Evidenced‐based clinical practice guideline for prostate cancer (summary: Japanese Urological Association, 2016 edition)

Abstract

These guidelines cover a wide range of topics from prostate cancer epidemiology to palliative care. Questions arising in daily clinical practice have been extracted and formulated as clinical questions. In the 4 years since the previous edition, there have been major changes -for example, robot-assisted prostatectomy has rapidly come into widespread use, and new hormones and anticancer drugs have been developed for castration-resistant prostate cancer. In response to these developments, the number of fields included in this guideline was increased from 11 in the 2012 edition to 16, and the number of clinical questions was increased from 63 to 70. The number of papers identified in searches of the existing literature increased from 4662 in the first edition, published in 2006, to 10 490 in the 2012 edition. The number of references has reached 29 448 just during this review period, indicating the exponential increase in research on the topic of prostate cancer. Clinical answers have been prepared based on the latest evidence. Recommendation grades for the clinical answers were determined by radiologists, pathologists, and other specialists in addition to urologists in order to reflect the recent advances and diversity of prostate cancer treatment. Here, we present a short English version of the original guideline, and overview its key clinical issues.

Magnetic resonance imaging/transrectal ultrasound fusion‐targeted prostate biopsy using three‐dimensional ultrasound‐based organ‐tracking technology: Initial experience in Japan

“…The utility of MRUS fusion biopsy has been reported in Western countries . As few reports about MRUS fusion biopsy have been reported in Asia, including Japan, the role of MRI and new biopsy techniques are under debate in Japan . The biopsy techniques to target MRI‐suspicious lesions include cognitive biopsy, in‐bore MRI biopsy or MRUS image fusion biopsy.…”

“…[2][3][4][5][6][7][8][9][10] As few reports about MRUS fusion biopsy have been reported in Asia, including Japan, the role of MRI and new biopsy techniques are under debate in Japan. 11 The biopsy techniques to target MRI-suspicious lesions include cognitive biopsy, in-bore MRI biopsy or MRUS image fusion biopsy. The MRUS image fusion techniques are supported by various technologies, including a technique using real-time 3-D US.…”

Quality of life in active surveillance for early prostate cancer

“…The frequency of complications for a transrectal prostate biopsy includes hematuria (4–66%), rectal bleeding (1–37%), urinary retention (0.2–1.1%), erectile dysfunction (7–12%), infection (0.6–3.1%) and death due to the procedure (0–0.1%). The frequency of complications for a transperitoneal prostate biopsy includes hematuria (10–42%), urinary retention (0.6–39%), infection (0–2%) and death due to the procedure (0–0.1%) . Kakehi et al .…”

“…Thus, the inclusion criteria for AS are decreased cancer positive cores, a low PSA density and a low GS. In the guidelines of the JUA, the answer for the Clinical Question, “AS is indicated for which patients?” is “PSA ≤10 ng/mL, clinical stage ≤pT2, number of positive cores ≤2 (but not limited to this figure in cases of targeted biopsy and saturation biopsy), a GS ≤6 and PSAD <0.2 or <0.15 ng/mL.” These criteria have the recommendation grade B in the guidelines of the JUA. Thereafter, patients choosing AS are electing to undertake follow‐up examinations.…”

“…There are various clinical studies regarding AS; however, the inclusion criteria and protocol are unified. Tables and show the inclusion criteria and follow‐up protocol of existing clinical research on AS, respectively …”