After a diagnosis of prostate cancer is made, staging of the tumor is done to clarify the therapeutic approach. In some cases, the tumor is carefully monitored without treatment. Active surveillance involves regular testing and research. When tests show a change in condition, the attending physician may decide to proceed with active treatment. There are five main approaches to treating prostate cancer. 1. Surgery Patients in good general condition can undergo surgical treatment. One of the following types of surgery is used for prostate cancer: Pelvic lymphadenectomy: lymph nodes are removed from the pelvis and examined under a microscope. If cancer cells are found in them, the prostate is usually not removed, but is approached according to alternative schemes. Radical prostatectomy: In this procedure, the entire prostate, surrounding tissue and seminal vesicles are removed. There are two types of radical prostatectomy – retropubic and perineal. In retropubic prostatectomy, the surgeon accesses the prostate through an incision in the abdomen. Surrounding lymph nodes can be removed through the same opening. In the perineal procedure, the prostate is removed through an incision in the perineum, the area between the scrotum and the anus. Lymph nodes can be removed through a separate incision. Transurethral resection of the prostate: in this, tissue is removed from the prostate using a resectoscope – a thin tube with a cutting tool on its tip, which is inserted through the urethra. The procedure is used to relieve symptoms before starting other treatment or in men who cannot undergo radical prostatectomy due to poor general condition. 2. Radiotherapy In it, tumor cells are destroyed with the help of a source of radiation. There are two types of treatment: External: with the help of a device outside the body, radiation is directed at the tumor; Internally: radioactive substances sealed in needles, beads, or catheters are placed near or inside the tumor. In all cases, the radiation reaches and destroys the tumor cells. The method of introduction depends on the type and stage of neoplasia. 3. Hormonal therapy Medicinal products are used that stop the growth and division of cancer cells. The male sex hormone testosterone stimulates cell division in prostate cancer to the greatest extent, so one of the therapeutic approaches is to block its action in the body. Hormonal therapy can be carried out with one or more of the following groups of drugs: Luteinizing hormone-stimulating hormone agonists: these are lueprolide, goserelin and buserelin. They stop the production of testosterone in the testicles. Antiandrogens: they block testosterone receptors and prevent it from exerting its physiological effects. These are flutamide, enzalutamide and nilutamide. Estrogens: they stop the secretion of testosterone in the testicles, on the principle of feedback. They are rarely used,because of the risk of serious side effects. NEWS_MORE_BOX 4. Chemotherapy Chemotherapy uses medicinal substances that stop the growth of cancer cells or kill them. When drugs are taken by mouth or given intravenously, they reach the tumor cells through the bloodstream. This is called systemic therapy. When chemotherapeutic agents are injected into the cerebrospinal fluid, into an organ or body cavity, they primarily affect the tissues immediately adjacent to the site of administration. Which of the two approaches is used depends on the type and stage of the tumor. 5. Biological therapy It is a method of supporting the immune system in its fight against the tumor. Also called biotherapy or immunotherapy. Biotechnologically obtained products are mostly used. In addition to the alternatives listed, new therapies are currently being developed and tested. Some of them are: Cryosurgery: with the help of special instruments, the tumor mass is frozen. High-intensity ultrasound: tumor cells are destroyed using high-energy waves. A special probe that emits the waves is inserted into the rectum. Proton radiotherapy: tumor cells are destroyed using focused streams of protons – small, positively charged particles. Some of the tests used to make the diagnosis or stage the tumor may be repeated to determine the effectiveness of the treatment and the condition of the tumor. Also, based on the results obtained from these tests, it is decided whether the treatment should be continued, changed or discontinued. Some tests may be performed at certain intervals after the end of treatment. This is necessary for the detection and timely and successful treatment of relapses, if they occur.Some of the tests used to make the diagnosis or stage the tumor may be repeated to determine the effectiveness of the treatment and the condition of the tumor. Also, based on the results obtained from these tests, it is decided whether the treatment should be continued, changed or stopped. Some tests may be carried out at certain intervals after the end of treatment. This is necessary for the detection and timely and successful treatment of relapses, if they occur.Some of the tests used to make the diagnosis or stage the tumor may be repeated to determine the effectiveness of the treatment and the condition of the tumor. Also, based on the results obtained from these tests, it is decided whether the treatment should be continued, changed or discontinued. Some tests may be carried out at certain intervals after the end of treatment. This is necessary for the detection and timely and successful treatment of relapses, if they occur.