The power of selecting "Ze" | Dialogue with Professor Xue Wei: "The front is moving forward", Abiraterone is expected to benefit more prostate cancer patients

*Only for medical professionals to read for reference.
Speed ​​to punch in the discipline construction and clinical diagnosis and treatment experience of top urology experts! The Department of Urology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine (hereinafter referred to as Renji Urology) has a long history.
Since 2000, Renji Urology has transformed from a comprehensive to a subspecialty development, and has made considerable progress.

As one of the national key specialties, Renji Urology has opened nearly ten subspecialties of single disease, including oncology, pediatric urology, kidney transplantation, etc.
, with both the "hard power" of advanced medical technology and the echelon of mature talents.
Soft power".

 Professor Xue Wei, director of the Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, as an administrative leader, is also deeply involved in the diagnosis, treatment and research of prostate cancer.
He is committed to improving the prognosis and survival of prostate cancer patients.
The "medical community" sincerely invites Xue Wei Professors share subject construction and experience in prostate cancer diagnosis and treatment.

 Common development: Specialties and general medicines complement each other.
As mentioned above, since 2000, Renji Urology has transformed from comprehensive development to sub-specialty development.
In response, Professor Xue Wei added: "Our department has made the following changes: First of all, almost all senior doctors in the department diagnose and treat specific diseases as the unit.

Because only with a single disease as the direction, can they perform more in-depth and more precise disease diagnosis and treatment.

 Chinese hospitals have basically formed since the 1970s The model of vertical management
has been adopted , but in fact there are great obstacles to the development of young doctors.
Therefore, our department adopts flat management and development based on sub-specialties and single diseases for the entire administrative management situation.

 Currently our department has There are nearly 10 sub-specialties, and some refinements have been made in the sub-specialties.
For example, the sub-specialties of prostate cancer are divided into different directions such as minimally invasive surgery and endocrine precision treatment.
Different responsible doctors collaborate and provide fast speed for young doctors.
The vast world of growth will make each sub-specialty more outstanding. "The day is just around the corner: New endocrine drugs are expected to improve the status of prostate cancer diagnosis and treatment in China.
Among all prostate diseases, prostate cancer is especially popular among elderly men, and has gradually become a major stubborn disease that endangers the health of elderly men.

Worldwide, prostate cancer is the second most common problem among men.
Common malignant tumors are also the fifth most common cause of cancer-related deaths in men[1].
The first
article of JNCC (Journal of the NationalCancer Center) published an online publication entitled "Statistics of Cancer Incidence and Death in China in 2015" by the Hejie Academician team.
The article pointed out that: prostate cancer has become the sixth most common malignant tumor in Chinese men and the first in urinary system tumors, and there is an upward trend [2].

 "Although the incidence of prostate cancer is rising, it has benefited from early prostate cancer screening.
The system continues to improve.
At present, about 70% of prostate cancer patients in the clinic are in the early stage.
While the treatment effect is greatly improved, the patient's survival period is also continuously extended.

However, due to geographical differences, the proportion of advanced prostate cancer is still relatively high in underdeveloped areas.
I believe that this situation will improve as the public gains insight into prostate cancer.

"Professor Xue Wei introduced.

 In addition to the specific characteristics of the disease, the treatment of prostate cancer is also quite distinctive: as a hormone-dependent disease, endocrine therapy has been clinically applied for nearly a century and has been widely recognized by clinicians.
An unshakable cornerstone position in cancer treatment.

Professor Xue Wei said: “As the understanding of endocrine therapy gradually deepens and broadens, it is currently undergoing neoadjuvant, postoperative adjuvant or progressing to metastatic castration-resistant prostate cancer (mCPRC).
, The application of new endocrine drugs represented by abiraterone has sufficient experience.

Although most of our country's current medication experience refers to the relevant results of foreign studies, I believe that in the near future, Chinese doctors can also have their own endocrine therapy experience, and relevant research and data will develop like bamboo shoots after a rain.

"A new hope: Abiraterone helps prostate cancer patients benefit throughout the entire process.
" In the past, patients with advanced metastatic prostate cancer, especially CRPC, lack effective treatment methods other than chemotherapy, and most doctors are reluctant to face the stage of CRPC.

However, as the new endocrine drugs represented by the original research abiraterone have gradually matured in recent years, the scope of application has become more and more extensive.

 At present, new endocrine drugs are no longer limited to late-stage applications.
Due to their better'anti-androgenic' effects, more and more clinicians choose'easy to use first'-neoadjuvant therapy for localized prostate cancer (LPC) or It is the first-line treatment for early metastatic hormone-sensitive prostate cancer (mHSPC), and it turns out that new endocrine drugs have better effects.

"Professor Xue Wei said.
The
 LATITUDE study confirmed [3] Abiraterone combined with prednisone and androgen deprivation therapy (ADT) combined treatment, compared with placebo + ADT, can significantly prolong the overall survival (OS) period of high-risk mHSPC patients.
53.
3 months (HR 0.
66, p<0.
0001), which improves the quality of life of patients while delaying the progression of imaging.

 In terms of neoadjuvant therapy, although ADT can bring good effects in the treatment of LPC, high-risk LPC recurrence The effect of ADT alone is not completely satisfactory.

A phase II clinical study of the 2020 American Society of Clinical Oncology Symposium on Urogenital System (ASCO GU) [4] suggests that the neoadjuvant intensive ADT program is in ADT On the basis of the combination of abiraterone can bring better benefits to patients, "this may also be the direction and new treatment options that can change the Chinese diagnosis and treatment guidelines in the future.

"Professor Xue Wei said.

 The road ahead: from MDT to disease-centered teamwork.
"Prostate cancer is actually a very special type of tumor.
At present, most clinics adopt a multidisciplinary diagnosis and treatment (MDT) model.
But I personally think that in the future diagnosis and treatment process, prostate cancer will tend to work together with a dedicated team. This team will include doctors in different departments such as surgery, oncology, radiotherapy, imaging, interventional, etc.
, covering the entire process from diagnosis to diagnosis and treatment for more accurate and orderly diagnosis and treatment.

 Take Renji Urology as an example.
We are also in this direction to reserve some medical resources.
In the diagnosis of prostate cancer, we will introduce experts from the interventional oncology department to do more precise puncture.
In the treatment of early prostate cancer, surgeons play a greater role.
Effect; if unfortunately the course of the patient progresses to an advanced stage, the oncologist will immediately give systemic treatment to the whole body, so as to gradually realize the transformation from MDT to disease-centric team building.

"Professor Xue Wei said.
I
 believe that in the near future, with the joint blessing of new drug development and discipline construction, the prognosis of Chinese prostate cancer patients can be "improved" and usher in a better long-term survival.

 Reference materials: [1]GLOBAL CANCER OBSERVATORY: ProstateCancer.
Cancer Today.
http://gco.
iarc.
fr/today/data/pdf/fact-sheets/cancers/cancer-fact-sheets-19.
pdf.
Published 2018.
Accessed December 2020.
[2]Siwei Zhang, Kexin Sun, RongshouZheng, Hongmei Zeng, Shaoming Wang, Ru Chen, Wenqiang Wei, Jie He,Cancerincidence and mortality in China, 2015,Journal of the National CancerCenter,Volume 1, Issue 1, 2021,Pages 2-11,[3]Fizazi K, Tran N, Fein L,et al.
Abiraterone acetate plus prednisone in patients with newly diagnosedhigh-risk metastatic castration-sensitive prostate cancer (LATITUDE): finaloverall survival analysis of a randomised, double-blind, phase 3 trial.
[J].
LancetOncol.
2019 May;20(5):686-700.
[4]McKay,RR, Xie, W.
, Fennessy, FM, Zhang, Z.
, Lis, R .
, Rathkopf, DE, .
.
.
&Wagner, A.
(2020).
Results of a phase II trial of intense androgen deprivationtherapy prior to radical prostatectomy (RP) in men with high-risk localizedprostate cancer (PC).
Professor Xue Wei, deputy dean and director of the Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine Chief Physician, Professor, Ph.
D Supervisor, Shanghai Leading Talent, Shanghai Excellent Academic Leader, Shanghai Medical Leading Talent, Standing Committee Member, Urology Branch, Chinese Medical Association, Deputy Chairman, Urology Branch, Shanghai Medical Association, Member, Urology Branch, Chinese Medical Association, Urology, Chinese Medical Association Deputy Secretary-General of the Robotics Group of the Chinese Medical Association, Member of the Oncology Group of the Urology Branch of the Chinese Medical Association, Member of the Editorial Board of the Chinese Journal of Urology and Shanghai Medicine, Visiting Scholar of the MD Anderson Cancer Center, USA In 2015, was selected as the Shanghai Education Commission's High Altitude Discipline Construction Plan *This article is only Used to provide scientific information to medical professionals, and does not represent the views of this platform