Hara Isao
Division of Urology, Kobe University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2006 Feb;33(2):178-82.
The number of prostate cancer patients is rapidly increasing in Japan, as aging people are more common and the lifestyle is more westernized. Another reason is that prostate specific antigen (PSA) is prevalent and PSA test can detect organ-confined prostate cancer in the early stage. In the past, endocrine therapy was the main treatment modality since many prostate cancer patients were diagnosed in the advanced stage. However, endocrine therapy is not suitable for young patients with organ-confined prostate cancer. Surgery and radiation therapy are becoming standard therapy for these patients. Although retropubic radical prostatectomy is widely performed,urinary incontinence and sexual dysfunction are still problems. Other approaches such as laparoscopic prostatectomy, portless endoscopic prostatectomy and perineal prostatectomy are also performed. Radiation therapy is commonly used for organ-confined prostate cancer in Europe and the U.S.A. The advancement in computer technology has made it possible to accumulate enough radiation dose to target without damaging the surrounding organs (3 D conformal, intensity-modulated radiotherapy). Heavy ion particle radiotherapy is also attempted in some institutes. Moreover, brachytherapy can be another choice in radiation therapy. In Japan, only high-dose brachytherapy with (192)Ir has been performed. In July 2003, permanent seed brachytherapy with (121)I was legally approved in Japan, and more organ-confined prostate cancer patients are expected to undergo this treatment. There are several treatment modalities for organ-confined prostate cancer patients these days. Therefore, not only tumor grade and stage, but also patients'lifestyle and thought should be considered in determining treatment.
在日本，前列腺癌患者的数量正在迅速增加，这是因为老龄化人口更为普遍，且生活方式更加西化。另一个原因是前列腺特异性抗原（PSA）普遍存在，PSA检测能够在早期发现局限于器官的前列腺癌。过去，由于许多前列腺癌患者在晚期才被诊断出来，内分泌治疗是主要的治疗方式。然而，内分泌治疗并不适用于患有局限于器官的前列腺癌的年轻患者。手术和放射治疗正成为这些患者的标准治疗方法。虽然耻骨后根治性前列腺切除术被广泛施行，但尿失禁和性功能障碍仍然是问题。其他方法，如腹腔镜前列腺切除术、免气腹内镜前列腺切除术和会阴前列腺切除术也在施行。放射治疗在美国和欧洲常用于局限于器官的前列腺癌。计算机技术的进步使得在不损伤周围器官的情况下向靶区累积足够的辐射剂量成为可能（三维适形放疗、调强放疗）。一些机构也在尝试重离子粒子放疗。此外，近距离放射治疗也可以是放射治疗中的另一种选择。在日本，仅施行过用（192）铱的高剂量近距离放射治疗。2003年7月，用（121）碘的永久性粒子植入近距离放射治疗在日本获得合法批准，预计会有更多局限于器官的前列腺癌患者接受这种治疗。如今，对于局限于器官的前列腺癌患者有几种治疗方式。因此，在确定治疗方案时，不仅要考虑肿瘤的分级和分期，还应考虑患者的生活方式和想法。
