Diagnosis and treatment of prostate cancer

  The clinical diagnosis of prostate cancer is based on rectal examinations, serum PSA, transrectal prostate ultrasound and pelvic MRI. The diagnosis of prostate cancer requires pathological examination through prostate puncture biopsy.  The malignancy of prostate cancer can be assessed by histological grading. The most commonly used is the Gleason scoring system, which classifies the malignancy of prostate cancer as 2-10 based on the sum of the scores of the major and minor structural areas in the prostate cancer tissue, with the best differentiation being 1+1=2 and the worst being 5+5=10.  Treatment For patients with early stage prostate cancer, radical treatment methods can be used. The methods that can cure early stage prostate cancer are radioactive particle implantation, radical prostatectomy, and radical external radiation therapy.  The indications for radioactive particle implantation should meet the following 3 conditions: 1. PSA <10ng/ml; 2. Gleason score of 2-6; 3. Clinical stage of T1-T2a.  The indications for radical prostatectomy should meet the following 4 conditions: 1, PSA <10-20ng/ml; 2, Gleason score ≤7; 3, clinical stage T1-T2c; 4, patients with life expectancy ≥10 years.  Radical radiotherapy is suitable for patients with limited prostate cancer. Techniques such as three-dimensional conformal radiotherapy and intensity-modulated conformal radiotherapy are mainly used. In addition, external radiation therapy can also be used as adjuvant therapy for patients with pT3-4 pathology, seminal vesicle invasion, positive cut margins or persistently elevated PSA after radical prostatectomy; it can also be used as palliative treatment for patients with advanced or metastatic prostate cancer.  For patients with mid-stage prostate cancer, a combination of therapeutic approaches should be used, such as surgery + radiotherapy, endocrine therapy + radiotherapy, etc.  For patients with hormone-sensitive advanced prostate cancer, endocrine therapy is the main treatment. The methods of endocrine therapy include debulking and anti-androgen therapy or debulking + anti-androgen therapy. The efficacy of surgical debulking or pharmacological debulking is basically the same. However, almost all patients will eventually develop hormone-non-dependent prostate cancer or hormone-resistant prostate cancer. Second-line endocrine therapy or newer endocrine therapy drugs may be used for patients with desmoid-resistant prostate cancer. Patients with hormone-resistant prostate cancer should be continuously maintained in a depressed state with concurrent polyene paclitaxel and mitoxantrone based chemotherapy. Patients with prostate cancer with bone metastases should be treated with a combination of osteoprotective agents to prevent and reduce bone-related events, relieve bone pain, improve quality of life, and increase survival rates. External radiation therapy or radionuclides may also improve local bone pain.