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*Only for medical professionals to read for reference.
Professor Hou Sichuan explained the treatment and development of prostate cancer in the "new" era.
About 6 years ago, Lao Zhang (pseudonym), a patient with multiple metastases of advanced prostate cancer, developed severe anemia, bone pain, and wasting.
He was treated at Qingdao Municipal Hospital.
At that time, 78-year-old Zhang could not bear the pain caused by chemotherapy, and his family almost gave up treatment.
As his attending doctor, Professor Hou Sichuan from Qingdao Municipal Hospital chose androgen deprivation therapy (ADT) combined with abiraterone therapy for him, and the effect was very good.
Coincidentally, another young patient, Lao Wang (pseudonym), also found Professor Hou Sichuan because of advanced high-risk prostate cancer.
Lao Wang was only 50 years old when he was diagnosed, but he had already had liver and lung metastases, which is very scary for prostate cancer patients.
Professor Hou Sichuan treated him with ADT and abiraterone.
After 11 months of treatment, the liver and lung metastases gradually disappeared.
Subsequently, Professor Hou Sichuan performed the implantation of prostate cancer seeds on the patient's primary lesion, and the condition was well controlled.
Up to now, no new lesions have been found in imaging examinations, prostate-specific antigen (PSA) has also been maintained at a low level, and the patient’s lost work ability has been restored and he can go to work normally.
As the director of the Department of Urology at Qingdao Municipal Hospital, Professor Hou Sichuan has treated countless prostate cancer patients and has extensive clinical experience.
He introduced us to the construction of the subspecialty of prostate cancer and the current status and future development of prostate cancer diagnosis and treatment.
Strengthen the construction of subspecialties and improve treatment capabilities.
The incidence and mortality of male prostate cancer in my country are increasing year by year [1], and compared with European and American countries, most of the prostate cancer patients in my country are at the advanced/locally advanced stage and distant metastasis when they are diagnosed.
, The mortality rate is higher.
Most prostate cancer patients fail to be diagnosed early and receive systematic and standardized treatment.
"In order to concentrate medical resources, enable patients to receive systematic treatment, and achieve better treatment results, Qingdao Municipal Hospital has opened a prostate cancer subspecialist.
We are also one of the earliest units in China to open a prostate cancer subspecialist.
" Professor Hou Sichuan Introduced, regardless of personnel, equipment and technology investment, the Prostate Cancer Sub-specialty Department of Qingdao Municipal Hospital has fully concentrated the superior resources of all parties.
In terms of staffing, the prostate cancer subspecialty team is composed of experts, directors and doctors who have been engaged in urology for a long time, and cooperates with imaging, pathology and other disciplines to comprehensively improve the early screening, molecular diagnosis, and staging of prostate cancer.
And treatment.
At the same time, many advanced equipment and technologies have been introduced.
For example, we have carried out systemic prostate biopsy earlier, that is, prostate biopsy under ultrasound positioning; and launched fusion puncture, that is, magnetic resonance imaging (MRI) and ultrasound imaging during the puncture process.
Real-time fusion targeted precise puncture can well detect suspicious prostate cancer lesions.
In addition, prostate saturation puncture was also carried out.
Regarding the future development of the prostate cancer subspecialty, Professor Hou Sichuan said that attention should be paid to the professional training of the team.
"Since the establishment of the prostate cancer subspecialty department, our team has regularly organized personnel to go abroad for further study.
At the same time, it also pays attention to exchanges with domestic experts, such as the Fudan University Affiliated Cancer Hospital, Sun Yat-sen University Cancer Hospital, Peking University Cancer Hospital and Shandong University Qilu The hospital’s multidisciplinary collaboration (MDT) team communicates.
Of course, we still communicate more with the grassroots hospitals, because when the grassroots hospitals encounter some difficult cases, there will be some confusion in their diagnosis and treatment.
On the other hand, prostate cancer Specialty construction also needs to improve the level of cognition.
Whether it is precise treatment of prostate cancer or individualized treatment, we need to have sufficient cognition.
Of course, professional equipment and technology for prostate cancer treatment are also very important.
For example, we mostly used it in the past.
Traditional prostate cancer surgery, but now we have more advanced Olympus high-definition laparoscopy, 3D laparoscopy, fourth-generation robot-assisted laparoscopic radical prostatectomy, etc.
The development of these prostate cancer diagnosis and treatment technologies has made more and more Patients receive effective treatment, which also increases our confidence in treatment. "New" weapon, New Hope Professor Sichuan Hou said that the incidence and detection rate of prostate cancer are getting higher and higher.
When I first started working more than 30 years ago, prostate cancer patients were still relatively rare.
Many patients with
prostate cancer can be seen in the ward during the consultation.
Prostate cancer has become the second largest tumor
in urology after bladder cancer.
In China, the level of diagnosis and treatment of prostate cancer is uneven.
Generally speaking, big cities and economic development The early diagnosis and detection rate of prostate cancer in the region is higher than that in rural areas and economically underdeveloped areas.
"We found in the consultation that most of the patients transferred from the grassroots are advanced or high-risk prostate cancer patients who have developed distant metastases.
"For these patients, traditional endocrine therapy (ADT) alone is not enough.
We need to combine existing methods, such as radiotherapy, for comprehensive treatment.
In recent years, many new types of endocrine therapy have emerged on the basis of traditional treatment.
Therapeutic drugs (such as abiraterone, apatamide, etc.
) have improved the short life expectancy and poor prognosis of previous metastatic prostate cancer.
A
number of studies have confirmed that metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic prostate cancer Castration-resistant prostate cancer (mCRPC) patients can achieve good results with new endocrine therapy for overall survival and progression-free survival.
New endocrine therapy provides us with a new therapeutic weapon.
"New" drug Abiraterone helps patients After long-term survival, the treatment of mCRPC patients is mainly chemotherapy, but many patients will be affected by factors such as age, physical condition, physical condition, and serious adverse reactions of chemotherapy, and cannot receive chemotherapy treatment, and the patient's prognosis is poor.
In 2015, the original research Arbiter Long was approved for mCRPC in China and was approved for the treatment of newly diagnosed high-risk mHSPC in 2018.
COU-AA-301/302 study results show that the use of ADT+abiraterone+prednisone (AAP) regimen to treat mCRPC patients without chemotherapy can significantly extend the median overall survival (OS) to 34.
7 months and reduce the risk of death 19% (HR=0.
81, P=0.
0033).
The emergence of abiraterone has greatly improved the previous dilemma of mCRPC patients with an average survival time of less than one year after diagnosis, and extended the patient's survival to nearly 3 years.
Subsequent large-scale trials once again confirmed the excellent efficacy of abiraterone.
LATITUDE is a large-sample, multi-center, randomized, double-blind phase III clinical study that included 1199 newly diagnosed high-risk mHSPC patients.
The primary endpoints were OS and imaging progression-free survival (rPFS) [2].
The results showed that, compared with the control group (placebo + ADT), the experimental group (abiraterone + prednisone + ADT) significantly prolonged the median OS, from 36.
5 months to 53.
5 months, while the risk of death was reduced by 34 %.
And the PSA reaction rate is also very good, reaching 91%.
This is a great advancement in the field of prostate cancer treatment and has brought significant survival benefits to patients.
Expert profile Professor Sichuan Hou Chief physician Peking University Medical School Doctor of clinical medicine, doctoral tutor.
Assistant to the Dean of the Third Clinical Medical College of Qingdao University, Assistant to the Dean of Qingdao Municipal Hospital, Director of the Department of Surgery, Director of the Surgical Base of the Residential Training Base of Qingdao Municipal Hospital, and Director of the Urology Center.
The leader of urology in Shandong Province, and the leader of outstanding disciplines in Qingdao.
Concurrently serving as the chairman of the Urology Committee of Shandong Association of Integrated Traditional Chinese and Western Medicine, the vice chairman of the Urology Branch of Shandong Medical Association, the vice chairman of Shandong Andrology Association, the vice chairman of Shandong Medical Association, the member of Chinese Society of Sexuality, Shandong Province.
Institute directors and other positions.
The first most beautiful doctor in Qingdao, he was awarded the honorary titles of Shandong Province Fumin Xinglu Medal and Shandong Province Health Guardian.
Engaged in urology for more than 33 years.
He has in-depth research on the basic and clinical aspects of prostate diseases and urogenital tumors.
He is good at laparoscopic and Da Vinci-assisted laparoscopic surgery, minimally invasive treatment of prostate hyperplasia, and comprehensive treatment of prostate cancer and kidney cancer.
And urothelial cancer, minimally invasive treatment of adrenal gland, kidney, ureter, prostate and bladder tumors, treatment of urinary tract stones through natural channels, laparoscopic kidney-sparing tumor resection, prostate cancer and bladder cancer radical resection, in situ controllable Ileum neobladder surgery, complicated urethral stricture and various urination abnormalities, as well as difficult and complicated operations.
Presided over more than ten provincial and municipal projects, published more than 50 papers at all levels including SCI and Chinese series, and participated in the compilation of 10 monographs such as "Guo Yinglu Male Science".
References: [1] Li Hanzhong, Dong Dexin, et al.
Hot research and prospects of prostate cancer.
Chinese Journal of Surgery.
2015, Volume 53, Issue 4, pp.
253-256.
[2] Fizazi K, Tran N, Fein L, et al.
Abiraterone acetate plus prednisone in patients with newly diagnosed high-risk metastatic castration-sensitive prostate cancer (LATITUDE): final overall survival analysis of a randomised, double-blind, phase 3 trial[J].
Lancet Oncol.
2019;20(5) :686-700.
Professor Hou Sichuan explained the treatment and development of prostate cancer in the "new" era.
About 6 years ago, Lao Zhang (pseudonym), a patient with multiple metastases of advanced prostate cancer, developed severe anemia, bone pain, and wasting.
He was treated at Qingdao Municipal Hospital.
At that time, 78-year-old Zhang could not bear the pain caused by chemotherapy, and his family almost gave up treatment.
As his attending doctor, Professor Hou Sichuan from Qingdao Municipal Hospital chose androgen deprivation therapy (ADT) combined with abiraterone therapy for him, and the effect was very good.
Coincidentally, another young patient, Lao Wang (pseudonym), also found Professor Hou Sichuan because of advanced high-risk prostate cancer.
Lao Wang was only 50 years old when he was diagnosed, but he had already had liver and lung metastases, which is very scary for prostate cancer patients.
Professor Hou Sichuan treated him with ADT and abiraterone.
After 11 months of treatment, the liver and lung metastases gradually disappeared.
Subsequently, Professor Hou Sichuan performed the implantation of prostate cancer seeds on the patient's primary lesion, and the condition was well controlled.
Up to now, no new lesions have been found in imaging examinations, prostate-specific antigen (PSA) has also been maintained at a low level, and the patient’s lost work ability has been restored and he can go to work normally.
As the director of the Department of Urology at Qingdao Municipal Hospital, Professor Hou Sichuan has treated countless prostate cancer patients and has extensive clinical experience.
He introduced us to the construction of the subspecialty of prostate cancer and the current status and future development of prostate cancer diagnosis and treatment.
Strengthen the construction of subspecialties and improve treatment capabilities.
The incidence and mortality of male prostate cancer in my country are increasing year by year [1], and compared with European and American countries, most of the prostate cancer patients in my country are at the advanced/locally advanced stage and distant metastasis when they are diagnosed.
, The mortality rate is higher.
Most prostate cancer patients fail to be diagnosed early and receive systematic and standardized treatment.
"In order to concentrate medical resources, enable patients to receive systematic treatment, and achieve better treatment results, Qingdao Municipal Hospital has opened a prostate cancer subspecialist.
We are also one of the earliest units in China to open a prostate cancer subspecialist.
" Professor Hou Sichuan Introduced, regardless of personnel, equipment and technology investment, the Prostate Cancer Sub-specialty Department of Qingdao Municipal Hospital has fully concentrated the superior resources of all parties.
In terms of staffing, the prostate cancer subspecialty team is composed of experts, directors and doctors who have been engaged in urology for a long time, and cooperates with imaging, pathology and other disciplines to comprehensively improve the early screening, molecular diagnosis, and staging of prostate cancer.
And treatment.
At the same time, many advanced equipment and technologies have been introduced.
For example, we have carried out systemic prostate biopsy earlier, that is, prostate biopsy under ultrasound positioning; and launched fusion puncture, that is, magnetic resonance imaging (MRI) and ultrasound imaging during the puncture process.
Real-time fusion targeted precise puncture can well detect suspicious prostate cancer lesions.
In addition, prostate saturation puncture was also carried out.
Regarding the future development of the prostate cancer subspecialty, Professor Hou Sichuan said that attention should be paid to the professional training of the team.
"Since the establishment of the prostate cancer subspecialty department, our team has regularly organized personnel to go abroad for further study.
At the same time, it also pays attention to exchanges with domestic experts, such as the Fudan University Affiliated Cancer Hospital, Sun Yat-sen University Cancer Hospital, Peking University Cancer Hospital and Shandong University Qilu The hospital’s multidisciplinary collaboration (MDT) team communicates.
Of course, we still communicate more with the grassroots hospitals, because when the grassroots hospitals encounter some difficult cases, there will be some confusion in their diagnosis and treatment.
On the other hand, prostate cancer Specialty construction also needs to improve the level of cognition.
Whether it is precise treatment of prostate cancer or individualized treatment, we need to have sufficient cognition.
Of course, professional equipment and technology for prostate cancer treatment are also very important.
For example, we mostly used it in the past.
Traditional prostate cancer surgery, but now we have more advanced Olympus high-definition laparoscopy, 3D laparoscopy, fourth-generation robot-assisted laparoscopic radical prostatectomy, etc.
The development of these prostate cancer diagnosis and treatment technologies has made more and more Patients receive effective treatment, which also increases our confidence in treatment. "New" weapon, New Hope Professor Sichuan Hou said that the incidence and detection rate of prostate cancer are getting higher and higher.
When I first started working more than 30 years ago, prostate cancer patients were still relatively rare.
Many patients with
prostate cancer can be seen in the ward during the consultation.
Prostate cancer has become the second largest tumor
in urology after bladder cancer.
In China, the level of diagnosis and treatment of prostate cancer is uneven.
Generally speaking, big cities and economic development The early diagnosis and detection rate of prostate cancer in the region is higher than that in rural areas and economically underdeveloped areas.
"We found in the consultation that most of the patients transferred from the grassroots are advanced or high-risk prostate cancer patients who have developed distant metastases.
"For these patients, traditional endocrine therapy (ADT) alone is not enough.
We need to combine existing methods, such as radiotherapy, for comprehensive treatment.
In recent years, many new types of endocrine therapy have emerged on the basis of traditional treatment.
Therapeutic drugs (such as abiraterone, apatamide, etc.
) have improved the short life expectancy and poor prognosis of previous metastatic prostate cancer.
A
number of studies have confirmed that metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic prostate cancer Castration-resistant prostate cancer (mCRPC) patients can achieve good results with new endocrine therapy for overall survival and progression-free survival.
New endocrine therapy provides us with a new therapeutic weapon.
"New" drug Abiraterone helps patients After long-term survival, the treatment of mCRPC patients is mainly chemotherapy, but many patients will be affected by factors such as age, physical condition, physical condition, and serious adverse reactions of chemotherapy, and cannot receive chemotherapy treatment, and the patient's prognosis is poor.
In 2015, the original research Arbiter Long was approved for mCRPC in China and was approved for the treatment of newly diagnosed high-risk mHSPC in 2018.
COU-AA-301/302 study results show that the use of ADT+abiraterone+prednisone (AAP) regimen to treat mCRPC patients without chemotherapy can significantly extend the median overall survival (OS) to 34.
7 months and reduce the risk of death 19% (HR=0.
81, P=0.
0033).
The emergence of abiraterone has greatly improved the previous dilemma of mCRPC patients with an average survival time of less than one year after diagnosis, and extended the patient's survival to nearly 3 years.
Subsequent large-scale trials once again confirmed the excellent efficacy of abiraterone.
LATITUDE is a large-sample, multi-center, randomized, double-blind phase III clinical study that included 1199 newly diagnosed high-risk mHSPC patients.
The primary endpoints were OS and imaging progression-free survival (rPFS) [2].
The results showed that, compared with the control group (placebo + ADT), the experimental group (abiraterone + prednisone + ADT) significantly prolonged the median OS, from 36.
5 months to 53.
5 months, while the risk of death was reduced by 34 %.
And the PSA reaction rate is also very good, reaching 91%.
This is a great advancement in the field of prostate cancer treatment and has brought significant survival benefits to patients.
Expert profile Professor Sichuan Hou Chief physician Peking University Medical School Doctor of clinical medicine, doctoral tutor.
Assistant to the Dean of the Third Clinical Medical College of Qingdao University, Assistant to the Dean of Qingdao Municipal Hospital, Director of the Department of Surgery, Director of the Surgical Base of the Residential Training Base of Qingdao Municipal Hospital, and Director of the Urology Center.
The leader of urology in Shandong Province, and the leader of outstanding disciplines in Qingdao.
Concurrently serving as the chairman of the Urology Committee of Shandong Association of Integrated Traditional Chinese and Western Medicine, the vice chairman of the Urology Branch of Shandong Medical Association, the vice chairman of Shandong Andrology Association, the vice chairman of Shandong Medical Association, the member of Chinese Society of Sexuality, Shandong Province.
Institute directors and other positions.
The first most beautiful doctor in Qingdao, he was awarded the honorary titles of Shandong Province Fumin Xinglu Medal and Shandong Province Health Guardian.
Engaged in urology for more than 33 years.
He has in-depth research on the basic and clinical aspects of prostate diseases and urogenital tumors.
He is good at laparoscopic and Da Vinci-assisted laparoscopic surgery, minimally invasive treatment of prostate hyperplasia, and comprehensive treatment of prostate cancer and kidney cancer.
And urothelial cancer, minimally invasive treatment of adrenal gland, kidney, ureter, prostate and bladder tumors, treatment of urinary tract stones through natural channels, laparoscopic kidney-sparing tumor resection, prostate cancer and bladder cancer radical resection, in situ controllable Ileum neobladder surgery, complicated urethral stricture and various urination abnormalities, as well as difficult and complicated operations.
Presided over more than ten provincial and municipal projects, published more than 50 papers at all levels including SCI and Chinese series, and participated in the compilation of 10 monographs such as "Guo Yinglu Male Science".
References: [1] Li Hanzhong, Dong Dexin, et al.
Hot research and prospects of prostate cancer.
Chinese Journal of Surgery.
2015, Volume 53, Issue 4, pp.
253-256.
[2] Fizazi K, Tran N, Fein L, et al.
Abiraterone acetate plus prednisone in patients with newly diagnosed high-risk metastatic castration-sensitive prostate cancer (LATITUDE): final overall survival analysis of a randomised, double-blind, phase 3 trial[J].
Lancet Oncol.
2019;20(5) :686-700.
