Porcine reproductive and respiratory syndrome virus (PRRSV) poses a significant economic challenge to Japan's swine industry. This review synthesizes the epidemiological evolution of PRRSV in Japan by examining the available scientific literature from its initial Type 2 isolation in 1993 to recent events. Endemic Type 2 strains, initially dominated by Cluster III (Lineage 4), diversified significantly. This diversification was marked by key events including the emergence of vaccine-associated Cluster II (Lineage 5), and incursions of virulent Cluster IV/Lineage 1F (MN184A-like) strains and Type 1 virus around 2008. By 2018-2020, Clusters II and IV predominated nationwide, a trend strongly linked to widespread modified live virus (MLV) vaccination. The recent detection of the globally significant NADC34-like (Lineage 1A) strain underscores ongoing foreign incursion risks. Current MLV vaccines face challenges, including safety concerns and limited cross-protection against diverse field strains. Consequently, effective control requires integrated strategies, comprising optimized vaccination, stringent biosecurity, advanced molecular surveillance, improved diagnostics, and coordinated regional control programs guided by systematic herd classification and stakeholder partnerships. The development of next-generation vaccines and sustained multi-stakeholder collaboration are critical for mitigating the impact of PRRSV in Japan.