( 20 010010) 787 1092 1/32 498.50 4 980 2004 9 1 2004 9 1 1 1 000 ISBN 7-204-05940-9/R 019 1880.00 ( 20.00 )
...1...1...2...3...4...5...6...8...9...12...13...14...15...15...17...17...19...19...20 I
...21...22...23...24...26...27...28...28...30 6...30...32...34...35...36...37...37...39 E...40...42...43...44 II
...46 E...47...48...50 CK 20MRNA...53...54...55 PA...56 VEGF...57...59...60...60...62...63...64...64...65...65...74...75...76...77 III
...79...80...82...83...84...86...87...89...91...92...94...94...95...96...98...99... 100... 103... 104... 105... 106... 107 IV
... 109... 110... 110... 112... 117... 118... 119 PSA... 120... 121... 123... 125... 126... 127... 128 PET... 129... 130... 132... 133... 135... 135... 137 V
... 139... 140... 141... 141... 142... 143... 144... 144... 145... 146... 147... 148... 149... 150... 151... 152... 153... 153... 154... 155... 157... 157 VI
... 158... 160... 161... 163 MRI... 163 CT... 164... 165... 166 (PSA)... 167... 168... 169... 170... 172... 173... 175... 176... 177... 178... 179... 180... 182 VII
... 182... 183... 185... 186... 187... 189... 191... 191 A... 192... 193 VIII
3 Maastricht Maurice P.A.Zeegers 43 1
10 10 23% 2 Zeegers 20 20 (ACS) 53 200 12 200 28% 43% () 2
30 () 15 15 9 9 () 9 9 6 ( ) 9 6 () 1 2 24 12 12 9 9 ( ) 9 24 24 1 2 () 3
(TURBt) (1) (2) () 1 2 () 4
CT 5
CT 1 2 3 1 2 3 B 4 6
5 CT MRI 6 (ABO(H) T CEA ) -GRS) 15.1 YAG (PDT) ( 30g 30g 30g 20g 20g 30g 30g 20g 20g 15g 30g 30g 30g 7
30 30 150g 150g 30 150g 150g 150g 150g 150g 3 4 20g 30g 20g 30g 20g 20g 30g 30g 20g 20g 30g 30g 30g 15g 15g 30g 20g 20g (M-VAC) M-VAC 33% 8
(H.Barton Grossman) 11 307 T2 T4 (251 56 63 ) 3 M-VAC 77 46 5 57%43% 1/3 M-VAC M- VAC 9
90% 95% 50% 90% 100% 1976 (Morales) 50% 90%( 70%) ( ) 10
7.5 108 8 8 0.5cm 11
100 150mg 50 60ml 1 6 1 2 8 12 3 Fas pcmv Lipofectine Fas Northernblot Fas EJ Fasm RNA 12
Fas EJ Fas Fas EJ Fas Fas Fas Fas CK19 ( ) 13
CK19 CK19 92.5% 79.3% 82.4% 93.5% 83.1%97.7% 50.8% 5.6% 14
4 50 40% 10% 2/3 7 8 5 21% 4 5 15
(DNA) DNA DNA 3 1 50 2000 16
2007 Silvano Gallus 31 45 70 3702 12 6 10 (HRT) HRT Gallus HRT 17
18 ( ) 000
80 80% 1 12 45 " 19
" ( 71 3 ) 77 28 22 16 11 10 5 FU C 15 10.7 ( ) 8 3.2 17 1.5 15 2.1 1.6 16.5 4.3 20
10 58 41 ( 100.6pg/mL 247.9pg/mL) 87.5%98% 400pg/mL 21
III 140 3 5 10 15 81 (58%) 6.8 35 12 (34%) 1 22
9 3 Ta T1 957 Ta T1 23
5% ) ( ( ) 20 1 2 24
3 HE 36% 86% 4 5 D 6 25
DNA PCR ( ) 95% 973 5 13 36 ( ) 80 14 92 88%(65 26
) 48 88% (50%) DPC4 3 Immuno Cyt Immuno Cyt 95% 27
Mayo Graduate Sanjay Ramakumar 22 57 139 ( 70%99%) 44%95% 11 10 0.05% 0.08% 28
1983 1997 3 14 776601 815 250 (30.7%) ( 215 12 10 ) 1997 1997 1998 78905 48007 171 (0.36%) 75 60 (80%) 22 ( 0.045%) 70 0.22% 10mm 38.1% 11 20mm47.6% 21mm 14.3% 12 9 ( ) 0.06% 7939 6 (0.08%) 8 18mm 4 3 1 29
MCM5 (DNA) 36 MCM5 8 6 30
5 1800 50 60 18.5 2 24 3.09 34.2 18.1 11.6 10 6 5 5 10 10 5 3 1 56.73% 6.7% 74.44 7.7% 84.46% 3.6% 91.67% 2.6% 31
RNA DNA JUro(1999 161 388) 57 70% Mayo Ramakumar (BTA)stat 74% 139 99% BTAstat 73% 95% 44% 32
BTAstat Vanderbilt SmithJr BTA BTA BTA 5 94 9 3 2 2 1 1 BTA NMP22 33
(FDP) CL Lewis( ) LewisX 90% 7 9 11 17 34 30 7 9 11 17 34
23.5% 38.2% 14.7%11.8% 7 29.4% 52.9%55.9% 82.3% 27.6% 51.7% 73.7% 83.3% 35
50 70 1979 P 30mg 19 (113 A ) 15mg (113 B ) 1 38.5 157 A B 3 ( 64.5% 78.4%) 36
A B 14.8%19.1% Maastricht MauriceP.A.Zeegers 12 1/3 70% - C E 37
10 12 500 1000 10 38
B- 39
3 E E 40
E 1000 E 4 25% E E E E E E E 28 E 41
E 2 F 3 Colin Cooper E 2 F 3 Cooper E 2 F 3 E 2 F 3 E 2 F 3 1 E 2 F 3 E 2 F 3 Cooper 9 42
130 000 330 000 65% 30% (The Journal of Urology) 9 345 20 111 111 43
Kuakini (AbrahamM.Y.Nomura) 10 3 CK19 ( ) 44
( ) CK19 CK19 92.5% 79.3% 82.4% 93.5% 83.1% 97.7% 50.8% 5.6% 100% 45
25% 5.5 2.7 1988 13 5.5 4.25 15 46
E E E 100 16 E10 C E E 2002 56500 12600 E DNA 47
E C EricJ.Jacobs Jacobs Jacobs 11 20 LeeE.Moore 48
Moore 123 10mcg/L 2006 10 99mcg/L 50mcg/L Moore ( 300mcg/L) 49
DNA 50
2000 2500 2 2 3 51
10 52
CK 20mRNA (RT PCR) 20(CK 20)mRNA 91 CK 20mRNA 25 91 37 (41%) CK 20mRNA 20 17 (85%) 25 CK 20mRNA CK 20mRNA TNM CK 20mRNA 53
CK 20mRNA CK 20mRNA 2001 1 123 33 (27% ) 54
SPARC 63 SPARC SPARC 30% 26 SPARC SPARC 50% Tokushima Masahito Yamanaka Yamanaka' SPARC SPARC SPARC SPARC 55
SPARC Yamanaka PA (PA ) 8.1% 50% 70% PA PA PA 56
PA 62 ( 43 19 28 71 ) PA 18 48 5 8.1% PA 10ml 50ml 30 2 1 6 1 2 3 PA PA VEGF (VEGF) 68 57
10 VEGF 68 49 19 60.2(25 85) UICC 32 36 16 29 23 10 VEGF 68 42 VEGF (42/68 ) 62% VEGF VEGF VEGF (5/16 )31% (19/29 )66% (18/23 )78% VEGF VEGF (28/36 )78% (14/32 )44%(P 0.01) VEGF VEGF 5 VEGF (P 0.05) VEGF VEGF 58
3000 40 40 59
80% survivin 90% 10 1997 () 60
61 135 90% 70% 50% 33% 1cm
(19 ) 1 0.39 60% 7 3 ( 180 ) 62
(445 ) 10 15 ( 1 2 ) 1 2 1 2 0.54 1 2 1 2 0.56 P-gP170 40 20 P-gP170 P- gp 170 42% 15% P-gP 170 70% 33% P-gP 170 63
MCM 5 (DNA) 36 MCM 5 8 P-gp 170 (MDR) MDR (mdrl) P-gp 170 MDR 60% 64
12 30%33% mdrl P-gp 170 40 ( 30 10 C ) 20 P-gp 170 P-gp 170 (42%) (15%)(P 0.05) P-gp 170 (70%) (33%)(P 0.05) P-gp 170 80 50 65
tru () cut franzen CT (MR) 66
67 ( ) CT MR 70% 90% () x
C 20% 70% A 10% 20% B 25% C 25% D 35% Al 3 2/3 1% B A 2 35% 68
B B 1 5% 20% 15 50% 70% B 2 50% 25% 35% 86% B2 15 25% C C 5 60%10 30% 36% 15 11% D 5 30% () 1% 5% 69
( ) 80% 90% A B 10% 25% 30% 70%24 5 B 80% C 56% 3 30% 40% 4 5% 12% () 90% 57% 40% 3% DNA DNA mrna 70
( ) 500ng/dI 50ng/dl () (LH) DNA lmg 2mg () DNA () (LHRH-A) LHRH A 71
LHRH A Leydig 3 5 21 28 LHRH-A Buserelin LHRH A 1 () 70% 80% 10% 15% 6 8 1985 72
73 Alberta 95% ( ) 10% 85%
6% 25% 3% 10 D 2 50%3 5 80% 10 90% 90% (1) 15% 50% 34% 74
(2) 10% 30% 5% (3) (PSA) PSA ()PAP (4) ( CT ) PSA PAP 75
(1) (2) (3) 76
( ) 77
75% 78
2.1 11 600 150 32% D D 79
D D PSA 50 5 10 80
50 PSA( ) PSA 10ng/ml PSA 80% 81
(NCI) (Journal of the National Cancer Institute) 238 471 122 ( ) NCI (AnnW.Hsing) 70% 53% 82
(Janet Stanford) (PSA) 50 1998 1435 50 (PSA) 4.0ng/mt 83
PSA 4.0ng/mt 87.87% 4.0ng/mt 12.3% 10 0.7% 10 700 50 50% Christopher 84
Cheng 1997 63 T1 T2 15 /10 160 /10 Rainy Umbras Yoshio Aso 1990 2015 4 30 40 ( - ) Cheng 30 40 2123 PSA) 288 PSA 2 4ng/ml 158 PSA 4ng/ml 85
30 000 8 ( 21 4 7 2/3) 7 12-86
- - 20 17000 87
18% 88
50 30% 80 50% 3 7 89
10%-20% E 20% 20 40 200 E 400 800 90
Purdue DavidJ.Waters ( 62 69 ) DNA 80% DNA 57% DNA 91
60% - 404 130 274 92
- - 93
Memorial Sloan-Kettering Moshe Shike 1 350 ( ) 20% ( 36g/d/2kcal) 5 8 PSA PSA 94
1 400 50 (NSAID) 4% 9% 70 79 83% NSAID 30 1967 1997 6000 30 30 466 340 3 3 95
5000 10% 1899 30 30 A - C - A - 5 8 2 96
A - D D3 D E E E C C B 12 B 6 D 3 A 97
20 5 5 98
(Prostate Cancerand Prostatic Diseases) Guess (prostate-specificantigen PSA) PSA 99
10 18 14g 14 70% PSA PSA 50% 9500 100
25 20 101
E 102
20 50 50 1079 1259 103
20 50 1994 1998 600 20 20 20 3 104
30 30 100 60 60 1500 15 30 100 105
(1) 10 6 3 30 1 10 15 6 10 1 106
(2) 15 9 15 30 6 60 15 15 15 30 30 1 20 30 (3) 30 250 15 1 4 5 9 15 6 3 107
108 41 19 5
1993 2000 20 80 B 20 71 3 6 109
(ADT) ADT ADT 2%1.8% 8%6.5% 110
(EBRT)10 76% (Marco Van Vulpen) 26 ( T3 ) EBRT 36 79% 57% ( ) 3 4 1 2 86% 2 36 91% 36 2 111
112
(1) 1) 2) 3) (2) 1) 2) 3) (GnRH-A) 113
4) (3) 1) 2) (4) 1973 (5) 60 1) 2) 3) (6) (7) 114
50 30 30 10 15 10 10 10 10 6 1.5 ( ) 10 10 10 10 6 6 3 12 12 15 15 9 9 60 50 50 50 50 15 15 15 10 10 ( ) 10 10 10 10 10 10 115
30 30 10 10 15 30 10 30 15 30 30 30 30 30 60 30 30 60 30 30 2 3 500 ( ) 250 250 10 10 10 10 400 1 2 116
(PSA) 75% PSA PSA(tPSA) PSA Johns Hopkins AlanW.Partin cpsa 831 tpsa tpsa cpsa PSA 14% 117
D D ( ) (Constantinos Koumenis) Zemplar FDA Zemplar Zemplar 118
Zemplar Zemplar D Zyflamend Zyflamend COX-2 Rofecoxib( Vioxx)celecoxib( Celebrex) COX-2 Columbia A.E.Katz Zyflamend huzhang oregano Scutellariabaicalensis Katz Zyflamend 78% 119
Katz Zyflamend Katz PSA 11 94 (PSA) PSA PSA 4 10ng/mL (Stephen Mikolajczyk) propsa PSA 2 4ng/mL PSA 4ng/mL 120
2ng/mL PSA 1 091 PSA 2 4ng/mL PSA 4 10 2 4ng/ml ProPSA 90% 19% PSA PSA ProPSA 29 Gleason 7 28 (ProPSA ) PSA ProPSA PSA PSA PSA 121
6 17 Charles A.Coltman 18000 55 5mg (PSA) 3.0ng/mL 4368 7 18.4% 4692 24.4% (p 0.001) Gleason 7 8 9 10 37.0% 22.2%(p=0.005) 5 SanAntonio Coltman 18.3 122
9.8% Sloan-Kettering Peter T.Scardino PSA Scardino (The New England Journal of Medicine2003 348 2491 2499) 123
(MRI) (Mukesh G.Harisinghani) MRI MRI MRI MRI FDA MRI 124
20 2 2 1000pmol/L 3 (PSA) 95% 1 70% 80% 125
Lars Holmberg 1989 10 1999 2 695 T1b T1c T2 6.2 53 62 4.6% 8.9%( 0.50 95% P=0.02) 37% 376 326 (28%vs.44%) (80%vs.45%) 126
(49%vs.21%) ( ) Patrick C.Walsh 10 10 DebraL.Bemis Zyflamend ( ) COX-2 127
Zyflamend COX-2 COX-2 Zyflamend NewChapter 10 PSA Arnold M.Kwart Roberto Pedraza 74 83 PSA (LHRH) PSA PSA 6 36 6 128
18 36 LH Kwart Pedraza LHRH 108 " 6 18 3 LH PSA 10000 PET 21% 129
(PSA) PSA 11C-acetate (PET) 18F-FDGPET 4 (The Journal of Nuclear Medicine) 46 PSA PET 11C-acetatePET (14 ) CT 18F-FDGPET (Antonia Dimitrak opoulou-strauss) (Ludwig G.Strauss) 11C-acetatePET 18F-FDGPET 130
SanDiego Peter A.S.Johnstone 1018 T1 T3 1988 2000 85.3 3 15 60 60 PSA (p 0.001) Gleason (p=0.023) 131
(p=0.033) 12 15 Kenneth A.Iczkowski Florida 62 (TERT) TERT 28 Gleason 3 6 34 Gleason 7 10 Iczkowski 100% 64% 132
Iczkowski TERT Iczkowski M.D. (Leslie R.Schover) 1 000 133
13% 8% (59%) 38% 3/10 16% 134
Duke omega-3 ( ) Wendy Demark-Wahnefried 5% 20 30 (PDT) 135
Timothy R.Nathan PDT PSA PSA PSA PDT Nathan PDT PDT PDT 136
Nathan 14 PDT PSA 9 PSA 5 PDT 91% Nathan 4 7 PDT 4 137
695 6 9% 5% 35 54 53 62 (New England Journal of Medicine) Uppsala (Lars Holmberg) (Patrick Walsh) 138
(Martin Resnick) 60 70 PSA( ) U PSA 139
140 61 PSA
75% 412 Michel Bolla Zoladex 78% 62% 74%40% 141
80% 1990 142
1993 923 1224 25 1995 2001 50 59 45% PSA 143
19 3 DukeK.Bahn 590 5.4 24 26 2 144
15 3 15 2.5 A 1 8% 2%5 10 A 2 30% 20%5 10 B 1 30%5 20% B 2 80%5 10 70% C 50%5 75%10 D 1 85%5 3 145
D 2 50%3 5 80% 10 90% 90%2 (1) 15 15 15 12 10 30 20 20 30 10 10 (2) 15 146
15 12 10 12 20 10 15 10 15 20 10 10 (3) 10 10 10 6 10 10 10 10 6 10 (1) C TUR 147
148 (2) D (3) (1) (TUR) C TUR (2) A2 B
(3) (4) (1) 1 2 (2) (3) 149
(4) (1) (2) (3) 150
C D 151
152 30% 40% 50% 12% 1% 5% 40% 16% 8%
10% 16% 17% 4% 90% (1) A B 6500CGY C 7000CGY A B 80% 90% A B C 5 85% 75% 58% 10 61% 46% 38% (2) A B 5 80% C 70% A 15% B C 40% 50% (3) B 7 61% 153
(1) T0 T3 (2) A 2 B C (3) (4) 154
20% 30% (1) (2) 20% 40% 155
(1) (2) (LHRH-A)LHRH-A LH LH 3 4 LHRH-A (3) 2 4 (4) (5) LHRH-A 156
(1) 95% (2) C D 157
PSA PAP 1 2 158
(1) (2) (3) (4) -180 159
(5) (1) (2) (3) 160
(4) (5) 161
70% B 5 162
(FNA) MRI MRI 163
MRI CT B MRI MRI (1) (2)T1 (3)T2 (4) (5)T2 (6) (7)MRI CT CT CT CT 164
CT A B CT CT CT CT CT X (1) (2) X 165
(3) (4) (5) 5 166
(1) (2) (3) (4) (5) B (PSA) 167
(PAP) PSA PSA PSA PSA PSA (1)PSA PSA PSA 0.75ng/ml PSA (2)PSA (PSAD) PSA PSA PSA PSAD (3) PSA PSA PSA 168
40 A B C D 169
(1) (2) D (3) 170
Whitmore A B C D (1)A A 9% A (2)B B B 11% (3)C C 60% 5 10 75% 44% (4)D D 3 171
36% A B C D (PIN) (AAH) (1) (PIN) PIN PIN PIN 2.6% 68.80% PIN (2) (AAH) AAH PIN BPH 3.7% 19.60% AAH 20 40 172
AAH 15% 24% AAH 31% PIN AAH P ABCD TNM OSCC TNM (1)T PTx PT 0 PT 1 PT 1a 173
PT 1b 5% 5% PT 1c PT 2 PT 2a PT 2b TP 2c PT 3 PT 3a PT 3b PT 3c PT 4 PT 4a PT 4b 1/2 1/2 () () (2)N N x N 0 N 1 174
N 2 2 2 5 5 N 3 5 (3)M M x M 0 M 1 M 1a M 1b M 1c Broders Anderson Mostofi Gleason Mostofi Schroeder (WHO) Mostofi Mostofi 175
176 Mostofi ( ) ( ) ( ) ( ) 50 208
97% (1) (2) 177
(3)B B (4) (PSA) PSA ( ) PSA (PSA ) PSA PSA (5) 178
(1) (2) C D (1) (2) 2 5 179
(3) (4) (5) (1) 180
192 ) ( (2) (3) (4) -180 (5) 181
20% 30% (1) (2) (3) 30% (1)A A 182
9% (2)B B 40% 11% (3)C 44% (4)D 36% A B C D 183
97% 3% (1) (2) (3) ( ) 184
(4) (1) (2) 24 65% 20% (3) (PSA) 185
(4)X (5) B (6)CT (7) A B C D 186
(1) (2) D (3) 187
50 60 10% 70 79 30% 5% 20% 18/10 / 24/10 / 1.0/10 / 188
97% 100% AMARC ( ) (PSA) PSA A (AMACR) AMACR Rubin 4 DNA (128 ) 342 ( )AMACR (1 ) (2 ) (3 ) (4 4 DNA 3 AMACR(P 0.001) ( RT PCR) ( ) AMACR AMACR 189
(108 ) (26 ) (75 ) (116 ) (17 ) AMACR 1.31 2.33 2.67 3.20 2.50(P 0.001) 3.2 1.3 ( 1.9 P 0.001) (3 4 ) Rubin 94 AMACR AMACR 97% 100% AMACR Rubin AMACR AMACR AMACR AMACR AMACR 190
Gleason 4 103 100 27 12 27 26 10.5ng/mL Gleason 7 191
(HIFU) HIFU 20 PSA HIFU A A(chromograninA) PSA Shinzou Isshiki 108 66 192
A A A A 72.5ng/mL 45.3ng/mL(p=0.044) D A 49.7ng/mL A PSA 172.1ng/mL A Isshiki PSA A 3 2001 11 19 125I 193
10 20 I25I 103Pd CT 125 125 194
CT 5 97% 5 58% 1/8 1/20 400 2000 195