National Health Research Institutes

Division of Cancer Research

Taiwan Cooperative Oncology Group (TCOG)

115 128 No. 128, Yen-Chiu-Yuan Road, Sec. 2, NanKang, Taipei 115, Taiwan, R.O.C.

TEL(02)2653-4401 FAX(02)2782-3755

http://www.nhri.org.tw

GPN1009200289

30

ISBN 957-01-3531-X

(())

()

(())

(NHRI)

(TCOG)

TCOG

115 128

886-2-26534401

886-2-27823755

http://www.nhri.org.tw

10

TCOG

GPN1009200289

ISBN957-01-3531-X

1982

24

(http://www.nhri.org.tw)

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TCOG () 1

(())

2000

1979 98 1995

884 7.2 / [1]1995

371 1998 540

4.82 / 14.25 /

[2]2000 635 5.59

/ 1993 1.71 /

1.2 /1997 2.0

/ [3] 1995 168,665

34,475 53.5 / 22.9

/ [4]1997 137 / 101

/ 20 /

[5, 6] 1998 150 /

27.3 / [3] 65 ~ 75

70%

TCOG () 2

* 87 (2002 2 )

70-87

CIR

& C

MR

(per

100

000

popu

latio

n)

2.05 2.00 2.41 2.282.93 3.09

4.10 3.915.26 5.67

6.15

8.07

9.94

12.3 6

14.2 5

5.56

1.401.450.80 0.76 1.02 1.29 1.36 1.26

1.50 1.79 2.05 1.86 2.21 2.192.50

3.37 3.39 4.204.78 4.82

0

2

4

6

8

10

12

14

16

70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87

Year

Crude Incidence Rate Crude Mortality Rate

TCOG () 3

1.

2.

(digital rectal examination DRE)

(prostate specific antigen PSA)

[7]

[8, 9]

45

[10] (PSA

)

(biopsy)

TCOG () 4

PSA

(15%) 3.5 4.0 ng/ml

PSA PSA

PSA

finasteride (Proscar) PSA [11, 12, 13,

14]

3. PSA

PSA [13, 14]

PSA 4.1 ~ 9.9 ng/ml

20 ~ 30%PSA 10.0

ng/ml 50% [15]

PSA 4 20 16%

[16]

PSA 4.0 ng/ml (4.1 ~ 9.9 ng/ml)

TCOG () 5

A. (Age-specific PSA cutoff

values)

PSA (

) PSA 40 ~ 49

2.5 ng/ml50 ~ 59 3.5 ng/ml60 ~ 69 4.5

ng/ml70 6.5 ng/ml [17]

(sensitivity) (specificity) [18,

19]

4.0 ng/ml [20]

PSA [21]

B. (PSA density PSAD)

PSA Benson

PSAD cutoff point 0.15

[22] [23 ~ 25]

TCOG () 6

PSA assay

PSA PSAD

[26]

PSAD transitional zone

PSA

C. (PSA velocity)

Carter PSA velocity > 0.75

ng/ml/year

[27] PSA

PSA

PSA Carter Smith Catalona

18 PSA

PSA velocity [28, 29]

PSA

assay PSA

PSA [30]

PSA velocity PSA

TCOG () 7

D. / (PSA free/total ratio)

PSA 4.0 ~ 10.0 ng/ml

90% free/total ratio cutoff point

( assay ) PSA

Catalona 1998 773

PSA 4.0 ~ 10.0 ng/ml free/total

ratio cutoff point 25% 95%

20% 20% [31]

free/total PSA cutoff point

() Hybritech assay

25% cutoff point assay

cutoff pointsfree/total PSA ratio

PSA isoform

assay (standardization)

PSA PSA < 4.0 ng/ml DRE

PSA

free/total ratio [32]

PSA > 4.0 ng/ml free/total ratio

TCOG () 8

PSA

(negative)

A.

(a) high grade prostate intraepithelial neoplasia (PIN)

atypical gland ()

(b) (benign) follow PSA

PSA

B.

(a) PSA > 10 ng/ml

(b) PSA < 10 ng/ml follow PSA PSA

0.75 ng/ml/year

4. (Gleason grading system)

[33]

TCOG () 9

grade

grade 1

grade 5

grade (Gleason score)

Gleason grade

7

6

grade 4 [34]

grading

5. (clinical staging and pathologic staging)

staging system 1992 AJCC UICC

1997 AJCC TNM system

Staging (1) (2)

TCOG () 10

Primary tumor (T) 1997 AJCC T1 Clinically inapparent tumor not

palpable or visible by imaging

T1a Tumor incidental histologic finding in 5% or less of tissue resected

T1b Tumor incidental histologic finding in more than 5% of tissue resected

T1c Tumor identified by needle biopsy (because of elevated PSA)

T2 Tumor confined within the prostate Tumor confined within the prostate T2a Tumor involves half of a lobe or less Tumor involves one lobe T2b Tumor involves more than half of a

lobe, but not both lobes Tumor involves both lobes

T2c Tumor involves both lobes T3 Tumor extends through the prostate

capsule Tumor extends through the prostate capsule

T3a Unilateral extracapsular extension Extracapsular extension (unilateral or bilateral)

T3b Bilateral extracapsular extension Tumor invades seminal vesicle(s) T3c Tumor invades seminal vesicle(s) T4 Tumor is fixed or invades adjacent

structures other than the seminal vesicles

Tumor is fixed or invades adjacent structures other than the seminal vesicles: bladder neck, external sphincter, rectum, levator muscles, and/or pelvic wall

T4a Tumor invades bladder neck, external sphincter, rectum

T4b Tumor invades levator muscle or pelvic wall

Regional lymph node (N) N0 No regional lymph node metastasis N1 Metastasis in a single regional lymph

node 2 cm in greatest diameter

N2 Metastasis in a single regional lymph node 2 ~ 5 cm or multiple regional lymph node 5 cm

N3 Metastasis in a regional lymph node 5 cm

TCOG () 11

Distant metastases (M) M0 no distant metastasis M1a involvement of nonregional lymph

node

M1b involvement of bone(s) M1c involvement of other distant site

Histologic grading () Gleason grade G1 well differentiated 2-4 G2 moderately differentiated 5-7 G3-4 poorly differentiated 8-10

1992 AJCC UICC 1997 AJCC Stage 0 T1a N0 M0 G1 Stage I T1a N0 M0 G1 Stage I T1a N0 M0 G2,3-4 Stage II T1a N0 M0 G2,3-4 T1b N0 M0 any G T1b N0 M0 any G T1c N0 M0 any G T1c N0 M0 any G Stage II T2 N0 M0 any G T2 N0 M0 any G Stage III T3 N0 M0 any G Stage III T3 N0 M0 any G Stage IV T4 N0 M0 any G Stage IV T4 N0 M0 any G any T N1 M0 any G any T N1 M0 any G any T any N M1 any G any T any N M1 any G

(extraprostatic

extension) (local

staging) 63%body coil MRI

71%endorectal MRI 83%

TCOG () 12

T1c

(pathologic stage equivalent)

(organ

confined disease) (seminal vesicles)

25%

progression

progression [34]

free/total PSA ratio RT-PCR

for PSA [35, 36]

6. (Prostatic acid phos-phatase PAP)

PSA PAP

(tumor marker)Whitmore-Jewett staging system D0

PAP metastasis PAP activity

PAP

PAP 80% (advanced disease)

PAP Stamey

PSA PAP [37]Burnett

TCOG () 13

DREPSAGleason grade clinically

localized prostate cancerPAP [38]

7.

basemidglandapex

(hypoechoic lesion)

(isoechoic) Brawer

[39]2,036 TRUS-biopsy

25.5% 85.6% 14.4%

(benign) 74.5% 71.6%

28.4%2,036 TRUS-biopsy

75.2% ( 29.1% 70.9%) 24.8% (

14.9% 85.1%)

(hypoechoic cancer)

(tumor volume)

(microscopic)

TCOG () 14

8.

A. (Bone scan) [40,

41] (false positive rate) [40]

PSA 10 ng/ml

TRUS biopsy

[42] (false negative rate)

(baseline evaluation)

B. (CT) (MRI)

(local staging) [43, 44]

(pelvic

imaging) T3 ~ T4 stage ()PSA 20 ng/ml

(poorly differentiated cancer)

[45]Partin nomogram

T2 T3

TCOG () 15

9. (Pelvic lymph node dissection)

PSA stage migration

(radical prostatectomy)

(positive rate)

(imaging study)

T3PSA > 20 ng/ml > 6

[46]

10. PSA T stage

understaging Partin [47]

T stagePSA level

(pathologic stage)

PSA

Partin nomogram ()

nomogram

[48]

TCOG () 16

(probability)

1992 AJCC

TABLE I

Clinical Stage T1c (nonpalpable, PSA elevated) Gleason Score PSA Range

(ng/mL)Pathologic

Stage 24 56 3+4=7 4+3=7 810

Organ confined 95 (8999) 90 (8893) 79 (7485) 71 (6279) 66 (5476) Extraprostatic

extension 5 ( 111) 9 ( 712) 17 (1323) 25 (1834) 28 (2038)

Seminal vesicle 0 ( 0 1) 2 ( 1 5) 2 ( 1 5) 4 ( 110)

02.5

Lymph node 1 ( 0 2) 1 ( 0 4) 1 ( 0 4) Organ confined 92 (8298) 84 (8186) 68 (6274) 58 (4867) 52 (4163) Extraprostatic

extension 8 ( 218) 15 (1318) 27 (2233) 37 (2946) 40 (3150)

Seminal vesicle 1 ( 0 1) 4 ( 2 7) 4 ( 1 7) 6 ( 312)

2.64.0

Lymph node 1 ( 0 2) 1 ( 0 3) 1 ( 0 4) Organ confined 90 (7898) 80 (7883) 63 (5868) 52 (4360) 46 (3656) Extraprostatic