Prostate cancer is mainly related to these three factors! Do elderly patients need surgery in the early stages?

Author: Yang Yong, Chief Physician, Peking University Cancer Hospital

Reviewer: Lu Wenhong, Researcher, Institute of Science and Technology, National Health Commission

Prostate cancer is a common malignant tumor in elderly men. Generally speaking, its malignancy is low, and most prostate cancers grow slowly. From diagnosis to life-threatening, 80% of patients can survive for more than 10 years. Of course, there are also more special pathological types with shorter survival and life-threatening.

The main risk factors for prostate cancer found in clinical practice are family history of prostate cancer, high androgen levels, and high-protein diet.

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Family history is mainly genetic inheritance. For example, if the father has prostate cancer, his son’s risk of developing prostate cancer is 1-3 times higher than the general population.

Low androgen levels have little to do with prostate cancer. Men with high androgen levels, such as bald men, men with heavy body hair, usually have high androgen levels. According to epidemiological surveys, men with high androgen levels have a higher risk of prostate cancer, and the onset of the disease is slightly earlier.

High-protein diet mainly comes from red meat, such as pork, beef, and lamb, and white meat, such as rabbit, fish, and chicken. Excessive intake of red meat is related to prostate cancer.

There is no conclusive evidence that environmental factors, such as atmospheric environment and human environmental factors (such as sexual frequency), have a significant impact on the occurrence of prostate cancer. In particular, no direct association has been found between human environmental factors and prostate cancer.

There are generally no symptoms in the early stages of prostate cancer. The presence of hematuria indicates that the prostate cancer has grown to a certain extent and has invaded the posterior urethra or bladder neck and bladder bottom. Once there are obvious difficulties in urination and pain from bone metastasis, it is almost without exception in the late stage. Some even have metastases without obvious symptoms. Therefore, in order to detect prostate cancer early, it is necessary to have regular physical examinations every year to screen for indicators related to prostate cancer.

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Radical prostatectomy can control the tumor in early stage prostate cancer. But in late stage, surgery cannot completely remove the tumor and comprehensive treatment is needed.

In fact, for prostate cancer, whether to have surgery or not also depends on the patient's age. Because it grows slowly, patients may have a longer survival period, so for elderly patients, even if diagnosed early, surgery is not particularly recommended. Because elderly patients themselves are in poor physical condition and face the risk of surgical complications; in addition, not having surgery will not affect his life expectancy.

Currently, many domestic and international guidelines recommend that for patients over 75 years old, given that surgery cannot prolong their lifespan, it is recommended to use existing drugs to control the disease. However, if the patient is in good physical condition, even if he is 75 or 80 years old, he may still have a survival period of more than 20 years, and the patient himself prefers surgical treatment. There is a life expectancy calculation formula that can accurately predict his future life expectancy by comprehensively considering the patient's physical condition. Therefore, many international guidelines point out that surgery is not recommended for patients with a life expectancy of less than 10 years; while for patients with early prostate cancer with a life expectancy of more than 10 years, surgical treatment is recommended.

Most prostate cancer surgeries are now minimally invasive, with the prostate cancer being completely removed through laparoscopy or robotics. Because the prostate covers the posterior urethra and is between the bladder neck and the urethra, after the tumor is removed, the distal urethra and bladder neck must be re-anastomosed, and bilateral pelvic lymph node dissection must be performed if necessary.