Editor’s Note: The 15th Shanghai Urological Oncology Academic Conference, hosted by the Shanghai Anti-Cancer Association and jointly organized by the Urological Oncology Committee of the Shanghai Anti-Cancer Association and Fudan University Shanghai Cancer Center, was grandly held in Shanghai from December 12 to 14, 2025. Centered on the theme “Precision Integration · Intelligent Leadership,” the conference brought together leading domestic and international experts to conduct in-depth discussions and exchanges, comprehensively analyzing disruptive advances in the field of urological oncology over the past year. At this conference, Professor Bo Dai from Fudan University Shanghai Cancer Center delivered an outstanding presentation entitled “Interpretation of the 2025 Expert Consensus on the Full-Course Management of Prostate Cancer.” In an interview with UroStream, Professor Dai further shared his perspectives on the background of the consensus, molecular imaging, and emerging concepts in oligometastatic disease management.UroStream: Could you introduce the background, development process, and clinical significance of the Expert Consensus on the Full-Course Management of Prostate Cancer (2025 Edition)?
Professor Bo Dai: Work on expert consensus regarding the full-course management of prostate cancer has been ongoing for several years. The version released this year represents the 2025 edition, incorporating a series of updates based on prior versions. The development of this consensus was driven by several key considerations. First, prostate cancer has now become the most common malignant tumor of the urinary system in China, imposing a substantial disease burden. Second, many Chinese patients are diagnosed at an advanced stage, which contributes to overall treatment outcomes and prognoses that remain inferior to those seen in Western countries, with an approximate 20% gap in 5-year overall survival. In addition, disparities persist among hospitals at different levels in China, with some primary-level institutions lacking standardized management or timely updates in knowledge, resulting in missed opportunities to provide optimal and up-to-date treatments.
Against this backdrop, the Male Genitourinary Oncology Committee of the Chinese Anti-Cancer Association, under the leadership of Chairman Professor Ye Dingwei, organized the development of this consensus. Multiple large medical centers with extensive experience in prostate cancer management were invited to participate. Senior experts from these centers served as advisors or reviewers, while a group of mid-career experts, including myself, acted as principal authors. A total of seven lead authors collaborated by dividing responsibilities across early-stage, intermediate-stage, and advanced-stage disease, as well as the entire disease spectrum from castration-sensitive to castration-resistant prostate cancer. Drafts were then reviewed, revised, and finalized through expert evaluation.
This consensus was written strictly in accordance with internationally recognized methodologies for clinical guideline and consensus development. Prior to publication, all members of the Male Genitourinary Oncology Committee voted on the proposed recommendations, ensuring that only viewpoints and strategies endorsed by the vast majority of experts were incorporated into the final document. As a result, the consensus adheres to international standards in both structure and rigor. It covers a broad scope, ranging from screening, early biopsy techniques, and diagnostic technologies, to the management of localized, locally advanced, metastatic hormone-sensitive, and metastatic castration-resistant prostate cancer, addressing key issues across every stage of disease management.
We hope that following the release of the 2025 consensus, a series of nationwide educational programs will help physicians, particularly those in primary-level hospitals, to better understand and implement these recommendations in clinical practice, ultimately improving outcomes for patients and significantly elevating the overall standard of prostate cancer care in China.
UroStream: The consensus discusses several cutting-edge diagnostic technologies, such as PSMA-PET imaging. When PSMA-PET findings are inconsistent with conventional imaging, how should clinicians make decisions based on your experience?
Professor Bo Dai: A substantial portion of the consensus addresses molecular imaging modalities such as PSMA PET-CT and PSMA PET-MR. In the past, only a limited number of major centers were capable of performing these examinations, primarily within the context of clinical research. However, with the continued development of multidisciplinary urological oncology teams and advances in nuclear medicine, an increasing number of institutions are now able to implement molecular imaging in routine practice. Therefore, the consensus emphasizes the importance of discussing the role of molecular imaging in disease staging, treatment response assessment, and lesion localization.
Regarding the question of how to proceed when conventional imaging results differ from PSMA-PET findings, the consensus recommends that molecular imaging results should play a decisive role in guiding treatment strategies. Conventional CT and MRI often have limited sensitivity in detecting low-volume disease, particularly in clinical scenarios such as biochemical recurrence or non-metastatic castration-resistant prostate cancer with low PSA levels. In contrast, PSMA-based molecular imaging can detect micrometastatic lesions that are not visible on traditional imaging, thereby providing more accurate staging and guiding subsequent treatment decisions. Numerous studies have demonstrated that PSMA-PET offers superior sensitivity and specificity compared with conventional imaging.
Accordingly, when both PSMA-PET and conventional imaging identify metastatic disease but yield inconsistent findings, treatment decisions should be guided primarily by PSMA-PET results. If molecular imaging is unavailable and the disease is classified as non-metastatic based on conventional imaging, management may still follow recommendations based on traditional imaging. This pragmatic approach balances ideal precision with real-world feasibility.
UroStream: The consensus also addresses oligometastatic prostate cancer, a population for which local treatment remains controversial. Could you share your perspective based on the consensus and your center’s experience?
Professor Bo Dai: Oligometastatic prostate cancer, also referred to as low-volume metastatic disease, represents a substantial patient population in China. These patients present with metastatic disease at diagnosis but have a limited metastatic burden, typically defined by the absence of visceral metastases and the presence of no more than three to five bone or lymph node lesions.
Historically, systemic therapy was considered the mainstay of treatment for these patients. However, treatment concepts have evolved significantly in recent years. The STAMPEDE trial represents a landmark study in prostate cancer. In this trial, metastatic prostate cancer patients receiving systemic therapy were randomized to receive additional local radiotherapy to the primary tumor. Results demonstrated that in patients with low metastatic burden, combined local and systemic therapy significantly improved radiographic progression-free survival and overall survival. Although these findings were derived from subgroup analyses, they have nonetheless influenced clinical practice and provided new therapeutic insights.
Inspired by these results, our center conducted further investigations into the role of primary tumor surgery in oligometastatic prostate cancer. Several years ago, we published a prospective phase II study in European Urology Oncology, showing that in selected patients with oligometastatic disease, combining radical prostatectomy with standard androgen deprivation therapy resulted in prolonged radiographic progression-free survival and overall survival compared with androgen deprivation therapy alone. Although this was a single-center study with a relatively small sample size, it nonetheless provided valuable evidence supporting local treatment in this setting.
Based on available evidence, the 2025 consensus recommends that carefully selected patients with oligometastatic prostate cancer who respond well to systemic therapy may receive local radiotherapy to the primary tumor in accordance with existing guidelines. For patients in good physical condition who fully understand the potential risks and benefits, primary tumor surgery may also be considered to further enhance treatment outcomes.
That said, many unanswered questions remain. For example, whether metastatic lesions themselves should also receive local radiotherapy following primary tumor surgery, and whether additional strategies could further improve outcomes, are topics that warrant further investigation. Our center is currently conducting clinical studies to address these issues. Should more compelling evidence emerge and appropriate opportunities for updates arise, we will promptly revise the consensus to reflect new knowledge.
Professor Bo Dai
