[Partial penectomy for penile cancer in a centenarian man].

A 100-year-old man visited our hospital with a complaint of penile tumor formation with bleeding and pain. The tumor was 5cm in long diameter with an irregular surface, and extended from the glans via the coronal sulcus to the dorsal surface of the preputium. The clinical diagnosis was stage I penile cancer, and partial penectomy was performed. The pathological diagnosis was well-differentiated squamous cell carcinoma (pT1bcN0M0). To our knowledge, including foreign references, this is the oldest penile cancer patient in the literature. On discussing the operative course in very elderly patients, appropriate preoperative examination for circulatory and respiratory risks and evaluation of cognitive ability are considered essential. Although it is not difficult to conclude that only this operative procedure reveals enough radicality, we believe that it was the appropriate selection for relief of the patient's pain with full consideration of the invasiveness and risks.

The investigation of ureteral sympathetic innervation, using semi-serial sections: why does the alpha1-adrenergic receptor antagonist work well for ureteral stones?

PURPOSE: The efficacy of the alpha1-adrenergic receptor antagonist against ureteral stones was clarified on the basis of ureteral sympathetic innervation. METHODS: Semi-serial sections of retroperitoneal tissue were prepared from one each of donated male and female cadavers, and the nerve distribution in the ureter was investigated. Sympathetic nerve fibers were identified by immunostaining of tyrosine hydroxylase. RESULTS: We were able to prepare semi-serial sections of the male right and female left ureters, in which 202 and 210 sympathetic nerve bundles were distributed. Sympathetic nerve bundles were distributed throughout the entire ureter. The number of nerve bundles was highest in the portion close to the bladder in the male right ureter (eight bundles/mm) and in the portion crossing the common iliac artery in the female left ureter (seven bundles/mm). CONCLUSION: Adrenergic sympathetic nerve fibers were distributed throughout the ureter. Therefore, alpha1-adrenergic receptor antagonists may act on the entire ureter, reducing its tonus. As a result, these antagonists may be useful for improving the stone-freeing rate and inhibiting pain attacks.

[Cae of double cancer involving of the bladder and prostate which was treated by radical cystectomy 8 years after radical prostatectomy].

A 66-year-old man was diagnosed as having prostate cancer (T2aN0M0) and neoadjuvant hormone therapy was started from 17 February 1995. During observation, superficial bladder cancer was incidentally found and the first transurethral resection was carried out on 21 June 1995. Radical prostatectomy was performed on 8 May 1996. Thereafter, bladder cancer demonstrated repeated recurrence. At the time of the third recurrence, malignant trasformation was recognized as TCC G3 T2 or more invasive, and radical cystectomy with ileal conduit was performed on 12 May 2004 when the patient was 74 years old. From the perspective of double cancer, the frequency of diagnosing localized prostate cancer with superficial bladder cancer is expected to increase because PSA screening is being increasingly performed recently. Because of the possibility of malignant transformation in patients with superficial bladder cancer, in cases of coincident of cancers, it remains controversial which treatment should be selected for the previously diagnosed prostate cancer. Here, we report the clinical course and discuss this issue to some extent.

Positive effect of prostaglandin on regulation of prostatic blood flow.

OBJECTIVES: To investigate the effects of prostaglandin E2 (PGE2) and its antireceptor antibody on prostatic blood flow regulation using a rat model. We estimated that PGE2 participated in the signaling pathway of hormonal regulation of the prostatic blood flow. METHODS: The rats were castrated and injected locally with dihydrotestosterone (200 ng/head) or PGE2 (250 ng/head) directly into the prostatic membrane. After local dihydrotestosterone or PGE2 administration, anti-PGE2 receptor antibody (200 ng/head) was injected locally to investigate interruption of the signaling pathway. After administration, we evaluated the relative prostatic blood flow using a laser blood flow meter. The change in cyclooxgenase-2 mRNA expression and the changes in PGE2 concentration in response to androgen stimulation were also examined. RESULTS: PGE2 was involved in blood flow regulation with activity equal to that of androgen. The effect of dihydrotestosterone was abolished by coadministration with anti-PGE2 receptor antibody. Cyclooxgenase-2 gene expression was upregulated in response to androgen stimulation. The PGE2 concentration also increased in response to androgen stimulation. CONCLUSIONS: Our finding of PGE2 participation in androgen regulation of prostatic blood flow might lead to pathophysiologic elucidation of prostatic diseases.

[A case of prostate cancer diagnosed pathologically by bone metastatic site biopsy].

A 61-year-old man consulted our hospital complaining of high prostate specific antigen (PSA) value and difficulty to urinate. Prostate biopsy had been performed at another hospital, but did not reveal cancer. PSA was 18.5 ng/ml. Transrectal ultrasound-guided prostate biopsy was performed, but cancer was not detected. Later, PSA rose rapidly, and findings suggesting bone metastasis at right pubic bone and left sacro-ilial joint were found on computed tomography (CT), bone scintigraphy and magnetic resonance imaging (MRI). A repeat prostate biopsy was performed, but cancer was not detected from the prostate. On right pubic bone biopsy, poorly to moderately differentiated adenocarcinoma was detected. PSA immunohistochemical staining was positive, and the diagnosis was bone metastasis from prostate cancer. After endocrine therapy was started, PSA declined and bone metastasis disappeared on bone scintigraphy.

Two pedigrees of hereditary prostate cancer.

We encountered two pedigrees of hereditary prostate cancer. In one family, the father and his two sons had prostate cancer, and in the other family, three brothers developed prostate cancer. The mean age of these six individuals at the first examination was 65.3 years. Two individuals had stage B disease; three individuals, stage D disease; and one individual, disease of unknown stage. Histopathologically, two, one, and three individuals had well-, moderately, and poorly differentiated adenocarcinoma, respectively. As of September 28,2000, five of the six individuals were still alive. In a search of the literature, these were found to be the seventh and eighth pedigrees in Japan that met the criteria of hereditary prostate cancer proposed by Carter and colleagues in 1993.