2022 CSCO Professor Ye Dingwei: Based on the experience of Fudan tumors, the diagnosis and treatment of prostate cancer needs to be accurately combated and jointly won

Guide

The 25th National Congress of Clinical Oncology and the 2022 CSCO Annual Conference were held
in Beijing, Jinan and Harbin from November 5 to 12 in the form of a combination of offline and online.
The theme of this year's conference is precision innovation, wisdom and humanities, and we will join hands with experts and scholars in various oncology fields across the country to carry out in-depth academic exchanges and scientific and technological cooperation, share clinical research and innovation achievements, deeply discuss precision oncology based on multidisciplinary standardized comprehensive treatment, and actively promote the development of
disciplines.
In the special conference on prostate cancer, Professor Ye Dingwei from Fudan University Cancer Hospital shared the development direction of prostate cancer diagnosis and treatment with the experience of Fudan Cancer Hospital.

Professor Yip Dingwei

Vice President of Fudan University Cancer Hospital Chief expert of urological oncology MDT

Director of Shanghai Institute of Urological Oncology

Director of the Institute of Prostate Cancer, Fudan University

Chairman of the Prostate Cancer Expert Committee of the Chinese Society of Clinical Oncology (CSCO).

Chairman of the Urology Committee of China Primary Health Care Foundation

Former Chairman of the Chinese Anti-Cancer Association Urogenital Tumor Committee (CACA-GU).

Deputy leader of the Oncology Group of the Urology Branch of the Chinese Medical Association (CUA).

Chairman of the Chinese Prostate Cancer Alliance (CPCC).

Vice Chairman of the Urothelial Cancer Expert Committee of the Chinese Society of Clinical Oncology (CSCO).

Vice Chairman of the Kidney Cancer Expert Committee of the Chinese Society of Clinical Oncology (CSCO).

Vice Chairman of the Immunotherapy Expert Committee of the Chinese Society of Clinical Oncology (CSCO).

Chairman of the Urologic Oncology Collaborative Group (UCOG) of China Cancer Hospital

Standing Director of Chinese Anti-Cancer Association and Standing Director of Chinese Society of Clinical Oncology

Leader of the prostate cancer group of the Urogenital Tumor Committee of the Chinese Anti-Cancer Association (CACA-GU).

Deputy leader of the writing team of the Chinese edition of the NCCN guidelines for the diagnosis and treatment of kidney cancer

Member of the NCCN Expert Committee on the Asian Diagnosis and Treatment of Prostate, Kidney and Bladder Cancer

Member of the St.
Gallen Consensus Expert Committee on Advanced Prostate Cancer

Member of the Asia-Pacific Consensus Expert Committee on Advanced Prostate Cancer

Chairman of the Urological Oncology Committee of Shanghai Anti-Cancer Association

Vice President of Urologist Branch of Shanghai Medical Doctor Association

President-elect of the Asia-Pacific Prostate Society (APPS).

Vice President of the Asia-Pacific Society of Cryosurgery, etc

Professor Ye Dingwei pointed out that prostate cancer ranks first in the world in the incidence of male tumors and the first in the incidence of urological malignant tumors in China, but the epidemiological data of China and Europe and the United States are different
.
The number of new cases of prostate cancer in the United States far exceeds that in China, but the number of prostate cancer deaths in China exceeds half
that in the United States.
Therefore, there is still a long
way to go to improve the 5-year survival rate of prostate cancer patients in China.

Precision strikes

So what is the future development direction of prostate cancer diagnosis and treatment in China? The answer given by Professor Ye Dingwei is: precision strike, joint victory
.
Precision crackdown refers to the first accurate screening and promotion of prostate cancer to reduce patients' pain and medical costs; Secondly, after the diagnosis of the patient, the patient should be accurately evaluated to help diagnosis and treatment with accurate staging; Third, carry out precise surgery for early prostate cancer, implement symptomatic measures, and improve the cure rate of early prostate cancer; Finally, the middle and advanced prostate cancer was accurately classified and treated
.
In view of the above content, Professor Ye Dingwei made a detailed elaboration
based on the work experience of Fudan Cancer Hospital.

Professor Ye Dingwei pointed out that to explore a suitable prostate cancer accurate screening system for Chinese, we first need to explore corresponding markers
.
With the help of prostate-specific antigen (PSA) and prostate health index (PHI) in European and American countries, the detection rate of prostate cancer has increased, and the proportion of early prostate cancer has increased, resulting in a significant decrease in mortality
.
However, in China, under the same indicators, the detection rate of prostate cancer is low, the proportion of patients with excessive puncture is higher, and there is more waste
of medical resources.
In response to this situation, Professor Ye Dingwei led a multi-center study to clarify the difference in PHI cut-off values in Eastern and Western populations (PHI of 40 for Chinese groups and 30 PHI for European populations), and constructed a PHI-based Chinese group early screening scale for prostate cancer (Nomogram), which significantly improved the accuracy
of early diagnosis 。 At the same time, Professor Ye Dingwei pointed out that it is necessary to implement the first Chinese "Expert Consensus on Prostate Cancer Screening" led by CACA-GU to combine and promote
the "Prostate Cancer Accurate Screening Base" (regional center) and the "Prostate Cancer Accurate Screening Community Service Station" (community sinking).

Second, accurate imaging evaluation
of the patient throughout the life cycle is required.
Fudan Cancer Hospital is the first in China to carry out precision medicine imaging based on PSMA, and the detection rate of metastases is much higher than that of traditional imaging, breaking through the dilemma of accurate staging of prostate cancer patients
.
However, PSMA PET-CT still has certain limitations in non-metastatic castration-resistant prostate cancer (nmCRPC), and Fudan Cancer Hospital uses PSMA+FDG dual precision imaging to guide the restaging of nmCRPC, which improves the detection rate
of metastasis in patients with nmCRPC who have no metastases on traditional imaging.

Third, based on the characteristics of the pelvis of Chinese people and the difference in the coagulation mechanism of Eastern and Western populations, Professor Ye Dingwei deeply cultivated minimally invasive treatment, created a precision robot (da Vinci Xi) surgical treatment system that conforms to the Chinese people, and entered the era of "dual-machine parallelism" of da Vinci Xi surgical system, "quality" and "quantity" fly together, pursuing three consecutive victories
of tumor control, urinary control function preservation and sexual function recovery.
At the same time, Professor Ye Dingwei pointed out that prostate cancer surgery should not be blindly done, and it is necessary to choose an accurate time for accurate prostate cancer tracking, and through neoadjuvant therapy, a considerable proportion of patients' pathological specimens show pathological complete remission
.
Secondly, Fudan Cancer Hospital performed surgical treatment for oligometastatic primary lesions, which proved that surgery can still perform primary lesion resection in the era of robotic surgery, reducing the risk of imaging progression and death of
patients.

Finally, Professor Ye Dingwei mentioned that Fudan Cancer Hospital took the lead in genomic research on highly lethal prostate cancer to achieve accurate typing, and found that the BRCA2 mutation rate of China's high-risk metastatic prostate cancer population far exceeded that of Western populations by several times, and clarified the preferred genetic detection range of Chinese groups: BRCA2, MSH2, PALB2 and ATM
.
Subsequently, Fudan Cancer Hospital combined the genomic characteristics of Chinese population and proposed a Chinese plan for precise treatment of the five major pathways of mCRPC mutations
.