Dialogue with Professor Xu Changbao: Abiraterone moves forward to bring greater survival benefits to patients with prostate cancer and choose "Ze" power

*Only for medical professionals to read for reference, Professor Xu Changbao shared the experience of clinical diagnosis and treatment of prostate cancer
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"Director Xu, I am very grateful to you!" an old gentleman said from the bottom of his heart
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This is a patient with metastatic prostate cancer.
As his attending doctor, Professor Xu Changbao, director of the Department of Urology at the Second Affiliated Hospital of Zhengzhou University, chose Abiraterone for it
.

It has been nearly 8 years since he was diagnosed.
The old man has been taking medication.
His prostate-specific antigen (PSA) is still very well controlled and his quality of life is high
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What is the "secret" for prostate cancer patients to obtain high-quality long-term survival? Professor Xu Changbao shared with us some of his experience summarized in his long-term clinical work
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Professor Xu Changbao’s wonderful video The key to the treatment of prostate cancer is "early", and it is more important to talk about strategies in the middle and late stages.
Although prostate cancer was considered to be a high-incidence tumor in European and American countries in the past, the incidence of prostate cancer in China has shown a linear upward trend in recent years and has become a urology department.
One of the most common tumors
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However, unlike European and American countries, the early diagnosis rate of prostate cancer in China is not ideal
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In the United States, about 80% of patients are diagnosed at an early stage, while only about 30% of patients in China are diagnosed at an early stage
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"This difference determines the different prognosis of treatment
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" Professor Xu Changbao said, "The goal of treatment for prostate cancer in the early stage is radical cure, but once it reaches the advanced stage, the goal is to prolong the life of the patient and improve the quality of life of the patient
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Therefore, I often tell patients that chronic gastritis cannot be cured, so if a tumor can be cured at an early stage, such a tumor is actually not terrible.
The key is to treat it early
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"How should prostate cancer be treated when it is in the middle and late stages? Professor Xu Changbao believes that we must use strategies
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"The same prostate cancer patient meets different doctors, and his outcome may be different
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"There are many treatment drugs and treatment methods for advanced prostate cancer, and how to choose the right treatment drugs and treatment methods is skillful, which is a relatively big test for doctors
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Professor Xu Changbao’s wonderful video Abiraterone is for advanced prostate cancer.
Treatment offers new options "Abiraterone, as a new type of endocrine therapy, plays a huge role in the treatment of prostate cancer, especially advanced prostate cancer
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"Professor Xu Changbao introduced that before the advent of abiraterone, the treatment effect of advanced prostate cancer was not satisfactory.
Once a patient enters the stage of castration-resistant prostate cancer (CRPC), it is equivalent to being sentenced to "death with suspension of execution", and The reprieve is very short
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After the advent of abiraterone, the treatment of these patients has been brought into a new field
.
The results of the
COU-AA-301/302 study [1,2] show that the use of androgen deprivation therapy (ADT) + Abiraterone + prednisone (AAP) regimen in the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) without chemotherapy can significantly prolong the median overall survival (OS) to 34.
7 months and reduce the risk of death by 19% (HR=0.
81, P=0.
0033)
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"For advanced tumors, this result is very gratifying
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"Subsequently, a large, super-multicenter study verified the efficacy of abiraterone on metastatic hormone-sensitive prostate cancer (mHSPC)
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The LATITUDE study [3] is a randomized, double-blind, phase III trial conducted in 235 clinical centers in 34 countries, including 1199 newly diagnosed high-risk mHSPC patients
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The final analysis results showed that compared with the control group (placebo + ADT), the experimental group (abiraterone + prednisone + ADT) had a significantly longer median OS (36.
5 months vs 53.
3 months) and a lower risk of death by 34 %, while the PSA reaction rate is as high as 91%
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The OS results of the LATITUDE study are based on the excellent performance of Abiraterone in clinical research.
In 2015 and 2018, Abiraterone was approved in China for the treatment of mCRPC and mHSPC, respectively
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"European and Chinese guidelines both recommend abiraterone as the first-line treatment for mHSPC and mCRPC
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Moreover, the guidelines for abiraterone for high-risk and low-risk patients are first-line recommendations, and there is no need to grade abiraterone according to risk like chemotherapy
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" Professor Xu Changbao Wonderful video.
Good medicine must be used well.
The use of abiraterone in the mHSPC stage will benefit even more.
Abiraterone has been approved for marketing in China and has also been included in medical insurance, which has benefited a large number of prostate cancer patients
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Professor Xu Changbao has accumulated a lot of medication experience in the clinical practice of applying abiraterone in the treatment of advanced prostate cancer
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First of all, Professor Xu Changbao emphasized that no matter how good the drug is, we must grasp the timing of the drug
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"Before there is no complete cure for tumors, the timing of drug selection is particularly important
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If a so-called good drug is put on a dying tumor patient, it will not be able to achieve good results
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" Xu Changbao The professor said, "My personal opinion is not to put Abiraterone in use too late, just use it in the early mHSPC stage
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"Professor Xu Changbao said that the key to the treatment of prostate cancer is to grasp the stage before it has developed to CRPC, and to extend this stage as much as possible, so that the patient can benefit the most
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Once the CRPC stage is reached, the survival time cannot be prolonged too much.

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"Do not wait until the last resort, and only to patients spend new endocrine therapy
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"Secondly, Professor Xu Changbao emphasized the importance of side effects management
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He pointed out that no matter how good the drug is, there are side effects.
For example, abiraterone, as an androgen receptor blocker, can not only block the synthesis of androgen in the testes, but also adrenal androgen synthesis and can block the tumor itself, full block androgen
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However, it also brings a series of side effects
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joint use of hormones would help to alleviate the side effects of abiraterone brought
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"I touched I have been to two or three patients who took abiraterone, but did not take hormones at the same time, and finally developed refractory hypokalemia, which could not be corrected and the drug could only be stopped
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"Regarding the dosage of hormones, there are clinical trials using 5 mg qd, but the instructions recommend the use of 5 mg bid
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In this regard, Professor Xu Changbao believes that the dosage of hormones should be adjusted according to the specific conditions of the patient
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If the patient uses 5 mg of hormones, it can be maintained.
In good condition, there is no need to use 10 mg
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The larger the amount of hormone, the greater the possible side effects
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However, if individual patients still show symptoms of corticosteroid deficiency after using 10 mg of hormone, you may need Increase the amount
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"The amount of hormones needs to be flexibly balanced
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"In addition, because hormone supplementation will have a certain impact on the cardiovascular system, Professor Xu Changbao emphasized that patients should also pay attention to the cardiovascular health of patients when taking medication, and timely management should be carried out when adverse reactions occur
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"The only way to manage the adverse reactions of patients is to manage well.
, The patient can take the medicine for a long time, so that the medicine can fully exert its anti-tumor effect, so that the patient can really get treatment
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"So, it's not that the medicine is good, the patient will definitely be able to treat it well
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Only when the medicine is good and the doctor manages the patient well, can the medicine be used to its fullest effect
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"Professor Xu Changbao concluded
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Professor
Xu Changbao’s wonderful video will further improve the survival of prostate cancer patients.
Doctors must do this first.
As a doctor, we must do a good job in popular science, improve the common people’s awareness of the disease, and increase the rate of early diagnosis
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As a surgeon Doctor, Professor Xu Chang Po young man think to do a surgery is great
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However, after many years of practice, he gradually realized the importance of science
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"do a surgery can save a patient, but if I do science, and many If people have knowledge of this disease, then the early diagnosis rate of prostate cancer will be greatly improved
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"Professor Xu Chang Po hope, the early diagnosis of prostate cancer can reach 80% to 90%, so that patients with prostate cancer called indeed been a very good treatment, its life may be extended for 20 years, 30 years or even longer
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The first Second, to manage prostate cancer patients well, to fully benefit the patients and prolong their lives, clinicians must keep pace with the times and continue to learn
.
In the
face of more and more new drugs such as apatamide and enzalutamide, Only after the clinician fully understands these drugs, can he choose the appropriate drugs and treatment plans according to the patient's individual situation
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In addition, Professor Xu Changbao pointed out that in recent years, great progress has been made in genetic testing and immunotherapy research for prostate cancer
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At present, genetic testing is more widely used in prostate cancer patients, and there are already drugs for different gene mutations
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Immune combination therapy for advanced prostate cancer has also seen relatively optimistic data in large studies
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"The treatment of advanced tumors in the future may enter the stage of multi-method and multi-drug combination therapy
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" Professor Xu Changbao's wonderful video Expert profile Professor Xu Changbao Chief physician, professor, doctor of medicine, master tutor, Director of Urology Department of the Second Affiliated Hospital of Zhengzhou University, China Director of Henan Center of South China Base of Urology Alliance, Director of Henan Urology Diagnosis and Treatment Center, Director of Institute of Urology, Zhengzhou University, winner of 2020 CUA Special Award "Diamond Award" in the field of urinary calculi, Chinese Medical Association Urology Branch National member of the 10th, 11th and 12th committees of the Urology Group, member of the Standing Committee of the Urology Branch of the Chinese Medical Equipment Association, member of the Standing Committee of the Chinese Human Health Science and Technology Promotion Association for the Prevention and Treatment of Urinary Stones, and the Chinese Medical Association Henan Provincial Urology Committee Vice Chairman, Vice Chairman of Henan Urological Surgeons Association, Vice Chairman of the Ninth Urology Professional Committee of Zhengzhou City
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The first member of the Chinese Urolithiasis Union (CUC), the first member of the International Urolithiasis Union (IAU), the international member of the European Urology Association, the member of the Urology Professional Committee of the Cross-Strait Medical Exchange Association, and the Chinese Urolithiasis Union.
He is a member of the Collaborative Center for Diagnosis and Treatment of Stones, and the first member of the Chinese Union of Urinary Infection and Inflammation Prevention and Treatment
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Member of the editorial board of "Chinese Journal of Urology", "Journal of Modern Urogenital Oncology", "Journal of Clinical Urology", "Journal of Modern Urology"
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References: [1] de Bono JS, Logothetis CJ, Molina A, et al.
Abiraterone and increased survival in metastatic prostate cancer.
N Engl J Med.
2011 May 26;364(21):1995-2005.
[2] Ryan CJ, Smith MR, Fizazi K, et al.
Abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naive men with metastatic castration-resistant prostate cancer (COU-AA-302): final overall survival analysis of a randomised, double-blind , placebo-controlled phase 3 study.
Lancet Oncol.
2015;16(2):152-60.
[3] Fizazi K, Tran N, Fein L, et al.
Abiraterone acetate plus prednisone in patients with newly diagnosed high-risk metastatic castration-sensitive prostate cancer (LATITUDE): final overall survival analysis of a randomised, double-blind, phase 3 trial[J].
Lancet Oncol.
2019;20(5):686-700.
*This article is only for Scientific information provided by people does not represent the views of this platform