The “4th Annual Conference of the Urology Physicians Branch of the Chinese Medical Association (2024)” was successfully held in Beijing from April 13th to 14th. During the conference, Professor Qiang Wei from West China Hospital, Sichuan University, shared insights on “Standard Treatment of mHSPC in the Era of Novel Hormonal Therapy.” Subsequently, “Oncology Frontier – Urology News” invited Professor Qiang Wei to discuss the significance of early initiation of novel hormonal therapy for mHSPC patients, the comparison between dual and triple therapy, and precise treatment selection strategies.
“Oncology Frontier – Urology News”: In China, mHSPC patients are often older, in poor physical condition, and have a low rate of PSA normalization during treatment. What benefits do you think early initiation of novel hormonal therapy can bring to patients?
Professor Qiang Wei: Prostate cancer patients in China often present at later stages, with many cases already diagnosed at the metastatic stage. For such patients, it’s crucial to rapidly and effectively control disease progression. Initiating the use of novel hormonal therapy drugs as soon as possible is essential. Studies have shown that if patients achieve a serum prostate-specific antigen (PSA) level below 0.2 ng/ml within 7 months of treatment, their survival will be significantly prolonged.
Therefore, both clinical practice and major treatment guidelines emphasize the early use of novel hormonal therapy drugs, combined with androgen deprivation therapy (ADT), to rapidly reduce patients’ PSA levels to below 0.2 ng/ml. Currently, there are various types of novel hormonal therapy drugs, including apalutamide, darolutamide, enzalutamide, abiraterone, and domestically produced relugolix. Early use of these drugs helps improve patients’ survival outcomes.
“Oncology Frontier – Urology News”: Novel androgen deprivation therapy significantly improves the survival rate of metastatic prostate cancer and has become the standard recommended treatment. How do you view dual therapy compared to triple therapy?
Professor Qiang Wei: Current clinical guidelines recommend the combination of androgen deprivation therapy (ADT) with novel hormonal therapy drugs for the treatment of metastatic castration-sensitive prostate cancer. This treatment strategy includes dual therapy with ADT and drugs such as apalutamide, enzalutamide, darolutamide, abiraterone, or relugolix.
Triple therapy has also received widespread attention recently, which involves combining ADT with darolutamide and chemotherapy drugs, or ADT with abiraterone and chemotherapy drugs. This triple treatment regimen is an intensified combination therapy model that adds docetaxel to the standard ADT and novel hormonal therapy drugs. For patients with a high tumor burden, this regimen can effectively and rapidly control symptoms, thereby improving patient prognosis.
“Oncology Frontier – Urology News”: For mHSPC patients with a high tumor burden, how can treatment strategies be selected to prolong survival and delay progression to mCRPC?
Professor Qiang Wei: For patients with high tumor burden metastatic castration-sensitive prostate cancer, it is recommended to initiate ADT combined with novel hormonal therapy as early as possible to initiate systemic treatment promptly. Secondly, intensify treatment by adding docetaxel chemotherapy to the existing ADT combined with novel hormonal therapy. In addition to the above medications, other drugs can be used as needed. For example, for patients with extensive bone metastases, drugs to prevent skeletal-related events, such as zoledronic acid and denosumab, can be added. For symptomatic patients, such as those with lower urinary tract symptoms, symptomatic treatment drugs can also be used.
“Oncology Frontier – Urology News”: What are your expectations for the future application of novel hormonal therapy drugs in prostate cancer?
Professor Qiang Wei: Novel hormonal therapy drugs have been widely used in the clinical management of prostate cancer. Especially in the mHSPC stage, these drugs have become the gold standard of treatment. For metastatic castration-resistant prostate cancer (mCRPC), due to the previous widespread use of first-generation anti-androgen drugs such as bicalutamide and flutamide, when the disease progresses to the CRPC stage, it is necessary to switch to the use of novel hormonal therapy drugs.
The application of novel hormonal therapy drugs can be divided into two main scenarios: one is for newly diagnosed mHSPC patients, and the other is for patients who were originally in the mHSPC stage and received first-generation anti-androgen therapy but have now progressed to the mCRPC stage. In addition, future clinical research data in locally high-risk patients may support the use of novel hormonal therapy drugs in the perioperative or postoperative period.
Professor Qiang Wei
Director, Department of Urology, West China Hospital, Sichuan University
Director of Sichuan Province Kidney Disease and Urology Clinical Research Center
Vice Chairman of the Urology Physicians Branch of the Chinese Medical Association
Vice Chairman of the Urology Physicians Branch of the Chinese Physician Association
Vice Chairman of the Male Reproductive Tumor Special Committee of the Chinese Anti-Cancer Association
Vice Chairman of the Prostate Cancer and Renal Cancer Special Committee of the Chinese Society of Clinical Oncology (CSCO)
Chairman of the Robotic Surgeons Branch of the Sichuan Medical Association
Chairman of the Male Reproductive Tumor Special Committee of the Sichuan Anti-Cancer Association
Chairman of the Urology Branch of the Chengdu Medical Association
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