A phase III multicenter, randomized, controlled study of combined androgen blockade with versus without zoledronic acid in prostate cancer patients with metastatic bone disease: results of the ZAPCA trial.

OBJECTIVE: To examine the antitumor activity of zoledronic acid (ZA) combined with androgen deprivation therapy (ADT) for men with treatment-naive prostate cancer and bone metastasis. METHODS: We enrolled 227 men with treatment-naive prostate cancer and bone metastasis. Participants were randomly assigned (1:1 ratio) to receive combined androgen blockade alone (CAB group) or ZA with combined androgen blockade (CZ group). Time to treatment failure (TTTF), time to the first skeletal-related event (TTfSRE), and overall survival (OS) rates were estimated using the Kaplan-Meier method. Hazard ratios (HRs) were calculated using the Cox proportional hazards model. Median follow-up duration was 41.5 months. RESULTS: Median TTTFs were 12.4 and 9.7 months for the CZ and CAB groups, respectively (HR 0.75; 95 % CI 0.57-1.00; p = 0.051). For men with baseline prostate-specific antigen levels <200 ng/mL, median TTTFs were 23.7 and 9.8 months for the CZ and CAB groups, respectively (HR 0.58; 95 % CI 0.35-0.93; p = 0.023). Median TTfSREs were 64.7 and 45.9 months for the CZ and CAB groups, respectively (HR 0.58; 95 % CI 0.38-0.88; p = 0.009). OS was similar between the groups. CONCLUSIONS: This study failed to demonstrate that combined use of ZA and ADT significantly prolonged TTTF in men with treatment-naive prostate cancer and bone metastasis. However, it generates a new hypothesis that the combined therapy could delay the development of castration resistance in a subgroup of patients with low baseline prostate-specific antigen values <200 ng/mL. The treatment also significantly prolonged TTfSRE but did not affect OS.

Serum luteinizing hormone concentration is significantly associated with recovery of urinary function after radical prostatectomy.

OBJECTIVE: To perform a longitudinal investigation of the correlation between functional recovery and sex hormone concentrations after radical prostatectomy (RP). PATIENTS AND METHODS: A total of 72 consecutive patients undergoing RP between January 2012 and June 2013 were prospectively included and serially followed after surgery for comparative analysis. Their luteinizing hormone (LH) and total testosterone (TT) concentrations were measured before surgery and 3 and 12 months after surgery. They also filled out a health-related quality of life questionnaire before and at 1, 3, 6 and 12 months after surgery. RESULTS: The mean LH concentration increased from 4.28 U/L at baseline to 5.53 U/L at 3 months and remained high at 12 months after RP (both P < 0.001). There were no significant changes in the TT concentration after RP. LH at baseline was negatively correlated with the urinary function (UF) score at 3 and 12 months after RP (P = 0.030 and 0.032, respectively). After RP, subjects with high baseline LH (n = 37) were more likely than those with low LH concentrations to report lower UF scores (P = 0.014). Multivariate analysis of variance in an interaction of time × LH concentration for UF scores indicated a significant relationship between changes in UF score and LH concentration (P = 0.004). CONCLUSIONS: Radical prostatectomy affects sex hormones by increasing LH concentrations, while TT concentrations remain stable after surgery. Baseline LH concentrations are significantly associated with the recovery of urinary outcomes after RP.

Providing prostate cancer survivorship care in Japan: Implications from the USA care model.

Despite an increasing number of prostate cancer survivors in Japan, the current delivery of prostate cancer survivorship care is insufficient and lacks a multidisciplinary approach. We carried out a study to characterize prostate cancer survivorship care in Japan, examine the Japanese workforce available to deliver survivorship care, introduce a conceptual framework for survivorship and identify opportunities to improve Japanese survivorship care. We systematically searched PubMed for prostate cancer survivorship care studies, including those from Japan. We also searched the internet for prostate cancer guidelines relevant to survivorship care. We found 392 articles, of which 71 were relevant, read in detail and reported here. In Japan, survivorship care is mostly provided by urologists. Primary care as a specialty does not exist in Japan, and there are no independent nurse practitioners or physician assistants to assist with survivorship care. Japanese quality of life studies characterize the long-term effects of prostate cancer treatment, but routine use of patient-reported outcomes is not common in Japan. In the USA, in light of a growing comprehensive awareness of challenges facing survivors and their providers, the American Cancer Society prostate cancer survivorship care guidelines serve as a tool for optimizing the management of long-term treatment effects and coordination of care. In order to deliver high-quality survivorship care in Japan, urologists need to establish collaborations with other disciplines within the delivery system. A multidisciplinary guideline for prostate cancer survivorship care in Japan appears warranted.

[Inflammatory Myofibroblastic Tumor of the Bladder : A Case Report].

A 39-year-old female visited our hospital because of a bladder tumor. Computed tomography and magnetic resonance imaging showed a retrovesical tumor in dome of the bladder. Cystoscopy showed edematous inflammatory changes of the mucosa of the bladder wall. We diagnosed her with urachal carcinoma from cystoscopy finding and image inspections. She received partial cystectomy with pelvic lymphadenectomy. Histopathological examination revealed inflammatory myofibroblastic tumor because these specimens presented positive for anaplastic lymphoma kinase in immunohistochemical studies. She has been followed up for 16 months without any evidence of local recurrence.

[Total penectomy for corpus cavernosum abscess: a case report].

Abscess of corpus cavernosum penis is a rare infection condition. A 69-year-old-man was referred toour hospital with gradual development of penis swelling. T2-weighted magnetic resonance imaging of the pelvis showed abscess formation in the corpus cavernosum. There was no apparent cause of his penile abscess from either history or clinical examination. Open drainage improved his clinical symptoms transiently. However, severe penile pain relapsed, and abscess progressively extended in the corpus cavernosum and spongiosum, necessitating total penectomy. The surgical specimen revealed intensive inflammation and his condition improved immediately after penectomy.

Long-term quality of life after radical prostatectomy: 8-year longitudinal study in Japan.

OBJECTIVES: To assess long-term health-related quality of life in patients undergoing radical prostatectomy. METHODS: A total of 120 patients with at least 5 years of follow up after radical prostatectomy were included in the present study. Health-related quality of life outcomes were assessed using three questionnaires, the Short Form 36-Item Health Survey, the University of California, Los Angeles Prostate Cancer Index and the International Prostate Symptom Score. RESULTS: A total of 91 patients (73%) responded at a median follow-up time of 102 months (range 85-123 months). Among general health-related quality of life domains, mental and role composite summary score remained stable throughout the follow-up period. At the final survey, no significant differences were observed in any of the domains compared with the age-matched average score of the Japanese population. Although the slight decrease in urinary function scores and International Prostate Symptom Score beyond 5 years postoperatively compared with 5 years, the differences were not significant. The sexual function summary score showed a substantially lower score just after radical prostatectomy and remained at a deteriorated level (P < 0.001). Responders at the final survey were more likely to report favorable general, urinary and sexual outcomes at 60 months compared with non-responders. CONCLUSIONS: When taking age-related changes into account, general health-related quality of life seems to remain stable in the long term after radical prostatectomy: patients with favorable health-related quality of life outcomes during the first 5 years after radical prostatectomy maintain favorable outcomes thereafter.

Low-dose maintenance gemcitabine-carboplatin chemotherapy could be an alternative to continuous standard chemotherapy for patients with metastatic urothelial carcinoma.

OBJECTIVES: To examine whether low-dose maintenance gemcitabine-carboplatin chemotherapy is beneficial for patients with metastatic urothelial carcinoma. METHODS: We retrospectively reviewed the records of 36 patients with metastatic urothelial carcinoma who received first-line chemotherapy (gemcitabine/cisplatin, gemcitabine/carboplatin, or methotrexate/vinblastine/adriamycin/cisplatin) between 2006 and 2012. Those who had responded, but were unable to tolerate ongoing first-line chemotherapy, had been switched to low-dose maintenance chemotherapy consisting of 1 g/m(2) of gemcitabine and area under the curve 2-4 of carboplatin given on day 1 of a 6-week cycle, and were continued unless disease progression was seen. RESULTS: After a median of three cycles of first-line chemotherapy, 17 patients had been switched to low-dose maintenance chemotherapy. The median age was 70 years (range 56-79 years), and 12 patients (70.6%) had renal dysfunction (creatinine clearance <60 mL/min). The median number of cycles of low-dose maintenance chemotherapy was six (range 2-22), and the median survival time from initiation of first-line chemotherapy was 12 months (range 4-32 months). Adverse events requiring hospitalization were seen in three patients, but all of them recovered within a few days with conservative treatment. Seven patients discontinued within 9 months, whereas 10 patients continued on low-dose maintenance chemotherapy for ≥9 months. Patients with only lymph node metastases or who had a good response to previous first-line chemotherapy were likely to be able to continue low-dose maintenance chemotherapy. CONCLUSIONS: Low-dose maintenance gemcitabine-carboplatin chemotherapy might represent an alternative for patients with metastatic urothelial carcinoma not tolerating continuous first-line standard chemotherapy regimens.

[Upper tract urothelial carcinoma associated with giant hydronephrosis due to ligation of a ureter: a case report].

A 73-year-old woman was referred to our hospital with a complaint of left lumbar backache. Computed tomography (CT) revealed left giant hydronephrosis containing high-density fluid suspected of hemorrhage in the renal pelvis and swelling of cervical and mediastinal lymph nodes. Positron emission tomography (PET)-CT showed a small high uptake lesion in the left kidney parenchyma, and cervical and mediastinal lymph nodes. Percutaneous pelvic puncture yielded discharge of hemorrhagic fluid with negative cytology. Preoperative diagnosis was left giant hydronephrosis due to ligation of a left ureter at uterine myomectomy 43 years ago with renal hemorrhage caused by recent back injury, and cervical and mediastinal lymph node involvement of unknown origin. Because severe lumbar backache persisted, we performed palliative left nephrectomy and biopsy of cervical lymph nodes. The pathological diagnosis was invasive urothelial carcinoma with squamous differentiation and lymph node involvement.

Salvage chemotherapy with docetaxel, ifosfamide and nedaplatin (DIN) for patients with advanced germ cell tumors: a preliminary report.

OBJECTIVE: We investigated the efficacy and toxicity of a docetaxel, ifosfamide and nedaplatin regimen as salvage therapy for patients with advanced testicular germ cell tumor. METHODS: Eleven patients with advanced germ cell tumor refractory or relapsed after cisplatin-based chemotherapy were treated using docetaxel, ifosfamide and nedaplatin. The docetaxel, ifosfamide and nedaplatin regimen comprised docetaxel (75 mg/m(2)) on Day 1, ifosfamide (2 g/m(2)) on Days 1-3 and nedaplatin (75 mg/m(2)) on Day 2 of a 3-week cycle. RESULTS: Ten (91%) of the 11 patients achieved favorable responses, including complete response in one case and partial response in nine cases. Nine (81%) of the 11 patients have continued to show no evidence of disease after docetaxel, ifosfamide and nedaplatin therapy followed by subsequent surgical resection, with a median follow-up period of 52 months. One patient died of the disease 3 months after completing docetaxel, ifosfamide and nedaplatin chemotherapy. One patient was lost to follow-up with a status of alive with disease. Ten (91%) of the 11 patients developed Grade 4 leukopenia, which was managed using granulocyte colony-stimulating factor. No patients developed sensory neuropathy or renal dysfunction. CONCLUSIONS: The docetaxel, ifosfamide and nedaplatin regimen was efficacious and well-tolerated as salvage chemotherapy for patients with advanced germ cell tumor.

The relationships between preoperative sexual desire and quality of life following radical prostatectomy: a 5-year follow-up study.

INTRODUCTION: There were few studies about the relationship between sexual desire (SD) and radical prostatectomy (RP). AIMS: We assessed the relationships between RP and quality of life (QOL) according to the preoperative SD. MAIN OUTCOME MEASURE: General QOL was measured with Short Form 36. Sexual function and bother were measured with the University of California, Los Angeles Prostate Cancer Index (PCI). Changes of postoperative SD were also evaluated using PCI. METHODS: We analyzed data from 285 men who underwent RP and were prospectively enrolled into a longitudinal cohort study. Patients were divided into two groups according to whether they had SD at baseline, which is addressed in the PCI questionnaire: a low SD (LSD) group and a high SD (HSD) group. The assessments were completed before treatment and 3, 6, 12, 24, and 60 months after RP. RESULTS: Of the 244 men, 52% had high or a fair level of SD before RP, whereas 48% reported that the level of their SD was low. The HSD group reported better sexual function and sexual bother scores than the LSD group at baseline (both P < 0.001). Fifty-one percent of the HSD group reported that SD at 3 months was poor or very poor, which did not return to the preoperative level at all postoperative time points. Nearly 20% of the LSD group regained higher SD after RP than the baseline level. The HSD group showed worse sexual bother scores than the baseline throughout the postoperative follow-up (P < 0.001). However, the LSD group demonstrated equivalent sexual bother scores after RP compared with the baseline. CONCLUSIONS: RP adversely affected SD as well as sexual function and sexual bother. The patients who had HSD experienced greater distress concerning their sexual dysfunction postoperatively than those with LSD.

Racial differences in sexuality profiles among American, Japanese, and Japanese American men with localized prostate cancer.

INTRODUCTION: Although there were marked racial differences in the clinical outcomes among Japanese men (JP), Caucasian men (CA), and Japanese American (JA) men with localized prostate cancer, the effect of race/ethnicity on sexual profiles remains unclear. AIM: To determine differences of sexual profiles in JP, CA, and JA with localized prostate cancer. METHODS: A total of 412 JP, 352 CA, and 54 JA with clinically localized prostate cancer were enrolled in separate studies of health-related quality of life outcomes. We developed a collaborative study in each database. MAIN OUTCOME MEASURE: Sexual function and bother were estimated before treatment with validated English and Japanese versions of the University of California in Los Angeles Prostate Cancer Index (UCLA PCI). RESULTS: The CA reported the highest sexual function score of all. Even after controlling for age, prostate specific antigen, clinical T stage, Gleason score and comorbidity, the JP were more likely than the CA to report poor sexual desire, poor erection ability, poor overall ability to function sexually, and poor ability to attain orgasm. With regard to sexual bother, however, no differences were reported between CA and JP. The JA reported sexual function closely approximate that of the JP, and they were less likely than the CA to report erection ability and intercourse. The JA were more likely to feel distress from their sexual function than the CA. When the JA were divided into two groups according to the ethnicity of their partners, UCLA PCI sexual function scores were equivalent between JA-partnered men and men partnered with other races. On the other hand, JA-partnered men were significantly less likely to report sexual bother scores than men partnered with other races. CONCLUSION: We found significant interethnic variations among CA, JP, and JA with prostate cancer in terms of their sexual profiles. Ethnicity and/or country appear to modify some of these variables.

Impact of nocturia on disease-specific quality of life for men with localized prostate cancer.

OBJECTIVES: We assessed the impact of nocturia on the general and disease-specific health-related quality of life (HRQOL) for men with localized prostate cancer. MATERIALS AND METHODS: A total of 620 men with prostate cancer were enrolled to our study. All of the subjects completed the questionnaires before primary treatment. We evaluated general HRQOL with the Short Form 36-Item Health Survey (SF-36). The prostate-specific HRQOL was assessed with the University of California, Los Angeles Prostate Cancer Index (PCI). Night-time urinary frequency was assessed by the seventh score of the International Prostate Symptom Score. RESULTS: Of the 581 men, 47 (8%) men reported no nocturia, while 189 (32%) were categorized with one void per night and 345 (59%) with two or more voids per night. Disease-specific HRQOL, including urinary function, bowel function, and sexual function, was negatively associated with increase in frequency of nocturia. The subjects who reported two or more voids per night had significantly lower scores than those of the no nocturia or one void per night group in several domains of the SF-36 and PCI. Based on the proportion odds model, age, urinary function, bowel function, and sexual function showed a strong association with frequency of nocturia. CONCLUSIONS: We found a strong association between the frequency of nocturia and disease-specific HRQOL as well as general HRQOL. Increased severity of nocturia is negatively correlated with overall health status and HRQOL outcomes.

Long-term quality of life following primary treatment in men with clinical stage T3 prostate cancer.

OBJECTIVES: We evaluated the changes of health-related quality of life (HRQOL) during the 5 years after radical prostatectomy (RP) or external beam radiation therapy (EBRT) for clinical stage T3 prostate cancer (cT3PC). PATIENTS AND METHODS: A total of 750 patients who underwent RP (n = 575) or EBRT (n = 175) participated in our longitudinal outcomes study. Of these patients, 48 RP patients (8%) and 63 EBRT patients (36%) presented with cT3PC and were included in this analysis. Patients completed the general and disease-specific HRQOL with the Short Form 36 (SF-36) and University of California, Los Angeles Prostate Cancer Index, respectively. RESULTS: When examining the mean SF-36 values by time, there was significant impact on treatment outcomes for several items of the general HRQOL in the RP subjects. Those who underwent EBRT reported no significant changes in the general HRQOL throughout the follow-up period. With regard to disease-specific HRQOL, the RP subjects had significantly worse urinary HRQOL post-operatively than the EBRT subjects (P < 0.001). The scores for sexual function declined over the 60 months, but more so in the RP group. The two groups showed similar bowel HRQOL scores throughout the follow-up periods. CONCLUSIONS: Both primary treatments for cT3PC can offer satisfactory functional outcomes from the HRQOL perspective, except for a persistent decrease in the sexual activity score. These results may guide the treatment selection and clinical management of patients with HRQOL impairments after treatment for cT3PC.

Sexual quality of life for localized prostate cancer: a cross-cultural study between Japanese and American men.

INTRODUCTION: Race and ethnicity are important factors in health-related quality of life (QOL) because of racial differences in preferences for, and trust in, health systems. Such factors are likely to affect QOL and patient satisfaction with care. RESULTS: Using a self-reported questionnaire, Japanese men with prostate cancer reported lower sexual function scores at baseline. In detail, Japanese men were more likely than American men to report poor sexual desire, poor erection ability, poor overall ability to function sexually, poor ability to attain orgasm, poor quality of erections, infrequency of erections, infrequency of morning erections, and intercourse in the previous 4 weeks. However, Japanese men were less likely than American men to be concerned about their sexual function. Two years after surgery, American patients were more likely than Japanese patients to regain their baseline sexual function. The use of phosphodiesterase-5 (PDE-5) inhibitors has been widely publicized as the solution to erectile dysfunction after prostate cancer treatment. Although PDE-5 inhibitors have been available in Japan since 1999, it is striking that Japanese men with localized prostate cancer are much less likely (only 10%) to use PDE-5 inhibitors than American men. CONCLUSION: Japanese patients with localized prostate cancer report worse sexual function but are less concerned about their reduced function. In the absence of a biological explanation for such differences, however, we suspect that cultural differences may explain the differences between QOL survey results from Japanese or American men with prostate cancer.

Health-related quality of life in men with localized prostate cancer.

With the established effectiveness of diverse treatments for localized prostate cancer, the identification of the physical and psychological consequences of the disease and its various treatments has become critical. In the present review, we aim to familiarize the reader with the methodologies of health-related quality of life (HRQOL) research and to review the recent literature on HRQOL outcomes in patients with localized prostate cancer. Studies have shown that prostate cancer and its treatment affect both disease-specific HRQOL (i.e. urinary, sexual, and bowel function) as well as general HRQOL (i.e. energy/vitality and performance in physical and social roles). However, these effects appear to differ according to the type of treatment, stage of disease, age of the subjects, time after treatment, and, more importantly, race or ethnicity. By including HRQOL in clinical decision-making, we can help our patients make more informed treatment choices for localized prostate cancer.

Association of lower urinary tract symptoms with sexual dysfunction: a cross-cultural study between Japanese and American men with localized prostate cancer.

OBJECTIVE: To assess the association of lower urinary tract symptoms (LUTS) with sexual function, and estimate the correlates of LUTS among Japanese and American men with localized prostate cancer. PATIENTS AND METHODS: In all, 343 Japanese men and 307 American men with prostate cancer were enrolled in the study. Sexual function and sexual bother were measured separately with the University of California-Los Angeles Prostate Cancer Index and obstructive/irritative voiding symptoms were measured with the American Urological Association Symptom Index (AUA SI). RESULTS: Japanese men had worse sexual function scores than the American men before treatment, whereas no differences were reported between Japanese and American men in sexual bother scores. Japanese and American men also did not differ meaningfully in AUA SI. However, those with moderate to severe LUTS reported significantly worse sexual bother scores than those with mild symptoms in both Japanese and American men (P = 0.004 and <0.001, respectively). The Japanese men were more likely to have LUTS than were American men (odds ratio 1.60, P = 0.029). Age and sexual function were highly associated with LUTS (odds ratio 1.35, P = 0.027; and 0.652, P = 0.001, respectively). The comorbidity count was independently associated with worse urinary symptoms (odds ratio 1.23, P = 0.015). CONCLUSIONS: We posit that cultural differences in the meaning or salience of sexual functioning, and the interpretation of the questionnaire in quality-of-life surveys, might explain the different profiles in the association of LUTS with sexual activity in Japanese and American men with localized prostate cancer.

Five-year follow-up of health-related quality of life after intensity-modulated radiation therapy for prostate cancer.

OBJECTIVE: We evaluated health-related quality of life (HRQOL) in patients with localized prostate cancer who underwent intensity-modulated radiation therapy (IMRT) or three-field conformal radiotherapy (3DCRT). METHODS: A total of 97 patients underwent 3DCRT and 36 underwent IMRT for localized prostate cancer between 2002 and 2004. We measured the general and disease-specific HRQOL with the Medical Outcomes Study 36-Item Health Survey and University of California, Los Angeles Prostate Cancer Index, respectively. RESULTS: There were no significant differences in the pre-operative characteristics of the two groups. The patients in the 3DCRT group were more likely to receive hormonal therapy compared with the IMRT group before and after radiation therapy (P < 0.001 and P = 0.011, respectively). With regard to general HRQOL domains, both the 3DCRT and IMRT group scores showed no significant difference between baseline and any of the observation periods. At 60 months after treatment, the 3DCRT group had significantly worse bowel function and bother scores than baseline (both P < 0.001). On the other hand, there were no significant differences between the baseline and any of the post-treatment time periods in the IMRT group. In the 3DCRT group, sexual function remained substantially lower than the baseline level (P = 0.023). The IMRT group tended to show a decrease in sexual function, which was not statistically significant (P = 0.11). CONCLUSIONS: IMRT can provide the possibility to deliver a high irradiation dose to the prostate with satisfactory functional outcomes for long-term periods.