最新攝護腺癌臨床指引台日版本之比較
盧致誠 范文宙 鄭哲舟
奇美醫療財團法人柳營奇美醫院 外科部 泌尿外科
Comparison of clinical practice guidelines in prostate cancer between Japan and Taiwan
Chih-Cheng Lu, Wen-Chou Fan, Tse-Chou Cheng
Division of Urology, Department of Surgery, Chi Mei Medical Center, Liouying, Tainan
Purpose:
This study is to compare the clinical practice guidelines in managing prostate cancer(CaP) between Japan and Taiwan.
Materials and Methods:
CPGs by Japanese Urological Association (JUA) and Taiwan Cooperation Oncology Group (TCOG) were reviewed.
Results:
Up to March 2015, the online guideline for CaP by JUA was available since 2006(updated in 2008).The latest CPG for CaP by TCOG was available in 2010(the third edition since 1999). Neither JUA nor TCOG had English version so far. JUA had a revised printed version published in April 2012. Evidence based medicine (EBM) was clearly applied by JUA but not by TCOG. In diagnosis, MRI is not suggested before transrectal prostatic biopsy in TCOG. The reference range of serum prostate specific antigen (PSA) was based on Japanese people data with age specific consideration by JUA, but was based on data from USA not from Taiwanese data by TCOG. The age to start PSA checking was 55 years mentioned by JUA and 50 years by TCOG. In treatment, watchful waiting therapy was more detailed by JUA than by TCOG. Proton and heavy ion therapy were discussed in JUA but not in TCOG. Chemoprevention of CaP was mentioned in JUA but not in TCOG. Phytotherapy were not approved by JUA nor TCOG. For localized CaP, primary hormone therapy was recommended in JUA but not mentioned in TCOG.
Conclusion:
EBM is essential for modern CPGs. Variation exists between Japanese and Taiwanese editions. From views of EBM, revision of Taiwanese CPG for CaP is strongly suggested. Further study is needed to confirm these findings.