PROSTATE CANCER

Prostate cancer family care points Prostate cancer symptoms for the next performance of urinary tract obstruction, frequency, novel, difficulty urinating, urinary and fine, s...

Surgical treatment of prostate cancer Surgical treatment: 1) prostate cancer radical operation, covering the prostate gland and prostate capsule; 2) removal of pelvic lymph nod...

A basic treatment programs
Prostate cancer treatment can be divided into surgical treatment, hormonal therapy, radiotherapy, chemotherapy and treatment in Chinese medicine. Specific selection of the program, according to the patient's age, systemic symptoms, the cancer staging, state immunity and comprehensive consideration. General radical surgery for early adopters, five-year survival rate 75% 10 55% survival rate, 15-year survival rate of 33%. The frail elderly or have complications or pelvic metastasis of patients, radiotherapy should be OK, five-year survival rates of 60%, 10-year survival rate 39%. Using advanced endocrine, chemical treatment and Chinese medicine.

Currently, in accordance with prostate cancer staging, treatment programs used as follows:
A1 governance prostatic hyperplasia period when the accidental discovery of cancer, lesions limitations, the majority of well-differentiated, most patients in stable conditions, slow development, only about 1% risk of dying from cancer. The prognosis is good, generally not in favor of immediate radical prostatectomy surgery or radiotherapy, endocrine therapy. Regular follow-up to digital rectal examination and ultrasound examination, serum acid phosphatase. In line with the treatment of Chinese medicine to control its development.

A1 treatment for a period of not possible that 35% of patients with tumors in progress, and should therefore be considered radical resection of the prostate or radiation therapy.
The majority of tumor differentiation B1 better, but surgery found that 5% -20% of the patients had a lymph node metastasis, it should be OK radical resection of prostate cancer, after radical 15 without cancer survival rate was 50% -70%.

B2 Approximately 50% of patients had tumor violations spermatheca, while 25% -35% of patients with lymph node metastasis, it should be OK before adenocarcinoma radical surgery and pelvic lymph node dissection, testis resection, endocrine therapy, radiotherapy, radiotherapy and organization. B2 15 after radical surgery without cancer survival rate was 25%.

There is no unified treatment of stage C, therefore, the treatment more difficult, most have pelvic lymph node metastasis. The general treatment of the following methods: 1 pair of frail elderly, the poor general condition of patients suitable for the in vitro expansion of the scope of radiotherapy. ② endocrine therapy (including two testicular resection), the demotion after treatment, in vitro expansion of the scope of radiotherapy and radical surgery for prostate cancer combined. ③ organization radiotherapy and radiotherapy in vitro, to apply to lymph node metastasis and distant metastasis, and the general condition good.

D to endocrine, immune therapy and chemotherapy, D0, D1 may be for the purposes of pelvic lymph node dissection, early treatment of endocrine tumor extends survival time, five-year survival rate around 30%.

Chinese medicine should be treated consistently throughout, in accordance with specific circumstances Diagnosis and Prescription.
2, Chinese medicine treatment
(1) Syndrome Treatment
1. Kidney Deficiency
Symptoms: weak low back pain, dizziness realism, Ms Li River not voiding urine and fine lines, frequency, body weight loss, edema, tongue red, white moss, Shen Fine foot of the clock pulse weak. Kidney-see with the weather chills, pond, impotence lung, kidney-yin deficiency with the see dry mouth, upset insomnia, night sweats asthma.
Treatment: Kidney-positive are advised to Bushen, - shengyinxuzheng are advised to nourish Yin.
Recipe: Kidney - who used Youguiyin Jiawei. Fuzi 9g system, cinnamon 6g, ready land 9g, of Medlar, Eucommia, yam all 12g, 15g Dodder, Zhigancao 5g.
- Shengyinxuzheng to use Liuweidihuang pill Jiawei, medicinal: Polygonatum 6g, tuckahoe, Zexie, the Plantago 10g, raw land 9g, yam 12g, Zhigancao 5g.
2. Damp-heat
Symptoms: urgency frequency, have novel or see with urine, anorexia, Tongue symptoms, pulse a few slip.
Treatment: Qingre Lishi, detoxification Tonglin.
Recipe: eight is San Jiawei. Notices with, Pink, Rhizoma Imperatae, Solanum nigrum, Scutellaria Barbata, the BAIYing 30g, climbing, Zexie, the 15g Plantago, Phellodendron, Akebia, Atractylodes all 10g, Zhigancao 5g.
3. Drug-Stasis
Symptoms: Pain or waist and back pain, lower backache pain, difficulty urinating or hematuria, a purple tongue ecchymosis, vein-string.
Treatment: Qingrejiedu, Blood Circulation.
Recipe: Five disinfect drinking Jiawei. Rhizoma Imperatae, Solanum nigrum, Scutellaria Barbata, BAIYing, Response to 30g, Forsythia, dandelion, Kushen, the wild chrysanthemum 15g, Mr Wong, the Dongkuizi 10g, licorice 5g.
(2), the prescription
1. Tony compound Yang Yang Quan Tang Shu-chuen, Solanum nigrum, indica, the soil Poria 30g, 15g climbing, albeit 5g, a daily, Paeunia Oral.
2. Toad pill Toad 20g, light powder 5g, gypsum, Pseudomonas, frankincense and myrrh, the bile alum 10g, 20g realgar, three snails, Cinnabar 30g. Apart from the above drugs and Toad, the snail is smaller surface will crush snails with a Toad-stick inquiry, Add to all other drugs, for a total crush pills, such as bean size. Per serving three two times a day.
3. Cancer pain scattered on March 7 and weighing floor, Yuan Hu, Hill arrowhead. Root, Huangyaozi, Radix Aconiti all 30g, borneol 5g. A total of inquiry bowl, three times a day, each time 3g.
4. Tri, Tri-Ezhu injection, Ezhu the contour to produce 5%, 10%, 20% concentration injection for intramuscular injection. Each 2ml, every hour two times.
5. Anticancer pink powder, the powder 30g light, Scorpion, Xuejie, cinnamon, March 7 powder, the hawksbill 60g, centipede, Radix Aconiti, Radix Aconiti Kusnezoffii, frankincense and myrrh, Angelica, Yuan Hu, the placenta powder 90 g, 20 toad skin. A total fine of inquiry, encapsulated. Each served two, two times a day, sending water.
3, treatment
(1) surgical indications
1. High-grade prostate cancer.
2. Digital rectal examination of the prostate tumors confined to the prostate, and Rectal tumor invasion and can not promoters.
3. No transfer of symptoms.
4. Patients generally good competent surgery.
(2) choice of surgery
1. Radical prostatectomy for prostate cancer, including radical surgery of the prostate capsule of the prostate and to achieve the elimination of all tumor tissue in vivo purposes. Surgical approach adopted after the perineum or suprapubic incision is used after suprapubic incision. Simultaneous detection of the rear bottom of the bladder and seminal vesicle invasion of the tumor near the pelvic area and the lymph node metastasis. Radical prostatectomy for general surgery patients, accounting for only 5% of all cases and 10%.
Right B2 prostate cancer is radical surgery for prostate cancer have a different view, some scholars think B2 radical mastectomy patients is not the best choice because of this patient's seminal vesicle violation rate was as high as 56%. Thus B2 period of radical, depending on the pathological tumor grade and whether pelvic lymph node metastasis. Some scholars have called for the current period even C D0 period for prostate cancer or testicular castration of the male hormone entire block, and endocrine drug treatment service, after narrowing in local lesions (demotion treatment) further radical prostate surgery.
2. Expanding radical prostatectomy high-frequency electric knife, in situ will be extensive local tumor excision, it is particularly noteworthy for the bladder base, seminal vesicle and vasectomy after resection of the residual bladder rear fascia and around the membrane surrounding the urethra urine reproductive diaphragm. Phase C is mainly applied to prostate cancer, and interstitial radiation therapy combined, but such a broad expansion of operation and the lack of satisfactory results.
3. Transurethral resection of the prostate (TURP) is applied to the frail elderly have occurred complications such as urinary obstruction, the local disease has reached stage C, TURP only ease the symptoms without the possibility cured. In TURP can prevent uremia, improve the quality of life of patients, many patients can be repeated transurethral resection of the treatment to reduce mouth bladder obstruction. If complemented by non-surgical treatment, surgical treatment can increase the value, and different general TURP surgery, mass violations of cancer, landmark (such as fine-Fu) has not very clear, and more attention should be paid to surgery not to damage sphincter.
4. Bilateral Testicular resection of men from 95% of the male hormone testosterone. In addition to removal testicular production of testosterone sources to the forefront of androgen-dependent tumor growth slow or dissipated. The operation is simple, safe and side effects. After surgical resection can be achieved within 12 hours of castration levels (serum concentrations of testosterone than 1.75mmol / L, respectively. But after resection of testosterone can cause secondary adrenocortical mesh with the proliferation of the adrenal androgen secretion hyperthyroidism. So surgery often conducted jointly with other therapies, can make good effect. testicular for the treatment of prostate cancer is an effective method of treatment.
5. Pelvic lymphadenectomy pelvic lymph node metastasis of prostate cancer incidence rate higher, there should be full inspection of pelvic lymph node metastasis. If there is transfer, should make pelvic lymphadenectomy.
4, <BR> endocrine therapy for prostate cancer growth, as most dependent on the male hormone, through any of the following ways may reduce the role of androgen in the prostate cancer treatment.
1. Promoting the release of gonadal hormone analogue (LHRH-A) to promote inhibition of pituitary hormone release, inhibiting the formation of testosterone to "castration" purposes. Easy to use these drugs, safety, side effects. Common: on the Suppression (enatone), 3.75mg/day, subcutaneous injection every four times a week.
2. Estrogen drugs can inhibit brain estrogen promoting the release of the anterior pituitary luteinizing hormone, thereby eliminating testes produce androgen stimulation of the prostate, estrogen may also have a direct inhibition of testosterone. Common drugs are: (1) Dual. Through the feedback inhibition pituitary hormone secretion, which produce testosterone suppression of testosterone, free to reduce the concentration of testosterone. Directions: 3 - 5 mg daily oral above, the amount of 1 - 3 mg / day. There are nausea, vomiting, edema, impotence, breast pain, venous thrombosis of the Shanghai adverse reaction. (2) poly phosphate estradiol. The drug formulations for the long-term, a monthly intramuscular injection at the time 80-80mg, adverse reactions less than diethylstilbestrol. (3) ethinyl estradiol (ethynylestradiol). Each dosage of 0.05 - 0.5 mg daily oral 3-6, adverse reactions are dizziness, nausea, vomiting. (4) The three methicillin-chloroethylene. Oral each mg every other day at a service. (5) estrogen plus testosterone for the treatment of bone pain and distant metastasis good effect, the early effects of treatment were 80%, and bone metastases can be seen, and the enlargement of the prostate tumor nodules shrunk or disappeared.
3. Anti-Androgens
(1) - steroidal anti - androgen. Progesterone is the main categories: 1 cyproterone acetate chlorine to progesterone. Role of progesterone can prevent dihydrocodeine of testosterone receptors in the nucleus and integrate complex and can inhibit the pituitary luteinizing hormone release. Each dose of 100mg daily oral administration of the two. Adverse reactions are breast development in men. ② A ene chlorhexidine acetate hydroxy progesterone. Obviously progesterone and anti - androgen effect by inhibiting the secretion of testosterone mesenchymal cells. Oral dosage of 250 mg per day, for the majority of prostate cancer patients effectively. Adverse reactions are cardiovascular and gastrointestinal reactions, about 10% of breast man mast. ③ acetate megestrol acetate. Its role and the same natural progesterone, 4 mg oral dose of each month at 2. ④ The Palace progesterone (MPA). A central and peripheral anti - androgen effect. Oral dosage of 100 mg each time, three times daily. ⑤ Chlormadinone. Ye can shrink the prostate, for the use of 100 mg per day orally, three months after service of the daily 50mg. Adverse reactions are gastrointestinal and cardiovascular response, and decreased libido.
(2) non-steroidal anti - androgen. ① flutamide. Daily dosage of 750mg, three times taking after meals, less adverse reaction, diarrhea, fever face, male breast development. ② ketoconazole. An antifungal, large doses can stop the testes and adrenal testosterone synthesis, the amount of 200-400mg every eight hours of oral one. After treatment possible reversible liver damage, nausea, fatigue, dry skin and mucosal adverse reactions. The need to apply rapid suppression of testosterone to castration levels, such as prostate cancer metastasis to the spine and spinal cord compression, lower limb paralysis when imminent.
5, radiological choice
Not applicable to partial resection of the prostate, without distant metastases found cases, but also as an auxiliary choice TURP surgery. A2 period has become, B and C of prostate cancer certainly effective.
1. In vitro main radiotherapy linear accelerator or 60Co. Dose of 6-8 weeks of 65 - with 70Gy. External 80-90% A and B stage prostate cancer can be controlled, but failed because of the transfer. After the five-year survival rate of prostate cancer B available control failure because of the transfer. After the five-year survival rate was 75% B, C for the period of 55%. 10 survival rate close to 40%. But patients in serious radiation enteritis or proctitis need surgery.
2. The organization radiotherapy radionuclide 125I, or 222Ra 198AU passing by Madigan, perineum or rectum, with a view to surgical tumor site directly under irradiation. In recent years by ultrasound-guided transrectal inserted near the tumor site, good effect, but seldom carried out. .
3. Radionuclide radiation treatment of radionuclide bone metastases 32P, 89Sr systemic radiotherapy to a certain extent, can alleviate the pain of bone metastasis and reducing disease development. Case implementation of the C irradiation is effective radiotherapy choice.
6, chemical treatment process
(1) Chemotherapy Indication
Chemotherapy alone in the treatment of prostate cancer is not possible to achieve a satisfactory effect, but more toxic reaction, the general as adjuvant therapy after surgery to extend patient survival. General application in prostate cancer has spread outside the capsule and pelvic lymph node metastasis in patients, endocrine therapy and radiotherapy also available after the failure of chemotherapy.
(2) single-agent chemotherapy
A commonly used drug methotrexate (MTX) and cyclophosphamide (CTX), 5-fluorouracil (5-FU), Adriamycin (ADM), cisplatin (DDP), estradiol Mechlorethamine phosphate (EMP), mitomycin C (MMC). But all of the reports on the effect of drugs vary widely. The total effect seems to good to mitomycin C (MMC), doxorubicin (AMD), cisplatin (DDP), vinblastine (updates). The Medical Act as follows:
MMC 10mg/m2, intravenous, repeated every 3 weeks. Efficiency 38%.
Available 1.5mg/m2, intravenous, linked five days, repeated every 4 weeks. Efficiency 35%.
ADM 20 ~ d1, intravenous, linked three days, repeated every 3 weeks. Efficiency 13% to 37%.
DDP 40mg/m2, intravenous, linked five days, repeated every 3 weeks. Efficiency 15% to 40%.
(3) Combination Chemotherapy
Combination chemotherapy is better than single drug efficacy. Certainly not at the moment, the following programs are available.
1. Program 1
Available 1.5mg/m2, intravenous injection of 1 to 5 days;
ADM 50mg/m2, intravenous, a day.
Efficiency 29%.
2. Program 2
ADM 50mg/m2, intravenous, one day;
MMC 5mg/m2, intravenous, 1,2 days;
5-fluorouracil 750mg/m2, intravenous, 1,2 days.
Efficiency 41%.
3. Program 3
ADM 50mg/m2, intravenous, one day;
MMC 10mg/m2, intravenous, one day;
Available 1.5mg/m2, intravenous injection of 1 to 5 days.
Efficiency 41%.
4. Program 4
ADM 20mg/m2, intravenous injection of 1 to 3 days;
DDP 40mg/m2, intravenous injection of 1 to 5 days.
7, chilled treatment
Apply to the relatively large size of prostate cancer, surgical resection not, poor general condition of patients. Treatment for the adoption of perineal incision exposed the prostate, bladder and seminal vesicle rear bottom, using frozen tumor and probe contact spermatheca back to local cooling, leading to tumor tissue necrosis. Also, the urethra can freeze, bleeding little less surgical trauma. Cryotherapy for patients but also promote immunity, kidney, lung and metastatic degradation occurred. According to some reports frozen after the perineum, the survival rate of patients with the corresponding stages of prostate patients undergoing resection of the prostate all, the survival rate after the same.
8, immunotherapy
Prostate cancer patients after surgery, radiotherapy or chemotherapy and other ways to reduce the tumor tissue to a trace amount, plus with immune therapy, the body can remove the small amount of residual tumor tissue, can achieve better results. BCG immunotherapy available, fabricated vaccines, cancer vaccines, interferon, immune serum, chemical and immunological agents.

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