Editor's Note: Prostate cancer is the most common malignancy of the male genitourinary system. Compared to Western countries, a larger proportion of prostate cancer patients in China are diagnosed at intermediate to advanced stages, leading to poorer prognosis. At the recent 2024 Annual Meeting of the Urology Physicians Branch of the Chinese Medical Doctor Association (CUDA), Urology Frontier invited Dr. Sujun Han from the National Cancer Center/Cancer Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College, to discuss the background of the development of single-disease quality control indicators for prostate cancer, the value of promoting standardized diagnosis and treatment, and treatment strategies for advanced patients, with the goal of improving both survival rates and quality of life for prostate cancer patients.
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Urology Frontier: As a member of the Prostate Cancer Quality Control Expert Committee of the National Cancer Quality Control Center, could you share the background of developing single-disease quality control indicators for prostate cancer?
Dr. Sujun Han: Cancer remains a leading threat to global health, with China bearing the highest cancer burden worldwide due to its large population. The five-year survival rate for cancer patients in China has been steadily improving, rising from 30.9% in 2003 to 40.5% in 2015, but it still lags behind that of developed countries. The gap is particularly noticeable in cancers like prostate cancer. In response, the National Health Commission and other government bodies have introduced major public health policies such as the “Healthy China 2030” Plan and the “Opinions on Implementing the Healthy China Initiative” by the State Council, which emphasize improving medical quality and patient safety. These policies have driven the development of quality control standards across various medical fields, with the goal of increasing the overall five-year cancer survival rate by 15% by 2030, reaching at least 46.6%.
For prostate cancer specifically, the five-year survival rate in China is 66.4%, significantly lower than the nearly 100% in the United States. Moreover, there are significant disparities in the quality of prostate cancer diagnosis and treatment across different regions and healthcare institutions in China, leading to variations in patient survival rates. To ensure that patients across various medical institutions receive standardized, high-quality care, it is essential to develop a set of unified, scientific, and feasible quality control indicators. These indicators help standardize physicians’ diagnostic and treatment practices, minimizing discrepancies in prostate cancer diagnosis, treatment, and follow-up. By monitoring and evaluating quality control data, we can continuously improve the comprehensive management of prostate cancer. The development of single-disease quality control indicators for prostate cancer is a multidisciplinary and scientifically rigorous process aimed at standardizing care across different healthcare institutions, ultimately improving patient outcomes.
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Urology Frontier: The 2024 National Performance Evaluation for Tertiary Public Hospitals introduced new cancer quality control indicators. How do these indicators guide the standardization of prostate cancer diagnosis and treatment?
Dr. Sujun Han: The introduction of new cancer quality control indicators in the performance evaluation for tertiary public hospitals plays a critical role in standardizing prostate cancer diagnosis and treatment in several ways:
- Clarifying Diagnostic and Treatment Standards: The introduction of these indicators provides standardized procedures and guidelines for prostate cancer diagnosis and treatment, ensuring that hospitals at all levels have clear protocols to follow.
- Improving Treatment Quality: By incorporating quality control indicators into performance evaluations, hospitals are encouraged to focus more on the quality of prostate cancer care, reducing misdiagnoses and missed diagnoses, and standardizing physicians’ practices to improve the overall effectiveness and safety of treatments.
- Promoting Rational Resource Allocation: Quality control indicators help hospitals allocate medical resources more effectively, ensuring that prostate cancer patients receive necessary support and attention at every stage of diagnosis, treatment, and rehabilitation.
- Strengthening Multidisciplinary Collaboration: Prostate cancer treatment requires collaboration among various disciplines, including urology, pathology, radiology, and oncology. The indicators encourage hospitals to establish and improve multidisciplinary teams.
- Enhancing Data Monitoring and Feedback: The performance evaluation requires hospitals to collect and analyze data on prostate cancer diagnosis and treatment. By monitoring this data, hospitals can identify problems and shortcomings in the treatment process and make timely improvements.
In summary, the newly introduced cancer quality control indicators help promote the standardization of prostate cancer diagnosis and treatment, improve the quality of medical services, and ultimately lead to better patient outcomes.
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Urology Frontier: In China, many prostate cancer patients are diagnosed at intermediate to advanced stages. How do you think early diagnosis and treatment can be promoted to improve the current state of prostate cancer care?
Dr. Sujun Han: Early diagnosis and treatment of prostate cancer are crucial for improving patient outcomes and quality of life. Here are some strategies to promote early diagnosis and treatment:
- Raising Public Awareness: Increasing public awareness about prostate cancer through media and community activities is essential, particularly targeting high-risk groups such as men over 50 and those with a family history of the disease.
- Enhancing Screening: Promoting the use of prostate-specific antigen (PSA) testing and digital rectal exams as routine screening methods is important. Regular PSA testing is recommended for high-risk groups to facilitate early detection of abnormalities.
- Establishing Screening Guidelines: Developing and updating evidence-based prostate cancer screening guidelines can provide clear screening recommendations for doctors and patients.
- Training Healthcare Professionals: Providing specialized training for primary care providers can improve their ability to recognize and diagnose prostate cancer at an early stage.
- Optimizing Resource Allocation: Ensuring that primary healthcare institutions have the necessary equipment and trained personnel to conduct initial prostate cancer screening and diagnosis is critical.
- Building Multidisciplinary Teams: Encouraging the establishment of multidisciplinary teams comprising urologists, radiologists, pathologists, and oncologists to collaborate on prostate cancer diagnosis and treatment.
- Conducting Scientific Research: Supporting research on early diagnosis and treatment of prostate cancer, including exploring new biomarkers and diagnostic technologies, is vital.
- Improving Health Insurance Policies: Including prostate cancer screening and early treatment in health insurance coverage can reduce the financial burden on patients.
By implementing these comprehensive measures, the early diagnosis rate of prostate cancer can be improved, leading to better treatment outcomes and enhanced survival quality for patients.
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Urology Frontier: For patients diagnosed with advanced prostate cancer, what treatment strategies do you recommend to improve both survival time and quality of life?
Dr. Sujun Han: The treatment of advanced prostate cancer should be individualized, comprehensive, and managed throughout the patient’s journey.
First, treatment strategies should be tailored and stratified based on the patient’s age, overall health, disease progression, and personal preferences. The advancement of precision medicine allows patients with advanced prostate cancer to receive targeted therapies based on specific molecular mutations. Participation in clinical trials that offer access to the latest treatments is also encouraged.
Second, the treatment of advanced prostate cancer requires the collaboration of a multidisciplinary team that includes urologists, oncologists, radiologists, pathologists, and other specialists. Androgen deprivation therapy (ADT) is often the foundation of treatment, combined with novel endocrine agents, chemotherapy, PARP inhibitors, immune checkpoint inhibitors, radiopharmaceuticals, external radiotherapy, and surgery, among other approaches. Comprehensive and integrative treatment plans should be provided to patients.
Finally, these patients need to be managed by a multidisciplinary team throughout their treatment, rehabilitation, and follow-up. Supportive care and symptom management, including pain control, osteoporosis treatment, management of treatment-related adverse effects, psychological support, and nutritional counseling, are essential. The goal is to improve both survival and quality of life for patients.
Dr. Sujun Han:
- Position: Associate Chief Physician, Department of Urology, National Cancer Center/Cancer Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College.
- Current Roles: Vice Chairman of the Youth Committee, Urology Physicians Branch, Chinese Medical Doctor Association. Member of the Prostate Cancer Quality Control Expert Committee, National Cancer Quality Control Center. Member of the Bladder Cancer Quality Control Expert Committee, National Cancer Quality Control Center. Standing Member of the Bladder Cancer Professional Committee, Chinese Anti-Cancer Association for Integrative Medicine. Member of the Kidney Cancer Group, Chinese Anti-Cancer Association Urology and Male Reproductive System Tumors Professional Committee. Member of the Urology and Male Reproductive System Tumors Professional Committee, China Human Health Science and Technology Promotion Association.
