Department of Urology, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan.
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Jpn J Clin Oncol. 2024 Sep 4;54(9):1045-1051. doi: 10.1093/jjco/hyae079.
In previous large-scale studies conducted through 2010, androgen deprivation therapy (ADT) was the most common initial treatment for prostate cancer patients in Japan. However, recent advancements in treatment technologies have significantly affected the management of prostate cancer in Japan. This study analyzed the trends in initial treatments for prostate cancer based on two nationwide surveys.
Two Japan-wide multi-institutional surveys, J-CaP2010 and J-CaP2016, were conducted to enroll patients newly histologically diagnosed with prostate cancer in 2010 and 2016-18, respectively. Both surveys included age at diagnosis, initial PSA level, ISUP Grade Group, TNM classification, and initial treatment for prostate cancer.
J-CaP2010 included data from 8192 patients across 140 institutions, whereas J-CaP2016 included data from 21 841 patients across 186 institutions. In J-CaP2016, the proportion of radical prostatectomy (RP) and radiation therapy (RT) in the initial treatment increased (from 32% to 36% and 21% to 26%, respectively), whereas the proportion of ADT decreased (from 40% to 29%) compared with those in J-CaP2010. The increase in RP or RT was noticeable in patients aged 75 years and older (from 20% to 38%) and those with high-risk localized cancer (from 58% to 74%) or locally advanced cancer (from 38% to 56%). The proportion of active surveillance or watchful waiting increased in patients with low-risk localized cancer (from 21% to 41%). The proportion of robot-assisted RP within all RPs and the proportion of intensity-modulated RT within all RTs increased remarkably (from 2.3% to 78% and 20% to 50%, respectively).
In Japan, RP and RT have increased as initial treatments for prostate cancer, whereas ADT has decreased. Consequently, RP has emerged as the most commonly selected initial treatment, replacing ADT.
在 2010 年之前进行的几项大规模研究中，雄激素剥夺疗法（ADT）是日本前列腺癌患者最常见的初始治疗方法。然而，近年来治疗技术的进步极大地影响了日本前列腺癌的治疗管理。本研究基于两项全国性调查分析了前列腺癌初始治疗的趋势。
分别于 2010 年和 2016-18 年进行了两项全日本多机构调查 J-CaP2010 和 J-CaP2016，以招募新诊断为前列腺癌的患者。两项调查均包括诊断时的年龄、初始 PSA 水平、ISUP 分级组、TNM 分类和前列腺癌的初始治疗。
J-CaP2010 纳入了来自 140 家机构的 8192 例患者的数据，而 J-CaP2016 纳入了来自 186 家机构的 21841 例患者的数据。在 J-CaP2016 中，根治性前列腺切除术（RP）和放疗（RT）的初始治疗比例增加（分别从 32%增加到 36%和从 21%增加到 26%），而 ADT 的比例降低（从 40%降低到 29%）与 J-CaP2010 相比。在 75 岁及以上的患者（从 20%增加到 38%）和高危局限性癌症患者（从 58%增加到 74%）或局部晚期癌症患者（从 38%增加到 56%）中，RP 或 RT 的增加更为明显。在低危局限性癌症患者中，主动监测或观察等待的比例增加（从 21%增加到 41%）。所有 RP 中的机器人辅助 RP 比例和所有 RT 中的强度调制 RT 比例均显著增加（从 2.3%增加到 78%和从 20%增加到 50%）。
在日本，RP 和 RT 已成为前列腺癌的初始治疗方法，而 ADT 则减少。因此，RP 已成为最常选择的初始治疗方法，取代了 ADT。
