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Teach you the precise diagnosis and treatment of prostate cancer
Prostate cancer ranks first in the world in the incidence of male tumors and is also the first malignant tumor
of the urinary system.
The incidence of prostate cancer in China has also increased year by year, and has become a major killer threatening men's health in China
.
Recently, the 25th National Congress of Clinical Oncology and the 2022 Chinese Society of Clinical Oncology (CSCO) Annual Conference are being held, and the prostate cancer whole-process management diagnosis and treatment forum, one of the agenda items of the conference, has been successfully concluded
.
At the meeting, Professor Ye Dingwei from Fudan University Cancer Hospital gave a report entitled "The Development Direction of Prostate Cancer Diagnosis and Treatment - Fudan Cancer Experience", summarizing the current experience of Fudan University Cancer Hospital in the diagnosis and treatment of prostate cancer.
Professor Ye Dingwei delivered a report
at the CSCO conference, Professor Ye introduced that the development direction of prostate cancer diagnosis and treatment in China is mainly precision strike + joint victory, in order to carry out precise blows on prostate cancer, it is necessary to start from four aspects:
- Precise screening for prostate cancer;
- Precise staging;
- Precise molecular typing;
- Precise surgery should be carried out for early prostate cancer, and symptomatic measures
should be implemented for intermediate and advanced prostate cancer.
Explore a Chinese accurate screening system for prostate cancer
Professor Ye mentioned that the first step in building an accurate screening system is to establish biomarkers for screening prostate cancer
.
In Europe and the United States, the early screening markers of prostate cancer are mainly prostate health index (PHI) and prostate-specific antigen (PSA).
However, the cut-off values of PHI and PSA in China and European and American countries are obviously different
.
In order to explore a screening system suitable for Chinese, China and Europe collaborated to conduct a clinical study and established a Chinese-appropriate PHI cut-off value, with a PHI of around 40 in Europe and 30
in China.
After establishing the PHI threshold, the next step is to construct a PHI-based prostate cancer early screening scale, which is also designed by Fudan University Cancer Hospital based on Chinese patients, and the advent of the scale has increased the early diagnosis rate of prostate cancer from 52% It rose to 74.
5%.
After establishing tumor markers for early screening, the next step is to promote the model
.
Led by the Chinese Anti-Cancer Association Urogenital System Oncology Special Committee (CACA-GU), China's first "Prostate Cancer Screening Expert Consensus" was built, and with the base as a regional center, the "Prostate Cancer Screening Community Service Station" was established to promote the early screening of prostate cancer and benefit prostate cancer patients
.
Full-cycle accurate imaging of prostate cancer
In addition to biological screening, early imaging screening is also an important means
to detect primary and metastatic prostate cancer.
Professor Ye Dingwei introduced that Fudan University Cancer Hospital is the first medical institution in China to carry out precision medicine imaging based on PSMA, which is superior to MRI and ECT, and has a good early detection rate
for oligometastatic prostate cancer.
Studies have shown that the detection rate of precision medicine imaging metastases based on PSMA is as high as 78%, which is much higher than that of traditional medical imaging methods
.
Of course, if there are still certain difficulties in accurately staging prostate cancer based only on PSMA PET-CT, Fudan University Cancer Hospital took the lead in developing PSMA+FDG dual precision imaging in China to guide the restaging of nmCRPC, which is very effective for patients who fail to find metastases by traditional medical imaging methods (such as magnetic resonance and ECT).
The detection rate of metastases is as high as 73%.
PSMA+FDG dual precision imaging has a detection rate of up to 73% for metastases (screenshot from Professor Ye's report)
In order to further improve the detection rate, Fudan University Cancer Hospital combines clinical and scientific research, and scientific research and clinical departments work together to optimize and modify the molecular structure of PSMA, and synthesize a new probe with higher affinity and more suitable for tumor detection.
This method further improves the detection rate
of prostate cancer metastases.
Innovative precision surgery for prostate cancer
After solving the problem of accurate screening and accurate diagnosis, the next step is to improve the accuracy of prostate cancer treatment
.
Radical prostatectomy is an important means for the treatment of early-stage prostate cancer, but there are many difficulties in prostate cancer surgery, such as: large amount of bleeding, high probability of postoperative urinary incontinence, and high
incidence of sexual dysfunction.
How to perform more accurate surgical treatment for prostate cancer patients is also the focus
of Professor Ye Dingwei's team.
To this end, Professor Ye's team has been deeply engaged in the minimally invasive treatment of da Vinci robot, controlling the operation time, blood loss, urinary control function and sexual function within a reasonable range, and exploring surgical methods that conform to the anatomical characteristics of the Chinese pelvis, which greatly improves the quality of
life of patients.
For patients with metastatic prostate cancer, Professor Ye believes that radical local treatment (i.
e.
, debulking surgery or radiotherapy) + androgen deprivation therapy (ADT) should be performed on the primary tumor, which can significantly improve the progression-free survival of patients compared with ADT therapy alone
.
Surgery or radiotherapy combined with ADT is significantly better than ADT (screenshot from Prof.
Ye's report).
Precise classification of highly lethal prostate cancer
In addition to the above experience, Professor Ye also proposed that prostate cancer with a high fatality rate should be accurately classified
.
In order to identify patients with high-lethal prostate cancer, Professor Ye's team led a Chinese herd germline genomics study, deeply analyzed the genetic characteristics of Chinese, found that the BRCA2 gene mutation rate of high-risk metastatic prostate cancer population is high, and formulated the genetic detection range according to several genes with significant changes: BRCA2, MSH2, PALB2 and ATM
.
In addition to accurate classification in diagnosis, Professor Ye's team also gave precise treatment plans
based on the genomic characteristics of cCRPC patients and some of the most common gene pathways with mCRPC mutations.
For example, AKT inhibitor + abiraterone can significantly benefit
patients with mCRPC with PTEN deficiency.
Figure: For prostate cancer patients with PTEN deficiency, AKT inhibitor + abiraterone can significantly benefit patients (screenshot from Professor Ye's report).
Finally, Professor Ye introduced that China still has a long way to go in the diagnosis and treatment of prostate cancer, the 5-year survival rate of prostate cancer patients in the United States is as high as 97.
5%, while the 5-year survival rate of prostate cancer in China's 21 major medical centers is 69.
2%, and the improved diagnosis and treatment model established by Fudan University Cancer Hospital has only increased the 5-year survival rate of patients to 82.
6%, and there is still room
for improvement in the survival rate of prostate cancer patients in the future.
