Select the power of "Ze" to talk to Professor Zhou Fangjian: Popularize the MDT diagnosis and treatment model, and apply Abiraterone to improve the survival of prostate cancer patients

*Only for medical professionals to read for reference.
The new endocrine therapy is the biggest breakthrough in the diagnosis and treatment of metastatic prostate cancer in recent years.
Listen to Professor Zhou Fangjian's interpretation of the use of new endocrine therapy under the MDT diagnosis and treatment mode! Sun Yat-sen University Cancer Center is one of the most important cancer diagnosis and treatment centers in China.
It is at the forefront of exploration in terms of single-disease management and multidisciplinary teams, and the related work is fruitful
.

As prostate cancer enters the era of multidisciplinary diagnosis and treatment (MDT), Sun Yat-sen University Cancer Center has also widely used the MDT model in the treatment of early and late prostate cancer patients, especially for patients with metastatic castration-resistant prostate cancer (mCRPC).
MDT has played an important role, significantly improving the prognosis of patients, and has also guided an important development direction for the diagnosis and treatment of prostate cancer in China
.

The Medical Oncology Channel specially invited Professor Zhou Fangjian, the leader of the Department of Urology, Sun Yat-sen University Cancer Center, to share on the exploration and future development of prostate cancer MDT model, the use and experience of new endocrine therapy and other topics
.

Ten years of sharpening a sword, arduous exploration, and steadily building the MDT model for prostate cancer and the team’s exploration and team building of MDT diagnosis and treatment.
Professor Zhou Fangjian first clearly pointed out: “MDT refers to a group of people with different medical backgrounds.
Treatment issues meet at a certain time, and everyone can independently contribute to the patient’s diagnosis and treatment discussion.
This is the most effective mode to achieve individualized tumor treatment and provide the best therapeutic effect
.
The
MDT mode is suitable for multiple patients .
The diagnosis and treatment of individual tumors is fundamentally different from the previous difficult and complex case consultations.
It is to solve the problem of the direction of diagnosis and treatment of a certain patient, rather than the specific diagnosis and treatment measures
.

" Professor Zhou Fangjian said: "Although MDT has many advantages, But it is not easy to build an MDT team
.

First, it needs a good hospital platform, and the construction of various disciplines must be complete; second, it needs multidisciplinary experts who are enthusiastic about MDT work.
For example, the prostate cancer MDT team needs excellent urology, oncology, pathology, radiotherapy and imaging.
Experts and more
.

"The construction of our prostate cancer MDT team has started in 2005.
After nearly 10 years of hard work, the team can truly operate effectively and smoothly.
This makes us very proud.
We also need to thank the hospital's MDT team of various subject experts and Support from colleagues across the country
.

"Professor Zhou Fangjian further introduced the achievements of the prostate cancer MDT team: "First of all, our team has been committed to the popularization of early diagnosis and treatment of prostate cancer.
If we want to truly improve the curative effect and achieve cure, we need to treat early patients.
Carry out radical treatment
.

Second, we provide training for primary-level urologists and some medical oncologists, such as the "Prostate Cancer Elite Training Course" for primary-level doctors four times a year
.

After these efforts, the proportion of patients with early prostate cancer has been increasing in the last ten years, reflecting the effectiveness of early diagnosis and treatment
.

"From the perspective of the ratio of radical treatment, the ratio of radical surgery and radiotherapy for early-stage prostate cancer patients has reached 2:1, basically reaching the foreign level
.

As we all know, the first diagnosis of prostate cancer is usually in the urology department, and the urological surgeon will give first choice to radical resection and will not easily introduce patients to radiotherapy
.

However, the MDT team will proceed from the patient’s interests.
If the patient is better treated with radiotherapy, he should go to radiotherapy.
If the operation is good, he should perform surgery.
The two methods are close to the effect of the patient’s decision.
This is a highlight of our MDT team’s work in recent years.

.

"For patients with advanced prostate cancer, we will adopt comprehensive treatment after MDT discussion
.

In the past, we only performed castration therapy alone, with fewer combination medications or local treatments
.

After discussion by the MDT team, we will add new endocrine drugs, stereotactic radiotherapy (SBRT) and other new radiotherapy methods or radical surgery at the right time to continuously optimize the treatment plan, significantly extend the survival of some patients or reduce symptoms, and Allow patients to maintain a better quality of life
.

"After endocrine therapy, advanced prostate cancer will eventually progress to the stage of castration resistance, which is the main reason for the final death of prostate cancer patients, and the MDT mode has significantly improved the treatment effect than before
.

Previously, the average survival time of mCRPC patients was about 1 year, but now the survival time of patients generally reaches about 3 years, and the survival time of many patients can exceed 5 years
.

"After several years of operation of MDT, the level of prostate cancer diagnosis and treatment in primary hospitals in our province and neighboring provinces has been greatly improved, and the goal of China's health dream of not leaving the province for serious illnesses has been partially achieved
.

We summarized the experience of the MDT team and published many research papers, which were cited by the Chinese Society of Clinical Oncology (CSCO) prostate cancer diagnosis and treatment guidelines, the National Comprehensive Cancer Network (NCCN) prostate cancer diagnosis and treatment guidelines, and were also cited by the Department of Urology.
Quoted in "Campbell's urology" (Campbell's urology)
.

"In response to the new situation of prostate cancer, clinicians have a long way to go.
Professor Zhou Fangjian's team strongly advocates early diagnosis and treatment, and proposed that the epidemiological characteristics of prostate cancer in China are different from those in European and American countries
.

Professor Zhou Fangjian pointed out: "Compared with developed countries in Europe and America.
The incidence of prostate cancer in China is still at a relatively low level, but the incidence is increasing at a faster rate, which is mainly related to the improvement of living standards, such as the increase in protein and fat intake, and the increasing aging of the population
.

"Due to the large population base, the incidence of prostate cancer has risen slightly, and the total number of patients will increase significantly
.

According to the 2015 "Analysis of the Epidemiology of Malignant Tumors in China", the incidence of prostate cancer in China is about 10.
23 per 100,000 [1], while the incidence of developed countries in Europe and the United States can be as high as 100-200 per 100,000.
However, due to the large population base in China, The total annual incidence of prostate cancer is about 72,000, which far exceeds that of the United States
.

At present, prostate cancer ranks sixth in the incidence of male malignant tumors in China and the tenth in mortality.
It has become the most common urinary tumor in men in China, and its incidence exceeds that of bladder cancer and kidney cancer
.

"Another major feature of the incidence of prostate cancer in China is the low rate of early diagnosis and more advanced patients with distant metastases
.

The proportion of patients undergoing radical surgery is low, and the proportion of patients undergoing systemic palliative care is high
.

Therefore, the prognosis of patients is relatively relative.
The mortality rate is significantly higher than that of European and American countries
.

However, in recent years, through the unremitting efforts of Chinese urologists in popularizing science education and early screening, the proportion of early patients has gradually increased, the proportion of advanced patients has gradually decreased, and the death of prostate cancer The rate has also fallen accordingly, but this is still a long-term and arduous task
.

" Professor Zhou Fangjian said
.

Make good use of new endocrine therapy, let this "newest weapon" benefit more patients Endocrine therapy has a very important position in the treatment of prostate cancer, especially for the treatment of advanced and metastatic prostate cancer, and some of the early prostates that have undergone radical treatment Cancer patients also need endocrine therapy after biochemical recurrence
.

However, whether the previous endocrine therapy, that is, traditional antiandrogenic therapy, can improve the survival of patients has been controversial
.

In recent years, a number of large-scale clinical studies have shown that combined use of new endocrine drugs such as abiraterone and apatamide on the basis of traditional castration therapy can significantly improve the survival of patients compared with castration therapy alone
.

Professor Zhou Fangjian pointed out: “In the past, patients who used endocrine therapy or chemotherapy alone for mCRPC patients had a very limited survival period.
However, after the combined application of abiraterone, a new endocrine therapy drug, the median survival time of patients can reach 34.
7 months, and the risk of death A relative reduction of 19% (COU-AA-302 study) [2]
.

So now the standard endocrine therapy for advanced prostate cancer is no longer a simple castration therapy, but requires a combination of castration therapy and new endocrine drugs.
The protocol has been recommended by major guidelines and is the biggest progress in endocrine therapy for prostate cancer in recent years
.

” Professor Zhou Fangjian also shared a successful case of a new type of endocrine therapy in clinical work: “For example, a 69-year-old patient, prostate specific antigen (PSA) ) At the time of admission, more than 300 ng/mL, puncture revealed acinar adenocarcinoma (Gleason score 4+4=8 points), and multiple bone metastases throughout the body
.

Our initial regimen was traditional castration therapy, and 6 months later The patient’s PSA dropped to <1 ng/mL
.

But after 3 years of maintenance treatment, the patient’s PSA rose to 4.
0 ng/mL again, so we added a new endocrine therapy abiraterone, and used radiotherapy to control local lesions.
After 3 months, the patient’s PSA It is once again reduced to 0.
003 ng/mL, suggesting a good tumor control effect.
At present, the patient’s progression-free survival has exceeded 7 years, which is a very successful treatment case
.

"Early diagnosis and early treatment, precise diagnosis and treatment, and MDT promote the development of prostate cancer diagnosis and treatment.
Professor Zhou Fangjian said: “At present, the most important thing is early diagnosis and treatment
.

Because the cause of prostate cancer is still unclear, primary prevention is very difficult, and secondary prevention is early Early diagnosis and treatment, with definite curative effect and low cost
.

By monitoring PSA for screening, it is expected that prostate cancer can be diagnosed at an early stage and radical treatment can be carried out.
This is the best way to treat any cancer with the best effect, the least pain, and the lowest cost
.

After all, when any tumor is in its advanced stage, treatment is very difficult
.

Therefore, it is very important to realize early diagnosis and treatment through methods such as popular science propaganda and grassroots doctor training
.

"The second major development direction of prostate cancer diagnosis and treatment is precision treatment
.

Radical surgery for patients with early prostate cancer is not perfect, and there are many complications such as erectile dysfunction and urinary incontinence.
In the future, as more patients are diagnosed at a younger age, erectile dysfunction will have a significant impact on the quality of life of patients
.

Therefore, more precise treatment is needed to remove the prostate cancer lesions through focal treatment instead of completely removing the prostate, so as to maintain the patient's quality of life
.

Genetic testing is also an important direction for precision treatment.
It can detect specific mutations to distinguish patients who are prone to progress in advance
.

"The third major development direction is MDT diagnosis and treatment.
MDT will help the growth of the team and the training of young doctors, improve the level of the prostate cancer diagnosis and treatment team, and also help improve the treatment effect, especially for mCRPC patients who are more difficult to treat.
Endocrine therapy, chemotherapy and other methods are organically combined, and even some new therapies are being developed.
Use these methods rationally to improve the prognosis of patients and achieve the best curative effect
.

"Expert introduction Professor Zhou Fangjian, director of the Department of Urology, Sun Yat-sen University Tumor Hospital, Chief Physician, Professor, Ph.
D.
Supervisor, Chief Expert of Prostate Cancer Single Disease, Sun Yat-Sen University Tumor Hospital, China Anti-Cancer Association Urogenital Tumor Special Committee 1st and 2nd Vice Chairman of the Second Council of the Chinese Society of Clinical Oncology (CSCO) Vice Chairman of the CSCO Expert Committee on Prostate Cancer Vice Chairman of the CSCO Expert Committee on Bladder Cancer Vice Chairman of the South China Da Vinci Surgical Robot Technology Training Center Director of the Guangdong Anti-Cancer Association Urogenital Tumor Specialist Chairman of the Committee, Vice Chairman of the Ninth Committee of the Urology Branch of the Guangdong Medical Association, Member of the Urology Branch of the Chinese Medical Association, Member of the Chinese Journal of Urology, Standing Editor of the Chinese Journal of Cancer References: [1] Zheng Rongshou, Sun Kexin, Zhang Siwei, Et al.
Analysis of the prevalence of malignant tumors in China in 2015[J].
Chinese Journal of Oncology,2019,41(1):19-28.
[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[J].
The Lancet Oncology, 2015, 16(2): 152-160.
*This article is only used to provide scientific information to medical professionals and does not represent the views of this platform