Editor's Note: The 2024 Annual Meeting of the Urological Surgeons Branch of the Chinese Medical Association (CUDA) was held in Xi'an from August 8 to 11, 2024. The conference was hosted by the Chinese Medical Association and the CUDA Urological Surgeons Branch, with the Air Force Medical University Xijing Hospital serving as the organizer and the Shaanxi Provincial Medical Association Urological Surgeons Branch as a co-organizer. Under the theme "Healthy China, Urology First," the conference showcased the latest achievements in urology. At the event, Urology Frontier interviewed Dr. Tie Zhong from The Second Affiliated Hospital of Xi'an Jiaotong University to review the recent progress in the treatment of metastatic hormone-sensitive prostate cancer (mHSPC) in China. The discussion focused on the benefits of new endocrine therapies and individualized treatment strategies, providing guidance for the future development of mHSPC.
1. Urology Frontier: What recent advances have been made in the treatment of metastatic hormone-sensitive prostate cancer (mHSPC)?
Dr. Tie Zhong: The incidence of prostate cancer has been steadily increasing, and the number of mHSPC patients in clinical practice is also on the rise. In the past, systemic treatment was the primary approach for mHSPC, with endocrine therapy strategies such as androgen deprivation therapy (ADT) and ADT combined with first-generation antiandrogens (CAB) being the mainstay. These strategies dominated mHSPC treatment until the introduction of the chemotherapy drug docetaxel, which shifted the treatment landscape. Subsequently, a new wave of endocrine therapies (NHTs), including abiraterone, enzalutamide, darolutamide, and the domestically developed relugolix, emerged, offering more options for treating mHSPC.
In this context, we must adopt a stratified approach to the diagnosis and treatment of mHSPC, categorizing patients based on tumor burden into high or low, and biological characteristics into high-risk or low-risk. Treatment strategies should be tailored accordingly. For example, high-tumor burden and high-risk patients may require more intensive treatment strategies, such as chemotherapy combined with NHT. Overall, the development of new drugs has brought significant breakthroughs in the treatment of mHSPC, extending the time to progression to metastatic castration-resistant prostate cancer (mCRPC), delaying disease progression, improving overall survival (OS), and reducing mortality risk.
2. Urology Frontier: What benefits do new endocrine therapies bring to hormone-sensitive prostate cancer patients in China?
Dr. Tie Zhong: Prostate cancer in China has the following characteristics: First, it is the fastest-growing male cancer in the country. Second, a significant proportion of Chinese prostate cancer patients present with advanced disease at diagnosis, with about 30% in locally advanced stages and another 30% already metastatic. Third, the average age of prostate cancer patients in China is higher, with elevated baseline prostate-specific antigen (PSA) levels, and a higher proportion of high-tumor burden and high-risk patients compared to developed Western countries. This presents Chinese prostate cancer specialists with more significant challenges than their counterparts in Europe and the United States.
As mentioned earlier, the introduction of drugs such as abiraterone, apalutamide, darolutamide, and relugolix has significantly improved overall survival rates in Chinese prostate cancer patients and extended the time to progression from mHSPC to mCRPC.
3. Urology Frontier: How should individualized treatment strategies be developed based on a patient’s disease risk and tumor burden in clinical practice?
Dr. Tie Zhong: There are many treatment options for prostate cancer, and for each patient, it is essential to consider factors such as age, physical condition, expected lifespan, and the availability of antitumor drugs to develop an individualized treatment plan. For mHSPC, patients should be stratified based on tumor burden and risk level. Although some new endocrine therapies can benefit patients across all risk levels, in clinical practice, we must also consider factors such as the patient’s physical condition, drug side effects, and the economic aspects of treatment. For high-tumor burden, high-risk patients, we recommend a combination of ADT with new antiandrogens, and possibly adding chemotherapy, to provide a more precise and comprehensive treatment strategy for better clinical outcomes.
4. Urology Frontier: What are the future research directions for mHSPC?
Dr. Tie Zhong: Despite the availability of excellent treatment options such as chemotherapy and new endocrine therapies for mHSPC, some patients still experience disease progression and develop mCRPC. Therefore, there is still much research to be done in the future. First, we need to explore ways to effectively delay the progression of mHSPC patients, keeping them in the hormone-sensitive phase for as long as possible so that existing treatments remain effective. Second, once a patient progresses to mCRPC, subsequent treatment options are relatively limited, with only modest improvements in overall survival. Therefore, developing new drugs for mCRPC patients is crucial. Third, given the current state of prostate cancer in China, we need to focus on early diagnosis and early treatment to reduce the proportion of patients presenting with advanced disease and improve overall treatment outcomes. These are the key strategies for the future of prostate cancer treatment.
About Dr. Tie Zhong
- PhD, Professor, Chief Physician, and Doctoral Supervisor
- Director of the Department of Urology, Second Affiliated Hospital of Xi’an Jiaotong University
- Director of the Urology Research Institute, Xi’an Jiaotong University
- Chair of the Department of Surgery, Xi’an Jiaotong University
- Standing Committee Member of the Urology Branch, Chinese Medical Association, and Leader of the Andrology Group
- Standing Committee Member of the Urological Surgeons Branch, Chinese Medical Doctor Association
- Member of the Andrology and Sexual Medicine Physician Branch, Chinese Medical Doctor Association
- Member of the Medical Robotics Physician Branch, Chinese Medical Doctor Association
- Member of the Urological and Male Reproductive Tumor Professional Committee, Chinese Anti-Cancer Association
- Chair of the Urology Branch, Shaanxi Medical Association
- Director of the Urology Quality Control Center, Shaanxi Province
- Chair of the Urology Professional Committee, Shaanxi Rehabilitation Medical Association
- Chair of the Urological Oncology Professional Committee, Shaanxi Anti-Cancer Association
- Chair of the Sexual Medicine Professional Committee, Shaanxi Health Association
- Director of the Urology Alliance, Xi’an Jiaotong University School of Medicine
- Renowned Physician, Xi’an Jiaotong University School of Medicine
