High-intensity focused ultrasound therapy for prostate cancer.

Recent advances in high-intensity focused ultrasound, which was developed in the 1940s as a viable thermal tissue ablation approach, have increased its popularity. High-intensity focused ultrasound is currently utilized the most in Europe and Japan, but has not yet been approved by the Food and Drug Administration, USA, for this indication. The purpose of the present report is to review the scientific foundation of high-intensity focused ultrasound technology and the clinical outcomes achieved with commercially available devices. Recently published articles were reviewed to evaluate the current status of high-intensity focused ultrasound as a primary or salvage treatment option for localized prostate cancer. Improvements in the clinical outcome as a result of technical, imaging and technological advancements are described herein. A wide range of treatment options for organ-confined prostate cancer is available. However, high-intensity focused ultrasound is an attractive choice for men willing to choose less invasive options, although establishing the efficacy of high-intensity focused ultrasound requires longer follow-up periods. Technological advances, together with cultural and economic factors, have caused a dramatic shift from traditional open, radical prostatectomy to minimally invasive techniques. High-intensity focused ultrasound is likely to play a significant role in the future of oncology practice.

[Myocardial metastasis from renal cell carcinoma treated with sorafenib].

We present a case of myocardial metastasis from renal cell carcinoma (RCC) during the treatment with sorafenib. A 63-year-old male, who had undergone right radical nephrectomy, received interferon-alpha (IFN), interleukin (IL-2) and 5-flurouracil (5-FU) for the treatment of lung and pleural metastases. However, since this metastasis showed progressive disease, we administered sorafenib. Nine months after the introduction of sorafenib, he complained of dyspnea. Chest computed tomography and cardiac ultrasonography revealed a low density mass at the cardiac muscle of the left cardiac ventricle, suggesting myocardial metastasis of RCC. Molecular targeted therapy achieved a longer survival in advanced RCC patients in comparison with the immunotherapy using cytokines. Therefore, in metastasis evaluation, some organs which have been regarded as rare sites should be carefully evaluated.

[Holmium laser enucleation of the prostate (HoLEP) in patients with continuous oral anticoagulation: first reported cases in Japan].

Oral anticoagulation (OA) has been considered as a strict contraindication to transurethral resection of the prostate (TURP). In recent years, some studies have shown that holmium laser enucleation of the prostate (HoLEP) has less blood loss compared to TURP. Thus we have performed HoLEP in patients with benign prostatic hyperplasia (BPH) under continuous OA from September 2009, and herein we report our first nine cases. Patients received HoLEP by a single surgeon at our institution. HoLEP was performed successfully in all patients. The mean times to complete enucleation and morcellation were 48.2 and 5.1 minutes, respectively. The mean tissue weight of enucleation was 37 grams. The mean hemoglobin and sodium loss after HoLEP were 1.7 g/dl and 1.3 mEq/L, respectively, and the catheterization time was 1.6 days. Blood transfusion, clot retention or transurethral resection syndrome were not observed in any cases. HoLEP has excellent hemostatic properties, and is a safe and effective procedure for patients with symptomatic BPH under the condition of continuous OA.

[An effective method to shorten the learning curve of HoLEP].

Holmium laser enucleation of the prostate (HoLEP) is a safe and effective treatment for patients with symptomatic benign prostatic hyperplasia (BPH), but is a difficult operation. To shorten the learning curve, we evaluated the surgical outcome of successive bilateral lobe enucleations with HoLEP. Performed by an inexperienced endourologist and an expert. Between March and July on 2009, we evaluated 20 cases of HoLEP performed by a beginner who underwent successive bilateral lobe enucleations and 20 cases of HoLEP performed by an expert. Enucleation time was shortened when successive bilateral lobe enucleations were performed by the beginner using HoLEP (115 vs 92 minutes, p<0.05). The enucleation time was significantly shorter in the expert group than in the beginner group. However, there were no significant differences in morcellation time, enucleated tissue weight, hemoglobin decrease level, sodium decrease level, catheterization time or significant incontinence time between the two groups. The postoperative evaluations was excellent in both groups. We conclude that HoLEP is a safe and effective operation. However, close supervision by an expert is required. In addition, learning from the easier part of enucleation to elaborate skill sets required to perform HoLEP is prerequisite for success.

Cost comparison of curative therapies for localized prostate cancer in Japan: a single-institution experience.

PURPOSE: In addition to open surgery, curative therapies for prostate cancer now include endoscopic surgery and radiation therapies. Because of the expansion and subdivision of treatment methods for prostate cancer, the medical fee point schedule in Japan was revised in fiscal year 2006. We examined changes in medical income and expenditure after this revision of the medical fee system. MATERIALS AND METHODS: We studied income and expenditure, after institution of the new medical fee schedule, for the five types of therapies for prostate cancer performed at our hospital: two surgical therapies (radical retropubic prostatectomy and laparoscopic prostatectomy) and three radiation therapies (three-dimensional conformal radiation therapy, (192)Ir high-dose-rate brachytherapy, and (125)I low-dose-rate brachytherapy). RESULTS: Low-dose-rate brachytherapy was found to be associated with a profit of yen199 per patient. Laparoscopic prostatectomy, a highly advanced medical treatment that the fee revision changed from a partially insured to an insured procedure, yielded a profit of yen75,672 per patient. However, high-dose-rate brachytherapy was associated with a loss of yen654,016 per patient. CONCLUSION: Given the loss in hospital income per patient undergoing high-dose-rate brachytherapy, the medical fee point system for this procedure should be reassessed.

The effects of cardioactive drugs on cardiomyocytes derived from human induced pluripotent stem cells.

Developing effective drug therapies for arrhythmic diseases is hampered by the fact that the same drug can work well in some individuals but not in others. Human induced pluripotent stem (iPS) cells have been vetted as useful tools for drug screening. However, cardioactive drugs have not been shown to have the same effects on iPS cell-derived human cardiomyocytes as on embryonic stem (ES) cell-derived cardiomyocytes or human cardiomyocytes in a clinical setting. Here we show that current cardioactive drugs affect the beating frequency and contractility of iPS cell-derived cardiomyocytes in much the same way as they do ES cell-derived cardiomyocytes, and the results were compatible with empirical results in the clinic. Thus, human iPS cells could become an attractive tool to investigate the effects of cardioactive drugs at the individual level and to screen for individually tailored drugs against cardiac arrhythmic diseases.

Interactive-plan technique conquers the disadvantages of volume-reducing hormone therapy in 125I permanent implantation for localized prostate cancer.

BACKGROUND: The purpose of this study was to assess the impact of hormone therapy on post-implant dosimetry in patients in whom pre-plan and interactive-plan techniques were used for transperineal brachytherapy against prostatic cancer. METHODS: The subjects comprised 244 patients treated using (125)I seed implantation as monotherapy. The prescribed dose to the periphery of the prostate was 145 Gy. The pre-plan technique was used for 116 patients, and the interactive-plan technique for 128 patients. Hormone therapy was used in 71 patients (29.1%). The D90 (dose to 90% of prostate volume) of post-implant computed tomography (CT) analysis was assessed in both groups. In addition, the ratio of post-implant CT volume to preoperative ultrasonography (US) volume was assessed. RESULTS: In the pre-plan group, D90 was significantly lower for patients who received hormone therapy than for those who did not (P = 0.035). However, in the interactive-plan group, D90 did not differ between patients with and without hormone therapy (P = 0.467). The CT-to-US prostate volume ratio was 1.022 for patients who received hormone therapy and 0.960 for patients who did not (P = 0.021). CONCLUSION: Post-traumatic swelling following implantation is increased by cessation of hormone therapy and may reduce D90. However, the present results suggest that the interactive-plan technique overcomes this disadvantage of hormone therapy.

Expression of S100A2 and S100A4 predicts for disease progression and patient survival in bladder cancer.

OBJECTIVES: To determine the expression patterns and prognostic value of S100A2 and S100A4 in surgical specimens from radical cystectomy for transitional cell carcinoma of the urinary bladder. METHODS: Immunohistochemical staining for S100A2 and S100A4 was performed in 92 archived radical cystectomy and 38 normal specimens. The immunoreactivity of these proteins was stratified on a 0 to 6 scale and then correlated with the pathologic features and clinical outcome. RESULTS: S100A2 expression was significantly decreased in the bladder cancer specimens compared with the controls (P <0.0001), and S100A4 expression was significantly greater in the bladder cancer specimens (P = 0.03). The loss of expression of S100A2 and increased expression of S100A4 were associated with muscle invasion (P <0.05). These alterations in expression were also associated with a greater risk of disease progression and a decreased chance of cancer-specific survival at a median follow-up of 25.3 months (P <0.0001 for both). After adjusting for the effects of the pathologic findings, S100A4 expression remained a significant predictor of disease progression (P <0.0001) and cancer-specific survival (P <0.0001). CONCLUSIONS: S100A4 appeared to be an independent predictor for the treatment outcome in bladder cancer. The expression patterns of S100A2 and S100A4 correlated well with the pathologic stage, disease progression, and cancer-specific mortality. This finding could aid in identifying more biologically aggressive cancers and thus patients who might benefit from more intensive adjuvant therapy.

Long-term results of three different minimally invasive therapies for lower urinary tract symptoms due to benign prostatic hyperplasia: comparison at a single institute.

OBJECTIVE: We analyzed the efficacy and durability of three different minimally invasive therapies (MIT) for lower urinary symptoms performed at a single institution based on a 5-year prospective cohort study. METHODS: The pre- and postoperative evaluation was made in 103 patients with the following three MIT options: (i) transurethral microwave thermotherapy (TUMT, n = 34); (ii) transurethral needle ablation (TUNA, n = 29); and (iii) transrectal high intensity focused ultrasound (HIFU, n = 40). RESULTS: All three treatments significantly improved the symptom scores up to 2 years after treatment. However, no statistical difference was observed in the efficacy between MIT. The percentage of men requiring the secondary treatment also showed no statistical differences. Cox's proportional hazards multivariate regression model revealed the baseline peak flow rate (Qmax) and total International Prostate Symptom Score (IPSS) but the types of MIT are independent significant factors for determining the long-term clinical results of MIT. CONCLUSION: Our data showed no statistical differences in either the efficacy or in the durability between the three MIT. The baseline Qmax and total IPSS are the significant factors for determining the long-term results of MIT.

Immediate effect of Shakuyaku-kanzo-to on muscle cramp in hemodialysis patients.

We administered 2.5 g of Shakuyaku-kanzo-to granule to 61 patients who had muscle cramp during hemodialysis (HD) sessions and examined its immediate effects. We selected 10 patients who wanted to take the drug at home, out of cases, for whom the drug was effective on the study described above and had them take the drug in the same way at the beginning of muscle cramp at home examined the effects. In the study during HD sessions, muscle cramp and its associated pain disappeared in 5.3 +/- 3.9 min on average in 54 out of 61 cases. In the study of patients who took the drug at home, muscle cramp disappeared within 10 min in all cases. Shakuyaku-kanzo-to is thought to be very useful for muscle cramp during HD sessions of hemodialized patients because it has immediate effects by its oral administration on the occasion of cramp. With regard to the muscle cramp, which appears at home after HD sessions, the patients can cope with it by taking the drug by themselves. This is an epoch-making therapy, for it was impossible to cope with muscle cramp except in hospitals because the therapy of muscle cramp was limited to intravenous infusion of hypertonic solutions of dextrose, mannitol, and saline during HD sessions.

Long-term effects of transurethral microwave thermotherapy.

BACKGROUND: To identify the clinical valuables predicting a favorable outcome after transurethral microwave thermotherapy (TUMT) of the prostate with Prostatron. METHODS: One hundred and two patients with lower urinary symptoms were treated with TUMT using a Prostatron device with the low-energy protocol (Prostasoft version 2.0 J). The pre-operative subjective score and objective voiding parameters were collected from the medical record. To test the differences in the risk of the necessity for additional treatments for several subgroups, Kaplan-Meier survival analyses and log-rank tests were used. RESULTS: The Kaplan-Meier analyses showed that 67% of the patients received additional treatment within five years. The median period for receiving additional treatment was 37 months. The patients with a peak flow rate greater than 6.5 mL per second, with a urethral length less than 40 mm, or with an age over 64 years all demonstrated a significantly longer period before receiving additional treatment, when compared with their counterparts. These three factors were also significant in multivariate analysis to predict the long-term outcome. CONCLUSIONS: Overall durability of TUMT was limited. Aged patients with a relatively high peak flow rate or with a short prostatic urethral length resulted in lower risk of receiving additional treatments after TUMT.