"Fei" long vision - big coffee visit wang shuo, Jiang Shusuan, Professor Wang Yong: with ADT treatment as a companion, continue to write the life of prostate cancer patients

New drugs are booming, and various treatments are emerging in an endless stream, but prostate cancer has come all the way without androgen deprivation therapy (ADT), which is the basic treatment method for prostate cancer and runs through the follow-up treatment of patients

Professor Wang Shuo

Deputy Director of the Department of Urology, The First Hospital of Zhejiang University

Director of the Minimally Invasive Center of the First Hospital of Zhejiang University

Member of the Robotics Group of the Urology Branch of the Chinese Medical Association

Member of the Endoscopic and Robotics Branch of the Chinese Anti-Cancer Association

Chairman of andrology Branch of Zhejiang Medical Association

Professor Jiang Shusuan

Deputy Director of The Department of Urology, Hunan Provincial Cancer Hospital, Chief Physician, M.

Visiting Scholar at UC Davis, USA

Member of the National Youth Committee of the Urological Male Germline Tumor Professional Committee of the Chinese Anti-Cancer Association

Member of the Youth Committee of the Urology Professional Committee of Hunan Medical Association

Member of the Prostate Group of the Andrology Professional Committee of Hunan Medical Association

Member of the Robotics Group of the Urology Committee of Hunan Medical Association

Standing Committee Member of andrology Drug Research Professional Committee of China Association of Chinese Medicines

Standing Committee Member of Andrology Professional Committee of Hunan Association of Traditional Chinese Medicine and Integrative Medicine

Deputy Leader of the Youth Committee of the Urology Professional Committee of Hunan Association of Traditional Chinese Medicine and Integrative Traditional and Western Medicine

Member of the Standing Committee of the Professional Committee for the Management of the Whole Course of Urinary Diseases of the Hunan Health Management Association

Mainly focuses on minimally invasive treatment and functional protection

Professor Yong Wang

Chief Physician of the Second Hospital of Tianjin Medical University, M.

Deputy Director of the Medical Department of the Second Hospital of Tianjin Medical University

Postdoctoral Fellow, Tianjin Institute of Urology, Visiting Scholar, University of Rochester, Johns Hopkins University, USA

Tianjin Youth Medical Pioneer, Tianjin Specially Invited Young Scholars

Tianjin "131" innovative talent level 2, Tianjin Medical University Young Outstanding Teacher

Member of the Youth Group of the Urology Branch of the Chinese Medical Association

Youth member of the Urological Male Germline Tumor Professional Committee of the Chinese Anti-Cancer Association

He is a youth member of the Urology Professional Committee of the Chinese Association of Research Hospitals

Member of Tianjin Academic Group of Genitourinary Professional Committee of China Association for the Promotion of International Exchanges in Healthcare

Youth Member of Urology Branch of Tianjin Medical Association

Member and Secretary of the Urology Committee of Tianjin Association of Integrative Traditional and Western Medicine

Member of the Urological Oncology Committee of Beijing Oncology Society

Clinical work is engaged in minimally invasive surgical treatment of prostate cancer and comprehensive treatment

Looking forward to "before" and looking back - caring for male "life glands"

Medical Pulse: Healthy China, Urinary First

Professor Jiang Shusuan:

Pulse: Imaging has always been one of the main tools for early diagnosis of prostate cancer

Professor Wang Shuo:

Prostate-specific membrane antigen (PSMA) is a biological target with great potential for development
.

The ^18F-labeledPSMA-PET/CT is most commonly used clinically, and it is currently the most advanced molecular imaging method
for evaluating prostate cancer.

¹⁸F-PSMA- PET/CT has good early diagnostic value
for radical prostatectomy, especially in postoperative patients, whether there is biochemical recurrence.

Our hospital introduced ^{a new 18}F-PSMA-PET/MRI this year, which reflects tumor localization more effectively than MRI, which is of great significance
for the diagnosis of puncture.

PSMA-PET/CT broadens the examination and evaluation methods for patients with biochemical recurrence, and can further develop a precise and individualized optimal clinical treatment strategy
.

"Diagnosis" insight - exploring testosterone levels in combination with ADT

Medical Pulse: In recent years, the concept of ADT combination therapy and deep ketone reduction has been put forward by domestic and foreign scholars, please talk about what are the latest advances in ADT treatment, and how should we implement the concept of deep ketone reduction?

Professor Wang Shuo:

In clinical practice, when the testosterone level of patients < 20ng/dl, or lower, the incidence of biochemical recurrence and metastasis can be significantly reduced, and the survival without progression and overall survival will be better<b10>.

Thus, the concept of deep hypothermia was proposed
.

The 2021 edition of the "Chinese Expert Consensus on Testosterone Management for Prostate Cancer" also recommends that testosterone levels < 20ng/dl, which can be used as an observation point to<b14> judge the prognosis and survival benefits of prostate cancer treatment.

At present, the concept of deep ketone reduction is still being explored and studied in
depth.

We know that gonadotropin-releasing hormone agonists (GnRH-a) are the most commonly used class of drugs
for ADT treatment.

There are current dosage forms for January and March in China, and there are also June dosage forms
abroad.

The repeated outbreak of the epidemic is in the middle of summer, and the queues in large hospitals are difficult, and patients are running back and forth more hard, so the use of triprelin In March dosage form can fully meet the clinical needs
.

Professor Jiang Shusuan:

With the advancement of prostate cancer diagnosis and treatment technology, the treatment strategy of metastatic hormone-sensitive prostate cancer (mHSPC) has been greatly developed, and combination therapy has become one
of the main exploration directions of mHSPC treatment.

The ARCHES post-mortem study, published at this year's EAU conference, confirmed that patients with mHSPC reduced PSA to undetectable levels with novel endocrine therapy drugs plus ADT, and that patient clinical outcomes improved
.

At the same time, the sound of deep ketone reduction has also become stronger
with the increase of evidence-based medical evidence.

In clinical practice, trippreeline is often used as one
of the means of deep ketone lowering.

The 3-month dosage form of triporeline has been used in our hospital for many years and has the advantages of deep ketone reduction, potent reduction of PSA, and causes fewer
complications.

Most importantly, the tropreeline 3-month dosage form is intramuscular, which is less painful and patient compliance is better
than subcutaneous injection.

"Full" course dialogue – regular standardized follow-up is key

Medical Pulse: Standardized follow-up for the stability of prostate cancer patients "escort", please talk about, how to care for patients throughout the process? What items need to be monitored by follow-up?

Professor Wang Shuo:

Urological surgeons need to monitor the following items for patients who are reviewed: First, observe whether there are clinical manifestations such as pain caused by new pathological fractures, limb sensorimotoria caused by spinal cord compression; Second, PSA can be used as an evaluation index of the efficacy and prognosis of ADT; Third, patients who have received castration therapy need to be regularly monitored for testosterone levels, testosterone management is an important part of the whole process of prostate cancer management, after testosterone reaches castration level, we must reduce testosterone to a lower level, that is, < 20ng/dl; Fourth, evaluate biochemical indicators such as creatinine, hemoglobin, liver function, and alkaline phosphatase; Fifth, for advanced patients, it is necessary to pay attention to the evaluation<b10> of CT, MRI and other imaging.

Professor Wang Yong:

The diagnosis and treatment of urinary tumors needs to be patient-centered, from diagnosis, treatment to follow-up for standardized management
of the whole process.

ADT is always present at all stages of prostate cancer treatment, and we must monitor both testosterone and PSA
at the same time.

Studies have found that serum testosterone < 20ng/dl, and the overall survival rate of patients is higher<b14>.

In order to achieve such a goal, our department has done two major tasks in testosterone management, first of all, we need to improve the doctor's awareness of testosterone management, only in this way can we timely detect the occurrence, development and outcome of the disease; Secondly, in the follow-up process, it is necessary to carry out popular science education
for patients.

The day "rises" and the moon is constant - the future of accurate diagnosis and treatment of prostate cancer can be expected

Medical Pulse: In recent years, thanks to the development of prostate cancer diagnosis and treatment technology, and the joint efforts of Urological Surgeons in China, China's prostate cancer has been on the highway of the development of precision treatment inheritance model, please talk about what views are there on the diagnosis and treatment of prostate cancer?

Professor Jiang Shusuan:

DNA damage repair genes represented by BRCA1 and BRCA2 not only lead to an increased risk of prostate cancer, but also make prostate cancer have unique clinical pathological characteristics, such as early age of onset and strong familial aggregation
.

Therefore, in the early stage of prostate cancer, it is of great clinical significance
to conduct accurate screening of people with poor prognosis through genetic testing.

In addition, clinical efforts are needed to carry out greater nuclide therapy, such as radium 223, ¹⁷⁷Lu- PSMA-617
.

At present, the drug treatment of prostate cancer mainly includes ADT, chemotherapy, immunity and targeted therapy-based systemic therapy, it is believed that with the continuous deepening of research, different mechanisms and different types of program combinations (such as two, triple, etc.
) can better improve the prognosis
of patients.

Professor Wang Yong:

Precise treatment and full management run through the entire treatment process
of prostate cancer.

Molecular marker detection is a prerequisite for screening people who benefit from targeted therapy, so our department divides patients into different types according to the genetic test results and adopts personalized treatment strategies
.

At the same time, the prostate sub-specialty group of our department set up a full-process management team and distributed a follow-up manual
to each patient.

If the patient has some cardiovascular and cerebrovascular diseases during endocrine therapy, the patient can take the follow-up manual and go to the designated doctor of the cardiac/surgery department for diagnosis and treatment
.

If the patient has symptoms of bone pain, he can go to the pain department or orthopedic department for diagnosis and treatment
.

Even at the end of the patient's life, there is a comprehensive conditioning of the TCM department to improve the quality of life
.

brief summary

In recent years, new drug research in the field of prostate cancer has emerged in an endless stream, and the old treatment pattern has undergone fundamental changes
.

From the international and domestic conferences in the past two years to see the new era of prostate cancer treatment, the basic position of ADT is still difficult to shake
.

With the release of more and more clinical trial results and the development of medical technology, it is believed that more patients will benefit from
diagnosis and treatment.

Approval number: DIP-CN-010205 valid until 2024-8-29

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