Treatment principles for prostate cancer

The treatment principles for prostate cancer are as follows:

Stage A is a cancer discovered accidentally during the treatment of prostatic hyperplasia. The lesions are localized and most are well differentiated. Most patients have stable conditions and slow progression, and only about 1% may die from cancer. Since patients in this stage have a good prognosis, immediate radical prostatectomy, radiotherapy, or endocrine therapy is generally not recommended. Regular follow-up can be performed, including rectal examination, B-ultrasound examination, and determination of blood acid phosphatase.

Most B1 stage tumors are well differentiated, but 5% to 20% of patients have lymphatic metastasis during surgery. Therefore, patients at this stage should undergo radical prostatectomy, and the 15-year cancer-free survival rate after radical surgery is 50% to 70%. About 50% of patients at B2 stage have tumors that have invaded the seminal vesicles, and 25% to 35% of patients have lymph node metastasis, so radical prostatectomy and pelvic lymph node dissection, orchiectomy, endocrine therapy, radiotherapy, and intra-tissue radiotherapy should be performed. The 15-year cancer-free survival rate after radical surgery for B2 stage is 25%.

There is no consensus on the treatment of stage C. Because tumors at this stage are difficult to treat, most pelvic lymph nodes have metastasized. The following methods are generally used for treatment: ① For elderly and weak patients with poor general condition, extended-range external radiotherapy is suitable; ② Endocrine therapy (including bilateral orchiectomy), after downgrading, extended-range external radiotherapy and radical prostatectomy are combined; ③ Intra-tissue radiotherapy and external radiotherapy are suitable for patients without lymph node metastasis and distant metastasis and with good general condition.

Endocrine therapy, chemotherapy and immunotherapy are the main treatments for stage D, and pelvic lymph node dissection can be performed for stage D1. Early application of endocrine therapy can prolong the survival of the disease, with a 5-year survival rate of about 3%.