Real-world prostate-specific antigen response and progression to castration-resistant prostate cancer among men with metastatic castration-sensitive prostate cancer treated with apalutamide: a multi-institutional study in the Chu-shikoku Japan Urological Consortium.

BACKGROUND: Japanese men receiving apalutamide often experience skin-adverse events (AEs), possibly requiring treatment interruption or dose reduction. However, concerns have arisen regarding the impact of these adjustments on the efficacy of apalutamide. Our study evaluated the efficacy, safety, and persistence of apalutamide in men with metastatic castration-sensitive prostate cancer (mCSPC). METHODS: We retrospectively reviewed the medical records of 108 men with mCSPC from 14 Japanese institutions. The primary outcomes were the efficacy of apalutamide: prostate-specific antigen (PSA) response (50%, 90% and < 0.2 decline) and progression to castration-resistant prostate cancer (CRPC). The secondary outcomes were the skin-AE and compliance of apalutamide. RESULTS: PSA50%, PSA90% and PSA < 0.2 declines were observed in 89.8, 84.3 and 65.7%, and the median time to CRPC progression was not reached. PSA < 0.2 decline and an initial full dose of apalutamide were significantly associated with a longer time to CRPC. The most common AE was skin-AE (50.9%), and there was no association between the occurrence of skin-AE and the time to CRPC (P = 0.72). The median apalutamide persistence was 29 months, which was longer in the initial full dose recipients than in the reduced dose recipients. The dosage is reduced in about 60% of patients within the first year of treatment in the initial full dose recipients. CONCLUSIONS: Our findings indicate the effectiveness of apalutamide in Japanese men with mCSPC, despite a substantial portion requiring dose reduction within a year among the initial full dose recipients.

[A Case of Chromophobe Renal Cell Carcinoma Producing Interleukin-6 with Stauffer Syndrome].

A 41-year-old male consulted a local doctor with fever and left flank pain. He was introduced to our hospital for a left renal mass detected by ultrasonography. Blood analysis revealed elevated white blood cell count, C-reactive protein, bilirubin and aspartate transaminase. Computed tomography demonstrated a left renal mass (expansive growth), which was 11 cm in maximum diameter and enhanced moderately at the corticomedullary phase. Neither distant metastasis, infectious findings nor hepatobiliary abnormalities were observed. The patient underwent laparoscopic radical nephrectomy with a clinical diagnosis of non-clear cell renal cell carcinoma cT2bN0M0 with Stauffer syndrome. The surgery required 186 minutes of insufflation, and estimated blood loss and specimen weight were 44 ml and 695 g, respectively. There were no complications. Histopathological diagnosis was chromophobe renal cell carcinoma-classic pattern (ChRCC-C), which was producing interleukin-6 in the tumor cytoplasm immunohistochemically. Postoperatively, there was early defervescence with complete resolution of the Stauffer syndrome. No relapse or liver dysfunction has occurred at 5 years after operation. To our knowledge, this is the first reported case in the literature of ChRCC accompanied by Stauffer syndrome.

Real-world analysis of apalutamide-associated skin adverse events in Japanese patients with advanced prostate cancer: a multi-institutional study in the Chu-shikoku Japan Urological Consortium.

BACKGROUND: Apalutamide-associated skin adverse events are more common in the Japanese than in the global population. However, limited clinical data have hampered further understanding. This real-world study investigated the clinical characteristics of skin adverse events in patients with advanced prostate cancer. METHODS: We retrospectively reviewed 119 patient records from 16 institutions in Japan. Skin adverse events were graded according to the Common Terminology Criteria for Adverse Events (v5.0). The incidence and characteristics of skin adverse events (along with the clinical risk factors for their incidence, worsening, and recurrence) were evaluated. RESULTS: Fifty-five patients (46.2%) experienced skin adverse events. The median times to the incidence and remission of skin adverse events were 62 and 30 days, respectively. Grade 3 skin adverse events were observed in 15 patients (12.6%). The median time from the first incidence to apalutamide interruption was significantly longer in patients with progression to grade 3 skin adverse events than in those without such a progression (8 vs. 0 days, p = 0.005). Skin adverse events were observed in 45.2% of patients who resumed apalutamide treatment (median treatment interruption time: 31.5 days). Sixteen patients (13.4%) permanently discontinued apalutamide due to skin adverse events. No significant clinical risk factors for the incidence, worsening and recurrence of apalutamide-associated skin adverse events were observed. CONCLUSIONS: Nearly half of the Japanese patients in this study experienced skin adverse events following apalutamide administration. The time to apalutamide discontinuation after the incidence of skin adverse events was positively correlated with the worsening of these events.

[Retroperitoneal Dedifferentiated Liposarcoma with Metaplastic Bone Formation : A Case Report and Review of the Literature].

A 69-year-old female was introduced to our department for a retroperitoneal mass, 25 mm in diameter, in the right perirenal space indicated by computed tomography (CT). On the basis of magnetic resonance imaging (MRI), retroperitoneal soft tissue sarcoma was suspected. Because she rejected surgical treatment, we continued imaging surveillance. Subsequently, the mass grew larger, but her intention did not change. At 21 months after initial consultation, CT revealed further increase of the above mass and a new lesion with calcification. Ultimately, she underwent mass resection with concomitant resection of the right kidney. Histological examination showed dedifferentiated liposarcoma with metaplastic bone formation and positive surgical margin, but she refused adjuvant chemotherapy. She has survived 7 months since the operation with no evidence of recurrence.

The efficacy of STRATAFIX® spiral PDS for vesicourethral anastomosis during robot-assisted laparoscopic radical prostatectomy: a single-center retrospective study.

PURPOSE: To investigate the efficacy of continuous suturing using barbed suture for vesicourethral anastomosis (VUA) during robot-assisted laparoscopic radical prostatectomy (RARP). MATERIALS AND METHODS: Seventy-three consecutive patients who underwent RARP by a single surgeon between 2020 and 2022 were retrospectively divided based on the suture type used for VUA: group A, 3-0 poliglecaprone-25 RB-1 needle (Monocryl®), n = 46; group B, 3-0 spiral polydioxanone (PDS) barbed suture with RB-1 needle (STRATAFIX®), n = 27. RESULTS: There was no significant difference in patient background characteristics between groups, including age, body mass index, and clinical stage. However, group B had a significantly shorter operative time, console time, hospital stay, and duration of urethral catheterization. The VUA time was significantly shorter in group B than in group A (17.9 min vs. 10.6 min; p < 0.001). Only 1 case of minor leakage was observed during the intraoperative leak test (1 patient in group A). There was no significant difference in the number of pads used at 1, 3, 6 months and 1 year postoperatively. There were no urethral strictures, and there was no significant difference in pathologic results or postoperative prostate-specific antigen progression between groups. CONCLUSIONS: Our study suggests that the use of barbed suture during VUA for RARP is associated with reduced VUA time.

Metastatic small cell bladder cancer treated with sequential systemic therapy including pembrolizumab and amrubicin: A case report.

Introduction: Small cell bladder cancer is a relatively rare tumor, representing <1% of all bladder tumors. Amrubicin monotherapy is used as second-line treatment for small cell lung cancer in Japan. Case presentation: A 79-year-old woman presented with gross hematuria and was diagnosed with small cell bladder cancer (T2 or higher). Neoadjuvant chemotherapy with etoposide and cisplatin resulted in a partial response. Robot-assisted radical cystectomy was performed, and radical resection was achieved. As we identified metastasis in the pleura 1 year later, we administered carboplatin and etoposide, which resulted in a partial response. Although pembrolizumab was initiated as maintenance therapy, it was not effective. Amrubicin was given as third-line therapy, and stable disease was achieved without serious adverse effect for 6 months. Conclusion: Although there is no established treatment for metastatic small cell bladder cancer, the current case report suggests the effectiveness of amrubicin in this setting.

Cut-to-the-light technique is useful for complete obstruction of a Wallace ureteroileal anastomosis.

Introduction: Obstruction of a ureteroileal anastomosis after urinary diversion is an unpleasant situation for patients and clinicians alike. Case presentation: A 48-year-old man who underwent a radical cystectomy for muscle-invasive bladder cancer and urinary diversion using the Wallace technique complained of right back pain. Computed tomography showed right hydronephrosis. Cystoscopy via the ileal conduit revealed complete obstruction of the ureteroileal anastomosis. We performed a bilateral approach (antegrade and retrograde) to use the cut-to-the-light technique. A guidewire and 7Fr single J catheter could be inserted. Conclusion: The cut-to-the-light technique was useful for complete obstruction of the ureteroileal anastomosis, the length of which was <1 cm. Herein, we report on the cut-to-the-light technique with a literature review.

Isolated rupture of the corpus spongiosum with urethral injury diagnosed by pre-surgical MRI.

Introduction: Penile fracture is typically defined as the rupture of the corpus cavernosum. Case presentation: A 61-year-old man presented with swelling, pain, and bruising of his penis, along with gross hematuria. He reported that he sustained this injury while having sex with his wife. We suspected a penile fracture and obtained magnetic resonance imaging, which showed a rupture of the ventral corpus spongiosum and clarified the appropriate approach for repair. We used a direct transverse incision to repair both the urethral injury and the corpus spongiosum. Surgery went well, without any significant intraoperative or postoperative complications. We removed the urinary catheter on postoperative day 8, and cystoscopy showed no urethral stenosis on postoperative day 17. The patient's postoperative erectile function was the same as before his injury. Conclusion: Magnetic resonance imaging was useful for detect the site of rupture. Ventral direct transverce incision made him a good clinical course.

Bladder stone formation around polyethylene glycol after use of SpaceOAR Hydrogel.

Introduction: Radiation therapy is used as primary, adjuvant, and salvage therapy for prostate cancer. When using radiation therapy, the SpaceOAR® system is considered easy to use and useful for reducing the irradiated dose and toxicity to the rectum. Although SpaceOAR® system have been reported some adverse event including death. Case presentation: A 74-year-old male was diagnosed with prostate cancer of clinical stage cT2aN0M0 and intermediate risk by the National Comprehensive Cancer Network guidelines. We inserted the SpaceOAR® Hydrogel before performing intensity-modulated radiation therapy, as the patient had ulcerative colitis. We did not recognize any complications during or after the procedure, although magnetic resonance imaging revealed hydrogel in the bladder retrospectively. Fourteen months after the procedure, the patient was presented with macrohematuria and we found a bladder stone including hydrogel. Conclusion: We report the first case of a bladder stone after use of SpaceOAR® Hydrogel. We must be careful of taking place it.

The Simultaneous Onset of Pancreatitis and Colitis as Immune-related Adverse Events in a Patient Receiving Nivolumab Treatment for Renal Cell Carcinoma.

Immune checkpoint inhibitors (ICIs), which have anti-tumor effects, are currently approved for treatment of several kinds of advanced malignancies. However, with their increasing use, a variety of immune-related adverse events (irAEs) in administered patients have been reported. We herein report a rare case of the simultaneous onset of acute pancreatitis and colitis as irAEs during nivolumab treatment given to a patient with renal cell carcinoma, who then shown marked improvement with corticosteroid therapy.

Asymptomatic Immune Checkpoint Inhibitor-associated Myocarditis.

We herein report the case of a 75-year-old man with asymptomatic immune checkpoint inhibitor (ICI)-associated myocarditis diagnosed on the basis of elevated levels of creatine kinase (CK), CK-myocardial band and troponin I (TNI). He was suspected of being complicated with myasthenia gravis (MG). High-dose prednisolone (PSL) is associated with a risk of MG exacerbation; therefore, PSL therapy was gradually increased from 5 mg/day to 20 mg/day, which resulted in the normalization of the TNI level, and no PSL-related side effects occurred. MG easily complicates myocarditis as an immune-related adverse event; thus, the treatment plan should be carefully considered.

Case report of a ureteral obstruction by Candida albicans fungus balls detected by magnetic resonance imaging in kidney transplant recipient.

In kidney transplant recipients, acute renal failure resulting from a ureteral obstruction by fungus balls is uncommon. We report a 60-year-old man diagnosed with ureteral obstruction caused by Candida albicans fungus balls early after transplant. Diagnosis was made by a T2-weighted magnetic resonance image, which demonstrated fungus balls as a low-intensity mass in the pelvis and microscopic examination findings in the urine. The patient was treated successfully with an antifungal agent and direct irrigation. It should be noted that fungus balls may cause ureteral obstruction of transplanted kidneys, possibly resulting in graft failure. Imaging of the kidneys and collecting system and aggressive debridement that adds to systemic therapy are necessary for early diagnosis and are central to a successful outcome.

Extracellular activation of Wnt signaling through epigenetic dysregulation of Wnt inhibitory factor-1 (Wif-1) is associated with pathogenesis of adrenocortical tumor.

Wnt/ß-catenin signaling is considered to be an essential regulator of adrenocortical oncogenesis. Wnt inhibitory factor-1 (Wif-1), an extracellular regulator of Wnt signaling, is frequently down-regulated by hypermethylation of the promoter CpG. We investigated epigenetic regulation of Wif-1 and its association with adrenocortical (AC) tumor pathogenesis in light of Wnt activation. The AC tumors showed a high prevalence of Wif-1 promoter methylation and low prevalence of Wif-1 mRNA transcription as compared to the normal adrenal (NA) samples. Furthermore, a significant correlation was found between Wif-1 promoter methylation and mRNA transcription in the tumors. Either intracellular ß-catenin accumulation or ß-catenin mRNA transcription was significantly elevated in the AC tumors, which also showed an inverse correlation with Wif-1 mRNA transcription. Cyclin D1, a target gene of Wnt signaling, was also up-regulated in the AC tumors as compared with the NA samples. In addition, down-regulation of Wif-1 was correlated with increased cyclin D1 at both mRNA and protein levels. However, despite the proposed activation of Wnt signaling in AC tumors, only 2 of 20 with intracellular ß-catenin accumulation showed ß-catenin mutations. Thus, genetic alterations of ß-catenin and epigenetics-related Wif-1 promoter hypermethylation may be important mechanisms underlying AC tumor formation though aberrant canonical Wnt/ß-catenin signaling activation.