Time rewards those who strive, and success comes to those who persevere. As 2023 draws to a close, the year has left behind many noteworthy achievements in China’s field of urology, especially in the areas of prostate cancer surgery and drug treatments. On this occasion, Urology Frontier interviewed Xu Zhang, Academician of the Chinese PLA General Hospital and a pioneer in laparoscopic techniques in China’s urological surgery. In this interview, he shared significant developments in surgical and medical treatments for prostate cancer over the past year.

Innovative Urological Techniques: Chinese Doctors Leading a New Revolution

Urology Frontier: As a pioneer and leader in laparoscopic urological surgery in China, can you tell us about the most significant changes in prostate cancer surgery in recent years, especially in the past year?

Academician Xu Zhang: Over the past two or three decades, we have witnessed and participated in a major “technological revolution” in surgery. We’ve established a laparoscopic theory and system with Chinese characteristics and introduced robotic surgery technology. These advancements have gradually transformed traditional treatment methods for urological diseases. In the era of open surgery, incisions were large, the operations were rough, and the trauma to patients was significant. However, with the development and application of laparoscopic and robotic surgeries, urology has undergone a remarkable transformation.

In prostate cancer surgery, this shift has been especially pronounced. The prostate is located deep within the pelvic floor, surrounded by complex structures, and operates in a confined space, making the procedure extremely challenging. In the past, open radical prostatectomies were fraught with the risk of massive bleeding, which compromised visibility and often resulted in incomplete tumor removal or damage to critical structures that affected postoperative urinary control and sexual function.

With the advent of laparoscopic and robotic-assisted surgeries, we’ve seen significant improvements. Robotic surgery, in particular, allows for an almost complete view and control during the procedure. The 3D high-definition visual system of robotic surgery magnifies the surgical field by 10 to 15 times, enabling us to see the anatomical structures more clearly. Another crucial feature is the flexibility of the robotic arms, which function like a miniature version of our wrists, shrinking down to 8 millimeters in size, allowing for more precise anatomical dissection. This precision makes robotic-assisted radical prostatectomy a highly effective and targeted treatment, ensuring maximum tumor removal while preserving vital structures for urinary control and sexual function.

Looking back at 2023, the most significant change in the field of prostate cancer surgery—and urology as a whole—has been the domestic production of robotic surgery systems. While China initially imported Da Vinci robots from abroad, the development of homegrown robotic systems has been a game-changer, providing a safe, reliable, and more accessible option for Chinese doctors and patients, especially in regions where imported systems are not feasible due to cost or availability.

Another notable development has been the strides we’ve made in developing intelligent and remote-controlled robotic technology. In 2023, we successfully performed several long-distance “remote” surgeries, including radical prostatectomies, linking cities such as Beijing and Sanya, Beijing and Harbin, and Hangzhou and Xinjiang. These remote surgeries allow top-quality surgical techniques from metropolitan centers like Beijing and Shanghai to reach patients in remote areas, offering them access to cutting-edge surgical care without the need to travel.

China Made a Breakthrough in Drug Innovation, Offering Better ADT Options for Prostate Cancer Patients

Urology Frontier: Besides the innovations in surgical techniques, what advancements have been made in drug therapies for prostate cancer in China over the past year?

Academician Xu Zhang: As a urologist, I treat many prostate cancer patients. With economic development, the incidence of prostate cancer in China has been increasing, and given our large population, the number of prostate cancer patients is significant. Prostate cancer is now one of the most common malignant tumors in urology departments across many hospitals.

In recent years, medical technology has rapidly advanced, and prostate cancer treatment now includes various surgical, medical, and radiation therapies. We focus on the comprehensive management of prostate cancer, from early screening and diagnosis to providing individualized treatment plans. Throughout the treatment process, androgen deprivation therapy (ADT) remains a cornerstone. Despite the emergence of new endocrine therapies (NHT), PARP-targeted therapies, and other novel drugs, ADT remains the foundation of prostate cancer treatment.

In 2023, Chinese pharmaceutical companies made impressive progress in drug innovation, particularly in the development of new and improved ADT formulations. One of the standout achievements is the Goserelin microsphere, an improved formulation of the classic drug used in castration therapy for prostate cancer. Previously, Goserelin was administered as an implant, but the new microsphere formulation is a modified drug that offers equivalent efficacy, fewer side effects, and improved patient compliance. This microsphere technology had long been monopolized by Western countries, and its breakthrough marks a significant achievement for Chinese pharmaceutical innovation.

The Goserelin microsphere, developed using second-generation microsphere technology, highlights China’s ability not only to innovate in targeted drug therapies but also in drug formulations. This drug has been included in the updated National Medical Insurance Drug List, effective from January 1, 2024. We are thrilled that more Chinese patients will have access to this “made in China” medicine, helping to contribute to the vision of a “Healthy China 2030.”

Academician Xu Zhang

• Academician, Chinese PLA General Hospital

• Director, Department of Urology, PLA General Hospital

• Committee Member, Chinese Academy of Medical Sciences

• Chair-elect, Chinese Urological Association

• Chair, Beijing Urological Association

• Deputy Director, China Organ Donation Management Center

• Chair, Minimally Invasive Urological Surgery and Robotics Committee, China Anti-Cancer Association

• Member, Central Health Protection Committee Expert Group

• Director, PLA Trauma and Surgery Laboratory

• Chief Scientist, National High-Tech R&D Program and PLA Major Scientific Projects

• Recipient of the National Science and Technology Progress Award

• Founder of Laparoscopic and Robotic Urological Surgery in China

• Editor-in-Chief of Bladder and Journal of Minimally Invasive Urology