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Keywords:

  • epidemiology;
  • Japan;
  • neoplasm;
  • prostate

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Acknowledgments
  7. Member of the Cancer Registration Committee of Japanese Urological Association
  8. References
  9. Appendix

Abstract Background:  The purpose of the present paper was to investigate etiology, diagnosis, initial treatment, pathological findings and final outcomes for prostate cancer in Japan.

Methods:  From 2001, the Japanese Urological Association initiated computer-based registration of prostate cancer patients in Japan to estimate etiology, diagnosis, initial planed treatment, pathological findings and final outcome.

Results:  A total of 173 institutions responded and 4529 patients who were diagnosed with prostate cancer in 2000 were registered. In the first year, background factors, diagnostic procedures and initially planned treatment were recorded. The analysis of these registered cases is presented here. Nearly 30% of the cases demonstrated <10 ng/mL of prostate specific antigen. The six-core biopsy was the most commonly used procedure. The clinical T staging distribution was as follows: T1c, 20.3%; T2a, 21.8%; T2b, 17.3%; T3a, 15.8%; T3b, 11.0%; and T4, 8%. More than 70% of cases were diagnosed as M0. Hormone therapy alone was the initial treatment plan in more than half of the cases.

Conclusion:  This is the first report on prostate cancer patients in Japan based on multi-institutional registration. Pathological findings and final outcome will be surveyed later by the Japanese Urological Association. After 5 years, adopted treatment, pathological results and final outcome will be registered.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Acknowledgments
  7. Member of the Cancer Registration Committee of Japanese Urological Association
  8. References
  9. Appendix

Prostate cancer is known around the world as a disease of elderly men. Parkin et al. reported that three-quarters of cases occur in men over 65 years of age.1 In Japan, although the incidence of prostate cancer has been much less than in American and European countries, it has been sharply rising during the last two decades, a trend also observed in other Asian countries. Even before the introduction of prostate specific antigen (PSA) testing in the early 1990s, incidence rates had been rising in many countries.1–5 Changes from traditional Japanese to more Western lifestyles and nutritional habits have been implicated in the increase in the incidence of prostate cancer in Japan.3 In the early 1990s, the PSA test contributed to the earlier diagnosis of prostate cancer, which is also reflected in the increased incidence. Now, in Japan as in other developed countries, prostate cancer is a large and growing public health problem whose risk factors are essentially unknown.

The precise nature of this problem differs from one country to another because of the wide range of national incidence and, to a much lesser degree, survival profiles that have been reported.1,5–8 Recently, however, Nakata et al.4 reported that the mortality rate of prostate cancer patients in Japan has been increasing as rapidly as the incidence, while in North America the mortality rate has actually declined even in the face of rising incidence.9 The Japanese Urological Association (JUA) and the Japanese Society of Pathology revised the 2nd edition of General Rule for Clinical and Pathological Studies on Prostate Cancer to the 3rd edition in 200110 and, in accordance with this new edition, initiated a study to estimate the etiology, diagnosis, initial treatment, pathological findings and final outcomes for prostate cancer in Japan by employing computer-based registration of prostate cancer patients from institutions all over Japan. The registration program has been established by the members of committee for revision of General Rule for Clinical and Pathological Studies on Prostate Cancer. Here we report the background data at diagnosis from the initial registration of 4529 patients who were diagnosed pathologically with prostate cancer in 2000.

Methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Acknowledgments
  7. Member of the Cancer Registration Committee of Japanese Urological Association
  8. References
  9. Appendix

Using a CD-ROM program developed by the members of committee for revision of General Rule for Clinical and Pathological Studies on Prostate Cancer and the staff of the National Cancer Center, new patients who were diagnosed by pathology to have prostate cancer in 2000 were registered. Age, occupation, race, concomitant malignancy, family history, past history and symptoms were entered as background factors for each prostate cancer patient. The findings from digital rectal examination (DRE), imaging, PSA level, number of cores taken by biopsy, number of positive core(s), histology of the biopsy specimen, Gleason score, 5th tumor, nodes, metastases (TNM) classification (5th edition), diagnostic process and initial treatment plan were also entered. The collected data were analyzed.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Acknowledgments
  7. Member of the Cancer Registration Committee of Japanese Urological Association
  8. References
  9. Appendix

One hundred and seventy-three institutions responded and 4529 patients who were diagnosed with prostate cancer in 2000 were registered. Approximately 14 000 new prostate cancer patients were estimated in Japan this year;9 therefore, approximately 30% of total cases were covered by this registry.

Background data

The age distribution of patients is summarized in Figure 1. More than one-quarter of all patients were 70–74 years old, and three-quarters were 60–79 years old. The ethnic distribution was as follows: Japanese, 99.56%; non-Japanese Mongolians, 0.29%; and Caucasian, 0.13%. Only 71 patients (1.57%) had a family history of prostate cancer in either their father (0.66%), brother (0.82%), or uncle (0.09%). Common occupations of the registered patients were the following: retired (61.29%), office clerks or associate professionals (8.06%), corporate or general managers (6.93%), agricultural, forestry, or fishery workers (6.71%), and professionals or technicians (6.62%). A total of 520 patients (11.48%) had a history of other malignancies.

image

Figure 1. Age distribution of prostate cancer newly diagnosed in 2000 and registered. Registered cases were divided into 5-year age groups as indicated. Bars indicate the number of cases equal to and above the age on the left lower corner and below the age on the right lower corner of each bar. The numbers below each bar indicate the percentage of cases in each age group among all registered cases.

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Initial evaluation

Of all the patients, 71.08% (3219 cases) presented with some symptoms and 339 cases (7.49% of all and 35.17% of metastatic disease) presented with symptoms from metastases.

The most commonly used staging modalities were transrectal ultrasonography (TRUS; 78.32%) and bone scan (73.53%), followed by computed tomography (CT; 66.75%) and magnetic resonance imaging (MRI; 42.77%). The findings from local imaging studies are summarized in Table 1. As expected, local imaging studies yielded better sensitivity (66.17% produced a positive finding) than DRE (58.29% true-positives; Table 2).

Table 1.   Findings of local imaging study
 n(%)
Not visible125527.71
Confirmed within prostate158034.89
Extra-capsule 73216.16
Invades adjacent structure 68515.12
Uncertain 2776.12
Total4529100.00
Table 2.   Findings of digital rectal examination
 n(%)
Not palpable170637.67
One lobe109024.07
Both lobe 76016.78
Extra-capsule 48110.62
Seminal vesicle invasion 1132.50
Extra-prostate 1964.33
Uncertain 18.34.04
Total4529100.00

The PSA level distribution is summarized in Figure 2. Nearly 30% of prostate cancer cases diagnosed in 2000 demonstrated a PSA value of <10 ng/mL.

image

Figure 2. Distribution of prostate specific antigen (PSA) value of registered cases. Registered cases were divided into groups of PSA value by 10 ng/mL as indicated. The PSA value was measured by Tandem-R and includes all Tandem-R compatible kits, such as E-test Tosoh, Chemilumi ACS-PSA, Shifalite PSA and Lumipulse PSA. Bars indicate the number of cases equal to and above the value on the left lower corner and below the value on the right lower corner of each bar. Cases with PSA ≥ 90 ng/mL were counted as a single group. The numbers below each bar indicate the percentage of cases in each group among all registered cases.

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A summary of the biopsy statistics is shown in Tables 3–5 and Figure 3. Because the same number of cores is usually taken from each lobe, the 5th, 7th, and 9th core samples are supposed to be additional targeted biopsies of suspicious lesions (Table 3). The percentage of biopsies yielding all positive cores was higher for the 6-core than for the 8-core biopsy (Fig. 3). However, the percentage of biopsies yielding only one positive core was higher for the 8-core procedure. A total of 99.8% of tumors were determined pathologically to be adenocarcinoma, followed by neuroendocrine tumors (0.1%). Moderately differentiated adenocarcinoma (43.5%) was the most common differentiation state found in this population, followed by well-differentiated (31.3%) and poorly differentiated adenocarcinomas (20.6%). Gleason grade classification is summarized in Tables 4,5; grade 3 was found to be the most common grade in both primary and secondary dominant tumors.

Table 3.  Number of adopted biopsy cores
Core(s)n(%)
  1. Uncertain, 168 patients.

1  50.12
2 932.30
3 521.28
4 2646.52
5 902.22
6212852.52
7 2826.96
8 61615.20
9 902.22
≥10 432 10.66
Total4052100
Table 4.  Primary Gleason grade
Gleason graden(%)
1 3768.30
2 54111.90
3115525.50
4 69515.30
5 3086.80
Uncertain1454 32.10
Total4529100
Table 5.  Secondary Gleason grade
Gleason graden(%)
1 2515.50
2 55212.20
3102022.50
4 78017.20
5 3126.90
Uncertain1614 35.60
Total4529100
image

Figure 3. Number of cancer-positive cores in (a) 6-core biopsy (n = 2128) and (b) 8-core biopsy (n = 616). Registered cases were divided into groups by number of cancer-positive cores as indicated. Bars indicate the number of cases in each group. The percentage of cases in each group among each subgroup of 6- or 8-core biopsy is indicated over or below the bars.

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Initial staging

Clinical T stage of this population is summarized in Figure 4. The clinical T staging distribution is as follows: T1c, 20.3%; T2a, 21.8%; T2b, 17.3%; T3a, 15.8%; T3b, 11.0%; and T4, 8%. Regionally limited lymph node metastases examined mainly by CT were found in 501 cases (11.06%), and 3569 cases (78.80%) were diagnosed as negative lymph node metastasis.

image

Figure 4. Distribution of local staging (T staging). Registered cases were divided into groups by local staging as indicated according to the 1997 International Union Against Cancer (UICC) tumor, nodes, metastases (TNM) classification. Bars indicate the number of patients for each T stage. The numbers below each bar indicate the percentage of cases in each age group among all registered cases.

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Distant metastases are detailed in Table 6. More than 70% of patients were negative for distant metatstasis.

Table 6.  M stage
M stagen(%)
M0324371.61
M1a 400.88
M1b 861 19.01
M1c 631.39
MX 3227.11
Total4529100

Initial treatment strategies

Selected plans are summarized in Figure 5. Hormonal therapy alone was chosen for more than half of the cases. Prostatectomy with or without hormonal therapy was planned for 27.4% (1240 cases). Irradiation with or without hormonal therapy was not very common (8.1%). For cases of T1c to T3N0M0 (2671 cases total), 45.90% (1226 cases) were scheduled to undergo hormonal therapy without any other additional treatment. Irradiation was not commonly advised for this group (10.8%).

image

Figure 5. Initial treatment plan for (a) all registered cases (n = 4529) and (b) cases of T1c to T3 without lymph node or distant metastases (n = 2671). Registered cases were divided into groups by initial treatment plan, which includes each treatment modality and appropriate combinations, as indicated. W/W, watchful waiting; RRP, retropubic radical prostatectomy; Hx, hormonal therapy; Rx, irradiation. Bars indicate the number of cases in each group. The numbers below each bar indicate the percentage of cases in each group among all registered cases or the subgroup of patient at stage T1c to T3 without lymph node or distant metastases.

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Additional data are summarized in Appendix I–IV.

Acknowledgments

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Acknowledgments
  7. Member of the Cancer Registration Committee of Japanese Urological Association
  8. References
  9. Appendix

These clinicopathological statistics are the results from a number of institutions in Japan. We are also grateful to Dr E Okajima and Dr K Kawashima (Division of Urology, National Cancer Center, Tokyo), and Ms M Nakamura, a secretary of cancer registration office, for special efforts to analyze and summarize the data.

This document was established by the Cancer Registration Committee of the Japanese Urological Association. Members of this task force include: Hiroyuki Fujimoto, md, National Cancer Center Hospital, Tokyo; Tsuneharu Miki, md, Chair, Cancer Registration Committee of the Japanese Urological Association, Kyoto University of Medicine, Kyoto; Masaru Murai, md, Keio University School of Medicine, Tokyo; Tomoaki Fujioka, md, Iwate Medical Univeristy School of Medicine, Iwate; Seiji Naitoh, md, Graduate School of Medical Science, Kyushu University, Kyushu; Tadao Kakizoe, md, National Cancer Center, Tokyo; Akihiko Okuyama, md, Graduate School of Medical Science, Kyushu University, Kyushu; Hideyuki Akaza, md, Institute of Clinical Medicine, University of Tsukuba, Tsukuba; Youichi Mizutani, md, Kyoto University of Medicine, Kyoto; and Sadao Kamidono, md, Kobe University School of Medicine, Kobe, Japan.

Member of the Cancer Registration Committee of Japanese Urological Association

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Acknowledgments
  7. Member of the Cancer Registration Committee of Japanese Urological Association
  8. References
  9. Appendix

This document was established by the Cancer Registration Committee of Japanese Urological Association. Members of this task force include: Hiroyuki Fujimoto, MD, National Cancer Center hospital, Tokyo; Tsuneharu Miki, MD, Chair, Cancer Registration Committee of Japanese Urological Association, Kyoto University of Medicine, Kyoto; Masaru Murai, MD, Keio University School of Medicine, Tokyo; Tomoaki Fujioka, MD, Iwate Medical University School of Medicine, Iwate; Seiji Naito, MD, Graduate School of Medical Science, Kyushu University, Kyushu; Tadao Kakizoe, MD, National Cancer Center, Tokyo; Akihiko Okuyama, MD, Graduate School of Medicine, Osaka University, Osaka; Hideyuki Akaza, MD, Institute of Clinical Medicine University of Tsukuba, Tsukuba; Youichi Mizutani, MD, Kyoto University of Medicine, Kyoto; Sadao Kamidono, MD, Kobe University School of Medicine, Kobe.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Acknowledgments
  7. Member of the Cancer Registration Committee of Japanese Urological Association
  8. References
  9. Appendix
  • 1
    Parkin DM, Bray FI, Devesa SS. Cancer burden in the year 2000. Eur. J. Cancer 2001; 37 (Suppl. 8): 466.
  • 2
    Breslow N, Chan CW, Dhom G et al. Latent carcinoma of prostate at autopsy in seven areas. Int. J. Cancer 1977; 20: 6808.
  • 3
    Akazaki K, Stemmermann GN. Compararative study of latent carcinoma of the prostate among Japanese in Japan and Hawaii. J. Natl Cancer Inst. 1973; 50: 113744.
  • 4
    Nakata S, Takahashi H, Ohtake N, Takei T, Yamanaka H. Trends and characteristics in prostate cancer mortality in Japan. Int. J. Urol. 2000; 7: 2547.
  • 5
    Quinn M, Babb P. Patterns and trends in prostate cancer incidence, survival, prevalence and mortality. Part I. International comparisons. BJU Int. 2002; 90: 16273.
  • 6
    Parkin DM, Pisani P, Ferlay J. Estimates of the world-wide incidence of 25 major cancers in 1990. Int. J. Cancer 1999; 80: 82741.
  • 7
    Coleman MP, Esteve J, Damieki P et al. Trends in Cancer Incidence and Mortality. IARC. Scientific Publications no. 121. International Agency for Research on Cancer, Lyons, 1993.
  • 8
    Whittlemore AS. Trends in Cancer Incidence and Mortality. Cancer Surveys , Vol. 19, 20. Imperial Cancer Research Fund/Cold Spring Harbor Laboratory Press, New York, 1994.
  • 9
    The Research Group for Population-based Cancer Registration in Japan. Cancer incidence and incidence rates in Japan in 1997: estimates based on data from 12 population-based cancer registries. Jpn J. Clin. Oncol. 2002; 32: 31822.
  • 10
    Japanese Urological Association and The Japanese Society of Pathology. General Rule for Clinical and Pathological Studies on Prostate Cacner. Kanehara, Tokyo, 2001.

Appendix

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Acknowledgments
  7. Member of the Cancer Registration Committee of Japanese Urological Association
  8. References
  9. Appendix
I. General statistics
I.1. Background
Table 7. I.1.1. Races
RaceNumber%
Japanese4509 99.56
Mongolian (without Japanese) 130.29
White  60.13
Uncertain  10.02
Total4529100
Table 8. I.1.2. Family history of prostate cancer
 Number%
Father300.66
Brother370.82
Uncle 40.09
Total711.57
Table 9. I.1.3. Occupation
OccupationNumber%
Service workers 1012.23
Transportal and postal related workers 631.39
Corporate and general managers 3146.93
Craft, related trades workers and elementary occupations 1653.64
Mining labourers  80.18
Office clerks and associate professionals 3658.06
Professionals and technicians 3006.62
Agricultural, forestry and fishery workers 3046.71
Sales workers 1192.63
Protective services workers 140.31
Others or retired100222.12
Uncertain1774 39.17
Total4529100
Table 10. I.1.4. Distribution of organs of concomitant malignancy
OrganNumber
Kidney 33
Urothelial 111
Testis2
Penile3
Head and neck 34
Lung 50
Esophageal 10
Stomach107
Colon120
Liver and gall bladder 19
Pancreas9
Skin6
Hematological8
Sarcoma3
Breast1
Uncertain and other4
Total520
Negative4022
I.2. Symptoms
Table 11. I.2.1. Urological
SymptomsNumber%
+321971.08
1273 28.11
Uncertain 370.82
Total4529100
Table 12. I.2.2. Metastatic
SymptomsNumber%
+ 3397.49
413791.34
Uncertain 531.17
Total4529100
I.3. Staging method and findings
Table 13. I.3.1. Modality of image study
Number% in all cases 
CT302366.75
MRI193742.77
Bone scan333073.53
TRUS354778.32
I.4. Pathological findings in biopsy specimens
Table 14. I.4.1. Histological type
Pathological typeNumber%
Adenocarcinoma4519 99.80
Neuroendcrine tumor  30.10
Transitional cell carcinoma  20.00
Other  20.00
Uncertain  30.10
Total4529100
Table 15. I.4.2. Predominant differentiation
Pathological patternNumber%
W/D141631.30
M/D197243.50
P/D 931 20.60
Uncertain 2104.60
Total4529100
Table 16. I.4.3. Poorer differentiation
Number% 
W/D 95921.20
M/D166436.70
P/D133729.50
Uncertain 569 12.60
Total4529100
I.5. TNM classification
Table 17. I.5.1. T stage distribution
T stageNumber%
  1. TNM stage followed by 1997 UICC's TNM classification.

T0 120.27
T1a 1663.73
T1b 781.75
T1c 90120.26
T2a 96821.77
T2b 771 17.34
T3a 70215.79
T3b 49111.04
T4 3588.05
Total4447100
Table 18. I.5.2. N stage distribution
N stageNumber%
N0356978.80
N1 50111.06
NX 459 10.13
Total4529100
Table 19. I.5.3. M stage distribution
M stageNumber%
M0324371.61
M1a 400.88
M1b 861 19.01
M1c 631.39
MX 3227.11
Total4529100
II. General statistics in clinical T1c-T3N0M0 prostate cancer
Table 20. II.1. Age distribution
Age rangeNumber%
  1. Cases were divided into age groups by 5 years as indicated. Bars demonstrate the number of cases between equal and over the age on the left lower corner and below the age on the right lower corner of each bar. The numbers below each bar indicates the percentage of cases in each age group among all registered cases.

<54 381.42
55–59 1234.61
60–64 27910.45
65–69 56221.04
70–74 75628.30
75–79 506 18.94
80–84 2408.99
85–89 1324.94
90–94 271.01
95>  80.15
Total2671100
Table 21. II.2. Findings of image study
Number% 
Not visible 83631.87
Confined within prostate120946.09
Extra-capsule 416 15.86
Invades adjacent structure 1284.88
Uncertain 821.30
Total2671100

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Table 22. II.3. DRE findings
Number% 
Not palpable117443.95
One lobe 78629.43
Both lobe 362 13.55
Extra-capsule 2158.05
SV invasion 401.50
Extra-prostate  50.19
Uncertain 893.33
Total2671100

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Table 23. II.4. Number of cancer positive core(s) in systematic prostate biopsy
Core(s)Number%
  • *

    uncertain: 158 patients.

1 63125.03
2 592 23.48
3 44317.57
4 29611.74
5 1927.62
6 2268.97
7 552.18
8 461.83
9 160.64
10 or more 160.64
Total2513100

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Table 24. II.5. Correlation between DRE findings and image findings
DREImage findings
Not visibleConfinedExtra-capsuleInvadesUncertainTotal
Not palpable678 409 37 22281174
One lobe111 510111 3123786
Both lobe 29 204 88 2516362
Extra-capsule 5 31159 15 5215
SV invasion 1  2 11 25 140
Extra-prostate 0  2 0 3 05
Uncertain 12 51 10 7 989
Total8361209416128822671
Table 25. II.6. T stage distribution
StageNumber%
  • T stage followed by 1997 UICC's TNM classification.

T1c 72126.99
T2a 79429.73
T2b 52819.77
T3a 426 15.95
T3b 2027.56
Total2671100
Table 26. II.7. Correlation between Gleason's score and T stage
Gleason’s scoreT stage (1997 UICC)Total
T1cT2aT2bT3aT3b
  • The Gleason grade was not judged in 943 patients.

 237 2816 2 1 84
 348 501913 3133
 451 653116 4167
 573109705122325
 691109613922322
 793101988849429
 817 26253515118
 918 24284418132
10 5 4 5 4 0 18
Total4335163532921341728
III. Correlation between PSA and clinicopathological factors in clinical T1c-T3N0M0 prostate cancer
Table 27. III.1. PSA distribution
PSA(ng/dl)Total%
  • Cases were divided into groups of PSA value by 10 ng/mL as indicated. Methods of measurement was Tandem-R as the standard, and include all Tandem-R compatible kits, such as E test TOSOH, CHEMILUMI ACS-PSA, SHIFALITE PSA and LUMIPULSE PSA. Bars demonstrate the number of cases between equal and over the value on the left lower corner and below the value on the right lower corner of each bar. Cases with PSA equal and over 90 ng/mL were counted as a group. The numbers below each bar indicates the percentage of cases in each group among all registered cases.

 0–1066336.131
10–2050427.466
20–3020411.117
30–401206.54
40–50 74 4.033
50–60 45 2.452
60–70 372.016
70–80 412.234
80–90 170.926
90> 201.09
1725100 
Table 28. III.2. Correlation between PSA and clinical T stage
PSA(ng/dl)T stageTotal
T1cT2aT2bT3aT3b
  1. Cases were divided into groups of PSA value by 10 ng/mL as indicated. Bars demonstrate the percentage of each T stage among each PSA group. Cases with PSA equal and over 90 ng/mL were counted as a group.

 0–10251236107 46 23663
10–20150178 99 58 19504
20–30 42 62 44 30 26204
30–40 22 29 28 25 16120
40–50 5 12 21 27 974
50–60 10 8 7 18 245
60–70 4 6 7 13 737
70–80 3 7 4 20 741
80–90 4 5 3 3 217
90> 1 5 5 4 520
Total4925483252441161725

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Table 29. III.3. Correlation between PSA and Gleason's score
PSA(ng/dl)Gleason's scoreTotal
2345678910
  1. Cases were divided into groups of PSA value by 10 ng/mL as indicated. Bars demonstrate the percentage of each Gleason's score among each PSA group. Cases with PSA equal and over 90 ng/mL were counted as a group. The numbers below each bar indicates the number of cases in each PSA group.

 0–1024634983889424224663
10–2019292865618322202504
20–301863120387102204
30–4025517925950120
40–50130961948174
50–6010143935145
60–7000132945137
70–8002333744141
80–90 00042310017
90>10012232020
Total49110932201962898181121725

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IV. Main initially planed treatment for fresh cases without concomitant malignancy patients in clinical T1c-T3N0M0 prostate cancer
Table 30. IV.1. Age distribution and treatment
Age rangeTreatmentTotal
W/WRPPRPP+HxRxRx+HxHx
  1. Clinical T1c-T3 cases were divided by age. Bars demonstrate the percentage of adpoted treatment among each age group.

55–59344352418106
60–6451017441441239
65–6961481411041108454
70–74211321222763229594
75–791218381536268387
80–8481088163188
85–895002193101
90>100002423
Total61444410681679442094

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Table 31. IV.2. PSA and treatment
PSA(ng/dl)TreatmentTotal
W/WRPPRPP+HxRxRx+HxHx
  1. Clinical T1c-T3 cases were divided into groups of PSA value by 10 ng/mL as indicated. Bars demonstrate the percentage of adpoted treatment among each PSA group. Cases with PSA equal and over 90 ng/mL were counted as a group.

0–10181521102627161494
10–201089831234175403
20–302203561280155
30–40012191144288
40–500811063257
50–60053022535
60–70027121729
70–80006052334
80–90010031014
90>012011115
Total30290276461065761324

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Table 32. IV.3. Main treatment and clinical T stage
Initial treatmentT stageTotal
T1cT2aT2bT3aT3b
  • Bars demonstrate the percentage of adpoted treatment and each stage.

W/W391472062
RPP16717388292459
RPP+Hx1101261056317421
Rx11311212369
Rx+Hx3729284630170
Hx202255181202108948
Total5666284213541602129

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IV.4. T stage, age and initially planed treatment
Table 33. T1c
AgeW/WRPPRPP+HxRxRx+HxHxTotal
<5406310212
55–59120900333
60–6433817131274
65–69450402922127
70–7416442751549156
75–798814295394
80–84600013845
85–89100001920
90>000004 4
Total391661101137202565

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Table 34. T2a
AgeW/WRPPRPP+HxRxRx+HxHxTotal
<54063000 9
55–5911313224 35
60–6413718204 62
65–690633631025137
70–7454944111370192
75–7915119382111
80–842003141 47
85–894001027 32
90>000002 2
Total141731253129255627

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Table 35. T2b
AgeW/WRPPRPP+HxRxRx+HxHxTotal
<54112011 6
55–59186006 21
60–6411916135 45
65–69125421529103
70–740313261136116
75–792472749 71
80–840001129 31
85–890001019 20
90>100007 8
Total7881051228181421

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Table 36. T3a
AgeW/WRPPRPP+HxRxRx+HxHxTotal
<540 11010 3
55–59037024 16
60–6406180512 41
65–69191921117 59
70–74081541152 90
75–7911321154 72
80–840104338 46
85–890000117 18
90>000008 8
Total229631245202353

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Table 37. T3b
ageW/WRPPRPP+HxRxRx+HxHxTotal
  1. Clinical T1c-T3b cases were divided by age.

  2. Correlation between adopted treatment and each stage were plot the percentage of each groups

  3. Abbreviations are follows: W/W; watchful waiting, RRP; retropublic radical prostatectomy, Hx: hormonal therapy, Rx; irradiation.

<54001001 2
55–59000001 1
60–64015038 17
65–690142615 28
70–7400411322 40
75–790030630 39
80–840000217 19
85–890000011 11
90>000003 3
 0217330108160

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V. Institutions that were registered
InstitutionNumberNumber of patients
  1. Thirty three patients in 4565 were deleted because of duplication, insufficient date, etc.

University Hospital 311159
National Hospital 11 422
General Hospital1312984
Total173 4565?
InstitutionNumber of patients
Hokkaido
 Hokkaido University Graduate School of Medicine29
 Otaru Municipal Hospital26
 Asahikawa City Hospital17
 Bibai Rosai Hospital10
 Asahikawa Red Cross Hospital20
 Kin-Ikyo Chuou Hospital17
 Kushiro City General Hospital20
 Jinyukai Hospital21
 Hokkaido Hospital for Social Health Insurance16
 Muroran City General Hospital40
Aomori Prefecture
 Aomori Rosai Hospital21
Iwate Prefecture
 Iwate Rousai Hospital20
Miyagi Prefecture
 Tohoku University Hospital 21
 Ishinomaki Red Cross Hospital13
 Miyagi Cancer Center59
Fukushima Prefecture
 Fukushima Medical University Hospital24
 Fujita Public Hospital29
Ibaraki Prefecture
 Institute of Clinical Medicine University of 31
Tsukuba
 Kitaibaraki Municipal General Hospital 8
 Hakujuji General Hospital 6
Tochigi Prefecture
 Rosai Hospital for Silicosis12
Gunma Prefecture
 Gunma University Hospital52
 Gunma Cancer Center21
 Tatebayashi Kousei Hospital41
 Motojima General Hospital 8
Saitama Prefecture
 National Defense Medical College35
 Koshigaya Municipal Hospital22
 Saiseikai Kanagawaken Hospital36
 Yokoham Rosai Hospital55
 The International Goodwill Hospital27
Niigata Prefecture
 Niigta Cancer Center Hospital64
 Niigata City General Hospital37
 Itoigawa General Hospital 5
Toyama Prefecture
 Toyama Medical and Pharmaceutical University26
 Toyama Prefectural Central Hospital16
 Toyama Red Cross Hospital16
 Asahi General Hospital 3
 Kamiichi Welfare Hospital 8
 Saiseikai Toyama Hospital 5
Ishikawa Prefecture
 Kaga Chuoh Hospital 9
Fukui Prefecture
 Fukui Prefectural Hospital 8
 Obama Community Hospital 2
 Fukui General Hospital 4
Yamanashi Prefecture
 Yamanashi Medical University27
 Yamanashi Prefectural Central Hospital27
Nagano Prefecture
 Shinshu University School of Medicine43
 Matsumoto National Hospital51
 Ina Central Hospital39
 Nagano Red Cross Hospital58
 Nagano Municipal Hospital53
Gifu Prefecture
 Gifu University School of Medicine19
 Gifu Municipal Hospital27
 Kizawa Memorial Hospital13
 Gifu Red Cross Hospital10
Shizuoka Prefecture
 Hamamatsu Medical Center36
 Hamamatsu Red Cross Hospital12
 Seirei Mikatahara General Hospital68
 Hamaoka Municipal Hospital 6
Aichi Prefecture
 Fujita Health University46
 TOYOTA Memorial Hospital15
 Josai Municipal Hospital, City of Nagoya16
 Meijo Hospital13
 National Chubu Hospital22
 Koyo Hospital 7
Tottori Prefecture
 Nozima Hospital11
Shimane Prefecture
 Masuda Red Cross Hospital18
Okayama Prefecture
 Okayama University Graduate School of Medicine and Dentistry39
 Kawasaki Medical School71
 Okayama Central Hospital40
 Kurashiki Medical Center49
 Kawasaki Hospital27
 Kurashiki Central Hospital68
 Konko Hospital11
Hiroshima Prefecture
 Kohsei General Hospital 5
Yamaguchi Prefecture
 Yamaguchi University School of Medicine17
Tokushima Prefecture
 Tokushima Municipal Hospital21
 Tokushima Red Cross Hospital30
 Oe Kyodo Hospital17
Kagawa Prefecture
 Kagawa Medical University31
 Kagawa Prefectural Central Hospital51
 Sanuki Municipal Hospital12
Ehime Prefecture
 National Shikoku Cancer Center57
 Matsuyama Shimin Hospital28
 Saiseikai Imabari Hospital24
 Matsuyama Red Cross Hospital37
 Shikoku Central Hospital 8
 Jyuzen General Hospital17
Kochi Prefecture
 Hata Kenmin Hospital13
Fukuoka Prefecture
 Graduate School of Medical Sciences, Kyushu University35
 Kokura National Hospital13
 Omuta City General Hospital27
 Hara Sanshin General Hospital102
 Yahata City Hospital10
 Chikushi Hospital Fukuoka University16
 Tagawa Municipal Hospital 4
 Nippon Steel Yawata Memorial Hospital 6
 Satte General Hospital 9
 Saitama Municipal Hospital27
 Kawaguchi Municipal Medical Center29
 The Kitasato Institute Medical Center Hospital22
 Saiseikai Kurihashi Hospital25
 Jichi Omiya Medical Center29
Chiba Prefecture
 Graduate School of Medicine, Chiba University 32
 Matsudo Municipal Hospital38
 Kameda Medical Center23
 Yatsu Hoken Hospital19
 Juntendo University Urayasu Hospital28
Tokyo
 Keio University School of Medicine138
 Kidney Center, Tokyo Women's Medical University79
 Showa University School of Medicine45
 International Medical Center of Japan35
 National Tokyo Medical Center83
 National Cancer Center Hospital101
 Tokyo Metropolitan Ohkubo Hospital 9
 Cancer Institute Hospital94
 Toranomon Hospital100
 Minamitama Hospital18
 Inagi Municipal Hospital14
 Nagakubo Clinic36
 Tokyo Medical University Hachioji Medical Center17
 Kosei General Hospital22
 National Hospital Tokyo Disaster Medical Center21
Kanagawa Prefecture
 Kitasato University96
 Yokohama City Kowan Hospital 9
 Yokosuka Kyosai Hospital40
 Kawasaki Municipal Kawasaki Hospital14
 St. Marianna University School of Medicine Toyoko Hospital22
Mie Prefecture
 Faculty of Medicine, Mie University16
 Takeuchi Hospital32
Shiga Prefecture
 Nagahama City Hospital26
Kyoto
 Kyoto Second Red Cross Hospital20
 Kyoto Yawata Hospital 2
 Saiseikai Kyoto Hospital29
 Hukuchiyama City Hospital 9
Osaka
 Wakakusa Hospital 5
 Kinki University School of Medicine19
 The Center for Cancer and Cardiovascular Diseases, Osaka90
 Osaka Police Hospital39
 Osaka Kosei-Nenkin Hospital27
 Higashiosaka City General Hospital22
 Osaka Seamen`s Insurance Hospital10
 Osaka Red Cross Hospital30
 Rinku General Medical Center Izumisano Municipal Hospital25
 Ohno Memorial Hospital 9
 Kanbara Hospital 3
 Bellland General Hospital32
Hyogo Prefecture
 Kobe National Hospital17
 Nishiwaki Municipal Hospital18
 Hara Genitourinary Hospital27
 Ashiya Municipal Hospital26
 Shinsuma Hospital 4
 Self Difense Forces Hanshin Hospital 1
 Takayama Clinic18
 Kakogawa Municipal Hospital19
Nara Prefecture
 Nara National Hospital 6
 Yamato Takada Municipal Hospital14
 Saiseikai Chuwa Hospital15
 Nara Social Insurance Hospital10
 Kokuho Central Hospital 9
 Ikoma General Hospital 2
Wakayama Prefecture
 Wakayama Rosai Hospital17
 Hidaka General Hospital 7
 Kinan General Hospital 2
Nagasaki Prefecture
 Nagasaki University School of Medicine28
 Isahaya Insurance General Hospital22
Oita Prefecture
 Oita National Hospital16
 Nakatsu Daiichi Hospital21
 Yamaga General Hospital 3
Miyazaki Prefecture
 Miyazaki Medical College21
 Kenritu Nobeoka Hospital16
 Kushima City National Health Insurance Hospital 5
Kagoshima Prefecture
 Satsumagun Ishikai Hospital10
Okinawa Prefecture
 Okinawa Prefectural Naha Hospital 9