Prostate cancer in mature men: asymptomatic in the early stage
During the consultation, a 76-year-old old man’s prostate index PSA was as high as 300 ng/ml. Prostate cancer was confirmed by prostate biopsy, and bone scan showed that there were multiple bone metastases. After further inquiry, he learned that the old man was I have been feeling weak in my lower extremities recently.
Dr. Chen Jiahong from the Department of Urology, Zhongxiao District, Taipei City United Hospital, said that prostate cancer that has metastasized to the bone may compress the spinal nerves and cause weakness in the lower extremities. If not treated in time, it may lead to paralysis.
“After the computed tomography was done, it was found that the spinal nerve of the old man was indeed compressed. After further discussion, it was decided to use hormone injections combined with a new generation of oral androgen receptor blockers for treatment.”
Fortunately, after receiving treatment for a period of time, not only did the old man’s weakness in his lower limbs improve a lot, but his prostate index PSA dropped to almost zero. Make the old man very happy!
Asymptomatic early prostate cancer that has metastasized at the time of discovery
Prostate cancer tends to occur in middle-aged and elderly people. Currently, it ranks 5th among the top 10 cancers in men in Taiwan. The number of patients has increased every year. In the past 20 years, it has tripled, and there are about 6,000 new cases every year. Dr. Chen Jiahong explained that about 30% of the patients had metastases when they were diagnosed with prostate cancer, and the average survival time of these patients was about 4 years.
In recent years, there have been more and more prostate cancer patients in Taiwan, which may be related to several factors. One is the aging of the population. Prostate cancer is more common in middle-aged and elderly people. The number of patients with prostate cancer has also increased. The second is the prostate index PSA (Prostatic specific antigen, prostate specific antigen) is more commonly used, so more early prostate cancer can be found. Another possibility is related to dietary habits. Usually, eating more high-fat and red meat may increase the risk of cancer. Compared with Europe and the United States, the malignant degree of prostate cancer in Asians is higher, and everyone should pay more attention.
“If you have a family history of prostate cancer, you have a higher chance of developing prostate cancer.” Dr. Chen Jiahong reminded, “At present, several genes related to prostate cancer have also been found. People with these genes may develop in the future. developed prostate cancer.”
Early-stage prostate cancer has few symptoms and goes undetected by the patient. When the tumor grows larger, frequent urination and poor urination may occur. Because the symptoms are similar to prostate hypertrophy, it is easy to be ignored. As the disease progresses, prostate cancer may compress the rectum and make bowel movements difficult, edema if it spreads to the lymph, and pain and discomfort if it spreads to the bone. Dr. Chen Jiahong said, “Prostate cancer in stages 1 and 2 usually doesn’t feel much, and the more serious symptoms appear in stages 3 and 4.”
Active treatment, careful maintenance
The treatment of prostate cancer includes local treatment and systemic treatment. Dr. Chen Jiahong said, “local treatment” is for tumors located in the prostate. Traditional surgery or Da Vinci robotic arm surgery can be used to remove the entire prostate, or Use radiation therapy, cryotherapy, etc.
If prostate cancer cells have metastasized to other organs and bones along with the blood and lymph, the patient needs to receive “systemic treatment”, such as hormone therapy, a new generation of androgen receptor blockers, chemotherapy, etc.
Hormone therapy is an important treatment modality because male hormones can promote prostate cancer growth. The so-called “castration”, which in the past may have removed the testicles to reduce male hormones in the body, can now use drugs to suppress male hormone production. Prostate cancer that responds to hormonal therapy is called “castration-sensitive prostate cancer.”
However, after receiving hormone therapy for about two years, it may evolve into “castration-resistant prostate cancer”, Dr. Chen Jiahong analyzed, “The male hormones in our body mainly come from the testes and adrenal glands, but studies have found that some prostate cancer cells also It develops the ability to secrete hormones, which leads to the failure of hormone therapy. During the treatment process, if it is found that the originally controlled and stable prostate index PSA begins to climb, it means that the hormone therapy is gradually ineffective.”
After the hormones failed, only chemotherapy was left in the past, but because of the obvious side effects and limited effectiveness, the patient’s acceptance was low. The new generation of androgen receptor blockers developed in recent years is to solve the treatment dilemma of the past.
The new generation of androgen receptor blockers can prevent androgen from binding to cell receptors, block the signal transmission pathway, help control the disease, reduce the PSA index, help prolong the survival period of patients, delay the time to enter chemotherapy, and also It can reduce the pain of cancer metastasis, reduce the risk of fracture, and improve the quality of life.
Compared with chemotherapy, the new generation of androgen receptor blockers have fewer side effects, less burden on the heart and liver, and higher patient acceptance. The oral dosage form is more convenient for patients without hospitalization.
Dr. Chen Jiahong said, “In the beginning, new-generation androgen receptor blockers were only used in castration-resistant prostate cancer, but new research has found that when new-generation androgen receptor blockers are used in combination with hormonal therapy, It’s also helpful for patients, without having to wait until hormonal therapy fails.”
Intimate reminder
Dr. Chen Jiahong reminded that prostate cancer is a relatively slow-progressing cancer, but it cannot be ignored, because prostate cancer is easy to metastasize to the bones, which may cause severe bone pain, which is very uncomfortable.
Patients should discuss with their doctors in detail, and active treatment can improve the quality of life and prolong the survival period. If there is bone transfer, pay attention to the environment at home and try to prevent falls and collisions to reduce the chance of fractures.