Mitsuzuka Koji, Arai Yoichi
Department of Urology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan,
Int J Clin Oncol. 2014 Oct;19(5):793-9. doi: 10.1007/s10147-014-0738-7. Epub 2014 Aug 26.
The incidence of prostate cancer in Japan is increasing due to both the spread of screening and the rapid aging of the population. Most of this increase is expected to be attributable to the increase in the elderly male population. The management of various types of cancers in elderly patients is of growing interest, but several problems are encountered when evaluating elderly patients with localized prostate cancer, especially when radical prostatectomy (RP) is under consideration. First, life expectancy, health status, lifestyle, and available treatment modalities differ between regions, countries, and individuals, which potentially affects the choice of treatment options by both physicians and patients. Second, life expectancy is key when considering indications for RP. Many tools are available for predicting life expectancy, but their utilization varies greatly among physicians. Third, the malignant potential of latent or incidentally detected prostate cancer in Japanese men might be higher than those in other countries, and elderly men with prostate cancer are likely to have high-risk or locally advanced tumors, which may in turn support the more frequent use of radical treatments in elderly men. Fourth, patients treated with RP are likely to have fewer and less severe comorbidities than those treated with other treatments, which would complicate the comparison of outcomes. Fifth, the balance between survival benefits and adverse effects is an important influence on indications for RP. If robot-assisted laparoscopic RP can reduce the risk of adverse effects, indications for RP could be altered. Sixth, although several general health status screening tools such as the Geriatric 8 are available, no screening tools specialized for localized or Japanese prostate cancer patients exist. In conclusion, further study is needed to clarify the management of elderly Japanese patients with localized prostate cancer, because prostate cancer often requires different considerations to other types of cancer.
由于筛查的普及和人口的迅速老龄化，日本前列腺癌的发病率正在上升。预计这种增长大部分归因于老年男性人口的增加。老年患者各种癌症的管理越来越受到关注，但在评估老年局限性前列腺癌患者时会遇到几个问题，尤其是在考虑根治性前列腺切除术（RP）时。首先，不同地区、国家和个体之间的预期寿命、健康状况、生活方式和可用的治疗方式存在差异，这可能会影响医生和患者对治疗方案的选择。其次，预期寿命是考虑RP适应症时的关键。有许多工具可用于预测预期寿命，但医生对它们的使用差异很大。第三，日本男性潜伏性或偶然发现的前列腺癌的恶性潜能可能高于其他国家，患有前列腺癌的老年男性可能有高危或局部晚期肿瘤，这反过来可能支持在老年男性中更频繁地使用根治性治疗。第四，接受RP治疗的患者可能比接受其他治疗的患者有更少、更不严重的合并症，这会使结果比较变得复杂。第五，生存益处和不良反应之间的平衡对RP适应症有重要影响。如果机器人辅助腹腔镜RP可以降低不良反应的风险，RP的适应症可能会改变。第六，虽然有几种一般健康状况筛查工具，如老年8项，但不存在专门针对局限性或日本前列腺癌患者的筛查工具。总之，需要进一步研究以阐明老年日本局限性前列腺癌患者的管理，因为前列腺癌往往需要与其他类型的癌症进行不同的考虑。
