2021 CSCO prostate cancer research is developing rapidly at home and abroad, and clinical diagnosis and treatment is expected to usher in a new breakthrough!

Editor's note On September 25-29, 2021, the 24th National Clinical Oncology Conference and the 2021 CSCO Annual Conference will be held in a grand combination of online and offline
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The theme of this conference is "Focus on Innovative Research, Leading the Future of Originality"
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As one of the most influential academic celebrations in the field of oncology in China, big coffees from all over the country gather to talk about the research progress and innovation in the field of oncology
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On the afternoon of September 27, the Prostate Cancer Precision Diagnosis and Treatment Forum with the theme "Focus on the Forefront, Accurate First" was officially held
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At the meeting, Professor Ye Dingwei from Fudan University Cancer Hospital, Professor Wei Qiang from Sichuan University West China Hospital, Professor Zhou Fangjian from Sun Yat-sen University Cancer Center, and Professor Qi Jun from Shanghai Jiaotong University Xinhua Hospital discussed the current status and treatment progress of prostate cancer in China.
Commented and shared
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01 Looking at the country-the prospect of prostate cancer treatment is very exciting.
Professor Ye Dingwei said that the standardized incidence of prostate cancer in Asia is lower than that of other continents, but the standardized mortality rate is similar to that in North America
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At the same time, the geographical distribution of prostate cancer in Asia shows that there is significant heterogeneity in the incidence and mortality of prostate cancer in different regions of Asia, and the incidence of prostate cancer in 35.
2% of Asian countries ranks among the top three male malignant tumors-these data All indicate that prostate cancer is gradually becoming a common tumor in Asian countries
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High-fat and high-protein diets, smoking, alcohol abuse, overweight and obesity in Asian populations are all high-risk risk factors for prostate cancer
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In response to the high mortality rate of prostate cancer in Asia, Professor Ye Dingwei pointed out the importance of a nationwide PSA screening strategy
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Prognosis trend data for prostate cancer in Asian countries show that countries that adopt a nationwide PSA screening strategy have seen a rapid increase in the survival rate of prostate cancer
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Regarding the current situation in Asia where the incidence of prostate cancer is gradually increasing and the mortality rate is also high, Professor Ye Dingwei proposed the "one core", "two persistence", and "three advances" diagnosis and treatment ideas
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1) One core: prolong survival time and improve quality of life
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2) Two adherences: adhere to full-process management: standardization is the fundamental and precision-oriented; adhere to multi-disciplinary cooperation: technology empowers and advances
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3) Three advancements: advance early screening; advance international cooperation; advance precision medicine
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Figure 1 Professor Ye Dingwei and his team Professor Wei Qiang also expressed their views on the current status of the treatment of prostate cancer in China
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He said that in the past 20 years, the treatment of prostate cancer has been booming, and new endocrine treatment drugs such as enzalutamide, abiraterone, and apatamide have emerged in an endless stream, cytotoxic chemotherapy drugs and androgen receptor (AR) pathway targeting Inhibitors have become the mainstay of the treatment of advanced prostate cancer
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In recent years, China's prostate cancer drug clinical research projects have been increasing year by year, and China's participation in internationally important phase III clinical studies has gradually increased
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On this basis, Professor Wei Qiang made a supplementary summary on the treatment and research and development of prostate cancer in China.
He put forward the following points: 1) The incidence of prostate cancer in China is currently showing a trend of rapid growth, and the proportion of patients with advanced prostate cancer has increased in recent years.
2) The rapid development of domestic prostate cancer surgical technology, and robot-assisted laparoscopic surgery has gradually become the mainstream operation; 3) With the launch of new prostate cancer drugs and the optimization of treatment, the prognosis of domestic prostate cancer patients has improved significantly; 4) China Participation in important international clinical research is gradually increasing, and the development of new prostate cancer drugs in China is accelerating
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Professor Wei Qiang said that with the continuous emergence of prostate cancer drugs in the country, he expects more local innovative drug research to emerge in the future, so as to accelerate the development of domestic prostate cancer clinical practice
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02 Looking at the world-the rapid progress of prostate cancer clinical research Professor Zhou Fangjian introduced the global diagnosis and treatment progress of prostate cancer in 2021 at the conference
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Professor Zhou Fangjian mentioned that early diagnosis and treatment of prostate cancer is the key to improving the prognosis, but the traditional PSA examination + prostate biopsy can increase the early detection rate and also lead to the problem of over-diagnosis and treatment
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In this regard, STHLM3MRI study 1 proposed that MRI+targeted biopsy can be used to replace traditional screening strategies to reduce the problem of overdiagnosis and treatment
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The results of the study showed that compared with traditional standard biopsy, targeted biopsy after positive MRI can reduce 406 biopsies, 366 benign biopsies, and 88 cases of clinically insignificant prostate cancer
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Professor Zhou Fangjian also introduced PROFILE Study 2 and P1204 Study 3
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The PROFILE study suggests that there is a significant correlation between PRS and biopsy results and clinically significant prostate cancer
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The P1204 study suggests that preoperative PSMA-PET/CT detection can be used as a predictor of early biochemical recurrence (BCR): the risk of BCR in patients with PSMA positive and lymph node metastasis is significantly increased
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As for the treatment of prostate cancer, Professor Fangjian Zhou reported on the latest developments in two major treatments: 177Lu-PSMA-617 radioligand therapy: precisely targeting tumor cells to emit β-wave radiation, inducing cell apoptosis, and targeted killing At the same time as tumor cells, the damage to surrounding tissues is minimized
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A VISION study showed that 4,177Lu-PSMA-617 can significantly prolong the overall survival (OS) of patients with metastatic castration-resistant prostate cancer (mCRPC)
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177Lu-PSMA-617 combined with Best Standard of Care (SOC) significantly prolonged the patient’s OS (15.
3 months vs 11.
3 months, P＜0.
001) and imaging progression-free survival (rPFS) (8.
7 months vs 3.
4 months, P ＜0.
001), and the safety is good, no additional safety issues worthy of attention
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Figure 2 VISION study results PI3K/AKT/mTOR pathway activation is the pathogenesis of a variety of cancers, and PTEN is critical to inhibit the activation of PI3K/AKT pathway
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The IPATential 150 study showed that when PTEN was indeed clearer, the Ipatasertib combined with abiraterone treatment group had better survival benefits
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Among them, Ipatasertib is an oral, highly specific small molecule drug that can target and bind to all three subtypes of AKT (Protein Kinase B) and block the PI3K/AKT signaling pathway
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Capivasertib, as a potent, highly selective, orally active small molecule kinase inhibitor, has similar activity to AKT1, AKT2 and AKT3 subtypes; CAPltello-281 research shows that Capivasertib can be used in combination to treat metastatic hormone sensitivity of PTEN deficiency Prostate cancer
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03 Clinical practice of urology, PSMA diagnosis and treatment in the future, imaging examination is an important factor that affects the treatment strategy of prostate cancer, and the examination results will directly affect the patient's treatment decision and prognosis judgment
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Professor Qi Jun pointed out that compared with traditional imaging examinations, PSMA PET/CT has higher sensitivity and specificity
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Figure 3 Comparison of PSMA PET/CT and traditional imaging examination.
In the initial clinical staging, 68Ga-PSMA-PET-CT or MRI can improve the accuracy of the initial tumor staging5 and optimize the treatment plan
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A study evaluated 68Ga-PSMA-PET-MRI for TNM staging of primary prostate cancer and its impact on treatment decisions.
A total of 122 patients were enrolled and received PSMA-PET- before planned radical prostatectomy (RP).
MRI detection
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The results showed that a total of 119 patients had local positive results of PSMA, with a total positive rate of 97.
5%, and 33.
6% of patients modified their treatment strategies after imaging
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Based on the results of this study, the U.
S.
Food and Drug Administration (FDA) officially approved 68Ga-PSMA-PET for the detection of prostate cancer in 2020.
The indications are prostate cancer patients who are suspected of having metastasis before radical surgery or radiotherapy.
Patients with abnormal PSA suspected of having prostate cancer recurrence
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Figure 4 Recommendations of common urology guidelines for PSMA for initial staging.
Professor Qi Jun also mentioned the application of PSMA in BCR monitoring
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A study of 635 patients who relapsed after radical prostatectomy or radical radiotherapy used PSMA-PET/CT or PET/MRI to detect the lesions.
The results of the study showed that PSMA-PET has high accuracy, repeatability and safety
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At the same time, for patients with M1 detected by PSMA-PET, doctors can turn the treatment plan into systemic treatment more
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Therefore, Professor Qi Jun pointed out that the various urology guidelines recommend the use of PSMA in recurrence monitoring at different levels
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Figure 5 Recommendations of common urology guidelines on PSMA for recurrence monitoring Professor Qi Jun pointed out that PSMA can also be used for tumor burden evaluation and efficacy evaluation
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For patients with non-metastatic castration-resistant prostate cancer (nmCRPC), PSMA-PET can be stratified to choose a reasonable treatment plan
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A study showed that CT alone can detect lesions in 33% of patients, while PET-CT increased this ratio to 75% (of which, 29% of patients had pelvic disease, and 45% of patients were in M1 stage.
)
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At the same time, for patients with mCRPC, PSMA-PET-CT can provide a reference for the choice of treatment options for these patients.
PSMA-PET-CT for mCRPC patients can find more visceral metastases, and PSMA-PET-CT is evaluating tumor burden.
It is more accurate when compared with the curative effect
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Finally, Professor Qi Jun also shared with you the exploration of PSMA in the treatment of castration-resistant prostate cancer (CRPC) patients
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A multi-center Phase II prospective study in Australia-TheraP Study 6, which included 200 mCRPC patients who progressed after first-line treatment and received 177Lu-PSMA-617 or cabazitaxel chemotherapy.
The primary endpoint of the study was PSA remission.
Rate (PSA50) and safety
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The results of the study show that PSMA treatment has a better PSA remission rate and safety
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Figure 6 Results of TheraP study The VISION study also confirmed that 177LU-PSMA-617 can improve patient survival and become a new treatment option for mCPRC
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Professor Qi Jun concluded that although PSMA technology still has shortcomings, due to the huge clinical demand, in the future, PSMA detection technology will have an important impact on the diagnosis and treatment of prostate cancer, which has extremely important value and significance
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Summary In recent years, international and domestic clinical research on the diagnosis and treatment of prostate cancer has gradually increased.
This not only provides doctors with more choices in clinical diagnosis and treatment, but also brings new hope to prostate cancer patients around the world.

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In the future, with the approval of more drugs and the exploration of new therapies, we have reason to believe that prostate cancer, as the second most common tumor in men in the world, will continue to make new breakthroughs in clinical diagnosis and treatment, and prostate cancer patients will also have more Good quality of life and longer survival expectations
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References: 1, Fklund M, et al.
N Engl I MED.
2021.
PMID: 34237810.
2, 2021 EAU P0992.
3, 2021 EAU P1204.
4, 2021 ASCO presentation.
5, Maurer T, et al.
Nat Rev Urol.
2016 Apr;13(4):226-35.
6、 Hofman MS,et al, 177Lu-PSMA-617 versus cabazitaxel in patients with metastatic castration-resistant prostate cancer(TheraP): a randomised open-label, phase 2 trial.
Lancet.
2021 Feb 27;397(10276):797-804.
7, Morris, et al.
Phase III study of lutetium-177-PSMA-617 in patients with metastatic castration-resistant prostate cancer(VISION); ASCO 2021.