Old age prostate cancer

　　How is elderly prostate cancer caused? Briefly described as follows:

　　1. Androgen Level

　　The etiology of prostate cancer is unknown. Although almost no prostate cancer is found in individuals with malformed testicles since childhood, and the prostate cancer can significantly shrink after orchidectomy, there is no objective evidence to prove that the level of androgens in the body is related to the occurrence of prostate cancer, nor is there sufficient evidence to show that there is a causal relationship between benign prostatic hyperplasia and prostate cancer.

　　2. Cell Genetic Damage

　　In recent years, more and more research shows that genetic damage to cells plays an important role in the pathogenesis of prostate cancer. Environmental factors such as radiation, chemical substances, and DNA mutations or other types of abnormalities caused by physical damage, namely the activation of oncogenes (such as Ha-ras, C-erbB-2, myc) and the loss or mutation of tumor suppressor genes (such as P53) can produce carcinogenic effects in sensitive cells.

　　3. Other

　　Hypotheses such as excessive sexual activity, recurrent prostatic infection or chronic inflammation, smoking, industrial carcinogens such as cadmium, etc., cannot explain the high incidence in Europe and America and the low incidence in Asia, as well as the significant differences in incidence among different races and regions.

　　Elderly prostate cancer often complicates with hematuria, anemia, bone metastatic cancer, and other diseases. Elderly prostate cancer itself is a serious disease that endangers the health of the elderly and affects their life expectancy, and it must be treated in a timely manner.

　　What are the symptoms of elderly prostate cancer? Briefly described as follows:

　　1. Clinical Symptoms

　　Early prostate cancer often has no symptoms. When the tumor grows to block the urinary tract, it presents with symptoms similar to benign prostatic hyperplasia, including gradually worsening urinary flow, frequency, urgency, urinary retention, incomplete urination, difficulty urinating, and even urinary incontinence. Hematuria is not common. In the late stage, symptoms such as back pain, leg pain (due to nerve compression), anemia (due to widespread bone metastasis), lower limb edema (due to lymphatic and venous回流受阻), bone pain, pathological fractures, paraplegia (due to bone metastasis), difficulty urinating (due to rectal compression), oliguria, anuria, and uremic symptoms (due to compression of both ureters) may occur. Some patients seek medical attention for metastatic symptoms without primary prostate symptoms.

　　2. Digital rectal examination

　　Digital rectal examination is the primary diagnostic step. During the examination, the size, shape, irregular nodules, size, hardness, extent of spread, and seminal vesicle condition of the prostate should be checked. During routine physical examination, if the prostate is enlarged, hard, nodular, with an uneven surface, central groove disappeared, and the gland is fixed or invades the rectum. Tumors originating in the transitional zone can only be felt when they reach a certain size, and the tumor is often as hard as stone, but there is a great deal of variation. The infiltrative lesions may be softer, and it is sometimes difficult to distinguish between the digital rectal examination of prostate cancer associated with benign prostatic hyperplasia. The differential diagnosis of prostate hard nodules includes granulomatous prostatitis, prostatic calculi, prostatic tuberculosis, non-specific prostatitis, and nodular prostatic hyperplasia, and should be carefully differentiated.

　　How to prevent elderly prostate cancer? Briefly described as follows:

　　1. Tertiary Prevention

　　Primary Prevention: Also known as etiologic prevention. It involves taking effective preventive measures against the causes and risk factors of malignant tumors. Since the 1940s, dietary and nutritional factors have become the focus of attention for tumor induction. Reducing high-fat diets and consuming a moderate amount of vitamin A, C, E, and fiber-rich foods can reduce the incidence of prostate cancer. Chemoprevention was initiated by Dr. Michael Sporn in the mid-1970s. The definition of chemoprevention is the use of natural or synthetic compounds for drug intervention to reverse or inhibit the occurrence of cancer in the preclinical or early stages, thereby preventing the development of invasive cancer. Finasteride is a 5α-reductase inhibitor that can block the conversion of testosterone to the active metabolite dihydrotestosterone, playing a very important role in the occurrence of prostate cancer. This preparation was used in an unprecedented large-scale clinical phase III trial by the Prostate Cancer Prevention Trial (PCPT) in the United States. A one-year follow-up study conducted by the Association of Health Workers found that tomato-based foods and strawberries are the main sources of lycopene (a non-carotenoid vitamin A, with antioxidant properties), which can reduce the risk of prostate cancer. Those who consume tomato products more than 10 times a week have a risk of prostate cancer that is inversely proportional to those who consume less than 1.5 times. Selenium is an essential non-metal trace element with antioxidant and anti-proliferative properties, which can induce apoptosis and promote differentiation. Clark et al. conducted experimental studies on the role of selenium in humans and found that follow-up observation can reduce the incidence of prostate cancer.

　　Second-level prevention: Due to the long preclinical period of prostate cancer, the incidence rate is very high among men over 50, it is very necessary to carry out screening for prostate cancer. There are three methods of screening: physical examination, namely digital rectal examination (DRE); serological examination, namely determining the level of serum prostate-specific antigen (PSA); imaging diagnosis, namely transrectal ultrasonography (TRUS). Data from the American Cancer Society's prostate cancer screening research program shows that the sensitivity of DRE is 50%, and the specificity is 94%; some suggest that men over 50 or those with high-risk factors should have a DRE every year. Unlike carcinoembryonic antigen, PSA is produced only by the prostate, and the higher the level of PSA, the more specific it is to prostate cancer. A level of PSA greater than 10ng/ml has a specificity exceeding 90%. If PSA is combined with DRE, it will be better than using any single method.

　　Third-level prevention: It is effective comprehensive treatment after the diagnosis of the disease, based on the clinical stage, physical condition of elderly tumor patients, and considering whether the actual life expectancy of the patient is longer than the natural life expectancy of tumor patients. Palliative treatment is adopted for advanced patients to relieve pain and improve the quality of life of patients.

　　2. Risk Factors and Intervention Measures

　　Many scholars have studied the risk factors related to prostate cancer, but no definitive conclusions have been reached. It is generally believed that prostate cancer occurs more frequently in men with frequent sexual activity and multiple offspring, but only a few reports have shown statistically significant differences. Herpesvirus type 2, Simian virus, and cytomegalovirus were once considered possible carcinogens, all of which are pathogens transmitted through sexual contact, but the spouses of prostate cancer patients rarely develop cervical cancer. Occupational and environmental studies suggest that cadmium and zinc may be chemical carcinogens for this disease, but no conclusions have been reached. Studies on diet suggest that excessive intake of fat is positively correlated with the incidence of prostate cancer. A report from Japan suggests that consuming more green and yellow vegetables can reduce the incidence of prostate cancer. Surveys on education level have found that the incidence is higher among those with primary education and lower among those with university education; the incidence is higher among early marriage and lower among late marriage; the incidence is higher among those with a family history of prostate cancer, which may be related to genetic susceptibility and the same living environment; and there are more male children among patients. In response to risk factors, advocating late marriage, low fertility, attention to reproductive organ hygiene, and moderate sexual activity can reduce the incidence of prostate cancer in old age.

　　3. Community Intervention

　　According to the epidemiology of prostate cancer, there is a year-by-year increasing trend in elderly prostate cancer. Tumors are becoming an increasingly serious social problem and are one of the main medical burdens of the contemporary era. In order to achieve early diagnosis and early treatment, many countries have launched screening programs for prostate cancer. Community health stations have the obligation to conduct annual screenings for high-risk populations, including elderly males, to carry out cancer prevention publicity, provide nursing guidance and treatment for patients during the recovery period.

　　What examinations should be done for elderly prostate cancer? Briefly as follows:

　　Prostate acid phosphatase (PSA) is the most important marker for prostate cancer. The sensitivity of PSA is poor, and patients with increased alkaline phosphatase should pay attention to whether there is extensive bone metastasis. In the late stage of prostate cancer, compression of both ureters can lead to increased blood creatinine, urea nitrogen, and decreased CO2 binding power.

　　1. Prostate acid phosphatase (PAP)

　　The use of serum acid phosphatase as a marker for prostate cancer has a history of 40 years. Due to the lack of specificity of acid phosphatase and the poor stability of the enzyme at room temperature, there is biological variation in the enzyme within 24 hours, making it difficult to determine the significance of abnormal increased levels. In addition to prostate cancer, the tumors of many other organs and tissues can cause increased levels of acid phosphatase, so its practical value is greatly affected.

　　2. Prostate-specific antigen

　　Prostate-specific antigen (PSA) is an enzyme produced only by prostate epithelial cells, a glycoprotein that can hydrolyze the clot of seminal fluid, and its function is related to male fertility. The molecular weight of PSA is about 30000, containing 240 amino acids and 7% carbohydrates. It is very similar to the proteases of the kininogenase family and exists in blood and seminal plasma. PSA is a marker that is more sensitive than PAP, but its specificity is still not high for the screening and diagnostic of prostate cancer. The serum PSA of patients with prostate cancer and benign prostatic hyperplasia (BPH) can increase, and it is an important marker for monitoring the prognosis of prostate cancer.

　　3. Cytological and histological examination

　　Since cancer cells can be detected in the seminal fluid of patients with prostate cancer, prostate cancer can be diagnosed by examining the urine sediment or seminal fluid smear. Pathological diagnosis can be obtained through needle biopsy, with a high accuracy of 80% to 90%.

　　(1) Transrectal ultrasound examination

　　Transrectal ultrasound examination is a relatively accurate method of examination, which can detect cancer nodules with a volume greater than 4ml. Tumors are often hypoechoic, solitary or multiple, and some tumors with few echoes may not be detected during ultrasound examination. Ultrasound examination can accurately understand the three-dimensional image of the tumor and can measure the volume of the tumor.

　　(2) Prostate biopsy

　　4. Radioimmunoimaging

　　5. CT and MRI

　　CT and MRI are of no value in the diagnosis of A and B stage prostate cancer. These two examination methods cannot display images of diagnostic significance and cannot provide the biological behavior of the cancer. Patients in C and D stages can use CT and MRI to determine whether the tumor has extended beyond the capsule and seminal vesicle, and whether it is compressing the ureter to cause hydronephrosis.

　　6. X-ray examination

　　Renal pelvis angiography can detect advanced prostate cancer extending to the bladder, compressing the ureter to cause hydronephrosis, and bilateral renal function status. When bone metastasis occurs, osteolytic bone destruction can be shown on X-ray films, and pathological fractures can be found.

　　7, Bone scan

　　Nuclear skeletal scan can detect bone metastasis of prostate cancer earlier than X-ray film, and for patients who have undergone radical prostatectomy, if PSA ≤ 20ng/ml, bone scan will not show any abnormalities.

　　After elderly people get prostate cancer, they should pay more attention to their diet, eat more fish, because fish are rich in certain beneficial fatty acids. Eat fruits and vegetables every day, and limit the intake of sugar and salt, which can prevent cancer and maintain heart health. The following are some food therapy prescriptions recommended for patients with prostate cancer.

　　1, Stewed tofu with loach fish

　　You can choose live loach fish, fresh tofu, salt, ginger, and monosodium glutamate in appropriate amounts. In the preparation, first cut the loach fish open, remove the gills and internal organs, clean it, and then put it in a stewing bowl. Add an appropriate amount of salt, ginger, and water. Boil it with high heat first, then simmer it with low heat until it is five years old, and then add the tofu blocks to the stewing bowl. Boil it with low heat until the loach fish meat is tender, and add seasonings to eat.

　　2, Soup of white osmanthus and lean pork

　　You can choose fresh white osmanthus and fresh lean pork. In the preparation, first clean the blood and dirt from the lean pork, cut it into pieces. Rinse the white osmanthus with water, then put the two above into the pot, add an appropriate amount of water, and simmer with medium heat. After the soup is cooked, add a little salt for seasoning and drink the soup and eat the meat.

　　3, Stewed black chicken with chestnuts

　　Remove the intestines and feathers from the black chicken, cut into pieces, and put them in the pot with chestnuts, sea horses, salt, and ginger. Add an appropriate amount of water and steam. Eat 2-3 times. It is beneficial to the spleen and kidney, suitable for patients with prostate cancer.
.

　　The following is a brief description of the treatment methods for elderly prostate cancer:

　　First, treatment

　　The choice of treatment plan for prostate cancer should be made according to the age, tumor stage, tumor grade, tumor volume, clinical symptoms, complications, and associated diseases of the patient at the time of diagnosis. The treatment of prostate cancer includes surgery, hormones, chemotherapy, radiotherapy, and immunotherapy, etc.

　　1, Surgical operation: Surgery can be performed for patients with tumors confined to the prostate without metastasis or patients with good general condition.

　　(1) Radical prostatectomy for prostate cancer: The surgical range includes the prostate gland and its capsule. There are reports that there is no recurrence for 15 years after surgery, with a survival rate of 50.9%. It is suitable for stages A and B, and can be combined with endocrine therapy.

　　(2) Pelvic lymph node dissection: Some patients in stage B2 and CD can be treated accordingly. It can be combined with radical prostatectomy according to the condition and general condition, and can be combined with radiotherapy and endocrine therapy.

　　(3) Transurethral resection of the prostate: It is mainly used to relieve bladder neck obstruction. If there is residual cancer tissue confirmed by biopsy, radical prostatectomy should be performed.

　　2, Radiotherapy: It has a definite curative effect on A, B, and C stage lesions and has become the main method of treating prostate cancer. It is used before, after surgery, or in combination with chemotherapy and endocrine therapy. For patients in the advanced stage who cannot undergo surgery, simple radiotherapy can be used. The main methods are 60Co and linear accelerators. According to statistics, the 5-year survival rate after treatment is 75% for stage B and 55% for stage C.

　　3. Radioisotope Treatment: Radioisotope treatment focuses on the radioisotope treatment of prostate cancer and the treatment of bone pain in patients with bone metastases. Radioisotope internal irradiation treatment involves implanting radioisotopes into the site of prostate cancer, and using short β particles or α particles emitted by the marker to concentrate on the lesion, producing sufficient ionizing radiation biological effects locally, with the aim of inhibiting or destroying the pathological tissue.

　　4. Cryotherapy: The mechanism of cryotherapy is to use low-temperature freezing to tumor tissue, causing physiological or metabolic inhibition of the tissue, followed by structural destruction, and the tumor tissue becomes degenerative and necrotic, achieving the goal of clinical cure. It is the same as local radiotherapy for radical prostatectomy. Cryotherapy is also a local treatment method for prostate cancer.

　　5. Endocrine Treatment: Prostate is an androgen-dependent organ, and the growth of most prostate cancers depends on androgen stimulation. Therefore, reducing the production and action of androgens can make endocrine treatment effective for most stage III and IV prostate cancer patients who cannot be operated on or have bone and other organ metastases.

　　6. Chemotherapy: After endocrine treatment fails, single-agent or combined chemotherapy can be selected. Many randomized controlled studies believe there is no significant difference between single-agent or combined chemotherapy.

　　7. Optimal Treatment Plan: Surgical and Endocrine Treatment.

　　8. The clinical staging and pathological grading of rehabilitation treatment are the main reasons affecting prognosis. The prognosis of patients with lymph node metastasis is very poor. The 5-year survival rate of stage I and II patients is 70%; the 5-year survival rate of stage III patients is 50%; the 5-year survival rate of stage IV is 25%. During the same period, good cell differentiation has a better prognosis.

　　II. Prognosis

　　The prognosis of prostate cancer is greatly related to its grading and staging. Due to the continuous emergence of new diagnostic technologies in recent years, new drugs and new therapies have been produced in treatment, so the prognosis of prostate cancer has greatly improved compared to before. There is evidence that for patients in stage A, especially A1 stage, whether or not treated does not affect survival rate, while for patients with progressive prostate cancer in stages B, C, and D, if treated actively, the survival rate can be greatly improved.