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Prostate cancer is an epithelial malignant tumor that occurs in the prostate. Pathological types of prostate cancer: adenocarcinoma (acinar adenocarcinoma), ductal adenocarcinoma, urothelial carcinoma, squamous cell carcinoma, adenosquamous cell carcinoma, etc. Prostate adenocarcinoma is more than 95%, so prostate cancer hereinafter refers to prostate adenocarcinoma.The incidence rate increased with age, and the peak age was 70-80 years old. Patients with familial inherited prostate cancer have a slightly earlier onset age.
Figure 1. Prostate Cancer.
The occurrence of prostate cancer is related to genetic factors. If there is no family member with prostate cancer, the relative risk is 1 and the absolute risk is 8. The relative risk of hereditary prostate cancer family members developing prostate cancer is 5, and the absolute risk is 35-45. In addition, the incidence of prostate cancer is related to sexual activity and dietary habits. People who engage in more sexual activity have an increased risk of developing prostate cancer. There is also a certain relationship between high-fat diet and disease incidence. In addition, the incidence of prostate cancer may be related to race, region, and religious beliefs.
The clinical diagnosis of prostate cancer mainly relies on digital rectal examination, serum PSA, transrectal prostate ultrasound, and pelvic MRI examination. CT has lower sensitivity in diagnosing early prostate cancer than MRI. Due to the high rate of bone metastasis in prostate cancer, a nuclear bone scan is usually performed before deciding on a treatment plan. The diagnosis of prostate cancer requires pathological examination through prostate biopsy. The malignancy of prostate cancer can be evaluated through histological grading, with the most commonly used being the Gleason scoring system. The malignancy of prostate cancer is divided into 2-10 points based on the sum of the scores of the main and secondary structural areas in the prostate cancer tissue, with the best differentiation being 1+1=2 points and the worst being 5+5=10 points.
Prostate cancer is often asymptomatic in its early stages. As the tumor progresses, the symptoms caused by prostate cancer can be summarized into two categories:
| Clinical Manifestations | Descriptions |
| Symptoms of oppression | The gradually increasing prostate gland compressing the urethra can cause progressive difficulty urinating, manifested as thin urine stream, short range, slow urine flow, interrupted urine flow, dribbling after urination, incomplete urination, and difficulty urinating. In addition, there are also frequent urination, urgency, increased nocturia, and even urinary incontinence. Tumor compression of the rectum can cause difficulty in defecation or intestinal obstruction, as well as compression of the vas deferens leading to ejaculation deficiency, compression of nerves causing pain in the perineum, and radiation to the sciatic nerve. |
| Transfer symptoms | Prostate cancer can invade the bladder, seminal vesicles, blood vessels and nerve bundles, causing hematuria, hematospermia, and erectile dysfunction. Pelvic lymph node metastasis can cause edema in both lower limbs. Prostate cancer is often prone to bone metastasis, causing bone pain, pathological fractures, and paraplegia. Prostate cancer can also invade the bone marrow and cause anemia or a decrease in overall blood count. |
Early stage (where the tumor is only located within the prostatic capsule) prostate cancer patients can achieve good treatment results and even be cured through radical surgery or radiation therapy. Due to the slow growth of tumors themselves, some low-risk and elderly patients can also choose to actively monitor according to their specific conditions and receive further treatment once their condition progresses. For locally advanced stage (tumor breaks through the prostate capsule but does not metastasize) and metastatic prostate cancer, androgen removal therapy is generally chosen to prolong the patient's survival and improve their quality of life; Some patients may choose surgical resection or comprehensive treatment with multiple methods based on radiotherapy.
Radical prostatectomy has the most effective treatment for prostate cancer. The main points are to remove the prostate and seminal vesicles, and then reconstruct the urinary tract. According to the patient's risk stratification and lymph node metastasis situation, whether to resect the lymphatic tissue and surrounding fat, muscle, nerve, blood vessels, etc. in the lesion area can be decided.
The doctor makes a vertical incision of about 20 centimeters under the navel to perform a prostatectomy. In rare cases, the incision is made in the perineum (between the scrotum and anus).
Make several small incisions in the abdomen, insert surgical tools and a camera through the incision, monitor with the camera and guide the removal of the prostate through external guidance. The advantages of this surgery compared with the traditional open surgery are: less trauma, short hospital stay, and reduced surgical complications. However, the incidence of urinary incontinence and erectile dysfunction after surgery is high.
By connecting surgical instruments with mechanical devices (robots) and inserting them into the abdomen through several small incisions, doctors can guide the surgery through a control and manipulation system. Compared to traditional minimally invasive surgery, more precise surgical resection can be achieved.
Drug treatment to kill rapidly proliferating cells, such as cancer cells, is used to treat patients who have already metastasized or have low hormone therapy sensitivity. Chemotherapy is administered by intravenous injection in the arm, or by tablet administration, or a combination of both. Methotrexate, cyclophosphamide, 5-fluorouracil and other drugs are currently commonly used chemotherapeutic drugs for prostate cancer. Chemotherapy drugs have non-specific killing effects on cancer cells, and the impact on patients' bodies will produce certain side effects. The side effects are mainly manifested as bone marrow suppression, poor appetite, muscle soreness, fatigue, etc.
It is a method to kill cancer cells by freezing tissues. Under the guidance of ultrasound, a cryoprobe is inserted into the prostate gland, and high-pressure argon gas is injected into the probe to rapidly cool down the treatment area in a short time to freeze the surrounding tissue. After 5-15 minutes, high-pressure helium gas is used to heat up and reheat the tissue, and this process is repeated several times to kill cancer cells. In the early stage of cryotherapy for prostate cancer, there were many complications and serious side effects, but now the technology has been improved, and the incidence of complications has also been reduced.
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