Editor’s Note: This September, the 28th Annual Meeting of the Chinese Society of Clinical Oncology (CSCO 2025), one of China’s most prestigious oncology conferences, was successfully held in Jinan. During the prostate cancer session, Professor Jianming Guo from Zhongshan Hospital, Fudan University, delivered a talk titled “Development Prospects of the Prostate Cancer MDT Model in China.” Multiple experts shared the latest advances and clinical experience in the management of prostate and other urological malignancies. Following the conference, Oncology Frontier – Urology Frontier invited Professor Guo for an in-depth discussion.Building a Functional MDT for Prostate Cancer Care
Q: Prostate cancer MDT involves urology, medical oncology, radiation oncology, pathology, and other specialties. How do you ensure efficient collaboration and avoid a “siloed” approach in clinical practice? What experience can you share from your team’s work in MDT development?
Professor Guo: Indeed, prostate cancer management has fully entered the era of multidisciplinary team (MDT) care. How do we avoid each specialty working in isolation? The approach varies by region and hospital, but in China, urology usually plays the leading role. This is because most patients first present with urinary symptoms or elevated PSA discovered during health screening, and subsequent imaging and biopsy are usually performed by urologists. As a result, early-stage patients often undergo surgery under urology’s care. For patients with advanced or metastatic disease, multidisciplinary consultation is commonly initiated at the urology clinic to formulate a treatment plan—further strengthening the urology-led model.
The key to effective MDT collaboration lies in proper patient stratification. Typically, patients are divided into three groups: localized disease, locally advanced disease, and metastatic disease. Metastatic cases are further classified as hormone-sensitive or castration-resistant.For localized disease, two curative options exist: radical surgery or radical radiotherapy. The choice depends on age, physical condition, and concerns about complications. Involving radiation oncologists in the decision-making process enables patients to receive more balanced and individualized advice.When the disease is locally advanced or metastatic, systemic therapy becomes the focus alongside local treatment. In China, systemic therapy is sometimes led by urologists, sometimes by medical oncologists. Given the cardiovascular toxicity and other adverse effects of certain systemic agents—and the need for chemotherapy in some cases—cardiologists, pulmonologists, and other specialists may be consulted. Cardiovascular complications are a major cause of mortality among elderly cancer patients, often more so than the cancer itself. To address this, our hospital has set up a dedicated cardio-oncology outpatient clinic to provide coordinated care.
New radionuclide therapies are now entering clinical practice, requiring input from nuclear medicine specialists. For patients with HRR mutations—particularly BRCA mutations—PARP inhibitors may be considered, which means precise molecular diagnostics from pathologists are critical. Radiologists also play an essential role by helping define lesion sites and evaluate nodal involvement.
Overall, a urology-led model with stratified patient management and an MDT assembled according to disease stage greatly improves outcomes and the patient experience. Patients receive one-stop service without the burden of visiting multiple departments. Not all patients require full MDT review—MDT is reserved for complex or challenging cases. At Zhongshan Hospital, we hold a dedicated prostate cancer MDT clinic every Tuesday afternoon, which is open for patient consultation.
Prostate Cancer as a Chronic Disease: The Case for Comprehensive, Long-Term Management
Q: With advances in diagnostics and therapies, prostate cancer is increasingly seen as a chronic disease. How can MDT provide end-to-end, integrated care—from diagnosis to rehabilitation—to improve quality of life and ensure long-term follow-up?
Professor Guo:The reason prostate cancer is now managed as a chronic disease is the dramatic improvements in survival thanks to advances in treatment, especially the availability of novel hormonal agents. In localized early disease, the recurrence rate after radical therapy is extremely low, with over 90% of patients achieving long-term survival. Even for de novo metastatic disease (mHSPC), combining androgen-deprivation therapy (ADT) with novel hormonal agents and chemotherapy has pushed median overall survival beyond 53 months in high-risk patients, and up to 8 years or more in the general metastatic population. This stands in sharp contrast to other malignancies that often progress rapidly.
Management strategies have also evolved. In the past, physicians tended to reserve potent therapies for later lines, only switching after relapse. Today, the paradigm has shifted: highly effective treatments—including novel hormonal agents and radionuclide therapy—are being used earlier. PARP inhibitor combinations such as olaparib + abiraterone, niraparib + abiraterone, and talazoparib + enzalutamide are now recommended for first-line mCRPC treatment. Novel hormonal agents (abiraterone, darolutamide, enzalutamide, apalutamide) are increasingly used in the hormone-sensitive setting. The aim of this “early, intensive intervention” approach is to maximize PFS and OS rather than waiting until castration resistance develops.Managing comorbidities is equally crucial. Many elderly patients survive their cancer but succumb to cardiovascular disease or other conditions. MDT’s role is to coordinate care across disciplines—urology, medical oncology, radiation oncology, nuclear medicine, pathology, radiology, cardiology—to ensure drug interactions are minimized and comorbidities such as hypertension, diabetes, and heart disease are appropriately managed. This comprehensive approach reduces adverse events and improves survival outcomes. As treatment technology advances, we expect patient prognosis to continue improving.
The Future: AI and Big Data in MDT
Q: Looking ahead, what role do you see for artificial intelligence (AI) and big data in MDT—such as in diagnosis, prognostic prediction, and tele-consultation?
Professor Guo: AI has become a major focus in medicine. Our center has already conducted multiple studies on AI-assisted kidney cancer diagnosis, demonstrating that CT-based AI analysis can accurately differentiate benign from malignant tumors, assess aggressiveness, and predict prognosis.
In prostate cancer, the value of AI may be even greater. Prostate cancer is one of the few malignancies that absolutely requires biopsy for diagnosis and treatment planning. Imaging alone is often insufficient, but surgery without biopsy risks overtreatment and complications like urinary incontinence or sexual dysfunction. At the same time, biopsies can be delayed or refused by patients.
AI cannot completely replace biopsy, but it can significantly improve accuracy. Current biopsy accuracy is only around 50%. By integrating multi-modal imaging—multiparametric MRI, CT, PSMA-PET/CT, bone scans—AI could boost diagnostic precision and reduce unnecessary procedures.
AI also has great potential in surgical planning. For example, lymph node dissection is recommended only for high-risk patients, but individual variability can lead to under- or over-treatment. AI-assisted analysis of fluorescence imaging and PSMA scans could pinpoint nodes that truly require dissection, avoid unnecessary interventions, and reduce the risk of positive margins. At international meetings such as AUA and EAU, studies have been presented showing that real-time staining of surgical specimens combined with AI can confirm margin status intraoperatively an exciting development for clinical practice.
Finally, AI can enhance prognostic prediction. By building predictive models that integrate clinical, pathological, and imaging data, AI can stratify recurrence risk. This would allow clinicians to avoid overtreatment in low-risk patients and initiate timely adjuvant therapy such as radiotherapy or hormonal therapy—in those at high risk of biochemical recurrence or metastasis.Looking forward, AI’s integration into diagnostics, surgical guidance, and prognostic assessment promises to transform prostate cancer care, improving both clinical outcomes and patient quality of life.
