[Ureteral Cancer Occuring in an Adult Megaureter : A Case Report].

A 86-year-old man visited our hospital to undergo a careful examination for asymptomatic gross hematuria. First, we performed cystoscopy and found a tumor projecting from the right ureteral orifice. We therefore performed computed tomography, which revealed right ureteral cancer projecting into the lower ureter and severe megaureter on bothsides. To evaluate the left megaureter, we performed retrograde pyelography, but were unable to insert a guide-wire. We therefore performed magnetic resonance-urography, which revealed an expanded left lower ureter, but no findings of hydronephrosis or any tumor lesions. Based on the findings of these examinations, we diagnosed the patient with right ureteral cancer with megaureter. Right nephroureterectomy and partial cystectomy were performed in April 2017. The pathological findings resulted in a diagnosis of invasive urothelial carcinoma. The patient experienced recurrence in his bladder at 3 months follow-up cystoscopy and underwent transurethral resection of bladder tumor.

Zoledronic acid combined with androgen-deprivation therapy may prolong time to castration-resistant prostate cancer in hormone-naïve metastatic prostate cancer patients - A propensity scoring approach.

OBJECTIVE: To clarify the oncological benefit of zoledronic acid for hormone-naïve metastatic prostate cancer, patient outcome of androgen deprivation therapy with zoledronic acid (ADT + Z) and androgen deprivation therapy alone (ADT) was compared. METHODS: Fifty-two patients with pathologically confirmed metastatic prostate cancer were prospectively enrolled and treated with combined androgen blockade (goserelin and bicalutamide) with zoledronic acid (4 mg every 4 weeks for 24 months). A propensity score-match with logistic regression analysis was applied to select 50 pair-matched cohorts (both from ADT + Z and from historical control cohorts who had undergone ADT alone), and patient outcomes were compared. RESULTS: Patients with ADT + Z had significantly longer time to progression (TTP) than those with ADT (median TTP; 24.2 vs. 14.0 months, p = 0.0092), while no significant difference of overall survival between two groups (p = 0.1502). Multivariate analysis for biochemical recurrence revealed treatment with ADT was the sole independent prognostic factor (HR: 1.724, 95% CI: 1.06-2.86, p = 0.0297). CONCLUSION: Combination of zoledronic acid with ADT may prolong time to castration resistant prostate cancer.

Significance of baseline bone markers on disease progression and survival in hormone-sensitive prostate cancer with bone metastasis.

PURPOSE: This study evaluated the baseline patient characteristics associated with the time to biochemical progression and overall survival in patients who participated in a phase II trial on zoledronic acid combined with the initial androgen-deprivation therapy for treatment-naïve bone-metastatic prostate cancer. METHODS: Patients received zoledronic acid 4 mg intravenously every 4 weeks for up to 24 months, concomitantly started with bicalutamide 80 mg orally every day and goserelin acetate 10.8 mg subcutaneously every 12 weeks. RESULTS: A total of 53 Japanese patients were enrolled between July 2008 and April 2010, and 52 patients were evaluable. Median follow-up period was 41.6 months. Updated median time to biochemical progression was 25.9 months (95 % confidence interval 14.5-49.9). Higher serum bone-specific alkaline phosphatase was an independent risk factor for time to biochemical progression based on multivariate analysis (hazard ratio 6.51; 95 % confidence interval 2.71-15.62; P < 0.001). Median time to biochemical progression for patients with serum bone-specific alkaline phosphatase level higher than 26 µg/L was 12.7 months. Multivariate analysis indicated that higher serum C-terminal telopeptide of type I collagen independently increased the risk of death (hazard ratio 9.62; 95 % confidence interval 2.11-43.89; P = 0.003). Median overall survival for patients with serum C-terminal telopeptide of type I collagen level higher than 8.0 ng/ml was 31.1 months. CONCLUSIONS: Baseline bone markers can be useful as predictors for disease progression and survival time in patients with bone metastasis from treatment-naïve prostate cancer treated with upfront zoledronic acid concomitantly started with androgen-deprivation therapy.

Phase II trial of zoledronic acid combined with androgen-deprivation therapy for treatment-naïve prostate cancer with bone metastasis.

BACKGROUND: The efficacy of zoledronic acid in patients with treatment-naïve prostate cancer is unclear. We conducted a phase II study to investigate the benefits of combined zoledronic acid and androgen deprivation therapy in treatment-naïve prostate cancer with bone metastasis. The primary endpoint was skeletal-related event-free survival at 24 months. METHODS: Subjects were treatment-naïve patients with histologically confirmed adenocarcinoma of the prostate and radiological evidence of bone metastasis. Treatment consisted of bicalutamide 80 mg daily, goserelin acetate 10.8 mg every 12 weeks, and zoledronic acid 4 mg every 4 weeks. Zoledronic acid was continued for 24 months. RESULTS: Of the patients enrolled between July 2008 and April 2010, 52 were included in the analyses. The median age of the patients was 72 years. The median baseline prostate-specific antigen level was 249.4 ng/mL. The median follow-up period was 33.3 months. The 24-month skeletal-related event-free survival rate was 84.4 % (95 % confidence interval 71.2-91.9). The median time to prostate-specific antigen progression was 25.9 months (95 % confidence interval 14.7-36.3). The median overall survival time was not reached. Improvement in pain or maintenance of no pain during the first 12 weeks was observed in 70 % of patients and the extent of bone disease was decreased in 10 % of patients at 12 months. Grade 3 osteonecrosis of the jaw was observed in three patients (5.8 %). CONCLUSION: Zoledronic acid concomitant with androgen deprivation therapy as initial treatment in patients with treatment-naïve prostate cancer with bone metastasis resulted in an encouraging skeletal-related event-free survival rate at 24 months.

Clinical Outcome of Small Renal Cell Carcinoma after Delayed Surgery versus Immediate Surgery.

BACKGROUND: This study was undertaken to investigate the growth rate and clinical outcome of patients with a small renal mass (SRM) after delayed surgery versus immediate surgery. METHODS: We reviewed the clinical records of 328 patients with SRM ≦ 4cm at diagnosis, who underwent delayed or immediate surgical intervention from January 2000 to December 2011. Radiographic evaluation using CT scan and MRI were performed at least every 6 months and the tumor size was determined at least twice in the delayed surgery group. RESULTS: A total of 292 RCC patients with pT1aN0M0 were identified; among them, 32 patients had been managed with delayed surgery intervention. No statistically significant difference was observed in overall survival rate (OSR) and cancer recurrence-free rate (CRFR). But cancer-specific survival rate (CSSR) was significantly lower in the delayed surgery group (p=0.0002). CONCLUSIONS: The overall survival rate of delayed surgery was not inferior compared with that after immediate surgery. Delayed surgery intervention for SRMs is a treatment option in the current study.

[Efficacy of a basket catheter used in transurethral lithotripsy].

Between January 2005 and August 2010, transurethral lithotripsy (TUL) was performed in 117 patients with upper urinary tract stones. TUL was performed without the basket catheter ZeroTipTM in 50 patients (group A) and with ZeroTip TM in 67 patients (group B). There was no significant difference in the successful stone disintegration rate between group A (86%) and group B (90%). However, the postoperative successful stone-free rate was 76 and 88% (p＝0.04) in groups A and B, respectively, and the intraoperative successful stone-free rate was 43 and 71% (p＝0.002), respectively. Intraoperative ureteral stents were placed in 62 and 46% of the patients in groups A and B (p＝0.004), respectively. By successfully becoming stone-free with this procedure, the need of ureteral stent placement decreased, thereby reducing the postoperative cases of irritable bladder caused by a ureteral catheter, and contributing to improvement of the patient's quality of life.

[Analysis of prognostic factor in 52 castration-resistant prostate cancer treated with docetaxel].

The prognostic factor was retrospectively analyzed in 52 castration-resistant prostate cancer treated with docetaxel (DTX) in our institutions from April, 2006 to August, 2009. The treatment outcomes were decided with prostate specific antigen (PSA) progression-free survival and overall survival. These were calculated by Kaplan-Meier methods and tested with Log-rank test. Median PSA progression-free survival was 8.8 months and median overall survival was 24.1 months. Prognostic factors on PSA progression were PSA value before DTX treatment and rate of PSA decrement after DTX treatment. Prognostic factors on overall survival were Gleason score (GS), PSA value before DTX treatment, rate of PSA decrement after DTX treatment and positive of bone metastasis in Log-rank test. Odds ratio of PSA ≧20 ng/ml before DTX treatment was 2.99 and PSA decreasing rate < 30% was 3.65. These were statistically significant (p < 0.001) risk factors in the overall survival.

[Giant bladder stone nine years after neobladder construction: a case report].

Urinary stone formation after orthotopic neobladder construction is a delayed complication. A giant bladder stone was found in a 67-year-old man who had undergone radical cystectomy and orthotopic neobladder substitution (Hautmann method) in 1998. The stone was removed by cystolithotripsy and weighed 108 g.

[A case of inflammatory pseudotumor of renal pelvis showing a complete response to antibiotics].

A 20-year-old woman was admitted with chief complaints of high fever and right lumbago. Abdominal computed tomography (CT) and ultrasonography revealed a right renal pelvic tumor 25 mm in diameter. Although malignancy could not be confirmed by the scan, we administered antibiotics based on a diagnosis of inflammatory pseudotumor of the renal pelvis. After treatment, no tumor was detected. In such cases,because diagnosis is generally difficult, surgery is usually performed. However, in this case, the patient showed a complete response to antibiotics.