[CLINICOPATHOLOGICAL STUDY OF PROSTATE BIOPSY IN PATIENTS RECEIVING DUTASTERIDE FOR BENIGN PROSTATIC HYPERPLASIA].

OBJECTIVE: Dutasteride is a 5-alpha reductase inhibitor used to treat benign prostatic hyperplasia. Dutasteride lowers prostate-specific antigen (PSA) levels, which may lead to delays in the diagnosis and treatment of prostate cancer (PCa). This study investigated patients who underwent prostate biopsy (PBx) while receiving dutasteride to investigate whether this agent affects the diagnosis and treatment of PCa. PATIENTS AND METHODS: PBx was performed on six patients receiving dutasteride for > 3 months at our medical institutions between January 2010 and June 2013. No patients underwent PBx before dutasteride administration. We performed PBx both for patients with high initial PSA levels and for those with elevated PSA levels with or without initial PSA decline after dutasteride administration. We also investigated clinicopathological findings. RESULTS: Mean age at the start of administration was 69.5 ± 5.9 years (range, 59-77 years), mean duration of administration was 14.1 ± 7.4 months (range, 4.0-23.5 months), mean prostate volume at the start of administration was 70.4 ± 30.7 ml (range, 18.8-104.6 ml), and mean PSA level at the start of administration was 7.7 ± 3.3 ng/ml (range, 4.9-14.2 ng/ml). PSA density was 0.098 ± 0.045 ng/ml/cm3 (range, 0.042-0.181 ng/ml/cm3), and PSA level at PBx was 5.4 ± 2.7 ng/ml (range, 2.5-10.7 ng/ml). We detected three PCa patients, and clinical stage in each case was cT1cN0M0. Radical retropubic prostatectomy was performed in two cases, and androgen-deprivation therapy was performed in one case. CONCLUSION: All PCa were detected in the early clinical stage. No delays in detection or treatment of PCa were seen in any cases. Careful observation of PSA levels is simple and useful for detecting PCa in patients under dutasteride administration.

[Nutcracker syndrome treated by endovascular stenting of the left renal vein].

We describe endovascular stenting of the left renal vein to treat Nutcracker syndrome accompanied by gross hematuria. A 26-year-old woman with a history of hematuria and left flank pain was admitted to another hospital in January 2009. She was referred to our hospital in August 2010 for further investigation and treatment for suspected Nutcracker syndrome based on her medical history and the recurrent gross hematuria. Computed tomography (CT) imaging revealed compression of the left renal vein between the aorta and the superior mesenteric artery and cystoscopy revealed bloody urine from the left ureteric orifice. Ureteroscopy revealed diffuse bleeding from the renal pelvic mucosa. The cytodiagnosis of urine was Class II. She developed left flank pain and further recurrent hematuria in July 2011 and sought active treatment by stenting at our hospital. After we obtained the approval of the Ethical Review Board in our institution, we treated by endovascular stenting of the left renal vein. The venous phase of selective renal angiography during the procedure revealed dilation of the mid-renal vein with delayed flow into the inferior vena cava and tortuous dilated collateral vessels. Two ELUMINEXX Vascular Stents (12 x 40 mm) were deployed at the stenotic site of the left renal vein via the right femoral vein. This strategy improved the stenosis and collateral vessels. No significant postoperative adverse events developed other than dull back pain that disappeared after a few days, and the patient was discharged on postoperative day 4. CT findings three months after the procedure confirmed resolution of the left renal vein compression. Six months post-procedure, the patient had no left flank pain or further hematuria.

Additive effect of zoledronic acid on serum prostate-specific antigen changes for hormone-sensitive prostate cancer patients with bone metastasis treated by combined androgen blockade.

Combined androgen blockade is widely used to treat patients with advanced prostate cancer. Recently, zoledronic acid was proven to be effective in preventing skeletal-related events for prostate cancer patients with bone metastases. Aim of the present study was to assess the effect of adding zoledronic acid to combined androgen blockade in the treatment of hormone-naïve metastatic prostate cancer patients by analyzing the changes of biomarker levels. Patients were treated with either a combination of combined androgen blockade and zoledronic acid (n=23) or combined androgen blockade alone (historical control combined androgen blockade group, n=42). Zoledronic acid was injected intravenously at 4 mg every 4 weeks for 2 years. Prostate-specific antigen and bone turnover markers (alkaline phosphatase and pyridinoline cross-linked carboxyterminal telopeptide of type 1 collagen) were examined before treatment and at 3, 6, and 12 months after treatment. Sequential changes of prostate-specific antigen, alkaline phosphatase and pyridinoline cross-linked carboxyterminal telopeptide of type 1 collagen for the two groups versus pretreatment levels were compared. Prostate-specific antigen values in both groups significantly declined at 3, 6 and 12 months compared with pretreatment levels. However, the decline of the prostate-specific antigen was lower in the combined androgen blockade group. Alkaline phosphatase significantly declined at 6 and 12 months in the combination of combined androgen blockade and zoledronic acid group, with no significant changes seen in the combined androgen blockade group. The addition of zoledronic acid to combined androgen blockade showed prostate-specific antigen and bone turnover markers response compared with combined androgen blockade therapy only, suggesting a potential antitumor effect of zoledronic acid in the management of metastatic prostate cancer patients.

Clinical usefulness of bone markers in prostate cancer with bone metastasis.

Bone metastases occur in approximately 70% of patients with advanced prostate cancer. Skeletal-related events have been correlated with reduced survival and quality of life of patients with prostate cancer. Biochemical markers of bone metabolism (e.g. bone formation, bone resorption, osteoclastogenesis) might meet an unmet need for useful, non-invasive and sensitive surrogate information for following patients' skeletal health. Recently, zoledronic acid and denosumab have been proven to have the potential for preventing skeletal-related events among prostate cancer patients with bone metastasis. An improved understanding of the mechanisms underlying bone metastasis has also led to the recognition of multiple molecular targets and advances in therapy. However, estimating the efficacy of these agents is difficult. A clinical trial for castration-resistant prostate cancer is currently underway based on the definition of The Prostate Cancer Clinical Trials Working Group, and bone turnover markers are being used as conventional end-points for the clinical trial. Bone turnover markers are useful surrogate markers reflecting the effect of new therapeutic drugs and prognosis, as well as assessment of bone metastases. In particular, N-terminal cross-linked telopeptide of type 1 collagen and bone-specific alkaline phosphatase are widely used bone metabolism markers, and offer reliable surrogate markers to detect bone metastatic spread and to predict prognosis for prostate cancer patients with bone metastases.

Hematospermia associated with congenital arteriovenous malformation of internal iliac vessels.

The presence of blood in the ejaculate is called hematospermia or hemospermia. While often perceived as a symptom of little significance, hematospermia can cause great concern to men who experience it. We report an unusual case of hematospermia associated with pelvic arteriovenous malformation (AVM). A 60-year-old man who visited our hospital complaining of hematospermia and pollakisuria was found to have AVM and aneurysmal changes in the left side of the pelvis using computed tomography (CT). The patient was treated with steel coil embolization of the left inferior gluteal artery, and after the procedure the hematospermia and pollakisuria remained absent without flare-ups.

Testicular tumor in Down syndrome.

A 33-year-old male patient with Down syndrome, who stayed in a welfare institution, visited our hospital due to left testicular enlargement. He was diagnosed as having a left testicular tumor and underwent radical inguinal orchiectomy. Preoperatively, serum level of beta-human chorionic gonadotrophin (beta-HCG) increased to 0.9 ng/mL (normal range <0.2 ng/mL). For the last 2 years after orchiectomy, the serum level of beta-HCG remained normal. Histopathological examination of specimen revealed a typical seminoma. It is currently thought that risk of developing leukemia in patients with Down syndrome is 20- to 30-fold higher than that in normal subjects. Furthermore, the incidence of testicular cancer as a complication other than leukemia is expected to increase because of the increasing postpubertal population with Down syndrome.