Treatment methods for prostate cancer abroad

What are the treatments for prostate cancer abroad? Treatments for prostate cancer include follow-up observation, transurethral resection of the prostate (TURP), radical prostatectomy, radiotherapy, cryotherapy, endocrine therapy, comprehensive treatment, etc. The choice of a specific treatment plan should be based on the patient's age, general condition, various examinations and the predicted clinical stage of prostate cancer, the tumor histological grade obtained from the puncture biopsy specimen, the Gleason score, and the presence or absence of pelvic lymph node metastasis and distant metastasis.

1. Treatment methods for prostate cancer abroad

(1) Prostate cancer T1a:

①Observe and wait.

②Radiotherapy.

③ Radical surgery: life expectancy>10 years, Gleason>7, PSA>4μg/L after TUR.

(2) T1b, T1c, T2a, T2b:

① Life expectancy < 10 years, observation and waiting or radiotherapy.

② Life expectancy > 10 years, radical surgery or radiotherapy.

(3) T3a:

① Androgen removal therapy.

②Radiotherapy.

③Radiotherapy and androgen removal therapy.

④ Radical prostatectomy may be considered (life expectancy > 10 years, Gleason < 7).

(4) T3b, T4, N0:

① Androgen removal therapy.

②Radiotherapy.

③Radiotherapy and androgen removal therapy.

(5)TxN1:

①Observe and wait.

② Radiotherapy and androgen removal therapy.

③Radiotherapy.

(6)TxN2: androgen deprivation therapy.

2. Specific treatment options

(1) The natural course and treatment options of localized prostate cancer:

At present, the main treatments for patients with localized prostate cancer (clinical stages T1 and T2) include radical prostatectomy, radiotherapy, or clinical follow-up observation. So far, there has been no large-scale randomized paired study to directly compare the advantages and disadvantages of surgery and radiotherapy. Some retrospective surveys and studies have shown that if the pathological grade of the tumor and the PSA level are taken into account during the study, the 5-year survival rate of patients treated with these two methods is basically the same, with no significant difference. Since there is no evidence to indicate which of these two methods is better, when we choose the appropriate treatment for patients, we mainly consider the patient's general condition and health status, the side effects of the treatment, the patient's preferences and wishes, etc. For example, compared with radiotherapy, the risk of urinary incontinence and erectile dysfunction after radical prostatectomy is greater, but the effect on intestinal function is small. Therefore, when treating localized prostate cancer, the needs and wishes of patients should be fully considered.

(2) Clinical observation and follow-up:

A considerable number of patients with early localized prostate cancer can be followed up clinically without immediate treatment, because the long-term survival rate of these patients during the observation period is basically the same as that of people of the same age without prostate cancer. Most prostate cancer patients who choose to follow up are older, have a short life expectancy, may have occult tumors, and have no obvious clinical manifestations. In addition, since the chance of tumors in the transitional zone invading the rectovesical space is small and the possibility of distant metastasis is small, follow-up observation is also one of its feasible options. The ideal patient for follow-up observation should be a patient with serum PSA <4ng/ml, a short life expectancy, and a low tumor pathological grade. The most attractive thing about this "therapy" is that it does not have the mortality problem associated with various treatments. However, patients often realize that they have untreated cancer in their bodies, which will cause serious ideological and psychological burdens, which is why people rarely choose follow-up observation.

(3) Radical prostatectomy:

Radical prostatectomy has gone through a century of development. In 1904, Dr. Young of Johns Hopkins University in the United States completed the first transperineal radical prostatectomy, which included the entire prostate, seminal vesicles, and Denonvilliers fascia. In 1945, Young reported the results of 184 cases of transperineal surgical treatment, with a follow-up of 5 to 27 years, and a cure rate of 55%. In 1948, Minin first performed retropubic radical prostatectomy; in 1954, Chute introduced in detail the surgical method of retropubic retrograde radical prostatectomy; in 1958, Campbell introduced the treatment method of retropubic antegrade radical prostatectomy. Due to the large surgical trauma of radical prostatectomy, the extremely high incidence of postoperative urinary incontinence and erectile dysfunction, and the high surgical mortality rate, the clinical application of radical prostatectomy is greatly limited. In 1979, Walsh et al. from Johns Hopkins University in the United States proposed a radical prostatectomy technique that preserves the nerves based on anatomical research results, which greatly reduced intraoperative blood loss and the incidence of postoperative urinary incontinence and impotence. Now, radical prostatectomy has been accepted by most urologists and has become a classic surgical method for prostate cancer, especially localized prostate cancer.