Professor Sun Ting From the beginning to the end, the optimization strategy of the whole process management of prostate cancer

Edited and written by Yimaitong, please do not reprint
without authorization.

"An "Medicine" Leye" is a humanistic case collection project
cooperated by Beijing Chen Jumei Public Welfare Foundation and Yimaitong.
The series of interviews with urologists will focus on the field of prostate cancer, discuss the significance of standardized diagnosis and treatment path of prostate cancer and the management of the whole course of prostate cancer to clinical patients based on real clinical needs, and highlight the research spirit and professionalism of urological oncologists
.

There is a sentence in the "Zhou Yi Zhizhi" that reads: "Change in the name of transformation; What is done is called a cause, and the people of the world are called a cause
.
"With the acceleration of new drug research and development and the improvement of medical standards, the survival period of prostate cancer, a common male malignant tumor, is prolonged
.
Since prostate cancer has gradually shown the characteristics of "chronic disease" with long survival cycle and quality of life, it is imperative to implement effective whole-process management
.
Patient-oriented, whole-process management is never a slogan, but a practical action
.
In this issue, we specially invited Professor Sun Ting from the First Affiliated Hospital of Nanchang University to interview
the importance of whole-process management of prostate cancer and how to implement the concept of whole-process management in clinical practice.

Based on the patient, from the beginning to the end, the whole process of prostate cancer management is three steps

In recent years, with the advancement of clinical research and the strengthening of international exchanges, the diagnosis and treatment level of prostate cancer in China has been in line with international standards
.
Based on the whole process of patient management is an important concept in the clinical diagnosis and treatment of prostate cancer, Professor Sun Ting said that the whole process management of prostate cancer can be roughly divided into three parts:

The first part is prostate cancer screening
.
In China, due to the lack of public awareness of prostate cancer prevention, about 60% of patients are in the advanced or intermediate or advanced stage at the time of diagnosis, which brings great pressure
to the follow-up treatment of the disease.
Based on this feature, the importance of strengthening early screening of prostate cancer is particularly prominent, and early prostate cancer screening for men over 50 years old and men over 45 years old with family history can help detect early prostate cancer patients and significantly improve the 5-year survival rate
of patients.

The second part is the diagnosis
of prostate cancer.
Under the current MDT model, accurate diagnosis is not only an important basis for formulating personalized diagnosis and treatment plans, but also an important reference for timely adjustment of treatment plans during the treatment process, running through the whole process
of prostate cancer diagnosis and treatment.

The third part is follow-up
for prostate cancer.
Because prostate cancer has a long course, patients need long-term monitoring
.
Professor Sun Ting said that prostate cancer patients need to maintain a follow-up frequency every 3 months to ensure timely intervention
when the disease progresses.
The MDT diagnosis and treatment team will ensure the continuity of follow-up by establishing personal files for patients to achieve long-term monitoring
of disease progress.

Tailor-made, different from person to person, personalized diagnosis and treatment to benefit from

Compared with other tumors, prostate cancer is significantly heterogeneous and the treatment system is more complex, and the treatment from metastatic hormone-sensitive prostate cancer (mHSPC) to metastatic castration-resistant prostate cancer (mCRPC) stage varies
from person to person.
The MDT diagnosis and treatment model can effectively improve the survival benefits
of patients through the joint participation of doctors from different departments such as oncology, medical oncology, urology, imaging, oncology chemotherapy, pathology and radiotherapy.

Based on the concept of individualized diagnosis and treatment, Professor Sun Ting shared a relatively special case
with us.
A young patient in his 30s with a very high PSA level at the beginning of admission, the diagnosis team determined the diagnosis of magnetic resonance, whole body bone scan and accurate puncture through MDT discussion, so as to confirm that the patient had prostate cancer, and then found that the patient had some genetic mutations through genetic testing, which means that he may not respond well
to certain therapeutic drugs.
Based on the diagnosis results and individual characteristics of the patient, Professor Sun Ting and the diagnosis and treatment team formulated a personalized treatment plan
for neoadjuvant therapy followed by surgery.
The treatment results showed that after 3 months of neoadjuvant therapy, the patient's PSA level had decreased by 99.
9%, and the benefit was obvious
.
The patient is still in neoadjuvant therapy, and if the subsequent tumor can shrink to the debulking level, radical surgery can be performed, and the patient will have a higher survival benefit
.

Professor Sun Ting said that individualized treatment plans should be based on
disease treatment guidelines.
At present, foreign NCCN, AA, EAU and domestic CSCO, CUA and other guidelines recommend androgen deprivation therapy (ADT) + new endocrine therapy (NHT) mode
for patients with intermediate and high-risk prostate cancer.
Existing new endocrine drugs mainly include abiraterone, enzalutamide, apatamide and bicalutamide
.
The choice of NHT needs to be decided according to the patient's physical condition, such as prostate cancer patients with cardiovascular disease, in order to avoid the occurrence of cardiovascular adverse events, the use of enzalutamide with better safety and fewer cardiovascular side effects is a good choice
.

Life trust, trust is related, doctors and patients work hand in hand

The importance of regular follow-up for prostate cancer patients is undeniable
.
Professor Sun Ting said that in order to improve and maintain the cooperation of patients, the department team will regularly publicize and educate on the diagnosis and treatment of prostate cancer, and organize different teams to be responsible for the physical examination and follow-up management
of different patients.
For patients or family members with poor compliance, the diagnosis and treatment team chooses to use meticulous and powerful communication to convey the correct treatment concept to the patient, and help the patient establish a healthy treatment concept
with real and vivid cases.
Even for patients who fall off during the follow-up process, the diagnosis and treatment team will not give up, but try to reconnect with patients through patient explanation and guidance, and strive to guide patients to re-enter the
diagnosis and treatment system.

To maintain the long-term management mode of prostate cancer follow-up, not only the maintenance of the diagnosis and treatment team, but more importantly, the patient's own heartfelt trust
in the diagnosis and treatment team.
Professor Sun Ting said that doctors under the MDT model always have a sincere sense of responsibility for patients, always hope to help patients strive for the greatest survival benefits with the best medical services, and very much hope to establish a due trust relationship with patients, because mutual trust is the first step
in treatment.
A good doctor must start from his own specialty, take the patient as the center for the management of the entire disease, and strive for
patients to have a longer living space, greater treatment benefits and a higher quality of life.

Medical progress, prolonged survival, and the grassroots of chronic diseases can be expected in the future

With the breakthrough of medical technology, the living space of prostate cancer patients has become more and more broad
.
Professor Sun Ting said that at present, the whole process management of prostate cancer patients at home and abroad tends to achieve "chronic disease", that is, under the premise of long-term survival of patients, the whole process management
is carried out to ensure the quality of life and survival of patients.
If the recovery is good, the frequency of follow-up can be reduced to once every six months, and the underlying diseases that occur during the interval can be handed over to the community primary hospital to improve the convenience of the patient's
life.
However, it should be noted that patients must still be followed up with the initial MDT team, and at least once a year to maintain the continuity and effectiveness
of diagnosis and treatment.

Expert Talk

With the implementation of the 2035 National Health Plan, Professor Sun Ting believes that more advanced treatment concepts and drugs will be introduced into the clinic in the future, and the diagnosis and treatment level of prostate cancer in China will be further improved, until it achieves synchronous development with the international frontier, and prostate cancer patients will also receive higher treatment guarantee and survival benefits
.
It is hoped that doctors and patients will work hand in hand to create a long-term harmonious and warm diagnosis and treatment environment, and strive for a brighter tomorrow
for all prostate cancer patients.

Special thanks: Beijing Astellas Pharmaceutical Co.
, Ltd