The prognosis and the impact of radiotherapy in clinically regional lymph node-positive prostate cancer: Which patients are candidates for local therapy with radiation?

BACKGROUND: This study aimed to identify the prognostic and predictive factors of local radiotherapy in clinically regional lymph node-positive prostate cancer. PATIENTS AND METHODS: This study includes patients who were newly diagnosed with regional lymph node-positive prostate cancer between 2008 and 2017. We investigated the prognostic value of clinicopathological parameters for progression-free survival (PFS) and overall survival (OS) as well as the differential prognostic impact of radiotherapy by subgroup analysis. RESULTS: Among the 93 men enrolled as patients, 48 (51.6 %) were treated with radiotherapy. The biopsy positive core rate and biopsy Gleason score were associated with PFS, and the number of lymph node metastases was associated with both PFS and OS. Patients who underwent radiotherapy showed better PFS and OS. High-risk features (at least 2 criteria among ≥75% biopsy positive core rate, Gleason score ≥9, and ≥2 positive lymph nodes) were especially associated with improved outcomes after undergoing radiotherapy. CONCLUSION: We identified prognostic factors for clinically regional lymph node-positive prostate cancer and showed the benefits of local radiation therapy. Patients with high-risk features may be especially suitable candidates for radiotherapy.

Giant Penile Lymphedema Caused by Chronic Penile Strangulation with Rubber Band: A Case Report and Review of the Literature.

We treated a 65-year-old Japanese man with a giant penile lymphedema due to chronic penile strangulation with a rubber band. He was referred to our hospital with progressive penile swelling that had developed over a period of 2 years from chronic use of a rubber band placed around the penile base for prevention of urinary incontinence. Under a diagnosis of giant penile lymphedema, we performed resection of abnormal penile skin weighing 4.8 kg, followed by a penile plasty procedure. To the best of our knowledge, this is only the seventh report of such a case worldwide, with the present giant penile lymphedema the most reported.

Sorafenib-induced reversible posterior leukoencephalopathy in patients with renal cell carcinoma: A report of two cases.

Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare clinicoradiological syndrome that is characterized by neurological symptoms, including seizures, headaches, visual abnormalities, confusion and encephalopathy, accompanied by vasogenic edema of the posterior white matter observed on neuroimaging. Sorafenib is an inhibitor of pro-angiogenic receptor tyrosine kinases, such as vascular endothelial growth factor receptor 2, platelet-derived growth factor receptor ß, and vascular endothelial growth factor receptor 3. In the previous research literature, only one case of sorafenib-induced RPLS, in a patient with hepatocellular carcinoma, has been reported. The current report presents two cases of sorafenib-induced RPLS in patients with metastases from a renal cell carcinoma. In the first case, a 75-year-old female patient developed a fever, fell down and was unable to move her limbs as instructed after 11 days of sorefenib treatment. Brain magnetic resonance imaging (MRI) demonstrated no typical RPLS findings. As all of the symptoms were resolved after sorafenib discontinuation, sorafenib was restarted. However, the patient remained unable to walk steadily and to articulate properly after 10 days. MRI again demonstrated no notable findings, and her condition improved only after discontinuation of the sorafenib. In the second case, a 75-year-old male patient experienced a fall due to loss of consciousness. T2-weighted and fluid-attenuated inversion recovery MRI revealed high-intensity signals on both sides of the cerebellar hemisphere and pons, and also partially on both sides of the frontal lobe. At 33 days after sorafenib discontinuation, he had recovered sufficiently to walk by himself with a walker, and a repeat MRI revealed a significant improvement. Although one case took a longer time, both cases were fortunately reversible by discontinuation of sorafenib treatment and administration of combined-modality therapy (including oxygen, steroids, verapamil, digoxin and nicardipine hydrochloride). The oncology community should be alerted to this uncommon and life-threatening adverse event.

Determination of adequate pelvic lymph node dissection range for Japanese males undergoing radical prostatectomy.

The present study aimed to determine the adequate pelvic lymph node dissection (PLND) range for Japanese males undergoing radical prostatectomy. A total of 467 Japanese patients who underwent antegrade radical prostatectomy at the National Kyushu Cancer Center (Fukuoka, Japan) were retrospectively reviewed. The patients were divided into two groups according to the PLND extent: The standard (obturator + internal iliac nodes) group and the expanded (standard + additional nodes) group, which accounted for 64.5% (301/467) and 35.5% (166/467) of the patients, respectively. No differences were observed in the preoperative and postoperative characteristics of the two groups. In addition, there was no difference in PSA recurrence between the two groups. There were no differences between the standard and expanded groups in the low-, intermediate- and high-risk groups (P=0.1456, P=0.1581, P=0.2125, respectively). The median number of lymph node dissection was 13 and 19, in the standard and expanded groups respectively (P<0.0001). However, regarding the number of lymph node metastases and the rate of patients with lymph node metastasis, no significant difference was observed between the standard and expanded groups (P=0.4219 and P=0.4257, respectively). According to multivariate analysis, a significant difference in the presence of lymph node metastasis (hazard ratio 3.547; P=0.0247), but not in the PLND extent, was detected in patients with prostate specific antigen failure (P=0.0655). When expanding the dissection extent, the number of dissected lymph nodes increases, but is not associated with the number or rate of positive lymph nodes. Thus, the current dissection range is considered to be appropriate for Japanese men undergoing radical prostatectomy.

Biochemical failure after radical prostatectomy in intermediate-risk group men increases with the number of risk factors.

INTRODUCTION: We aimed to determine whether the number and type of risk factors are associated with biochemical recurrence-free survival after radical prostatectomy in men with D'Amico intermediate-risk prostate cancer. MATERIALS AND METHODS: Between August 1998 and May 2013, 481 Japanese patients underwent antegrade radical prostatectomy. The relationships between the rate of PSA failure after radical prostatectomy and the number and type of risk factors were examined in the intermediate-risk group. RESULTS: According to the D'Amico criteria, the low-, intermediate-, and high-risk groups comprised 107, 222, and 152 patients, respectively. The median follow-up period after surgery was 54.1 months. The 5-year PSA failure-free rates in the low-, intermediate-, and high-risk groups were 96.5%, 88.9%, and 72.6%, respectively (P < 0.001). The 5-year PSA failure-free rate in the intermediate-risk group with one, two, and three intermediate risk factors was 94.9%, 88.4%, and 49.0%, respectively (P < 0.001). The difference between the high- and intermediate-risk group with three intermediate risk factors was statistically significant based on the log-rank test (P = 0.039). CONCLUSION: The number of intermediate risk factors is significantly associated with the PSA failure-free survival rate after radical prostatectomy in the intermediate-risk group. Patients classified into the intermediate-risk group based on all three intermediate risk factors are less likely to achieve a complete cure through surgery alone.

Predictive factors of late biochemical recurrence after radical prostatectomy.

OBJECTIVE: To assess the characteristics of biochemical recurrence in the late period (>5 years after radical prostatectomy) and the differences in the predictors of biochemical recurrence in different periods, we conducted a multicenter retrospective study. METHODS: We reviewed 478 men who underwent radical prostatectomy for clinically localized prostate cancer. All of the patients were followed up for at least 5 years. The cohort was then divided into three groups; no recurrence group, recurrence <5 years after surgery group and recurrence ≥5 years after surgery group. The background characteristics of each group were compared using the χ2 test. A Cox multivariate regression analysis was performed to determine the predictors of biochemical recurrence in each period. RESULTS: Biochemical recurrence occurred in 135 men. In 113 (84%) of the patients, biochemical recurrence occurred at <5 years after surgery; in 22 (16%), it occurred at ≥5 years after surgery. The proportion of men with a low preoperative prostate-specific antigen level was significantly larger in the latter group (P = 0.0023). A preoperative prostate-specific antigen level and a positive surgical margin were significant predictors of biochemical recurrence at <5 years after surgery (hazard ratio: 1.03 and 3.20). A positive surgical margin was also a significant predictor of biochemical recurrence at ≥5 years after surgery (hazard ratio: 3.03); however, a high preoperative prostate-specific antigen level was not. CONCLUSIONS: Biochemical recurrence occurred at ≥5 years after surgery in 16% of the patients. A positive surgical margin predicted biochemical recurrence in both the early and late periods.

Sub-millisecond timing-jitter-free tuning of parametric dispersion compensator.

We demonstrate sub-millisecond tuning of a prototype parametric tunable dispersion compensator (P-TDC) based on cascaded polarization-diverse four-wave mixing (FWM) process with a fast tunable and highly wavelength-stable pump light source. The pump light source is developed using a tunable distributed amplification chirped sampled grating distributed reflector laser that is fully wavelength tunable by on-chip heaters with a 3-dB frequency response of 45 kHz, resulting in fast dispersion tuning of less than 50 µs without additional timing jitter. The P-TDC is developed as the first prototype to satisfy essential requirements for practical network uses: stable input-polarization diversity, input-wavelength preservation, and seamless dispersion tunability for entire C-band input wavelengths are simultaneously achieved.

Ureterosciatic hernia successfully treated by ureteral stent placement.

A 76-year-old woman with history of cholecystectomy, hysterectomy, and vesicourethral suspension presented with acute lumbar backache and discomfort in the lower abdomen and severe nausea, with frequent vomiting, but without any associated fever. Physical examination revealed knocking tenderness at the left costal-vertebral angle. The patient's serum white blood cell count was 14,900/mm(3) and the results of other laboratory tests, including urinalysis, were normal. Non-enhanced computed tomography revealed left hydroureteronephrosis and obstruction of the distal left ureter with herniation into the sciatic foramen. A left ureteral stent was inserted with a double-J stent. The stent was removed after 2 months and thereafter the patient did not experience any recurrence.