[Prostate cancer].

Abstract

Although the incidence of latent or incidental cancer of the prostate is quite similar among Japanese and Americans, the incidence of clinically manifest prostate cancer and the mortality rates of prostate cancer are significantly higher in the latter. But, recently, the incidence of clinical cancer in Japan has been increasing exponentially, and the change in dietary habits is considered to be a major cause of this increase. Comparing the histological differences of prostate cancer between the Japanese and the Americans, the cribriform pattern is predominant in Japanese clinically significant cancer. On the other hand, a simple glandular pattern is predominant in American clinically significant cancer. These differences between Japanese and American prostate cancer suggest that each prostate cancer arises from different sources. For the organ-confined prostate cancer (stage A2 and B); radical prostatectomy has been considered the definitive treatment. But radiotherapy is now considered another radical treatment for localized prostate cancer which results in reduced morbidity. A heavy particle beam and brachytherapy are an even more radical modality that can deliver a greater dose of radiation to a localized lesion without affecting the surrounding normal tissue. For locally advanced prostate cancer (stage C); For the purpose of downstaging and radical treatment of locally advanced prostate cancer, combination of neoadjuvant hormonal therapy and radical prostatectomy has been expected. This regimen resulted in a significant decrease of positive surgical margins, but did not result in decrease of PSA failure. The impact on patient survival will be determined by the long-term follow-up. For advanced prostate cancer (stage D); In the study of the comparison of bilateral orchiectomy with or without flutamide in stage D2 prostate cancer, neither significant improvement of combination group on progression-free survival nor overall survival has been shown. From this result, the true efficacy of MAB is not certain.