Editor's Note: In the stage of metastatic hormone-sensitive prostate cancer (mHSPC), effective treatment is crucial to delaying the progression to castration-resistant stages (mCRPC), thereby extending patient survival. From August 8-11, 2024, the Annual Meeting of the Urological Surgeon Branch of the Chinese Medical Doctor Association (CUDA) was grandly held in Xi'an, Shaanxi Province. At the conference, Dr. Kan Gong from Peking University First Hospital delivered a comprehensive presentation on the "Clinical Value of Novel Endocrine System Therapies in mHSPC." Following the event,Urology Frontier invited Professor Gong to further discuss the clinical needs of mHSPC patients, novel endocrine treatment strategies, and the exploratory research conducted by his team.Urology Frontier: What are the characteristics of mHSPC patients in China, and what are the urgent diagnostic and treatment needs that still need to be addressed?
Dr. Kan Gong: The current status of prostate cancer diagnosis and treatment in China is not optimistic, with several aspects, including incidence, mortality, and 5-year survival rates, needing significant improvement. Specifically, the latest 2024 cancer data for China show that prostate cancer ranks as the 6th most common male malignancy and the 7th leading cause of cancer death among men. Additionally, prostate cancer has become the most common tumor in the male urogenital system in China. Moreover, the 5-year survival rate for prostate cancer in China is only 69.2%, compared to 97.4% in developed countries like those in Europe and North America.
It is clear that there is still a gap between China’s prostate cancer diagnosis and treatment practices and those of developed countries. Therefore, improving the current diagnostic and treatment landscape and enhancing patient survival have become key goals for us as urologists. As we approach the goals outlined in the “Healthy China 2030” plan, we must adhere to relevant guidelines for standardized diagnosis and treatment, providing more precise and individualized care for prostate cancer patients.
In China, about 30% of newly diagnosed prostate cancer patients already have metastases (advanced stage), which significantly affects the potential for a cure. Therefore, it is crucial to strengthen early screening, diagnosis, and treatment of prostate cancer patients. Since mHSPC represents a key treatment window for delaying disease progression to mCRPC, it should receive sufficient attention from clinicians. In clinical practice, how should treatment strategies be selected? Currently, both domestic and international guidelines continue to optimize treatment recommendations for low and high tumor burden mHSPC based on evidence-based medicine, providing better guidance for clinical decision-making. Combining classical ADT treatment with novel antiandrogen drugs, chemotherapy, and other therapies can rapidly reduce PSA levels, extend overall survival, and improve quality of life, thereby giving both patients and doctors confidence and achieving satisfactory treatment outcomes.
Urology Frontier: What benefits can early initiation of novel endocrine therapy bring to patients? Does using novel endocrine therapies too early risk leaving no treatment options after progression?
Dr. Kan Gong: Research shows that if a patient’s serum prostate-specific antigen (PSA) level can be reduced to below 0.2 ng/ml within 7 months of treatment, their survival will be significantly extended. Therefore, both clinical practice and treatment guidelines emphasize the early use of novel endocrine therapy drugs. In recent years, there have been several research advancements in the treatment of mHSPC, demonstrating that combining ADT with novel endocrine therapies or chemotherapy can improve overall patient outcomes. These treatment strategies have also been recommended by the updated NCCN guidelines and relevant guidelines and expert consensus from China’s CSCO.
Urology Frontier: mHSPC has now entered the era of novel endocrine therapies. How should dual or even triple therapy be approached?
Dr. Kan Gong: For patients in the mHSPC stage, several globally recognized trials, such as the ARASENS study, ARANOTE study, TITAN study, CHART study, and PROact study, have been conducted. The results of these studies are significant for standardizing mHSPC diagnosis and treatment and improving patient prognosis. For patients with high tumor burden mHSPC, systemic treatment with ADT combined with novel antiandrogens and chemotherapy can provide survival benefits. For patients with low tumor burden mHSPC, ADT combined with novel antiandrogens can also offer survival benefits and improve quality of life. Reviewing international and Chinese guidelines and consensus, standardized dual or triple therapy can improve the prognosis for mHSPC patients.
Urology Frontier: What explorations has your team conducted to further improve the benefits for mHSPC patients?
Dr. Kan Gong: This year, our team conducted several prospective, multicenter, randomized controlled studies to explore new treatment strategies and further improve patient outcomes. One study focused on mHSPC patients with oligometastases and relatively low tumor burden, administering novel endocrine therapy combined with ADT for 6 to 12 months, followed by PSMA PET/CT re-evaluation and PSA assessment. Patients with indications for cytoreductive surgery or radiotherapy received appropriate treatments to further refine the treatment strategy and prognosis for mHSPC patients. Additionally, our team explored robotic surgery, conducting a prospective, randomized controlled study on the reinforcement and reconstruction of posterior and lateral aspects during Da Vinci robotic surgery. We hope that the results of this single-center study will improve immediate and long-term urinary control recovery for patients post-surgery.
Dr. Kan Gong
Deputy Director, Urology Research Institute, Peking University Chief Physician, Professor, Doctoral Supervisor Third Batch “National High-Level Talent Special Support Program (Ten Thousand Talents Program)” Vice Chairman, Urology Branch, China International Exchange and Promotive Association for Medical and Health Care Member, Oncology Group, Urology Branch, Chinese Medical Association Member, Rare Diseases Branch, Chinese Medical Association Member, Urology Tumor Committee, Chinese Medical Doctor Association Editorial Board Member, China Urology Diagnosis and Treatment Guidelines—Prostate Cancer
