"Philippines" has a long vision - big coffee visits Professor Zhou Liqun and Wei Qiang: "Chinese Expert Consensus on Testosterone Management in Prostate Cancer (2021 Edition)"

Editor's note Prostate cancer, as one of the common male malignant tumors, has the characteristics of late stage of disease diagnosis and rapid increase in incidence in recent years in Chi.
Androgen deprivation therapy (ADT) is one of the most important basic treatments for prostate cancer, and its main goal is to reduce serum testosterone (T) and maintain it below castration leve.
Testosterone is closely related to the occurrence and development of prostate canc.
Since the publication of the Chinese Expert Consensus on Testosterone Management in Prostate Cancer [1] (hereinafter referred to as the "Consensus"), the scientific management model of testosterone has become more and more important in clinical practi.
Recently, I Maitong has the honor to invite Professor Zhou Liqun from Peking University First Hospital and Professor Wei Qiang from West China Hospital of Sichuan University to interpret the 2021 version of the "Consensus" for our reade.
Professor Zhou Liqun Doctor of Medicine, Second-level Professor, Chief Physician, Doctoral Supervisor Director of the Institute of Urology, Peking University Director of the Department of Urology, Peking University Medical School Honorary President and Past President of the Urology Branch of the Chinese Medical Association Member of the Standing Committee of the Scientific Association, Vice-Chairman of the Urology Branch of the Beijing Medical Association, Executive Vice-Chairman of the Professional Committee of Post-Graduation Medical Education and Surgery (Urology) of the Chinese Medical Doctor Association Chairman of the Strategic Alliance, Vice Chairman of the Urology Professional Committee of the China Research Hospital Association Professor Wei Qiang, Director of the Department of Urology, West China Hospital, Sichuan University Deputy head of the Minimally Invasive Group of the Urology Branch of the Chinese Medical Association and member of the Minimally Invasive Robotics Group Member of the Urology Branch of the Chinese Medical Doctor Association and deputy head of the Oncology Group Committee of the Robotic Doctors Branch of the Chinese Medical Association ) Vice Chairman of the Prostate Cancer Special Committee Vice Chairman of the Urology Branch of the Cross-Strait Exchange Society Vice Chairman of the Urology Branch of the China Research Hospital Association Vice Chairman of the Urology Branch of the China Health Promotion Association Chairman and Head of the Minimally Invasive Study Group Director of the Provincial Urology Quality Control Center Director of the Urology Branch of the Chengdu Medical Association to standardize the whole process, a new concept in the new era Professor Zhou Liqun: "Consensus" was first released in 2017, based on domestic The current status of clinical application of testosterone management, combined with the update of national guidelines, consensus and literature evidence in recent years, the Urology Branch of the Chinese Medical Association (CUA), the Urology Branch of the Chinese Medical Doctor Association (CUDA) and the Chinese Anti-Cancer Association Urogenital System Experts from the three authoritative organizations of the Oncology Professional Committee (CACA-GU) jointly organized an update and launched a new version of the "Consensus" in April 202Compared with the old version of the expert consensus, the new version of the testosterone management consensus highlights four core ideas: ● Testosterone management needs to go through the whole process: including diagnosis, evaluation, treatment and efficacy evaluation; ● Monitoring testosterone at important disease nodes: including diagnosis, recurrence, new metastasis, At initiation of castration-resistant prostate cancer (CRPC), curative therapy, ADT method changes, chemotherapy, other treatments; Simultaneous testosterone testing with PSA: especially at important disease initiation points, treatment switch points, or disease progression stages Timely and simultaneous monitoring of testosterone and PSA; T<20 ng/dL is a better prognostic indicator: Deep ketone reduction during ADT (lower levels of testosterone < 20 ng/dL) can be used as a reference indicator for better clinical prognosis and adjustment of treatme.
It can be seen that this "consensus" update emphasizes the importance of standardized whole-process management of testostero.
Under the background of normalized management of the new crown epidemic, more standardized means better prognos.
Professor Wei Qiang: Testosterone management runs through multiple processes of prostate cancer diagnosis, evaluation, treatment and prognosis evaluation, and is of great significance to patients with different disease stag.
Several studies have shown that the baseline serum testosterone level is correlated with the risk of prostate cancer and disease outco.
Therefore, monitoring the baseline testosterone value at important nodes of the disease (the starting point of the disease stage and the treatment switching point) is very important for the prognosis of patien.

In addition, the significance of testosterone management should be popularized to patients and their families, so as to obtain cooperati.
Figure 1 Deep ketone reduction at key time points in testosterone management, a new choice under new technology Professor Wei Qiang: It is recommended by domestic and foreign guidelines that during ADT treatment, testosterone should be monitored regularly, and testosterone should reach and stably maintain below the castration lev.
However, in the past, limited by detection technology, "T < 50 ng/dL" was used as the castration standard for testosterone in clinical practi.
In recent years, with the development of medical technology, clinicians have gradually realized that lowering testosterone to deeper levels can lead to better prognosis for patien.
Univariate analysis of patients with metastatic prostate cancer showed that patients with testosterone levels ≤25 ng/dL in the first month of ADT treatment had a lower risk of developing CRPC (HR=46, 95%CI: 08-96, P =013); at 6 months of ADT, patients with testosterone levels <20 ng/dL had significantly longer time to progression to CRPC compared with patients with testosterone levels ≥20 ng/dL (48 vs 24 months, P =02
Results of multivariate analysis confirmed that testosterone level <20 ng/dL was an independent predictor of longer overall survival (OS) in patien.
Based on multiple evidences, the new version of EAU and the Canadian consensus all recommend "T < 20 ng/dL" as the new castration standa.
This "consensus" recommends for the first time that lower levels of testosterone during ADT are associated with better disease prognosis and outco.
Professor Zhou Liqun: Currently, commonly used drugs for ADT include luteinizing hormone-releasing hormone agonist (LHRHa) and luteinizing hormone-releasing hormone antagonist (LHRH antagonist), which are two types of drugs that inhibit testosterone producti.
They inhibit the secretion of testosterone by the testes by inhibiting LHRH secreti.
At present, LHRHa is more widely used clinically in China, including triptorelin, goserelin and leuproli.
A retrospective analysis study [2] showed that there were some differences in the reduction of testosterone levels among the three drugs, and the triptorelin treatment group both reduced testosterone levels to <20 ng/month at 6 and 9 months of treatme.
dL, and the 3-month dosage of triptorelin reduced testosterone levels to <10 ng/dL in the highest proportion (P < 00
From theory to practice, new exploration under a new journey Professor Wei Qiang: CRPC is a characteristic disease stage of prostate cancer, and it is also an important time node for switching clinical treatment strategi.
Testosterone levels below castration are necessary for the diagnosis of CRPC and should be maintained in the subsequent treatment of CR.
In recent years, longer-acting LHRHa dosage forms have gradually gained clinical acceptance compared with traditional single-month dosage for.
Especially during the novel coronavirus pneumonia epidemic, the application of the 3-month dosage form reduces the travel risk of patients under the premise of ensuring the same testosterone control level, and its clinical application advantages are fully reflect.
Today, triptorelin has been included in the medical insurance, but it has not yet entered the "National Essential Drug List" (referred to as the "Essential Drug List.
get better treatme.
Professor Zhou Liqun: In this "consensus", in view of the important clinical value of testosterone management during ADT, the expert group has drawn up a standardized flow chart for testosterone monitoring and management, so that clinicians can quickly understand and easily apply .
The "consensus" recommends that testosterone be tested regularly every month before the start of ADT and within 6 months of treatment; after the disease has reached a stable state, the testosterone test interval can be extended to once every 3-6 mont.

It should be noted that while emphasizing testosterone monitoring, do not forget the detection of P.

PSA and testosterone are monitored together and double-labeled in parallel, which can maximize the benefits of castration therapy for patien.

As one of the commonly used ADT drugs, triptorelin can not only effectively reduce the PSA level of prostate cancer patients to <4 ng/ml [3], but also deeply reduce the testosterone level [4], so that the "double standard parallel" not only Become a slogan, but really benefit the patie.

Therefore, we also call for the inclusion of "triptorelin acetate for injection 75mg", "triptorelin pamoate for injection 15mg" and other LHRHas into the "essential drug list" so that patients in grassroots areas can also receive Treatment covera.

Figure 2 Standardized flow of testosterone monitoring and management during ADT treatment The standardized management of testosterone is an effort to improve the overall survival of patients with prostate canc.

References: [1] Urology Branch of Chinese Medical Association, Professional Committee of Urogenital Tumors of China Anti-Cancer Association, Urology Branch of Chinese Medical Doctor Associati.

Chinese Expert Consensus on Testosterone Management in Prostate Cancer (2021 Edition) [.

Journal of Urology, 2021,42(04):241-24[2] Shim M, Bang WJ, Oh CY, et .

Effectiveness of three different luteinizing hormone-releasing hormone agonists in the chemical castration of patients with prostate cancer: Goserelin versus triptorelin versus leuproli.

Investig Clin Ur.

2019 Jul;60(4):244-25[3] Li Ningchen, Song Yi, Jiang Haowen, Ding Qiang, Gan Weidong, Guo Hongqian, Sun Zeyu, Hu Zhiquan, Ye Zhangqun, Wei Qiang, Na Yan Q.

Efficacy and safety of long-acting gonadotropin-releasing hormone analogs in the treatment of metastatic prostate cancer[.

Chinese Journal of Surgery, 2008(21):1653-165[4] Lebret T, Rouanne M, Hublarov O, et .

Efficacy of triptorelin pamoate 125 mg administered subcutaneously for achieving medical castration levels of testosterone in patients with locally advanced or metastatic prostate canc.

Ther Adv Ur.

2015 Jun;7(3):125-3 Approval Number: DIP -CN-008483 is valid until 2024-5-6 Editor: Bing Xin Review: Bing Xin Execution: LR Click "Read the full text", more exciting content of prostate cancer is waiting for you to explo.