prostate cancer Introduction
What is prostate cancer?
Prostate cancer occurs when the normal balance of tissues within the prostate gland is disrupted, leading to uncontrolled cell growth and the accumulation of abnormal cells. These abnormal cells can even spread to other parts of the body, such as the pelvis and bones, via nearby lymph nodes or blood vessels. The growth and activity of prostate cancer are closely related to testosterone, a male hormone secreted by the testicles. In addition to understanding the symptoms of prostate cancer, knowing the diagnostic and treatment methods is crucial for early treatment and improving survival rates.
Prostate cancer ranks fourth among the top ten most common cancers in Hong Kong and third among the most common cancers in men. In 2018, there were 2,204 new cases of prostate cancer in Hong Kong, with a total of 468 deaths. The median age of onset was 71 years old. The peak age of onset for prostate cancer is approximately between 65 and 75 years old; men under the age of 40 have a very low chance of developing prostate cancer.
I. Risk factors for prostate cancer
The causes of prostate cancer are still unknown, but past studies suggest that it may be related to the patient's age, weight, race, genetics, dietary habits, and infections.
Your doctor may perform further tests, such as a liver ultrasound scan, bone scan, or PET-CT scan, to determine the size, location, extent, and location of the cancer, thus deciding on the most appropriate treatment.
Prostate cancer rarely occurs in men under 40, but the incidence increases with age, typically occurring in men over 65.
Prostate cancer rarely occurs in men under 40, but the incidence increases with age, usuallyoccurringin men over 65.
Prostate cancer incidence is higher among people of European and American descent, with the highest rates observed in people of African descent, while the incidence is generally lower in Asian populations.
If your father or brother has prostate cancer, your risk will increase by 2 to 3 times.
Studies show that a high-fat diet and smoking increase the risk of prostate cancer.
Long-term prostate infection and inflammation may be related to long-term, chronic bacterial or viral infection.
II. Symptoms of prostate cancer
The symptoms of prostate cancer vary at different stages and can be divided into early, intermediate, and late-stage symptoms:
Early symptoms of prostate cancer:
- Difficulty urinating
- Weak or intermittent urine flow.
- Dribbling of urine occurs at the end of urination.
- After urinating, I feel like I haven't completely emptied my bladder.
- Frequent urination, especially at night.
- Unable to hold urine.
Symptoms of mid-stage prostate cancer:
- Urinary incontinence
- Painful urination
- Hematuria
- Acute urinary retention (having the urge to urinate but being unable to do so, accompanied by pain)
- Urinary tract infection
- Blood in the urine or semen.
Symptoms of advanced prostate cancer:
- Bone pain – caused by bone metastasis, the pain is most often located in the spine, pelvis, or ribs.
- Paralysis - due to a tumor compressing the spinal cord.
- Lower limb swelling – due to cancer cells metastasizing to the lymph nodes.
- Anemia – due to bone marrow being invaded by cancer cells or kidney failure caused by ureteral obstruction.
III. Diagnosis and Treatment of Prostate Cancer
Men should consider regular prostate cancer screenings starting at age 50 (or earlier if there is a family history of prostate cancer). Routine screenings typically include the following two relatively simple tests:
PSA test
PSA stands for Prostate-specific antigen. A PSA test is a blood test used for prostate cancer screening, and more importantly, it serves as an indicator for monitoring the disease after diagnosis. PSA is a protein secreted by the prostate gland, and its secretion level is closely related to the size of the prostate. When the prostate gland has problems, a large amount of protein enters the bloodstream, leading to elevated PSA levels.
Generally, a PSA level below 4.0 ng/mL is considered "normal," but other factors can also cause elevated PSA levels. Therefore, doctors consider the following factors when evaluating PSA test results:
- Age: Generally, PSA levels tend to be higher with increasing age.
- Prostate size
- Previous PSA test results (if you have had a PSA test before)
- Other medical conditions: such as benign prostatic hyperplasia or prostatitis.
- Are you currently taking any medications? Some medications may lower PSA levels, so please be sure to inform your doctor about all the medications you are taking.
- Urinary tract infections and urinary tract surgery: These can lead to elevated PSA levels.
An elevated PSA level increases the risk of prostate cancer, but it doesn't guarantee that prostate cancer will be present. Generally, older men have slightly higher PSA levels than younger men, as shown in the table below:
| Age | PSA normal range |
|---|---|
| 40 years old or above | 0–2.5ng/mL |
| 50 years old or older | 0–4ng/mL |
| 60 years of age or older | 0–4.5ng/mL |
| 70 years old or older | 0–6.5ng/mL |
Digital rectal examination (DRE)
The doctor will put on a lubricated glove and insert a finger into your rectum through the anus to feel for any lumps or abnormalities in the prostate gland.
Tissue biopsy
A prostate biopsy (commonly known as a "needle aspiration") involves extracting a sample of prostate tissue, examining it under a microscope, and conducting pathological examinations to confirm the presence of cancer cells. Currently, prostate biopsy technology is rapidly developing and can be combined with imaging techniques to improve accuracy. Methods include:
- Transrectal ultrasound-guided prostate biopsy (TRUS); and
- Transperineal Ultrasound-guided Prostate Biopsy (TPUS).
Magnetic Resonance Imaging (MRI)
MRI can be used to examine whether the prostate capsule, the seminal vesicles adjacent to the prostate, and the pelvic cavity have been invaded by the tumor, as well as whether there is tumor metastasis in the lymph nodes within the pelvic cavity. In principle, MRI is a very important imaging tool for the diagnosis and staging of prostate cancer. Furthermore, MRI does not produce radiation, so patients can use it with peace of mind.
Other image scans
Once prostate cancer is diagnosed, doctors may recommend that some high-risk patients undergo pelvic and abdominal CT scans, positron emission tomography (PET) scans, chest X-rays, and isotope bone scans to determine whether the tumor has spread.
Staging of prostate cancer
Accurate staging is crucial for determining treatment goals and plans. Prostate cancer staging is primarily based on the following factors:
- TNM staging of tumors
- Prostate cancer pathological grading – Gleason Grading System
- PSA Index
TNM Staging
- T (Tumor): This refers to the extent of the primary tumor's influence. Based on the size and severity of the impact, it is designated as T1 to T4 (generally referred to as stages one through four).
- M (Metastasis): This refers to whether cancer cells have spread to other parts of the body, such as bones and liver. If not, it is M0; if so, it is M1.
- N (Node): This indicates whether cancer cells have spread to the lymph nodes. N0 represents no lymph node spread; N1 to N3 represent different numbers and degrees of lymph node spread.
| Punctuation marks | Clinical significance |
| TX | The primary tumor status could not be assessed. |
| T0 | No evidence of primary tumor. |
| Tis | The tumor had not spread to surrounding tissues in its early stages. |
| T1 to T4 | It is divided into four stages based on the size of the tumor and the extent of its spread. |
| NX | The condition of the lymph nodes cannot be assessed. |
| N0 | The cancer cells have not yet spread to any lymph nodes. |
| N1 to N3 | The cancer cells have spread to the nearby lymph nodes, classified as N1 to N3 based on the number of affected nodes. |
| M0 | The cancer cells have not spread to other parts of the body. |
| M1 | The cancer cells have spread to other parts of the body. |
Prostate cancer staging and survival rate
Early
In stages one and two, the cancer cells are still confined to the prostate gland. With appropriate treatment, the five-year survival rate for prostate cancer is nearly 100%.
Medium-term
In stage three, the cancer cells have spread to the lymph nodes, or the tumor has invaded the outer capsule of the prostate gland. With current treatment options, the five-year survival rate for prostate cancer remains close to 100%.
Late
This is stage four, where the cancer cells have spread to other organs in the body. The 5-year survival rate for prostate cancer at this stage is approximately 40%.
Small cell lung cancer accounts for approximately 15% of all lung cancer cases, and most are caused by smoking. This type of lung cancer generally grows faster than non-small cell lung cancer, and about 70% of patients already have metastatic disease at the time of diagnosis.
Prostate Cancer Pathological Grading – Gleason Grading System
Tumor samples are placed under a microscope, and each of the two most common degrees of differentiation of the cancer cells is given a score from 1 to 5, resulting in a total score of 2 to 10. A higher Gleason score indicates a faster growth rate of prostate cancer and a higher risk of metastasis.
| Total score | Clinical significance |
| 2 to 6 points | The tumor is well-differentiated and has a low degree of malignancy. |
| 7 points | The tumor is moderately differentiated, highly malignant, and grows rapidly. |
| 8 to 10 points | The tumor is poorly differentiated, highly malignant, and grows very rapidly. |
PSA Index
| Tumor invasion range | Gleason score | PSA Index |
| Confined solely to the prostate gland (low risk) | <7 | <10ng/mL |
| Confined to the prostate gland only (intermediate risk) | 7 | 10-20ng/mL |
| The cancer has invaded the tissues surrounding the prostate or has spread to the seminal vesicles (T3b) (high risk). | 8-10 | >20ng/mL |
Active monitoring
Early-stage or low-risk prostate cancer may not require immediate treatment because it grows slowly and is not life-threatening. Doctors will regularly monitor the patient's condition by performing PSA tests, digital rectal exams, and other examinations. Treatment will only begin if cancer cells are found to be growing or spreading. Active monitoring does not mean "giving up on treatment," but rather a strategy of treating only when necessary.
Who is suitable for active surveillance?
- Low-risk group
- Gleason score < 7
- PSA level < 10
- The tumor is very small.
- The tumor is confined solely to the prostate gland.
Surgery
Prostate cancer surgery has two main objectives.
- Radical surgery
This treatment is suitable for patients with early-stage prostate cancer, aiming for a complete cure by removing the entire prostate gland. - Palliative surgery
This treatment is suitable for patients with advanced prostate cancer. For example, orchiectomy (testicular removal surgery) controls tumor growth by reducing male hormone production. On the other hand, some patients experience difficulty urinating because the tumor is too large and obstructs the prostate and urethra. Surgically removing the obstructing tumor can improve urination problems and enhance the patient's quality of life.
There are generally three different surgical approaches for prostate cancer. Regardless of the technique used, patients will require general anesthesia.
- Open surgery
- Laparoscopic surgery
- Laparoscopic surgery assisted by robotic arms
Who is a suitable candidate for radical prostatectomy?
- The tumor is still confined to the prostate gland.
- The patient's life expectancy is 10 years or more.
- The patient's physical condition is strong enough to withstand the surgery.
Which surgical procedure is right for me?
Currently, most hospitals primarily use laparoscopic surgery. However, some patients still have to opt for open surgery due to the following circumstances:
The patient has undergone multiple abdominal surgeries, resulting in peritoneal fibrosis or intestinal adhesions;
Alternatively, patients with tracheal and bronchial problems may not be able to tolerate the use of carbon dioxide to inflate the abdominal cavity during laparoscopic surgery.
What are the risks of prostate cancer surgery?
Currently, laparoscopic surgery is the mainstream surgical treatment for prostate cancer, and it carries very low risks. The main risks are related to anesthesia, followed by bleeding and rare instances of intestinal damage.
Most patients who undergo laparoscopic surgery can eat and walk around 2 to 3 days after the operation, and some can even be discharged to rest at home. They return to the hospital for a follow-up examination and removal of the urinary tract approximately one week later. Whether further treatment, such as radiation therapy, hormone therapy, or chemotherapy, is needed depends on the pathology report. Generally, if there is no lymph node metastasis, clear tumor margins, and no metastasis to the seminal vesicles, further treatment is not required.
What are the possible side effects of prostate cancer surgery?
- Erectile dysfunction and fertility
- Urinary leakage and urinary incontinence
Who is a suitable candidate for targeted hormone inhibitors?
Radiotherapy
Radiation therapy (commonly known as "electrotherapy") uses high-energy radiation to destroy the DNA of cancer cells, thereby inhibiting their growth and division and inducing apoptosis. Radiation therapy is very effective in treating locally advanced or locally advanced prostate cancer and, like surgery, can be used as a radical treatment.
There are generally three different surgical approaches for prostate cancer. Regardless of the technique used, patients will require general anesthesia.
- Open surgery
- Laparoscopic surgery
- Laparoscopic surgery assisted by robotic arms
Intensity-modulated radiation therapy（IMRT）
- By using numerous fine beams of radiation directed from different angles, the beams converge at the tumor site. This allows for the adjustment of the radiation dose distribution based on the shape of the tumor and its relative position to surrounding tissues, concentrating the high-dose area on the tumor and minimizing damage to healthy tissue.
Volumetric-modulated arc therapy (VMAT)
This technology rotates 360 degrees around the patient in a dynamic manner, with the computer system selecting the optimal irradiation angle. Due to the increased selection of irradiation angles, it not only allows for precise targeting of the tumor and uniform dose delivery, but also reduces the impact on normal tissues and significantly shortens treatment time. This is particularly beneficial for patients who have undergone multiple abdominal surgeries, resulting in peritoneal fibrosis or intestinal adhesions;
Alternatively, patients with tracheal and bronchial problems may not be able to tolerate the use of carbon dioxide to inflate the abdominal cavity during laparoscopic surgery.
Image-guided radiotherapy (IGRT)
- Not only does it have the function of IMRT, but it also uses the image navigation system of the robotic arms installed on both sides of the treatment instrument to generate images and real-time computed tomography 3D images. Using alignment fusion technology, it can accurately locate the patient before each treatment to obtain real-time position parameters, and make real-time corrections to reduce errors, so that the radiation beam can accurately irradiate the correct position and reduce damage to other normal tissues.
Stereotactic body radiotherapy (SBRT)
- This is a highly precise radiation technique that can accurately detect the location of tumors and irradiate only the tumor without affecting other nearby tissues. Therefore, it can be used to implement a high-dose, low-frequency treatment regimen, reducing the treatment course from the original 36 to 39 sessions to 5 sessions.
Internal radiation therapy (Brachytherapy)
- Multiple radioactive metal particles are surgically implanted into the prostate gland for brachytherapy. The radiation dose to these particles gradually decreases, eliminating the need for removal. Although the procedure is short, it is only suitable for low- to intermediate-risk prostate cancer because the radiation does not reach adjacent tissues. While brachytherapy has become increasingly popular abroad in recent years, it is not common in Hong Kong, and clinical experience with it is limited.
What side effects can chemotherapy cause?
- In early-stage prostate cancer, radiotherapy can be used as a curative treatment, with a cure rate comparable to surgery.
- For patients who still have risk factors after surgery, or whose PSA levels rise again after surgery, suggesting local recurrence, radiotherapy can also be used.
- For high-risk prostate cancer, it is recommended to use radiation therapy in combination with hormone therapy.
- Studies have shown that in advanced prostate cancer that has spread to the lymph nodes, combining radiation therapy with hormone therapy leads to better disease control and improved survival rates compared to hormone therapy alone.
- For advanced prostate cancer, the goal of radiation therapy is palliative, such as relieving pain, reducing the risk of fractures, or improving urinary symptoms.
What side effects can radiation therapy cause?
- Side effects from radiation therapy for prostate cancer are generally few. Because the bladder and rectum are very close to the prostate, side effects mainly involve bowel and urinary issues, such as painful urination, abdominal pain, and diarrhea. These are usually mild and resolve after the treatment is completed.
- In the long term, a small percentage of patients may develop chronic enteritis or chronic cystitis, but these are generally mild, and the risk of more serious complications is less than 5%.
Hormone Therapy
Hormone therapy, also known as androgen deprivation therapy (ADT), is a systemic treatment that works by using various methods to remove or block male hormones that stimulate the growth of prostate cancer cells. Once prostate cancer cells are deprived of the stimulation of male hormones, their growth rate slows down significantly, and they may even shrink and die.
The benefits of hormone therapy are its significant effectiveness and gentle nature. Most prostate cancer patients respond ideally to hormone therapy, with tumor growth slowing and shrinking, and PSA levels decreasing. Moreover, compared to chemotherapy and radiation therapy, it has fewer side effects, and patients have excellent tolerance and adherence to the medication.
Hormone therapy includes two main categories: surgery and medication.
Surgery
Orchiectomy (testicle removal surgery):
More than 90% of male hormones are produced by the testicles. Surgical removal of the testicles eliminates the primary source of male hormone production. This simple procedure is performed by a surgeon, and patients receive local or spinal anesthesia, typically requiring a few days in the hospital before returning home. Its advantages are its thoroughness and one-time nature; however, because it is a permanent and irreversible procedure, some men may choose medication as a treatment option.
Drug
Hormone control medication offers both oral and injectable options, with injectables being the more common method. Patients need to attend injections at a hospital or clinic as scheduled, typically every 1, 3, or 6 months, depending on the medication used. The advantage is that it avoids the need for testicular removal, reducing the psychological impact on men.
Pituitary Downregulators:
The principle is to indirectly suppress the production of male hormones by interfering with the pituitary gland's endocrine system. This type of injection is suitable for patients who do not wish to undergo orchiectomy or only require short-term hormone therapy (such as combined with radiation therapy for radical treatment). Commonly used drugs include luteinizing hormone-releasing hormone agonists (LHRH agonists), such as Leuprorelin. Initially, male hormone levels will rise and then fall, and patients may find their symptoms more pronounced. Therefore, a testosterone receptor blocker (anti-androgen) may be needed for the first two weeks to mitigate this temporary effect.
Testosterone receptor blockers：
In recent years, the medical community has developed "luteinizing hormone-releasing hormone antagonists" (LHRH antagonists), such as degarelix, which can completely block the increase of male hormones. The advantage is that they take effect quickly, and patients need to inject once a month.
Targeted hormonal drugs
Furthermore, it can reduce the impact on normal tissues and significantly shorten treatment time. It is also suitable for patients who have undergone multiple abdominal surgeries, resulting in peritoneal fibrosis or intestinal adhesions;
Alternatively, patients with tracheal and bronchial problems may not be able to tolerate the use of carbon dioxide to inflate the abdominal cavity during laparoscopic surgery.
Who is a suitable candidate for hormone therapy?
Doctors typically recommend hormone therapy for the following types of patients:
- For patients with early-stage prostate cancer who are not suitable for curative surgery or radiation therapy:Although their prostate cancer is in its early stages, due to old age, frailty, or co-existing chronic conditions such as heart disease, they may not be able to tolerate surgery or radiation therapy. In such cases, hormone therapy is a relatively gentle method to control the disease.
- Patients who have completed radiation therapy:In some patients, even if prostate cancer has not spread after completing radiation therapy, doctors may recommend a period of hormone therapy to eliminate any remaining cancer cells in the body and further consolidate the treatment results.
- Patients with advanced prostate cancer:In late-stage patients, where cancer cells have already spread or metastasized, curative treatment through surgery or radiation therapy is no longer possible. Hormone therapy can help control cancer cells throughout the body.
What side effects can hormone therapy cause?
PSA levels must be monitored during hormone therapy because residual prostate cancer cells may transform into hormone-resistant tumors over time, so regular monitoring is necessary.
Hormone therapy may cause the following side effects:
- Decreased libido, impaired sexual function
- Erectile dysfunction
- Hot flashes
- Breast pain and swelling
- Increases the risk of osteoporosis.
Hormone Therapy
Chemotherapy, also known as "chemo," works by using anti-cancer drugs to kill cancer cells. Chemotherapy drugs travel through the bloodstream to reach all parts of the body, making it a systemic treatment.
When is chemotherapy used?
Patients with metastatic castration-resistant prostate cancer (mCRPC): Their cancer cells have spread and are no longer responding to nodule hormone therapy.
For patients with metastatic hormone-sensitive prostate cancer (mHSPC): Previously, chemotherapy was considered when prostate cancer had spread to other organs and hormone therapy had failed. However, by the time chemotherapy was used after hormone therapy had failed, the patient's body was often already very weak and unable to tolerate the side effects. In recent years, the medical community has advocated combining hormone therapy with chemotherapy, that is, using chemotherapy simultaneously with the initiation of first-line hormone drugs. This approach reduces the chance of prostate cancer cells developing resistance to hormone therapy, allowing the disease to be controlled for a longer period, extending the patient's overall survival by up to 20 months. It also allows patients to receive chemotherapy in better physical condition, reducing discomfort during treatment.
Chemotherapy drugs used to treat prostate cancer?
Docetaxel：
- Its mechanism of action is to inhibit cancer cell division and induce apoptosis by binding to free tubulin. It is usually used in conjunction with steroid drugs.
Cabazitaxel:
It is also a paclitaxel-based chemotherapy drug with similar effects to docetaxel, and is usually used after docetaxel treatment has failed or resistance has developed.
Docetaxel and cabazitaxel have been proven to effectively slow the growth of cancer cells and alleviate symptoms, thereby prolonging patient survival time and improving their quality of life. Therefore, they are currently the most commonly used chemotherapy drugs for the treatment of prostate cancer.
Other chemotherapy drugs used to treat prostate cancer include mitoxantrone and estramustine. The use of carboplatin, oxaliplatin, and cisplatin in prostate cancer is still under investigation.
During treatment, doctors will closely monitor the patient's physical condition, including blood tests for various blood cell counts and PSA levels, and may also arrange imaging scans if necessary.
What side effects can chemotherapy cause?
Side effects of chemotherapy are a primary concern for patients. Indeed, chemotherapy drugs destroy rapidly growing cancer cells, but they also damage rapidly growing normal cells, such as hair follicle cells, oral and gastrointestinal mucosal cells, and bone marrow hematopoietic cells, inevitably causing various side effects such as hair loss, nausea, vomiting, and decreased immunity. However, not every side effect will occur, and side effects experienced by other patients may not occur in oneself. Furthermore, chemotherapy side effects are usually temporary, and the body gradually recovers after treatment. In addition, modern chemotherapy drugs have improved significantly, with milder side effects compared to older drugs, making them less severe than imagined. Patients assessed by their doctors as suitable for chemotherapy can theoretically complete the treatment course successfully.
Radioisotope Therapy
Radionuclide therapy for prostate cancer uses alpha or beta rays emitted by radioactive materials to treat patients. When these drugs are injected intravenously, the diseased tissue absorbs the radiation released by the drugs and is destroyed, subsequently shrinking and undergoing apoptosis. The following briefly describes two types of radioisotopes used in mCRPC patients with bone metastases:
Radium-223
Through intravenous injection, a small amount of radioactive radium is implanted into the prostate and, like a "missile," selectively attaches to tumors on the bones, then releases radium-223 to kill cancer cells. Because the radiation emitted by radium-223 is very short-range, patients usually do not need to worry about the radiation affecting their family members after returning home from treatment.
Studies have shown that radium-223 isotope therapy is beneficial for mCRPC patients with bone metastases. Adding radium-223 to the existing treatment regimen not only effectively controls tumors that have metastasized to the bones and slows disease progression, but also helps alleviate pain caused by bone metastases, improves quality of life, and extends the overall survival rate of prostate cancer patients.
"Lu177-PSMA therapy"
Lutetium-177 (Lu-177) combined with prostate-specific membrane antigen (PSMA) is also known as "Lu177-PSMA therapy".
Lloydium-177 is a low-radiation radioactive element, while PSMA is a receptor that adheres to the surface of prostate cell membranes. When prostate cells become cancerous, these receptors increase abnormally. When prostate cancer cells spread, a large number of PSMA receptors also appear on the surface of cells in metastatic sites (mainly bones).
Lu177-PSMA therapy combines the therapeutic radioactive element Lu-177 with PSMA ligands to form a preparation. When this preparation is injected into the patient's body, it binds to PSMA receptors on the surface of cancer cells and kills the cancer cells by releasing beta radiation, thereby improving the severe bone pain caused by bone metastasis in the patient.
Lu177-PSMA therapy is administered intravenously, and patients can go home after only a few hours to a day of observation. Doctors will arrange blood tests or imaging scans to monitor the patient's condition.
Who is a suitable candidate for Lu177-PSMA therapy?
Before starting Lu177-PSMA therapy, the doctor will assess the patient's physical condition to fully determine if the patient is suitable for the relevant treatment. The patient must meet the following criteria:
- The patient was confirmed to have mCRPC, and their condition continued to deteriorate.
- Patients who have received anti-androgen drugs and/or chemotherapy but with little effect or whose condition continues to worsen;
- Positron emission tomography (PET) scans showed that PSMA uptake was significantly higher than that in the liver;
- According to the performance status assessment developed by the Eastern Cooperative Oncology Group (ECOG), a score of 2 or below indicates a survival of more than 12 weeks.
What side effects can radioactive isotope therapy cause?
Because the radiation emitted by radioactive isotopes is short-range, it effectively delivers radioactive material to the tumor with minimal impact on adjacent normal tissues, resulting in mild side effects. Patients may experience dry mouth, fatigue, or a decrease in blood cell count, but these are not severe and are only temporary.
IV. How to diagnose prostate cancer
Radioisotope Therapy
Because the radiation emitted by radioactive isotopes is short-range, it effectively delivers radioactive material to the tumor with minimal impact on adjacent normal tissues, resulting in mild side effects. Patients may experience dry mouth, fatigue, or a decrease in blood cell count, but these are not severe and are only temporary.
Because the radiation emitted by radioactive isotopes is short-range, it effectively delivers radioactive material to the tumor with minimal impact on adjacent normal tissues, resulting in mild side effects. Patients may experience dry mouth, fatigue, or a decrease in blood cell count, but these are not severe and are only temporary.
Patients with metastatic castration-resistant prostate cancer (mCRPC):
Their cancer cells had spread and were no longer effective against nodule hormones.
Patients with metastatic hormone-sensitive prostate cancer (mHSPC):
Studies have shown that early combination therapy, including targeted hormone inhibitors combined with first-line hormone therapy, or targeted hormone inhibitors combined with surgery and radiation therapy, can effectively prolong the survival time of these patients.
Elderly and frail prostate cancer patients:
Some older patients, those with poor physical condition, and those who cannot tolerate chemotherapy are also suitable for using targeted hormone inhibitors with milder side effects.
Because the radiation emitted by radioactive isotopes is short-range, it effectively delivers radioactive material to the tumor with minimal impact on adjacent normal tissues, resulting in mild side effects. Patients may experience dry mouth, fatigue, or a decrease in blood cell count, but these are not severe and are only temporary.
What are the benefits of targeted hormone inhibitors?
- Extending survival:
Targeted hormone inhibitors can comprehensively block the growth factors required by prostate cancer cells. Studies have confirmed that patients who switched to targeted hormone inhibitors due to the failure of novotestinosin hormone drugs can have their survival extended by an average of more than ten months, and some patients can have their survival extended to twenty, thirty months or even longer. - Symptom relief:
Bone metastasis is a common occurrence in patients with advanced prostate cancer. Targeted hormone inhibitors can reduce symptoms such as bone pain, fractures, and vertebral collapse, thereby greatly improving the quality of life for patients.
What side effects can targeted hormone inhibitors cause?
- Targeted hormone inhibitors have mild side effects, with serious side effects occurring in less than 5% of patients. Common side effects include increased blood pressure, edema, and elevated liver enzymes.
FAQ
What is prostate cancer?
Prostate cancer is a common cancer in men. It occurs when cells in the prostate grow uncontrollably due to gene mutations, forming a tumor. It can even spread to other parts of the body, such as bones or pelvis, via the lymphatic system or bloodstream. Its growth is closely related to the male hormone testosterone.
Who are at high risk for prostate cancer?
People at high risk for prostate cancer include:
- Age: Men over 65 years of age have a significantly increased risk of developing the disease.
- Family history: People with a family history of prostate cancer in their immediate family (father or brother) have a higher risk.
- Lifestyle habits: High-fat diets, smoking, and obesity are associated with disease risk.
- Race: The incidence rate is higher in African American men and relatively lower in Asians.
What are the early symptoms of prostate cancer?
Early-stage prostate cancer may present with mild symptoms, including:
- Difficulty urinating
- Nighttime urination
- Reduced or interrupted urine flow rate
- The feeling of not being completely empty from the bladder after urination
If you experience any of the above symptoms, consult a doctor as soon as possible.
How is prostate cancer diagnosed?
Prostate cancer is usually diagnosed using the following methods:
- PSA test: Detects the concentration of prostate-specific antigen in the blood.
- Digital rectal examination: The doctor checks the prostate for any abnormal lumps.
- Imaging examinations: including magnetic resonance imaging (MRI) and computed tomography (CT) scans.
- Biopsy: A sample of prostate tissue is taken for pathological examination.
What are the treatment options for prostate cancer?
Treatment methods depend on the stage of cancer and the patient's health condition; common methods include:
- Surgery: Early-stage patients may choose radical surgery to remove the prostate.
- Radiation therapy: uses high-energy rays to destroy cancer cells, suitable for patients with locally advanced or locally advanced cancer.
- Hormone therapy: Suppressing male hormones and slowing tumor growth
- Chemotherapy: Suitable for patients with advanced disease or those who have not responded to hormone therapy.
Are hormone therapy suitable for prostate cancer patients?
Hormone therapy is suitable for the following prostate cancer conditions:
- Unable to undergo surgery or radiation therapy: For example, elderly or frail patients.
- Postoperative adjuvant therapy: to eliminate residual cancer cells
- Advanced cancer: Controlling its spread or alleviating symptoms
How to reduce the risk of prostate cancer?
Methods to reduce risk include:
- Maintain a balanced diet, increase your intake of vegetables and fruits, and avoid high-fat foods.
- Quit smoking and limit alcohol intake
- Maintain a healthy weight and engage in moderate exercise.
- Regular checkups are recommended, especially for men with a family history of PSA infection or those over 50. Consult your doctor about whether you need a PSA test or other screenings.
How does prostate cancer spread?
The main ways in which prostate cancer spreads include:
Local spread: Cancer cells spread from the prostate to surrounding tissues, such as the bladder neck, seminal vesicles, or rectum.
Lymph node spread: Cancer cells spread to adjacent or distant lymph nodes via the lymphatic system.
Hematogenous spread: Cancer cells travel through the bloodstream to distant organs. The most common sites of metastasis are bones (such as the spine, pelvis, and ribs) and lungs. Bone metastases often cause bone pain, fragility, or the risk of fractures, while lung metastases can lead to difficulty breathing or chest pain.
If metastasis occurs, treatment options may include radiation therapy, hormone therapy, or chemotherapy to control the spread of cancer cells and alleviate symptoms.
What are the survival rates at different stages of prostate cancer?
Survival rates for prostate cancer are closely related to the stage of the disease.
Early stages (stages one and two): 5-year survival rate approached 100%.
Mid-term (Phase III): 5-year survival rate remains close to 100%.
Late stage (stage IV): 5-year survival rate approximately 40%.
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Doctor Updates
Manulife Health Seminar, September 18, 2025: New Trends in the Treatment of Lung Cancer, Breast Cancer, and Prostate Cancer – Dr. Li Yu-chung of the Hong Kong United Oncology Centre shares his insights.
On September 18, 2025, Dr. Li Yu Chung, Jacky of the Department of Clinical Oncology at the Hong Kong United Oncology Centre (HKUOC) will share the latest treatment trends in lung cancer, breast cancer, and prostate cancer at the Manulife Health Seminar. The seminar will be held at Manulife Tower in Kwun Tong from 10:30 a.m. to 11:30 a.m. All are welcome to attend and learn about the cutting-edge treatment technologies and personalized plans!
【240711 Team Medicine Sharing Seminar】 New Trends in the treatment of lung cancer, breast cancer and prostate cancer
With advancements in medicine, cancer treatment has entered an era of precision and personalized care. Taking lung cancer, Hong Kong's leading cancer killer, as an example, next-generation sequencing technology can detect over 300 cancer genes at once, helping doctors screen and find the most appropriate treatment plan or clinical trial program. This not only avoids delaying treatment but also makes better use of limited resources to maximize benefits for patients.
