Clinical outcomes of prostate cancer patients in Yokosuka City, Japan: A comparative study between cases detected by prostate-specific antigen-based screening in Yokosuka and those detected by other means.

OBJECTIVES: To investigate whether prostate-specific antigen-based screening reduced the prostate cancer mortality rate in Yokosuka, Japan. METHODS: We carried out a cohort study, in which we compared clinical outcomes between patients detected by prostate-specific antigen-based screening (S group n = 524) versus those detected by other means (NS group n = 1044). Clinical and pathological factors were evaluated using Cox regression analyses and the Kaplan-Meier method. RESULTS: A total of 1.5% (8/524) of patients in the S group and 6.7% (70/1044) of those in the NS group died from prostate cancer during follow up. A total of 8.0% (42/524) of patients in the S group and 11.4% (119/1044) in the NS group died from other causes. The 10-year cancer specific survival rates of the S and NS groups were 97% and 86%, respectively (P < 0.001). The median age was significantly lower in the S group than the NS group: 71 and 73 years, respectively (P < 0.001). The rate of Gleason score 8-10 was significantly lower in the S group than the NS group: 9.7% and 16.7%, respectively (P < 0.001). The rate of patients with metastasis or prostate-specific antigen 100 ng/mL or more was significantly lower in the S group than the NS group: 7.8% and 23.0%, respectively (P < 0.001). On multivariate analysis, Gleason score 8-10 compared with Gleason score 6 was independently associated with cancer-specific survival (hazard ratio 4.808, 95% confidence interval 1.044-22.14, P = 0.044). CONCLUSIONS: Prostate-specific antigen-based population screening in Yokosuka City might help to reduce the prostate cancer mortality rate.

[Pancreatic metastasis from renal cell carcinoma 25 years after radical nephrectomy].

We report a case of pancreatic metastasis from renal cell carcinoma detected 25 years after radical nephrectomy. A 74-year-old man, who had undergone radical nephrectomy for renal cell carcinoma at age 49, was found by computed tomography to have a strongly enhanced mass on the pancreatic head. The patient underwent pancreaticoduodenectomy and the pathological diagnosis was metastatic renal cell carcinoma. This was evidently a slow growing tumor because the metastatic pancreas tumor was well demarcated and the metastasis was found 25 years after the primary operation. Aggressive surgical treatment of isolated metastatic lesions offers a chance of long-term survival. Patients with a history of RCC should undergo a long-term follow-up to detect and evaluate metastasis to pancreas as well as other organs.

[Splenosis mimicking local recurrence after radical nephrectomy: a report of two cases].

Splenosis is autotransplantation of splenic tissue and usually follow traumatic or surgical rupture of the spleen. We report two cases of splenosis which presented as a local recurrence after radical nephrectomy for left renal cell carcinoma (RCC). The patients were a 65- and a 71-year-old male, who had been operated for RCC including splenectomy because of disrupture of the splenic capsule 8 and 9 years earlier respectively. In both cases, follow up computed tomographic scans showed small nodules under the left diaphragm. Although we initially suspected local recurrence, we considered the possibility of splenosis. Both patients underwent technetium-99m Sn colloid scans and were diagnosed with splenosis successfully. Therefore, we could avoid unnecessary surgical explorations.

[Five-year results of prostate specific antigen (PSA) screening in Yokosuka City--comparative study between PSA-screened group and non-screened group].

A mass screening of subjects for prostate specific antigen (PSA) was conducted to investigate whether this method is effective in detection of early stage prostate cancer. From 2001 to 2005, 1022 patients in Yokosuka City with pathologically diagnosed prostate cancer by using prostate needle biopsy were divided into screened (S: 276 patients) and non-screened (NS: 746 patients) groups. Clinical factors (mean age, PSA at diagnosis, clinical stage, Gleason score, WHO classification, cases of radical prostatectomy) were evaluated and analyzed. Statistical significance was analyzed by Mann-Whitney's U-test. The mean age was 70.7 and 72.7 (p<0.0001) in the S group and NS group, respectively; mean PSA at diagnosis was 10.5 and 18.6 ng/ml (P=0.0139); percentage of organ-confined disease (T2b or lower clinical stage), 75 and 55 (p<0.0001); percentage of non-metastatic diseases was 92 and 77 (p<0.001) and percentage of pathologically poor-risk cancer (8 or more Gleason score) was 22 and 38 (p=0.0004), respectively. In conclusion, PSA mass screening was found useful to detect early stage prostate cancer in Yokosuka City. Further studies should be conducted to determine whether PSA mass screening will be able to decrease mortality of prostate cancer.

[Multi-center trial on the early effects of silodosin on lower urinary tract symptoms associated with benign prostatic hyperplasia].

Silodosin (URIEF), a new so-called 3rd generation alpha-1 blocker, is widely expected to be effective and useful for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), due to its high specificity to alpha-1A receptor. We evaluated the efficacy of Silodosin, on 187 males 50 years old or over with the diagnosis of BPH. Silodosin significantly improved the International Prostate Symptom Score (IPSS) and quality of life (QOL) score from the day after administration was started. Among 166 patients whose data were available for the analysis of efficacy of Silodosin, 77.5% showed apparent subjective improvement. Eighty three patients, who had been taking another alpha-1 blocker but without satisfactory effects, showed almost the same improvements in IPSS and QOL score after switching to Silodosin as the remaining 83 patients who had no preceding treatment with an alpha-1 blocker. The improvements were not only in voiding symptoms but also in storage symptoms. The patients, who had serious storage symptoms, responded rather well to Silodosin and showed significant improvement. Taken together, Silodosin showed a quick effect for improving subjective symptoms and QOL, and was found to be useful for the management of LUTS with BPH.

Clinical anatomical study of pedicled vascularised scapular bone graft using the angular branch.

This study is an anatomical investigation of the angular branch of thoracodorsal artery, and examines the possible range of clinical targets for pedicled vascularised scapular bone graft. Forty-six cadavers were studied. The blood vessel length was calculated, and the distance required to reach the distal humerus from the lower end of the articular surface of the humeral head as reference point was compared with bone length. The length from reference point was an average of 121.7 mm. It was thought that the maximum distance to arrive in reference point to the distal humerus was a total of blood vessel length and transplantation bone length, which was an average of 246.3 mm. This was longer than the average of 240.8 mm of bone length from reference point to humeral medial condyle. This study had confirmed that a pedicled vascularised scapular bone graft using the angular branch could be transplanted to the distal humerus.

[Clinical significance of pelvic lymph-node dissection for the patients with locally invasive bladder cancer--correlation between the number of retrieved lymph nodes and prognosis].

The objective of this study was to know the effects of pelvic lymph node dissection on the survival of the patients who received radical cystectomy without neoadjuvant chemotherapy or radiotherapy. Between 1984 and 2000, 104 patients underwent operation at our institution for tumors clinically diagnosed as locally invasive bladder cancer (T2-4NxM0). Survival rates and 8 prognostic factors (age, sex, size, multiplicity, type, pT, N, pv) were analyzed by uni- and multivariate analysis. The significant factors were size, type, pT, N, pv by univariate analysis. Of these 5 factors, N factor was the most significant by multivariate analysis. Patients (N-) who had more than 20 lymph nodes retrieved showed better survival than the others.

[Clinical analysis of double cancer involving bladder and prostate].

Between January 1989 and March 2002, we treated 299 male bladder cancer patients and 416 prostatic cancer patients. Of these, 17 patients (5.7% of the male bladder cancer patients and 4.1% of the prostatic cancer patients) had double cancer consisting of prostatic cancer and bladder cancer. The mean age at diagnosis of the first and second cancer was 71.6 years and 75.5 years, respectively. Of the 8 patients with synchronous tumors, 3 patients had latent prostate cancer when they underwent total cystoprostatectomy. The mean interval between the first and second cancer was 45.3 months. The mean follow-up period was 84.7 months (ranged from 5 to 324 months) and two patients died of cancer (bladder: 1, prostate: 1). In the literature, the coincidence of bladder cancer and prostatic cancer is the highest in the urological field. In follow up of either of these cancer patients, it is important to be aware of not only progression of the first cancer but also generation of a second cancer.

[Three cases of pulmonary hamartoma appearing after radical nephrectomy for renal cell carcinoma].

We report 3 patients with pulmonary hamartoma, all of whom had undergone nephrectomy for renal cell carcinoma. A lung tumor was detected 2 to 9-months following nephrectomy. Preoperative diagnosis was pulmonary metastasis from renal cell carcinoma and pulmonary tumor resection was performed in each case. There was a 9- to 12-month interval between the detection and resection of the lung tumor. The histological diagnosis of the lung tumor in all three patient was pulmonary hamartoma. Following the resection of the lung tumor, recurrence was not noted in any of the patients.

[Etiology of nocturia and clinical efficacy of naftopidil on nocturia in patients with benign prostatic hyperplasia--analysis of frequency volume charts].

The etiology of nocturia in 70 patients with benign prostatic hyperplasia (BPH) who had nocturia of two or more times were examined based on frequency volume charts (FVC). Nocturia was classified into four groups: nocturnal polyuria, low capacity, combined nocturia, and no evidence of abnormality. Nearly half of the cases had nocturnal polyuria only. A little under 70% of patients had associated nocturnal polyuria (nocturnal polyuria+combined nocturia). Naftopidil was administered for three months to the patients with BPH who had nocturia with a urinary frequency of two or more times. Clinical efficacy was evaluated in 32 patients based on FVC and naftopidil was shown to improve nocturia. The improvement in nocturia was determined by the increment in voided volume.

[The significance of urine cytology three consecutive days after transurethral resection as a predictor of superficial bladder cancer recurrence].

To determine whether there was any correlation between recurrence of superficial bladder cancer and the results of urinary cytology examined for 3 consecutive days after transurethral resection of the bladder cancer (TURBT), we retrospectively studied 64 patients with newly diagnosed Ta/T1 transitional cell carcinoma (TCC) of the bladder who had previously undergone TURBT. Urine cytology samples were reported as negative (class I, II) or positive (class III, IV, V). We used the Kaplan-Meier method to calculate the non-recurrence rate, and Cox-proportional hazard models to determine the prognostic significance of clinical and pathological findings. If any sample among the three consecutive cytology examinations was positive, we defined the case as positive. After a mean follow up of 19.5 months, 22 cases (34.4%) demonstrated recurrence probabilities of 24.1% and 42.3%, at 12 and 24 months, respectively. Of the positive cytology group (n = 33), 15 patients (45.5%) had recurrent tumor, while in the negative group (n = 31), only 7 cases (22.6%) developed recurrence. Multivarite analysis demonstrated that tumor size (p = 0.0022, Hazard ratio 8.9316), result of urine cytology for three consecutive days after TUR (p = 0.0051, Hazard ratio 4.5728), and age (p = 0.0124, Hazard ratio 3.7652) were associated with tumor recurrence. We suggest that positive results on urinary cytology for three consecutive days after TUR are indicative for tumor recurrence.

[Squamous cell carcinoma of the ureter arising seventeen years after total cystectomy for squamous cell carcinoma of the bladder: a case report].

We report a case of squamous cell carcinoma of the ureter. A 62-year-old woman had undergone total cystectomy and ileal conduit because of squamous cell carcinoma of the bladder when she was 44 years old. Seventeen years later, she complained of edema and oliguria. Antegrade pyelography and loopography revealed a left ureteral tumor. She underwent left ureterectomy and extirpation of the conduit. Pathological diagnosis was moderately differentiated squamous cell carcinoma of the ureter, pT2. The patient is alive without recurrence or metastasis in the first year after surgery.

[Results of adjuvant intravesical Bacillus Calmette-Guérin therapy for grade 3 superficial bladder cancer].

To examine the incidence of recurrence, progression and survival in patients with grade 3 superficial bladder cancer after transurethral resection (TUR) and adjuvant intravesical instillation of Bacillus Calmette-Guérin (BCG), we retrospectively studied 39 patients with grade 3 superficial bladder cancer. Nineteen patients with high-grade superficial bladder cancer (pTa, pT1) and 5 patients with grade 3 carcinoma in situ (CIS) received intravesical instillation of BCG after transurethral resection of the bladder tumor (BCG group and CIS-BCG group). The Tokyo 172 strain BCG was given for 8 weeks, as a rule, in a dose of 80 mg in 40 ml of saline instilled into the bladder. As a control, 15 patients with grade 3 superficial bladder cancer who did not receive BCG therapy after TUR were compared (non-BCG group). Of the BCG group (n=19), 4 patients (21.1%) had recurrent tumor and 3 had invasive progression after BCG therapy and died as a result of tumor progression, while in the non-BCG group (n=15), 8 cases (53.3%) developed recurrence, only one case had progression and died of cancer. In the CIS-BCG group (n=5), 3 patients (60.0%) had recurrent tumor and 2 had invasive progression. Univariate analysis (Logrank test) demonstrated that tumor size and adjuvant instillation of BCG were associated with tumor recurrence except for carcinoma in situ, but tumor progression and survival did not differ significantly. Our results suggest that BCG therapy prevents grade 3 superficial bladder cancer (pT1, pTa) recurrence.