Editor’s Note: The 2025 Pujiang Prostate Cancer Academic Congress, held in conjunction with the CSCO Prostate Cancer Committee (CSCO-PC) Annual Meeting, the CACA Genitourinary Oncology Committee (CACA-GO) Prostate Cancer Meeting, and the Chinese Prostate Cancer Consortium (CPCC) Annual Conference, took place in Shanghai from June 27–28. With the theme “Global Insight · Chinese Practice · Precision Breakthrough,” the event brought together leading domestic and international experts to share cutting-edge progress and clinical experience in prostate cancer. During the conference, Professor Xiaojie Bian of Fudan University Shanghai Cancer Center spoke with Oncology Frontier – Urology Frontier to discuss the current landscape and future prospects of innovative drug development for prostate cancer.01
Oncology Frontier – Urology Frontier: What are some of the most potentially groundbreaking advances in the treatment of advanced prostate cancer in recent years?
Prof. Xiaojie Bian: Recent years have witnessed continuous breakthroughs in the treatment of prostate cancer. Starting from conventional endocrine therapy, the field has progressed through taxane-based chemotherapy and cancer vaccines, and has now entered an era of novel modalities including PARP inhibitors, antibody-drug conjugates (ADCs), and radioligand therapy (RLT). These advancements are providing patients with more therapeutic options and renewed hope.
Among these, radioligand therapies targeting prostate-specific membrane antigen (PSMA) have shown promising efficacy in recent international conferences. Lu177-PSMA has demonstrated clear survival benefits and is capable of prolonging overall survival. Although not yet approved in mainland China, patients may access this treatment through participation in clinical trials.
Another notable development is the ongoing Phase III trial of an epigenetic inhibitor targeting EZH2 in mainland China. Phase II data have already shown encouraging antitumor activity in patients with metastatic castration-resistant prostate cancer (mCRPC).
Additionally, ADCs represent a hot area of investigation. At the 2025 ASCO Annual Meeting, early data on a B7-H3–targeted ADC indicated potential tumor response and survival benefits in prostate cancer patients. However, we still need more robust Phase III data to confirm its impact on survival and quality of life.
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Oncology Frontier – Urology Frontier: In the comprehensive management of advanced prostate cancer, how do multidisciplinary teams (MDTs)—including urologic surgery, medical oncology, and radiation oncology—collaborate to optimize outcomes?
Prof. Xiaojie Bian: Unlike many other conditions, cancer is a systemic disease. While early-stage prostate cancer patients may achieve long-term survival after curative surgery, many are diagnosed at an advanced stage due to the lack of widespread screening. By the time of diagnosis, the disease may have already spread to the bones, lymph nodes, lungs, liver, or other organs. In these cases, treatment must extend beyond the primary tumor to address systemic disease.
This calls for close collaboration among urologists, medical oncologists, radiologists, and pathologists to formulate individualized treatment plans. For example, in patients with large prostate tumors causing urinary obstruction, urologic surgery may be required for symptom relief. The resected tissue is then sent to pathology for detailed analysis, including tumor type (e.g., acinar adenocarcinoma), Gleason score, and identification of specific subtypes such as intraductal carcinoma, ductal adenocarcinoma, or neuroendocrine carcinoma. These findings help tailor treatment strategies.
Medical oncologists work alongside urologists to determine whether patients should receive novel hormonal agents combined with androgen deprivation therapy (ADT), chemotherapy, or even local radiotherapy. When the disease is confined to the prostate or limited to bone lesions with associated pain, radiation oncologists play a crucial role in developing palliative radiotherapy plans to alleviate symptoms and enhance quality of life.
Furthermore, nuclear medicine physicians contribute significantly to radioligand therapy (RLT) planning. These experts work with urologists and oncologists to determine whether radioligand therapy should be combined with endocrine therapy or whether local surgery is also warranted. This multidisciplinary approach enables us to deliver truly personalized treatment plans that help patients live longer and better.
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Oncology Frontier – Urology Frontier: Comprehensive treatment clearly offers more benefits for patients. With continuous advances in cancer therapy, which directions in advanced prostate cancer research do you find most promising over the next 5–10 years?
Prof. Xiaojie Bian: Our current research efforts have extended beyond traditional anti-androgen therapies. While androgen receptor (AR) targeting remains a cornerstone of treatment, and novel hormonal therapies continue to play a central role in managing advanced prostate cancer, we are increasingly recognizing that some patients harbor AR pathway mutations that confer resistance to these treatments. This highlights the urgent need for new therapeutic strategies.
Several promising avenues are under active investigation. These include PROTAC (proteolysis-targeting chimeras) targeting AR degradation, CYP11A1 inhibitors and EZH2 inhibitors aimed at overcoming resistance driven by AR-LBD mutations. Some of these therapies have already progressed to Phase III clinical trials.
At the same time, ADCs and radioligand therapies are gaining significant traction. Historically, molecular testing—such as identifying homologous recombination deficiency (HRD) mutations—has been used to guide the application of PARP inhibitors. Now, we are also focusing on membrane protein expression levels that are linked to tumor aggressiveness and poor prognosis. ADCs and radioligand therapies are designed to selectively target tumor cells by binding to these surface proteins (e.g., PSMA), delivering cytotoxic agents or radiation directly to the cancer.
Over the next 5 to 10 years, I believe ADCs and radioligand therapies will play an increasingly prominent role in the clinical management of prostate cancer.
