[Outcome of Low-Dose-Rate Brachytherapy in Patients with Prostate Cancer and the Characteristics of Patients with Recurrence].

In our hospital, 553 patients with clinically localized prostate cancer underwent low-dose-rate (LDR) brachytherapy between March 2007 and December 2019. The patients were stratified based on the following prognosis according to the D'Amico risk classification criteria: low-risk and intermediate-risk groups (PSA ＜10, ≦T2a, GS : 3＋4 (≦30%)) were treated with LDR brachytherapy without supplemental extra beam radiotherapy (EBRT), while some patients in the high- and intermediate-risk groups were treated with LDR and supplemental EBRT. The 5- and 10-year overall survival rates were 94.8 and 85.5%, disease-specific survival rates were 99.8 and 97.7%, and biochemical recurrence-free survival rates were 95.7 and 90.7%. By risk stratification, the 5- and 10-year biochemical recurrence-free survival rates were 98.0 and 98.0% (low risk), 96.1 and 89.6% (intermediate risk), and 90.6 and 77.3% (high risk). The LDR outcome was generally good, but, 32 recurrence cases were observed. In the recurrent group, 9 patients did not undergo the recommended therapeutic strategy and 26 patients did not undergo preoperative magnetic resonance imaging.

Exogenous SPARC suppresses proliferation and migration of prostate cancer by interacting with integrin ß1.

BACKGROUND: The matricellular protein secreted protein acidic and rich in cysteine (SPARC) plays an important role on tumor metastasis and progression in several cancers. However, the roles of SPARC in prostate cancer (PCa) remain unclear. METHODS: To identify SPARC protein in prostate tissue, immunohistochemical analysis of SPARC was conducted using human prostate tissue microarray. To detect SPARC expression in prostate cancer (LNCaP, DU145, and PC-3) and stromal cells, RT-PCR, western blot analysis, and ELISA was conducted. To reveal the function of exogenous SPARC in PCa cells, AKT phosphorylation was confirmed by western blot analysis after coculture with stromal cells. Proliferation and migration of PCa cells were examined by addition of SPARC. The interaction between SPARC and integrin ß1 was confirmed by western blot analysis after immunoprecipitation. RESULTS: SPARC protein was expressed well in normal tissue compared with PCa tissue. ELISA showed high secreted SPARC protein in normal prostate-derived stromal cell (PrSC) compared with PCa-derived stromal cell (PCaSC) and PCa. PCa cells cocultured with PrSC showed reduced AKT phosphorylation more than with PCaSC. PCa cells cocultured with PrSC whose SPARC was knocked-down restored AKT phosphorylation. Moreover, PCa cells treated with SPARC led to reduced AKT phosphorylation. Immunoprecipitation with SPARC revealed interaction of SPARC and integrin ß1 in PCa cells. Inhibited proliferation and migration of PCa cells by SPARC was restored by integrin ß1 neutralizing antibody. CONCLUSIONS: Reduced SPARC secretion from stromal cells might affect PCa progression mediating through limiting AKT phosphorylation after interaction with integrin ß1.

Increases in bone turnover marker levels at an early phase after starting zoledronic acid predicts skeletal-related events in patients with prostate cancer with bone metastasis.

OBJECTIVE: To examine whether bone turnover markers could be predictive markers of the probability of newly arising skeletal-related events (SRE) after the start of zoledronic acid treatment in patients with prostate cancer with bone metastasis. PATIENTS AND METHODS: In all, 30 patients with prostate cancer with bone metastasis were treated with zoledronic acid infusion every 4 weeks. Serum C-terminal crosslinking telopeptide of type 1 collagen (1CTP), bone alkaline phosphatase (BAP), and prostate-specific antigen (PSA) levels were measured at the start of zoledronic acid treatment to establish baseline values, and every 4 weeks thereafter. To judge in the early phase whether zoledronic acid is effective in these patients, we retrospectively compared 1CTP, BAP, and PSA levels at 1, 3, and 6 months after starting zoledronic acid treatment with those at baseline. RESULTS: SRE-free survival of patients with increases of 1CTP levels at 1 and 3 months and BAP levels at 3 months were significantly poorer than those of patients with decreases in 1CTP or BAP levels (P = 0.001, P = 0.042, and P = 0.004, respectively). Overall survival of patients with increases of 1CTP levels at 1 and 3 months and of BAP levels at 6 months were significantly poorer than those of patients with decreases of 1CTP or BAP levels (P = 0.013, P = 0.027, and P = 0.035, respectively). CONCLUSION: The measurement of 1CTP and BAP levels at an early phase after starting zoledronic acid treatment may be useful for physicians to inform patients of their prognosis and to determine the subsequent treatment plan.

Antibiotics therapy was effective in preventing bilateral staghorn renal matrix stones.

Herein we report a case for which antibiotic therapy was effective in preventing bilateral staghorn renal matrix stones. A 34-year-old man was referred to our hospital for right lower abdominal pain and fever. Blood data and urinary analysis indicated a urinary tract infection and renal failure. The diagnosis was bilateral pyelonephritis for staghorn renal matrix stones. He had undergone percutaneous neprolithotripsy (PNL) for bilateral staghorn renal matrix stones. Almost all fragments were removed by the grasper. However, 3 months after the operation, bilateral staghorn renal matrix stones rapidly developed, so he underwent PNL again. After the operation, low-dose antibiotic therapy was continued to prevent pyelonephritis. As a result renal matrix stones did not reoccur. Until now, 1 year after the start of antibiotic therapy, no further sign of relapse has been noted.

Clinicopathological outcomes of clinical T1a renal cell carcinoma by tumor size.

OBJECTIVE: We performed a retrospective review of clinical T1a renal cell carcinoma patients treated in our institution. The clinicopathological findings and patients' prognoses were analyzed according to tumor size, and risk factors for tumor recurrence were elucidated. METHODS: A total of 140 cases of sporadic renal cell carcinoma with a diameter of 4 cm or less on computed tomography findings for preoperative evaluation were treated as clinical T1a. Patients underwent radical nephrectomy or nephron-sparing surgery, and were evaluated postoperatively every 3-6 months to screen for metastatic disease. Patients' medical records were reviewed retrospectively and the status of each patient was assessed. RESULTS: There were four cases of clinically metastatic disease at diagnosis. There were no correlations between tumor size and pathological stage, Fuhrman nuclear grade or histological type. The rate of cases with microvascular invasion on pathological findings increased according to tumor diameter. Disease recurrence occurred in six patients (5.7%) during a mean postoperative follow-up of 41.7 months. There was a significant difference in the recurrence-free rate between pT1a patients with a tumor diameter of 31 mm or more and other patient groups. In terms of microvascular invasion on histological findings, the probability of non-recurrence at 7 years was 0% for patients with and 92.9% for those without microvascular invasion. CONCLUSIONS: Among T1a renal cell carcinoma, tumors over 30 mm in diameter may have aggressive biological potential, possibly due to microvascular invasion. Long-term follow-up is needed for these tumors.

Successful treatment for metastases from renal cell carcinoma with alternation of interferon-alpha subtypes.

Here we present a case in which alternation of interferon-alpha (IFN-alpha) treatments was effective in treating pulmonary metastases and lymph node metastases from renal cell carcinoma (RCC). A 56-year-old man underwent left radical nephrectomy under the diagnosis of left RCC. The histological diagnosis was clear cell carcinoma G2, IFN-alpha, pT1b. He subsequently underwent two operations for right pulmonary metastasis and right hilar lymph node metastasis. Postoperatively he was treated with intramuscular administration of natural IFN-alpha (Sumiferon) which prevented definite recurrence for 1 year. However, multiple pulmonary metastases and left hilar lymph node metastasis occurred 11 months after discontinuation of Sumiferon. Therefore, treatment with another natural IFN-alpha (OIF) was started. Although OIF was continued for 7 months, pulmonary metastases and left hilar lymph node metastasis continued to progress. Therefore, treatment was changed to Sumiferon, after which the pulmonary metastases and left hilar lymph node metastasis decreased in size. The metastases showed no progression for 16 months after switching from OIF to Sumiferon.

[Asymptomatic pheochromocytoma of the urinary bladder : a case for which preoperative diagnosis was possible].

A 62-year-old man who was diagnosed as having a bladder tumor by computerized tomography in another hospital. On August 4,2006 he visited our hospital. Cystoscopic examination revealed a submucosal tumor posterior to the right orifice. Computer tomography and magnetic resonance imaging showed the same findings. Therefore, we considered the possibility of asymptomatic pheochromocytoma of the urinary bladder. 131I-metaiodoberzyl guanidine scanography showed an abnormal accumulation in the bladder. Endocrinologic examination disclosed an increased level of serum and urinary noradrenalin. Pheochromocytoma of the bladder was diagnosed, and on October 25, 2006 a partial cystectomy and right ureteroneostomy were performed. Histologically, the tumor was pheochromocytoma of the urinary bladder. He has been receiving follow-up clinical observation for 30 months following the operation, and there has not been any evidence of recurrence.

A case of bone, lung, pleural and liver metastases from renal cell carcinoma which responded remarkably well to zoledronic acid monotherapy.

Herein, we report a rare case in which bisphosphonate zoledronic acid (ZA) effectively treated not only multiple bone metastases but also lung, pleural and liver metastases from renal cell carcinoma (RCC). Recently, ZA is used to treat skeletal-related events (SREs) such as bone pain caused by bone metastasis from many kinds of cancer. The patient in the present report had multiple bone metastases from RCC. Remarkable improvement of the bone metastasis was observed following treatment with ZA at a dosage of 4 mg administered once every 4 weeks. Moreover, lung, pleural and liver metastases also diminished markedly in size in response to the treatment. The metastases have shown no progression for 20 months since starting the ZA treatment. We believe that the present report is the first of its kind announcing that ZA monotherapy has been effective for lung, pleural and liver metastases from RCC.

Successful Treatment of a Large Superficial Bladder Cancer with Neoadjuvant Arterial Infusion Chemotherapy: A Case Report.

We present a case in which neoadjuvant arterial infusion chemotherapy was effective in treating a large superficial bladder cancer. A 50-year-old male was admitted to the Kanazawa Medical Center with the complaint of dizziness. The patient exhibited severe anemia, and his computer tomography showed a large bladder tumor. Cystoscopy revealed a large papillary tumor. Magnetic resonance imaging showed no muscle invasion and no metastasis. To avoid a prolonged operation time and excessive blood loss, we performed neoadjuvant arterial infusion chemotherapy for tumor volume reduction before transurethral resection of the bladder tumor (TUR-BT). The arterial infusion chemotherapy was performed twice, and the tumor size gradually reduced from 275 to 28 cm3. After neoadjuvant chemotherapy, TUR-BT was safely performed without blood transfusion. The tumor was staged as T1 with G1. This is the first report demonstrating that neoadjuvant arterial infusion chemotherapy is effective in treating large superficial bladder cancer and is a possible strategy for bladder preservation.

The bisphosphonate YM529 inhibits osteolytic and osteoblastic changes and CXCR-4-induced invasion in prostate cancer.

Bisphosphonates are useful for the treatment of prostate cancer bone metastasis. However, the role of bisphosphonate on the development of the osteoblastic component of prostate cancer bone metastases is not defined. In the present study, the third-generation bisphosphonate, YM529 (minodoronate), was tested for its effects on the osteolytic PC-3 and novel osteoblastic LNCaP-SF cell lines. YM529 inhibited both osteolytic and osteoblastic changes in an intratibial tumor injection murine model. In vitro, YM529 inhibited both the proliferation and the invasion of both prostate cancer cell lines. The stromal cell-derived factor-1 (or CXCL12)/CXCR-4 pathway is believed to play an important role in the development of prostate cancer bone metastases. Thus, we determined if YM529 affected this pathway. YM529 suppressed CXCR-4 expression in PC-3 and LNCaP-SF in vitro and in vivo and this was associated with decreased in vitro invasion. These results suggest that YM529 may inhibit cancer cell invasion into the bone matrix by repressing the expression of CXCR-4 in bone metastasis lesions.

Impact of Gleason Pattern 5 on outcomes of patients with prostate cancer and iodine-125 prostate brachytherapy.

BACKGROUND: The Gleason grading system is a powerful predictor of prostate cancer (PCa) prognosis. Gleason scores (GS) of 8-10 are considered as a single high-risk grade category, and Gleason Pattern 5 (GP5) predicts biochemical recurrence. We report the clinical outcomes of patients treated with 125I prostate brachytherapy for clinically localized PCa and prognosis in the presence or absence of GP5. METHODS: We enrolled 316 patients with T1c-T2N0M0 PCa and undergoing prostate brachytherapy treatment. All patients were followed up for ≥ 1 year. The primary endpoint was biochemical recurrence-free survival. Biochemical recurrence was defined by the Phoenix criteria. Survival curves were calculated by the Kaplan-Meier method, and the prognostic impact of biochemical recurrence was analyzed using a Cox proportional hazards model. RESULTS: The 5-year biochemical recurrence-free survival rate for all patients was 95.2%, and according to the D'Amico risk classification criteria, the rates were 98.7% for patients in low-risk, 96.9% in intermediate-risk, and 81.1% in high-risk groups (P < 0.0001). The 5-year biochemical recurrence-free survival rates for patients with GS8 or GS9-10 were 87.7% and 61.5%, respectively (P = 0.0057). Multivariate analysis found that GS and clinical T stage were independent predictors of biochemical recurrence. CONCLUSIONS: The presence of GP5 in GS9-10 prostate cancer has a worse prognosis than GS8 prostate cancer in the absence of GP5 for patients undergoing prostate brachytherapy.

Mucosa-associated lymphoid tissue lymphoma involving the kidney: a case report and review of the literature.

Mucosa-associated lymphoid tissue (MALT) lymphomas arise from various anatomic sites, mostly observed in the gastrointestinal tract; however, involvement of the kidney is extremely rare. We report a case of MALT lymphoma involving the kidney in a 70-year-old man. Radical nephrectomy was performed under the diagnosis of renal cell carcinoma preoperatively. However, the renal specimen showed that the diffuse small- to medium-sized lymphocytes were scattered and formed colonies, and the neoplastic lymphoid cells were positive for CD20, CD79α, and Bcl-2, but negative for CD10 and Cyclin D1; therefore, the final histological diagnosis was MALT lymphoma involving the renal pelvis. Although he was referred to the department of hematology, no additional treatment was given postoperatively, and he has survived for 4 months without evidence of a recurrence of lymphoma at the last follow-up. To the best of our knowledge, to date 37 reports of MALT lymphoma involving the kidney have been published in the literature. We report a case of MALT lymphoma involving the kidney, and review the existing literature.

[A case of Sertoli cell tumor].

We report a case of Sertoli cell tumor. A 33-year-old man visited our clinic with a complaint of painless left scrotal swelling on September 29th, 2003. An elastic firm induration larger than a hen's egg in size was palpable on the surface of the left testis. Tumor markers for testicular tumor such as human chorionic gonadotropin-beta, alpha fetoprotein, and lactate dehydrogenase were not elevated. However, ultrasound showed a low echoic mass in the left testis. Therefore, we performed left high orchiectomy under the diagnosis of left testicular tumor. Its histology showed Sertoli cell tumor. Neither recurrence nor metastasis has been detected for about 8 months after the operation.

[Four cases of spontaneous rupture of the urinary bladder].

Between November 1997 and March 2001, 4 female patients from 44 to 65 years of age with a spontaneous rupture of the urinary bladder were analyzed. They complained of abdominal pain and had undergone an intra-pelvic gynecological operation (3 for uterine cancer, 1 for an ovarian cyst) several years before. The three with uterine cancer had also received radiation therapy. For their present condition, spontaneous urinary bladder rupture, their treatment was indwelling a urethral catheter. Two of them have had no recurrence of urinary bladder rupture after one month since having the urethral catheter indwelt. One, however, had to have the catheter re-indwelt due to unsuccessful suturing of the urinary bladder wall. The fourth patient had bilateral nephrostomy tubes due to severe radiation cystitis. Thus, one can infer that intra-pelvic gynecological operations and radiation therapy are major factors causing spontaneous urinary bladder rupture. While indwelling a urethral catheter may be effective for some patients with a spontaneous rupture of the urinary bladder, it may be very difficult to treat more complicated cases.

[A case of carcinosarcoma of the urinary bladder].

We report a case of carcinosarcoma of the urinary bladder. A 68-year-old man visited our hospital with complaints of asymptomatic macroscopic hematuria, cold sweat and general malaise. Excretory urography revealed a filling defect in the left wall of the bladder, and subsequent cystoscopy revealed a non-papillary sessile tumor. The tumor was transurethrally resected and its histology showed carcinosarcoma which was characteristics of a mixture of transitional cell carcinoma with spindle cell sarcoma. The patient underwent total cystectomy and his bladder was reconstructed with the ileum. Nevertheless, he died of multiple organ metastases 3 months after the surgery.

[Comparative study of operation and surveillance for patients with renal angiomyolipoma].

Twenty-three patients (6 men and 17 women) with renal angiomyolipoma (AML) were analyzed. They were divided into two groups; 9 patients in the operated group and 14 patients in the surveillance group. The operations for AML were performed on 3 patients suspected of having renal cancer or 6 patients with an AML more than 5 cm in size who had some symptoms as a result of the presence of the tumor. The patients in the surveillance group had tumor less than 4 cm in diameter, and did not have any symptoms. No changes in tumor size were observed during the intervals between observation checkups. The male to female ratio, the average age and the location of AML were not significant in either group. However, the tumor size was significantly larger in the operated group. Thus, the tumor size is considered to be an important factor when deciding the necessity of surgical treatments for AML. Pre-operative diagnosis and treatment strategies, including thin-section computed tomography and selective arterial embolization for AML were discussed.

[Toxic shock syndrome due to methicillin resistant staphylococcus aureus (MRSA) after total prostatectomy].

A 55-year-old man with prostate cancer received a total prostatectomy. Two days after the operation, he suffered from high fever and shaking chilliness, followed by skin eruption, hypotension, diarrhea and chest pain. The results of blood bacterial culture and endotoxin were negative. Toxic shock syndrome was suspected, and the administration of vancomycin (VCM) and continuous hemodialysis-filtration (CHDF) were performed. The steroid pulse therapy for adult respiratory distress syndrome (ARDS) and the treatments for DIC were also done, and they were effective. The desquamation of the extremity was observed on 10 days after the operation. MRSA was finally identified from pus discharge of the operation wound 13 days after the operation. The prevention and treatments for toxic shock syndrome were discussed.

Urodynamic evaluation before and immediately after robot-assisted radical prostatectomy.

OBJECTIVE: To evaluate continence status and mechanism of urinary incontinence immediately after robot-assisted radical prostatectomy (RARP) by performing urodynamic evaluation. METHODS: A total of 87 patients with localized prostate cancer who underwent RARP were included. Filling cystometry, urethral pressure profilometry, and abdominal leak point pressure (ALPP) tests were performed before and immediately after RARP. RESULTS: The mean urine loss ratio (ULR), calculated by dividing the total urine volume by the weight of urine loss after RARP, was 17.8%. Nerve-sparing (NS) surgery significantly affected ULR compared with non-NS surgery. In the comparison between preoperative and postoperative results, the mean maximal cystometric capacity (MCC) and maximal closure urethral pressure (MUCP) decreased from 341 mL and 84.6 cm H2O to 250 mL and 35.6 cm H2O, respectively. No urine leakage was observed in ALPP test preoperatively; however, urine leakage was observed postoperatively in 75 patients (86%), with a mean ALPP of 47.7 cm H2O. Multivariate analysis revealed that MCC, MUCP, and ALPP after RARP were predictive factors for ULR. Linear correlations were found between ULR and MUCP and between ULR and ALPP after RARP. NS status and MUCP after RARP (r=0.247; P=.021) and the ALPP (r=0.254; P=.018) were significantly correlated. CONCLUSION: In urodynamic evaluation immediately after RARP, MCC, MUCP, and ALPP were found to predictive factors for urinary incontinence. The NS procedure contributed to continence status after RARP.

Retrospective analysis of the efficacy of two cycles of M-VAC neoadjuvant chemotherapy followed by radical cystectomy for muscle-invasive bladder cancer.

BACKGROUND: Neoadjuvant chemotherapy before radical cystectomy for muscle-invasive bladder cancer is a commonly used treatment modality. However, in terms of chemotherapeutic regimens and the number of cycles of neoadjuvant chemotherapy, there is yet no international consensus, as various studies indicate the efficacy of several platinum-based combination chemotherapeutic regimens. We determined the efficacy of two cycles of neoadjuvant chemotherapy with methotrexate, vinblastine, adriamycin, and cisplatin followed by radical cystectomy. PATIENTS AND METHODS: The study population included patients with clinical stage T2 - T4a, N0, M0 bladder cancer who underwent radical cystectomy. Clinical courses were compared between 27 patients treated with two cycles of M-VAC neoadjuvant chemotherapy and 25 treated with cystectomy alone. RESULTS: The incidence of pT0 was 25.9% in the group treated with neoadjuvant chemotherapy. The probabilities of disease-free and cause-specific survival were significantly higher in patients treated with, than without neoadjuvant chemotherapy. On univariate Cox proportional hazards regression analysis for the patients treated with neoadjuvant chemotherapy, pathological stage and the pathological findings of venous involvement were significant prognostic factors. CONCLUSION: The results of this retrospective study demonstrated the clinical effectiveness of two cycles of neoadjuvant M-VAC chemotherapy for muscle-invasive bladder cancer.