[Treatment of genitourinary malignancy--present concept and controversy]

Recently, various progresses have been made in the treatment of the genitourinary malignant tumors. Effectiveness of the intravesical instillation of anti-cancer agents and biological reaction modifiers has been proved in the treatment and prevention of the superficial bladder cancer. Among them, superiority of BCG is now attracting attention of all the urologists. For the invasive bladder cancer, the M-VAC therapy (the combination chemotherapy of methotrexate, vinblastine, actinomycin and cis-platinum) has been found to be extremely useful. The multidisciplinary approach for the down-staging of the advanced bladder cancer has been advocated around the world. As for the prostatic cancer, that of the high stage is the main concern of the Japanese urologists, since the mass screening of the prostatic cancer has not prevailed in Japan. The LHRH agonists or the blockers of the androgen receptor have been replacing the classic antiandrogenic treatment consisting of castration and estrogen administration to treat the advanced carcinoma. On the other hand, the nerve-sparing total prostatectomy has been recommended for the low stage cancer by Walsh and associates to preserve potency. The testicular cancer has been most effectively treated with the combined chemotherapy. The PVB and VAB therapy are well known in the world. Lately, VP-16 (etoposide) was found to be a useful salvage agent. The least advance has been made in the treatment of renal cell carcinoma, although interferon therapy or LAK cell adoptive immunotherapy appears attractive.