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    Home > Active Ingredient News > Urinary System > 2021 edition of CSCO prostate cancer diagnosis and treatment guidelines update key points: attention to detail, precise treatment

    2021 edition of CSCO prostate cancer diagnosis and treatment guidelines update key points: attention to detail, precise treatment

    • Last Update: 2021-05-09
    • Source: Internet
    • Author: User
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    *Only for medical professionals to read and refer to this guideline update.
    After referring to the latest international large-scale clinical research data and high-quality meta-analysis, based on the continuously enriched local evidence-based medicine research data, we have chosen a method that is closer to the current status of clinical diagnosis and treatment in China.
    , To provide reference for Chinese doctors in clinical practice.

    The 2021 Chinese Society of Clinical Oncology (CSCO) Guidelines Conference will be held in Beijing from April 23 to 24 in a combination of online and offline methods.

    During the meeting, Professor Ye Dingwei from the Cancer Hospital of Fudan University gave a detailed and wonderful explanation on the updated points of the "2021 CSCO Prostate Cancer (PC) Diagnosis and Treatment Guidelines".

    This article will be based on the updated key points explained by Professor Ye, combined with relevant evidence-based medicine evidence and accessibility changes to share with readers, and jointly review the past and learn the new.

    Professor Ye mentioned that the 2021 version of the CSCO PC Guidelines update follows the principles of “evidence-based evidence, advancement with the times, precision medicine, diagnosis first, drug accessibility, therapeutic value, local data, and leading guidelines”.
    The first internal seminar is expected to be officially released on July 10.

    Professor Ye Dingwei’s MDT Diagnosis and Treatment Model for Prostate Cancer An article in Nature in 2018 suggested that the proportion of Asian PC patients participating in clinical trials has gradually increased from 0.
    25% in 1997 to 6% in 2014.
    Although progress has been made, it is still far from enough.
    Therefore, The 2021 version of the CSCO PC Guide "MDT Diagnosis and Treatment Model" emphasizes the importance of participating in clinical trials: clinical trials may bring better treatment opportunities for patients, and PC patients should be strongly encouraged to participate in clinical trials after evaluation.

    In addition, telemedicine can help patients obtain treatment opportunities and reduce medical costs.
    Therefore, the 2021 version of the CSCO PC guide also emphasizes the importance of network MDT: network-based telemedicine can help patients obtain fast, timely and undifferentiated treatment opinions.Prostate puncture infection-related complications published in JU in 2020 included a meta-analysis of 7 randomized studies involving 1330 patients and compared the impact of biopsy routes on infection complications.
    It was found that transrectal biopsy was compared with transperineal biopsy.
    The post infection complications were significantly higher (evidence level 1A).

    A meta-analysis of 8 randomized controlled studies involving 1786 patients showed that the use of povidone-iodine preparations before biopsy, in addition to preventive antibacterial, can significantly reduce the incidence of infectious complications (evidence level 1A).

    A meta-analysis of 11 studies including 1753 patients showed that after the use of prophylactic antibiotics, infections after transrectal prostate biopsy were significantly reduced (5.
    6% vs.
    11.
    6%) (evidence level 1A).
    Based on the above evidence, 2021 The CSCO PC guideline emphasizes complications related to puncture infection and coping strategies.

    Genetic testing and liquid biopsy The 2021 V2 NCCN guidelines recommended genetic testing populations are: tumor HRR mutation testing is recommended for patients with metastatic PC; tumor HRR mutation testing can be considered for limited-stage patients.

    Based on the latest study of Qilu Hospital of Shandong University, it was found that the mutation rate of TP53 in Chinese hormone-sensitive PC (HSPC) patients was 22.
    3%.

    As the core mutation of PC patients, TP53 is often associated with other gene mutations.
    This type of patients has a poor prognosis and is not sensitive to abiraterone or enzalutamide treatment.

    From TRITON2 and TRITON3 research and clinical practice, it was found that in patients with metastatic PC, the success rate of plasma testing was high (94% of ctDNA samples were tested successfully), and the BRCA1/2 mutation tissue and plasma testing were highly consistent (92 cases of matched samples, overall testing The agreement is 97%).

    In the Profound study, the detection of tissue and plasma samples was highly consistent (81% positive agreement rate and 92% negative agreement rate), and it also suggested that tissue samples and plasma samples tested similar drug efficacy data.

    Based on the above evidence, the 2021 version of the CSCO PC guidelines: the type of patients for the purpose of making treatment decisions is metastatic prostate cancer, the level III recommendation of the test type adds TP53, and the test sample type is updated to tumor tissue + plasma ctDNA sample.

    Table 1 2021 CSCO PC Guidelines for Genetic Testing and Liquid Biopsy Recommendations for the treatment of localized prostate cancer Early studies have shown that transurethral resection of the prostate (TUPP) before brachytherapy (BT) can lead to a higher incidence of urinary incontinence .

    The latest literature in 2020 suggests that patients who have previously received TUPP can receive brachytherapy without increasing urethral adverse reactions.

    Therefore, the 2021 version of the CSCO PC guidelines recommends that low-dose brachytherapy can be recommended for patients who have no recent history of transurethral resection of the prostate and have a good IPSS score for patients with limited extremely low-risk, low-risk and selected intermediate-risk PC patients.

    Treatment of metastatic hormone-sensitive prostate cancer.
    A meta-analysis published in JU and EU in 2020 shows that for patients with metastatic hormone-sensitive prostate cancer (mHSPC), combination therapy based on androgen deprivation therapy (ADT) is better than ADT alone.
    It is more effective, but it has not yet been confirmed which combination is more effective.

    At the same time, the 2021 EAU guidelines also emphasize that for patients with M1 first diagnosis, if there are no contraindications to combination therapy, sufficient life expectancy to benefit from combination therapy, and willingness to accept the increased risk of side effects, they should be based on ADT.
    Combine other treatments.

    Based on this, the 2021 version of the CSCO PC guidelines no longer recommends pure ADT treatment for mHSPC patients.

    The diagnosis and treatment of metastatic castration-resistant prostate cancer is based on the revision of the 2021 V2 NCCN guidelines, and the classification of the diagnosis and treatment chapters of metastatic castration-resistant PC (mCRPC) has been adjusted.

    Due to the complicated diagnosis and treatment plans for this type of patients, the previous classification of “first-line, second-line, and third-line” did not clearly describe the sequential relationship between the various plans, so the 2021 version of the CSCO PC guidelines adopts whether or not they have received new endocrine therapy/ Chemotherapy replaces the traditional classification method to more intuitively guide the treatment of this type of patients at different stages.

    Table 2 2021 CSCO PC Guidelines mCRPC treatment recommendations to prevent and treat bone-related events Desulumab is a fully human monoclonal antibody directed against the nuclear factor receptor activator KB ligand.

    Phase III clinical trials compared the effectiveness and safety of disulumab and zoledronic acid in the treatment of mCRPC.

    It was found that compared with zoledronic acid, Disulumab significantly delayed or prevented the occurrence of bone-related events.
    The time to first bone-related events was delayed by 3.
    6 months (P=0.
    008), and the average number of bone-related events was reduced by 18% (P=0.
    008).

    The 2021 V1 NCCN guidelines also list desulumab as the class I preference for anti-bone resorption in patients with bone metastases.

    Therefore, the 2021 version of the CSCO PC Guidelines: The status of desulumab as a drug treatment for patients with mCRPC bone metastases to prevent bone-related events has been updated from a Class II recommendation to a Class I recommendation.

    The local data update was published in the review of Nature Reviews Urology in 2021.
    The Cancer Hospital of Fudan University was invited to complete the epidemiological data of the Chinese population in the "Prostate Cancer Screening" chapter.
    This part of the data is also included in this edition of the guide.

    The review suggests that in countries implementing prostate cancer screening strategies, Japan’s five-year survival rate has increased rapidly, with an average annual increase of about 11.
    7%, and the 5-year survival rate is as high as 93%, while China’s annual increase is only 3.
    7%, and the 5-year survival rate 69.
    2%.

    The review also revealed that germline mutations of the DDR gene occur in 12%, 10%, and 8.
    1% of the Chinese population with high-risk, metastatic, localized, and localized prostate cancer, and that single nucleotide polymorphisms are associated with the incidence of prostate cancer.
    Risk-related, whole-genome studies have shown that there are big differences between East Asian and Asian populations, supplementing the data of "genetic counseling" in "genetic testing and liquid biopsy".

    At the same time, in the "Life Expectancy and Health Status Evaluation", it is emphasized that in the treatment of prostate cancer, it is particularly important to properly evaluate the patient, adjust the treatment plan according to the patient's functional status rather than age, and detect adverse events.

    According to research conducted by the Cancer Hospital of Fudan University based on the Chinese population, when the prostate health index (PHI) cut-off value is <27, 27~36, 36~55, and >55, the probability of developing prostate cancer is 9.
    4% and 16.
    3, respectively.
    %, 20.
    8% and 66.
    4%. Huashan Hospital, Fudan University Tumor Hospital, Xinhua Hospital, Ruijin Hospital and other multi-center studies suggest that PHI can help improve clinically meaningful prostate cancer in patients over 50 years of age who have a negative digital rectal examination and PSA2-10ng/ml in the Chinese population.
    The detection rate is better than the fPSA value alone.

    Summary of updated key points: Encourage PC patients to participate in clinical trials and conduct online MDT diagnosis and treatment.

    A transperineal prostate biopsy is recommended, povidone-iodine preparations are recommended before the biopsy, and prophylactic antibiotics are recommended for rectal prostate biopsy.

    Genetic testing for metastatic PC is recommended.
    TP53 is added to the level III recommendation of the testing type, and the testing sample type is updated to tumor tissue + plasma ctDNA sample.

    Low-dose brachytherapy can be recommended for localized PC patients with no recent history of transurethral resection of the prostate and a good IPSS score.

    For mHSPC patients, ADT alone is no longer recommended.

    The status of desulumab as a drug treatment for the prevention of bone-related events in patients with metastatic castration-resistant PC bone metastases has been updated to a category I recommendation.
    Based on local research results, the data of the relevant Chinese population has been updated.
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