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prostatic cancer

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Prostate cancer refers to an epithelial malignancy that occurs in the prostate. Prostate cancer pathologic types included adenocarcinoma (acinar adenocarcinoma), ductal adenocarcinoma, urothelial carcinoma, squamous cell carcinoma, and adenosquamous carcinoma in WHO 2004 pathology and genetics of tumors of the urinary system and male genital organs.

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Chinese name prostate epithelial malignancy

English name prostate cancer

Attending Department of Urology

Those with a family history of the disease, middle or old aged males were included in the multiple groups



Aetiology Pathol

The occurrence of prostate cancer is associated with genetic factors, with a relative risk of 1 if the person without prostate cancer in the family has a risk of 8; In contrast, family members with hereditary prostate cancer had a relative risk of 5 for prostate cancer of 35-45. In addition, the incidence of prostate cancer is related to sexual activity, dietary habits. Men with more sexual activity have an increased risk of prostate cancer. There is also a relationship between high-fat diet and morbidity. In addition, the incidence of prostate cancer may be associated with race, region, religion.

clinical manifestation

The early stages of prostate cancer are often asymptomatic, and as the tumor progresses, the symptoms caused by prostate cancer can be summarized into two main categories:

1. Compressive symptoms

Gradually increasing prostatic glands compressing the urethra can cause progressive dysuria, which manifests as thin urinary cords, short range, slow urine flow, interruption of urine flow, post urine dripping, incomplete voiding, labored urination, and, in addition, urinary frequency, urgency, increased nocturia, and even incontinence. Tumour compression of the rectum can cause diffi culty in stools or ileus, or compression of the vas deferens can cause ejaculation defi ciency, compression of the nerves causes perineal pain, and can radiate to the sciatic nerve.

2. Metastatic symptoms

Prostate cancer can invade the bladder, seminal vesicles, vascular nerve tracts and cause hematuria, hematospermia and impotence. Pelvic lymph node metastasis can cause edema of both lower limbs. Prostate cancer is often prone to bone metastasis, causing bone pain or pathological fracture, paraplegia. Prostate cancer can also invade the bone marrow to cause anemia or pancytopenia.

diagnosis

Clinical diagnosis of prostate cancer mainly relies on digital rectal examination, serum PSA, transrectal prostate ultrasound, and Pelvic MRI, and CT is less sensitive than MRI for the diagnosis of early-stage prostate cancer. Because of the high rate of bone metastasis from prostate cancer, a radionuclide bone scan is usually performed before deciding on a treatment option. Diagnosis of prostate cancer requires pathological examination by prostate needle biopsy.

Prostate cancer malignancy, which can be assessed by histologic grade, is the Gleason scoring system, which classifies prostate cancer malignancy on a 2-10 point scale based on the sum of the scores of major and minor structural areas in the tissue, with differentiation being 1 + 1 = 2 points and the difference being 5 + 5 = 10 points.



Treatment and prognosis

Radical treatments are available for patients with early-stage prostate cancer, and those that can cure early-stage prostate cancer are radioparticle implantation, radical prostatectomy, and radical external radiation therapy.

The indications for radioparticle implantation should fulfill the following 3 conditions: ① PSA < 10 ng / ml; ② A Gleason score of 2 to 6; ③ The clinical stage was T1 to T2a.

The indications for radical prostatectomy should fulfill the following 4 conditions: I) PSA < 10-20ng / ml; ② Gleason score ≤ 7; ③ Clinical stage T1 to T2C; ④ Patients with a life expectancy ≥ 10 years.

Radical radiotherapy is appropriate for patients with localized prostate cancer. Mainly three-dimensional conformal radiotherapy and intensity-modulated conformal radiotherapy and other techniques are used. In addition, external beam radiotherapy can be used as adjuvant therapy in patients with pathologically P T3 to 4, invasion of the seminal vesicles, positive resection margins, or persistently elevated postoperative PSA after radical prostatectomy; May also be used for palliative treatment of patients with advanced or metastatic prostate cancer.

Comprehensive treatment methods, such as surgery + radiotherapy, endocrine therapy + radiotherapy, etc., should be used for patients with intermediate stage prostate cancer.

Endocrine therapy is the mainstay of treatment for patients with hormone sensitive advanced prostate cancer, and approaches to endocrine therapy include castration (surgical castration or medical castration) and antiandrogen therapy (bicalutamide or flutamide) or castration + antiandrogen therapy. The efficacy of surgical castration or medical castration is essentially the same. But almost all patients will eventually develop hormone independent prostate cancer or hormone resistant prostate cancer. Patients with castration resistant prostate cancer may be offered second-line endocrine therapy or novel endocrine therapy agents (abiraterone, enzalutamide, etc.). Patients with hormone resistant prostate cancer should be maintained continuously in a castration resistant state while undergoing chemotherapy based on the polyene paclitaxel, mitoxantrone. Prostate cancer patients with bone metastases should be treated with a combination of bone protective agents (mainly bisphosphonates) to prevent and reduce bone related events, relieve bone pain, improve quality of life, and improve survival. Local bone pain may also improve with extracorporeal radiation therapy or radionuclides.

Studies based in the United States have found that screening for prostate cancer with PSA is problematic with overdiagnosis and overtreatment. To improve this, the clinical practice guidelines for prostate cancer developed by the national comprehensive cancer network in 2010 included close observation rather than "" aggressive treatment "" as one of the options for patients with prostate cancer diagnosed by prostate needle biopsy. The danger of close follow-up and the danger of overtreatment were asked to be fully explained by the physician to the patient, whose decision was made. The basic conditions for patients who can undergo close follow-up are ① patients with low-risk prostate cancer as revealed by pathological examination of biopsies (stage t1-t2a tumours, Gleason score 2-6, PSA < 10 ng / ml and life expectancy less than 10 years, ② patients with very low-risk prostate cancer (stage T1a tumors, Gleason score ≤ 6, PSA < 10 ng / ml, ≤ 50% of cancer tissue positive by needle biopsy < 3 positive cuts per needle, and PSA density < 0.15 ng / ml ⋅ g) in patients with a life expectancy of less than 20 years. A close observation protocol is to review PSA every 6 months and digital rectal examination every 12 months. After 1 needle biopsy of the prostate, particularly in patients with ≥ 10 positive initial needle biopsies, biopsy should be performed at 18 Months with a repeat biopsy. In addition, repeat needle biopsies should be performed in patients with low-risk disease and a life expectancy greater than 10 years, at a frequency of approximately every 12 months. Appropriate treatment should be taken during close observation if there is a tendency for the disease to progress.

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