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It is unclear whether experience at high-volume institute improves the treatment quality of prostate seed implantation. The aim of this study was to evaluate the effect of institutional experience on postimplant dosimetric parameters in a nationwide prospective cohort study.From July 2005 to June 2007, 2354 patients were registered in the Japanese Prostate Cancer Outcome Study of Permanent I‑125 Seed Implantation (J-POPS), and 1126 patients treated with seed implantation alone were evaluated. As a surrogate for institutional experience, we classified the J‑POPS institutions as high-volume (patient accrual volume was ≥120 patients per institution) or low-volume institutions (patient accrual volume was120 patients per institution). To compare treatment quality between institutions, we evaluated the postimplant dosimetric parameters including D90, V100/150 (prostatic dose parameters), UD5/90, U200 (urethral dose parameters), and rectum R100/150 (rectal dose parameters).In the 5 high-volume institutions (n = 601 patients), most of the patients were treated with144 Gy of D90, whereas in the 20 low-volume institutions (n = 525) some of the patients were treated with144 Gy. The V100 of most of the high-volume institution patients were90%, whereas in the low-volume institutions a considerable percentage of patients showed lower V100. Although there was no correlation between D90 and rectal dose parameters, UD90 had a moderate positive correlation with D90 in both the high- and low-volume institutions. U200 varied more widely in the low-volume institutions.Our findings indicate that the institutional patient accrual volume is associated with the treatment quality of I‑125 prostate seed implantation.

Background To date, research has not determined the optimal procedure for adjuvant androgen deprivation therapy (ADT) in patients with locally advanced prostate cancer (PCa) treated for 6 months with neoadjuvant ADT and external-beam radiation therapy (EBRT). Methods A multicenter, randomized, phase 3 trial enrolled 303 patients with locally advanced PCa between 2001 and 2006. Participants were treated with neoadjuvant ADT for 6 months. Then, 280 patients whose prostate-specific antigen levels were less than pretreatment levels and less than 10 ng/mL were randomized. All 280 participants were treated with 72 Gy of EBRT in combination with adjuvant ADT for 8 months. Thereafter, participants were assigned to long-term ADT (5 years in all; arm 1) or intermittent ADT (arm 2). The primary endpoint was modified biochemical relapse-free survival (bRFS) with respect to nonmetastatic castration-resistant prostate cancer (nmCRPC) progression, clinical relapse, or any cause of death. Results The median follow-up time after randomization was 8.2 years. Among the 136 and 144 men assigned to trial arms 1 and 2, respectively, 24 and 30 progressed to nmCRPC or clinical relapse, and 5 and 6 died of PCa. The 5-year modified bRFS rates were 84.8% and 82.8% in trial arms 1 and 2, respectively (hazard ratio, 1.132; 95% confidence interval, 0.744-1.722). Conclusions Although modified bRFS data did not demonstrate noninferiority for arm 2, intermittent adjuvant ADT after EBRT with 14 months of neoadjuvant and short-term adjuvant ADT is a promising treatment strategy, especially in a population of responders after 6 months of ADT for locally advanced PCa.

To investigate contemporary rates of variation in the biopsy Gleason grading in prostate cancer, between local and central pathologists, based on central review of the pathological slides from Seed and Hormone for Intermediate-risk Prostate Cancer (SHIP) 0804, a phase III, multicenter, randomized, controlled study. From April 2008 to May 2011, 18 Japanese institutions participated. All HE with the under-grading and over-grading of grades to be 14.6% and 20.1%, respectively. The central review resulted in numbers of tumor-bearing cores reassigned in 99 of 616 cases in which such information by the local pathologists was available (16.1%). Discordance in biopsy Gleason grading was still found in one third of the cases in the SHIP0804 study. This information is valuable in extrapolating the diagnostic error range in contemporary clinical studies conducted without central pathological review.

Purpose: To evaluate the incidence and the associated factors of rectal toxicity in patients with prostate cancer undergoing permanent seed implantation (PI) with or without external beam radiation therapy (EBRT) in a nationwide prospective cohort study in Japan (J-POPS) during the first 2 years. Methods and materials: A total of 2,339 subjects were available for the analyses. Rectal toxicity was evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Results: The 3-year cumulative incidence for grade ≥2 rectal toxicity was 2.88%, 1.76%, and 6.53% in all subjects, PI group and EBRT combination therapy group, respectively. On multivariate analysis, among all subjects, grade ≥2 rectal toxicity was associated with rectal volumes receiving 100% of the prescribed dose (R100; p < 0.0001) and EBRT combination therapy (p = 0.0066). R100 in the PI group (p = 0.0254), and R100 (p = 0.0011) and interactive planning (p = 0.0267) in the EBRT combination therapy group were also associated with grade ≥2 toxicity. The 3-year cumulative incidence of grade ≥2 rectal toxicity was 3.80% and 1.37% for R100 ≥ 1 mL and R100 < 1 mL, respectively, in the PI group (p = 0.0068), and 14.09% and 5.52% for R100 ≥ 1 mL and R100 < 1 mL, respectively, in the EBRT combination therapy group (p = 0.0070). Conclusions: Rectal toxicity was relatively rare in this study compared with previous reports. For Japanese prostate cancer patients, R100 < 1 mL in both PI and EBRT combination therapy groups and interactive planning in EBRT combination therapy group may be effective in decreasing the incidence of rectal toxicity.

Purpose The International Commission on Radiological Protection recommends removing the prostate before cremation if death occurs within 12 months after 125 I brachytherapy. However, the incidence of death within this time frame has not been robustly investigated in any country. The purpose this study was to investigate the incidence and cause of death and actions taken when death has occurred within 12 months after 125 I brachytherapy for prostate cancer in Japan. Methods and Materials Data were extracted from the Japan Radioisotope Association database to investigate the total number of implantation cases, number of early deaths after implantation, cause of death, and postmortem actions between September 2003 and the end of June 2010 in Japan. Early death was defined as occurring within 12 months after 125 I brachytherapy for prostate cancer. Results During the study period, 15,427 patients underwent 125 I brachytherapy and 43 (0.28%) died within 12 months after implantation. For 37 of the 43 patients (86%), the brachytherapy source was retrieved together with the prostate gland at autopsy; however, autopsy could not be performed in six (14%) of the deceased patients. The largest proportion of early deaths was because of cerebrovascular or cardiovascular disease (17/43, 40%), followed by malignant tumor (15/43, 35%), and respiratory disease or infection (7/43, 16%). Conclusions The incidence of early deaths within 12 months after 125 I brachytherapy in Japan was 0.28%. In almost all cases, the brachytherapy sources were removed in the intact prostate before the body was cremated and stored appropriately.

Nuclear chromatin decondensation (NCD) of the human spermatozoa was induced by 1% sodium dodecyl sulphate (SDS). NCD of the spermatozoa induced in healthy and fertile men was significantly stronger and at higher rates than that in infertile men. In 1% SDS with 6 mM zinc chelating EDTA, metallothionein (MT) significantly enhanced NCD in a healthy man. In contrast MT alone significantly inhibited sperm NCD. Sperm NCD rate induced by 1% SDS in 10 infertile men was significantly inhibited by adding 75 or 750 micrograms ml-1 of MT. By adding 1.5 mM zinc, MT at concentrations of 0.75, 7.5, 75, or 750 micrograms ml-1, enhanced the inhibitory effect of 1.5 mM zinc. This suggested that thiols in the MT could, when liberated from zinc by zinc-chelating EDTA, induce sperm decondensation by cleaving stabilizing S-S bridges and that zinc bound to MT could exert a chromatin stabilizing effect mediated by the zinc dependent type of chromatin stability. The present study suggested that zinc bound to MT, which is secreted mainly from the prostate gland, is one factor that contributes to the chromatin stabilizing effect of human prostatic fluid.

Sulfation is a key pathway in xenobiotic metabolism and chemical defense, and phenol sulfotransferase SULT1A1 plays a central role in this reaction. Genetic polymorphism of the SULT1A1 gene, SULT1A1, was reported to be associated with risks of several cancers; however, one study showed no significant relation between SULT1A1 genotype with prostate cancer risk. The present study was conducted to confirm the association of a G638A polymorphism, Arg213His, in SULT1A1 with familial prostate cancer risk in a Japanese population. A case-control study consisting of 126 cases and 119 controls was performed. In controls, GG, GA, and AA genotypes were observed in 85 (71.4%), 32 (26.9%), and 2 (1.7%), respectively; whereas, GG, GA, and AA genotypes were observed in 94 (74.6%), 32 (25.4%), and 0 cases, respectively. No significant differences were found in genotypic frequencies among cases and controls. Furthermore, stratification of cases according to clinical stages (localized or metastatic), pathological grades (Gleason score7, or7), age at diagnosis (70 years or70) and the number of affected relatives (2 or2) did not show any significant differences among categories. These findings suggested that genetic polymorphism of SULT1A1 might not be involved in genetic susceptibility to prostate cancer.

1987年から慢性腎不全の臨床治療として腎移植治療を継続的に施行している. 2006年12月までの20年間で62回 (59名) の生体腎移植を施行した. 移植腎生着率は, 1年92％, 5年81％, 10年62％であり, 患者生存率は1年95％, 5年91％, 10年91％であった. 生体腎提供者は親が49名と最も多く, 姻族は4名であった. ABO血液型不適合移植を8名, 2次移植を3名に施行した. 急性拒絶反応出現率は後半の10年で激減した. 腎移植後の妊娠出産を3名に認め, 合計5名の挙児を得た. 移植腎機能喪失原因は, 慢性移植腎症が7例と最も多く, 次いで死亡が4例であった. 腎移植後に甲状腺癌1名, 精巣腫瘍1名を認めたが, 現在再発なく移植腎機能も良好である.

1987年から慢性腎不全の臨床治療として腎移植治療を継続的に施行している. 2006年までの20年間で19例の献腎移植を施行した. 移植腎生着率は, 1年95％, 5年76％, 10年44％であり, 患者生存率は1年100％, 5年87％, 10年73％であった. 移植腎機能喪失原因は, 死亡が4例と最も多く次いで慢性移植腎症が3例であった. 現在当科外来通院中の11名の血清クレアチニンは1mg/dl前後であり移植腎機能は非常に良好である. また, 合併症は腎移植後13年経過する1症例に循環器系の合併症を認め薬物療法中であるが, その他の症例には合併症をほとんど認めず, 外来通院の11名は非常に高いQOLを保持している.

To assess, in a nationwide multi-institutional cohort study begun in 2005 and in which 6927 subjects were enrolled by 2010, the urinary and rectal toxicity profiles of subjects who enrolled during the first 2 years, and evaluate the toxicity profiles for permanent seed implantation (PI) and a combination therapy with PI and external beam radiation therapy (EBRT).Baseline data for 2339 subjects out of 2354 patients were available for the analyses. Toxicities were evaluated using the National Cancer Institute's Common Terminology Criteria for Adverse Events, and the International Prostate Symptom Scores were recorded prospectively until 36 months after radiation therapy.Grade 2+ acute urinary toxicities developed in 7.36% (172 of 2337) and grade 2+ acute rectal toxicities developed in 1.03% (24 of 2336) of the patients. Grade 2+ late urinary and rectal toxicities developed in 5.75% (133 of 2312) and 1.86% (43 of 2312) of the patients, respectively. A higher incidence of grade 2+ acute urinary toxicity occurred in the PI group than in the EBRT group (8.49% vs 3.66%; P.01). Acute rectal toxicity outcomes were similar between the treatment groups. The 3-year cumulative incidence rates for grade 2+ late urinary toxicities were 6.04% versus 4.82% for the PI and the EBRT groups, respectively, with no significant differences between the treatment groups. The 3-year cumulative incidence rates for grade 2+ late rectal toxicities were 0.90% versus 5.01% (P.01) for the PI and the EBRT groups, respectively. The mean of the postimplant International Prostate Symptom Score peaked at 3 months, but it decreased to a range that was within 2 points of the baseline score, which was observed in 1625 subjects (69.47%) at the 1-year follow-up assessment.The acute urinary toxicities observed were acceptable given the frequency and retention, and the late rectal toxicities were more favorable than those of other studies.

Objectives To clarify the effect of androgen concentration on blood flow regulation in seminal vesicles and to identify the androgen most responsible for this effect. Methods The androgen concentrations in the seminal vesicles and the seminal vesicle blood flow were measured at 0, 3, 6, 12, 24, 48, and 72 hours after castration. The androgen concentration was measured with a newly developed highly sensitive simultaneous androgen quantification method that uses liquid chromatography-tandem mass spectrometry. The blood flow was measured with the radioactive microsphere injection method. The change in seminal vesicle blood flow in 6-hour castrated rats after administration of 3 mg/kg testosterone, 3 mg/kg dihydrotestosterone (DHT), 3 mg/kg dehydroepiandrosterone, or 3 mg/kg testosterone plus 20 mg/kg finasteride was evaluated. Results A correlation was observed between the DHT concentration and blood flow in the rat seminal vesicle after castration. The DHT concentration and blood flow decreased after castration to 31.6% and 37.9%, respectively, of the normal level at 6 hours. The decline in DHT concentration and blood flow decreased further thereafter to 2.2% and 18.1%, respectively, of the normal level at 72 hours. Both testosterone and DHT fully restored the organ blood flow in castrated rat seminal vesicles. However, the blood-flow-increasing effect of testosterone was attenuated by more than 50% when administered in combination with finasteride. Dehydroepiandrosterone did not increase seminal vesicle blood flow. Conclusions The results of our study showed a strong correlation between the organ DHT concentration and blood flow in rat seminal vesicles. Of the various androgens, the most active androgen in the regulation of seminal vesicle blood flow was DHT.

Diethylstilbestrol (DES) is a synthetic oestrogen, and its anticancer effects are exerted in androgen-dependent prostate cancer. The administration of DES decreases serum testosterone to castration levels. However, in androgen-independent prostate cancer patients, who are already orchiectomised, the administration of DES improves symptoms and decreases prostate-specific antigen (PSA). The mechanisms responsible for these direct inhibitory effects have been explained as biological actions not mediated by oestrogen receptors. We assessed the gene expression profiles of prostate cancer cells treated with DES, and investigated direct inhibitory effects of DES. DES inhibited the proliferation of LNCaP and PC-3 cells. cDNA microarray analysis showed that expression of many genes was downregulated by DES. However, insulin-like growth factor binding protein 6 (IGFBP-6) gene expression levels were upregulated in PC-3 cells. IGFBP-6 gene expression and protein levels significantly increased after DES treatment. Recombinant IGFBP-6 inhibited cell proliferation, and the inhibitory effect of DES was neutralised by anti-IGFBP-6 antibody. From the immunohistochemical analysis of IGFBP-6 using biopsy samples from androgen-independent prostate cancer, we found IGFBP-6 expression in androgen independent prostate cancer, and that DES treatment increased the IGFBP-6 staining intensity of the cancer cells in one sample. These findings suggested that DES induces IGFBP-6, which inhibits cell proliferation in an androgen-independent prostate cancer cell line, PC-3. IGFBP-6 therefore might be involved in the direct effects of DES in androgen-independent prostate cancer.

PURPOSE To clarify the optimal duration and methods for adjuvant endocrine therapy after external beam radiation therapy (EBRT) in patients with locally advanced prostate cancer. MATERIALS AND METHODS Between 2001 and 2003, 215 patients with locally advanced prostate cancer were enrolled in the study. Patients were registered as primary candidates of the study and were treated with 6 months of LHRH agonist, with short-term of antiandrogen treatment for flare-up prevention. Patients with PSA levels below 10 ng/ml after the 6-month endocrine treatment were randomly divided into two arms. Then, a total dose of 72 Gy was given to the prostate. After 14 months of the protocol treatment, patients were treated with continuous androgen ablation (arm 1) or intermittent androgen ablation (arm 2). RESULTS A total of 188 cases (87%) remained in the protocol. The median PSA level at entry was 25.3 ng/ml. The Gleason score was 2–6 in 32 cases (16%), 7 in 94 cases (48%), and 8–10 in 68 cases (35%). The median PSA level showed a remarkable decrease to 1.1, 0.2, and 0.1 ng/ml, after 6, 8, and 14 months of the protocol treatment, respectively. Of the 157 cases treated with EBRT, 153 cases (97.5%) had no biochemical failure in the mean follow-up of 17.3 months. CONCLUSIONS The present study may reveal the possibilities of intermittent endocrine therapy after EBRT. However, the follow-up interval is short and little can be said about the results observed so far, exception of acute tolerance and patient acceptance of the protocol. © 2004 Wiley-Liss, Inc.

Anemia is a common complication in patients with chronic kidney diseases including posttransplant patients. Guidelines for the treatment of anemia in chronic kidney disease published by NHF-K/DOQI recommend the target hemoglobin and hematocrit (Hb and Ht) levels to be in the 11 to 12 g/dL and 33% to 36% ranges, respectively, which are somewhat higher than those recommended in Japan (Ht = 30%). However, these guidelines were established mainly from the data on hemodialysis patients with only limited information available as to the impact of anemia control in posttransplant patients. The aim of the present study was to evaluate cardiac function and quality of life (QOL) when the Ht was raised to about 36% by administration of recombinant-human-erythropoietin (rHuEPO) to patients with mild impairment of renal function (s-Cre2.0 mg/dL) after renal transplantation. Twenty-five patients were analyzed for cardiac function, blood data, and QOL in a prospective study encompassing 8 months of rHuEPO treatment. Using a once weekly subcutaneous dose of 6000 IU of Epoetin-beta, the Ht became 33% to 36% and Hb was 11 to 12 g/dL. Among the cardiac function tests, left ventricular end-diastolic diameter and left ventricular mass index decreased significantly. QOL did not show any significant changes after administration of rHuEPO. In conclusion, we demonstrated a potential benefit of using rHuEPO to maintain the Hb between 11 and 12 g/dL and the Ht between 33% and 36% in posttransplant patients with regard to the prevention of cardiovascular complications. Further study is required to establish the benefits of correcting anemia by rHuEPO on the outcome of posttransplant patients.

Objective: Hormone therapy for prostate cancer has empirically prevailed in Japan. We planned to evaluate the trends and outcome of hormone therapy for establishing an adequate guideline. Methods: Patients with prostate cancer who were initially treated by hormone therapy were registered through the J-CaP registration system. This report summarizes the background factors. Results: From January 2001 to October 2003, 17 872 patients were registered from 395 institutes throughout Japan. The background factors of 17 312 patients were analyzed. The 17 872 patients were estimated as composing more than half of newly diagnosed prostate cancer patients in Japan. Of these, 22.9, 35.1, 32.9 and 8.6% belonged to T1, T2, T3 and T4, respectively. For the purposes of hormone therapy, 77.5% was primary hormone therapy. Neoadjuvant setting and adjuvant setting were 18.1 and 4.3%, respectively. About 60% of the hormone therapy was combined hormone therapy with LH-RHa plus anti-androgens. Conclusion: Irrespective of patients’ age, TNM, stage of illness, or histological background, the majority of prostate cancer patients in Japan are receiving hormone therapy. It is necessary to evaluate whether this trend is merely a continuation of past experience of Japanese urologists or if there is a difference in the profile of effect and side-effect in the case of Japanese patients compared to therapy given in Westerners.

BACKGROUND It is known that BMP is a factor that strongly induces bone formation in muscle tissue. However, the expression of BMP-7 is not detected in normal bone tissues. Recently, we reported that the level of BMP-7 expression was significantly higher in metastatic bone lesions than in normal bone and that the high expression of BMP-7 in metastatic bone lesions was related to osteoblastic metastasis. The aim of this study was to investigate the level of BMP-7 gene expression in normal prostate glandular tissues, newly diagnosed prostate cancer tissues, and local recurrent prostate cancer tissues. METHODS Total RNA was extracted from 23 samples of normal prostate glandular tissues, 28 samples of newly diagnosed prostate cancer tissues, and 23 samples of local recurrent prostate cancer tissues. We also examined the expression of BMP-7 in human prostatic epithelial cells (HPECs) under conditions of androgen replacement. After reverse transcription of the RNA samples, the expression of BMP-7 was measured by real-time quantitative polymerase chain reaction (PCR). Glyceraldehyde phosphate dehydrogenase (GAPDH) was used as an internal standard. RESULTS The level of BMP-7 expression was highest in the normal prostate glandular tissue (P

The 1997 fourth Banff meeting revised the consensus for describing transplant biopsies. We have conducted a retrospective analysis of biopsies correlated between the Banff 97 classification and clinical outcome. The patients ( n=149), who had a total of 404 biopsy-proven rejections, were assessed and the biopsies taken from these patients were re-examined and classified according to the Banff 97 classification. Morphological changes in the glomeruli (g), interstitium (i), tubules(t), and arterial vessels (v) were scored. Severity of acute rejection was statistically associated with unresponsiveness to anti-rejection treatment ( P0.0001) and predicted an increased risk of graft failure ( P0.05). Each quantitative criterion (g, i, t, and v) was also statistically associated with unresponsiveness to anti-rejection treatment. Mean serum creatinine levels were significantly higher in the groups graded Banff 97 type I-III after 1 and 2 years of follow-up. The Banff 97 classification correlated with reversibility of rejection episodes and long-term graft survival.

To evaluate the accuracy and reliability of laser speckle blood flowmetry in the measurement of prostate blood flow, we performed a comparative study with the ordinary intra-arterial radioactive microsphere injection method using the well-known castrate-rat model. Adult male Wistar strain rats were used for the study. The rats were either only castrated or subcutaneous testosterone replenishment was followed subcutaneously 6 h after castration. The prostate blood flow was measured at different time courses after castration. The effect of a single androgen replenishment on prostate blood flow was also evaluated. The measurement of prostate blood flow was performed by both the radioactive microsphere injection method and laser speckle blood flowmetry, and then the outcomes were compared. Rapid reduction in prostate blood flow to 30% of the normal level was observed 24 h after castration in the measurements with the microsphere injection technique. The prostate blood flow decreased gradually after 24 h post-castration to 23 and 21% of the normal level at 48 and 72 h after castration, respectively. The laser speckle blood flowmetry also detected the decrease in prostate blood flow well, but in a more gradual manner. The prostate blood flow was 70, 52 and 35% of the normal level at 24, 48 and 72 h after castration, respectively. The effect of a single administration of testosterone to castrated rats had recovered the prostate blood flow to 74 and 98% of the normal level by measurement with the microsphere injection technique and laser speckle blood flowmetry, respectively. The different outcome in blood flow rate change between the methods can be explained according to their different mechanism of measurement, thus suggesting the capillary vessels are the early and most responsive portion for hormonal manipulation. In conclusion, the laser speckle blood flowmetry is a convenient and reliable method for evaluating prostate blood flow, especially when the organ is required for other biological and molecular assays, since the method does not require the excision of the organ for the measurement.

We estimated the risk of a rapid prostate specific antigen (PSA) increase in men with a low baseline PSA range of 0.0 to 2.0 ng/ml to investigate the validity of setting a re-screening interval of more than 1 year.Between 1988 and 1999, 6,252 men with baseline PSA 2.0 ng/ml or less without suspicious findings on digital rectal examination (DRE) and 7,304 with the same baseline PSA who did not undergo DRE at the time of baseline PSA measurement were re-screened. The risks of a PSA increase to 4.1 to 10.0, 10.1 to 20.0 and greater than 20.0 ng/ml were investigated and stratified by re-screening interval, baseline DRE status, and subdivided baseline PSA ranges of 0.0 to 1.0 and 1.1 to 2.0 ng/ml.A total of 28 cases (0.2% of 13,556) of prostate cancer were detected after an average re-screening interval of 3.6 years. High PSA above 10 ng/ml at diagnosis was noted in 5 patients (18%), including 2 with a great PSA increase to 1,928 and 298 ng/ml at re-screening intervals of 4 and 6 years, respectively.Setting 4 to 5-year re-screening intervals for PSA measurements in men with PSA 1.0 ng/ml or less can decrease the cost of PSA tests without lowering sensitivity. A re-screening interval for PSA measurement should be set annually for men with PSA 1.1 to 2.0 ng/ml to minimize the risk of missing aggressive cancer.

Objective: To investigate the diagnostic significance of prostate-specific antigen (PSA), density (PSAD), and PSAD adjusted by transition zone volume (PSATZD) in men with PSA levels between 2.1 and 4.0ng/ml. Methods: Between 1993 and 2000, 69 men with PSA levels between 2.1 and 4.0ng/ml underwent transrectal ultrasonography (TRUS) and 8-core prostate biopsy. Diagnostic accuracies for various cut-offs of PSAD and PSATZD were investigated according to subdivided PSA levels of 2.1 to 3.0ng/ml and 3.1 to 4.0ng/ml. Results: The detection rate of prostate cancer was 21.7% (15/69). The percentage of patients with extracapsular disease was 33.3% (5/15) and primary Gleason grade 4 or 5 was obtained in 4 (26.7%) patients. The transition zone volume and PSATZD in cancer cases were significantly different in comparison with those in non-cancer cases. The area under the receiver operating characteristic curve for PSATZD was significantly higher in comparison with that for PSAD in the same subdivided PSA ranges. The diagnostic efficiency for PSATZD was higher than that for PSAD. The diagnostic efficiency showed the highest value at the cut-off level for PSATZD of 0.23 and 0.28 in men with PSA levels of 2.1 to 3.0ng/ml and 3.1 to 4.0ng/ml, respectively. Conclusions: The use of PSATZD cut-offs as a biopsy indication may reduce many unnecessary biopsies without missing most prostate cancer cases in the PSA range of 2.1 to 4.0ng/ml.

慢性腎不全を合併した血友病A患者に, 抗凝固薬や止血法を工夫し安全に維持血液透析を施行できた1例を経験したので報告する.症例は38歳男性. 生来出血傾向は軽度であったが15歳時に血友病Aを指摘されていた. 18歳時糖尿病 (I型) と診断された. 徐々に腎機能が悪化し2000年10月感染をきっかけに腎不全が増悪し緊急透析導入となり, 社会復帰を考慮しCAPD管理となった. 以後, 時に腹膜炎, 肺水腫を併発し臨時血液透析を施行しつつCAPD継続していたが, 2002年4月左前腕内シャントを作製し, 同年10月CAPDの継続が困難となり維持血液透析へ移行となった.維持血液透析時の抗凝固療法は, 当初はnafamostat mesilate (フサン®) を使用したが, 第VIII因子活性20%, APTT 53.5秒, 透析前ACT180秒以上であったため, 無抗凝固薬透析を試みた. しかし, 透析終了時に少量の残血を認めたため, 透析開始時に静脈側からのdalteparin sodium (フラグミン®) 1,000単位のワンショットの全身ヘパリン化を施行し, 現在, 凝固トラブル, 出血症状はなく施行できている. また, 抜針時は第VIII因子製剤 (リコネイト®) 500単位を透析終了時静注し10-15分で止血可能であった. 使用24時間後の第VIII因子活性は平均23%で, 現在のところ第VIII因子インヒビターは陰性である.

Background & Aims : To clarify whether aspirin-dialminate administration suppresses the serum phosphorus (P) level in hemodialysis patients. Methods : The subjects were 13 hemodialysis patients who required antiplatelet therapy with aspirin-dialminate. Serum P and calcium (Ca) levels and the Ca-P product were measured after aspirin-dialminate administration, and they were compared with the levels before treatment. Results : Serum P level decreased from 5.66±1.45 to 4.72 ± 0.92 mg/dL, and the Ca-P product decreased from 53.4± 16.0 to 44.3 ± 10.3 after one month of aspirin-dialminate intake (p < 0.05), however, these effects were not maintained after 2 and 3 months. Serum Ca levels showed no change through the period of the present study. Conclusions : Aspirin-dialminate has an intermittent and limited effect on suppressing the serum P level and the Ca-P product in hemodialysis patients.

前立腺がん死を減少させる最も有効な予防手段は “早期に発見し, 適切に治療する” という第2次予防である.現時点においては, 第2次予防法として最も優れた手段は血液腫瘍マーカー主導スクリーニングである.我々は早期発見, 適切治療こそが前立腺がん死撲滅に一番寄与するであろうという考えのもとに, 1981年から群馬県で血液腫瘍マーカーによる集団検診を太田地区5市町村で開始し, 2003年の現在は70市町村中, 54市町村 (77%) で施行されている.群馬県は全国でもトップクラスの施行率である.1981年から現在までの20数年の間に, 腫瘍マーカーにも変遷がある.1981年から1991年まではPAP検査を, 1992年から現在まではPSA検査を用いた.我々は群馬県での前立腺がん検診データ解析から, 次のような有用な情報を得ることが出来た.1) PSA based検診は前立腺がん集団検診に最も適した検診システムである.2) 一定以上の施行率で, 長期にわたって検診を続けた市町村では転移がん (病期D) が減ってしまう (病期移動, Stage migration).3) 集団検診群の予後は外来受診者群より優れている.これらの結果は, 前立腺がん検診の有効性を示唆するものである.最近, Bartch教授らが行った前向き時系列研究はPSA検診のがん死減少効果があることを報告したが, 前述したわれわれの疫学研究の結果は彼らの結果を支持するものである.さらに, 本稿においては, 最近5年間に, われわれの教室で行われた前立腺がん検診に関連する研究 (家族性・遺伝性前立腺がん, PSA検査など) についてもsurveyし, 紹介した.

症例は, 31歳, 女性. 腎血管筋脂肪腫破裂による, 右腎摘出の既往がある. 2002年2月上旬, 左腎血管筋脂肪腫破裂による出血性ショック状態で当科緊急入院となった. 保存的治療で軽快せず, 左腎摘出術を施行し血液透析 (HD) に導入した. 手術前後で輸血量は約6,000mLに及んだ. 術直後のHD時の抗凝固剤はメシル酸ナファモスタットを使用し, 術後4回目より低分子ヘパリン2,500単位one shotに変更した. しかし, 返血時回路内に残血を認めたため6回目より2,700単位に増量したところ, 残血なくHDを施行できた. 血小板数は7.2万から19.3万の間を変動していた. その後ヘパリン透析に変更したところ, 全身倦怠感, 網膜剥離, 脈絡膜循環障害による視力障害, 血小板減少の増悪, 貧血などが出現した. この時の抗ヘパリン抗体は陰性であったが, 眼底所見, 臨床所見よりheparin-induced thrombocytopenia (HIT) を疑い, 輸血を併用しながら抗凝固剤をアルガトロバン, メシル酸ナファモスタットに変更してHDを施行した. アルガトロバンを使用して早期に治療したことにより, 約2か月で血小板数は15万まで回復し, 血栓症による視力障害も重篤な障害を残すことなく回復した.

Background & Aims : To assess the effectiveness of CT during arteriography (CTA) in superselective transarterial chemoembolization (TACE) for invasive bladder cancer, and to report preliminary results of superselective TACE. Methods : Angiography was performed in 20 patients with invasive bladder cancer, using a combined CT-Angiography system. Of the 20 tumors, 19 were T3, one was T2. The vesical arteries were selected using a 3F microcatheter, and perfusion was confirmed using CTA. TACE was performed after administrating 40 to 100 mg of cisplatin, with and without gelatin sponge particles. The effects of TACE were assessed by surgery or a combination of cystoscopy and CT in 15 cases. Results : The vesical arteries were successfully selected in 18 of 20 patients. In 16 small tumors, the tumor stain was clearly depicted on CTA. In two large tumors, the vascular supply was identified as involving multiple arteries. One case showed complete remission, six showed partial remission, and eight showed no change. Complications included mild local pain around the perineum during TACE, and transient nausea in some patients. Conclusion : CTA may be useful in superselective TACE for invasive bladder cancer, and may contribute to effective treatment of bladder tumors.

Routine screening for prostate cancer remains controversial. However, it is very important to show how the optimal rescreening interval should be set for men who want to be screened after informed consent. To solve this issue, the risk of prostate-specific antigen (PSA) increase above 4.0 ng/ml relative to baseline PSA levels and age was investigated. Between 1988 and 2000, 7,757 subjects screened twice or more and also with baseline PSA levels of 4.0 ng/ml or lower were enrolled in our study. All serum PSA levels were measured by E-test Tosoh II PA assay at one center. Interval PSA levels for men undergoing screening with a greater than 1 year interval were calculated on the assumption that PSA levels changed over time in a simple exponential fashion. Then, the cumulative rate of freedom from PSA increase above 4.0 ng/ml was estimated using the Kaplan-Meier technique stratified by baseline PSA ranges of 0.0 to 1.0, 1.1 to 2.0, 2.1 to 3.0 and 3.1 to 4.0 ng/ml and every 10 years of age ranges. Of the 7,757 subjects, 559 (7.2%) were expected to have had PSA levels increase above 4.0 ng/ml within 5 years after the baseline PSA measurements. The cumulative rate of freedom from the PSA increase above 4.0 ng/ml at 5 years was 98.7%, 92.9%, 70.3% and 38.5% in cases of baseline PSA levels of 1.0 ng/ml or lower, 1.1 to 2.0 ng/ml, 2.1 to 3.0 ng/ml and 3.1 to 4.0 ng/ml, respectively. The cumulative rates of freedom from the PSA increase were significantly decreased with the baseline PSA ranges being higher regardless of age range. Re-screening interval should be set stratified by baseline PSA levels, regardless of age and race. Rescreening interval should be set at 1, 1 to 2 and 3 to 5 years for men with baseline PSA ranges of 2.1 to 4.0 ng/ml, 1.1 to 2.0 ng/ml and 0.0 to 1.0 ng/ml, respectively, in individual-based screening. In mass screening system using PSA alone, rescreening interval should be set in the same manner as in individual-based screening, except for men with baseline PSA levels of 1.1 to 2.0 ng/ml, which should be set at 1 year to avoid developing incurable prostate cancer. © 2004 Wiley-Liss, Inc.

In order to clarify the incidence of bladder cancer with and without prostate cancer, we investigated bladder cancer discovered incidentally by urethrocystoscopy at prostate biopsy. Between April 1997 and December 2003, 498 patients who were suspected prostate cancer were performed prostate biopsy and urethrocystoscopy simultaneously. We investigate possible invasion of prostate cancer into the urethra or bladder mucosa as well as bladder cancer, including other benign lesions of the bladder by urethrocystoscopy. Prostate cancer was confirmed in 175 (35.1%) of the 498 patients histologically, and bladder cancer was discovered incidentally in 12 patients (2.4 %). The incidence of bladder cancer in patients with prostate cancer of 2.3% (4/175) was not significantly different from that in patients without prostate cancer, which was 2.5% (8/323). Superficial and those with a size less than 1 cm were noted in 11 patients (92%) and 10 patients (83%) respectively. High incidence rate of bladder cancer with prostate cancer was reported previously, however, there was no study to compare the incidence rate of bladder cancer between cases with and without prostate cancer. The present study suggests that asymptomatic tiny bladder cancer may be present at an unexpectedly high incidence rate in elderly males.

Prostate glands contain heavy metals such as zinc and cadmium, and epidemiological studies showed that both metals were associated with prostate cancer development. To understand the heavy metal metabolism in prostate glands, we investigated the regulation of metallothionein (MT), metal-responsive promoter element-binding transcription factor (MTF) and zinc transporter (ZnT) in human prostate cells and tissues. Growth of human prostate cancer cells, LNCaP and PC-3 cells, was suppressed by zinc or cadmium treatment in a dose-dependent manner. LNCaP cells expressed MT-1A, 1X and 2A mRNA, and PC-3 cells expressed MT-1X and 2A mRNA. Zinc or cadmium treatment up-regulated MTs, MTF-1 and ZnT-1 gene expression levels in both cell lines. In PC-3 cells, ZnT-1 protein was detected, and was up-regulated by the metal treatment. Human prostate cancer tissues expressed significantly lower levels of ZnT-1 gene in comparison with hyperplastic tissues. We demonstrated the ZnT-1 expression in human prostate for the first time. The present study showed that heavy metal-metabolizing proteins were involved in human prostate homeostasis, and that the metal metabolizing system might be different in malignant tissues.

The RNASEL gene on chromosome 1q25 has been identified as a prostate cancer susceptibility gene. We screened for RNASEL germline mutations in familial prostate cancer patients, and performed a case-control study to examine the association of specific variants with prostate cancer risk in the Japanese. Three variants within the RNASEL gene, G282A, G1385A and T1623G were identified. G1385 and T1623G variants result in previously reported Arg462Gln and Asp541Glu variants, respectively. The novel G282A variant does not cause amino-acid substitution. A case-control study consisting of 101 familial prostate cancer cases and 105 noncancer controls showed that the Gln/Gln genotype of codon462 was observed in 7.6% of controls. However, the Gln/Gln genotype was not observed in cases, and reduced prostate cancer risk (odds ratio (OR)=0.061, P=0.014). The Asp/Asp genotype of codon541 increased the familial prostate cancer risk (OR=7.37, P=0.0004). In subset analysis, a significant association was observed in patients with more than two affected members (OR=3.15, P=0.028), and weak associations were found in patients with metastatic disease (OR=2.40, P=0.11) and high-grade disease (Gleason score >or=7) (OR=3.07, P=0.14). These findings suggested that the polymorphic changes within the RNASEL gene may be associated with familial prostate cancer risk in a Japanese population.

Objectives To investigate the natural history of prostate-specific antigen (PSA) increase in men with and without prostate cancer to clarify the probability of cancer-related PSA increase. Methods Between 1986 and 2001, 504 men aged 79 years or younger with baseline PSA levels of 4.0 ng/mL or less and a PSA increase greater than 4.0 ng/mL on consecutive screening were enrolled in this study. The types of PSA increase were classified as “non-cancer-related PSA increase,” “suspicious cancer-related PSA increase,” and “cancer-related PSA increase.” The probability of a “cancer-related PSA increase” was investigated and stratified by baseline PSA levels and elapsed years until the PSA level increased to greater than 4.0 ng/mL. Results The probability of a “non-cancer-related increase,” “suspicious cancer-related PSA increase,” and “cancer-related PSA increase” was 57%, 15%, and 28%, respectively. The PSA velocity before the PSA increase was not significantly different between those with and without prostate cancer. A “non-cancer-related PSA increase” was observed in 92% of those with a PSA increase within 2 years of baseline PSA ranges of 2.0 ng/mL or less. Regardless of elapsed years until a PSA increase to greater than 4.0 ng/mL, a “suspicious cancer-related PSA increase” or “cancer-related PSA increase” was observed in almost one half of those with baseline PSA levels of 2.1 to 4.0 ng/mL. Conclusions Intensive serial observations should be recommended before undergoing biopsy for those with a PSA increase within 2 years of a baseline PSA range of 0.0 to 2.0 ng/mL. It may be difficult to distinguish between those with and without cancer using only subsequent total PSA measurements for the remaining cases, and prostate biopsy should be recommended at present.

Association between genetic polymorphisms of CYP1A1 and familial prostate cancer risk was examined by a case-control study of 185 individuals. Although the individual analysis of m1 or m2 genotype of CYP1A1 showed no significant association with prostate cancer risk, the presence of any mutated alleles significantly increased prostate cancer risk in comparison with wild-type genotypes by combination analysis (odds ratio [OR]=2.38; 95% confidence interval [CI]=1.72-3.29; P=0.0069). Furthermore, metastatic cancer had a significant association with mutated alleles of m1 and m2. These finding suggested that CYP1A1 polymorphisms has an association with prostate cancer risk, especially with progression of prostate cancer.

Aim: Vitamin D acts as an antiproliferative agent against prostate cells. Epidemiological study has shown that a low level of serum vitamin D concentration is a risk factor for prostate cancer. Vitamin D acts via vitamin D receptor (VDR), and an association of genetic polymorphisms of the VDR gene has been reported. In the current study, we examined the association of VDR gene polymorphisms with familial prostate cancer in a Japanese population. Methods: We performed a case–control study consisting of 81 familial prostate cancer cases and 105 normal control subjects. Three genetic polymorphisms (BsmI, ApaI and TaqI) in the VDR gene were examined by the restriction fragment restriction length polymorphism method. Results: Overall, there was no significant association of the VDR gene polymorphisms with familial prostate cancer risk in the cases and control subjects. However, a weak association between BsmI or TaqI genotypes and cancer risk was observed in subjects under 70 years of age. Stratification of cases by clinical stage or pathological grade did not show significant association between the VDR gene polymorphisms and prostate cancer risk. Conclusion: In the present study, we could not confirm any significant association between VDR gene polymorphisms with familial prostate cancer risk in a Japanese population. Further large-scale case–control studies are warranted to confirm the importance of VDR gene polymorphisms in familial prostate cancer.

Objectives To evaluate the usefulness of measuring the free/total prostate-specific antigen (PSA) ratio (%fPSA) in men with initial PSA levels of 4.1 to 10.0 ng/mL as a predictor of the future risk of developing prostate cancer. Methods Between 1989 and 2001, 201 subjects with an initial PSA level of 4.1 to 10.0 ng/mL, who had free PSA measured at initial screening using frozen serum and underwent consecutive screening at least once, were enrolled in this study. All participants were followed up by consecutive PSA measurements. Biopsies were performed for those with PSA levels greater than 10.0 ng/mL or with a PSA velocity of 1.0 ng/mL or greater in consecutive screening. The follow-up period was 1 to 12 years, and the mean number of screenings was 3.8. The usefulness of %fPSA, age, and total PSA as predictive factors of future prostate cancer morbidity was investigated. The cumulative non-prostate cancer rate was evaluated using Kaplan-Meier analysis relative to various %fPSA cutoffs. Results A total of 142 patients (71%) underwent prostate biopsy at least once during observation according to the biopsy criteria. The detection rate of prostate cancer was 26% (53 of 201) in consecutive screening. The most recent PSA velocity and serum PSA levels at last follow-up in patients with prostate cancer were significantly higher than in those without prostate cancer. The cumulative non-prostate cancer rate was significantly greater in subjects with %fPSA less than the cutoff than in those with %fPSA at the cutoff point or greater in the %fPSA cutoffs of 16% to 25%. Conclusions Men with PSA levels of 4.1 to 10 ng/mL who are not suspected of having prostate cancer by whatever means should undergo %fPSA measurement and be carefully monitored at short intervals over the long-term if they have lower %fPSA levels.

Background: It is important to preserve the neurovascular bundle (NVB) during nerve-sparing surgery. This article presents the preliminary results of our monitoring system for the postoperative preservation of erectile function. Methods: In 15 patients undergoing radical prostatectomy and 20 patients undergoing radical cystoprostatectomy, intraoperative electrical stimulation along the NVB was performed to measure changes in intracavernous pressure before and after prostate removal. Seven of the radical prostatectomy patients and eight of the radical cystoprostatectomy patients underwent nerve-sparing surgery. Postoperative erectile function was evaluated in 25 patients not receiving adjuvant hormonal therapy. Results: The NVB was judged to be preserved at least on one side electrophysiologically in 14 of 15 patients. Pathologically, three patients had pT3 cancer. Postoperatively, sufficient erectile function was demonstrated using the International Index of Erectile Function 5 in three patients, nocturnal penile tumescence in three patients, and a questionnaire or an interview in three patients. The other patients were incompletely erectile. None of the 11 patients not receiving adjuvant hormonal therapy, in whom NVB was not preserved, were erectile. Conclusion: If the successful criterion of nerve-sparing surgery is defined as a change in intracavernous pressure of 4 cm H2O or more being observed at least unilaterally, and the successful criteria of erectile function preservation includes being sufficiently erectile as revealed by an interview, the sensitivity of our system was 69.2% (9/13) and the specificity was 100% (12/12). Neither adverse reactions to the measurement, nor inadequacy of cancer excision accompanying NVB sparing, were observed. These results suggest that our system can predict postoperative erectile function fairly accurately.

The purpose of this study was to clarify the androgen-ablation-induced morphological changes in the capillaries and stroma near the epithelial cells in prostate and seminal vesicles (SV) using transmission electron microscopy (TEM). In ventral prostate (VP) and SV of immature male rats, the luminal areas of subepithelial capillaries and the width of the stromal layers between endothelia and epithelia were measured quantitatively after castration using TEM and a computed image analyzer. The luminal areas of the capillaries were significantly reduced in VP and SV in the short-term after castration. In the stromal layer, the width of the collagen layer surrounding the capillary significantly increased in VP and SV in the long-term after castration. These data suggest that the reduction of the capillaries and the thickening of collagen surrounding them are related to the involution of glandular epithelial cells in VP and SV after castration.

Background and Aims : To investigate the usefulness of intraarterial chemotherapy (IAC) with CDDP powder and lipiodol suspension (LCS) for invasive bladder cancer as a dose escalation modality of conventional IAC, we administered LCS into the internal iliac artery of dogs and evaluated pharmacokinetics of CDDP. Methods : An angiographic catheter was inserted to the internal iliac artery of an anesthetized dog under fluoroscopic guidance. CDDP solution, LCS, or a combination of CDDP solution and LCS were intra-arterially infused. For comparison, CDDP solution was also intravenously infused. The dose of CDDP ranged from 1 to 3 mg/kg. For combination study, the dose of CDDP ranged from 3 to 5 mg/kg. In all groups, blood samples were collected 5, 15, 30, 60, 120, and 180 minutes after administration, and serum Pt levels were measured. Results : In the LCS group, the serum Pt level was lower than those after intravenous or intraarterial infusion of CDDP solution. In the combination therapy group, the serum Pt level increased with the total dose of CDDP. Conclusions : Intraarterial infusion of LCS showed a lower systemic CDDP level. This method may reduce the incidence of side effects, suggesting the usefulness of intraarterial infusion therapy with LCS for invasive bladder cancer.

We attempted to identify factors that predict the outcomes of salvage external beam radiotherapy (sEBRT) in patients who showed local recurrence without systemic progression or isolated prostate specific antigen (PSA) recurrence after initial hormonal therapy.The subjects were 33 patients who were diagnosed as having local recurrence without systemic progression (30 cases) or isolated PSA recurrence (three cases). Of these patients, those with continuously decreasing PSA levels, which were 1.0 ng/ml or less 1-1.5 years after sEBRT, were regarded as good responders (GR) whereas the remaining patients were regarded as poor responders (nGR). Survival rates in these patients and factors that distinguish GR from nGR were evaluated retrospectively.The cancer-specific 10-year survival rate was 82.4% in the 33 patients, 100% in the 21 GR patients and 55% in the 12 nGR patients (P0.0001). Stepwise variable selection to discriminate between GR and nGR revealed that the time from sEBRT initiation to the nadir PSA was the most significant factor (P = 0.000097). Before sEBRT, GR can be predicted in patients with pre-sEBRT PSA30.0 ng/ml and PSA doubling time (PSADT)7.0 months, with a sensitivity of 95.2% (20/21), a specificity of 100% and an accuracy of 97.0%.Good responses to sEBRT can be expected in patients with local recurrence without systemic progression or isolated PSA recurrence after initial hormonal therapy when the patients show both pre-sEBRT PSA30.0 ng/ml and PSADT7.0 months.

BACKGROUND The authors evaluated a new age-adjusted and prostate volume-adjusted biopsy method for the detection of prostate carcinoma through the transperineal and the transrectal approaches in men with PSA levels of 4.1–10.0 ng/mL. METHODS The value of the adjusted biopsy method was calculated by using the following four factors: 1) life expectancy in Japanese men in 1998, 2) prostate volume estimated by transrectal ultrasonography, 3) tumor doubling time (4 years), and 4) tumor volume that influenced death (20 cc). The number of biopsy sites was set at 8–20. Between August, 1999 and December, 2001, 100 men age ≤ 79 years with prostate specific antigen (PSA) levels of 4.1–10.0 ng/mL underwent age-adjusted and volume-adjusted, systematic prostate biopsy. RESULTS The detection rate for the adjusted biopsy method was 46% (46 of 100 men). The clinical stage of prostate carcinoma was Stage II in 85% of patients and Stage III in 15% of patients. If routine six-sextant biopsy had been performed in all of the men who underwent adjusted systematic biopsy, then 15 of 46 patients (33%) with prostate carcinoma would have been missed. The detection rates of prostate carcinoma in men who underwent adjusted biopsies were relatively high, especially in men with PSA levels of 6.1–10.0 ng/mL, men age ≤ 64 years, men with prostate volumes ≥ 50 cc, and men with PSA density (PSAD) levels ≤ 0.15 ng/mL/cc compared with the detection rates from six-sextant and directed biopsies. The high detection rates were observed from biopsy sites at the posterior aspect of the lateral lobe through both the transperineal approach and the transrectal approach and at the anterior aspect of the transition zone through the transperineal approach. CONCLUSIONS The age-adjusted and prostate volume-adjusted prostate biopsy method was more useful for detecting clinically significant disease compared with the traditional six-sextant biopsy method. This adjusted biopsy method was especially useful in patients age ≤ 64 years, patients with large prostate volumes (≥ 50 cc), and patients with PSAD levels ≤ 0.15 ng/mL/cc. The authors recommend that patients undergo an additional transition zone biopsy at the anterior aspect through the transperineal approach. Cancer 2002;95:2112–9. © 2002 American Cancer Society. DOI 10.1002/cncr.10941

Background: Estrogen administration is known to increase serum triglyceride concentrations. This study measured changes in lipoproteins of patients with prostate cancer treated with estrogen to determine whether the increased triglyceride concentrations are associated with atherogenic lipoprotein patterns. Methods: Fifteen patients (52–87 years) with histologically diagnosed prostate cancer received diethylstilbestrol diphosphate (250 mg/day). Serum samples were collected before and after 1 and 2 weeks of treatment. Cholesterol and triglyceride profiles of major lipoproteins were determined by HPLC, remnant-like particle cholesterol and triglyceride concentrations by an immunoseparation technique, and apolipoproteins by immunologic methods. Results: Estrogen treatment induced a 63.3% increase in total triglyceride concentrations, which occurred in all major lipoprotein classes with significant increases in HDL-triglycerides (130.4%), LDL-triglycerides (60.7%) and VLDL-triglycerides (56.2%). HDL-cholesterol increased significantly by 26.8%, while LDL-cholesterol decreased (15.6%). Remnant-like particle triglyceride concentrations also increased significantly by 77%, whereas remnant-like particle cholesterol concentrations remained unchanged. Apolipoproteins A-I and A-II increased; apolipoprotein E and Lp(a) decreased. Conclusions: The techniques used here conveniently demonstrated that short-term estrogen treatment in prostate cancer patients resulted in triglyceride enrichment of all major lipoprotein classes but did not induce changes in the lipoprotein profiles generally recognized as increasing risk for cardiovascular disease, except for the elevation of plasma triglyceride and remnant-like particle triglyceride.

BACKGROUND A study was conducted to investigate the effectiveness of mass screening (MS) for prostate cancer in Japanese communities using the long-term follow-up results. METHODS Subjects were 279 patients with prostate cancer detected by MS in Gunma prefecture (MS group) and 624 patients with prostate cancer who did not undergo screening (non-MS group). From the follow-up data, the prognoses were compared between the groups. RESULTS The ratio of patients with Stage II cancer was higher for the MS group (59.1%) when compared to non-MS group (25.3%). As a whole, the prognosis of the MS group was more favorable than that of the non-MS group for relative survival rate. Prognosis was especially favorable for patients with Stage III prostate cancer in mass screening group considering the effect of lead-time bias. CONCLUSIONS Early detection and longer survival of the patients with prostate cancer detected by mass screening suggested the effectiveness of prostate cancer screening. Prostate 50: 262–269, 2002. © Wiley-Liss, Inc.

原発性陰嚢内硬化性脂肪肉芽腫の手術的摘除例と自然消退例について報告する.症例1 : 44歳男性, 陰茎基部にY字型腫瘤を認め腰椎麻酔下に摘除術を施行.症例2: 32歳男性, 陰茎基部正中に球形の腫瘤を認め局所浸潤麻酔下に摘除術を施行.症例3: 40歳男性, 陰茎基部にY字型腫瘤を認め抗生剤と消炎酵素剤の投与により約5週間で消退.症例4 : 52歳男性, 陰茎基部の左右非対称性Y字型腫瘤を認め4週間の様子観察にて完全に消退.病理組織学的に症例1, 症例2ともに典型的な硬化性脂肪肉芽腫の像であり, 症例2では一部にカンジダと桿菌を認めた.本疾患は比較的稀であるが, 陰茎基部陰嚢内でY字型の腫瘤を形成し著明な増大期を経た後に2～3ヶ月の全経過で自然消退に至ることが特徴的な臨床像である.本邦においては男子外陰部硬化性脂肪肉芽腫として196例の発症を数え, 現在までに未集計のものについて一覧で示した.

PURPOSE The incidence of testicular cancer is rare. However, it is a significant cancer in that it develops not only in old age but also in children and younger age. We investigated the epidemiological characteristics of testicular cancer in Japan, in order to elucidate its features and problems. PATIENTS AND METHODS We surveyed hospitals and clinics in and around Gunma prefecture that treated patients with urologic diseases and reviewed the pathology records from 1985 to 1994, and calculated the annual age-adjusted incidence rates of testicular cancer. Incidence rates in Japan were taken from the estimates made by 'The Research Group for Population-based Cancer Registration in Japan'. The annual number of deaths, annual age-adjusted death rates from 1947 and 1998, the age-specific death rates and decrease rate of them, and the prefectural standardized mortality ratio (SMR) from 1973 and 1998 was calculated from the data reported by Ohno et al. and statistical tables kept in 'Statistics and Information Department, Minister's Secretariat, Ministry of Health and Welfare'. RESULTS In Gunma Prefecture, the annual age-adjusted incidence rates tended to increase. In estimated data of national survey, it slightly increased from 1975-79 to 1980-84, and remained stable thereafter. The annual number of deaths and age-adjusted death rates tended to decrease from around 1980. The peak of age-specific death rates was seen in infants, age 20 to 40 and old age. The decrease in the age-specific death rate was prominent for age under 20 and old age, but not significant for age 25 to 34. Prefectures in which SMR was high (> or = 120) were distributed all over Japan, but prefectures in which SMR was low (< or = 80) were concentrated in western Japan. CONCLUSIONS The annual number of deaths and age-adjusted death rates began to decrease from around 1980, which coincided with the time the clinical trial of cis-platinum began. More than 100 deaths of testicular cancer are reported even now, early diagnosis, early treatment, and improvement of treatment strategy to far-advanced cases are necessary.

症例は32歳, 男性.腹痛の精査で, 後腹膜に巨大な腫瘍を認めた.病理組織学的所見, 画像所見より, 左腎転移, 多発性肺転移, 縦隔リンパ節転移を有する性腺外胚細胞腫瘍と診断された.PEB(CDDP+etoposide+bleomycin)療法4コースを施行し, 腫瘍マーカーの正常化, 腫瘍の著明縮小が得られた.画像上, 腎門部に残存腫瘍を認め, 残存腫瘍摘出術を行った.摘出標本より, 少量のviable cellを認め, 末梢血幹細胞移植を併用したVIP(CDDP+etoposide+ifosfamide)療法を3コース施行した.現在, 外来経過観察中であるが, 画像上の再発, 及び, 腫瘍マーカーの上昇を認めていない.