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This article is reproduced from the "Medical Oncology Channel" Authority-limited prostate cancer patients undergo biochemical progress under traditional endocrine therapy.
Doctors should quickly identify castration-resistant prostate cancer (CRPC) and perform traditional imaging tests in time to strengthen the treatment of non-metastasis State detection, and judge its transfer risk
.
Case list Brief medical history A 69-year-old male patient had no obvious cause of frequent urination, urgency, or dysuria in January 2017.
He was treated with oral medications in an outside hospital and his symptoms were poorly controlled
.
At the beginning of March 2017, her symptoms worsened, and a prostate cancer tissue biopsy was performed in the outpatient clinic
.
Normally healthy, denying history of chronic diseases such as hypertension, and no family history
.
Examination results: Pathological results: prostate adenocarcinoma; Gleason score: 3+4=7 points; total prostate specific antigen (tPSA): 27ng/ml
.
Auxiliary imaging examination: whole body bone imaging: skull, sternum, ribs, spine and limb bones are normal in shape, and no obvious signs of tumor bone metastasis are seen (Figure 1)
.
CT scan of the whole abdomen + chest: no obvious abnormalities in the liver, gallbladder, spleen, pancreas, and kidneys were found
.
No enlarged lymph nodes were found in the retroperitoneum and pelvic cavity .
Figure 1 The results of imaging examination (picture from the real case of Dr.
Li Jun) preliminary diagnosis of localized prostate cancer
.
After treatment in March 2017, pre-laparoscopic radical prostatectomy was performed, and PSA was checked regularly after discharge; in October, PSA was checked again at 0.
3 ng/ml, indicating a biochemical recurrence, and the patient was given goserelin 3.
6 mg + bicalutamide 50mg QD for endocrine therapy; in May 2019, follow-up found that PSA continued to rise to 0.
5ng/ml; in August, follow-up found that testosterone was 0.
60nmol/L, PSA rose to 2.
3ng/ml, and showed a continuous upward trend (Figure 2 ); In October, there was no obvious metastasis on the whole body bone scan (Figure 3)
.
Figure 2 The PSA curve of the patient after treatment (the picture is from Dr.
Li Jun’s real case) Figure 3 The patient’s reexamination of the bone scan results (the picture is from Dr.
Li Jun’s real case) According to the results of the examination, the patient’s testosterone remained at the castrated level (0.
60 nmol) /L), PSA value exceeds 2ng/ml, 3 consecutive increases and more than 50% increase from the baseline value, combined with the imaging examination results of no obvious metastasis on the whole body bone scan, resistance to non-metastatic castration according to authoritative guidelines The definition of prostate cancer (NM-CRPC) (Figure 4) can determine that the patient has entered a state of castration resistance and belongs to NM-CRPC
.
Figure 4 Classical NM-CRPC definition Note: EAU=European Urological Association; AUA=American Urological Association; NCCN=National Comprehensive Cancer Network PSA doubling time (PSADT) is an independent predictor of NM-CRPC prognosis.
The authoritative guide will " "PSADT≤10 months" is defined as a high-risk transfer risk
.
Compared with ordinary NM-CRPC patients, NM-CRPC patients with high risk of metastasis have a faster metastasis and a higher risk of death
.
Therefore, the risk of metastasis in this patient needs to be stratified
.
It took 1 month for the patient’s PSA to rise from 1.
5ng/ml to 2.
3ng/ml.
According to the PSADT calculator, it can be calculated that his PSADT was only 1.
62 months, much less than 10 months, which met the high-risk metastasis risk standard
.
The 2018AUA guidelines, 2018EAU guidelines and 2019NCCN guidelines strongly recommend apatamide for the first-line treatment of patients with high-risk metastasis risk NM-CRPC, and consider apatamide+androgen deprivation therapy (ADT) as a high-risk metastasis risk NM-CRPC The standard treatment plan for the patient
.
After communicating with the patient in November 2019, apatamide treatment was initiated
.
After the patient received apatamide treatment for 1 month, tPSA significantly decreased to 0.
8ng/ml
.
After continuous medication, tPSA remained steadily decreasing
.
The PSA has dropped to 0.
1ng/ml in the last reexamination, and the patient has achieved a deep PSA response (Figure 5)
.
Up to now, the patient's tPSA is well controlled, and there are no other uncomfortable symptoms, and the physical and mental state is ideal
.
Figure 5 The patient improved significantly after continuous apatamide + ADT treatment (the picture is from the real case of Dr.
Li Jun).
Case analysis.
As the treatment progresses, there are three key points in the patient's condition that need to be firmly grasped: the first is right Timely identification of the stage of NM-CRPC disease, the second is the accurate stratification of the risk of metastasis, and the third is the timely initiation of a new generation of androgen receptor (AR) inhibitor therapy
.
The patient's PSA continuously rises under traditional endocrine therapy, and clinicians need to be vigilant at this time
.
Follow-up in August 2019 found that the patient’s PSA had reached 2.
3 ng/ml, which exceeded the 2 ng/ml threshold specified in the guidelines, and the possibility of biochemical progress should be considered
.
Observing the PSA curve shows that the patient has experienced more than 3 consecutive increases in PSA, which is more than 50% higher than the baseline value, and testosterone remains at the castrated level, which is in line with the definition of biochemical progress
.
At the same time, the whole body bone scan of the patient showed no obvious metastasis.
At this time, it is necessary to recognize that the patient has entered the NM-CRPC stage at the first time
.
NM-CRPC patients can be divided into two categories according to the risk of metastasis, and the risk of metastasis is divided by the indicator PSADT
.
Studies have shown that compared with NM-CRPC patients with PSADT> 10 months, patients with PSADT ≤ 10 months progress more rapidly, and the median metastasis-free survival (MFS) and median overall survival (OS) are shorter (Picture 6)
.
Authoritative guidelines therefore define NM-CRPC patients with PSADT ≤ 10 months as high-risk patients with metastatic risk
.
Figure 6 The median MFS and median OS of NM-CRPC patients at high risk of metastasis are unsatisfactory.
The study further shows that about 60% of NM-CRPC patients are at high risk of metastasis, and their risk of bone metastasis or death is respectively non-high risk of metastasis.
12 times and 4 times the number of NM-CRPC patients! After accurately grasping his condition, the next step is to use appropriate treatment in accordance with the guidelines, that is, authoritative guidelines such as AUA, EAU, and NCCN all recommend apatamide therapy for high-risk metastasis risk NM-CRPC
.
The SPARTAN study confirmed that the treatment of high-risk metastasis risk NM-CRPC with apatamide + ADT can significantly delay disease progression.
Compared with placebo + ADT treatment, metastasis can be postponed by 24.
3 months, with a median MFS of 40.
5 months and a reduction of 72%.
The risk of metastasis or death reduces the risk of PSA progression by 94% (Figure 7)
.
Figure 7 Apatamide + ADT treatment compared with placebo + ADT treatment has significant benefits.
The patient in this case did obtain a satisfactory treatment effect after taking apatamide + ADT according to the guidelines, and the PSA decreased significantly and reached a deep level.
Responsive, no discomfort symptoms, very good quality of life
.
Case providing expert Dr.
Jun Li, Doctor of Urology, Deputy Chief Physician of Department of Urology, Sichuan Provincial People’s Hospital, Visiting Scholar of University of Düsseldorf, Germany, Deputy Director of Youth of Sichuan Anticancer Association Urology and Male Reproductive Society, Senior Citizen of Sichuan Province Member of Urology Branch of Medical Association, Youth Member of Andrology Branch of Sichuan Medical Association, Deputy Leader of CRPC Prostate Cancer Group of Chengdu Medical Association
.
Expert Comments Comment 1 This article shows a case of a patient who was successfully treated with NM-CRPC
.
The patient progressed after traditional endocrine therapy.
Soon after the doctor identified him as a high-risk metastatic NM-CRPC patient in a timely and accurate manner, he changed the treatment method and adopted apatamide+ADT treatment that was more suitable for the patient’s condition.
Good results have been achieved, effectively delaying the further progress of the disease and the occurrence of metastasis
.
This case also gave us positive enlightenment, that is, we need to pay special attention to the early diagnosis and treatment of NM-CRPC, especially the high-risk metastasis risk NM-CRPC
.
If the doctor does not accurately identify that the patient’s condition has progressed to the CRPC stage and is at high risk of metastasis, and the previous treatment is continued, the patient’s condition will be difficult to control, and even early metastasis will occur, becoming the terminal stage of prostate cancer-mCRPC, the patient The quality of life and prognosis will be greatly reduced
.
It is thanks to the timely and accurate diagnosis that the patient obtains a good treatment effect and a satisfactory quality of life
.
Expert profile Professor Zhou Fangjian Zhou Fangjian, chief physician, professor, doctoral supervisor, director of the Department of Urology, Sun Yat-sen University Cancer Prevention and Treatment Center, chief expert of the Prostate Cancer Multidisciplinary Comprehensive Treatment Coordination Group of Sun Yat-sen University Cancer Prevention and Treatment Center, major in urogenital tumors of Guangdong Anti-Cancer Association Chairman of the committee
.
The prostate cancer multidisciplinary team of Sun Yat-sen University Cancer Center is led by the chief expert Professor Zhou Fangjian.
It is composed of urology, radiotherapy, chemotherapy, biotherapy, pathology, imaging, ultrasound, nuclear medicine and other multidisciplinary fields.
An advanced team composed of prostate cancer experts, the diagnosis and treatment level is in line with international standards, and is in a leading position in China
.
Comment 2 Patients with prostate cancer can respond well to traditional endocrine therapy such as ADT in the hormone-sensitive stage, but as the treatment continues, it will almost inevitably eventually progress, metastasize, or enter the NM-CRPC stage
.
This is the case in this patient.
Castration resistance occurred after treatment with goserelin + bicalutamide, and PSADT was less than 10 months, and it was a NM-CRPC patient with high risk of metastasis defined by the guidelines
.
Fortunately, his doctor accurately grasped this change in the condition and responded quickly, and the patient's follow-up treatment was in good condition
.
It is necessary to emphasize the identification of "NM-CRPC" and "high-risk transfer risk"
.
According to the guideline definition, reaching testosterone castration level, occurrence of PSA progression, and no metastasis in traditional imaging examinations are the three main points for identifying NM-CRPC.
Clinicians especially need to firmly grasp serum testosterone levels <50ng/ml and PSA during follow-up.
Value> 2 ng/ml these two key thresholds
.
In addition, NM-CRPC patients with PSADT ≤ 10 months have the characteristics of high risk of metastasis and death, which cannot be ignored
.
After accurately identifying high-risk metastasis risk NM-CRPC patients, following the apatamide + ADT treatment recommended by the guidelines, and regular follow-up, will bring greater survival benefits to the patients
.
Expert profile Professor Qin Weijun Qin Weijun, chief physician, professor, doctoral supervisor, director of urology department of Xijing Hospital of the Fourth Military Medical University, science and technology star of the General Logistics Department of the People’s Liberation Army, member of the urology professional committee of the whole army, deputy chairman of the Shaanxi Association of Urologists, Member of the Standing Committee of the Shaanxi Provincial Society of Urology, Chinese Medical Association, and Member of the Standing Committee of the Shaanxi Provincial Society of Andrology
.
Good at precise treatment of urinary tract tumors and prostate diseases; complicated kidney transplantation techniques; good at endoscopic minimally invasive techniques in urology; deep attainments in difficult operations such as resection of vena cava tumor thrombus and giant tumors
.
References[1]Mottet N, et al.
EAU/ESTRO/ESUR/SIOG Guidelines on Prostate Cancer 2019.
[2]Michael S.
Cookson, et al.
AUA Guideline.
American Urological Association 2018.
[3]James LM et al .
NCCN Clinical Practice Guideline in Prostate Cancer 2019 v4.
[4]Presented by Saad F.
AUA 2018 Abstract PD 10-04.
[5]Hernandez RK, et al.
Estimating high-risk castration resistant prostate cancer (CRPC) using electronic health records.
Can J Urol 2015; 22 (4): 7858-64[6]Smith MR.
Denosumab and bone metastasis-free survival in men with nonmetastatic castration-resistant prostate cancer: exploratory analyses by baseline prostate-specific antigen doubling time.
J Clin Oncol 2013; 31: 3800-3806.
[7]Metwalli AR, et al.
Elevated alkaline phosphatase velocity strongly predicts overall survival and the risk of bone metastases in castrate-resistant prostate cancer.
Urol Oncol 2014;32 (6): 761-8.
[8] Wang Wei.
The value of PSADT in the follow-up of prostate cancer patients.
Journal of Modern Urology.
2008; 13 (2): 154-156.
[9] Smith MR, et al.
Apalutamide Treatment and Metastasis-free Survival in Prostate Cancer.
N Engl J Med 2018; 378 (15): 1408-1418.
Share, like, watch, pass on new medical knowledge
Doctors should quickly identify castration-resistant prostate cancer (CRPC) and perform traditional imaging tests in time to strengthen the treatment of non-metastasis State detection, and judge its transfer risk
.
Case list Brief medical history A 69-year-old male patient had no obvious cause of frequent urination, urgency, or dysuria in January 2017.
He was treated with oral medications in an outside hospital and his symptoms were poorly controlled
.
At the beginning of March 2017, her symptoms worsened, and a prostate cancer tissue biopsy was performed in the outpatient clinic
.
Normally healthy, denying history of chronic diseases such as hypertension, and no family history
.
Examination results: Pathological results: prostate adenocarcinoma; Gleason score: 3+4=7 points; total prostate specific antigen (tPSA): 27ng/ml
.
Auxiliary imaging examination: whole body bone imaging: skull, sternum, ribs, spine and limb bones are normal in shape, and no obvious signs of tumor bone metastasis are seen (Figure 1)
.
CT scan of the whole abdomen + chest: no obvious abnormalities in the liver, gallbladder, spleen, pancreas, and kidneys were found
.
No enlarged lymph nodes were found in the retroperitoneum and pelvic cavity .
Figure 1 The results of imaging examination (picture from the real case of Dr.
Li Jun) preliminary diagnosis of localized prostate cancer
.
After treatment in March 2017, pre-laparoscopic radical prostatectomy was performed, and PSA was checked regularly after discharge; in October, PSA was checked again at 0.
3 ng/ml, indicating a biochemical recurrence, and the patient was given goserelin 3.
6 mg + bicalutamide 50mg QD for endocrine therapy; in May 2019, follow-up found that PSA continued to rise to 0.
5ng/ml; in August, follow-up found that testosterone was 0.
60nmol/L, PSA rose to 2.
3ng/ml, and showed a continuous upward trend (Figure 2 ); In October, there was no obvious metastasis on the whole body bone scan (Figure 3)
.
Figure 2 The PSA curve of the patient after treatment (the picture is from Dr.
Li Jun’s real case) Figure 3 The patient’s reexamination of the bone scan results (the picture is from Dr.
Li Jun’s real case) According to the results of the examination, the patient’s testosterone remained at the castrated level (0.
60 nmol) /L), PSA value exceeds 2ng/ml, 3 consecutive increases and more than 50% increase from the baseline value, combined with the imaging examination results of no obvious metastasis on the whole body bone scan, resistance to non-metastatic castration according to authoritative guidelines The definition of prostate cancer (NM-CRPC) (Figure 4) can determine that the patient has entered a state of castration resistance and belongs to NM-CRPC
.
Figure 4 Classical NM-CRPC definition Note: EAU=European Urological Association; AUA=American Urological Association; NCCN=National Comprehensive Cancer Network PSA doubling time (PSADT) is an independent predictor of NM-CRPC prognosis.
The authoritative guide will " "PSADT≤10 months" is defined as a high-risk transfer risk
.
Compared with ordinary NM-CRPC patients, NM-CRPC patients with high risk of metastasis have a faster metastasis and a higher risk of death
.
Therefore, the risk of metastasis in this patient needs to be stratified
.
It took 1 month for the patient’s PSA to rise from 1.
5ng/ml to 2.
3ng/ml.
According to the PSADT calculator, it can be calculated that his PSADT was only 1.
62 months, much less than 10 months, which met the high-risk metastasis risk standard
.
The 2018AUA guidelines, 2018EAU guidelines and 2019NCCN guidelines strongly recommend apatamide for the first-line treatment of patients with high-risk metastasis risk NM-CRPC, and consider apatamide+androgen deprivation therapy (ADT) as a high-risk metastasis risk NM-CRPC The standard treatment plan for the patient
.
After communicating with the patient in November 2019, apatamide treatment was initiated
.
After the patient received apatamide treatment for 1 month, tPSA significantly decreased to 0.
8ng/ml
.
After continuous medication, tPSA remained steadily decreasing
.
The PSA has dropped to 0.
1ng/ml in the last reexamination, and the patient has achieved a deep PSA response (Figure 5)
.
Up to now, the patient's tPSA is well controlled, and there are no other uncomfortable symptoms, and the physical and mental state is ideal
.
Figure 5 The patient improved significantly after continuous apatamide + ADT treatment (the picture is from the real case of Dr.
Li Jun).
Case analysis.
As the treatment progresses, there are three key points in the patient's condition that need to be firmly grasped: the first is right Timely identification of the stage of NM-CRPC disease, the second is the accurate stratification of the risk of metastasis, and the third is the timely initiation of a new generation of androgen receptor (AR) inhibitor therapy
.
The patient's PSA continuously rises under traditional endocrine therapy, and clinicians need to be vigilant at this time
.
Follow-up in August 2019 found that the patient’s PSA had reached 2.
3 ng/ml, which exceeded the 2 ng/ml threshold specified in the guidelines, and the possibility of biochemical progress should be considered
.
Observing the PSA curve shows that the patient has experienced more than 3 consecutive increases in PSA, which is more than 50% higher than the baseline value, and testosterone remains at the castrated level, which is in line with the definition of biochemical progress
.
At the same time, the whole body bone scan of the patient showed no obvious metastasis.
At this time, it is necessary to recognize that the patient has entered the NM-CRPC stage at the first time
.
NM-CRPC patients can be divided into two categories according to the risk of metastasis, and the risk of metastasis is divided by the indicator PSADT
.
Studies have shown that compared with NM-CRPC patients with PSADT> 10 months, patients with PSADT ≤ 10 months progress more rapidly, and the median metastasis-free survival (MFS) and median overall survival (OS) are shorter (Picture 6)
.
Authoritative guidelines therefore define NM-CRPC patients with PSADT ≤ 10 months as high-risk patients with metastatic risk
.
Figure 6 The median MFS and median OS of NM-CRPC patients at high risk of metastasis are unsatisfactory.
The study further shows that about 60% of NM-CRPC patients are at high risk of metastasis, and their risk of bone metastasis or death is respectively non-high risk of metastasis.
12 times and 4 times the number of NM-CRPC patients! After accurately grasping his condition, the next step is to use appropriate treatment in accordance with the guidelines, that is, authoritative guidelines such as AUA, EAU, and NCCN all recommend apatamide therapy for high-risk metastasis risk NM-CRPC
.
The SPARTAN study confirmed that the treatment of high-risk metastasis risk NM-CRPC with apatamide + ADT can significantly delay disease progression.
Compared with placebo + ADT treatment, metastasis can be postponed by 24.
3 months, with a median MFS of 40.
5 months and a reduction of 72%.
The risk of metastasis or death reduces the risk of PSA progression by 94% (Figure 7)
.
Figure 7 Apatamide + ADT treatment compared with placebo + ADT treatment has significant benefits.
The patient in this case did obtain a satisfactory treatment effect after taking apatamide + ADT according to the guidelines, and the PSA decreased significantly and reached a deep level.
Responsive, no discomfort symptoms, very good quality of life
.
Case providing expert Dr.
Jun Li, Doctor of Urology, Deputy Chief Physician of Department of Urology, Sichuan Provincial People’s Hospital, Visiting Scholar of University of Düsseldorf, Germany, Deputy Director of Youth of Sichuan Anticancer Association Urology and Male Reproductive Society, Senior Citizen of Sichuan Province Member of Urology Branch of Medical Association, Youth Member of Andrology Branch of Sichuan Medical Association, Deputy Leader of CRPC Prostate Cancer Group of Chengdu Medical Association
.
Expert Comments Comment 1 This article shows a case of a patient who was successfully treated with NM-CRPC
.
The patient progressed after traditional endocrine therapy.
Soon after the doctor identified him as a high-risk metastatic NM-CRPC patient in a timely and accurate manner, he changed the treatment method and adopted apatamide+ADT treatment that was more suitable for the patient’s condition.
Good results have been achieved, effectively delaying the further progress of the disease and the occurrence of metastasis
.
This case also gave us positive enlightenment, that is, we need to pay special attention to the early diagnosis and treatment of NM-CRPC, especially the high-risk metastasis risk NM-CRPC
.
If the doctor does not accurately identify that the patient’s condition has progressed to the CRPC stage and is at high risk of metastasis, and the previous treatment is continued, the patient’s condition will be difficult to control, and even early metastasis will occur, becoming the terminal stage of prostate cancer-mCRPC, the patient The quality of life and prognosis will be greatly reduced
.
It is thanks to the timely and accurate diagnosis that the patient obtains a good treatment effect and a satisfactory quality of life
.
Expert profile Professor Zhou Fangjian Zhou Fangjian, chief physician, professor, doctoral supervisor, director of the Department of Urology, Sun Yat-sen University Cancer Prevention and Treatment Center, chief expert of the Prostate Cancer Multidisciplinary Comprehensive Treatment Coordination Group of Sun Yat-sen University Cancer Prevention and Treatment Center, major in urogenital tumors of Guangdong Anti-Cancer Association Chairman of the committee
.
The prostate cancer multidisciplinary team of Sun Yat-sen University Cancer Center is led by the chief expert Professor Zhou Fangjian.
It is composed of urology, radiotherapy, chemotherapy, biotherapy, pathology, imaging, ultrasound, nuclear medicine and other multidisciplinary fields.
An advanced team composed of prostate cancer experts, the diagnosis and treatment level is in line with international standards, and is in a leading position in China
.
Comment 2 Patients with prostate cancer can respond well to traditional endocrine therapy such as ADT in the hormone-sensitive stage, but as the treatment continues, it will almost inevitably eventually progress, metastasize, or enter the NM-CRPC stage
.
This is the case in this patient.
Castration resistance occurred after treatment with goserelin + bicalutamide, and PSADT was less than 10 months, and it was a NM-CRPC patient with high risk of metastasis defined by the guidelines
.
Fortunately, his doctor accurately grasped this change in the condition and responded quickly, and the patient's follow-up treatment was in good condition
.
It is necessary to emphasize the identification of "NM-CRPC" and "high-risk transfer risk"
.
According to the guideline definition, reaching testosterone castration level, occurrence of PSA progression, and no metastasis in traditional imaging examinations are the three main points for identifying NM-CRPC.
Clinicians especially need to firmly grasp serum testosterone levels <50ng/ml and PSA during follow-up.
Value> 2 ng/ml these two key thresholds
.
In addition, NM-CRPC patients with PSADT ≤ 10 months have the characteristics of high risk of metastasis and death, which cannot be ignored
.
After accurately identifying high-risk metastasis risk NM-CRPC patients, following the apatamide + ADT treatment recommended by the guidelines, and regular follow-up, will bring greater survival benefits to the patients
.
Expert profile Professor Qin Weijun Qin Weijun, chief physician, professor, doctoral supervisor, director of urology department of Xijing Hospital of the Fourth Military Medical University, science and technology star of the General Logistics Department of the People’s Liberation Army, member of the urology professional committee of the whole army, deputy chairman of the Shaanxi Association of Urologists, Member of the Standing Committee of the Shaanxi Provincial Society of Urology, Chinese Medical Association, and Member of the Standing Committee of the Shaanxi Provincial Society of Andrology
.
Good at precise treatment of urinary tract tumors and prostate diseases; complicated kidney transplantation techniques; good at endoscopic minimally invasive techniques in urology; deep attainments in difficult operations such as resection of vena cava tumor thrombus and giant tumors
.
References[1]Mottet N, et al.
EAU/ESTRO/ESUR/SIOG Guidelines on Prostate Cancer 2019.
[2]Michael S.
Cookson, et al.
AUA Guideline.
American Urological Association 2018.
[3]James LM et al .
NCCN Clinical Practice Guideline in Prostate Cancer 2019 v4.
[4]Presented by Saad F.
AUA 2018 Abstract PD 10-04.
[5]Hernandez RK, et al.
Estimating high-risk castration resistant prostate cancer (CRPC) using electronic health records.
Can J Urol 2015; 22 (4): 7858-64[6]Smith MR.
Denosumab and bone metastasis-free survival in men with nonmetastatic castration-resistant prostate cancer: exploratory analyses by baseline prostate-specific antigen doubling time.
J Clin Oncol 2013; 31: 3800-3806.
[7]Metwalli AR, et al.
Elevated alkaline phosphatase velocity strongly predicts overall survival and the risk of bone metastases in castrate-resistant prostate cancer.
Urol Oncol 2014;32 (6): 761-8.
[8] Wang Wei.
The value of PSADT in the follow-up of prostate cancer patients.
Journal of Modern Urology.
2008; 13 (2): 154-156.
[9] Smith MR, et al.
Apalutamide Treatment and Metastasis-free Survival in Prostate Cancer.
N Engl J Med 2018; 378 (15): 1408-1418.
Share, like, watch, pass on new medical knowledge
