Significance of PSA Screening in Niigata, Japan: Survey of Actual Status of New Cases of Prostate Cancer.

PURPOSE: This study aims to investigate the utility of prostate-specific antigen (PSA) screening by conducting an all-case survey of newly diagnosed prostate cancer patients at Niigata Prefecture, Japan. PATIENTS AND METHODS: Depending on whether patients were subjected to screening, information was prospectively collected on all prostate cancer patients newly diagnosed between October 1, 2019, and September 30, 2020, at all institutions in Niigata Prefecture where urologists performing prostate biopsy routinely work and differences in clinical parameters were investigated. RESULTS: PSA was measured in 478 out of 1332 patients (35.8%) as part of a community health screening. The rate of metastatic carcinoma (M1) in all patients was 14.9%. When patients were divided into three categories of population-based screening (community health screening and workplace health screening), opportunistic screening (PSA measurements at complete medical check-ups or on patient request), and testing triggered by clinical symptoms or findings, the proportion of metastatic cancer was 4.5%, 3.7%, and 30.6%, respectively, demonstrating that the number of distant metastases was significantly lesser in all patients who underwent screening. CONCLUSION: The one-year all-case survey of newly diagnosed prostate cancer patients demonstrated that PSA screening significantly contributed to the early diagnosis of current prostate cancer in Japan.

Perioperative antibiotics in radical cystectomy with ileal conduit urinary diversion: efficacy and risk of antimicrobial prophylaxis on the operation day alone.

OBJECTIVE: To determine the optimum schedule for perioperative antimicrobial prophylaxis (AMP) for bladder cancer patients submitted to radical cystectomy with ileal conduit urinary diversion. METHODS: We studied 77 consecutive bladder cancer patients who underwent radical cystectomy with ileal conduit. The 1-day group (n = 33) received pre-, intra- and postoperative administrations of 2 g of piperacillin on the operation day alone; the 3-day group (n = 44) received antibiotics for 3 days or more (same schedule as the 1-day group on the operation day and every 12 h thereafter). The study was designed and postoperative complications including surgical-site infection (SSI) were defined according to the modified Centers for Disease Control and Prevention criteria. RESULTS: No significant differences were found between the 1-day group and 3-day group in terms of total SSI (18.1% vs 20.5%), superficial incisional SSI (12.1% vs 13.6%), deep incisional SSI (12.1% vs 13.6%), space SSI (12.1% vs 11.4%), postoperative ileus (18.2% vs 11.4%), febrile urinary tract infections (15.2% vs 15.9%) or pneumonia (3.0% vs 4.3%), respectively. In both groups, disease stage and patients' underlying conditions such as diabetes did not have an influence on the incidence of postoperative complications. CONCLUSION: One-day AMP had equivalent efficacy to that of the standard prophylaxis protocol for preventing septic complications following radical cystectomy with ileal conduit. This finding supports the hypothesis that delivery of antibiotics on the operation day is critical in this setting.

Total and free prostate-specific antigen indexes in prostate cancer screening: value and limitation for Japanese populations.

AIM: To assess the efficacy and limitation of free/total prostate-specific antigen ratio (f/tPSA) at a single institution in Japan, focusing on the avoidance of pointless prostate biopsies. METHODS: In total, 631 men between 44 and 93 years old (mean 69.8 years) with elevated PSA underwent power-Doppler ultrasoundgraphy-guided transrectal 10-core prostate biopsies at Niigata Cancer Center Hospital, and their histological features were investigated with total PSA (tPSA) and f/tPSA. RESULTS: PCa was detected in 126 of 134 patients (94.3%) with tPSA of 26 ng/mL or higher. The detection rate was 59.4% for tPSA of 21-25 ng/mL, followed by 39.2% for 16-20 ng/mL, 30.0% for 11-15 ng/mL, 20.0% for 4.1-10 ng/mL and 7.6% for = or <4.0 ng/mL. f/tPSA of the PCa group was significantly lower than that of non-malignamt disorders in any tPSA ranges (mean 0.122 vs. 0.160, P<0.001). Receiver-operating characteristics analyses showed that f/tPSA (AUC:0.664) performed more valuably than tPSA (AUC:0.559) in patients with tPSA between 3.0-10 ng/mL (P<0.01). Although f/tPSA of 0.250 for the cut-off value might miss 1.8% PCa patients, it potentially spares 9.2% of unnecessary biopsies. CONCLUSION: f/tPSA is more valuable compared with tPSA alone for the prediction of the occurrence of PCa. We recommend 0.250 as the cut-off value for f/tPSA in PCa screening for Asian men having so-called grey-zone tPSA.

Outcomes of locally advanced prostate cancer: a single institution study of 209 patients in Japan.

AIM: To investigate the outcomes for Asian populations with locally advanced/clinical stage III prostate cancer (PCa) treated with currently prevailing modalities. METHODS: We reviewed the record of 209 patients with clinical stage III PCa, who were treated at Niigata Cancer Center Hospital between 1992 and 2003. Treatment options included hormone therapy-combined radical prostatectomy (RP+HT), hormone therapy-combined external beam irradiation (EBRT+HT) and primary hormone therapy (PHT). RESULTS: The 5- and 10-year overall survival rates were 80.3% and 46.1% in all cohorts, respectively. The survival rates were 87.3% and 66.5% in the RP+HT group, 94.9% and 70.0% in the EBRT+HT group and 66.1% and 17.2% in the PHT group, respectively. A significant survival advantage was found in the EBRT+HT group compared with that in the PHT group (P < 0.0001). Also, the RP+HT group had better survival than the PHT group (P = 0.0107). The 5- and 10-year disease-specific survival rates for all cases were 92.5% and 80.0%, respectively. They were 93.8% and 71.4% in the RP+HT group, 96.6% and 93.6% in the EBRT+HT group and 88.6% and 62.3% in the PHT group, respectively. A survival advantage was found in the EBRT+HT group compared with the PHT group (P = 0.029). No significant difference was found in disease-specific survival between the EBRT+HT and RP+HT groups or between the RP+HT and PHT groups. CONCLUSION: Although our findings indicate that radiotherapy plus HT has a survival advantage in this stage of PCa, we recommend therapies that take into account the patients'social and medical conditions for Asian men with clinical stage III PCa.

[Significance of re-measurement of prostate specific antigen before prostate biopsy].

To examine the natural change of prostate-specific antigen (PSA), we compared two PSA values, the first value with which we decided to perform prostate biopsy and the value obtained by remeasurement just before biopsy. To exclude cases with extremely high PSA, we examined 288 cases in which PSA was less than 50 ng/ml for comparison. Of the 288 cases, 93 were diagnosed with prostate cancer (CaP). The interval between the two PSA measurements was 1-90 days (average of 31.4 days). The first and second values were an average of 13.0 and 11.7 ng/ml, respectively, and the second value was significantly lower than the first value. When we divided them into CaP cases and non-CaPthe two cases, a significant difference between PSA values was found only in the non-CaP cases. Moreover, in the non-CaP cases with some clinical symptoms, the difference in PSA was marked between the first and second values, which averaged 11.2 and 9.2 ng/ml, respectively. When we decide to perform a biopsy, we should recognize that PSA sometimes is lower on re-measurement. Particularly in symptomatic cases, it is worth re-measuring PSA, which may save unnecessary biopsies.

[Prognosis of prostate cancer with elevated prostatic acid phosphatase].

To evaluate the significance of prostatic acid phosphatase (PAP), we analyzed 1,029 prostate cancer patients who were treated at the Niigata Cancer Center. We classified clinically localized prostate cancer with elevated PAP as stage DO. When stage DO was not taken into acount, the 5-year cause-specific survival rate for stage A, B, C and D was 94.7, 97.9, 87.7 and 42.4%, respectively. Taking stage DO into account, the cause-specific survival curve for stage DO patients was similar to those for stage B,C patients. The 5-year cause-specific survival rate for stage DO was 92.2% considering above 3 ng/ml as elevated PAP. A significant correlation was found between PAP and cause-specific survival for all cases but no correlation was found for non-metastatic disease patients. The significance of PAP in the staging of prostate cancer is limited.

[Clinical analysis of 1,000 patients with prostate cancer].

OBJECTIVES: Treatment outcomes for prostate cancer in our hospital were reported. MATERIALS AND METHODS: We analyzed 1,009 patients with prostate cancer treated at Niigata Cancer Hospital between 1983 and 2003. RESULTS: As for the clinical stage, 20 cases belonged to Stage I, 367 cases to Stage II, 269 cases to Stage III and 353 cases to Stage IV. The overall 5-year survival rate of the all 1,009 cases was 59.0%, comprising 78.2% for stage I, 82.0% for Stage II, 76.0% for Stage III and 30.0% for Stage IV cases. Disease-specific 5-year survival rates for Stage I, II, III and IV were 100%, 96.8%, 89.3% and 41.1% respectively. In Stage III patients, the radiotherapy (with endocrine therapy) group showed longer cause-specific survival than the endocrine therapy group (p = 0.0056). CONCLUSIONS: Our result suggest that the radiotherapy with endocrine therapy is useful for Stage III prostate cancer.

[Chemo-endocrine therapy for newly diagnosed stage D2 prostate cancer].

We evaluated 175 patients with newly diagnosed stage D2 prostate cancer who had been treated in our hospital between 1992 and 2003 to compare chemo-endocrine therapy with endocrine therapy alone. One hundred and thirty seven patients were treated with endocrine therapy alone. The other 38 patients received chemo-endocrine therapy, which included medical or surgical castration with/without antiandrogen plus VIP (Vincristine, Ifosfamide, Peplomycin) regimen or other cytotoxic agents. The patients treated with chemo-endocrine therapy had a significantly better prognosis than the patients treated with endocrine therapy alone (p<0.05), although treatment was not randomized. The cause-specific survival rates at 5 years for the chemo-endocrine therapy group and the endocrine therapy group were 61.6% and 34.8%, respectively. These data suggest that chemo-endocrine therapy is a potentially effective treatment for newly diagnosed stage D2 prostate cancer.

[Carcinoma in situ of the urinary tract--in patients with positive cytologies of upper urinary tract samples].

PURPOSE: The present two-tiered study demonstrates first, the value of upper urinary tract sampling in cytological diagnoses, and multiple cold punch biopsies of bladder, in the cases of carcinoma in situ (CIS) of the urinary tract. The second segment assesses the value of Double-J catheter-based BCG treatment, in the case of positive upper urinary-tract sampling. MATERIALS AND METHODS: We tested a total thirty three patients (26 man, 7 woman, median age: 67.8 years) who demonstrated two serial positive voiding cytologies. Cystoscopic investigations of bladder tumors, as well as radiologic studies of the upper urinary tract both yielded negative findings. Cytological samples obtained from upper urinary tract of all 33 individuals were next to subjected to multiple cold punch biopsies of bladder. RESULTS: Among the seven patients whose bladders displayed no abnormalities, cytological tests of the upper urinary tract samples determined that 2 of subjects fell into class III, while the other five were diagnosed class V. In 7 other cases diagnosed as suffering from dysplasia of bladder, cytological findings for two upper urinary tract were class I and II, while one case was class III, and 4 others fell within class V. Of the 19 patients suffering from bladder CIS, eight were diagnosed class I or II, three cases as class III and eight other cases, class V, in upper urinary tract cytologies. At the original site of the urinary CIS, the bladder was affected in 11 cases, the upper urinary tract in 9 patients, and a combined attack on the bladder and upper urinary tract, in 8 others. Of seventeen patients whose upper urinary tract samples produced positive reading, thirteen had had double-J catheter run from bladders to renal pelves as well as treatment consisting of the intravesical instillation of BCG. From thorough cytological evaluations, we learned that the urine of eleven of these 13 individuals, which initially tested positive, had turned negative following intravesical instillation of BCG. Although bladder vesicles proved susceptible to certain minor irritations and slight fevers were not uncommon on treatment-days, such side effects disappeared, once BCG treatment ended. CONCLUSIONS: From painstaking observations, it was concluded that cytological investigations of the upper urinary tract were indispensable to the proper diagnosis of urinary tract CIS, and that intravesical BCG treatment with Double-J catheter is both safe and effective when treating the patients suffering from upper urinary tract CIS.

Nephrectomy plus endoscopy-assisted intussusception ureterectomy for patients with renal pelvic cancer: long-term oncologic outcomes in comparison with nephroureterectomy plus bladder cuff removal.

PURPOSE: To assess long-term oncologic outcomes in patients with renal pelvic cancer who are receiving nephrectomy plus endoscopy-assisted intussusception ureterectomy. There has been no large study reporting long-term oncologic outcomes of this approach in comparison with those of conventional nephroureterectomy plus bladder cuff removal. PATIENTS AND METHODS: We reviewed 181 consecutive patients with renal pelvic cancer who underwent open nephroureterectomy with complete bladder cuff removal (cuff removal group, n = 33), nephroureterectomy with incomplete cuff removal (orifice-remaining group, n = 39), and nephrectomy with intussusception ureterectomy (intussusception group, n = 109). RESULTS: Patients in the intussusception group had larger tumor size, higher histologic grade, and more advanced pathologic stage (P = 0.005, 0.021, and 0.030, respectively), while the incidence of coexistent bladder/ureteral cancer was lower in this group (P < 0.001). The mean operative time was shorter in the intussusception group than in the cuff removal and orifice-remaining groups (201.2 ± 33.1 and 221.5 ± 47.2 min, respectively, P < 0.001). The 5-year extraurinary tract recurrence-free survival rate in the intussusception and cuff removal groups was 74.8% and 71.4%, respectively (log-rank P = 0.766), and it was lower in the orifice-remaining group compared with that in the intussusception group (P = 0.031). The 5-year urinary tract recurrence-free survival rate in the intussusception, cuff removal, and orifice-remaining groups was 76.6%, 65.0%, and 65.0%, respectively (intussusception vs cuff removal: P = 0.089). With both univariate and multivariate analyses, intussusception ureterectomy had no significant impact on urinary tract recurrence (multivariate P = 0.553, hazard ratio = 0.784). CONCLUSIONS: Nephrectomy plus endoscopy-assisted intussusception ureterectomy is an oncologically safe alternative for renal pelvic cancer patients, which is possibly associated with less patient morbidity.

Prostate-specific antigen/prostatic acid phosphatase ratio is significant prognostic factor in patients with stage IV prostate cancer.

OBJECTIVES: Novel prognostic indexes clinically applicable for patients with Stage IV prostate cancer are needed because prostate-specific antigen (PSA) tests occasionally fail to reflect the prognostic outcome. We investigated various clinicopathologic parameters in men with Stage IV prostate cancer and evaluated the utility of the PSA/prostatic acid phosphatase (PAP) ratio as a prognostic index. METHODS: We reviewed 241 patients with Stage IV prostate cancer, who were treated in Niigata Cancer Center Hospital from 1992 to 2004. Survival curves were generated using the Kaplan-Meier method. Univariate and multivariate analyses of survival associations, including age, performance status, clinical presentation, disease localization, pathologic findings, and serologic markers, were conducted using the log-rank test and Cox proportional hazard models. RESULTS: The 5-year overall survival rate using the Kaplan-Meier method for all 241 patients was 43.0%. No significant difference was found in the survival rates according to PSA level. However, the 5-year survival rate was significantly lower in patients with a PSA/PAP ratio of less than 3.0 (P = 0.0022): 24.2% and 48.0% in those with a PSA/PAP ratio of less than 3.0 and 3.0 or greater, respectively. On multivariate analysis using the proportional hazards model, the statistically significant prognostic factors of overall survival were alkaline phosphatase (P = 0.0413), lactate dehydrogenase (P = 0.0409), and the PSA/PAP ratio (P = 0.0113). CONCLUSIONS: The PSA/PAP ratio is a valuable prognostic indicator in men with Stage IV prostate cancer. Although our study found that other laboratory tests also had a prognostic influence, the PSA/PAP ratio was an essential index implicated in the physiopathology of prostate cancer.

Radical cystectomy for invasive bladder cancer: results of multi-institutional pooled analysis.

BACKGROUND: We report the outcome of radical cystectomy for patients with invasive bladder cancer, who did not have regional lymph node or distant metastases, at 21 hospitals. METHODS: Retrospective, non-randomized, multi-institutional pooled data were analyzed to evaluate outcomes of patients who received radical cystectomy. Between 1991 and 1995, 518 patients with invasive bladder cancer were treated with radical cystectomy at 21 hospitals. Of these, 250 patients (48.3%) received some type of neoadjuvant and/or adjuvant therapy depending on the treatment policy of each hospital. RESULTS: The median follow-up period was 4.4 years, ranging from 0.1 to 11.4 years. The 5-year overall survival rate was 58% for all 518 patients. The 5-year overall survival rates for patients with clinical T2N0M0, T3N0M0 and T4N0M0 were 67%, 52% and 38%, respectively. The patients with pT1 or lower stage, pT2, pT3 and pT4 disease without lymph node metastasis had 5-year overall survivals of 81%, 74%, 47% and 38%, respectively. The patients who were node positive had the worst prognosis, with a 30% overall survival rate at 5 years. Neoadjuvant or adjuvant chemotherapy did not provide a significant survival advantage, although adjuvant chemotherapy improved the 5-year overall survival in patients with pathologically proven lymph node metastasis. CONCLUSIONS: The current retrospective study showed that radical cystectomy provided an overall survival equivalent to studies reported previously, but surgery alone had no more potential to prolong survival of patients with invasive cancer. Therefore, a large-scale randomized study on adjuvant treatment as well as development of new strategies will be needed to improve the outcome for patients with invasive bladder cancer.