编者按：前列腺癌是当前威胁男性健康的最常见恶性肿瘤之一，如何采取精准的筛查和确诊策略，减少穿刺活检造成的侵入性损伤和心理负担，是当前研究的热点之一。SMART、PRECISION等研究旨在解决这一问题。在近日举行的2025年欧洲泌尿外科学会年会（EAU25）上，香港中文大学医院泌尿外科CHIU Ka Fung Peter（赵家锋）教授汇报了SMART研究最新结果，并在会后接受《肿瘤瞭望-泌尿时讯》的采访分享更多前列腺癌诊疗研究进展。

01

《肿瘤瞭望-泌尿时讯》

本次EAU大会您有多项研究入选口头或壁报展示，能否分享其中的关键发现？

赵家锋教授：非常感谢采访。我是香港中文大学的赵家锋医生。今天非常高兴有机会分享我们这次提交的一个重要摘要，名为SMART研究。这是一个随机对照临床试验，类似于既往的PRECISION研究，比较两种前列腺癌筛查策略：一种是先使用mpMRI检查，仅在MRI发现可疑病灶（PI-RADS评分≥3）后再进行MRI靶向活检（MRI组）；另一种是经会阴系统性活检（TP组）。

既往发表于NEJM的PRECISION研究指出，经直肠系统性活检在癌症检测上劣于MRI引导策略（MRI组的无临床意义肿瘤比例更低，绝对差异 -13个百分点；95%C：-19至-7；P<0.001），而我们的研究则显示，MRI优先策略在显著性癌症的检出率方面与经会阴系统活检相当（25.1% vs 29.0%，绝对差异 3.9%，95%CI:-11.9%至4.1%；P=0.34)）。但值得强调的是，我们仍然推荐MRI优先，因为它可以减少约45.2%的不必要前列腺活检（MRI组有45.2%的初筛男性PI-RADS score ≤2，可避免活检），对患者而言是重大利好。若MRI资源短缺或等待时间长，则经会阴系统活检是一个值得推荐的替代方案。这就是我们研究传达的核心信息。

UroStream: You have multiple studies selected for oral or poster presentation at this EAU conference. Would you share key findings?

Prof. Chiu Ka Fung Peter: Thank you for the interview. I'm Dr. Chiu Ka Fung from the Chinese University of Hong Kong. I'm glad to share our key abstract, the SMART study, a randomized controlled clinical trial comparing two prostate cancer screening strategies, similar to the PRECISION study published in the NEJM.

We conducted two screening strategies In our study,one strategy uses mpMRI first, with targeted biopsies only if suspicious lesions (PI-RADS score ≥3) are found (MRI group). The other uses transperineal systematic biopsy (TP group). While the PRECISION study found transrectal systematic biopsy inferior to MRI - guided strategy for cancer detection(the MRI group had a lower rate of clinically insignificant cancer, with a difference of -13 percentage points; 95% CI, -19 to -7; P<0.001), our study shows the MRI - first approach were comparable with transperineal biopsy in detecting clinically significant prostate cancer (csPCa)(25.1% vs 29.0%,absolute difference 3.9%,95%CI:-11.9%，4.1%;P=0.34). Notably, the MRI - first approach reduces unnecessary biopsies by about 45.2%( In MRI-arm, 45.2% had PI-RADS score ≤2 and avoided biopsy), a major patient benefit. Transperineal biopsy is a good alternative if MRI resources are limited or there are long waiting times. This is our study's core message.

02

《肿瘤瞭望-泌尿时讯》

您还参与了PIONEER大数据联盟的研究（摘要编号183），报告mHSPC治疗的真实世界现状。该联盟主要基于欧美数据，而香港是关键的亚洲节点。能否介绍这项研究带来的临床洞察？

赵家锋教授：当前转移性激素敏感性前列腺癌（mHSPC）的治疗范式，在过去五年中发生了巨大变化。早期我们主要使用雄激素剥夺治疗（ADT）单药治疗，但近年来逐步转向双联甚至三联治疗方案。

我们很自豪香港中文大学成为PIONEER大数据联盟中首个非欧洲加入的研究中心。该联盟是全球规模最大的前列腺癌高级别数据库。我们的初步分析显示，即使在欧美或亚洲等国家/地区，目前仍有40%-50%的患者仅接受ADT单药治疗，而当前指南已推荐双联或三联治疗作为标准方案。这一发现提示，全球仍存在治疗落实的巨大差距，也指出了未来提升患者治疗质量的潜力空间。

UroStream: Your research includes prostate cancer, like reporting mHSPC treatment from the PIONEER big data alliance. This large real-world study mainly utilized data from European and American countries, with Hong Kong being a crucial Asian hub. Could you introduce the key insights this study has brought to the treatment of mHSPC?

Prof. Chiu Ka Fung Peter: It’s very important to recognize that the treatment paradigm for metastatic hormone-sensitive prostate cancer (mHSPC) has changed significantly in the past five years. Previously, we treated patients with androgen deprivation therapy (ADT) alone. But now, over the last five to ten years, the standard has evolved to combination treatments—either doublet or even triplet therapies.

In our study, we are proud that the Chinese University of Hong Kong is the first site outside Europe to join the PIONEER Big Data platform for prostate cancer, which is the world’s largest database for advanced prostate cancer.One of our initial findings is that over 40%, and in some cases up to 50%, of patients—whether in Europe, the U.S., or Asia—are still receiving ADT alone, even though guidelines now recommend doublet or triplet therapy. So, there's still a lot of work to be done. This data gives us a clear insight into the gaps and highlights what we could do better to optimize care for our patients.

03

《肿瘤瞭望-泌尿时讯》

展望未来，您如何看待前列腺癌精准诊断的发展方向？

赵家锋教授：我们中心研发了一套基于人工智能（AI）辅助的前列腺癌MRI自动识别系统。医生只需将MRI图像输入系统，软件便能自动识别出前列腺的位置及肿瘤区域。从结果来看，该系统的诊断准确率已可媲美专业放射科医师的判断。不仅能用于MRI图像判读，还能辅助精准定位活检穿刺区域，极大提高了穿刺效率和准确性。

我相信未来，AI辅助前列腺MRI解读系统将会在越来越多的医院中得到应用，逐步成为常规诊疗的一部分。这将是前列腺癌精准诊断的重要方向。

UroStream: How can we look forward to the future of precision diagnosis of prostate cancer?

Prof. Chiu Ka Fung Peter: At our center, we have developed a novel system using AI assistance to automatically diagnose prostate cancer on MRI prostate scans. By simply uploading the films into the software, it can identify where the prostate and tumor are.The accuracy of the AI is comparable to that of a radiologist’s interpretation. It not only helps us diagnose prostate cancer via MRI, but also allows us to precisely target biopsies — improving diagnostic accuracy and reducing unnecessary interventions.

I believe AI-guided tools for radiology and MRI interpretation will become more common and eventually be adopted in hospitals worldwide. This will be the future of precision prostate cancer diagnosis.

▌参考文献：

[1]Chiu P.K-F.,et al.A multi-center randomized controlled trial comparing the detection of clinically significant prostate cancer by MRI-targeted approach versus 24-core transperineal systematic biopsy: Final results of the SMART trial. EAU25,abstract A0746

[2]Kasivisvanathan V, Rannikko AS, Borghi M, et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med. 2018;378(19):1767-1777. doi:10.1056/NEJMoa1801993

[3]Liu A.Q., et a.Differences in baseline characteristics and medication profiles in mHSPC patients based on real world evidence: PIONEER 2.0 Big Data Consortium for prostate cancer. EAU25,abstract P183

Dr CHIU Ka Fung Peter（赵家锋）

MBChB (CUHK), FRCSEd (Urol), FCSHK, FHKAM (Surg)

香港中文大学的临床副教授

香港泌尿外科学会会长（2022年起）

EAU青年泌尿科学者前列腺癌工作组成员

国际泌尿外科学会（SIY）uCARE研究理事会理事

《国际泌尿学杂志》（International Journal of Urology）编辑委员会成员

《外科前沿》（Frontiers in Surgery）泌尿外科副主编

《泌尿学大查房》（Grand Rounds in Urology）副主编

（来源：《肿瘤瞭望-泌尿时讯》编辑部）

声 明

凡署名原创的文章版权属《肿瘤瞭望-泌尿时讯》所有，欢迎分享、转载（开白可后台留言）。本文仅供医疗卫生专业人士了解最新医药资讯参考使用，不代表本平台观点。该等信息不能以任何方式取代专业的医疗指导，也不应被视为诊疗建议，如果该信息被用于资讯以外的目的，本站及作者不承担相关责任。

温馨提示

添加小助手请备注“泌尿”