2021 CCO Prof. Ye Dingwei: Prostate cancer, between East and West

On April 16, 2022, sponsored by the China Anti-Cancer Association, organized by Henan Cancer Hospital, China Institute of Integrative Medicine Development Strategy, Henan Cancer Foundation, and co-organized by the International Anti-Cancer Alliance and the Department of Medicine and Health of the Chinese Academy of Engineering, China's top medical event ——The 2021 China Oncology Congress (2021 CCO) was grandly held in Zhengzhou
.

In the keynote report session, Professor Ye Dingwei from Fudan University Cancer Hospital shared a report titled "Prostate Cancer, Between East and West", which mainly analyzed how to break through the dilemma of prostate cancer in China and how to use the "troika" Achieve precise treatment of prostate cancer in China
.

Expert Profile Professor Ye Dingwei Director of the Institute of Prostate Cancer, Fudan University Director of the Shanghai Institute of Urology and Oncology Director of the Urogenital Oncology Committee of the China Anti-Cancer Association Executive Director of the China Anti-Cancer Association Executive Director of the Oncology Group of the Urology Branch of the Chinese Medical Association Leader of the Asia Pacific Prostate Society (APPS) President-designate Prostate cancer has become the main killer of men's health in China.
Prostate cancer ranks first in the incidence of male tumors in the world, and ranks first in malignant tumors of the urinary system
.

The incidence of prostate cancer in China is increasing year by year, ranking fourth among male malignant tumors in Shanghai.
Prostate cancer has become the main killer that threatens the health of Chinese men
.

The difference between China and the West in the epidemiology of prostate cancer between China and Europe is that there are fewer incidences and more deaths
.

Among the global new cases, the United States accounted for 17% and China accounted for 8%; while the global deaths accounted for 8% and China accounted for 15%
.

The reason is that in China, the proportion of early-stage patients is less than 30%, the diagnosis and treatment plan are mainly based on experience, and the treatment department is dominated by urology
.

In the United States, early-stage patients account for nearly 90%, and the direction of diagnosis and treatment mainly tends to be precision medicine and individualized diagnosis and treatment, basically realizing a multidisciplinary diagnosis and treatment model
.

How to break through the dilemma of prostate cancer in China? Professor Ye Dingwei pointed out that in order to break through the dilemma of prostate cancer, it is necessary to navigate between China and the West, make good use of the "troika" of early screening, precise treatment and multidisciplinary participation, and embark on a road of innovation
.

One of the troika—the road to early screening is to establish an early screening system for Chinese prostate cancer.
Prostate-specific antigen (PSA) screening is currently the most widely used marker in the field of prostate cancer, but the specificity of PSA is poor.
It will lead to excessive needle biopsy.
To solve this problem, the prostate health index (PHl) is mainly used in the United States.
PHl has been listed in Europe and the United States.
It is widely used and is better than PSA.
It can increase the early cancer detection rate and reduce excessive needle biopsy.

.

The higher the PHI value, the higher the risk of prostate cancer
.

The application of PHI in the Chinese population has not yet achieved good results.
Chinese and European experts cooperated to carry out a study to establish the PHI cutoff value suitable for the eastern population.
The study was published in the European Urology, a top journal of urology.
Population PHI cutoffs were significantly different, with a PHI value of 30 for the Chinese population and 40 for the European population
.

The editor-in-chief Professor Zlotta commented that this study revealed the difference in PHI values ​​between the East and the West for the first time, and laid the foundation for the clinical application of PHI in the diagnosis of prostate cancer in the East population
.

China's "Fudan Strategy" for prostate cancer screening, Professor Ye Dingwei led the formulation and promotion of China's first "Prostate Cancer Screening Expert Consensus".
Screening community service stations” has achieved good results
.

The second troika - the road to precision treatment Explore the full-process precision treatment model for prostate cancer - early precision surgery Early prostate cancer surgery is difficult, the difficulty lies in: the amount of blood loss (average blood loss is 1000ml), and the postoperative urinary incontinence rate is high , High rate of sexual dysfunction
.

At present, the main use of minimally invasive methods (the introduction of laparoscope-surgical robots) has greatly improved the status quo, but it is far from enough, and there are still bottlenecks
.

Professor Ye Dingwei's team found that the anatomical characteristics of the Chinese people's pelvis are very different from those of the Westerners.
According to the unique characteristics, they explored a suitable surgical method for Chinese people ("deep toilet" vs "big washbasin")
.

Based on this, Professor Ye Dingwei's team created a "recovery technique": more minimally invasive, more precise, and better functional preservation, achieving a tumor control rate of > 99%, urinary control function recovery > 99%, and sexual function recovery > 99% , has reached the international leading level
.

Exploring the whole-process precision treatment model for prostate cancer - accurate mid-term staging Mid-term prostate adenocarcinoma focuses on accurate staging, but the difficulty lies in: for patients with non-metastatic hormone-resistant prostate cancer (nmCRPC), conventional medical imaging (bone scan/pelvic MR) cannot be accurately staging , cannot guide precise treatment
.

Professor Ye Dingwei's team took the lead in developing PSMA-based precision medical imaging in China, which significantly improved the diagnosis rate and strived to break through the predicament of accurate staging of patients in the mid-term.
However, there are still difficulties in accurate staging based on PSMA PET-CT.
This study used PSMA+FDG dual-precision imaging to guide the restaging of nmCRPC.
The results found that for nmCRPC patients with no metastases found on traditional imaging, 73% of the patients were found to have metastases by dual-precision imaging.
The results were published in Clinical Cancer in 2020.
Research Magazine
.

The editor-in-chief, Professor Keith T.
Flaherty, commented that the dual-precision imaging monitoring system provides a powerful tool for accurate staging of prostate cancer and changes the treatment options for patients with prostate cancer
.

Exploring the whole-process precision treatment model of prostate cancer - advanced precision classification Chinese patients with advanced prostate cancer have low treatment efficiency, single means and large side effects
.

Due to the lack of genomic data of Chinese patients, it is impossible to accurately classify advanced patients and achieve precise treatment.

.

Professor Ye Dingwei's team led a germline genomics study of Chinese populations in order to achieve "precise typing".
The results of the study were published in the European Urology journal in 2019, which confirmed for the first time the difference in the incidence of genetic mutations in DNA repair genes between Chinese and Western populations.
similarity (both around 12%)
.

An in-depth analysis of the distribution profiles revealed differences between Eastern and Western populations: Chinese high-risk and metastatic prostate cancer populations have higher BRCA2 mutation rates
.

It can be seen that it is necessary to recommend genetic testing in the Chinese prostate cancer population
.

Led by Chinese experts, a large-scale study from four centers from east, west, north, south, and south (fully representative of the Chinese population) was carried out.
The results of the study will be published in the journal JNCCN in 2021.
The study found and defined the preferred genetic testing for the Chinese population, including: BRCA2, MSH2 , PALB2, ATM genes
.

The third troika - the road of multidisciplinary participation to explore and promote the MDT model of Chinese urological tumors In 2005, Professor Ye Dingwei's team established a classic MDT team (MDT 1.
0) that brought together the wisdom and strength of experts in the hospital.
Fudan Oncology was the first in China to establish The center of the urogenital tumor multidisciplinary team, which lasted 16 years, has consulted more than 8,000 difficult cases
.

In 2015, relying on the Urinary Oncology Collaborative Group of China Cancer Hospital, the MDT 2.
0 model was established by integrating the resources of cancer hospitals across the country; in 2018, the China Urinary Oncology MDT Platform (MDT 3.
0) was established through the "Internet + MDT" model
.

MDT 3.
0: More than 1,000 difficult cases are referred from all over the country every year
.

At present, it has been included in 403 centers across the country, covering all provinces, municipalities and autonomous regions except Macau, and 21 international top centers have settled in
.

China's urological tumor MDT platform (MDT 3.
0) has obtained official certification, won the Shanghai Municipal Health and Family Planning Commission's "Smart Medical" project fund support and international praise
.

Next stop, where is the road? Through the "troika" and the joint efforts of Chinese experts, in 2018, data from 21 major medical centers in China showed that the 5-year survival rate (average data) of prostate cancer was 69.
2% (from less than 40%).
The study was published in Lancet Journal; In 2018, the 5-year survival rate of Fudan tumor prostate cancer was 82.
6%, but there is still a big gap with the 5-year survival rate of 97.
5% in the United States
.

Actively carry out clinical research on new drugs for urological tumors The position of Chinese scholars in the research and development of innovative drugs for urinary tumors has gone from having no right to speak to taking the initiative to participate and then lead the way.
Central clinical trials involving 206 centers in 21 countries
.

International cooperation Actively promote international cooperation in prostate cancer diagnosis and treatment.
China has actively established cooperative relations with diagnosis and treatment centers in many countries in North America, Europe and Asia to seek differences; and actively recommend international recognition of China's achievements
.

Professor Ye Dingwei led the formulation of the Chinese guidelines for the diagnosis and treatment of prostate cancer.
For the first time, the Chinese took the lead in compiling the Shanghai Consensus of the International Consensus on Urology "Asia-Pacific Expert Consensus on Prostate Cancer".
In 2019, Professor Ye Dingwei's team had 7 achievements written into the NCCN Guidelines, EAU and AUA International Authoritative Guidelines
.

Academic influence In the 2019 Asia Pacific Prostate Cancer Association Annual Meeting, Professor Ye Dingwei (the first time in China) was elected as the President-elect of APPS
.

Professor Ye Dingwei was invited to participate in the St.
Gallen Consensus Conference on Prostate Cancer (APCCC) (the top "club" in the international urological oncology session), and was invited to attend the 2021 conference for the first time as the only representative of China
.

In addition, Professor Ye Dingwei's team was invited to publish a review of prostate cancer in internationally renowned journals
.

In 2021, Fudan Oncology, as the first invited Asian team, will publish a heavy review in the journal Nature Reviews Urology, which has a huge influence in the field of urological oncology
.

On the occasion of the 40th anniversary of the inauguration of the Chinese Journal of Urology, Professor Ye Dingwei published a special commentary on the 40-year inauguration, reviewed the development of prostate cancer diagnosis and treatment in China over the past 40 years, and looked forward to the future development direction
.

Conclusion In the future, medical teaching and research will go hand in hand
.

Focus on the Troika: Develop early screening, deepen precision treatment, and innovate multidisciplinary models
.

Adhere to two major innovations: accelerate new drug research and promote international cooperation
.

Review: XY Typesetting: XY Execution: XY