Editor's Note: Prostate cancer is one of the most common malignancies threatening men's health. In China, a high proportion of patients are diagnosed at the locally advanced or advanced stage, and overall outcomes continue to lag behind those in developed countries. Improving the overall effectiveness of prostate cancer treatment requires a systematic approach to standardizing and harmonizing diagnosis and treatment nationwide, with quality control for individual diseases serving as a key entry point. Since its establishment in 2021, the Prostate Cancer Quality Control Expert Committee of the National Cancer Center has systematically advanced the development of a quality control framework. The new edition of the China Yearbook of Quality Control for Standardized Prostate Cancer Diagnosis and Treatment (hereafter, the Quality Control Yearbook) was recently released. In an interview with Oncology Frontier, Professor Yonghong Li of Sun Yat-sen University Cancer Center shared her insights into prostate cancer epidemiology, the foundational role of androgen deprivation therapy (ADT), the standardized use of treatments and clinical indicators, and future directions for quality control.PART 1
Understanding the Current Landscape: Prostate Cancer Epidemiology and Quality Control in Diagnosis and Treatment
Oncology Frontier: The new edition of the China Yearbook of Quality Control for Standardized Prostate Cancer Diagnosis and Treatment was recently released, providing a new framework for standardizing clinical practice. Based on your clinical experience and available data, could you describe the characteristics of prostate cancer epidemiology and the development of quality control indicators in China and Guangdong Province?
Professor Yonghong Li: The incidence of prostate cancer has continued to rise. It currently ranks sixth among malignancies in Chinese men and is one of the cancers with the fastest-growing incidence rates over the past 20 years. Notably, a high proportion of Chinese patients are diagnosed with locally advanced or advanced disease, and overall outcomes remain somewhat behind those in developed countries. By focusing on quality control for individual diseases, we aim to promote standardized, consistent, and equitable prostate cancer diagnosis and treatment nationwide, thereby improving overall treatment outcomes and bringing them in line with international advanced standards.
From an epidemiological perspective, data from the National Central Cancer Registry show that prostate cancer incidence among Chinese men is increasing overall, while mortality is also rising significantly. This trend has become increasingly pronounced as population aging accelerates. Notably, as healthcare services in rural China continue to improve and prostate-specific antigen (PSA) screening becomes more widely available, prostate cancer incidence has been increasing more rapidly in rural areas than in urban areas. The gap in incidence between rural and urban populations is gradually narrowing.
Regarding the development of a quality control system for diagnosis and treatment, systematic planning and steady implementation at the national level have already produced phased achievements. The Prostate Cancer Quality Control Expert Committee of the National Cancer Center was formally established in December 2021 to systematically advance standardized prostate cancer diagnosis, treatment, and quality control across China. Key indicators include the rate of preoperative TNM staging, the rate of standardized pathological specimen sampling and reporting, and the rates of standardized use of surgery, radiotherapy, and drug treatment. These indicators provide measurable and assessable technical criteria for prostate cancer quality control.
In Guangdong, our center established a multidisciplinary team (MDT) for prostate cancer in 2009 under the leadership of Professor Fangjian Zhou. A well-established prostate cancer MDT is a crucial foundation for effective quality control. In 2018, we began extending our experience across Guangdong Province, particularly to leading hospitals in prefecture-level cities. We helped these hospitals establish prostate cancer MDTs while sharing and exchanging practical experience.
The quality control objectives set by the National Cancer Center provide an effective mechanism for implementing standardized prostate cancer treatment, and quality control and standardization work complement each other well. We subsequently integrated our prostate cancer MDT activities closely with the national quality control objectives. In 2025, we also established the Guangdong Provincial Prostate Cancer Quality Control Center. By combining these two initiatives, we can use quality control more effectively to implement and advance standardized prostate cancer diagnosis and treatment. We hope that as Guangdong continues to lead in economic development, it will also lead nationally in prostate cancer quality control and standardized care, benefiting the people of Guangdong.
PART 2
The Therapeutic Cornerstone: ADT Throughout the Entire Course of Prostate Cancer Management
Oncology Frontier: In recent years, novel androgen receptor pathway inhibitors (ARPIs), PARP inhibitors, and PSMA-targeted therapies have entered clinical practice for prostate cancer. Nevertheless, the Quality Control Yearbook and clinical guidelines continue to identify ADT as the cornerstone of comprehensive disease management. Why, in your view, is the foundational role of ADT so firmly established?
Professor Yonghong Li: From a biological perspective, prostate cancer is fundamentally an androgen-dependent malignancy. The growth and survival of most tumor cells remain driven by androgen receptor (AR) signaling. ADT-induced medical or surgical castration blocks testosterone production, thereby inhibiting tumor growth at its source. Treatment strategies such as ARPIs, PARP inhibitors, and PSMA-targeted therapies are all built upon an environment of low testosterone levels in the body.
In clinical practice, ADT is used throughout the disease course: from neoadjuvant treatment for newly diagnosed high-risk or locally advanced disease, to first-line treatment for metastatic prostate cancer, and then to ongoing treatment in metastatic castration-resistant prostate cancer (mCRPC). ADT remains necessary in all these settings.
Even in the mCRPC stage, tumors have often adapted to a low-testosterone environment rather than becoming completely independent of AR signaling. International consensus therefore continues to emphasize maintaining castrate testosterone levels, defined as testosterone below 50 ng/dL. The new edition of the Quality Control Yearbook also recommends that, following ADT, testosterone levels should be monitored as a key follow-up indicator alongside PSA in routine clinical assessments.
ADT itself continues to evolve. Combining ADT with newer treatment modalities has expanded the options available to patients with prostate cancer. Some luteinizing hormone-releasing hormone (LHRH) agonists are now available in formulations administered once monthly, once every three months, or even once every six months, making long-term follow-up and management more convenient.
In addition, newer LHRH antagonists, exemplified by degarelix, can directly lower testosterone levels without an initial testosterone surge. This provides clinicians with another valuable treatment option. Degarelix may be a safer and more effective choice, particularly for patients with severe lower urinary tract symptoms, bone pain, or even spinal cord compression.
PART 3
Scientific Management: Selecting ADT Agents and Standardizing the Use of Clinical Indicators
Oncology Frontier: ADT itself may appear relatively straightforward, but delivering standardized treatment based on ADT requires careful clinical judgment. How do you view the selection of ADT agents—LHRH agonists versus LHRH antagonists—and the standardized use of clinical indicators such as PSA and testosterone levels?
Professor Yonghong Li: ADT-based monotherapy and combination regimens are used throughout the treatment course of advanced prostate cancer. In clinical practice, treatment strategies should be selected appropriately by taking individual patient characteristics into account.
First, achieving the goals of precision ADT management requires close attention to testosterone control. A testosterone level below 50 ng/dL is the accepted threshold for castration. Once this target has been achieved, lowering testosterone further to a deeper level of suppression—below 20 ng/dL—may be associated with better outcomes.
PSA is a key indicator for monitoring patients during prostate cancer treatment and follow-up. In general, among patients with advanced prostate cancer, a PSA nadir above 0.2 ng/mL is considered to be associated with a relatively poor prognosis and a higher risk of disease progression.
For patients receiving ADT, assessment is recommended every three to six months. One point deserves particular emphasis: for patients with metastatic hormone-sensitive prostate cancer (mHSPC) receiving ADT alongside other potent agents, such as ARPIs, PSA should be monitored monthly during the first three months of treatment.
Individual differences must also be taken into account. If patients develop severe symptoms, they should seek medical attention promptly rather than waiting until the next three-month assessment, so that appropriate symptomatic treatment can be provided.
PART 4
Looking Ahead: More Refined Quality Control and More Evidence From Chinese Patients
Oncology Frontier: Prostate cancer incidence is increasing in China, and the disease is becoming an increasingly important concern at the primary-care level. As a leading expert in quality control, what measures will you and your colleagues take in the future to standardize prostate cancer screening and ADT-based treatment strategies, while narrowing disparities in diagnosis and treatment between different levels of healthcare institutions?
Professor Yonghong Li: Over the past 20 years, China has accumulated extensive experience in screening for various cancers. As this work continues to advance, prostate cancer screening and early diagnosis and treatment are receiving increasing attention. High-quality randomized controlled trials (RCTs) and health economic analyses may be conducted in the future, and these would be particularly important for China.
Most of the data we currently rely on come from Western populations. However, China differs considerably in population characteristics, economic conditions, and social structure. We therefore urgently need evidence generated from Chinese patient populations.
Going forward, we will further update and refine prostate cancer quality control indicators to cover key aspects of comprehensive patient management, including diagnosis, testing, preoperative and postoperative drug treatment, follow-up management, and PSA monitoring.
For example, during initial treatment for patients with hormone-sensitive prostate cancer, we aim to promote standardized monthly PSA testing during the first three months. We will also work to implement more specific indicators, such as using a PSA level below 0.2 ng/mL as a treatment-response assessment target for pharmacological management of prostate cancer. These refinements will help standardize and improve the precision of prostate cancer care, enhancing the consistency and scientific rigor of clinical practice.
The success of pilot programs in standardized prostate cancer quality control and health management could also provide valuable experience and a practical model for the prevention and treatment of other cancers. In doing so, these initiatives could make a greater contribution toward achieving the Healthy China 2030 goal of increasing the overall five-year cancer survival rate by 15%.
Professor Yonghong Li
