台日韓三國在使用鐳223治療攝護腺癌於臨床指引之比較

盧致誠^1.2 范文宙¹ 鄭哲舟¹ 林嘉禾¹ 邱毅平¹ 王脩仁¹ 謝育哲¹

¹奇美醫療財團法人柳營奇美醫院 外科部 泌尿外科 ²國立中正大學 資訊管理學系

comparison of the application of Radium-223 for prostate cancer in the Practice Guidelines between Japan, Korea, and Taiwan

Chih-Cheng Lu^1,2, Wen-Chou Fan¹, Tse-Chou Cheng¹,Chia-Ho Lin¹, Yi-Ping Chiu¹, Hsiu-JenWang¹, Yu-Che Hsieh¹    

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Liouying, Tainan

²Department of Information Management, National Chung Cheng University, Chiayi

Purpose:

The objective is to compare the application of Radium-223 (Ra-223) in the treatment of prostate cancer (PCa) as outlined in the clinical practice guidelines (CPGs) of Japan, Korea, and Taiwan.

Materials and Methods:

The printed and online guidelines for prostate cancer (PCa) from Japan, Korea, and Taiwan were analyzed, with particular attention given to Ra-223 treatment for PCa.

Results:

The online and updated guidelines for PCa management were reviewed. The Japanese Urological Association (JUA) first introduced printed guidelines in 2006, with the most recent version released in 2023. In 2017, the Korean Society of Medical Oncology (KSMO) published its guidelines for managing metastatic prostate cancer, with an updated CPG released in 2020. In Taiwan, the Taiwan Cooperation Oncology Group (TCOG) developed its first PCa practice guidelines from 1999 to 2010, while the Taiwanese Urological Association (TUA) is set to release its latest version in 2024. Regarding the normal range for prostate-specific antigen (PSA), the JUA defines it based on data from the native population with age-specific considerations. However, similar parameters are not detailed in the TCOG or TUA guidelines. PCa staging aligns with the American Joint Committee on Cancer (AJCC) system. While this is referenced in the JUA, it is not explicitly detailed. Conversely, the AJCC staging from 2010 and updates from the 8th edition (2017) are outlined clearly in the TCOG and TUA guidelines. The definition of metastatic castration-resistant prostate cancer (mCRPC) is adequately provided across most guidelines but remains unclear in the TUA.

In Japan, the use of Ra-223 is thoroughly addressed within a section dedicated to clinical questions, discussing its role in managing symptomatic skeletal events and survival outcomes. In Korea, Ra-223 can be considered for patients who exhibit symptoms or visceral metastases and have not undergone prior docetaxel treatment. Moreover, its combination with treatments like abiraterone plus prednisone, docetaxel, or enzalutamide is not recommended. In Taiwan, Ra-223 received reimbursement approval from the National Health Insurance system in March 2019. However, it has not been extensively discussed in the TUA clinical practice guidelines.

Conclusion:

The roles of Ra-223 treatment for mCRPC vary across different clinical practice guidelines (CPGs). From the perspective of evidence-based medicine (EBM), it is recommended to update and revise the Taiwanese CPG for prostate cancer.