Individualized treatment of prostate cancer with traditional Chinese medicine

Prostate cancer is an androgen-dependent malignant tumor with a long natural course. Many patients present with no symptoms or mild symptoms, and by the time they seek medical treatment for symptoms such as bone pain, it is already in the late stage. Many early patients will experience PSA rebound and recurrence after radical prostatectomy; many patients will experience PSA rebound 5 or 6 years after radical prostatectomy and have to receive endocrine therapy. It is recommended that patients who have undergone radical prostatectomy should not relax and think that the cancer has been cured. This is incorrect and they should be closely followed up and observed.

Especially for patients with high Gleason scores and many postoperative pathological risk factors, early intervention with traditional Chinese medicine can significantly delay the time of endocrine therapy and even maintain long-term stability after surgery. For patients who need endocrine therapy or chemoradiotherapy after surgery, traditional Chinese medicine can enhance the sensitivity of endocrine drugs and chemotherapy drugs such as docetaxel, allowing patients to continue to be effective.

Some patients may ask, if PSA is measured after radical prostatectomy, does it mean that the tumor has recurred?

Because the prostate is connected to the bladder above and the urethra below, it is difficult to ensure that no prostate tissue will remain during the operation. As long as a little prostate tissue is left, a very small amount of PSA will be detected after the operation. Normal prostate tissue produces only 0.1ng/ml PSA per gram, while prostate cancer tissue produces 3.5ng/ml PSA per gram. Therefore, a trace amount of PSA after the operation indicates that the prostate has not been removed cleanly. It does not necessarily mean that there is residual prostate cancer or recurrence, but you must remain vigilant. Recurrence should only be considered if the PSA gradually increases.

For patients with advanced prostate cancer, almost all of them will progress to castration-resistant prostate cancer (CRPC) after endocrine therapy. Why does it develop into castration-resistant prostate cancer? As mentioned earlier, as an androgen-dependent malignancy, androgens stimulate the growth and metastasis of prostate pox cells. In endocrine therapy, single-castration therapy such as surgical castration or medical castration can block testicular androgens, and oral anti-androgen drugs can block androgens from the adrenal glands.

However, as the disease progresses, the androgen receptor will mutate, resulting in an increase in the ability of prostate tumor cells to biosynthesize androgens. The mutated androgen receptor is more sensitive to low levels of androgens. Although the patient's testosterone is still at a low level, the androgens secreted by tumor cells can still promote tumor evolution, causing a progressive increase in PSA. The disease state at this time is the castration resistance stage, and the patient's prognosis is poor and the expected survival time is short.

The main options for Western medicine treatment at this stage include: chemotherapy with docetaxel, oral abiraterone or new endocrine therapy such as enzalutamide. However, prostate cancer is a malignant tumor with great individual differences, and the effectiveness and duration of drugs also vary from person to person, so in clinical practice, we often encounter cases where chemotherapy or abiraterone is ineffective in reducing PSA.

The author has treated more than 100 cases of prostate cancer and believes that TCM has a definite effect in treating prostate cancer, and it should be treated individually. The efficacy is mainly reflected in prolonging survival, improving quality of life, reversing or delaying chemotherapy and endocrine drug resistance, and benefiting the survival of castration-resistant prostate cancer (CRPC) and metastatic castration-resistant prostate cancer (mCRPC) who have failed endocrine therapy and chemotherapy.