2025 Pujiang Prostate Cancer Conference
Editor’s Note: The 2025 Pujiang Prostate Cancer Academic Conference—held from June 27 to 28 in Shanghai—was jointly hosted by the Chinese Society of Clinical Oncology Prostate Cancer Committee (CSCO-PC), the Chinese Anti-Cancer Association Genitourinary Oncology Committee (CACA-GO), and the China Prostate Cancer Consortium (CPCC). With the theme "Global Wisdom, Chinese Practice, and Precision Breakthroughs," the conference brought together leading experts from China and abroad to discuss the latest advances and best practices in prostate cancer care. At the meeting, Professor Qiang Wei from West China Hospital, Sichuan University, delivered an insightful presentation on treatment escalation and de-escalation in metastatic hormone-sensitive prostate cancer (mHSPC) and shared key clinical perspectives in an interview with Oncology Frontier – UroStream.01
Oncology Frontier – UroStream Based on your clinical practice, how would you describe the characteristics of mHSPC in China and the recent trends in diagnosis and treatment?
Professor Qiang Wei: In recent years, the incidence of prostate cancer has been rising rapidly in China, with mortality rates also showing a clear upward trend. Compared to developed Western countries, the proportion of patients in China diagnosed at the metastatic stage remains significantly higher, which leads to a markedly increased risk of death.
Metastatic hormone-sensitive prostate cancer (mHSPC) can be divided into two main types: synchronous and metachronous. Synchronous mHSPC refers to patients who already have distant metastases at the time of their initial diagnosis and who are still sensitive to hormone therapy or have not yet initiated hormonal treatment. Metachronous mHSPC refers to those who were originally diagnosed with localized prostate cancer, underwent local treatment such as surgery or radiotherapy, and later developed biochemical recurrence followed by distant metastasis—yet still remain sensitive to androgen deprivation therapy (ADT).
These two types of mHSPC differ in clinical presentation and treatment strategy, and therefore should be approached differently in both diagnosis and management.
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Oncology Frontier – UroStream Current mHSPC treatment strategies include both doublet and triplet regimens. In clinical practice, how should PSA trends, imaging findings, and symptom evolution be integrated to guide individualized treatment decisions?
Professor Qiang Wei: In recent years, the landscape of systemic therapy for mHSPC has undergone significant transformation. Traditionally, treatment options were limited—primarily consisting of androgen deprivation therapy (ADT) combined with first-generation androgen receptor antagonists. Once patients progressed to the mCRPC stage, chemotherapy was the mainstay treatment.
However, with the emergence of multiple novel agents, clinicians now have a broader array of therapeutic choices. These include next-generation androgen receptor signaling inhibitors (ARSi) such as abiraterone, apalutamide, enzalutamide, and darolutamide; chemotherapeutic agents like docetaxel and cabazitaxel; radionuclide therapies such as radium-223 and lutetium-177 PSMA; and PARP inhibitors targeting homologous recombination deficiency (HRD) gene alterations, including germline BRCA mutations.
Currently, systemic treatment options for mHSPC fall into two primary categories:
- Doublet therapy: ADT plus a novel ARSi, now considered the standard of care for most patients with mHSPC.
- Triplet therapy: ADT combined with both a novel ARSi and docetaxel, typically reserved for patients with high-volume disease. Before initiating this intensified regimen, clinicians should thoroughly discuss potential toxicities and financial implications with the patient.
Furthermore, for patients who progress to mCRPC, personalized strategies can be employed: those harboring germline BRCA mutations or other HRD-related alterations may benefit from PARP inhibitors, while patients with PSMA-positive disease may be eligible for lutetium-177 PSMA-targeted radioligand therapy. These options offer further survival benefit in appropriately selected individuals.
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Oncology Frontier – UroStream Homologous recombination repair (HRR) mutations—particularly BRCA mutations—are known to worsen prognosis. For patients with mHSPC, how can we select precision treatment strategies to improve outcomes?
Professor Qiang Wei: This is a very important question. Indeed, patients with homologous recombination deficiency (HRD) mutations—especially those with BRCA mutations—tend to have poorer prognoses. For such patients, once the disease progresses to the mCRPC stage, three large randomized controlled trials—PROpel, MAGNITUDE, and TALAPRO-2—have demonstrated the clinical efficacy of combining PARP inhibitors (PARPi) with next-generation endocrine therapy and ADT. These studies confirm that PARPi-based precision therapy offers clear clinical benefits as a first-line treatment in specific patient populations, particularly those harboring HRD mutations.
However, whether this strategy can or should be implemented earlier, at the mHSPC stage, remains uncertain, as we currently lack robust phase III randomized clinical trial evidence in that setting. That said, there is a compelling rationale to believe that early intervention with targeted therapies in HRD-positive patients may delay progression to mCRPC. Still, this hypothesis must be validated through further clinical research.
