Current treatment situation faced by prostate cancer patients and their families

With the urbanization of China, the living standards of residents are constantly rising.

The number of prostate cancer cases is also on the rise. As for our hospital, the number of prostate cancer cases received has increased from single digits each year to over double digits each month now. This increase in incidence is alarming, but it is the reality we have to face.

Our hospital started to perform radical prostatectomy in 1989. In recent years, we have completed the transformation from open surgery to laparoscopic surgery, effectively overcoming complications such as massive bleeding or urinary incontinence, and combining comprehensive treatment measures to maximize the life expectancy of patients.

However, in daily work, we often find that we cannot fully communicate with patients and their families, which leads to some patients reaching a dead end in treatment. Therefore, I write this article.

1. Refusal to undergo prostate puncture:

When PSA is abnormal, nodules are felt during rectal examination, or nodules are found during imaging examination, these are all indications for prostate puncture. In addition, in subsequent treatment, when special medical insurance is required, the puncture pathology report will be used as the only basis. This routine prostate puncture is performed under hospitalization conditions, and the risk has been significantly reduced. We perform prostate punctures on hundreds of patients every year.

(1) I once encountered a case of advanced prostate cancer. It was said that the patient was observed from the time the PSA was 5.6ng/ml. The observation lasted for 7 years and was kept at over 200. When he was treated, bone metastasis was obvious. I asked the family why they only observed him but did not treat him. The family said that they consulted an old expert for rectal examination every three months, but he was told that there was nothing wrong, so they did not treat him. If the puncture was done in time and the diagnosis was confirmed, it might be possible to treat him earlier.

(2) Some cases are considered to be in the late stage, so biopsy is not performed: for example, if PSA is elevated or there are metastatic lesions. Therefore, biopsy is not performed. However, there are always misdiagnoses in clinical practice. PSA can also be elevated due to inflammation; other types of cancer can also metastasize in the prostate. Failure to obtain a pathological diagnosis through biopsy may lead to treatment deviations, and it is impossible to evaluate the treatment effect.

(3) Thinking that they are too old or in poor health, they do not undergo biopsy: In fact, without a pathology report obtained by biopsy, future treatment may be blind.

2. Dependence on endocrine therapy

Prostate cancer, unless it is a low-risk case (indications for active surveillance 1. Very low-risk patients, PSA <10, GS ≤6, positive biopsy index ≤3, tumor in each puncture specimen ≤50% of clinical T1c-2a prostate cancer. 2. Clinical T1a well-differentiated or moderate prostate cancer, younger patients with an expected life expectancy of >10 years. This type of disease requires close follow-up of PSA, TURS or prostate biopsy. 3. T1c-2a well-differentiated or moderate prostate cancer, asymptomatic patients with an expected life expectancy of <10 years. Otherwise, it is always progressing. Endocrine therapy alone cannot completely control the progression of cancer, not to mention that endocrine therapy for prostate cancer may lose its efficacy about 2 years after treatment, and turn into refractory prostate cancer that is ineffective for endocrine therapy, which is not conducive to the long-term treatment of patients.

3. Irregularity of endocrine therapy

Many patients use irregular endocrine treatment for symptom control or other reasons, which actually has very poor results.

4. Trust in radical surgery

Radical surgery can solve some cases, but it is not omnipotent for cases with lymph node metastasis or invasion of the capsule or seminal vesicle. These cases require further treatment after surgery, such as adjuvant endocrine therapy or salvage radiotherapy.

5. Management of biochemical recurrence

In clinical practice, we often encounter some patients who have undergone orchiectomy and have biochemical recurrence and become non-hormone dependent. Some doctors recommend the use of drugs such as Noradrenaline and Enanton. In fact, these drugs are often ineffective at this time because these drugs only act on the testicles. After orchiectomy, these drugs have lost their effect. However, due to the misunderstanding of these doctors, patients end up using them again.

Because of the high incidence of biochemical recurrence, intermittent endocrine therapy is now recommended, but it must be under the guidance of a specialist.

6. Current status of radical surgery: Because there are not many doctors who can perform radical surgery, some patients cannot get access to doctors who can perform radical surgery, which leads to treatment deviations.

What we discuss may be one-sided, and we welcome discussions.