Prostate cancer is actually not scary

Prostate cancer diagnosis: Prostate cancer is a tumor that progresses slowly and has no obvious symptoms. The most common symptoms are similar to those of prostate hyperplasia (BPH). Most patients only develop more serious symptoms (local invasion or distant metastasis) in the late stage, including bone pain and weight loss. Early diagnosis and treatment may give patients a better prognosis.

Digital rectal examination (DRE), prostate specific antigen (PSA), and transrectal ultrasound (TRUS) are the most basic tools for checking whether there is adenocarcinoma in the prostate. If the results of the prostate biopsy confirm the presence of cancer cells, further examinations will include CT scans, MRIs, bone scans, and cell differentiation tests (Gleason grading scores), which will help understand the condition (stage) of prostate cancer.

If the cancer cells are confined to the prostate, it can be divided into T1 or T2 stage (localized prostate cancer). T3 stage means that the cancer cells have invaded the prostate capsule or seminal vesicles. If the cancer cells have metastasized to other organs, such as bones, liver or lungs, it is in the terminal stage (N+ or M+).

Treatment options for prostate cancer

Several factors affect the treatment approach for localized prostate cancer, including expected survival, physical condition, and quality of life requirements. With an average life expectancy of 77 years for men in Taiwan, a 70-year-old man can expect to live for more than 10 years. For these patients with localized prostate cancer, radical prostatectomy or radiation therapy is the best option. However, for patients over 75 years old, castration or radiation therapy is the best option.

Complications of radical prostatectomy include urinary incontinence and sexual dysfunction, and for selected subgroups of patients, nerve-sparing prostatectomy may preserve sexual function.

The growth and development of the prostate gland depends on androgens, mainly testosterone and dihydrotestosterone, so clinically, androgens can be removed to treat prostate cancer. Scott and Boyd used hormone therapy in the 1960s to reduce the size of the prostate gland and turn lesions that were originally inoperable into tumors that can be surgically removed. Castration therapy includes surgical removal of the testicles, or the use of luteinizing hormone (LH-RH) analogs (such as Zoladex or Leuplin) to achieve the purpose of castration. It can also be used in combination with anti-androgens (such as Casodex, Flutamide and Androcur). Castration therapy can be used as neoadjuvant therapy (before surgery or radiation therapy), adjuvant therapy (after surgery or radiation therapy), or, as in most cases, in the treatment of severe conditions such as cancer cell metastasis (N1 or M1).

Today's radiotherapy can effectively control localized prostate cancer and is a life-prolonging option for patients. After radiotherapy, about 20-30% of patients still have positive biopsy results. The 10-year survival rate of radiotherapy is about the same as that of radical prostatectomy, so radiotherapy is a good choice for patients who are unwilling to undergo radical prostatectomy. For some metastatic lesions, radiotherapy can also provide pain relief.

For recurrent prostate cancer that is not responsive to castration or prostate cancer with poor control of multiple metastases, second-line castration therapy or chemotherapy can be considered. Extracts of traditional Chinese medicine (such as PC-SPES) and gene therapy and immunotherapy currently under research and development can also provide patients with another opportunity.

What are your options?

Some questions must be asked:

1. Is your prostate cancer really localized? Or has it already metastasized?

2. Does this cancer really progress slowly?

3. What is your physical condition? Are you able to withstand surgery?

4. Are you still young? Although prostate cancer progresses slowly, will it endanger your health in the future?

5. Can you tolerate the complications and inconveniences caused by prostate cancer treatment?

6. Does urinary incontinence, hematuria or abnormal bowel movements cause great trouble to your social activities or work?

7. Are you concerned about sexual dysfunction and erectile dysfunction?

8. If you cannot take life, health, and quality of life into consideration at the same time, what will be your final choice?

The treatment you choose will affect the final outcome of the disease, so you must fully discuss it with your doctor and even seek medical re-consultation.

How to face prostate cancer?

The treatment of prostate cancer has undergone revolutionary breakthroughs in the past 10 years. The invention of PSA testing has changed our concept of this disease. Prostate cancer is the most common malignant tumor in the United States, and it is also increasing in Taiwan. However, prostate cancer progresses slowly and has a relatively good prognosis. Therefore, as long as we can be vigilant and undergo PSA screening, if we are unfortunately diagnosed with prostate cancer, as long as we can work together with medical professionals, face it bravely, and choose a treatment method that takes into account both health and quality of life, we will be able to overcome the disease and live with more dignity.