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2 泌尿道腫瘤診療指引 ( ) > ( ) -1 : Group 1 <0.15ng/mL/g Group =7 / Group 2 4+3=7 / Group 3 8 / Group / Group 5 5 / Group 5 > / Group 4 Group 5 癌症診療指引128

3 泌尿道腫瘤診療指引 ( ) -2 0 < ( ) ( ) -4 CRPC treatment : abiraterone 07 - ( ) -2 : ( ) ( ) -4 CRPC treatment : abiraterone, Enzalutamide 癌症診療指引129

4 ct1 low grade high grade : : - -1 / 24 ( ) - -2 ct1 low grade high grade : : 癌症診療指引130

5 ( ) 4 Tis cta : 5 ct1, high grade : Gy (preferred) 4 Tis cta : 5 ct1, high grade : / Gy (preferred) 癌症診療指引131

6 Gy / / : / Gy / : / - -6 癌症診療指引132

7 攝護腺癌( 前列腺癌) 診療指引共識1 - ( ) -1 5 >5 T1c 6 / Group 1 (PSA) < 10 ng/ml < 3 50%) <0.15ng/mL/g T1-T2a 6 / Group 1 (PSA) <10 ng/ml T2b-T2c 3+4=7 / Group 2 4+3=7 / Group 3 (PSA) ng/ml T3a 8 / Group / Group 5 (PSA) >20 ng/ml T3b-T4 5 / Group 5 > / Group 4 Group 5 T, N1 T, N, M1 癌症診療指引133

8 攝護腺癌( 前列腺癌) 診療指引共識2 - ( ) -2 ( ) T1c 6 / Group 1 (PSA) <10 ng/ml < 3 50%) <0.15ng/mL/g T1-T2a 6 / Group 1 (PSA)<10 ng/ml : : : : : PSA 癌症診療指引134

攝護腺癌( 前列腺癌) 診療指引共識3 - ( ) -3 ( ) T2b-T2c 3+4=7 / Group2 4+3=7 / Group 3 10-20 ng/ml T3a 8 / Group

9 攝護腺癌( 前列腺癌) 診療指引共識3 - ( ) -3 ( ) T2b-T2c 3+4=7 / Group2 4+3=7 / Group ng/ml T3a 8 / Group / Group 5 >20 ng/ml docetaxel 2-3 : PSA 癌症診療指引135 10, 10, 2% +

10 攝護腺癌( 前列腺癌) 診療指引共識4 - ( ) -4 ( ) T3b-T4 5 / Group / Group 4 Group docetaxel ( ) 2-3 T, N1, M0 T, N, M * 1 ( ) * 1 * 2 癌症診療指引136 * 1: + ( ) * 2: denosumab zoledromic acid or Radium-223 CRPC : abiraterone, Enzalutamide

11 膀胱癌診療指引共識 cta ct1 / 24 ( ) ( ) Tis ct2 ct3 ct4 癌症診療指引137

12 膀胱癌診療指引共識 cta low grade cta high grade ct1 low grade ct1 high grade (high grade) ( ) : Mapping of upper tract collecting system every 1-2y for high grade tumors 癌症診療指引138

13 膀胱癌診療指引共識 cta, ct1, Tis (+/-Hyperthemia) 3 癌症診療指引139 2 Tis cta (preferred) ct1, high grade +

14 膀胱癌診療指引共識 ct2 +/- ( ) ( ) 40-45Gy 60-65Gy 2~3 ( ) ( ) (preferred) 癌症診療指引140-3 ( )

15 膀胱癌診療指引共識 /- ( ) ct3 ct4a + ( ) 40-45Gy Gy ~3-3 ( ) ( ) 癌症診療指引141

16 膀胱癌診療指引共識 ct4b / 2-3 / 40-45Gy Gy 2~3 / 癌症診療指引142

17 泌尿道腫瘤診療指引參考文獻 1. N. Mottet (Chair), J. Bellmunt, E. Briers (Patient Representative), R.C.N. van den Bergh (Guidelines Associate), M. Bolla, N.J. van Casteren (Guidelines Associate), et al. Guidelines on prostate cancer. European Association of Urology (2015) 2. STEFAN THÜROFF, M.D., CHRISTIAN CHAUSSY, M.D., GUY VALLANCIEN, M.D., WOLFGANG WIELAND, M.D., HANS J. KIEL, M.D., ALAIN LE DUC, M.D., High-Intensity Focused Ultrasound and Localized Prostate Cancer: Efficacy Results from the European Multicentric Study. JOURNAL OF ENDOUROLOGY (2003);Volume 17, Number 8 癌症診療指引143

18 癌症診療指引144 Men with High-Volume, ADT-naïve, Metastatic Disease (neoadjuvant or adjuvant) Docetaxel without Prednisolone with ADT mg/m 2 Docetaxel 75 1 Q3W 6 1 mg/m 2 Docetaxel QW 3 Men with Symptomatic mcrpc First-line Therapy Docetaxel with/without prednisolone mg/m 2 Docetaxel 75 1 Q3W 6 1 Prednisolone 5 mg PO BID mg/m 2 Docetaxel QW 3 Prednisolone 5 mg PO BID

19 chemotherapy Alternative 癌症診療指引145 Mitoxantrone + Prednisolone mg/m 2 Mitoxantrone 12 1 Q3W 10 2 Prednisolone 5 mg PO BID Cabazitaxel + Prednisolone mg/m 2 Cabazitaxel Q3W 10 4, 5 Prednisolone 10 mg PO QD 1. The study results of ECOG 3805 demonstrating OS benefit with early docetaxel chemotherapy may change standard of care in patients with extensive disease metastatic prostate cancer. 2. Tannock IF, de Wit R, Berry WR, et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med 2004;351: Takahiro Kojima, Toru Shimazui, Mizuki Onozawa, Sadamu Tsukamoto, Shiro Hinotsu, et al. Weekly Administration of Docetaxel in Patients with Hormonerefractory Prostate Cancer: a Pilot Study on Japanese Patients. 4. de Bono JS, Oudard S, Ozguroglu M, et al. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trial. Lancet 2010;376: Eisenberger M, Hardy-Bessard AC1, Kim CS, et al. Phase III Study Comparing a Reduced Dose of Cabazitaxel (20 mg/m2) and the Currently Approved Dose (25 mg/m2) in Postdocetaxel Patients With Metastatic Castration-Resistant Prostate Cancer- PROSELICA. J Clin Oncol. 2017;35(28):

20 癌症診療指引146 Perioperative Chemotherapy of Bladder Cancer (neoadjuvant or adjuvant) Gemcitabine + Cisplatin mg/m 2 Gemcitabine , 8 Q3W 4 1, 2 Cisplatin 70 1 Q3W 4 mg/m 2 Gemcitabine , 8 Q3W 4 1, 2 Cisplatin 35 1, 8 Q3W 4 mg/m 2 Gemcitabine , 8 Q3W 4 1, 2 Cisplatin 35 1, 2 Q3W 4 mg/m 2 Gemcitabine , 8, 15 Q4W 4 1, 2 Cisplatin 70 1 Q4W 4

21 CMV 癌症診療指引147 mg/m 2 Methotrexate 30 1, 8 Q3W 12 3 Vinblastine 4 1, 8 Q3W 12 Cisplatin Q3W 12 Folinic acid 15 mg Q6H 2, 9 Q3W 12 Adjuvant Intravesical Treatment mg/m 2 BCG 81 mg 1 QW 6 4 mg/m 2 Mitomycin mg 1 QW mg/m 2 Doxorubicin 40 mg 1 QW 6 8 Intravesical MDP regimen mg/m 2 Mitomycin 30 mg 1 Q3W 2 8 Doxorubicin 30 mg 8 Q3W 2 Cisplatin 30 mg 15 Q3W 2

22 for Metastatic Disease Chemotherapy 癌症診療指引148 First-line Therapy Gemcitabine + Ciaplatin mg/m 2 Gemctabine , 8 Q3W 4 2, 9 Cisplatin Q3W Gemcitabine + Ciaplatin mg/m 2 Gemctabine , 8 Q3W 4 2, 9 Carboplatin 4-5 AUC 1 Q3W DDMVAC mg/m 2 Methotrexate 30 1 or 2 Q2W , 11 Vinblastine 3 1 or 2 Q2W 3-4 Doxorubicin or 2 Q2W 3-4 Cisplatin Q2W 3-4

23 mg/m2 癌症診療指引149 Methotrexate 30 1 or 2 Q2W , 11 Vinblastine 3 1 or 2 Q2W 3-4 Doxorubicin or 2 Q2W 3-4 Carboplatin* 4-5 AUC 1 Q2W 3-4 *For Ccr<60 ml/hr only PD-1 inhibitor (cisplatin ineligible) mg/m 2 Atezolizumab 1200 mg 1 Q3W 12 mg/m 2 Pembrolizumab 200 mg 1 Q3W 13 Radiosensitizing Chemotherapy Regimens for Bladder-Preserving Chemoradiation Following a Maximal TURBT First-line Therapy Cisplatin + 5-FU mg/m 2 Cisplatin QW FU QW 3

24 + Motomycin C 5-FU 癌症診療指引150 mg/m 2 Motomycin C FU , Cisplatin + Paclitaxel mg/m 2 Cisplatin QW 3 15 Paclitaxel QW 3 1. Dash A, Pettus JA, Herr HW, et al. A role for neoadjuvant gemcitabine plus cisplatin in muscle-invasive urothelial carcinoma of the bladder: a retrospective experience. Cancer 2008;113: Von der Maase H, Hansen SW, Roberts JT, et al. Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 2000;18: Griffiths G, Hall R, Sylvester R, et al. International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: long-term results of the BA trial. J Clin Oncol 2011;29: Lamm DL1, Blumenstein BA, Crissman JD, et al. Maintenance bacillus Calmette-Guerin immunotherapy for recurrent TA, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest Oncology Group Study. J Urol. 2000; 163: Lundholm C1, Norlén BJ, Ekman P, et al. A randomized prospective study comparing long-term intravesical instillations of mitomycin C and bacillus Calmette-Guerin in patients with superficial bladder carcinoma. J Urol. 1996; 156: 372-6

25 Solsona E, Iborra I, Ricos JV, et al: Effectiveness of a single immediate mitomycin C instillation in patients with low risk 6. 癌症診療指引151 superficial bladder cancer: short and long-term followup. J Urol 1999; 161: Witjes JA1, v d Meijden AP, Collette L, et al. Long-term follow-up of an EORTC randomized prospective trial comparing intravesical bacille Calmette-Guérin-RIVM and mitomycin C in superficial bladder cancer. EORTC GU Group and the Dutch South East Cooperative Urological Group. European Organisation for Research and Treatment of Cancer Genito-Urinary Tract Cancer Collaborative Group. Urology ; 52: Chung-Hsin Chen, Hung-Ju Yang, Chia-Tung Shun, et al. A cocktail regimen of intravesical mitomycin-c, doxorubicin, and cisplatin (MDP) for non-muscle-invasive bladder cancer. 9. Von der Maase H, Sengelov L, Roberts JT, et al. Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. J Clin Oncol 2005;23: Sternberg CN, de Mulder PH, Schornagel JH, et al. Randomized phase III trial of high-dose-intensity methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) chemotherapy and recombinant human granulocyte colony-stimulating factor versus classic MVAC in advanced urothelial tract tumors: European Organization for Research and Treatment of Cancer Protocol no J Clin Oncol 2001;19: Sternberg CN, de Mulder P, Schornagel JH, et al. Seven year update of an EORTC phase III trial of high-dose intensity M-VAC chemotherapy and G-CSF versus classic M-VAC in advanced urothelial tract tumours. Eur J Cancer 2006;42: Balar AV, Galsky MD, Rosenberg JE, et al. Atezolizumab as first-line treatment in cisplatin-ineligible patients with locally advanced and metastatic urothelial carcinoma: a single-arm, multicentre, phase 2 trial. Lancet 2017;389: Balar AV, Castellano DE, O'Donnell PH, et al. Pembrolizumab as first-line therapy in cisplatin-ineligible advanced urothelial cancer: Results from the total KEYNOTE-052 study population. Clin Oncol 2017;6S:Abstract James ND, Hussain SA, Hall E, et al; BC2001 Investigators. Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. N Engl J Med 2012;366: Mitin T, Hunt D, Shipley W, et al. Transurethral surgery and twice-daily radiation plus paclitaxel-cisplatin or fluorouracilcisplatin with selective bladder preservation and adjuvant chemotherapy for patients with muscle invasive bladder cancer (RTOG 0233): a randomized multicentre phase 2 trial. Lancet Oncol 2013;14:

26 攝護腺癌放射治療共識 / ~81.0Gy / 38~ ~66Gy / 27~ ~56Gy / 25~ ~54Gy / 25~ ~2.0Gy ~37.50Gy / 5 : : 1. RTOG, Protocol 0126, A Phase III Randomized Study of High Dose 3DCRT/IMRT versus Standard Dose 3DCRT/IMRT in Patients Treated for Localized Prostate Cancer 2002 Activation 2. Willett CG, et al. Principles and Practice of Radiation Oncology. 5th edition Philadelphia Lippincott Williams & Wilkins;2007. pp Kuban DA, Tucker SL, Dong L, et al. Long-term results of the M.D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 2008;70: NCCN clinical practice guidelines in oncology for prostate cancer. Version 癌症診療指引152

27 膀胱癌放射治療共識癌症診療指引 ( +/- ) / ~66.0Gy / 30~ ~60.0Gy / 27~ ~50.4Gy / 20~ ~2.0Gy D : 1. NCCN clinical practice guidelines in oncology-bladder cancer. version RTOG 0712 Protocol Information A Phase II Randomized Study for Patients with Muscle-Invasive Bladder Cancer Evaluating Transurethral Surgery and Concomitant Chemoradiation by Either BID Irradiation plus 5-Fluorouracil and Cisplatin or QD Irradiation plus Gemcitabine Followed by Selective Bladder Preservation and Gemcitabine/Cisplatin Adjuvant Chemotherapy Radiation Therapy Oncology Group, Protocol 0926,. A Phase II Protocol For Patients With Stage T1 Bladder Cancer To Evaluate Selective Bladder Preserving Treatment By Radiation Therapy Concurrent With Cisplatin Chemotherapy Transurethral Surgical Re-Staging. website:

28 4. Efstathiou JA, et al. Late Pelvic Toxicity After Bladder-Sparing Therapy in Patients With Invasive Bladder Cancer: RTOG 89-03, 95-06, 97-06, J Clin Oncol 2009; 27: 癌症診療指引154

參考文獻 in-men-with-highly-advanced-prostate-cancer

參考文獻 in-men-with-highly-advanced-prostate-cancer 攝護腺癌抗癌藥物治療指引 Men with High-Volume, ADT-naïve, Metastatic Disease (neoadjuvant or adjuvant) Docetaxel without with ADT Docetaxel 75 1 Q3W 6 1 Docetaxel 30-35 1 QW 3 Men with Symptomatic mcrpc First-line