Search

We aimed to analyse late toxicity associated with external beam radiation therapy (EBRT) for prostate cancer using uniform dose-fractionation and beam arrangement, with the focus on the effect of 3D (CT) simulation and portal field size. We collected data concerning patients with localized prostate adenocarcinoma who had been treated with EBRT at five institutions in Osaka, Japan, between 1998 and 2006. All had been treated with 70 Gy in 35 fractions, using the classical 4-field technique with gantry angles of 0°, 90°, 180° and 270°. Late toxicity was evaluated strictly in terms of the Common Terminology Criteria for Adverse Events Version 4.0. In total, 362 patients were analysed, with a median follow-up of 4.5 years (range 1.0–11.6). The 5-year overall and cause-specific survival rates were 93% and 96%, respectively. The mean ± SD portal field size in the right–left, superior–inferior, and anterior–posterior directions was, respectively, 10.8 ± 1.1, 10.2 ± 1.0 and 8.8 ± 0.9 cm for 2D simulation, and 8.4 ± 1.2, 8.2 ± 1.0 and 7.7 ± 1.0 cm for 3D simulation (P < 0.001). No Grade 4 or 5 late toxicity was observed. The actuarial 5-year Grade 2–3 genitourinary and gastrointestinal (GI) late toxicity rates were 6% and 14%, respectively, while the corresponding late rectal bleeding rate was 23% for 2D simulation and 7% for 3D simulation (P < 0.001). With a uniform setting of classical 4-field 70 Gy/35 fractions, the use of CT simulation and the resultant reduction in portal field size were significantly associated with reduced late GI toxicity, especially with less rectal bleeding.

Objective: Effects of sorafenib in general clinical practice, especially those with patients of Asian ethnicity, have been rarely investigated. We assessed efficacy, safety and prognostic factors for progression-free survival in Japanese patients receiving sorafenib for advanced renal cell carcinoma. Methods: We performed a retrospective analysis of 159 Japanese patients with renal cell carcinoma. Progression-free survival was estimated by the Kaplan‐Meier method. Objective response (per Response Evaluation Criteria in Solid Tumors) and safety were assessed. Cox proportional hazards model was used to identify independent prognostic factors for progression-free survival. Results: The median progression-free survival was 9.0 months (95% confidence interval, 7.5‐10.6 months). In 142 patients with measurable lesions, the objective response rate was 21.8%, and disease control was achieved in 85 (59.9%) patients. Adverse events of any grade occurred in 152 patients (95.6%). Most common adverse events causing discontinuation or interruption of sorafenib were hand-foot skin reaction (22%), rash (10.7%) and liver dysfunction (10.7%). Dose reduction or therapy interruption due to adverse events was required in 128 patients (80.5%). Univariate and multivariate analysis revealed that favorable prognosis according to Memorial Sloan-Kettering Cancer Center prognostic factors and relative dose intensity during the first month of treatment of � 50% were significant factors for predicting superior progression-free survival with sorafenib treatment. Conclusions: Sorafenib was effective in Japanese patients with advanced renal cell carcinoma in general clinical practice and was tolerated although most patients required dose reduction or interruption of therapy. Future studies should establish new strategies for treatment without sacrificing both efficacy and patient quality of life.

PURPOSE The objective of our study was to compare T2-weighted magnetic resonance imaging (T2WI), combined T2-weighted and dynamic imaging (Dynamic), and combined T2-weighted and diffusion-weighted imaging (DWI) in the identification of the site of prostate cancer. MATERIALS AND METHODS Before radical prostatectomy, 85 patients with prostate cancer underwent magnetic resonance imaging using a 1.5-T endorectal coil; we excluded 3 patients treated with neoadjuvant hormonal therapy. The sites of prostate cancer in 82 patients were predicted by T2WI alone, T2WI + Dynamic, and T2WI + DWI, and the results were compared with the step-section analysis of radical prostatectomy specimens. The peripheral zone (PZ) and the transition zone (TZ) of the prostate were divided into left and right halves. Only tumors with a diameter of more than 5 mm were considered significant. RESULTS The sensitivity, specificity, positive predictive value (PPV), and the area under the receiver operating characteristic (ROC) curve (Az) for the prediction of the site of prostate cancer in the PZ of the prostate were as follows: 42%, 94%, 93%, and 0.76 for T2WI alone; 48%, 96%, 96%, and 0.78 for T2WI + Dynamic; and 50%, 96%, 96%, and 0.81 for T2WI + DWI. The sensitivity, specificity, PPV, and Az for the prediction of the site of prostate cancer in the TZ of the prostate were as follows: 31%, 92%, 76%, and 0.66 for T2WI alone; 46%, 82%, 67%, and 0.65 for T2WI + Dynamic; and 48%, 94%, 85%, and 0.71 for T2WI + DWI. CONCLUSION The Az value for the prediction of prostate cancer in the PZ and those in the TZ of the prostate was the highest for the combined T2WI and DWI approach.

A unique case of ganglioneuroma mimicking a lipomatous tumor in a 73-year-old man is reported. The tumor was incidentally found on radiography performed for unrelated reasons. Because of the fat element, CT and magnetic resonance imaging suggested myelolipoma inside or outside the right adrenal gland. The laparotomy indicated that the tumor was located on the right adrenal gland. It was well circumscribed but not encapsulated, and was approximately 2 cm in diameter. Microscopically, ganglioneuromatous component was scattered in the background of a large amount of adipose tissue. Because the presence of such a large amount of adipose tissue seems to be rare in ganglioneuromas, its histogenesis is discussed.

PURPOSE: Screening with prostate specific antigen (PSA) to detect prostate cancer was started in Ikeda City Osaka from 2003 as part of the city's health program. We evaluated the first year's result. MATERIAL AND METHOD: Fifty-year-old or elder men living in Ikeda City who wanted to have their serum PSA level (Tandem-R) measured to screen for prostate cancer was entered into the screening program. Men whose PSA levels detected to exceed 4.1 ng/ml were told they should visit a urologist for further examinations to detect possible prostate cancer. These examinations included prostate biopsy. The results of further examinations were reported to Ikeda City and evaluated. RESULTS: The population of fifty-years-old or elder men in Ikeda City was 18,161. 3738 (21.0%) men had their serum PSA levels measured. 367 (9.81%) of the men were told they should undergo further examinations to detect possible prostate cancer. 263 (71.7%) men visited a urologist for further examinations, and prostate biopsy was performed in 138 (52.5%) of them. Among these 138, prostate cancer diagnosed in 91 (65.9%). The positive rate of prostate biopsy was 65.9% (91/138), The detection rate for prostate cancer was therefore 2.43% (91/3738). Patient's numbers for each clinical stage were 57 (62.6%) in B, 30 (32.9%) in C, 4 (4.4%) in D. CONCLUSION: Prostate cancer was diagnosed in 2.34% of 3738 men who had their serum PSA levels measured, and in stage B two thirds had a positive diagnosis. PSA screening to detect prostate cancer as one of the health checks in Ikeda City was useful in detecting early prostate cancer.

A black-colored and well-circumscribed renal tumor in a 71-year-old woman is reported. The tumor was unique in that it was rich in vasculature and exclusively composed of perivascular epithelioid clear cells. Morphological features were reminiscent of conventional renal cell carcinoma (RCC). However, immunohistochemical examinations showed that the tumor cells did not express any epithelial markers, but diffusely and intensely expressed a melanocytic marker, gp-100/HMB-45. Another striking feature of the tumor was a large amount of cytoplasmic pigment that made the tumor wholly black. The pigment was not stained with Berlin-blue, completely bleached with potassium permanganate, and stained with Fontana-Masson staining, which suggests that the pigment was melanin. Morphological features and immunohistochemical findings indicated that the present tumor was an extreme example of a perivascular epithelioid clear cell tumor with a large amount of melanin, which has not been previously reported. One should be aware of the pure form of perivascular epithelioid clear cell tumor of the kidney because it is sometimes very difficult to differentiate this tumor from conventional RCC. Immunohistochemical examinations and the presence of cytoplasmic melanin can help the differentiation.

PURPOSE To assess the effectiveness and tolerability of estramustine sodium phosphate in men with hot flushes during combined androgen blockade (CAB) therapy for prostate cancer. PATIENTS AND METHODS Seven men with moderate to severe hot flushes were received estramustine sodium phosphate. Treatment response was assessed by hot flush score. RESULTS A significant reduction in the hot flush score was seen with all patients. No thromboembolic complications occurred in any patients. CONCLUSIONS Estramustine sodium phosphate appears to be a promising, well-tolerated and useful therapy for men with hot flushes during CAB treatment for prostate cancer.

Masashi Nakayama*, Osaka-city, Osaka, Japan; Takeshi Yamada, Tomohito Shimizu, Shinpei Nonen, Suita, Osaka, Japan; Kensaku Nishimura, Sakai, Osaka, Japan; Kazuo Nishimura, Osaka-city, Osaka, Japan; Tsuneo Hara, Ikeda, Osaka, Japan; Go Tanigawa, Toshiaki Yoshioka, Osaka-city, Osaka, Japan; Koji Hatano, Yasutomo Nakai, Hitoshi Takayama, Yasushi Fujio, Junichi Azuma, Suita, Osaka, Japan; Akihiko Okuyama, Osaka-city, Osaka, Japan; Norio Nonomura, Suita, Osaka, Japan

PURPOSE Since 2003, screening with prostate specific antigen (PSA) has been conducted to detect prostate cancer. We investigated the results between 2003 and 2007. PATIENTS AND METHODS Screening with PSA alone was performed for males aged over 50 years who desired prostate cancer screening. We used a PSA cutoff value of 4.00 ng per milliliter. RESULTS In 2003, there were 18,161 males aged over 50 years in Ikeda City. 3,738, 3,905, 4,129, 4,410, and 4,515 of the males underwent PSA screening in 2003, 2004, 2005, 2006, and 2007. The rate of elevated PSA levels was 7.9%-9.8% (median 9.1%). 161, 81, 70, 75 and 60 of the males visited us for secondary screening, and prostate biopsy was performed in 130 (80.7%), 57 (70.4%), 45 (64.3%), 38 (50.7%), and 42 (70.0%). Prostate cancer was detected in 91, 33, 29, 20 and 25 males, respectively. These values corresponded to 2.43%, 0.85%, 0.70%, 0.45% and 0.55% of the males who underwent primary screening. The incidence of prostate cancer was 0.96% during the 5 years. Clinical stage was B in 137 (69.2%), C in 52 (26.3%), D in 7 (3.5%), and unknown in 2. Surgery was performed in 87 (43.9%), endocrine therapy in 61 (30.8%), irradiation in 37 (18.7%), and follow up without treatment in 7 (3.5%). Treatment for 6 (3.0%) is unknown because they desired treatment at another hospital. CONCLUSIONS 198 males were diagnosed with prostate cancer between 2003 and 2007. The clinical stage B was present in 137 (69.2%), and the early treatment was achieved. This may lead to a future decrease in the mortality rate.

We present the case of a patient with renal cell carcinoma treated preoperatively with sorafenib. Complete resection of the left renal mass measuring 7.2 x 6.6 cm seemed to be difficult at diagnosis because of large renal hilar lymph nodes. With a short period of sorafenib administration, marked shrinkage of the renal mass and lymphadenopathy was observed after the patient experienced fulminant hepatic failure and a severe hand-foot skin reaction. Two-dimensional computed tomography revealed 60%, 78% and 84% reduction in the primary renal tumor, lung metastatic nodules and lymph nodes, respectively. Tumor shrinkage allowed for complete resection of the left kidney and the lymphadenopathy. Pathological findings revealed that over 90% of the renal tumor was substituted by necrotic fibrotic tissue and that the residual neoplastic component was diagnosed as clear cell carcinoma. The lymph nodes that were resected were negative for malignancy. At 6 months after radical nephrectomy, a new computed tomography scan revealed no evidence of disease with the disappearance of lung nodules.

Segmental infarction of the testis represents a rare entity in that there have been fewer than 40 cases documented in the literature. Like global infarction, segmental infarction of the testis can masquerade as a mass lesion or torsion of the testis. Reported herein is a very rare case of segmental testicular infarction due to atheroembolism in a 58-year-old man. The patient presented with severe left testicular pain and underwent left high orchiectomy on the clinical diagnosis of testicular torsion. The testis had a segmental hemorrhagic necrosis around which many cholesterol emboli were observed. This is the first report to describe cholesterol embolism-associated segmental testicular infarction.

A 46-year-old female underwent an excision of a parathyroid adenoma diagnosed as recurrent primary hyperparathyroidism 24 years after the initial excision of a parathyroid adenoma. We report a case of non-synchronous double adenomas of the parathyroid glands documented histopathologically.

We report on a mycobacterium tuberculosis after renal transplantation. This is, to our knowledge, the first case report on an isolated skin tuberculosis with mycobacterium tuberculosis after renal transplantation. A-68-year-old renal transplant recipient presented with a nodule in his right breast. A diagnosis of a mycobacterium tuberculosis skin infection was made and antimycobacterial therapy was started.

A rare case of bladtier cancer prtducing granulocyte colony-stimulating factor (G-CSF) is reported. A 63-year-old man with a progressive, grade 3 transitional cell bladder cacinoma, showed niarked leukocytosis (maximum 181,800/mm1) and an elevated serum G-CSF to 131.7 pg/mL. After rdical cystectomy and neoadjuvant chemotherapy, the tumor recurred locally. Immunohistochemical examination with monoclonal antibody specific for G-CSF revealed positive staininfi in the lotal recurrtant tumor. To our knowledge, there have been only seven cases reported of bladder cancer producing C;-CSF.

Introduction: We investigated the status of erectile function and urinary continence after radical prostatectomy to investigate a possible relation between them and then determined whether the status of postoperative urinary continence affected erectile function. Patients and Methods: Seventy-six patients who had no symptoms of erectile dysfunction or urinary incontinence preoperatively were included in this study. The postoperative status of erectile function and urinary continence was investigated using a self-reported patient questionnaire. Results: Thirteen of 27 patients (48.1%) who underwent nerve-sparing procedures maintained erectile function, while 7 of 49 patients (14.2%) who underwent non-nerve-sparing procedures maintained it postoperatively. None of the 27 patients in the nerve-sparing procedure group reported incontinence, whereas 3 of the 49 patients (6.1%) who underwent non-nerve-sparing procedures reported moderate incontinence. However, no significant correlation between the International Index of Erectile Function-5 score and the Incontinence Impact Questionnaire score was seen. Conclusion: No relation between the status of urinary continence and erectile function was shown, regardless of the nerve-sparing nature of the prostatectomy.

We report a case of xanthoma of the bladder incidentally discovered during transurethral ureteral lithotripsy for a right ureteral stone and histopathologically diagnosed by cold cup biopsy. Xanthoma, a disorder of the lipid metabolism without tumorous or inflammatory changes, is rare in the bladder with only 7 cases reported previously. Interestingly, 5 of these 7 cases were reported in the Japanese literature, as were cases of xanthogranulomatous cystitis. We have no explanation for this occurrence. Xanthoma, caused by macrophages with the ability to phagocytose, is a benign lesion. It is necessary to continue careful followup by cystoscopy to determine if xanthoma increases or decreases in size.