[LAPAROSCOPIC RADICAL PROSTATECTOMY OF 926 PATIENTS AT THE HIROSHIMA ENDOUROLOGICAL ASSOCIATION].

(Objective) The aim of this study is to investigate the treatment outcome of laparoscopic radical prostatectomy (LRP). (Patients and methods) The study cohort consisted of 926 hormone-naïve patients with localized prostate cancer who underwent LRP at the Hiroshima Endourological Association from January 2007 to December 2016. (Results) The mean age was 69.4 years, the mean initial PSA was 9.1 ng/ml, and the mean follow-up period was 40.3 months. The D'Amico Risk Classification was Low: 232 cases, Intermediate: 344 cases, and High: 350 cases. Nerve preservation was performed bilaterally for 138 patients and unilaterally for 181 patients. The mean operative time was 181.0 minutes and the mean estimated blood loss was 360.7 ml. As the number of experienced cases increased, the operative time was significantly shorter and the estimated blood loss was significantly decreased. According to Clavien-Dindo classification, the ratio of perioperative complication degree IIIa or above was 4.0% (37 cases). The pathological results were Gleason score (GS) ≤6: 174 cases, GS7: 514 cases, GS ≥8: 232 cases, pT2≥: 704 cases, pT3a: 172 cases, pT3b: 47 cases, pT4: 3 cases, pN0: 917 cases, and pN1: 9 cases. Positive surgical margins were found in 278 cases (30.0%). The biochemical recurrence-free survival rate at 5 years was 78.1%. In multivariate analysis, age (≥70 yrs), initial PSA (≥10 ng/ml), biopsy GS (GS ≥8), cancer positive core ratio at biopsy (≥30%), pT (pT≥3), pathological GS (GS≥8), positive surgical margin and total number of patients in the facility were predictive factors of postoperative biochemical PSA recurrence. Younger age and nerve preservation were found to be predictive factors for the early recovery of urinary continence after surgery, with 88% regaining urinary continence at 12 months after surgery. (Conclusion) This study revealed the clinical outcome and appropriate candidates for LRP in Japanese patients.

[A CASE OF G-CSF PRODUCING SARCOMATOID CARCIONOMA OF URETER].

We report a case of sarcomatoid carcinoma of the ureter in a 82-year-old woman. She was admitted to our hospital with right hydronephrosis. A computed tomography (CT) and retrograde pyelography (RP) showed a solid tumor at right ureter with right hydronephrosis and 3 cm solid tumor on the right abdominal wall. She underwent laparoscopic nephroureterectomy and excision of abdominal subcutaneous tumor. Pathological diagnosis was urothelial carcinoma with sarcomatoid variant, pT3, grade 3 and abdominal wall metastasis. Other metastasis occured in left kidney and ileum about 1 month after the operation, and then she underwent laparoscopic partial nephrectomy and ileocecal resection. The histopathological diagnosis was sarcomatoid carcinoma with positive staining for granulocyte-colony stimulating factor (G-CSF). The paient died of multiple metastases 5 months after first operation. As far as we know, this is the first report of G-CSF producing infiltrating sarcomatoid carcinoma of the ureter in Japanese paper.

[Comparison of pneumatic lithotripter and Holmium YAG laser in transureteral lithotripsy (TUL)].

OBJECTIVE: We retrospectively compared the clinical outcomes of Lithoclast assisted lithotripsy (L group) with those of Holmium YAG laser assisted lithotripsy (H group). PATIENTS AND METHODS: We analyzed records for operation time, duration of ureteral stenting, complication and stone-free rates in the L group (388 patients) and the H group (368 patients) for the primary procedure. RESULTS: The stone locations (L group/H group) were U1 in 141/181, U2 in 69/57, and U3 in 178/130. Respective median stone sizes (L group/H group) were: U1,: 10.0/10.0 mm; U2,: 7.0/10.0 mm;, and U3,: 6.0/7.0 mm. Secondary procedures were performed in 79 L group patients and 35 H group patients. The median operation times (L group/H group) were 29.5/25.0 minutes. The median durations of ureteral stenting (L group/H group) were 4.0/4.0 days. The stone-free rates (L group/H group) according to the locations of the stones were 69.3/82.0% in U1, 85.5/87.0% in U2, and 92.0/98.4% in U3. Complications (L group/H group) were ureter perforation in 8/5 cases, pyelonephritis in 7/2 cases, ureteral stricture in 2/6 cases, and stone push up in 27/13 cases. CONCLUSION: The operation time for holmium YAG laser assisted lithotripsy was significantly shorter than that of the Litoclast assisted procedure, and the stone-free rate with holmium YAG laser assisted lithotripsy was better than that with Lithoclast assisted lithotripsy for U1 and U3 stones.

Restoration of IGFBP-rP1 increases radiosensitivity and chemosensitivity in hormone-refractory human prostate cancer.

We previously reported the tumor-suppressive activity of insulin-like growth factor binding protein-related protein 1 (IGFBP-rP1) through induction of apoptosis in human prostate cancer cells. The aim of this study was to investigate the effects of IGFBP-rP1 for radiosensitivity and chemosensitivity in hormone-refractory human prostate PC-3 cancer cells. Five assays were performed using PC-3 cells transfected with IGFBP-rP1 (PC-3rP1) and control cells transfected with an empty vector (PC-3N): PC-3rP1 and PC-3N were compared by clonogenic survival assay, cell cycle analysis and apoptotic assay for radiosensitivity. The number of colonies of PC-3rP1 cells significantly decreased after 4 and 8 Gy of irradiation, compared with those of PC-3N in the clonogenic survival assay. After 16 hr irradiation at 8 Gy, the percentage of apoptotic cells significantly increased in PC-3rP1 compared with PC-3N. Growth of PC-3rP1 was significantly lower than that of PC-3N after docetaxel treatment both in vitro and in vivo. These results indicate that restoration of IGFBP-rP1 to PC-3 cells increases both their radiosensitivity and chemosensitivity.

Restoration of FGF receptor type 2 enhances radiosensitivity of hormone-refractory human prostate carcinoma PC-3 cells.

BACKGROUND: This study was undertaken to investigate the radiosensitizing effects of fibroblast growth factor receptor 2IIIb (FGFR2IIIb) in androgen-independent human prostate carcinoma PC-3 cells devoid of normally resident epithelial cell FGFR2IIIb. MATERIALS AND METHODS: A clonal line of PC-3 cells expressing FGFR2IIIb was established by stable transfection. Clonogenic cell survival, apoptosis and cell cycle distribution with and without gamma-irradiation were then compared between FGFR2IIIb-expressing PC-3 cells and control cells mock-transfected with vector alone. RESULTS: Gamma-irradiation resulted in an increase of clonogenic cell death concurrent with enhanced apoptosis and cell cycle arrest in the G2/M-phase in both transfected and untransfected cells. A quantitative analysis of all three parameters indicated that cells expressing FGFR2IIIb were significantly more sensitive to irradiation than control cells. CONCLUSION: These results indicate that restoration of FGFR2IIIb to PC-3 cells enhances their sensitivity to irradiation through acceleration of apoptosis and cell cycle arrest.

Clinical efficacy and tolerability of gosha-jinki-gan, Japanese traditional herbal medicine, in females with overactive bladder.

The efficacy and tolerability of a single-agent treatment with 7.5 g/day Gosha-jinki-gan in Japanese females with overactive bladder were analyzed objectively with linguistically validated questionnaires. A total of 44 Japanese females diagnosed as having overactive bladder were enrolled. Before and after the treatment, urinary frequency during the daytime and sleep was counted for two days, and the International Prostate Symptom Score index scores and quality of life index scores were examined. The efficacy assessment was done by comparing the quality of life index scores. The total scores of International Prostate Symptom Score, quality of life index scores and urinary frequency during the daytime and sleep were significantly decreased, respectively. Objective evaluation with the quality of life questionnaire yielded a result of excellent in 7%, improved in 46%, unchanged in 41% and worsened in 7%. Adverse reactions were observed in 9%. Gosha-jinki-gan could be a safe and effective potential therapeutic alternative in females with overactive bladder.

Overactive bladder in children should be strictly differentiated from monosymptomatic nocturnal enuresis.

INTRODUCTION: To elucidate the prevalence of concomitant overactive bladder in children with a chief compliant of primary enuresis, and to evaluate the pathogenetic difference between monosymptomatic and non-monosymptomatic enuresis. MATERIALS AND METHODS: All patients had evidence of primary enuresis. Neurogenic bladder was excluded. Urinary symptoms were evaluated by taking a history from the affected children and parents, and using a questionnaire and bladder diary. Voiding cystourethrography was performed for non-responders to exclude urinary abnormalities. RESULTS: Eighty-eight patients (9.8 +/- 3.1 years old) were enrolled. Initial assessment demonstrated that 24% had undervalued overactive bladders and 9% had constipation. Voiding cystourethrography was performed in 25%, demonstrating mechanical urethral obstructions in 8% and vesicoureteral reflux in 4.5%. Constipation, a history of urinary tract infections, mechanical obstructions and vesicoureteral reflux were strongly associated with non-monosymptomatic enuresis. CONCLUSIONS: Patients with non-monosymptomatic enuresis had a different clinical background, therapeutic response and pathogenetic abnormalities. In children an overactive bladder should be strictly differentiated from monosymptomatic enuresis.

Transurethral ethanol injection for prostatic obstruction: an excellent treatment strategy for persistent urinary retention.

OBJECTIVES: To evaluate the efficacy of transurethral ethanol injection into the prostate (TUEIP) for patients with persistent urinary retention resulting from benign prostatic hyperplasia or advanced prostate cancer. METHODS: Twenty-one Japanese men (elderly or at high risk anesthesiologically) who had developed persistent urinary retention because of benign prostatic hyperplasia or advanced prostate cancer were treated with TUEIP from January 2001 to January 2005. Patient age and preoperative prostate volume was 64 to 92 years (median 84) and 24.1 to 125 cm3 (mean 57.6), respectively. Under sacral or lumbar anesthesia, 6 to 14 mL (mean 10.6) of dehydrated ethanol (mean ratio for prostate volume 22.7%) was injected into the prostate under endoscopic guidance, followed by placement of an indwelling catheter. RESULTS: Of the 16 patients with benign prostatic hyperplasia and 5 with advanced prostate cancer, 14 (87.5%) and 3 (60%), respectively, were able to void spontaneously after catheter removal. The catheter had been left in place for 7 to 37 days (mean 12.4) after surgery. No additional treatment was required during the 2 to 24 months (mean 16) of follow-up. The postoperative residual urine volume of these 17 patients was 20 to 150 mL (mean 60) and their mean prostate volume had decreased from 52.7 to 37.9 cm3 (28.1% reduction) at 6 months postoperatively (P <0.001). No major complication was experienced. CONCLUSIONS: In patients with persistent urinary retention due to prostatic obstruction without severe complications, TUEIP removes the need for catheterization and allows spontaneous voiding. TUEIP may be an alternative to transurethral resection of the prostate for high-risk or elderly patients who cannot tolerate surgery.

Transrectal ultrasound-guided 10-core biopsy of the prostate for Japanese patients.

To determine the utility of transrectal ultrasound (TRUS)-guided 10-core prostate biopsy (sextant plus 4 far lateral cores) for Japanese patients, we compared it with the standard sextant for detection of prostate cancer. The study patients were 564 consecutive Japanese men (median age 71 years) who underwent 10-core biopsy because of PSA values of > or = 2.0 ng/ml at Hiroshima University Hospital between March 2000 and December 2004. The overall cancer detection rate for the 10-core biopsy was 42.6% (240/564), which was significantly higher than the 36.3% (205/564) for the standard sextant biopsy (P=0.0330), with a 14.6% (35/240) improvement. The 10-core biopsy also detected a significant number of additional cancers in the sub-groups of patients with PSA values of 2 to approximately 10 ng/ml (P=0.0275), a prostate volume of > 20 cc (P=0.0440), or normal findings of digital rectal examination (P=0.0304). The 10-core biopsy scheme detected 9.6% and 2.1 to approximately 8.3% more cancers than the lateral sextant (apex, lateral mid portion, and lateral base) and the probable different combinations of 8-core biopsy designs, respectively. Compared to the standard sextant biopsy, the 10-core biopsy did not detect an increased proportion of clinically insignificant cancers. There was no severe morbidity, and only 2 patients (0.4%) were briefly hospitalized due to high fever. These results show that the TRUS-guided 10-core biopsy yields a better prostate cancer detection rate than the 6-core or 8-core protocol without severe complications. Therefore, it seems to be practicable for Japanese patients.

The prevalence of overactive bladder and nocturnal enuresis in Japanese early adolescents: a questionnaire survey.

To assess the prevalence of overactive bladder (OAB) and nocturnal enuresis (NE) in early adolescents, we distributed an anonymous questionnaire about urinary symptoms to 624 middle school students aged 13 and 15 years. The questionnaire included items regarding age, gender, past and present diseases, urinary symptoms and bowel habits. OAB was defined as symptoms of increased daytime frequency occurring more than eight times during the daytime and/or urge incontinence occurring at least once a month. The overall response rate to the questionnaire was 32.4%, and the mean age +/- SD of all respondents was 13.9 +/- 0.89 years. The prevalence of OAB was 15.3% of all respondents (95% CI, 10.4-20.3%; 4.2-16.1% of boys and 12.5-28.3% of girls). The prevalence of OAB decreased with age from 17.6% of respondents aged 13-year-olds to 11.8% of 15-year-olds. The mean daytime frequency was 5.0 +/- 2.2 times. Increased daytime frequency was found in 10.4% (95% CI, 6.2-14.6%; 2.7-13.5% of boys and 6.1-19.0% of girls) and nocturia in 4.0% (95% CI, 1.3-6.7%). The prevalence of NE was 3.0% (95% CI, 0.65-5.4%; three boys and three girls). The results of this study demonstrate that some early adolescents had OAB or NE. Further large-scale studies would be required to investigate the prevalence and natural history of OAB and NE.

Impact of radical perineal prostatectomy on urinary continence and quality of life: a longitudinal study of Japanese patients.

AIM: We used self-completed questionnaires to obtain a longitudinal assessment of urinary continence and urinary, bowel, and sexual domain-related quality of life (QOL) in Japanese patients undergoing radical perineal prostatectomy (RPP). METHODS: A total of 41 Japanese patients with a median age of 69 years who underwent RPP between February 2002 and February 2004 were included in the study. We measured QOL by the University of California, Los Angeles, Prostate Cancer Index (UCLA-PCI) and assessed urinary continence on the basis of three different definitions of continence. The International Prostate Symptom Score (I-PSS) was also included to evaluate lower urinary tract symptoms (LUTS). RESULTS: When urinary continence was de fi ned as none, one, or two protective pads per day, 100%, 73%, 94%, 97%, or 100% of the patients were continent before, and 1, 3, 6, and 12 months after, RPP, respectively. When it was de fi ned as total control or occasional dribbling, the corresponding values were 97%, 70%, 84%, 94%, and 97%. Urinary function returned to the preoperative baseline level by 6 months postoperatively and scores for urinary bother had significantly surpassed the baseline by 12 months (P = 0.043). The I-PSS was significantly improved (P = 0.014), with a mean 4.7-unit decrease. Sexual function worsened significantly after surgery, and its recovery was less favorable. No significant change was observed in scores for bowel function or bowel bother. CONCLUSIONS: The majority of patients who undergo RPP rapidly regain urinary continence and QOL within 3-6 months. RPP has a favorable impact on LUTS.

[Ureteral cancer producing granulocyte colony-stimulating factor: a case report].

A 60-year-old man who underwent radical nephroureterectomy due to left ureteral cancer 22 months before (transitional cell carcinoma, pT4pN0Mx, grade 2, INF beta), was admitted to the hospital with the chief compliant of anorexia and body weight loss. The patient had severe leukocytosis and elevation of C-reactive protein, with no obvious focus of infection. Abdominal plain computed tomographic scan revealed left external ileac lymph node swelling. Positron emission tomography demonstrated left external ileac lymph node recurrence. Enzyme immunoassay of the serum demonstrated a markedly high concentration of granulocyte colony-stimulating factor (G-CSF; 790 pg/ml). Immunohistochemical examination of ureteral cancer cells with anti-G-CSF monoclonal antibody demonstrated G-CSF production in cancer cells. After diagnosed as lymph node recurrence of ureteral cancer producing G-CSF, the patient underwent radiotherapy (total 4000 Gy). CT after radiotherapy showed the complete disappearance of the lymph node swelling. To our knowledge, this is the second report of ureteral cancer proven to produce G-CSF in Japan.

Urological retroperitoneoscopic surgery for patients with prior intra-abdominal surgery.

OBJECTIVE: To determine whether previous intra-abdominal surgery is associated with surgical outcome in patients undergoing urological retroperitoneoscopic surgery. PATIENTS AND METHODS: One hundred seventeen cases of urological retroperitoneoscopic surgery, including 78 cases of retroperitoneoscopic radical nephrectomy (RN) for localized renal tumor and 39 cases of retroperitoneoscope-assisted radical nephroureterectomy (RNU) for upper urinary tract cancer, were evaluated. Thirty (38.5%) of the 78 patients who underwent RN and 13 (33.3%) of the 39 patients who underwent RNU had a history of intra-abdominal surgery. The patients were divided into two groups: those who had undergone prior intra-abdominal surgery (OP+) and those who had not (OP-). Patients' backgrounds, degree of surgical invasiveness, and period of convalescence were compared between the OP+ and OP- groups. RESULTS: There was no significant difference between the OP+ and OP- groups in terms of background, surgical invasiveness or convalescence, except for age in the patients who had undergone RN. Complications in the studied cases were unrelated to any history of intra-abdominal surgery. CONCLUSION: Previous intra-abdominal surgery is not associated with a negative outcome of urological retroperitoneoscopic surgery in patients with localized renal tumors and those with upper urinary tract cancer.

[Comparison of endoscopic versus open radical nephrectomy for stage T1 and T2 renal cancer].

The aim of this study was to compare the efficacy, efficiency and patient well-being of endoscopic radical nephrectomy (ERN) with those of open radical nephrectomy (ORN) in patients with stage T1 and stage T2 renal cell carcinoma during the period from 1995 to 2003. Eighty-four patients including 53 patients receiving ERN and 31 patients receiving ORN were evaluated. The two groups were analyzed for sex, side of tumor, clinical stage, age, tumor diameter, operative time, operative blood loss, postoperative time to oral intake and ambulation. There was no difference in patient background between the ERN and ORN groups. Although the mean operative times between the ORN and ERN group were not different (mean 240 versus 267 min. in ERN group, P N .S.), ERN patients had significantly less operative blood loss (mean 123 versus 469 ml. in ERN group, P < 0.01), significantly shorter time to start the oral intake of rice gruel (mean 1.4 versus 4.6 days. in ERN group, P < 0.01) and significantly shorter time to ambulation (mean 1.2 versus 3.1 days. in ERN group, P < 0.01). These findings revealed that endoscopic radical nephrectomy for the patients with stage T1 and T2 renal cell carcinoma appears to be associated with less morbidity and faster recovery rather than open radical nephrectomy.

Local anesthesia during 10 core biopsy of the prostate: comparison of 2 methods.

PURPOSE: We investigated the effectiveness of a new method, intraprostatic administration of local anesthesia vs traditional periprostatic injection for decreasing the discomfort caused by transrectal ultrasound guided, 10 core biopsy of the prostate. MATERIALS AND METHODS: We studied 71 patients who received intraprostatic anesthesia between October 2002 and March 2003, and 99 who received periprostatic anesthesia between October 2001 and September 2002 before prostate biopsy. After biopsy patients were given a questionnaire, which consisted of 5 questions about pain and 3 about morbidity, and were asked to complete it and mail it to our department. RESULTS: The mean score +/- SD for the degree of pain during biopsy in the periprostatic groups was 2.6 +/- 1.1 and that in the intraprostatic group was 1.9 +/- 1.1, which was significantly different (p <0.001). Other items, including the degree of pain after biopsy, duration and location of pain, and medicine intake for pain, were not significantly different between the 2 groups. There was no significant difference in morbidity, including hematuria, hemospermia and rectal bleeding, between the 2 groups. CONCLUSIONS: Intraprostatic administration of local anesthesia significantly decreases the pain associated with prostate biopsy compared with periprostatic nerve block. It is a simple, safe and rapid technique that should be considered in all patients undergoing transrectal ultrasound guided prostate biopsy.

Restoration of fibroblast growth factor receptor2 suppresses growth and tumorigenicity of malignant human prostate carcinoma PC-3 cells.

BACKGROUND: Fibroblast growth factors (FGFs) and their receptors (FGFRs) expedite stromal-epithelial communication in development and homeostasis of the human prostate. Loss of resident epithelial cell FGFR2IIIb that responds to stromal FGF7 and FGF10 accompanies malignant progression of both model animal and human prostate tumors. METHODS: We examined whether restoration of FGFR2IIIb by transfection in the malignant human prostate tumor PC-3 cell line restored cellular properties associated with less malignant tumors. Cell proliferation, apoptosis, and tumor cell implants were used to monitor malignant properties. Activity of FGFR2IIIb was assessed by immunoblot of FRS2 and p44/42 MAP kinase. Immunochemical analysis of pancytokeratin and lactoferrin expression was utilized to assess changes in cellular differentiation. RESULTS: Expression of FGFR2IIIb in PC-3 cells by transfection resulted in growth suppression in vitro and reduced tumor formation in vivo concurrent with increased cellular differentiation and apoptosis. CONCLUSIONS: The results indicate that restoration of FGFR2IIIb to the malignant human prostate epithelial cell prototype PC-3 restores properties associated with nonmalignant tumors and normal cells. This further suggests that epithelial cell resident, homeostasis-promoting FGFR2 may be involved in suppression of malignancy and that restoration may be a candidate for gene therapy of hormone-refractory prostate cancer.

Interaction of ligand-receptor system between stromal-cell-derived factor-1 and CXC chemokine receptor 4 in human prostate cancer: a possible predictor of metastasis.

Interaction of ligand-receptor systems between stromal-cell-derived factor-1 (SDF-1) and CXC chemokine receptor 4 (CXCR4) is closely involved in the organ specificity of cancer metastasis. We hypothesized that SDF-1-CXCR4 ligand-receptor system plays an important role in prostate cancer metastasis. To test this hypothesis, expression level of SDF-1 and CXCR4 was analyzed in prostate cancer (PC) cell lines (LNCaP, PC3, and DU145) and normal prostate epithelial cell line (PrEC). We also performed migration assay and MTT assay to investigate the chemotactic effect and growth-promoting effect of SDF-1 on DU145 and PC3 cells, respectively. Furthermore, we performed immunohistochemical analysis of CXCR4 expression in tissues from 35 cases of human prostate cancer. CXCR4 expression was detected in all three prostate cancer cell lines, but not in PrECs. SDF-1 significantly enhanced the migration of PC3 and DU145 cells in a dose-dependent manner, and anti-CXCR4 antibody inhibited this chemotactic effect. However, SDF-1 itself did not significantly stimulate the cell growth rate of prostate cancer cell lines. Positive CXCR4 protein was found in 20 out of 35 clinical PC samples (57.1%). Three patients with lung metastasis showed definitely positive CXCR4 immunostaining. Logistic regression analysis revealed that positive expression of CXCR4 protein was an independent and superior predictor for bone metastasis to Gleason sum (P < 0.05). Furthermore, among PC patients with PSA greater than 20 ng/mL, the positive rate of CXCR4 protein was significantly higher in patients with bone metastasis than in those with no bone metastasis (P = 0.017). These findings suggest that the interaction between SDF-1 and CXCR4 ligand-receptor system is involved in the process of PC metastasis by the activation of cancer cell migration. This is the first report to investigate the role of interaction of ligand-receptor systems between SDF-1 and CXCR4 in prostate cancer metastasis.

Restoration of insulin-like growth factor binding protein-related protein 1 has a tumor-suppressive activity through induction of apoptosis in human prostate cancer.

Insulin-like growth factor binding protein-related protein 1 (IGFBP-rP1), a member of the IGFBP super family, is down-regulated at the mRNA level in several solid cancers. We hypothesize that IGFBP-rP1 has a tumor-suppressive effect on prostate cancer growth and its inactivation is through CpG hypermethylation. We tested this hypothesis through expression analysis of IGFBP-rP1, transfection studies, growth analysis, and CpG methylation in prostate cancer cells and tissues. In situ hybridization revealed IGFBP-rP1 mRNA expression was detected in the stroma and epithelium of benign prostatic hyperplasia tissues but was either weak or lost in prostate cancer tissues. The mRNA expression for IGFBP-rP1 was lacking in DU145, LNCaP, ND-1, and PC-3 prostate cancer cell lines, and after demethylation (5-aza-dC treatment), the expression was restored suggesting that methylation inactivated IGFBP-rP1 expression in prostate cancer cells. We further tested whether transfection of IGFBP-rP1 can modulate prostate cancer cells growth. We transfected PC-3 cell lines with IGFBP-rP1 cDNA (PC-3-rP1) and Northern blotting confirmed mRNA transcript of IGFBP-rP1 in these PC-3-rP1 clones. A 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay showed growth rate was significantly lower in PC-3-rP1 cells than in the nontransfected control. In addition, the medium obtained from PC-3-rP1 cells reduced the growth rate in both PC-3-rP1 and control PC-3 cells. A soft agar colony-forming assay revealed that colony formation was markedly decreased in PC-3-rP1 cells. The number of apoptotic cells and caspase-3 expression were increased in the PC-3-rP1 cells as compared with control PC-3 cells. This is the first study that suggests inactivation of IGFBP-rP1 is through CpG methylation, and tumor-suppressive activity of IGFBP-rP1 is through induction of apoptosis in an IGF-I independent manner in prostate cancer.

Topographic anatomy of the male perineal structures with special reference to perineal approaches for radical prostatectomy.

AIM: Although perineal approaches for radical prostatectomy have recently gained renewed attention as excellent methods for minimally invasive surgery, the most commonly used techniques, Belt's and Young's approaches, have inadequacies regarding the topographical relationship between the rectourethral and levator ani muscles. METHODS: Using macroscopic observations of sagittal slices of 27 male pelvises and smooth muscle immunohistochemical staining of semiserial sections of another eight pelvises, we investigated the topographical anatomy of the perineal structures and their interindividual variations in elderly Japanese men. RESULTS: The inferomedial edge of the levator ani was located 5-15 mm lateral to the midsagittal plane in an area between the urethra and the rectum. The rectourethral smooth muscle had a superoinferior thickness of 5-10 mm and occupied a space between the right and left levator slings. The levator was adjacent to, or continuous with, the striated anal sphincters. A thick connective tissue septum, composed of smooth muscle, was evident between the rectal smooth muscle and the anal sphincter-levator ani complex. CONCLUSION: Because the connective tissue septum guides the surgeon's finger upwards towards the rectoprostatic space, Belt's approach appears relatively easy; however, rectal injury can sometimes occur if the surgeon loses this guidance. In contrast, if the levator edge is identified as the first step in Young's approach, the rectourethral muscle can be precisely divided, leaving a 3-5-mm margin from the rectum and sphincter-levator complex. Clinical investigations are now required to modify Young's approach based on the present results.

[Ductal carcinoma of the prostate with multilocular cystic formation].

A 72-year-old man was admitted to our department with the complaint of nocturia. PSA was elevated to 18.2 ng/ml. Transrectal ultrasonography, CT scan and MRI showed multilocular cystic lesions at the posterior site of the prostate, with rectal and bladder invasion and lymph node metastasis. Transrectal needle biopsy of the prostate and fluid aspiration of the prostatic cyst were performed. The aspirated fluid was bloody, but the result of cytology was negative. Histopathological examination of the needle biopsy specimen revealed ductal carcinoma of the prostate. We diagnosed this case as a T4N1M0 prostatic cancer, and started endocrine therapy. Thirty-nine cases of adenocarcinoma of the prostate with cystic formation in the Japanese literature are reviewed.