In recent years, the incidence of prostate cancer in China has continued to rise, creating an urgent need to improve diagnostic and treatment strategies tailored to this growing patient population. At the 5th Annual CUDA Yanqi Lake Meeting (2025), hosted by the Chinese Urological Doctor Association, UroStream invited Professor Liqun Zhou, Institute of Urology, Peking University, to discuss the importance of early screening, optimized diagnostic approaches, and advances in neoadjuvant therapy. His insights point toward practical steps for enhancing the survival and quality of life of prostate cancer patients in China.

UroStream: Prostate cancer incidence in China continues to rise, and one major reason is the low rate of early screening. How do you think PSA screening and other early detection strategies should be optimized to promote earlier diagnosis in high-risk populations?

Professor Liqun Zhou: The rising incidence of prostate cancer in China is the result of several converging factors. First, with the continuous increase in life expectancy, prostate cancer—a disease that predominantly affects older men—naturally becomes more prevalent. Second, advancements in diagnostic technologies have made early detection more feasible. Although PSA screening is not yet widely implemented at a population level, the broader use of PSA testing during routine check-ups, as well as imaging tools such as MRI and ultrasound, along with biopsy procedures, has led to increased identification of early-stage cases. Third, lifestyle changes, particularly the increasing adoption of Western dietary habits including higher red meat consumption, are also believed to contribute to the rising incidence.

Despite these developments, the clinical management of prostate cancer in China still faces many challenges, and as urologists, we carry a significant responsibility. Data from the CUA-CPCC national clinical database highlights a concerning trend: among over 20,000 newly diagnosed prostate cancer cases collected from more than 30 top-tier hospitals, only 42% were diagnosed at an early stage. A striking 58% had either locally advanced disease (28%) or distant metastases (30%) at the time of diagnosis. This clearly illustrates the urgent need to improve early detection rates.

Experience from developed countries has shown that community-based PSA screening can significantly increase the proportion of early-stage diagnoses. However, given China’s massive population, implementing widespread PSA screening would require enormous financial investment—something that may not be economically feasible at the national level for now. From a professional standpoint, we recommend that PSA testing, along with digital rectal examination (DRE) and non-invasive imaging such as ultrasound, be included in annual health checks for men over the age of 50. For individuals with a family history of prostate cancer—such as those with a father, grandfather, or brother previously diagnosed—the starting age for screening should be lowered to around 45.

It is also important to recognize the trend of prostate cancer appearing in younger men. In my clinical experience, the youngest patient to undergo radical prostatectomy was only 37 years old, which is a clear indication that the disease is gradually affecting younger populations.

In conclusion, making full use of routine physical examinations to include PSA testing is essential for promoting early diagnosis and intervention. This is especially important for men over 50, and for those over 45 with a family history. Such measures can significantly improve outcomes for prostate cancer patients across China.

UroStream: Prostate cancer in China is increasingly affecting younger patients. As a urologic surgery expert, what are the technical challenges of preserving sexual function during radical prostatectomy? How do you balance complete tumor removal with function preservation?

Professor Liqun Zhou: With continuous improvements in living standards and medical technology, our philosophy and practice in prostate cancer treatment have undergone significant change—particularly regarding patients’ expectations for preserving sexual function. In the past, due to traditional cultural views and economic limitations, many middle-aged and older men paid little attention to sexual function preservation and postoperative recovery when undergoing radical prostatectomy. Today, however, even patients in their 70s or 80s express clear expectations for preserving sexual function post-surgery. This shift reflects not only social progress but also a growing emphasis on quality of life.

The top priority in prostate cancer treatment is still complete tumor removal. If the tumor cannot be fully excised, the patient’s survival is at risk, and no further treatment can truly be effective. That is why early detection, diagnosis, and intervention are so crucial. For patients diagnosed at an early stage, preserving sexual function—provided that radical cure is achievable—has become an important consideration. Sexual function is not only critical to quality of life but is also physiologically tied to faster recovery of urinary continence, since the neurovascular bundles involved in sexual function are also essential for sphincter control.

Surgical techniques have evolved considerably, from open surgery to laparoscopic procedures, and now to robot-assisted surgery. These advancements have made it possible to perform more precise operations, particularly in early-stage patients undergoing intrafascial radical prostatectomy. With enhanced surgical accuracy, we can achieve both complete tumor removal and better preservation of sexual function, while reducing the risk of postoperative transient or stress urinary incontinence.

UroStream: At the recent EAU 2025 Congress, you and your team explored neoadjuvant therapy strategies for prostate cancer. How do these approaches contribute to improving survival outcomes in China, and what future directions are worth pursuing?

Professor Liqun Zhou: In fact, research into neoadjuvant therapy for prostate cancer began over 15 years ago. At that time, the standard approach primarily involved combined androgen blockade (CAB) using first-generation anti-androgens. However, due to limitations in both therapeutic efficacy and available medical technology, these regimens required at least eight months before any significant apoptosis of tumor cells could be observed. This lengthy treatment window was difficult for both patients and clinicians to manage, leading to disappointing results. As a result, earlier clinical guidelines often dismissed neoadjuvant therapy as ineffective or unnecessary.

With ongoing medical advancements and the emergence of new-generation anti-androgen agents—such as enzalutamide and abiraterone—the landscape has changed dramatically. These newer therapies, when used in combination with androgen deprivation therapy (ADT), have shown significant promise as neoadjuvant treatments. Numerous international studies have demonstrated that in high-risk patients—those with T3/T4 tumors, high ISUP grades, or lymph node involvement—combining next-generation anti-androgens with ADT can lead to improved prognosis.

Chinese researchers have also been actively exploring this field. For example, Professor Wei Xue’s team at Renji Hospital, Shanghai Jiao Tong University, has reported on the use of preoperative chemotherapy in prostate cancer, highlighting its potential to enhance treatment efficacy. Similarly, our team at the Peking University Urology Research Institute is conducting related studies, and one of our neoadjuvant treatment projects was recently selected for presentation at EAU 2025.

In summary, the development of novel anti-androgens and the introduction of chemotherapy-based regimens have revitalized interest in neoadjuvant therapy for prostate cancer. These advances have not only renewed clinical recognition of its value but also hold the potential to reshape future treatment guidelines. As research deepens and clinical experience expands, neoadjuvant therapy is expected to become an integral component of prostate cancer management—ultimately improving outcomes and quality of life for patients.

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Professor Liqun Zhou

MD, Associate Professor (Level II), Chief Physician, Doctoral and Postdoctoral Supervisor

• Director, Institute of Urology, Peking University
• Chair, Department of Urology, Peking University Health Science Center
• Honorary Director, The First Affiliated Hospital of Henan University
• Former Chair, and now Honorary Chair, Urology Branch of the Chinese Medical Doctor Association (CMDA)
• Executive Member, Urology Branch, Chinese Medical Association
• Deputy Chair, Urology Branch, Beijing Medical Association
• Member, Urologic Oncology Committee, Chinese Anti-Cancer Association
• Standing Committee Member, Translational Urology Expert Working Group, CMDA
• Vice Chair, Functional Urology Expert Committee, CMDA
• Standing Deputy Chair, Precision Urology Expert Committee, CMDA
• Chair, Admissions Committee, CUDA Micro-Invasion and Robotics Group
• Chair, CUA Micro-Invasion Expert Committee
• Chair, CUA Collaboration Group on Prostate Cancer
• Chair, CUA UTUC Diagnosis and Treatment Expert Panel
• Chinese Editor-in-Chief, Journal of Clinical Oncology (Chinese Edition, Urologic Oncology Section)
• International Editorial Board Member, The Journal of Urology

Recognized as a top-tier academic leader by Henan University and awarded the title of Distinguished Professor. He is a recipient of the CUA Golden Scalpel Award, National Medical Outstanding Contribution Award, and the Outstanding Chinese Urologist Contribution Award (World Chinese Urological Association).

He has published over 610 academic papers, including more than 260 in English and over 160 as first or corresponding author in international journals. He has led numerous national and ministerial-level research projects, including major initiatives under the “863” Program and national key R&D programs. He has served as principal investigator for over 15 national-level and special-focus projects. In addition, he has served as editor-in-chief of 7 academic monographs and authored 2 specialized volumes.