Prostate cancer prevention and control situation is grim!

Prostate cancer is one of the most common malignant tumors of the male urinary system
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According to the 2020 Global Cancer Report, prostate cancer ranks sixth in male malignant tumor incidence and ninth in mortality
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The situation of prostate cancer prevention and treatment in China is also not optimistic.
In 2020, the number of new cases of prostate cancer in China will exceed 110,000, and the number of deaths will exceed 50,000.
At present, the morbidity and mortality are still showing a rapid upward trend
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Although the five-year survival rate of patients has increased to 66.
4% in the past decade, compared with the overall five-year survival rate of nearly 100% in developed countries such as the United States, there is a large gap
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At present, the situation of prostate cancer prevention and treatment is not optimistic.
What diagnosis and treatment difficulties does the disease face? What are the breakthroughs in clinical treatment? What benefits does the entry of related therapeutic drugs into medical insurance bring to patients? Recently, in response to the above questions, Sina Pharmaceutical (sinayiyao) interviewed Professor Ji Zhigang, director of the Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
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There is a significant gap in the survival rate of prostate cancer at home and abroad.
Promoting early diagnosis and early treatment is the top priority.
Compared with European and American countries, the incidence of prostate cancer in China is lower, but the mortality rate is higher
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Professor Ji Zhigang introduced this phenomenon with a set of "reversal" of comparative data: in 2018, the proportion of new prostate cancer patients in China accounted for only 8% of the global patients, and the United States accounted for 17%; in the same year, patients died of prostate cancer in China It accounts for 15% of total prostate cancer mortality worldwide, compared with only 8% in the United States
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The reason why there is such a significant gap in the survival rate of prostate cancer patients at home and abroad is that most of the patients in China are in the advanced stage of the disease when they are first diagnosed, and only 1/3 of the newly diagnosed patients are in the early stage, that is, localized prostate cancer.
It is easy to cause patients to miss the best time for treatment, and the overall prognosis is far worse than that of European and American countries
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The situation in foreign countries is very different.
In the United States, localized prostate cancer cases account for 81%, lymph node metastasis cases account for 12%, and distant metastasis cases account for only 4%; Japanese localized prostate cancer cases account for nearly 50% of cases.

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In response to this situation, Professor Ji Zhigang said that it is necessary to promote early diagnosis if the country wants to improve the survival rate of prostate cancer
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Currently, prostate-specific antigen (PSA) is recommended as an early screening method for prostate cancer
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The normal value of PSA used in China is 4ng/mL.
ASCO and NCCN guidelines recommend that patients with prostate cancer should have a PSA follow-up every 3 months
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In addition, Professor Ji Zhigang suggested that due to the strong occult nature of early prostate cancer, in addition to PSA follow-up, a comprehensive judgment can be combined with serum testosterone levels, digital rectal examination (DRE), prostate biopsy, and imaging examinations
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Resolving the urgent need of prostate cancer patients nmCRPC is a key stage of "delaying metastasis" In addition to early screening, timely intervention is also crucial
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If some delays are not made, cancer cells may metastasize to other organs and parts other than the prostate, and the corresponding treatment will become more difficult
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It is understood that the growth of prostate cancer is heavily dependent on androgens, and the conventional treatment is to reduce androgen levels in patients, that is, surgical castration and/or androgen deprivation therapy (ADT)
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However, the more status quo is that "cancer cell metastasis" occurs from time to time
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On the one hand, because prostate cancer is occult and has a long incubation period, early-stage patients have almost no symptoms, and the intervention is not timely, and the optimal treatment time window has been missed when visiting a doctor; on the other hand, the current treatment methods have limitations, such as traditional endocrine therapy or Single ADT therapy can only suppress androgens in the testis and adrenal gland, while androgens secreted by tumor cells are still promoting the progression of prostate cancer, and patients with localized prostate cancer often develop metastases in a relatively short period of time
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Once metastasis occurs, the patient's condition will accelerate or even deteriorate, and the risk of death due to uncontrollable progression is greatly increased
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Therefore, "delaying metastasis" is crucial for prostate cancer treatment
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According to Professor Ji Zhigang, there is a special stage in "delaying metastasis" that cannot be ignored - non-metastatic castration-resistant prostate cancer (nmCRPC)
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nmCRPC is generally considered to be the clinical stage with the highest risk of developing metastatic castration-resistant prostate cancer (mCRPC), and approximately one-third of patients will develop bone metastases 2 years after diagnosis, resulting in pain, fractures, and spinal cord compression, which are life-threatening
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The data show that after the progression from nmCRPC to mCRPC, the annual risk of all-cause mortality increases from 16% to 56%
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Faced with such a large risk of metastasis, timely intervention in the nmCRPC stage and delaying the patient's entry into the mCRPC stage with the worst prognosis is one of the key breakthroughs in reducing prostate cancer mortality
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It is worth noting that for a long time in the past, due to the low clinical attention of nmCRPC and no treatment that can bring significant survival benefits, the number of patients diagnosed in real-world clinics is much lower than the actual number of patients, and many patients.
Missed the opportunity for early intervention and missed the best treatment time window, which led to a stalemate in the treatment of nmCRPC
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Breaking through the deadlock in the treatment of nmCRPC patients Prostate cancer drug dalotamide is covered by medical insurance The emergence of new androgen receptor inhibitors (ARi) has brought a breakthrough in the treatment of nmCRPC
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After 2018, domestic and foreign guidelines (AUA/EAU/NCCN/CSCO guidelines) unanimously recommend the use of novel ARi therapy as the preferred standard regimen for nmCRPC
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At the end of 2021, a new type of ARi, Bayer’s Nobegol® (Darotamide), was added to the National Medical Insurance Drug List for the treatment of prostate cancer.
nmCRPC patients at high risk of metastasis
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In nearly a year of clinical practice, darotamide has been widely recognized by experts and scholars in the field of prostate cancer
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According to Prof.
Ji Zhigang, darotamide has a unique molecular structure and binds to the receptor with high affinity, thereby inhibiting the receptor function and the growth of prostate cancer cells
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With good data performance such as significant survival benefit, darotamide is also recommended by NCCN guidelines and "CSCO Prostate Cancer Diagnosis and Treatment Guidelines" as class I for the treatment of high-risk metastatic nmCRPC patients
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The phase III ARAMIS study confirmed that daptamide treatment of nmCRPC can not only delay metastasis, improve survival, but also maintain the quality of life of patients: compared with the placebo + ADT treatment group, daptamide + ADT can reduce the median metastasis-free rate of nmCRPC patients The survival time (MFS) was significantly prolonged to 40.
4 months, and the risk of death was reduced by 31%; in addition, the incidence of adverse events and drug discontinuation rates were comparable to placebo, which was able to maintain the quality of life of patients
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However, treatment is a long-term process, and in addition to the treatment plan itself, the impact of the economic burden on patients cannot be ignored
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It is worth mentioning that the new medical insurance catalog has been officially implemented on January 1, 2022
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As a class of highly efficient and safe innovative therapeutic drugs, Dalotamide will greatly reduce the economic burden of patients and benefit more patients after being included in the medical insurance
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Professor Ji Zhigang said that the new ARi such as darotamide has brought new opportunities.
ARAMIS clinical research shows that the new ARi has good effect, enabling patients to receive timely and effective treatment in the nmCRPC stage, prolonging the survival period, and maintaining a better prognosis and better prognosis.
The higher quality of life, coupled with the inclusion of medical insurance, has also reduced the economic cost of patients.
It is expected that the drug will be put into more clinical use in the future
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