Early effect of dutasteride added to alpha-1 blocker therapy for patients with lower urinary tract symptoms associated with benign prostatic hyperplasia.

OBJECTIVE: To investigate the hypothesis that 5-alpha-reductase inhibitors exert early ameliorative effects on voiding and storage symptoms in men with lower urinary tract symptom-associated benign prostatic hyperplasia. METHODS: This was a prospective study involving the participation of eight outpatient clinics in Chiba Prefecture, Japan. The patients received dutasteride (0.5 mg) once daily orally for 24 weeks as an add-on to their ongoing therapy with an alpha-1 blocker. The study patients recorded their urinary symptoms every day for 14 days after starting dutasteride. The International Prostate Symptom Score, prostate volume, uroflowmetry results, and residual urine volume were checked at 3 and 6 months after starting dutasteride. RESULTS: A total of eighty-eight patients participated in the present study; 74 were eligible for analysis of the early effects of dutasteride. The median age was 69.6 years (range 54-89), the median prostate volume was 50.3 mL (range 24.7-103.3) and the median International Prostate Symptom Score was 17.6 (range 8-35). The proportion of patients with International Prostate Symptom Score improvements (≥3 points, or ≥25%) or 3 points or more decreased International Prostate Symptom Score were defined effective, 37 (50.0%) and 47 (63.5%) experienced improvement at 1 month after administration, respectively. CONCLUSION: This is the first prospective clinical study to show the early beneficial effects of 5-alpha-reductase inhibitors for lower urinary tract symptom-associated benign prostatic hyperplasia. Patients with severe symptoms were found to be responsive to dutasteride. The influence of the placebo effect was not denied. Further study is necessary.

[Clinical outcomes after combined therapy with dutasteride in patients with unsuccessful trial without catheter after treatment with an alpha1-adrenergic receptor blocker monotherapy for acute urinary retention caused by prostatic hyperplasia].

OBJECTIVE: The outcome of trial of voiding without catheter in patients treated combination therapy with dutasteride and alpha1-adrenergic receptor blocker for acute urinary retention caused by benign prostatic hyperplasia was not reported. We evaluated the clinical efficacy of combination therapy with dutasteride in patients with unsuccessful trial without catheter after treatment with an alpha1-adrenergic receptor blocker monotherapy for acute urinary retention caused by benign prostatic hyperplasia. PATIENTS AND METHODS: Patients with acute urinary retention due to prostatic hyperplasia were catheterized and treated alpha1-adrenergic receptor blocker monotherapy. After two weeks later, patients were put on trial without catheter. 52 patients who were unsuccessful trial without catheter administered combination therapy with dutasteride and alpha1-adrenergic receptor blocker. We use criteria that voiding urine volume over 100 ml and post-void residual urine volume below 100 ml in deciding whether catheter should be removed. RESULTS: 33 (63.5%) men did not require re-catheterization within 7 months after combination therapy. The successful rate of Performance Status (PS) 0-1 group was significantly superior to that of PS 2-4 group. CONCLUSIONS: PS 0-1 men catheterized for AUR can void more successfully after catheter removal than PS 2-4 men if treated with combination therapy.

[A CASE OF PERSISTENT RETROPERITONEAL ABSCESS CAUSED BY RESIDUAL SILK SUTURE AFTER SURGERY].

A 61-years-old male with left renal cancer and ipsilateral adrenal tumor had carried out partial nephrectomy and adrenalectomy via open retroperitoneal approach. Fourteen days after surgery, febrile reaction occurred and CT revealed an abscess developed in the retroperitoneal space. Open drainage and lavage of retroperitoneal space had performed, and irrigation of drainage tract had been continued for persistent flow of purulent discharge from abscess touching upper pole of the kidney for about 4 months. After 127 days of second surgery, two clusters of silk suture were sucked out during irrigation. Soon after the episode, flood of purulent discharge from drainage tract was ceased and retroperitoneal abscess was diminished drastically. It should be in mind that the foreign boy like silk suture used during surgery would cause persistent retroperitoneal abscess.

[Case of progressive prostatic carcinoma in a patient with acquired hypogonadism].

We report a case of progressive prostatic carcinoma in a patient with acquired hypogonadism. An 86- year-old man was admitted to our hospital complaining of weakened urinary flow. He had had hypophysectomy because of a pituitary tumor at 75 years old. Needle biopsy of the prostate showed poorly differentiated adenocarcinoma in the whole region and bone scan revealed bone metastasis of right scapula. The patient was treated with anti-androgen monotherapy because of secondary hypogonadism, but the prostate specific antigen score, continued to increase. Despite secondary anti-androgen and steroid therapy, he died 13 months after admission.

Implications of insulin-like growth factor-I for prostate cancer therapies.

In the last decade, abundant evidence has suggested that the insulin-like growth factor (IGF) family comprises a multi-component network of molecules involved in the regulation of both physiological and pathological growth processes in the prostate. The IGF axis plays an important role in the tumorigenesis and neoplastic growth of prostate cancer. Epidemiological observations indicate that circulating IGF-I levels are positively associated with increased risk of prostate cancer. Activation of IGF-I receptor (IGF-IR) by IGF-I has mitogenic and anti-apoptotic effects on normal and malignant prostate cells. Therapeutic alternatives in men with progressive prostate cancer after androgen ablation are very limited and more effective therapies are needed for such patients. Inactivation of the IGF-I axis represents a potential target to treat androgen-independent prostate cancer. This review addresses epidemiological studies of IGF-I and therapeutic strategies including reduction of IGF-I levels, inhibition of IGF-IR and the signaling mechanisms involved.

[Two cases of spontaneous rupture of upper urinary tract caused by the primary ureteral or renal pelvic tumor: a case report].

We report two cases of spontaneous urinary rupture caused by primary ureteral or renal pelvic cancer. Case 1: A 76-year-old man presented with macrohematuria and left back pain. Magnetic resonance imaging showed left middle ureteral tumor and rupture of upper ureter. Left nephroureterectomy was performed. Histological findings revealed urothelial carcinoma, G2, pT1, lt-u0, ew0, ly0, v1. At five months postoperatively, he died of lymph node metastases after two courses of adjuvant chemotherapy. Case 2: A 59-year-old man presented with macrohematuria and left back pain. Computer tomography showed left renal pelvic tumor with extravasation of urine. Left nephroureterectomy was performed. Examination of surgical specimen revealed a renal pelvic tumor and rupture hole at the renal pelvis. Histological finding revealed urothelial carcinoma, G3, pT3, lt-u0, ly0, v1. One course of adjuvant chemotherapy was performed. At six months postoperatively, he was free from recurrence.

[Extrarenal angiomyolipoma with spontaneous rupture: a case report].

We present a very rare case of retroperitoneal extrarenal angiomyolipoma (AML) with spontaneous rupture. A 67-year-old woman without tuberous sclerosis was admitted to our hospital complaining of sudden right flank pain. We suspected right renal AML with rupture by imaging analysis, but the diagnosis was extrarenal AML by surgery and pathological examination.

Severe Hypophosphatemia Following Denosumab Administration in a Hemodialysis Patient with Progressive Prostate Cancer.

In a 68-year-old man on maintenance hemodialysis (HD), severe anemia was detected. Bone marrow biopsy was performed for investigation of pancytopenia and pathological examination revealed adenocarcinoma of the prostate. Prostate specific antigen (PSA) was 574 ng/mL. After androgen deprivation therapy was initiated, PSA decreased to 13.7 ng/mL. But subsequent elevation of PSA and pain due to bone metastases were recognized. Denosumab (120 mg) was administered. Although improvement of bone pain was observed, severe hypocalcemia occurred. Severe hypophosphatemia was subsequently detected. When we use denosumab in dialysis patients with advanced cancer, we should be careful of hypophosphatemia.

Clinical evaluation of transrectal power doppler imaging in the detection of prostate cancer.

To evaluate the clinical usefulness of power Doppler imaging (PDI), we compared this method to gray-scale transrectal ultrasound (TRUS) in the detection of prostate cancer. A total of 101 men with abnormally high serum prostate specific antigen (PSA) levels and/or abnormal digital rectal examination (DRE) findings were assessed using TRUS and PDI. Random systematic sextant and bilateral far lateral prostate biopsies were performed in all cases. In addition, when TRUS revealed a hypoechoic lesion or PDI revealed a hypervascular lesion (HVL), these lesions were directly biopsied. Of the 101 patients, 48 (47.5%), 42 (41.5%) and 42 (41.5%) were suspicious of having prostate cancer by DRE, TRUS and PDI, respectively. Prostate needle biopsy revealed prostate cancer in 39 patients (38.6%) and benign prostatic diseases in 62 patients (61.4%). If prostate needle biopsy was avoided when PDI was negative, then PDI eliminated the need for biopsy in 59 of the 101 patients (rate of biopsy procedures saved: 58.4%) and missed only 8 (13.6%) prostate cancers. Moreover, in 63 patients with intermediate PSA (3-10 ng/ml), the rate of biopsy procedures saved by DRE, TRUS, and PDI was 60.3%, 65.1%, and 68.3%, respectively, and the rate of cancers missed was 26.3%, 19.5%, and 14.0%, respectively. In a total of 826 specimens of TRUS-guided prostate biopsy, 126 (15.3%) specimens had adenocarcinoma. Site by site based analysis of the present series revealed 34.1% of prostate cancer sites were isoechoic and hypervascular. On a site by site basis, PDI had better sensitivity, specificity, positive predictive value and negative predictive value than TRUS. In 48 patients without abnormal DRE findings, on a site by site basis, the sensitivities of TRUS and PDI were 22.9% and 34.4%, respectively. Gleason score was associated with a positive rate of PDI on both a patient basis and site by site basis. From these results, on a patient basis, we conclude that PDI was helpful in the indication for prostate biopsy for all patients or patients with intermediate PSA level. On a site by site basis, PDI may be able to select prostate cancer sites at biopsy, in particular in patients without abnormal DRE findings.

[Silicate calculi: report of four cases].

Among four patients with silicate calculi, stones were spontaneously discharged in two and after extracorporeal shock-wave lithotripsy in two. Two of them had a history of taking magnesium silicate. Thirty two cases of silicate calculi previously reported in the Japanese literature were reviewed.

[A case of thyroid cancer metastasizing to the bilateral kidneys].

A 66-year-old woman was admitted with a chief complaint of macroscopic hematuria. She had a past history of mediastinal tumor that had been surgically treated 11 years earlier and had been pathologically diagnosed as papillary thyroid cancer. Enhanced computed tomography demonstrated slightly enhanced renal tumors in both kidneys. Endoscopic findings showed bleeding from the left ureteral orifice. To control macroscopic hematuria, left nephrectomy was performed. Since, two months late severe bleeding occurred from the right ureteral orifice, right nephrectomy was performed and hemodialysis was initiated. The pathological findings of the bilateral renal tumors were papillary thyroid cancer suggesting metastases from the primary mediastinal tumor.

Improved prostate cancer detection using systematic 14-core biopsy for large prostate glands with normal digital rectal examination findings.

OBJECTIVES: To evaluate in a retrospective study the improvements in prostate cancer detection rates for patients with a prostate gland larger than 30 cm3 using a systematic 14-core biopsy strategy compared with a systematic 8-core biopsy. METHODS: We retrospectively assessed 273 patients with screened prostate-specific antigen (PSA) levels of 3.0 to 50.0 ng/mL. A total of 204 patients with a prostate volume of 30 cm3 or larger and with normal digital rectal examination findings were enrolled in this study. Of the 204 patients, 110 underwent 8-core biopsy and 94 underwent 14-core biopsy of the prostate. We compared the cancer detection rates of prostate biopsy between the 8 and 14-core groups using total PSA, free/total PSA ratio, PSA density, and PSA density adjusted by transition zone volume. We also analyzed the Gleason grade of the biopsy core and the radical prostatectomy specimens. RESULTS: Of the 204 patients, 40 (19.5%) were identified as having prostate adenocarcinoma. The cancer detection rate for the 8 and 14-core groups was 14.5% (16 of 110 patients) and 24.5% (23 of 94 patients), respectively. The 14-core biopsy had a statistically significant greater cancer detection rate than did the 8-core group in patients with a prostate volume of 30 to 40 cm3 (36.7% versus 11.8%, respectively, P<0.05) and a PSA density adjusted by transition zone volume of 0.38 ng/mL/cm3 or greater (47.8% versus 20.0%, respectively, P <0.05). The difference in tumor grade between the 8 and 14-core biopsy samples was not statistically significant. CONCLUSIONS: The 14-core prostate needle biopsy is a recommended method for detecting prostate cancer in a large-volume prostate gland without increasing the risk of complications.

Pretreatment serum testosterone level as a predictive factor of pathological stage in localized prostate cancer patients treated with radical prostatectomy.

OBJECTIVE: Pretreatment serum level of testosterone (T) is a potential prognostic factor for prostate cancer. The present study was conducted to evaluate the clinical significance of pretreatment serum T level in patients with clinically localized prostate cancer. MATERIALS AND METHODS: The subjects were 82 clinically localized prostate cancer patients treated with radical prostatectomy, whose pretreatment T levels were recorded. We investigated clinical and pathological factors such as pretreatment serum T level, age, pretreatment PSA or pathological Gleason score concerning the association with pathological stage and biochemical recurrence. RESULTS: The mean pretreatment T level was significantly lower in patients with non-organ-confined prostate cancer (pT3-T4, N1; 3.44+/-1.19 ng/ml) than in patients with organ-confined cancer (pT2; 4.33+/-1.42 ng/ml) (p=0.0078). Multivariate analysis demonstrated that pathological Gleason score, pretreatment serum T level and pretreatment PSA were significant predictors of extraprostatic disease. When the patients were divided into high and low T level groups according to the median value, pretreatment T levels were not significantly associated with PSA recurrence rates (p=0.7973). CONCLUSIONS: A lower pretreatment T level appears to be predictive of extraprostatic disease in patients with localized prostate cancer.