasing hormone analogs, HRH-A, represented by the drugs treprostinil and goserelin).
Antiandrogen: blocking the binding of androgens to their receptors, thus blocking the action of androgens. Representative drugs bicalutamide.
③Endocrine treatment options.
1.Destructive treatment
Surgical depot: i.e., bilateral orchiectomy, which can cause a rapid and sustained decrease in testosterone to very low levels. The main adverse effect is the psychological impact on the patient. After surgical denervation, it is not possible to adjust the treatment plan flexibly, and a few patients are not effective in endocrine therapy, so drug denervation should be preferred in general.
Pharmacological depot: for luteinizing hormone-releasing hormone analogues (HRH-α), represented by leuprolide, goserelin and treprostin, which have been in clinical use for more than 15 years and are currently the main method of pharmacological depot treatment. After the injection of these drugs, testosterone levels gradually increase, reaching a peak after one week, and then gradually decrease until the depot level is reached in 3-4 weeks.
A very important point: Since there is a transient increase in testosterone when HRH-α is first injected, anti-androgen drugs should be given from 2 weeks before or on the day of injection until 2 weeks after the injection to counteract the aggravation of the disease caused by the transient increase in testosterone.
2.Antiandrogen treatment
There was no significant difference in overall survival with single anti-androgen treatment compared with desmotherapy, and the patient’s sexual and physical status improved significantly during the medication period, and the incidence of osteoporosis decreased.
Method: Bicalutamide 150mg orally once daily.
3.Maximum androgen blockade (MAB)
That is, the combination of depot treatment and anti-androgen treatment.
MAB can prolong overall survival by 3-6 months and reduce the risk of death by 20% compared with depot treatment alone.
IV. Follow-up of prostate cancer patients
Detection of changes in serum PSA levels is an essential part of prostate cancer follow-up.
(a) Follow-up after radical prostatectomy
(1) PSA should not be detected 6 weeks after successful radical prostatectomy
(ii) PSA remains elevated indicating the presence of PSA-producing tissue in the body, i.e. by residual prostate cancer lesions.
③The first PSA test after radical prostatectomy is recommended between 6 weeks and 3 months postoperatively
④Serum PSA level below 0,2ng/m is considered as no tumor progression
⑤Serum PSA levels higher than 0,2ng/m on both consecutive sides suggest biochemical recurrence of prostate cancer.
(II) Follow-up after radical radiotherapy
①The prostate gland still exists after radiotherapy and PSA decreases slowly, and the decrease to the lowest point may be after 3 years.
The lower the PSA value after radiotherapy, the higher the cure rate. It is generally believed that the prognosis is better for those with a minimum PSA level below 0,5ng/m within 3-5 years.
③ PSA level more than 2ng/m after radiotherapy is considered as biochemical recurrence of prostate cancer.