How should prostate cancer be treated? Specificity of treatment methods

The incidence and mortality of prostate cancer in my country have shown a clear upward trend in recent years. The characteristics of prostate cancer determine the particularity of the treatment method, which mainly includes:

(1) Radical prostatectomy: Radical prostatectomy plus bilateral orchiectomy can be performed for early-stage patients, but the operation is difficult and has a high incidence of complications such as postoperative urinary incontinence, urinary retention, and sexual dysfunction. Laparoscopy can now also be used to perform prostatectomy, reducing the pain of patients.

(2) Endocrine therapy: Because prostate cancer is hormone-dependent, it is more sensitive to hormone therapy. Therefore, endocrine therapy can significantly improve symptoms, but some patients may develop drug resistance. Therefore, it is unclear whether it can prolong the patient's life.

(3) Radiotherapy: Radiotherapy can only relieve symptoms for some patients and cannot completely cure prostate cancer. It can also cause radiation damage to the rectum and bladder.

(4) Systemic chemotherapy: It is used for patients with postoperative tumor recurrence and endocrine therapy failure. However, systemic chemotherapy has serious side effects, is difficult for patients to accept, and has uncertain efficacy. Currently, there are no sensitive chemotherapy drugs, and systemic chemotherapy is generally not recommended.

(5) Cryotherapy: Cryotherapy can be used to treat prostate cancer through perineal puncture. It can relax the age and indications of patients who receive radical treatment. It has the advantages of short treatment time, less pain, avoiding the risk of complex anesthesia, reducing postoperative complications and repeatability. For patients with hormone-independent prostate cancer in the middle and late stages, cryotherapy can remove part of the tumor, relieve lower urinary tract obstruction, improve symptoms, and improve the quality of life of patients during their limited survival period. Cryotherapy is the only treatment method that can achieve precise removal of tumor cells while keeping the patient's resected tissue intact.

(6) High-energy focused ultrasound therapy: It can be used through rectal or extracorporeal irradiation to generate a high temperature of 70 to 100°C in the prostate target area, causing tissue coagulation and necrosis, directly killing cancer cells.

(7) Microwave coagulation therapy: It can be performed through the urethra or perineum as a palliative treatment for patients with advanced prostate cancer. It can be combined with endocrine therapy and radiotherapy to effectively relieve the patient's urinary tract obstruction symptoms, thereby improving the patient's quality of life and prolonging life.

(8) Radiofrequency ablation therapy: Under the guidance of B-ultrasound or CT, the treatment is usually performed by placing electrodes through perineal percutaneous puncture. The treatment effect and range can be monitored in real time. After treatment, the prostate volume can be significantly reduced, PSA can be reduced, and urinary tract obstruction symptoms can be improved.

(9) Radioactive particle implantation: In addition to achieving the same therapeutic effect as radical surgery, radioactive particle implantation for the treatment of prostate cancer also has the following characteristics: A. It can avoid late rectal or bladder damage, nerve damage and impotence caused by surgery or external irradiation. After radioactive particle treatment, 80% of patients retain their sexual ability; B. Low-energy, continuous, low-dose intratumoral irradiation has significant biological characteristics and can effectively act on tumor tissue; C. The radiation source intensity is low and has little effect on normal tissue around the lesion; D. The technology is simple and only requires one treatment.

(10) Castration surgery.