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 organized with the Annual Meeting of the Chinese Society of Clinical Oncology Prostate Cancer Committee (CSCO-PC), the Chinese Anti-Cancer Association Genitourinary Oncology Committee (CACA-GO) Prostate Cancer Meeting, and the Annual Conference of the Chinese Prostate Cancer Consortium (CPCC). With the theme “Global Vision · Chinese Practice · Precision Breakthrough,” the event attracted numerous domestic and international experts to share the latest advances and real-world experiences in prostate cancer.Professor Philip Kwong from the Integrated Oncology Centre (IOC), Hong Kong, delivered a presentation titled “Metastatic Hormone-Sensitive Prostate Cancer: New Strategies, New Horizons”, and in an exclusive interview with Oncology Frontier – UroStream, shared additional insights on research and clinical practice in the mHSPC field.
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Oncology Frontier: Currently, ADT+ARPI has become the new standard for mHSPC. Faced with a variety of ARPIs, how do you think we should make individualized choices for different mHSPC patients?
Dr. Philip Kwong: Now we have four ARPIs that can be used together with ADT in mHSPC, including abiraterone, enzalutamide, apalutamide, and the latest darolutamide. Although we don’t have head-to-head trial data, based on real-world experience and previous studies, the efficacy and survival benefit of these four drugs are similar, and the toxicity is more or less the same. When choosing, we can analyze these drugs one by one.
Abiraterone is the oldest drug available, and we are more familiar with it, but it has to be used together with steroids. For patients with diabetes, we might be more cautious about using steroids. However, there are now generic versions of abiraterone, which are cheaper, so it could be a good option for patients with financial concerns. Enzalutamide is always a concern due to its CNS side effects, but in the mHSPC setting, these side effects are less frequent and less severe. Apalutamide is similar to enzalutamide but with fewer CNS side effects, and the more common adverse events are skin disorders. Darolutamide is a newer drug with less CNS penetration, which may make it a better choice for patients with pre-existing CNS disease or those taking multiple medications. Overall, all four drugs can be used in almost every patient, and the choice really depends on individual patient characteristics and financial considerations.
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Oncology Frontier: The ITT population in the H group of the STAMPEDE trial did not benefit from the combined radiotherapy regimen, but there was a survival benefit in the low-volume subgroup. Faced with different results, how do you view the value of radiotherapy for mHSPC?
Dr. Philip Kwong: These results show that we have to choose the patients very carefully and can’t use the same treatment for all patients. For high-risk patients or those with high-volume disease, the disease is very aggressive and there are many metastases. We need to treat them aggressively with systemic treatments like ADT plus ARPI or chemotherapy. For these patients, boosting the primary prostate cancer probably won’t change the scenario very much. But for low-volume disease, especially very small volume disease, the systemic treatment is already very good at controlling the disease. Boosting the primary tumor in this case is likely to improve survival. Nowadays, with PSMA PET-CT, we are finding more and more patients with oligo-metastasis. For these patients, we will not only give radiotherapy to the primary tumor but also consider giving precise radiotherapy to the oligo-metastasis. This will certainly improve overall survival and disease control. So we have to choose the patient very carefully to avoid overtreatment.
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Oncology Frontier: Currently, de-escalation therapy is a research hotspot in the mHSPC field. How can we achieve precise de-escalation of treatment based on molecular typing and liquid biopsy?
Dr. Philip Kwong: This is a follow-up discussion, actually a continuation of my previous talk. For patients with oligo-metastasis, we can give more local or precise treatment, and then hope to continue with less treatment for the patient. For mHSPC, the traditional concept is to give the same treatment to all patients until progression. But for patients with small volume disease or less risky disease, we might be able to use fewer drugs or even stop some drugs after achieving the best response. Molecular sequencing is a newer approach, and we are still in the infancy stage. But with a better understanding of different molecules and mutations, we might be able to identify patients who are more sensitive to hormones or other inhibitors and tailor-make the treatment for all patients. We are doing a lot of studies, and hopefully, in four or five years, we can have more positive results and apply it to most patients.
