Introduction
Prostate cancer is a common cancer in men, with incidences growing at an annual rate of 3%. The incidence is increased with age and the mortality rate is about 20%, characterized by obvious geographical and ethnic differences in the incidence rate. It is the highest in the regions of the Caribbean and Scandinavia and the lowest in China, Japan, and other countries. Prostate cancer rates of African-Americans are the highest in the world. The cause of prostate cancer is not clear so far and is associated with the impact of prostatic gonorrhea, virus and chlamydia infections, sexual activity intensity, and hormones. In addition, a high-fat diet and occupational factors (too much exposure to cadmium) also have certain relationships with the onset.
Early prostate cancer can have no warning symptoms other than elevated serum PSA values found by screening and (or) prostatic abnormal changes found by digital rectal examination. Once the symptoms appear, it often has become late progressive prostate cancer. It manifests as progressive dysuria (urinary thinned, urinary skewed, urinary bifurcated, or urinary prolonged), urinary frequency, urgency, dysuria, and vesical tenesmus. When it is severe, urinary dribbling and urinary retention occur. For advanced progressive prostate cancer, fatigue, weight loss, body pain, and other symptoms may appear. Because pain seriously affects diet, sleep, and mentality, in the long term the general condition is increasing frailty with weight loss, fatigue, and anemia, ultimately systemic failure and cachexia.
The treatment of early prostate cancer includes radical prostatectomy, radical radiotherapy, and watchful waiting; the treatment of advanced cancer mostly applies palliative treatment such as endocrine therapy and chemoradiotherapy. Because surgery can lead to urinary incontinence and impotence, radiotherapy may be complicated by acute gastrointestinal reactions, sexual dysfunction, urinary symptoms, urethral stricture, urinary incontinence, as well as genital and lower extremity edema. Endocrine therapy can only kill the hormone-dependent cancer cells and narrow cancer and prostate volume; it cannot completely eliminate it. The side effects of chemotherapy are significant with poor efficacy. In recent years, people have begun to look for new treatments with effectiveness and with fewer side effects and hyperthermia is one of them.
Treatments
1.Surgery
Radical prostatectomy (referred to as radical resection) is the most effective method for the treatment of localized prostate cancer, with three main operations, namely, traditional perineal, retropubic, and laparoscopic radical prostatectomy, developed in recent years. Timing of surgery: patients with transrectal biopsy should wait for 6–8 weeks, and patients with transurethral resection of prostate should wait for 12 weeks before surgery, so as to avoid the inflammatory response causing rectal and surrounding tissue damage. Also, nerve- sparing surgery is easier. In addition, percutaneous cryoablation has accurate positioning, minimal trauma during surgery, and good postoperative recovery. It has also been widely used clinically.
2.Radiotherapy
Radiotherapy for prostate cancer patients has many advantages such as good efficacy, broad indications, and fewer complications and is suitable for all patients at each stage. The local control rate and 10-year disease- free survival rate of early patients (T1-2N0M0) through radical radiotherapy are similar to those of radical prostatectomy. The therapeutic principle of locally advanced prostate cancer (T3-4N0M0) focuses on adjuvant radiotherapy and endocrine therapy. Palliative radiotherapy can be carried out for metastatic cancer to relieve symptoms and improve quality of life. In recent years, three-dimensional conformal radiotherapy and intensity-modulated radiotherapy are increasingly used in prostate cancer treatment and have become mainstream technologies in radiotherapy. Prostate cancer pelvic spread or lymph node metastasis can lead to pelvic pain, constipation, lower limb swelling, ureter blockage or hydronephrosis, and so on. Palliative radiotherapy can significantly improve these symptoms. Palliative radiotherapy for bone metastases of prostate cancer can significantly alleviate the symptoms of pain and spinal cord compression.
3.Chemotherapy
It is applied for endocrine-refractory metastatic prostate cancer patients to delay cancer growth and prolong the lives of patients. Studies have confirmed that docetaxel can effectively prolong the survival time of endocrine-refractory metastatic prostate cancer patients, whereas cabazitaxel can further extend the survival time of patients failed by the treatment of docetaxel. Many clinical trials are studying new drugs and drug combinations, aiming to find treatment means with more effectiveness and less adverse reactions.
4.Endocrine Therapy
Prostate cells without androgen stimulations will undergo apoptosis. Any treatment of androgen activity inhibition may be referred to as androgen deprivation therapy. Deprivation of androgen is primarily through the following strategies: (1) inhibition of testosterone secretion: surgical castration or medical castration (luteinizing hormone–releasing hormone analogs [LHRH-A]). (2) Block combination of androgen with receptor: application of antiandrogen drugs competitively closes the combination of androgen and prostate cells androgen receptor. The combination of the two can achieve the purpose of maximum androgen blockage. Other strategies include inhibition of adrenal gland source androgen synthesis as well as inhibition of the conversion of testosterone to dihydrotestosterone, and so on. Endocrine therapy aims to reduce the concentration of androgen in the body, inhibit adrenal gland source androgen synthesis, inhibit the conversion of testosterone to dihydrotestosterone, and block the combination of androgen with its receptor so as to suppress or control prostate cancer cell growth. Endocrine therapy methods include the following: castration, maximum androgen blockage, intermittent hormonal therapy, neoadjuvant endocrine therapy before radical treatment, and adjuvant endocrine therapy.
5.Hyperthermia
Prostate cancer is mainly adenocarcinoma, and hyperthermia combined with radiotherapy may improve the outcome. In recent years and among prostate hyperthermias, in addition to conventional local hyperthermia there are still other heating technologies focusing on local ultrahigh temperatures such as microwave, radio frequency, ultrasound, and so on. Hyperthermia can directly promote tumor cell apoptosis, inhibit continuous proliferation of primary or secondary lesions, and inhibit metastasis and has a better therapeutic effect on prostate cancer and benign prostatic hyperplasia. It is recommended to apply whole-body hyperthermia and local hyperthermia alternately. Simultaneously applying chelation detoxification therapy can have a synergistic effect; but be sure to avoid simultaneous application with medical ozone therapy. Hyperthermia can be carried out as long-term maintenance therapy.
6.Chelation Detoxification Therapy
Chelation detoxification therapy can improve immune function; can reduce chemoradiotherapy side effects such as nausea, vomiting, diarrhea, loss of appetite, weakness, fatigue, leukopenia, thrombocytopenia, and alopecia; and has the effect of directly killing cancer cells to induce cancer cell apoptosis, which is of great significance for prevention of tumor recurrence and metastasis. For medium-advanced patients whose physical conditions are not suitable for chemoradiotherapy, chelation detoxification therapy can be strengthened to alternate with chemotherapy. After the condition becomes stable, treatment frequency and therapeutic dose can be gradually reduced and, finally, chelation detoxification is given for long-term health treatment with a base quantum maintained to ensure that patients survive with cancer.
7.Medical Ozone Therapy
EBOO is preferred. Be sure to conduct chelation detoxification alternately and avoid scheduling treatment on the same day. Carry out systemic medical ozone treatment and at the same time give medical ozone acupoint injection. Because medium-advanced prostate cancer patients have been shown to have physical weakness, select medical ozone saline intravenous infusion as the first treatment. For patients with moderate physical weakness or accompanied by coagulation disorder, intravenous medical ozone saline or ozone minor autohemotherapy is applied. It is recommended for long-term application without treatment restrictions.
8.Traditional Chinese Medicine
For the syndrome of damp invasion of lower energizer, the prescription recommended is modified Bazheng Powder; for the syndrome of unconsolidation of renal Qi, the prescription recommended is modified Jinkui Shenqi Pill; for the syndrome of kidney-yang deficiency, the prescription recommended is modified Zuogui Decoction; for the syndrome of deficiency of kidney-yin, the prescription recommended is modified Liuwei Dihuang Pill; and for the syndrome of stagnation of blood and toxic stasis, the prescription recommended is Wuwei Xiaodu Decoction.
9.Acupuncture
The main syndrome of early prostate cancer is damp invasion of lower energizer, and the therapeutic principle should focus on clearing heat and eliminating dampness as well as opening up qi movement.
The main syndrome of medium-advanced prostate cancer is the deficiency of both spleen and kidney qi and the therapeutic principle should focus on enforcing spleen and nourishing kidney, as well as reinforcing lower Jiao.
10.Medicated Diet, Nutrition, and so on
Early nutritional support focuses on an herbal diet. Rationally complement with amino acids, digestive enzymes, and trace elements. For medium-advanced cancer patients who can eat, a medicated diet is to be given continuously and amino acids, trace elements, and so on are appropriately supplemented; for patients who are restricted in eating or totally unable to eat, total parenteral nutrition should be given as much as possible to ensure an adequate supply of nutrition and energy.
11.Others
Actively practice qigong, and rationally do exercise. Aerobic exercise requiring relatively low physical strength can be conducted. Adjusting attitude and maintaining a good state of mind can achieve the best prognosis. For medium-advanced patients, we should urge to actively practice qigong, give psychological music therapy, and so on to regulate emotions and guide them to have peace of mind and to overcome panic and desperation as well as to relieve psychological pressure so that they can face the disease with a positive, optimistic, and open-minded attitude.
Typical Case
67 year old male patient, first detected in March, 2006, pale red color urine accompanied by tingling, unsmooth urine. Patient was takings herbal tea and anti-inflammatory drugs (specific drugs and doses were unknown) as remedy but did not seek professional help. In June, 2006, his urine changed from pale red to dark red, most obviously in the first and latter stream of urine. Patient attended a Urology Clinic in Hong Kong. Cystoscopy revealed no abnormalities. Prostate cancer antigen (PSA): 174ng/ml; urinalysis: occult blood (+++). Prostate biopsy showed prostate adenocarcinoma. Prostate MRI showed a 1cm×2cm inhomogeneous occupation at the prostate right lobe and the left ischial permeability sclerosis destruction, consistent with metastatic cancer and T8 compression fracture. Prostate and testicular resection was subsequently recommended. Patient refused surgery, radiotherapy and chemotherapy. He came to Clifford Hospital to seek treatment. His condition on admission was as follows: urine intermittently presented pale red color, with beginning and latter stream most obvious. This was accompanied by mild dysuria, urinary frequency, and urgency; nocturia five to six times, which affected his sleep. Patient also experienced lumbosacral pain discomfort during activity.
Diagnosis: prostate cancer bone metastases.
Integrative treatment prescription: after admission, the patients was given endocrine therapy (Zoladex + Fugerel), TCM, acupuncture, hyperthermia, chelation and detoxification therapy, medical ozone, and other integrative treatments.
Treatment outcome: Patient was hospitalized for 42 days. After integrative treatment, patient’s condition was stable and general conditions were good with improvement in urination, without frequent micturition, urgency and hematuria. The KPS was 100. Prostate MRI review showed a 1 cm × 2 cm inhomogeneous occupation at the prostate right lobe, revealing a decrease in size. The left ischial permeablely hardened damage was seen by ECT check to be slightly reduced. PSA test prompted 1.01ng/ml (↑) and blood testosterone 27ng/dl. Patient was discharged home to convalesce. After discharge, the patient received regular follow up at Outpatient. He received one week of integrative treatment, consisting of whole body hyperthermia, local hyperthermia, chelation and detoxification therapy, and medical ozone every two months. Patient continued to practice tai chi and medical Qigong daily. Follow-up reviews have been conducted for over 6 years. His PSA has remained in the normal range, the prostate lesion was narrowed.
