Long a country with a relatively low incidence of prostate cancer, China is quickly catching up.
A sharp rise in cases, with an accompanying climb in mortality rates from the disease, has caught China’s healthcare system short-handed when it comes to making advanced surgical techniques available to all those who need it. “A handful of oncologists were operating on prostate cancer, and nobody knew if the way they were doing it was right or wrong,” says oncologist Dingwei Ye, the director-general of the Urinary Sector of the Chinese Anti-Cancer Association, and the head of the urinary surgical department of Fudan University Shanghai Cancer Center (FUSCC), a top institute in China that performs more than 36,000 cancer surgeries a year.
Though it has been one of the most common cancers in the U.S. for decades, prostate cancer has only jumped to prominence in China over the past 10 years, now ranking as the fifth most common cancer among men in the country. More routine screening and better diagnostic techniques are almost certainly large factors in the apparent rise, but there’s also a widespread belief among physicians that the disease itself is more frequently occurring, possibly due to a shift toward Western diets and lifestyles. Both metastatic and mortality ratio of prostate cancer are less than 10 percent in Europe, but Ye says it’s a frightening 70 percent for both metastasis and mortality in China.
Ye is a pioneer in China for bringing a systematic approach to prostatectomies to the region, following a stint at the MD Anderson Cancer Center in Houston in 1998. But it wasn’t easy importing the techniques, thanks in part to anatomical differences between typical Chinese patients and those Ye had trained on in the U.S. “It’s easier with the Caucasian pelvis, it’s flat and you operate like you’re working in a shallow pan,” he explains. “But the Asian pelvis is deeper, it’s as if you’re working inside a deep pot.” To complicate the challenges, the U.S. surgical instruments he relied on weren’t well-suited to the more difficult procedure, and hemorrhaging was a frequent problem.
Ye modified the procedure and the tools to better suit the typical Asian anatomy, specifying the technique precisely to set a clear standard and study its effectiveness. He has continued to refine the technique and assist in its dissemination to the surgical community. He established a specialized team at FUSCC that, for three consecutive years, performed one out of four prostate cancer operations in Shanghai, according to statistics from the Shen Kang Development Center, the non-profit overseeing all public hospitals in Shanghai. Now Ye’s techniques are followed in most cancer centers across China.
Ye’s group is also trying to lower the age and stage of diagnosis of the disease. He asserts that while only 5 percent of U.S. cases involve the cancer having spread beyond the prostate when first caught, that number leaps to 60 percent in China. One big reason: PSA tests, the screening tool that has long been widely applied in the U.S., only started popping up in China three years ago and is still a relative rarity in primary care, especially outside of private hospitals in major cities. (The practice of routine PSA screening has been under fire in the U.S. in recent years because it has been associated with false positives and overly aggressive treatments that carry a high risk of side effects.)
Public awareness of the disease, and especially of the need to screen for it, remains low in China, complains Ye. “It’s still not seen as one of the greater cancer threats,” he says, adding that the low awareness stands in sharp contrast to the attention being paid among Chinese patients to lung, breast, stomach and intestinal cancer. The problem is exacerbated by a lack of Chinese research into the disease that could otherwise garner publicity.
To promote more China-focused research into the disease, Ye established — and now heads — the Urological Chinese Oncology Group (UCOG), a national working group based at FUSCC that includes urological oncologists and other experts from more than 30 hospitals and medical institutions throughout China. Among the group’s efforts is a program to develop a robotic-surgery approach to prostate-cancer biopsies, which may roll out to Chinese hospitals as soon as 2019.
Ye has also worked to develop a multi-disciplinary-team approach to prostate cancer, combining specialists in surgery, radiotherapy, chemotherapy and even traditional Chinese medicine, as well as therapists focused on supporting patients’ post-treatment quality of life. He’s also been pushing for more funding for both research and treatment-cost-coverage from the Chinese government — prostate-cancer doesn’t currently qualify for the same level of coverage as other major cancers under the national healthcare-insurance plan. And Ye is forging international support as well, fostering expert exchanges and other connections with eight institutions around the world, including MD Anderson, the Duke University Cancer Institute, France’s Gustave-Roussy Cancer Center, and the Cancer Research Institute at Japan’s Kanazawa University.
But speeding progress of prostate cancer diagnosis and treatment in China will ultimately require more public demand for care. To promote that demand, along with better education and awareness, Ye’s team has hit WeChat and other Chinese social-media channels to get the word out on the disease’s symptoms, the need for more screening and healthier lifestyles that can be preventive to the disease, and to give the public more access to physicians, nurses and other experts who can answer questions. “We still have a long way to go here,” he says.
— Changhong Zhang
Changhong Zhang is a freelance healthcare writer based in Shanghai, China.