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" "Safety" is a humanities case collection project co-operated by Beijing Chen Jumei Public Welfare Foundation and Yimaitong
.
The
series of doctor interviews in urology will focus on the field of prostate cancer, and discuss standardized diagnosis and treatment of prostate cancer based on real clinical needs The importance of path and whole course management to clinical patients highlights the research spirit and professional quality of urological oncologists
.
This issue of oncology clinic is a field that bears the high expectations of countless patients and even the society, and generations of medical practitioners are seeking On the road, we continue to innovate and practice to maximize the benefits of patients
.
Since 1941, two professors, Huggins and Hodges, were the first to prove that surgical castration or application of estrogen can slow the progression of prostate cancer, and won the Nobel Prize for this.
Since prostate endocrine therapy has created a milestone in endocrine therapy for solid tumors, depleting or blocking androgen activity has always been one of the main treatment methods for prostate cancer.
It is also developing and iterating according to unmet clinical needs.
The emergence of CRPC provides more choices for patients with castration-resistant prostate cancer (CRPC)
.
In this issue, we invited Dr.
Cai Yi from Xiangya Hospital of Central South University to talk about the development history of prostate cancer in the past 80 years.
, and his outlook on the future treatment of prostate cancer
.
Expert profile Dr.
Cai Yi, MD, Department of Urology, Xiangya Hospital, Central South University, Member of the Basic Group of the Urology Branch of the Chinese Medical Association (CUA) Digital and Artificial Intelligence Looking back over the past 80 years, Dr.
Cai Yi pointed out that the first application of "castration" to prostate cancer was an accident.
Surgical castration has been the standard of care for prostate cancer for years
.
It was not until the 1970s (1971) that luteinizing hormone-releasing hormone (LHRH), the now well-established androgen deprivation therapy (ADT) drugs goserelin, leuprolide, and Prelin et al.
, these drugs inhibit the luteinizing hormone in patients by affecting the activity of the pituitary-pituitary-gonadal axis, thereby reducing the content of male serum testosterone and meeting the requirements of drug castration
.
In the 1960s, the first generation of anti-androgen drugs (often divided into steroids and non-steroids) were gradually used in the treatment of prostate cancer
.
Steroid drugs have less practical clinical application because of their relatively large side effects
.
Nonsteroidal antiandrogens include bicalutamide, flutamide, and nilutamide
.
However, with the emergence of more and more treatment options, such anti-androgen drugs have gradually withdrawn from clinical application
.
In the late 1990s, chemotherapy began to be used in the clinical treatment of patients with advanced prostate cancer.
Due to the clear benefit of chemotherapy in metastatic castration-resistant prostate cancer (mCRPC), docetaxel-based chemotherapy It has become the standard regimen for the treatment of mCRPC for more than ten years
.
After 2008, the emergence of a new generation of anti-androgen drugs, including abiraterone, enzalutamide, etc.
, brought more survival benefits to mCRPC patients and significantly improved the quality of life of patients
.
Since 2015, a new generation of anti-androgen drugs has gradually advanced from the original mCRPC stage to the non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic hormone-sensitive prostate cancer (mHSPC) stages, significantly improving the survival of patients
.
Dr.
Cai Yi said: "Endocrine therapy is a process of continuous progress
.
Even today, it is still the basis for the treatment of advanced prostate cancer, and it also plays a very important and cornerstone role
.
"The "demand" of patients and the "pursuit" of doctors promote the continuous development of advanced prostate cancer treatment.
Dr.
Cai Yi mentioned that prostate cancer is the most common urological malignant tumor in European and American men, and the incidence of prostate cancer in China is also increasing year by year.
Insufficient existing treatment plans
,
insufficient patient benefits, and urgent desire of doctors to improve diagnosis and treatment methods are the driving forces that drive the continuous clinical research in the field of prostate cancer and the development and renewal of more drugs
.
For example, with the development of the disease, the first-generation anti-androgen drugs represented by bicalutamide cannot continuously suppress androgen levels well, and may become agonists in the environment of androgen receptor (AR) overexpression.
On the contrary, it plays a role in promoting tumors
.
A new generation of endocrine therapy drugs represented by enzalutamide was developed and entered into clinical application in this context
.
It can block the binding of androgen to AR and inhibit the AR nucleus.
Translocation affects the binding of AR to DNA, inhibits the expression of oncogenes, and does not produce agonist effects in the context of high-level AR expression
.
In addition, according to the current data, whether it is sensitive to CRPC or metastatic hormones Prostate cancer (mHSPC), the new generation of endocrine therapy drugs have obvious survival benefits and can significantly improve the survival of patients
.
"Enzalutamide can significantly reduce the prostate-specific antigen (PSA) in patients who have entered the CRPC stage, reducing the The risk of imaging disease progression or death in mCRPC patients before chemotherapy significantly prolongs overall survival in mCRPC patients before chemotherapy and delays the time when mCRPC patients receive chemotherapy
.
Dr.
Cai Yi said, "More and more evidence shows that the new generation of endocrine therapy drugs can significantly improve the survival of patients, and at the same time significantly improve the quality of life of patients, which is also more and more patients will choose enzalutamide as the representative.
of the new generation of endocrine therapy drugs
.
"Clinical treatment options are "a hundred flowers blooming", prostate cancer patients can look forward to the future.
Dr.
Cai Yi pointed out that with the continuous change of prostate cancer treatment methods, clinicians are faced with more and more choices, and drugs with different mechanisms of action provide patients with better options.
At the same time, previously expensive drugs such as enzalutamide and abiraterone have entered the national medical insurance in the past two years.
More and more patients have the freedom of choice, which greatly reduces the economic burden - only ordinary people.
Only affordable drugs can truly benefit more patients
.
At the same time, Dr.
Cai Yi is also full of confidence in the future development of prostate cancer treatment
.
He said that the progress of prostate cancer is the largest in the field of urological tumors every year, and it is also May be the most breakthrough
.
In the next 3-5 years, immune drugs and targeted drugs may be added to the clinical decision-making based on endocrine therapy to complete the "map" of prostate cancer diagnosis and treatment
.
For urologists In other words, the abundance of prostate cancer diagnosis and treatment methods, the time of disease progression and the prolongation of patient survival are not only good news for patients, but also represent a higher challenge: the decision-making of prostate cancer treatment at each stage, the formulation of each treatment plan, will It affects the treatment outcome of individual patients
.
Dr.
Cai Yi pointed out that at this time, a urological oncologist is not only a surgeon, but also a physician and a member of the multidisciplinary diagnosis and treatment (MDT), working closely with doctors in various related departments , to formulate systematic clinical solutions
.
"From my own growth experience, I also feel the same way
.
In fact, there are not many things we can do alone, but if we all do one thing at the same time, we may be able to do more things and bring more benefits to patients
.
"Looking back on the past, looking forward to the future, and finding your own way from the current clinical practice, Dr.
Cai Yi pointed out that, unlike foreign countries, the proportion of newly diagnosed advanced prostate cancer patients and metastatic prostate cancer in China is very high, and the 5-year survival rate of Chinese prostate cancer patients is insufficient.
70%, while the 5-year survival rate of prostate cancer patients in the United States has reached more than 99%—the difference of nearly 30% is mainly due to the low proportion of patients in the early stage of initial diagnosis in China.
There is a huge gap that our urological oncologists need to constantly explore and strive to catch up
.
"I hope that in the future, in the field of prostate cancer, we can have our own voice and make our own data, and we hope that our young doctors can do something that is closer to clinical practice.
The study of the problem can bring about changes in our diagnosis and treatment
.
In the end, Dr.
Cai Yi concluded that although clinical work is getting busier and busier, understanding the development history of prostate cancer diagnosis and treatment, seeing some detours that predecessors have taken from the development stage, and exploring the thinking of previous researchers can give young doctors a better understanding.
Learning, growth and future research directions bring good hints
.
Special thanks to: Beijing Astellas Pharmaceutical Co.
, Ltd.
.
The
series of doctor interviews in urology will focus on the field of prostate cancer, and discuss standardized diagnosis and treatment of prostate cancer based on real clinical needs The importance of path and whole course management to clinical patients highlights the research spirit and professional quality of urological oncologists
.
This issue of oncology clinic is a field that bears the high expectations of countless patients and even the society, and generations of medical practitioners are seeking On the road, we continue to innovate and practice to maximize the benefits of patients
.
Since 1941, two professors, Huggins and Hodges, were the first to prove that surgical castration or application of estrogen can slow the progression of prostate cancer, and won the Nobel Prize for this.
Since prostate endocrine therapy has created a milestone in endocrine therapy for solid tumors, depleting or blocking androgen activity has always been one of the main treatment methods for prostate cancer.
It is also developing and iterating according to unmet clinical needs.
The emergence of CRPC provides more choices for patients with castration-resistant prostate cancer (CRPC)
.
In this issue, we invited Dr.
Cai Yi from Xiangya Hospital of Central South University to talk about the development history of prostate cancer in the past 80 years.
, and his outlook on the future treatment of prostate cancer
.
Expert profile Dr.
Cai Yi, MD, Department of Urology, Xiangya Hospital, Central South University, Member of the Basic Group of the Urology Branch of the Chinese Medical Association (CUA) Digital and Artificial Intelligence Looking back over the past 80 years, Dr.
Cai Yi pointed out that the first application of "castration" to prostate cancer was an accident.
Surgical castration has been the standard of care for prostate cancer for years
.
It was not until the 1970s (1971) that luteinizing hormone-releasing hormone (LHRH), the now well-established androgen deprivation therapy (ADT) drugs goserelin, leuprolide, and Prelin et al.
, these drugs inhibit the luteinizing hormone in patients by affecting the activity of the pituitary-pituitary-gonadal axis, thereby reducing the content of male serum testosterone and meeting the requirements of drug castration
.
In the 1960s, the first generation of anti-androgen drugs (often divided into steroids and non-steroids) were gradually used in the treatment of prostate cancer
.
Steroid drugs have less practical clinical application because of their relatively large side effects
.
Nonsteroidal antiandrogens include bicalutamide, flutamide, and nilutamide
.
However, with the emergence of more and more treatment options, such anti-androgen drugs have gradually withdrawn from clinical application
.
In the late 1990s, chemotherapy began to be used in the clinical treatment of patients with advanced prostate cancer.
Due to the clear benefit of chemotherapy in metastatic castration-resistant prostate cancer (mCRPC), docetaxel-based chemotherapy It has become the standard regimen for the treatment of mCRPC for more than ten years
.
After 2008, the emergence of a new generation of anti-androgen drugs, including abiraterone, enzalutamide, etc.
, brought more survival benefits to mCRPC patients and significantly improved the quality of life of patients
.
Since 2015, a new generation of anti-androgen drugs has gradually advanced from the original mCRPC stage to the non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic hormone-sensitive prostate cancer (mHSPC) stages, significantly improving the survival of patients
.
Dr.
Cai Yi said: "Endocrine therapy is a process of continuous progress
.
Even today, it is still the basis for the treatment of advanced prostate cancer, and it also plays a very important and cornerstone role
.
"The "demand" of patients and the "pursuit" of doctors promote the continuous development of advanced prostate cancer treatment.
Dr.
Cai Yi mentioned that prostate cancer is the most common urological malignant tumor in European and American men, and the incidence of prostate cancer in China is also increasing year by year.
Insufficient existing treatment plans
,
insufficient patient benefits, and urgent desire of doctors to improve diagnosis and treatment methods are the driving forces that drive the continuous clinical research in the field of prostate cancer and the development and renewal of more drugs
.
For example, with the development of the disease, the first-generation anti-androgen drugs represented by bicalutamide cannot continuously suppress androgen levels well, and may become agonists in the environment of androgen receptor (AR) overexpression.
On the contrary, it plays a role in promoting tumors
.
A new generation of endocrine therapy drugs represented by enzalutamide was developed and entered into clinical application in this context
.
It can block the binding of androgen to AR and inhibit the AR nucleus.
Translocation affects the binding of AR to DNA, inhibits the expression of oncogenes, and does not produce agonist effects in the context of high-level AR expression
.
In addition, according to the current data, whether it is sensitive to CRPC or metastatic hormones Prostate cancer (mHSPC), the new generation of endocrine therapy drugs have obvious survival benefits and can significantly improve the survival of patients
.
"Enzalutamide can significantly reduce the prostate-specific antigen (PSA) in patients who have entered the CRPC stage, reducing the The risk of imaging disease progression or death in mCRPC patients before chemotherapy significantly prolongs overall survival in mCRPC patients before chemotherapy and delays the time when mCRPC patients receive chemotherapy
.
Dr.
Cai Yi said, "More and more evidence shows that the new generation of endocrine therapy drugs can significantly improve the survival of patients, and at the same time significantly improve the quality of life of patients, which is also more and more patients will choose enzalutamide as the representative.
of the new generation of endocrine therapy drugs
.
"Clinical treatment options are "a hundred flowers blooming", prostate cancer patients can look forward to the future.
Dr.
Cai Yi pointed out that with the continuous change of prostate cancer treatment methods, clinicians are faced with more and more choices, and drugs with different mechanisms of action provide patients with better options.
At the same time, previously expensive drugs such as enzalutamide and abiraterone have entered the national medical insurance in the past two years.
More and more patients have the freedom of choice, which greatly reduces the economic burden - only ordinary people.
Only affordable drugs can truly benefit more patients
.
At the same time, Dr.
Cai Yi is also full of confidence in the future development of prostate cancer treatment
.
He said that the progress of prostate cancer is the largest in the field of urological tumors every year, and it is also May be the most breakthrough
.
In the next 3-5 years, immune drugs and targeted drugs may be added to the clinical decision-making based on endocrine therapy to complete the "map" of prostate cancer diagnosis and treatment
.
For urologists In other words, the abundance of prostate cancer diagnosis and treatment methods, the time of disease progression and the prolongation of patient survival are not only good news for patients, but also represent a higher challenge: the decision-making of prostate cancer treatment at each stage, the formulation of each treatment plan, will It affects the treatment outcome of individual patients
.
Dr.
Cai Yi pointed out that at this time, a urological oncologist is not only a surgeon, but also a physician and a member of the multidisciplinary diagnosis and treatment (MDT), working closely with doctors in various related departments , to formulate systematic clinical solutions
.
"From my own growth experience, I also feel the same way
.
In fact, there are not many things we can do alone, but if we all do one thing at the same time, we may be able to do more things and bring more benefits to patients
.
"Looking back on the past, looking forward to the future, and finding your own way from the current clinical practice, Dr.
Cai Yi pointed out that, unlike foreign countries, the proportion of newly diagnosed advanced prostate cancer patients and metastatic prostate cancer in China is very high, and the 5-year survival rate of Chinese prostate cancer patients is insufficient.
70%, while the 5-year survival rate of prostate cancer patients in the United States has reached more than 99%—the difference of nearly 30% is mainly due to the low proportion of patients in the early stage of initial diagnosis in China.
There is a huge gap that our urological oncologists need to constantly explore and strive to catch up
.
"I hope that in the future, in the field of prostate cancer, we can have our own voice and make our own data, and we hope that our young doctors can do something that is closer to clinical practice.
The study of the problem can bring about changes in our diagnosis and treatment
.
In the end, Dr.
Cai Yi concluded that although clinical work is getting busier and busier, understanding the development history of prostate cancer diagnosis and treatment, seeing some detours that predecessors have taken from the development stage, and exploring the thinking of previous researchers can give young doctors a better understanding.
Learning, growth and future research directions bring good hints
.
Special thanks to: Beijing Astellas Pharmaceutical Co.
, Ltd.
