Zoledronic acid improves clinical outcomes in patients with bone metastatic hormone-naïve prostate cancer in a multicenter clinical trial.

AIM: To assess whether zoledronic acid (ZOL) adds to the effect of combined androgen blockade (CAB) in patients with hormone-naive bone metastatic prostate cancer. PATIENTS AND METHODS: Patients were treated with either a combination of CAB (luteinizing hormone-releasing hormone agonist and bicalutamide) and ZOL (CAB-Z group) or CAB-alone (historical control patients, CAB-C group). ZOL was injected intravenously at 4 mg every 4 weeks. One hundred and five and 100 patients among 205 enrolled patients were assigned to the CAB-Z group and CAB-C group, respectively. The time to prostate-specific antigen (PSA) failure in patients in the CAB-Z group was compared to that in the CAB-C group. The primary end-point of the study was the time-to-PSA failure. RESULTS: PSA and serum N-telopeptide of type I collagen (NTx) levels were examined before treatment and every 3 months after treatment. PSA failure occurred in 42 (40.0%) patients in the CAB-Z group and 48 (48.0%) patients in the CAB-C group. The biochemical recurrence-free rate was significantly lower in patients in the CAB-C group (p=0.004, by log-rank test). The categorical biopsy Gleason score pre-treatment serum NTx and treatment with ZOL were shown to be independent predictors of PSA failure-free survival time (p=0.040, p=0.005 and p=0.026, respectively). CONCLUSION: ZOL given with CAB as initial treatment delays the time-to-PSA failure in patients with hormone-naive bone metastatic prostate cancer.

Quantitative analysis of survivin mRNA expression in bladder transitional cell carcinomas.

We assessed the expression levels of survivin mRNA in bladder transitional cell carcinoma (TCC) to provide additional information regarding its malignant potential. The real-time PCR method was used to detect the survivin mRNA level for 21 bladder tumor specimens, and for urinary exfoliated cells from 12 newly diagnosed bladder tumor patients. All bladder tumor specimens and 7 of 12 voided urine specimens expressed survivin mRNA. In tumor specimens, high grade, high stage tumors had the tendency to express more survivin mRNA. Of 12 superficial bladder tumor patients who had transurethral resection of bladder tumor (TURB), 3 showed high survivin mRNA expression and intravesical recurrence after the surgery. However, for the patients who had total cystectomy due to invasive tumor, no relations were observed between the survivin mRNA expression level and development of local recurrence and/or distant metastasis. Our results suggested that the quantitative analysis of the survivin mRNA may indicate local malignant potential, which contribute to the possibility of an intravesical recurrence.

[A clinical study of renal pelvic and ureteral cancer].

We investigated the clinicopathological features of 52 patients with transitional cell carcinoma of renal pelvic and/or ureter who underwent surgical treatment at Tokyo Medical University Hachioji Medical Center from April, 1992 to June, 2005. The patitents consisted of 38 males and 14 females, ranging from 29 to 86 years old with a median age of 68 years old. The mean follow-up period was 39 months. Pathologicaly, 32 cases were less than pT2 and 20 cases were pT3. Findings of lymphatic and venous invasion were present in 10 and 8 cases, respectively. The infiltration pattern (INF) of gamma was observed in 9 cases. The overall cause-specific survival rate was 95.8% at 1 year, 87.7% at 3 years and 80.6% at 5 years, respectively. According to univariate analysis, the high stage of tumor, the presence of lymphatic and/or venous invasion, the inclusion of infiltration pattern of gamma and positive reginonal lymph nodes indicated a significantly poor prognosis. On the other hand, multivariate analysis using Cox proportional hazards regression revealed the presence of infiltration pattern of gamma as the most significant predictor of survival.

[A case of leiomyosarcoma of the scrotum: chemotherapy with anti-cancer agents was effective for the lung metastasis].

A 59-year-old male was referred to our hospital with the chief complaint of a painless scrotal mass. A 6 X 4.5 X 4 cm elastic hard mass with irregular surface was palpable in the right scrotum. We diagnosed a tumor in the right scrotum and resected the tumor surgically. Histopathologically, the tumor was liposarcoma of the right scrotum. Lung tumors were found 20 months after resection of the origin. Systemic chemotherapy with new anti-cancer agents (Paclitaxel and Gemcitabine) was performed. The main tumor was reduced to 56% in its diameter after 6 courses of chemotherapy. Exclusion of the right middle and lower pulmonary lobe was performed. The final pathological diagnosis of the lung tumor was metastatic liposarcoma.

[Early effect of non-surgical treatment using betamethasone valerate ointment for phimosis in childhood].

We evaluated the early efficacy of non-surgical treatment using 0.07% betamethasone valerate ointment on, 34 boys with phimosis between January 2001 and June 2005. Patients were treated with 0.07% betamethasone valerate ointment applied to the distal aspect of the prepuce every other day for 2-6 weeks. During the treatment period, patients were instructed to retract the foreskin to penis root without overstraining. The overall success rate was 94.1% and therapeutic effects were observed in 58.8% of the patients in two weeks. There were no medical side effects. Treatment using betamethasone valerate ointment is very effective, easy and safe. We recommend this treatment for patients with phimosis and/or those with recurring balanoposthitis.

[Clinical evaluation of urinary NMP22 (nuclear matrix protein 22) bladder chek in the detection of patients with bladder cancer].

The clinical usefulness of the nuclear matrix protein 22 (NMP22) Bladder Chek test as a novel urine marker in the detection of patients with bladder cancer was evaluated in comparison with the urinary NMP22 enzyme-linked immunosorbent assay (ELISA) and urinary cytology. A total of 40 patients with pathologically proven bladder cancer voided urine specimen before treatment. The urine samples were divided for NMP22 Bladder Chek test, NMP22 ELISA, and urinary cytology. In the 40 patients with bladder cancer, the overall positive rate was 62.5% for the NMP22 Bladder Chek test, 55% for the NMP22 ELISA test, and 27.5% for urine cytology. There was a significant difference between NMP22 Bladder Chek, NMP22 ELISA and cytology. The positive rate with the NMP22 Bladder Chek and NMP22 ELISA was higher in the patients with high grade and large-size (1 cm < or =) tumor. In 40 patients presenting with microhematuria without urothelial cancer, the false positive rate 12.5, 10, and 0% for NMP22 Bladder Chek, NMP22 ELISA, and urinary cytology. No significant difference was found with the test. In conclusion, the urine NMP22 Bladder Chek test provided a higher positive rate than the NMP22 ELISA test and urinary cytology. Therefore, the NMP22 Bladder Chek test may be clinically more useful as a tumor marker for the diagnosis of bladder cancer.

[A case of liposarcoma of spermatic cord].

An 84-year-old male was referred to our hospital with the chief complaint of a painless inguinal mass. An elastic hard mass was palpable in the right inguinal region next to the spermatic cord. Ultrasonography and computed tomography showed an inguinal homogeneous mass which was slightly enhanced. Since the operation appearance indicated the tumor was arising from the right spermatic cord, right radical orchiectomy was performed. Histopathological examination revealed a well-differentiated liposarcoma of the right spermatic cord. This is the 70th case of liposarcoma of the spermatic cord reported in Japan.

Does transrectal ultrasound guided eight-core prostate biopsy improve cancer detection rates in patients with prostate-specific antigen levels of 4.1-10 ng/mL?

BACKGROUND: To investigate retrospectively whether the eight-core biopsy method improves the prostate cancer detection rate when compared with the standard sextant biopsy method in patients with prostate specific antigen (PSA) levels of 4.1-10 ng/mL. MATERIAL AND METHODS: Of 437 patients whose PSA levels ranged from 4.1 to 10 ng/mL, 237 underwent a transrectal ultrasound guided sextant biopsy (sextant group), and 200 underwent an eight-core biopsy (eight-core group). Eight core samples were obtained from each of the far lateral regions in addition to the standard sextant biopsy cores. None of the patients had a previous history of prostate biopsy. RESULTS: Of the 237 patients in the sextant group, prostate cancer was detected in 47 patients (19.8%) and in 50 of the 200 patients in the eight- core group (25.0%). The rates of detection in the two methods were not statistically significant. However, in patients whose PSA density was less than 0.1 ng/mL per cc, the cancer detection rates in the sextant group and the eight-core group were 4.5% and 18.8%, respectively (P = 0.046). The morbidity and complications of the eight-core biopsy method were not notable. CONCLUSIONS: Only in patients with PSA levels of 4.1-10 ng/mL and density of less than 0.1 ng/mL per cc was the eight-core biopsy method an improvement on the sextant biopsy method in terms of prostate cancer detection rate. Accordingly, a number of cores greater than eight will be required to improve the cancer detection rates in patients with PSA levels of 4.1-10 ng/mL and PSA densities of more than 0.1 ng/mL per cc.