[Recrudescent prostate cancer with a low serum PSA level and a high serum CEA level treated with docetaxel : a case report].

A 63-year-old man was hospitalized with an increased serum prostate specific antigen (PSA) level (72 ng/ml). A prostate biopsy was performed, and histological examinations indicated moderately and poorly differentiated adenocarcinoma with positive staining for carcinoembryonic antigen (CEA). The patient was diagnosed as having prostate cancer (clinical stage : T3bN0M0) and received radiotherapy and hormonal therapy. Five years after the diagnosis, the serum CEA level increased to 153.8 ng/dl, and the patient complained of abdominal pain. His serum PSA level remained normal (<0.1 ng/dl). Computed topography indicated multiple bone metastasis and the involvement of multiple lymph glands. A biopsy of a cervical lymph gland revealed poorly differentiated adenocarcinoma with positive staining for CEA. Gastrointestinal examination showed no evidence of abnormality. The diagnosis of metastatic prostate cancer was made, and docetaxel (60-70 mg/m2) was administered. Eight courses of docetaxel therapy led to an approximately 20% reduction in lymph volume, and the serum CEA level decreased. However, liver metastases developed 12 months later, and the patient died at 18 months after the diagnosis of metastatic prostate cancer with a high serum CEA level. We encountered a case of recrudescence of prostate cancer positive for CEA with a low serum PSA level and report the effect of docetaxel therapy for atypical prostatic carcinoma.

[A case of bladder cancer producing granulocyte colony-stimulating factor and interleukin-6 causing respiratory failure treated with neoadjuvant systemic chemotherapy along with sivelestat].

A 67-year-old man visited an urological clinic with a chief complaint of urination pain. Cystourethroscopy and magnetic resonance imaging (MRI) examination revealed a bladder tumor (cT3bN0M0). Marked leukocytosis and respiratory distress with pleural effusion appeared. Pulse steroid therapy improved the general condition partially. The patient was sent to our hospital for further examination. Serum granulocyte colony-stimulating factor (G-CSF) and interleukin-6 (IL-6) were high and the pathological findings of bladder tumor obtained by transurethral resection (TUR) revealed an urothelial carcinoma that produced G-CSF and IL-6. Neoadjuvant systemic chemotherapy was performed along with use of steroid and sivelestat, which ameliorated the respiratory distress. After three courses of systemic chemotherapy, serum G-CSF and IL-6 normalized and cystoprostatectomy was performed. The patient has been in good health at 20 months after the surgery with no evidence of recurrence.

[The clinical efficacy and safety of naftopidil 75 mg on benign prostatic hyperplasia patients with moderate or severe urinary disturbance].

We investigated the clinical efficacy and safety of administration of naftopidil at 75 mg for clinically benign hyperplasia patients who had moderate or severe urinary disturbance according to guidelines for clinical studies regarding urination disorder. Among patients with benign prostatic hyperplasia who were treated with a alpha1-adrenoceptor blocker, we administered naftopidil (75 mg/day) for 12 weeks to 85 patients in whom the global severity was evaluated as moderate or severe. This agent significantly reduced the international prostate symptom score (I-PSS) and residual urine volume, and improved the QOL index and maximum urine flow volume in comparison with the baselines. Concerning the global treatment response, a partial response or better was achieved in 83.8% of the patients. Neither blood pressure nor heart rate were changed in patients who continued to receive this therapy. Side effects included orthostatic hypotension (1 patient: discontinuation), dizziness (2 patients: discontinuation, 1 patient: continuation), and palpitation (1 patient: discontinuation). These results suggest that a once-a-day administration of naftopidil at 75 mg safely relieves urination/accumulated urine symptoms in patients with moderate or severe urination disorder related to prostatic hypertrophy.

[Clinical efficacy of tolterodine for patients with overactive bladder after insufficient efficacy by monotherapy with alpha1-adrenoceptor antagonist].

PURPOSE: The efficacy of alpha1-adrenoceptor (alpha1-AR) antagonist and anticholinergic agent combined therapy for patients with benign prostatic hyperplasia (BPH) together with overactive bladder (OAB) has been controversial. The purpose of this study was to evaluate the effect of tolterodine combined with alpha1-AR antagonist for patients with BPH and OAB after insufficient efficacy by monotherapy with alpha1-AR antagonist. The adverse event of this combined therapy was also assessed. MATERIALS AND METHODS: The study included 47 patients with BPH, whose OAB symptom persisted (OAB symptom score; OABSS > or =3) after monotherapy with alpha1-AR antagonist for more than 4 weeks. The mean age was 72.9 years and the mean prostate volume was 29.8 ml. Four mg/day of tolterodine with alpha-AR antagonist was administered for 8 weeks to patients. International prostate symptom score (IPSS), quality of life (QOL) index, OABSS, King's Health Questionnaire (KHQ) and residual urine volume (RUV) were assessed before and after combined therapy. RESULTS: Six patients were dropped out from this study because of dry mouth, constipation, onset of other disease and insufficient efficacy by self-judgment. IPSS (from 15.1 +/- 6.8 to 11.0 +/- 7.9; P < 0.01), QOL index (from 4.3 +/- 1.1 to 3.6 +/- 1.3; P < 0.01) and OABSS (from 7.0 +/- 3.0 to 5.4 +/- 2.9; P < 0.01) of 41 patients improved significantly by combined therapy. The storage symptom of IPSS subscore improved significantly (from 8.0 +/- 2.9 to 6.5 +/- 2.8; P < 0.01), whereas the voiding symptom did not improve. Regarding KHQ, the score of 3 domains (impact on life, role limitation, and physical limitation) improved significantly (P < 0.05). RUV did not change and no serious adverse event including urinary retention was found in this study. CONCLUSIONS: This study reveals that the combined therapy of alpha-AR antagonist and tolterodine represents an effective and safe treatment modality for patients with BPH and OAB, whose OAB symptom was not improved by antecedent monotherapy with alpha-AR antagonist.

Early efficacy of silodosin in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia.

OBJECTIVES: To evaluate the early efficacy of the alpha(1A)-adrenoceptor selective drug, silodosin, for the treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia. METHODS: A total of 68 patients with an International Prostate Symptom Score (IPSS) of >==8 and a Quality of Life (QOL) index of >==2 were included. Changes in the IPSS and QOL index were evaluated before and after 1, 2, 3, 4, 5, 6, 7, 14, and 28 days of twice daily oral administration of 4 mg silodosin. Next, changes in IPSS subscores as well as voiding, storage, and post micturition symptoms were assessed. Changes in total IPSS based on symptom severity were also determined. RESULTS: Total IPSS and QOL index improved significantly from 19.38 +/- 7.46, 4.68 +/- 1.07 at baseline to 15.81 +/- 7.40, 4.22 +/- 1.30 at day 1. The subscores of voiding, storage, and post micturition symptoms were significantly decreased from 8.93 +/- 3.95, 7.97 +/- 3.88, and 2.49 +/- 1.70 at baseline to 7.28 +/- 4.09, 6.52 +/- 3.47, and 2.02 +/- 1.56 at day 1, respectively. This trend continued throughout the study. Regardless of severity, total IPSS were significantly decreased at day 1 and maintained throughout the study. CONCLUSIONS: Silodosin may be considered a promising treatment for benign prostatic hyperplasia/lower urinary tract symptom patients.

[Hormonal chemotherapy for hormone-refractory prostate cancer].

To our knowledge, no standard chemotherapy for patients with hormone-refractory prostate cancer (HRPC) has been established. Since most patients with HRPC are elderly and have bone metastasis, cytotoxic chemotherapy causes them to be at high risk for myelosuppression. Therefore, chemotherapeutic agents with low toxicity and good compliance should be elected. We conducted three regimens for HRPC on an outpatient basis. Eligibility criteria were defined as serial rising PSA values on 3 or more occasions at least 2 weeks apart or radiological new or extensive lesions under hormonal therapy. The first regimen is comprised of cyclophosphamide (CPM), 100 mg/day, UFT, 400 mg/day, and estramustine phosphate (EMP), 560 mg/day in two daily fractions. The second regimen is comprised of an oral administration of dexamethasone (DEX) (0.5-2 mg/day). The third regimen is comprised of DEX, 1 mg/day, cyclophosphamide, 100 mg/day and UFT, 400 mg/day in two daily fractions. Post-therapy prostate-specific antigen (PSA) level in serum, objective response on bone scan or measurable disease, and symptomatic response on bone pain were assessed. All regimens showed clinical efficacy with mild toxicity. Indications and limitations of these regimens are discussed. Further, the combination trials of taxane and EMP in patients with HRPC are reviewed.

A new rapid method of glycolate test by diethyl ether extraction, which is applicable to a small amount of bacterial cells of less than one milligram.

The glycolate test is a method to discriminate N-acyl groups of muramyl residue in peptidoglycan of bacterial cell walls by color reaction without purification of the cell walls. The glycolyl residue presents red purple color by heating with 0.02% 2,7-dihydroxynaphthalene (DON) dissolved in concentrated H(2)SO(4). Instead of the previous column methods for quantitative analysis, a qualitative method by solvent works was developed to simplify and to miniaturize the analysis. In this method, solvents played two roles, removal of interfering materials and extraction of glycolic acid from the cell hydrolysates. Of several solvent systems tested, diethyl ether was studied in detail on such properties as the efficiency of glycolic acid extraction under several conditions, the ability of removing various interfering compounds, and the advantage on evaporation procedure of the solvent from extracts. DON reaction of the second diethyl ether extract from cell hydrolysate of "Micromonospora nigra" JCM 3328 showed a clear red purple color of a strong absorbance at 530 nm, which is the same as that of authentic glycolic acid. The solvent method was applied to 20 strains of typical actinomycete species whose acyl types have already been known (Uchida and Seino, 1997). All glycolate test positive strains showed the clear red purple color mentioned above, whereas acetyl type strains revealed no apparent color by the same procedures. Additional experiments indicated that the glycolate test could be determined with less than 1 mg of actinomycete cells by using a smaller amount of DON reagent and ordinary polypropylene tubes. The new method was discussed for advantages in the identification of actinomycetes and for possible applications to other fields.