Editor’s note: At the “CACA Integrated Prostate Oncology Conference” held from June 14–15, numerous Chinese experts and scholars gathered under the theme “Winning Through Integration in Cancer Control” to engage in academic discussions on the latest CACA prostate cancer guideline updates, recent research advances, and multidisciplinary team (MDT) evaluations of complex cases. Professor Dingwei Ye from Fudan University Shanghai Cancer Center delivered a keynote lecture titled “The Three Dimensions of Surgical Treatment for Prostate Cancer — Skill Advancement, Technological Innovation, and Conceptual Reform.” The following is a summary of his presentation.Prostate cancer ranks first in incidence and fifth in mortality among male cancers worldwide. It is also the most common malignant tumor of the urinary system. While the incidence of prostate cancer in China and other East Asian countries remains lower than in Western nations, it has been rising rapidly. In 2018, prostate cancer had become the third most common malignancy among men in Shanghai’s Pudong New Area. However, compared to developed countries such as those in Europe, North America, Japan, and South Korea, prostate cancer in China is often diagnosed at a later stage, with higher PSA levels at initial presentation—resulting in a five-year survival rate of around 70%, compared to over 90% in those countries.
Professor Dingwei Ye emphasized that radical prostatectomy remains a key treatment option for patients with localized prostate cancer, though there is still room for improvement. For non-localized disease, it is equally crucial to evaluate the indications and outcomes of surgery. Furthermore, identifying surgical platforms better suited to Chinese patients is essential to enhancing treatment effectiveness.
Since the launch of the Robotic Surgery Innovation Center by the Shanghai Institute of Urologic Oncology in 2023, the center has performed over 2,100 robot-assisted radical prostatectomies. This achievement marked the realization of a dual-platform robotic system operating in parallel, significantly advancing both the quality and quantity of surgeries. As a result, the “Fudan Cancer” approach to prostate cancer surgery continues to evolve—from the “1.0 model,” focused on achieving the triple goal of oncological control, urinary continence, and sexual function preservation, to the “2.0 model,” which aims to define the optimal surgical population, and now the “3.0 model,” centered on building novel surgical platforms.
Early-Stage Prostate Cancer Precision Surgery and Optimal Functional Outcomes
With deepening understanding of surgical anatomy, preserving key anatomical structures—such as the urethral sphincter, surrounding fascia and ligaments, and neurovascular bundles—along with enhanced functional reconstruction, has become central to radical prostatectomy. Traditional open prostatectomy techniques often result in significant bleeding and high rates of postoperative urinary incontinence and erectile dysfunction.
The Fudan Cancer Center team has developed surgical approaches tailored to the unique pelvic anatomy of Chinese patients (the “deep barrel” pelvis versus the “shallow pelvis” seen in Western populations). By advancing minimally invasive techniques and establishing a precision robotic surgery system using the da Vinci Xi platform, their operations have become more refined and efficient. Surgery time can be limited to around 60 minutes, with blood loss as low as 20 ml. Postoperative urinary continence and erectile function recovery rates reach approximately 99% and 70%, respectively—achieving the coveted “trifecta” outcomes.
Professor Dingwei Ye elaborated on key technical points and shared the Fudan Cancer Center’s surgical experience in robot-assisted radical prostatectomy:
1. Preserving Erectile Nerves and Restoring Erectile Function:
· To protect fragile neurovascular structures, minimize thermal coagulation to reduce nerve damage.
· To avoid positive surgical margins due to improper tumor handling, carefully identify areas of adhesion or invasion.
· To balance tumor control and preservation of the urethra, aim to retain as much of the functional urethra as possible while minimizing apical margin positivity.
2. Hemostasis with “Inward-Roll” Suturing of the Neurovascular Bundle (NVB):
· After preserving the nerves, expose the medial side of the NVB to avoid damage to medial nerve fibers.
· The lateral and rectal surfaces contain fewer nerves and offer more supportive tissue for suturing.
· Most bleeding arises from venous sinuses and can be controlled through compression and embedding techniques.
3. Modified Anterior Reinforcement to Stabilize Continence Mechanisms:
· The puboprostatic ligament plays a key role in continence and allows for precise, reliable suturing.
· Reinforcing the anastomosis can further reduce the risk of urinary leakage.
· Strengthening the bladder sphincter helps stabilize the bladder neck structure.
Advanced-Stage Patients Precision Selection to Improve Outcomes
For patients with locally advanced disease, lymph node metastasis, or castration-resistant prostate cancer (CRPC), conventional imaging methods such as bone scans and pelvic MRI often fall short in accurate staging. The Fudan Cancer Center team was among the first in China to apply PSMA-based precision imaging to overcome these limitations in intermediate and advanced-stage prostate cancer. Their work has advanced the clinical use of imaging techniques from 99mTc-PSMA SPECT/CT to 68Ga-PSMA PET/CT.
A study published in Annals of Surgical Oncology demonstrated that PSMA-based imaging provides superior sensitivity in detecting pelvic lymph node metastases compared to conventional MRI in patients with locally advanced prostate cancer, thereby guiding more precise pelvic lymph node dissection. Another study, published in the Asian Journal of Andrology, reported that PSMA imaging achieved a detection rate of 78% in cases of biochemical recurrence—significantly higher than the 40% detection rate of traditional imaging. Based on these findings, the team has begun incorporating PSMA imaging into salvage therapies and extended pelvic lymph node dissection protocols.
In addition, the Fudan team leads numerous surgical clinical trials, ranking first nationwide in trial leadership volume. These trials cover a range of interventions including neoadjuvant therapy plus surgery, surgery for oligometastatic disease, surgery combined with radiotherapy, and surgery followed by proton/carbon ion therapy.
Notably, following the success of the CHART study involving the next-generation antiandrogen drug rezvilutamide in the metastatic hormone-sensitive prostate cancer (mHSPC) setting, the team launched a Phase III trial evaluating next-generation antiandrogens in the neoadjuvant setting. In surgical trials for oligometastatic disease, a randomized controlled study published in European Urology Oncology in 2022 showed that cytoreductive surgery or radiotherapy combined with androgen deprivation therapy (ADT) significantly improved progression-free survival (PFS) compared to ADT alone.
The ongoing CHAMPION study (NCT05717582) is using PSMA PET/CT to guide maximal cytoreductive therapy for mHSPC patients with ≤10 metastatic lesions. Additionally, a prospective Phase II clinical trial led by the team is evaluating the combination of surgery and proton/carbon ion radiotherapy versus standard endocrine therapy for oligometastatic prostate cancer. Preliminary results indicate that the combined approach may prolong both radiographic PFS (rPFS) and overall survival (OS), potentially expanding treatment options for this patient population.
Made in China, Empowering Surgical Innovation China’s First Modular Robotic Surgery Platform
Globally, nearly 10,000 robotic surgical systems have been installed, enabling over 10 million surgeries. In China, urology is the clinical specialty with the highest utilization rate of robotic surgery. Robotic-assisted radical prostatectomy offers significant advantages, including greater surgical precision, minimally invasive procedures, improved functional recovery, and enhanced adaptability for complex cases.
Since 2021, Professor Dingwei Ye and his team have led the development of China’s first modular, split-design surgical robot. Coordinating a nationwide multicenter clinical trial, they have successfully completed 135 preclinical cases and carried out human trials in both urology and gynecology. This modular platform offers flexible equipment and instrument configurations, meeting the varying clinical demands of laparoscopic surgeons at different stages.
The system has received strong international recognition. Professor Vipul Patel, founder and president of the Society of Robotic Surgery (SRS), personally tested the system with the Fudan Cancer Center team and praised it highly:
“I barely needed a learning curve—the instruments were easy to handle, and I was able to perform precise dissection with great flexibility.”
Professor Ye was invited to present at the 2024 SRS World Congress and the CILR-AI Summit (Conference on Innovation in Laparoscopic and Robotic Technology), where he shared China’s advancements in robotic surgery, proudly representing Chinese innovation on the global stage.
At the prestigious Advanced Prostate Cancer Consensus Conference (APCCC)—often referred to as the elite international “club” of uro-oncology—Professor Ye has been the sole representative from mainland China for three consecutive terms. He collaborates with global experts to address key topics such as:
· The evolving role of local treatment in prostate cancer
· Multidisciplinary team (MDT) models for managing metastatic disease
· Localization and innovation of large-scale medical equipment
· Development of novel therapeutics and diagnostic technologies in prostate cancer
His contributions have been widely recognized by international peers and have elevated China’s voice in shaping global prostate cancer treatment guidelines.
Founded in 2002, the Department of Urology at Fudan University Shanghai Cancer Center has grown from just “three doctors and six beds” into one of China’s largest, most influential, and widely recognized centers for the treatment and research of male genitourinary tumors. Under the leadership of Professor Ye, the team continues to move forward—pioneering new paths and scaling new heights—contributing to China’s advancements in prostate cancer prevention and treatment with “Fudan solutions,” “Shanghai experience,” and “Chinese innovation.”
