Editor's Note: The Pujiang Prostate Cancer Academic Conference was held in Shanghai on June 26–27, 2026. In recent years, the development of multiple innovative therapeutic approaches—including radioligand therapy, antibody-drug conjugates (ADCs), bispecific antibodies, and PARP inhibitors—has accelerated rapidly. A series of clinical studies has opened new treatment pathways for patients with metastatic castration-resistant prostate cancer (mCRPC) and metastatic hormone-sensitive prostate cancer (mHSPC). To systematically review the evolving landscape of prostate cancer treatment, Oncology Frontier – UroStream invited Professor Xiao Lin Lu of Fudan University Shanghai Cancer Center to share his insights.Oncology Frontier – UroStream: Numerous clinical studies of ADCs, bispecific antibodies, and novel radioligand therapies were presented at the 2026 ASCO GU Symposium. Which category of innovative therapies do you believe is most likely to fundamentally reshape the overall treatment landscape of advanced prostate cancer over the next few years?
Professor Xiao Lin Lu: The greatest current challenge in the treatment of advanced prostate cancer lies in the population with metastatic castration-resistant prostate cancer (mCRPC). These patients generally have a poor prognosis and represent a major focus of global drug development. Our center is participating in multiple clinical trials of investigational therapies, covering radioligand therapy, next-generation PARP inhibitors, several ADCs, AR-PROTACs, T-cell engagers (TCEs), and other novel mechanisms. Each of these therapeutic approaches has demonstrated considerable potential for clinical application.
First, in the field of radioligand therapy, several products have already been successfully developed and marketed internationally. In China, development of drugs targeting the same pathways, as well as pipelines incorporating the next-generation high-energy radionuclide actinium-225, is progressing rapidly and in some areas is even approaching or surpassing international development.
Second, in the ADC field, domestic developers are conducting multicenter clinical trials of B7-H3 ADCs and HER1/HER3 bispecific ADCs. Development is progressing in parallel with international efforts, and these therapies have the potential to eventually replace conventional chemotherapy as standard treatment options.
In addition, novel agents such as EZH2 inhibitors targeting epigenetic mechanisms and T-cell engagers capable of enhancing immune-mediated antitumor activity have also generated encouraging early clinical data, with multiple independently developed pipelines being investigated in China.
Based on the clinical signals available to date, radioligand therapy and ADCs represent the two most potentially transformative therapeutic directions. At the same time, novel targeted agents and immune-engaging therapies also have considerable long-term clinical potential and warrant continued attention.
Oncology Frontier – UroStream: Beyond the clinical data from novel agents, what new signals regarding overall treatment strategies, patient stratification, and precision diagnosis presented at this year’s ASCO GU are particularly important for clinical practice?
Professor Xiao Lin Lu: Prostate cancer diagnosis and treatment have now fully entered the era of precision medicine. Precision diagnosis and molecular stratification provide the essential foundation for implementing innovative treatment strategies.
One important development is the rapid adoption of AI-based digital pathology. Artificial intelligence can facilitate automated interpretation of pathological slides, accurately distinguish different pathological subtypes within prostate cancer, assist in differentiating certain common subtypes of genitourinary tumors, and perform prognostic risk stratification. This can provide objective information to support subsequent individualized treatment decisions.
Another important trend is the increasingly close integration of molecular classification with targeted therapy. Taking PARP inhibitors as an example, homologous recombination repair (HRR) gene testing can identify patients who are more likely to benefit from treatment. The patient’s genomic alteration status is directly associated with prognosis and can also guide clinical treatment selection.
In the future, as AI databases continue to expand and multicenter real-world evidence accumulates, individualized patient stratification based on molecular characteristics, pathology, and imaging will continue to improve. This will facilitate precision management across the entire disease pathway, from early screening and diagnostic classification to treatment throughout the course of disease, ultimately improving the overall efficiency and quality of prostate cancer care.
Oncology Frontier – UroStream: Considering the current state of prostate cancer clinical practice and innovative drug development in China, how do you view the prospects for China-originated clinical research?
Professor Xiao Lin Lu: Drug development in China’s prostate cancer field has moved beyond the previous stage of simply following international developments. We have now entered a new phase characterized by parallel development across multiple therapeutic areas, with China leading in some fields.
Domestically developed radioligand therapies, multiple ADCs, novel targeted agents, epigenetic inhibitors, and T-cell engagers have reached internationally competitive levels. Looking ahead, these therapies are expected to continue contributing to the transformation of global prostate cancer treatment standards.
Most domestic innovative pipelines follow a development strategy of first establishing efficacy in later-line settings and then gradually moving treatment toward earlier lines. Several domestically developed radionuclide therapies have already entered clinical trials in earlier mHSPC populations, while ADCs are being investigated in first-line treatment as well as perioperative settings.
Supported by large-scale Phase III clinical trials designed around the characteristics of Chinese patients, domestically developed targeted therapies, radionuclide therapies, and ADC-based treatment strategies are expected to generate increasingly robust high-quality evidence. These efforts could help drive innovation in prostate cancer diagnosis and treatment not only in China, but also globally.
Professor Xiao Lin Lu
