Professor Ye Dingwei: Interpretation of the updated points of the CSCO prostate cancer diagnosis and treatment guidelines of the 2021 edition

On April 23-24, 2021, the Chinese Society of Clinical Oncology (CSCO) Guidelines Conference was successfully held in Beijing, the capital.

As one of the most influential academic festivals in the field of oncology in China, big coffees from all over the country gathered together to witness the update of multiple guidelines.

In the urinary system tumor special session on the afternoon of the 23rd, Professor Ye Dingwei from the Cancer Hospital of Fudan University explained the updated points of the 2021 CSCO prostate cancer diagnosis and treatment guidelines.

The guidelines for updating the guidelines are: evidence-based evidence, advance with the times; precision medicine, diagnosis first; drug accessibility, therapeutic value; local data, leading guidelines.

After the guide kick-off meeting and internal seminars, the new guide will be officially released on July 10.

01 The MDT Diagnosis and Treatment Model of Prostate Cancer The 2021 CSCO Prostate Cancer Guidelines "MDT Diagnosis and Treatment Model" emphasizes the importance of participating in clinical trials: clinical trials may bring better treatment opportunities for patients, and prostate cancer patients should be strongly encouraged after evaluation Participate in clinical trials.

In addition, the 2021 version of the CSCO prostate cancer guidelines also emphasizes the importance of network MDT: network-based telemedicine can help patients obtain rapid, timely and undifferentiated treatment opinions.

02 A study published in 2020 of complications related to prostate puncture infection found that compared with transperineal biopsy, the complications of infection after rectal biopsy were significantly higher (Class 1A evidence).

Another meta-analysis showed that the use of povidone-iodine preparations before biopsy, in addition to preventive antibacterial, can significantly reduce the incidence of infection complications (type 1A evidence).

A meta-analysis of 11 studies showed that after the use of prophylactic antibiotics, infections after transrectal prostate biopsy were significantly reduced (5.
6% vs.
11.
6%) (type 1A evidence).

Based on the above evidence, the 2021 version of the CSCO prostate cancer guidelines emphasizes complications related to puncture infection and coping strategies.

03 Genetic testing and liquid biopsy: update the detection of patient types, update the detection of patient types, update the 2021 V2 version of the NCCN guidelines recommended genetic testing population: patients with metastatic prostate cancer recommend tumor homologous recombination repair (HRR) mutation testing; limited-stage patients can also consider tumors HRR mutation detection.

Test content: Level III recommendation to add TP53 is based on the latest study of Shandong University Qilu Hospital found that the incidence of TP53 mutations in Chinese hormone-sensitive prostate cancer patients is 22.
3%, which is a high incidence.

TP53 is often associated with mutations in other genes and can be used as a core mutation in patients with prostate cancer.

Patients with TP53 mutations have a poor prognosis and are not sensitive to new endocrine therapies such as abiraterone or enzalutamide.

Types of test samples: tissue samples + plasma ctDNA samples TRITON2, TRITON3 studies have shown that in metastatic prostate cancer, plasma samples have a high success rate (94% ctDNA samples are successfully tested).

The study also found that the detection of BRCA1/2 mutant tissue samples and plasma samples were highly consistent.

Similarly, the Profound study showed that the test results of tissue samples and plasma samples were highly consistent: the positive agreement rate was 81%, and the negative agreement rate was 92%).

Based on the above evidence, the 2021 version of the CSCO prostate cancer guidelines for patients with metastatic prostate cancer for the purpose of making treatment decisions, the genetic testing type III recommended a new TP53, and a new tumor tissue + plasma ctDNA sample for the test sample type (I Grade/II recommendation).

Table prostate cancer gene detection and liquid biopsy 04 The treatment of localized prostate cancer (very low risk, low risk, intermediate risk) is based on a study discovered in 2020, for localized very low risk, low risk and some selected medium risk For prostate cancer patients, the 2021 version of the CSCO guidelines update: If there is no recent history of transurethral resection of the prostate and patients with a good IPSS score, low-dose brachytherapy can be recommended.

05 Treatment of Metastatic Hormone Sensitive Prostate Cancer (mHSPC) A study published in 2020 showed that for mHSPC patients, combination therapy based on androgen deprivation therapy (ADT) is more effective than ADT alone, but it has not been confirmed yet.
A combination method is more effective.

At the same time, the 2021 version of the EAU guidelines also emphasizes: For patients who are first diagnosed with mHSPC, if there is no contraindication to the combination therapy, if they have sufficient life expectancy to benefit from the combination therapy, and are willing to accept the increased risk of side effects, they should be based on ADT.
Combine other treatments.

Based on this, the 2021 CSCO prostate cancer guidelines no longer recommend ADT alone for mHSPC patients.

06 The diagnosis and treatment of metastatic trend-resistant prostate cancer (mCRPC) The 2021 version of the CSCO prostate cancer guidelines replaces the traditional first-line and second-line classification methods with whether they have received new endocrine therapy/chemotherapy in the past to guide the treatment of patients at different stages more clearly and intuitively.

Diagnosis and treatment of metastatic castration-resistant prostate cancer 07 Prevention and treatment of bone-related events Desulumab is a fully human monoclonal antibody directed against the nuclear factor receptor activator KB ligand.

A phase III study found that disulumab versus zoledronic acid can significantly delay or prevent the occurrence of bone-related events.

The 2021 V1 edition of the NCCN Guidelines recommends that Disulumab can be used as a class I preference for anti-bone resorption in patients with bone metastases.

In 2020, the National Medical Products Administration (NMPA) of China approved disulumab for the prevention of bone metastases from solid tumors and bone-related events caused by multiple bone marrow.

The 2021 version of the CSCO prostate cancer guidelines recommends: Disumab can prevent bone-related events in patients with mCRPC bone metastasis, and the recommendation is updated from category Ⅱ to category Ⅰ recommendation.

08 The local data update is based on a review published by the Fudan University Cancer Hospital in Nature Reviews Urology.
The new version of the CSCO guidelines has improved the epidemiological data of the Chinese population in the chapter "Prostate Cancer Screening": Countries that implement prostate cancer screening strategies, Japan’s five-year survival rate has increased rapidly, with an average annual increase of about 11.
7%, and a 5-year survival rate of 93%, while China’s annual increase is only 3.
7%, and the 5-year survival rate is 69.
2%.

At the same time, the "genetic counseling" data in "gene testing and liquid biopsy" was added: the incidence of DDR gene germline mutations in the Chinese population with metastatic, localized, and limited high-risk prostate cancer is 12%, 10%, and 8.
1%.
In addition, single nucleotide polymorphisms are associated with the risk of prostate cancer.
Genome-wide studies have shown that there are large differences between East Asian and Asian populations.