How to choose the treatment method for prostate cancer?

Elderly male patients are often troubled by prostate hyperplasia and are not unfamiliar with prostate cancer. The incidence of prostate cancer in Chinese is lower than that in Europe and the United States. With the improvement of living standards and the extension of life expectancy, the incidence of prostate cancer in my country has a trend of continuous growth. When it comes to tumor treatment, the commonly known treatment methods are surgery, chemotherapy and radiotherapy; most tumor treatments rely on these "three axes", and in addition to surgical treatment for tumors such as lung cancer and kidney cancer, targeted therapy plays an important role in metastatic tumors.

Compared with other tumors, the treatment of prostate cancer is specific. In addition to the above-mentioned "three axes", there is also an endocrine therapy, also known as hormone therapy; because the occurrence and development of prostate cancer depends on androgens, androgens are the nutritional source of prostate cancer cells, and prostate cancer cells will "starve to death" if their "food" is cut off; but in addition to androgen-dependent cells, prostate cancer also has androgen-independent cells, which can survive in the absence of "food".

Therefore, the treatment of prostate cancer needs to be "tailored" and different treatment plans should be adopted. For some patients with early prostate cancer, it is not necessary to treat them temporarily, observe the progress of the disease, and take treatment when appropriate. This is what doctors call "active monitoring" "treatment". Which patients with early prostate cancer need "active monitoring"?

Doctors need to comprehensively consider the clinical stage, pathological grade, physical condition, life expectancy, etc. of the patient's prostate cancer to make a judgment, such as clinical stage T1c-2a prostate cancer, PSA <10ng/ml, Gleason score ≤6, etc.; of course, the patient himself must be fully aware of the condition and accept the risk of tumor progression and metastasis. However, such patients should not be taken lightly. Close follow-up is recommended, and PSA and prostate ultrasound should be checked regularly. If the condition progresses, the treatment plan should be adjusted in time. When patients learn that they are diagnosed with prostate cancer, the first thing they think of is whether they can have surgery. Most patients with early prostate cancer can benefit from surgery.

Surgery usually refers to radical prostatectomy, which is indicated for organ-confined prostate cancer, no lymph node or bone metastasis, and a patient's life expectancy of more than 10 years. For patients with poor general condition, severe cardiovascular, cerebrovascular, and lung diseases who cannot tolerate major surgery, radiotherapy and cryotherapy can be used.

For early prostate cancer, radiotherapy can also effectively control the tumor and achieve the same therapeutic effect as surgery in the short term. There are two types of radiotherapy for prostate cancer: external irradiation and brachytherapy (isotope particle implantation). Compared with radiotherapy, cryotherapy has the advantages of no radiation risk and low rectal injury rate, and is also an option for the treatment of early prostate cancer. The clinical incidence of prostate cancer in my country is low. Due to the lack of publicity and health examinations, patients cannot distinguish between the similar symptoms caused by prostate hyperplasia and prostate cancer, making it difficult to detect early prostate cancer. By the time they have obvious symptoms such as difficulty urinating, hematuria, and bone pain and go to the hospital for treatment, most of them are diagnosed with advanced prostate cancer and lose the opportunity for surgical treatment.

So can patients just "sit and wait for death"? Fortunately, there is another "killer weapon" for the treatment of prostate cancer - endocrine therapy, that is, hormone therapy. American doctor Huggins found that removing the testicles to remove androgens in patients can treat advanced prostate cancer. There are currently several drugs that can achieve this treatment effect, such as leuprorelin, goserelin, triptorelin, etc.; there are also anti-androgen drugs, flutamide, bicalutamide, etc., which cut off the "food" source of prostate cancer cells through other pathways. Hormone therapy, as an important treatment for advanced prostate cancer, can improve patients' symptoms, relieve patients' pain, and delay disease progression, but hormone therapy is a palliative treatment method that cannot kill androgen-independent tumor cells. Most patients experience relief for 12-18 months through hormone therapy, and eventually their condition worsens again. Once you enter the castration-resistant prostate cancer stage, are there any good treatments?

Chemotherapy is one of the options. Chemotherapy includes a variety of treatment options, mainly docetaxel, mitoxantrone and other options. However, patients have an inexplicable fear of chemotherapy and worry about the reactions of various chemotherapy. They often refuse chemotherapy or seek other treatment options. At present, new drugs for the treatment of castration-resistant prostate cancer have been used in clinical practice and have achieved good results, such as abiraterone and enzalutamide. With the continuous deepening of research on the pathogenesis of prostate cancer, the development of new drugs for the precise treatment of prostate cancer has brought new hope of survival for patients with advanced prostate cancer.

Advanced prostate cancer metastasizes to bones, causing bone pain and pathological fractures, which seriously affect the patient's quality of life. For bone pain at fixed sites, local radiotherapy can relieve pain; for patients with extensive bone metastases, isotope therapy can relieve symptoms caused by multiple bone metastases, with the dual effects of analgesia and anti-tumor; commonly used isotopes in clinical practice include strontium-89.

Patients with advanced prostate cancer respond differently to various treatment options, and the effective duration of treatment varies. Therefore, it is necessary to develop an appropriate treatment plan based on the treatment effect of each patient. An individualized treatment plan should be selected according to each patient to alleviate the patient's symptoms, improve the patient's quality of life, and delay the progression of the disease as much as possible.