Editor's Note: From August 8-11, 2024, the Annual Meeting of the Chinese Urological Association (CUDA) was held in Xi'an, hosted by the Chinese Medical Doctor Association and its Urological Physician Branch, organized by Xijing Hospital of the Air Force Medical University, and co-hosted by the Urology Physician Branch of the Shaanxi Medical Doctor Association. Under the theme "Healthy China, Urology First," the conference showcased the latest advancements in urology from a broad perspective and multiple dimensions. On the first day of the academic sessions (August 9), Urology Frontier interviewed the conference host, Dr. Jianming Guo from Zhongshan Hospital affiliated with Fudan University, to share insights on the unmet clinical needs of prostate cancer in China, recent breakthroughs in clinical research, and future exploration directions.Urology Frontier: Could you elaborate on the unmet clinical needs of prostate cancer patients in China?
Dr. Jianming Guo: The number of prostate cancer patients in China is rapidly increasing. According to the latest data released by the National Cancer Center, the annual number of new cases has grown from 88,000 in 2015 to 134,200 in 2022. Given the large patient population, three main areas of unmet needs stand out:
- Early Detection: With the rising number of prostate cancer patients, we need to detect early-stage cases more efficiently. In developed countries like those in Europe and the U.S., approximately 95% of diagnosed prostate cancer patients are in the early stages. Unfortunately, many patients in China are diagnosed at an advanced stage, which is a significant loss. Although the early detection rate of prostate cancer in China is gradually improving with the promotion of prostate-specific antigen (PSA) screening, MRI, PET-CT, and prostate biopsy, there remains a substantial gap compared to Western countries. This disparity is largely due to issues with accessibility and affordability. For instance, Prostate-Specific Membrane Antigen (PSMA) PET/CT is not yet widely available in China, hindering the detection of metastases and the use of PSMA-targeted therapies.
- Surgical Treatment: For early-stage prostate cancer patients, surgical options have evolved from open surgery to laparoscopic surgery and now to robotic surgery. Robotic surgery is known for its precision, reduced bleeding, and better preservation of urinary and sexual functions. However, a significant drawback in China is the limited availability of robotic systems, with only about 400 units nationwide compared to over 6,000 in the U.S. Considering China’s large population, the demand for robotic surgical systems is expected to surge. On a positive note, China has been using the Da Vinci Surgical System for over a decade, accumulating rich experience. Domestic robotic systems have also been approved and are gradually entering clinical practice, showing promising development potential.
- Advanced Prostate Cancer: For patients with advanced prostate cancer, the challenge lies in extending survival and improving quality of life after developing castration resistance. In the metastatic hormone-sensitive prostate cancer (mHSPC) stage, first-line treatment with new endocrine therapies has significantly improved overall survival (OS). However, when patients progress to metastatic castration-resistant prostate cancer (mCRPC), the available treatment options are relatively limited. Although many clinical trials are ongoing, major breakthroughs have yet to emerge.
In summary, the three primary unmet needs for prostate cancer patients in China are early detection, surgical treatment, and advanced disease management, all of which require ongoing efforts to address.
Urology Frontier: In recent years, Fudan University-affiliated Zhongshan Hospital has achieved several research breakthroughs in prostate cancer. How have these findings impacted patient outcomes?
Dr. Jianming Guo: Like our colleagues across the country, the number of prostate cancer patients treated at Zhongshan Hospital has increased with rising incidence and detection rates. In terms of treatment, we have progressed from early open surgeries and laparoscopic procedures to robotic surgeries. At the end of 2009, we acquired our first Da Vinci Surgical System, becoming one of the first units in the country to perform Da Vinci robotic prostatectomy. To date, we have completed over 5,000 prostate cancer surgeries, bringing substantial benefits to patients. We have also participated in clinical trials for domestic minimally invasive Tumai® surgical robots. During this process, our young and middle-aged doctors contributed to device improvements, securing patents that have been applied in clinical practice. I believe that the integration of medicine and engineering, as well as collaboration between clinicians and industry, will jointly promote the development of innovative surgical instruments in China.
In clinical research, we were among the first to implement a multidisciplinary team (MDT) approach for integrated prostate cancer diagnosis and treatment. In basic research, we are involved in national projects related to gene typing of mCRPC. Surgically, we pioneered transvesical single-port robotic surgery, offering surgical opportunities to patients with a history of abdominal surgery and better protection of periprostatic tissues, leading to faster recovery of urinary control. In radiation therapy, we were early adopters of Radium-223, brachytherapy, and are currently conducting research on Lutetium-177 PSMA (177Lu-PSMA) for treating prostate cancer bone metastases. Clearly, we are engaged in various research or clinical applications across gene testing, surgery, radiotherapy, radioligand therapy, and medical treatment. However, we must continue to learn from more colleagues, constantly progress, and achieve further breakthroughs.
Urology Frontier: What areas of prostate cancer treatment merit further exploration in the future?
Dr. Jianming Guo: In diagnosis, prostate cancer still requires biopsy for confirmation, unlike most other tumors. Therefore, we are continually considering how to improve the precision and accuracy of prostate cancer diagnosis through imaging, potentially reducing or even eliminating the need for biopsy.
In treatment, further reducing invasiveness is also worth exploring. Although robotic surgery has significantly reduced trauma compared to the past, even minimally invasive procedures still involve some trauma. Postoperatively, some patients may experience urinary incontinence for a period, unable to achieve complete immediate urinary control. Previous attempts at non-surgical treatments, such as radiofrequency ablation, cryotherapy, irreversible electroporation, and radiotherapy, have shown both advantages and limitations. In the future, if we can achieve excellent treatment outcomes with drug therapy, many patients may avoid surgery. For example, current endocrine treatments have already significantly extended OS in many elderly patients. If we can effectively distinguish which tumors are indolent, surgery may be unnecessary. For elderly patients, exploring ways to further enhance quality of life without compromising health is also an essential direction for future research.
Dr. Jianming Guo
- Director, Department of Urology, Zhongshan Hospital, Fudan University
- Professor, Doctoral Supervisor
- Standing Committee Member, Urology Branch, Chinese Medical Doctor Association
- Member, Oncology Group, Urology Branch, Chinese Medical Association
- Vice Chair, Urology Branch, Shanghai Medical Association, and Chair of the Oncology Group
- Vice Chair, Urological Oncology Professional Committee, Shanghai Anti-Cancer Association
- Vice Chair, Urology and Andrology Branch, Shanghai Association of Integrative Medicine
- Standing Committee Member, Urological System Tumor Professional Committee, Chinese Anti-Cancer Association
- Standing Committee Member, Male Reproductive System Tumor Professional Committee, Chinese Anti-Cancer Association
- Standing Committee Member, Prostate Cancer and Urothelial Cancer Professional Committee, Chinese Society of Clinical Oncology
- Vice Chair, Urology Branch, Chinese Society of Sexual Medicine
- Standing Committee Member and Deputy Secretary General, World Association of Chinese Urological Surgeons
- Vice Chair, Urology Branch, Cross-Strait Medicine Exchange Association
- Vice Chair, Urology and Andrology Professional Committee, Chinese Geriatrics Society
