Professor Cui Feilun "claims" the male theory: talk about the clinical diagnosis and treatment of prostate cancer "intrigue" with androgens

"Safety with Medicine" is a humanistic case collection project cooperating with Beijing Chen Jumei Public Welfare Foundation and Yimaitong
.
The
series of interviews with physicians in urology will focus on the field of prostate cancer, and discuss the path of standardized diagnosis and treatment of prostate cancer based on real clinical needs.
And the significance of whole course management to clinical patients, highlighting the research spirit and professional quality
of urological oncologists .

The occurrence and development of prostate cancer are relatively unique androgen-dependent, which makes the pathological mechanism of prostate cancer more complex.
However, it has also promoted the continuous update of "anti" androgen-targeted treatment regimens
.

In recent years, clinical studies have found that even if patients enter the stage of castration resistance, new androgen receptor (AR) inhibitors such as enzalutamide can still provide The patients have brought significant survival benefits, and the endocrine therapy of prostate cancer has entered a new stage of development
.
In
this interview, Professor Cui Feilun, director of the Department of Urology of the First People's Hospital of Zhenjiang, was invited to explain the close relationship between androgens and prostate cancer.
He also introduced the development of "anti-male" treatment for prostate cancer that he had witnessed in many years of clinical practice
.

Expert Profile Professor Cui Feilun Chief Physician of the Department of Urology, Zhenjiang First People's Hospital, Postdoctoral Fellow in Clinical Medicine, Doctoral Supervisor Winner of the May 1st Medal of Jiangsu Province Young and middle-aged experts with outstanding contributions in Jiangsu Province enjoy special government allowances Chinese Medical Association for urinary stones in East China Director of Zhenjiang Sub-base of Disease Prevention and Control Base, Vice Chairman of the Professional Committee of Andrology of Jiangsu Medical Association, Standing Committee Member of the Professional Committee of Urology of Jiangsu Medical Association, Chairman of the Committee of Professional Committee of Urology of Zhenjiang Medical Association "Failure is also "male": androgens are involved in the occurrence and development of prostate cancer.
Professor Cui Feilun introduced that androgens are actually a key hormone in the human body, which can promote protein synthesis, including bone and muscle growth, and can also inhibit the body's Androgens play an important role in fat synthesis, stimulation of male reproductive organ development, promotion of sperm maturation, and maintenance of normal libido
.

However, androgens also play a key role in the differentiation and growth of tumor cells
.

Prostate cancer is a male malignant tumor triggered by hormones.
Androgens can combine with AR in the cytoplasm, activate AR and form dimers, mediate the expression of genes related to target cell proliferation, and promote the growth of prostate cancer cells; at the same time, cancer cells also It can promote androgen synthesis and inhibit its degradation, thereby prolonging androgen half-life, resulting in a vicious circle
.

Therefore, reducing androgen levels and inducing apoptosis of prostate cancer cells have become important means of clinical treatment of prostate cancer
.

The road to anti-androgen is long: from "androgen deprivation" to a more powerful new type of "androgen receptor inhibition" "Our understanding of each disease is a process from unknown to known, which is constantly cyclical and repeatedly corrected.
The same is true
.

"Professor Cui Feilun mentioned that in the early years, the stage that was no longer sensitive to androgen deprivation therapy (ADT) was defined as "androgen-independent prostate cancer", but later studies found that after ADT treatment, the progression of prostate cancer It still relies on the interaction of androgen and androgen receptor, but ADT treatment can no longer meet the needs of effectively inhibiting tumor growth, so this stage was renamed "castration-resistant prostate cancer (CRPC)"; it is currently believed that the body can pass Multiple other pathways reactivate the AR, progressing to CRPC
.

Therefore, at this stage, treatments targeting androgens and AR remain key to suppress tumor growth
.

In this context, it is more effective than traditional ADT drugs and first-generation AR inhibitors.
Drugs such as enzalutamide and apalutamide, which are powerful new AR inhibitors, have appeared in the clinic one after another
.

Novel selective AR inhibitors such as enzalutamide can act on the three key stages of the AR signal transduction pathway, blocking the Androgens bind to AR, inhibit AR nuclear translocation, and affect AR binding to DNA to prevent the regulation of gene expression and delay disease progression
.

Compared with first-generation AR inhibitors, drugs such as enzalutamide have stronger AR The combined effect can bring more benefits to patients
.

In addition, Professor Cui Feilun specifically mentioned that under the continuous promotion of medical insurance policies in recent years, this kind of new drugs has become very "people-friendly" and has high availability in China, which can be used for the majority of patients.
Prostate cancer patients provide more treatment options
.

Both internal and external: Prostate cancer is the "destiny" challenge of urologists.
Professor Cui Feilun mentioned that the feature of "androgen dependence" makes prostate cancer a very special type of urinary tumor.
On the one hand, endocrine therapy with the goal of "controlling androgen levels" continues to develop.
On the other hand, the different states of treatment response also refine the classification of disease stages, making clinical choices and treatment options more complex and diverse
.

Radical prostatectomy and local therapy are only the early surgical "battlefields", while the treatment of advanced prostate cancer needs to be based on endocrine therapy, and requires urologists to cooperate with pathology, oncology, imaging, radiotherapy and other multidisciplinary research.

.

Professor Cui Feilun lamented that at the International Expert Consensus Meeting on Prostate Cancer held every two years in the European town of St.
Gallen, there are only a few urologists, and there are international views that the multidisciplinary diagnosis and treatment model for advanced prostate cancer may be performed by physicians or oncologist-led
.

But in fact, due to more in-depth research on the pathophysiological basis of prostate cancer, the challenges of endocrine therapy often fall in the urology clinic, and urologists are often exposed to new endocrine therapy drugs earlier and have more prescribing experience
.

A survey of clinical prescription patterns found that the therapeutic effect of urologists in the treatment of advanced prostate cancer and the management of toxic and side effects were not weaker than those of oncologists and internal medicine physicians
.

"I once heard a professor from Harvard say that prostate cancer can be said to be an opportunity, or a challenge, that God has brought to urology
.

" Professor Cui Feilun joked
.

Heroes are late: under the background of traditional culture, giving more humanistic care to patients with prostate cancer For patients, the particularity of prostate cancer lies in the connotation of "hero" in traditional culture
.

"In the early years, surgical castration was commonly used in clinical practice, but many elderly patients could not accept the removal of the testicles.
He felt that this would be incomplete as a male
.

" Professor Cui Feilun mentioned that in recent years, with the development of clinical diagnosis and treatment technology and drugs, surgical treatment At the same time, the concept of clinical diagnosis and treatment is constantly improving.
In addition to delaying the development of the disease stage to the greatest extent, prolonging the overall survival period of patients and improving the psychological state, functional state, self-esteem and quality of life of patients have become clinical target of the intervention
.

"At present, people often talk about many surgical methods in academic exchanges.
The actual purpose is to preserve the patient's urinary continence and sexual function to the greatest extent under the premise of ensuring that the tumor tissue is removed cleanly
.

" Professor Cui Feilun pointed out that over the years, urologists have A lot of work has also been done, including optimizing surgical methods, studying different surgical approaches, using different anti-androgen treatments, etc.
, to balance surgical risks and clinical benefits, and ensure the best functional status of patients
.

At the same time, how to communicate with patients, how to relieve the psychological pressure of prostate cancer patients, how to explain possible surgical complications or adverse reactions to patients, and how to be anxious and think about what the patient thinks are also compulsory courses for urologists
.

   Summary Just like the physiological effects and potential cultural connotations of androgens at the same time, Professor Cui Feilun pointed out that clinical practice should also have both scientific and social attributes
.

"A doctor is called a Doctor, which requires us to be professionally knowledgeable.
In addition to the scientific attributes of basic research and clinical research, urologists also need to have social attributes and care about the psychological problems of patients, not only to cure the disease, but also to Cure people
.

” In addition, Professor Cui Feilun also mentioned that with the advancement of surgical technology into the fine era, with the assistance of computers and robots, the working life of surgeons will be greatly extended, and urologists are required to adapt to the changes of the times and dabble in different fields , in order to continuously improve their clinical response capabilities
.

Special thanks to: Beijing Astellas Pharmaceutical Co.
, Ltd.