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Background: There are pros and cons regarding the benefit of extended pelvic lymph node dissection (PLND) during surgery for prostate cancer (PCa). A randomized controlled trial failed to demonstrate any survival benefits, and the therapeutic role of PLND remains unclear. We evaluated early survival outcome using a propensity score (PS)-matched analysis. Methods: Three hundred ninety-nine patients with intermediate- to high-risk PCa were enrolled. They were determined to have a lymph node (LN) invasion probability of greater than 7% on the established nomogram. The National Comprehensive Cancer Network classification was used as risk stratification. Biochemical recurrence (BCR)-free survival was compared between the two groups divided by the threshold of the LN yield set at 15. Results: The mean LN yield was 23.7 and 3.4 in the sufficient (n = 217) and insufficient (n = 182) LN yield groups, respectively. In the unmatched cohort, the advantage of the 3-year BCR-free survival for sufficient LN yield remained at 10.0% (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.43-1.07; p = 0.098). In the PS-matched cohort with 133 patients in each group, the difference in the 3-year BCR-free survival rate widened to 15.8% (HR 0.54, 95% CI 0.31-0.93; p = 0.027). A Cox regression multivariate analysis performed on the model with postoperative pathological factors showed an independent predictive value of LN yield. Conclusions: The results demonstrate the therapeutic role of PLND in intermediate- to high-risk PCa. The benefit of PLND depends on the surgeon adhering to the template and removing a sufficient number of LNs in patients with an optimal risk-range.

Background To date, there is no standard established laparoscopic surgical method for managing urachal remnants because of their rarity, and several questions remain unanswered. This study aimed to determine the optimal surgical method for managing urachal remnants and presents the operative outcomes of our cases in relation to the findings from the existing literature. Methods We analyzed the data of 16 patients (7 women and 9 men; age range, 19–48 years) who underwent surgery for urachal remnants between January 2013 and March 2019 at our institution. Results In our cases, all urachal remnants were urachal sinuses, and the primary complaints were umbilical pain and pus discharge. Most of these symptoms were controlled using umbilical drainage and oral antibiotic intake; however, incisional drainage was required in two cases. In all cases, we performed a laparoscopic resection of the urachal remnants; one patient underwent an open conversion due to a very thick abdominal wall. A postoperative complication—local infection that was treated using re-suturing—was observed in one patient. No adverse events occurred in the other cases. Our method was appropriate because it allowed for complete urachal resection with good cosmetic results, i.e., a small and natural scar appearance. Additionally, if bladder injury occurred, bladder re-suturing was easily possible because of the laparoscopic port’s position. Conclusions We present an optimal method for laparoscopic urachal resection. This method may be recommended for young patients with an abdominal wall thickness of

The neuroendocrine (NE) pathway cannot be ignored as a mechanism for castration-resistant prostate cancer (CRPC) progression. The neuromediator, gastrin-releasing peptide (GRP) may be involved in the aberrant activation of the normal androgen receptor (AR) and increased AR variants. This study focused on plasma levels of progastrin-releasing peptide (ProGRP) and examined the treatment outcomes with androgen receptor axis-targeted (ARAT) agents.One hundred patients with metastatic CRPC were enrolled. Enzalutamide (ENZ) or abiraterone acetate/prednisone (AA/P) were administered to 50 patients each in a nonrandomized manner as a first-line or later choice. Plasma ProGRP levels were determined using a chemiluminescent enzyme immunoassay, and data were collected prospectively. The study endpoints were prostate-specific antigen (PSA) response and survival estimates.In the ENZ series, ProGRP levels correlated with the maximum PSA change from baseline (high ProGRP: -34.5% vs. low ProGRP: -85.7% p = .033). PSA progression-free survival (PFS), radiographic/symptomatic (r/s) PFS, and overall survival (OS) in patients with high ProGRP were significantly worse than those in patients with low ProGRP (median PSA-PFS: 3.3 vs. 10.0 months, p = .001, r/s PFS: 5.0 vs. 15.0 months, p 0.001, and OS 17.5 vs. 49.0 months, p .001, respectively). In addition, ProGRP showed an independent predictive value for all survival estimates in multivariate analyses. In the AA/P series, ProGRP levels did not correlate with the PSA change or predict PSA-PFS and r/s PFS, but they maintained a significant difference in OS (19.0 vs. 48.0 months, p = .003).Plasma ProGRP provides a consistent predictive value for OS in metastatic CRPC patients who underwent therapy with ARAT agents. Meanwhile, ProGRP showed different predictive profiles for PSA- and r/s PFS between ENZ and AA/P. These findings clinically suggest a mechanism for CRPC progression involving the NE pathway via the GRP. The underlying mechanism of different predictive profiles by the ARAT agent should be explored in future research.

Background/aim 18F-fluorodeoxyglucose (FDG) uptake measurement on positron emission tomography/computed tomography (PET/CT) is difficult in renal tumors because of the nearby renal parenchyma and urinary tract, which excrete FDG. We carefully examined the maximum standardized uptake value (SUVmax) on FDG-PET/CT and investigated the relationship between major glucose transporters in the kidney and clear cell renal cell carcinoma (ccRCC) progression. Patients and methods Forty-five patients with ccRCC underwent FDG-PET/CT for staging and nephrectomy. Glucose transporter mRNA expression was examined in the removed kidney. Results SUVmax was increased in high-stage and high-grade tumors. Glucose transporter 1 (GLUT1) mRNA expression was higher in tumor tissues, in contrast to other glucose transporters. SUVmax was not correlated with GLUT1 mRNA expression. Kaplan-Meier analysis showed reduced overall and recurrence-free survival in the high SUVmax group. Conclusion Primary ccRCC lesions show a high SUVmax and GLUT1 mRNA over-expression. SUVmax increases with tumor upstaging and upgrading.

Objectives: To avoid misunderstandings based on the failure to demonstrate oncological benefit from extended pelvic lymph node dissection (PLND) during radical prostatectomy in a recent randomized controlled trial. We evaluated early survival outcome in contemporary patients with limited to high-risk prostate cancer (PCa) using propensity score (PS)-matched analysis.Materials and Methods: Three-hundred and forty-seven patients with high-risk PCa were enrolled. They were determined to have a lymph node (LN) involvement probability of greater than 5%. Biochemical recurrence (BCR)-free survival was compared between two groups divided by adherence with extended template and timeframe related to improving PLND procedure.Results: The mean LN yield was 23.4 and 2.7, and the positive LN rate was 19.3 and 2.0% in the extended PLND and other groups, respectively. In the entire unmatched cohort, the estimated curve was 13.1% superior in 3-year BCR-free survival for the extended PLND group. The PS-matched cohort was converged in each LN yield group to 99 patients, and the difference in the 3-year BCR-free survival widened to 22.2% (hazard ratio 0.46, 95% confidence interval 0.27-0.80; p=0.005). The statistical difference was consistent in standard high-risk PCa, and was a significant trend in very high-risk PCa. In the analysis of two groups divided by timeframe, the difference in the BCR-free survival was a significant trend.Conclusion: The results possibly demonstrate the therapeutic role of extended PLND in high-risk PCa. Statistical demonstration of benefits depends on the quality of extended PLND and whether the study cohort is the optimal composition of cancer risk.

Background: A recent randomized controlled trial failed to demonstrate oncological benefit from extended pelvic lymph node dissection (PLND) during radical prostatectomy, while subgroup analysis suggested a potential benefit in high grade prostate cancer (PCa). We evaluated early survival outcome in contemporary PCa patients using propensity score (PS)-matched analysis.Methods: Three hundred and seventy-eight patients with high-risk PCa were enrolled. They were determined to have a lymph node (LN) involvement probability of greater than 5%. The National Comprehensive Cancer Network classification and Johns Hopkins University criteria were used as risk stratification. Clinical stage was determined by assessing digital rectal examination and multiparametric magnetic resonance imaging. Biochemical recurrence (BCR)-free survival was compared between the two groups divided by the threshold of LN yield, which was set at 15.Results: The mean LN yield was 23.9 and 3.4, and the positive LN rate was 20.1% and 2.0% in the sufficient and insufficient LN yield groups, respectively. In the entire unmatched cohort, the estimated curve was 15.6% superior in 3-year BCR-free survival for sufficient LN yield (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.40-0.94; p=0.025). The PS-matched cohort was converged in each LN yield group to 117 patients, and the difference in the 3-year BCR-free survival widened to 24.8% (HR 0.43, 95% CI 0.26-0.74; p=0.002). In the PS-matched analyses of subgroups, the statistical difference was consistent in both standard high-risk PCa (HR 0.43, 95% CI 0.20-0.93; p=0.033) and very high-risk PCa (HR 0.45, 95% CI 0.21-0.96; p=0.040). Conclusions: Our results possibly demonstrate the therapeutic role of PLND in high-risk PCa. The benefit of PLND depends on the surgeon complying with the extended template and removing a sufficient number of LNs in selected patients with an optimal risk-range.

Introduction Treatment-related neuroendocrine prostate cancer, a rare and aggressive malignancy that emerges during androgen deprivation therapy characterized by low serum prostate-specific antigen concentrations, is challenging to monitor because it is associated with predominantly visceral and lytic bone metastases. Case presentation We describe the case of a 69-year-old man with treatment-related neuroendocrine prostate cancer in whom the treatment response could be monitored using whole-body diffusion-weighted magnetic resonance imaging in addition to serum concentrations of neuroendocrine markers. The patient responded well to platinum-based chemotherapy and achieved a complete response, as evidenced by these diagnostic modalities. Conclusion Our case suggests that whole-body diffusion-weighted magnetic resonance imaging is useful in disease management for treatment-related neuroendocrine prostate cancer as well as the potential evaluation of mixed responses and treatment resistance.

Aim：To assess the index lesions（the largest and clinically significant ones）in cases of surgically confirmed prostate cancer（PCa）using a multi-parametric MRI at 3 tesla and to evaluate the relationships between the clinical-pathological features of index PCas and cancer visualization. Materials and Methods：This retrospective study included 67 patients who had undergone roboticassisted radical prostatectomy. Two radiologists reviewed the MRIs（axial and coronal T2-weighted imaging, diffusion-weighted imaging（DWI）with apparent diffusion coefficient mapping and dynamic contrast enhancement MRI（DCEI））. The patients were divided into 4 groups as follows：detected on all 3 sequences（A）, on 2 of 3 sequences（B）, on 1 of 3 sequences（C）, and on none of them（D）. In all groups, all PCa characteristics were assessed, including the PSA level, Grade Group（GG）based on the Gleason score（GS）, the D’Amico criteria, and the maximum tumour length（TL）of the biopsy specimen. Results：Of the 67 patients, 16 were high-risk according to the D’Amico criteria, and 15 of these 16 high-risk patients（94％）belonged to either Group A or Group B. In addition, the mean TL and GG were longer and higher, respectively, in Group A than in the other groups（p＜0.05）. Furthermore, in Group B, 3 of the 4 high-risk patients（75％）were detected using DWI and DCEI. The lesions detected using DWI and DCEI had higher GSs and were in a higher GG. Conclusion：PCas of pathologically higher grades and clinically higher risk were more readily detectableusing multiple parameters.

Background Increased expression of programmed cell death 1 ligand 1 (PD-L1) by tumor cells is thought to be a mechanism through which solid cancers promote immune tolerance. However, the association between PD-L1 expression and the prognosis of upper urinary tract urothelial carcinoma (UTUC) remains unknown. Methods We examined immunohistochemical PD-L1 expression and the tumor-infiltrating lymphocyte density (TILD) in 79 patients with UTUC who underwent nephroureterectomy. We classified the tumors into four types based on the combination of PD-L1 expression and TILD, and studied the clinicopathological characteristics of these four tumor types. Results Elevated expression of PD-L1 by tumor cells and a higher TILD were associated with a worse histological grade, higher pT stage, and higher peripheral blood neutrophil-to-lymphocyte ratio. Elevated expression of PD-L1 by tumor cells, a higher TILD, and type I, III, or IV tumors with elevated expression of either PD-L1 or TILD showed a positive correlation with poorer differentiation and local invasion. These three variables were associated with shorter progression-free survival and overall survival in univariate analysis, but only the latter was an independent determinant according to multivariate analysis. The patients who had type II tumors with lower PD-L1 expression and a lower TILD showed more favorable survival than the other three groups. Conclusions These findings suggest that PD-L1 expression and TILs in the tumor microenvironment influence the progression of UTUC. Accordingly, it is important to understand the immunologic characteristics of the tumor microenvironment to develop more effective treatment strategies for this cancer.

Forty-five patients with ccRCC underwent FDG-PET/CT for staging and nephrectomy. Glucose transporter mRNA expression was examined in the removed kidney.SUVPrimary ccRCC lesions show a high SUV

Background: Sarcopenia has recently been identified as a prognostic factor for various types of cancers. Our aim in this study was to investigate the relationship between sarcopenia and the clinical course and overall survival of patients with renal cell carcinoma (RCC) after surgical treatment. Methods: A retrospective analysis of the patients who underwent surgical treatment for RCC at our hospital, between 2008 and 2011, was conducted. Muscle mass was estimated by the cross-sectional area of the psoas major muscles at the level of L3, measured from computed tomography images. The area was normalized to height for between-comparison of the total psoas area (TPA, cm2/ m2). The median pre- and postoperative TPA was used as a cut-off to classify patients into high and low TPA groups. Overall survival, clinical and pathological factors were compared between high and low TPA groups. Results: The study group included 108 patients (83 males and 25 females). The median pre- and postoperative TPAs were 4.85 cm2/ m2 and 5.03 cm2/m2, respectively. Overall survival was longer among patients in the high than low TPA group (P=0.03), with sarcopenia being predictive of survival in males (P=0.004), but not in females. The pre- to postoperative change in TPA was predictive of postoperative adverse events, but not of surgical factors. Conclusions: A higher TPA is associated with longer overall survival after RCC surgery, particularly in males. The change in TPA after surgery was also predictive of postoperative adverse events, but did not influence operative factors.

Previous studies indicated inverse relationships between body mass index (BMI), diabetes and prostate-specific antigen (PSA) concentration besides an established positive relationship between age and PSA. Other causal relationships between clinical parameters including hypertension, hepatic function, tests, lipid profile and PSA were also suggested. Thus, we incorporated these parameters all together into the analysis to identify possible determinants of PSA concentration to improve the accuracy of PSA tests. Associations between PSA and the above-mentioned clinical parameters were examined among 14,486 men who visited our hospital for a routine health checkup, using linear regression analyses. Total of 1403 (9.7%) and 784 (5.4%) men were classified as diabetes and obesity, respectively. After adjusting age, significant PSA reductions were found in diabetic men, especially for men taking antidiabetics. Such association was seen when the diabetic status was represented by hemoglobin A1c (HbA1c) and fasting blood sugar (FBS) levels. That is, PSA levels were significantly reduced in men with higher HbA1c and FBS levels. Obesity was also associated with a reduction in PSA levels. Moreover, PSA levels were significantly decreased with increased ALT levels. PSA test results should be carefully interpreted especially for men with diabetes and obesity, in whom a substantial reduction in PSA concentration is likely to occur.

We report a rare case of extravasation of urine, which may be associated with bilateral complete ureteral duplication, vesicoureteral reflux (VUR), and benign prostatic hyperplasia (BPH). A 71-year-old male presented with a complaint of right abdominal pain. An extravasation of urine was noted, and was improved by indwelling urethral catheterization. Transurethral resection of the prostate and the endoscopic subureteral injection of dextanomer/hyaluronic acid were performed for the treatment of BPH and VUR, respectively. The post-surgery recovery was successful.

A 26-year-old woman presented to our hospital with right costovertebral angle (CVA) pain. Ultrasonographyand computed tomography(CT) scan indicated right hydronephrosis, and MAG3 renogram showed an obstructed pattern in the right kidney. Enhanced CT scan revealed an ureteropelvic junction obstruction (UPJO) with an aberrant vessel. To clarifythe ureteropelvic junction (UPJ) structure in detail, we utilized 3D-CT with retrograde pyelography (RP), which further revealed the true pinhole ureteral stricture of UPJ unaffected bythe aberrant vessel.

Background Many urologic surgeons refer to biopsy core details for decision making in cases of localized prostate cancer (PCa) to determine whether an extended resection and/or lymph node dissection should be performed. Furthermore, recent reports emphasize the predictive value of prostate-specific antigen density (PSAD) for further risk stratification, not only for low-risk PCa, but also for intermediate- and high-risk PCa. This study focused on these parameters and compared respective predictive impact on oncologic outcomes in Japanese PCa patients. Methods Two-hundred and fifty patients with intermediate- and high-risk PCa according to the National Comprehensive Cancer Network (NCCN) classification, that underwent robot-assisted radical prostatectomy at a single institution, and with observation periods of longer than 6 months were enrolled. None of the patients received hormonal treatments including antiandrogens, luteinizing hormone-releasing hormone analogues, or 5-alpha reductase inhibitors preoperatively. PSAD and biopsy core details, including the percentage of positive cores and the maximum percentage of cancer extent in each positive core, were analyzed in association with unfavorable pathologic results of prostatectomy specimens, and further with biochemical recurrence. The cut-off values of potential predictive factors were set through receiver-operating characteristic curve analyses. Results In the entire cohort, a higher PSAD, the percentage of positive cores, and maximum percentage of cancer extent in each positive core were independently associated with advanced tumor stage ≥ pT3 and an increased index tumor volume > 0.718 ml. NCCN classification showed an association with a tumor stage ≥ pT3 and a Gleason score ≥8, and the attribution of biochemical recurrence was also sustained. In each NCCN risk group, these preoperative factors showed various associations with unfavorable pathological results. In the intermediate-risk group, the percentage of positive cores showed an independent predictive value for biochemical recurrence. In the high-risk group, PSAD showed an independent predictive value. Conclusions PSAD and biopsy core details have different performance characteristics for the prediction of oncologic outcomes in each NCCN risk group. Despite the need for further confirmation of the results with a larger cohort and longer observation, these factors are important as preoperative predictors in addition to the NCCN classification for a urologic surgeon to choose a surgical strategy. Electronic supplementary material The online version of this article (doi:10.1186/s12894-017-0238-y) contains supplementary material, which is available to authorized users.

Introduction/Background Castration-resistant prostate cancer remains a therapeutic challenge, even after establishing the survival benefits of docetaxel chemotherapy. Metronomic chemotherapy stabilizes various cancers through antiangiogenic and immunomodulatory effects. We evaluate the activity of metronomic oral cyclophosphamide chemotherapy in metastatic CRPC patients, and assess predictive factors for clinical outcomes. Patients and Methods Twenty-four patients with metastatic CRPC received an oral cyclophosphamide and dexamethasone regimen. Of those, 11 patients (45.8%) had been exposed and resistant to previous docetaxel chemotherapy. Six patients had refused to receive docetaxel chemotherapy, and 7 patients could not receive the therapy because of deteriorated performance status. All patients had already shown resistance to continuous dexamethasone therapy. Demographic and clinical data were collected prospectively. Results A total of 16 patients (66.7%) experienced a reduction in PSA levels, and PSA decrease ≥ 50% was observed in 8 patients (33.3%). The median PSA progression-free and overall survival were 5.0 months and 19.0 months, respectively. The favorable PSA decrease had no associations with the progression-free and overall survival, but 7 patients (29.2%) in whom response had exceeded 8 months achieved long overall survival of 28 months in median. None of the patients discontinued therapy because of the presence of toxicities. Conclusion Metronomic cyclophosphamide is an active and well tolerated chemotherapy and can be an option for metastatic CRPC patients. The benefit of this regimen could not always be evaluated according to a favorable PSA decrease; thus, we must identify the predictive factors of response other than known clinical factors.

Background Renal cell carcinoma (RCC) with sarcomatoid differentiation is invasive, refractory to treatment, and has a higher mortality. Therefore, systemic therapy is still challenging, and the curative resection of localized or locally advanced RCC with sarcomatoid differentiation is very important. Axitinib is a potent and selective second-generation vascular endothelial growth factor receptor tyrosine kinase inhibitor with improved safety and tolerability. Axitinib is generally recommended as second-line therapy for advanced RCC because the phase III axitinib versus sorafenib in advanced RCC (AXIS) trial demonstrated that it achieved longer progression-free survival than sorafenib in patients with metastatic RCC after failure of an approved first-line regimen. Methods We present a 73-year-old man who had a large (13 cm in diameter) right RCC with sarcomatoid differentiation that directly invaded the duodenum and inferior vena cava. The patient presented with gastrointestinal bleeding, was unable to eat solid food, and had become emaciated. Thus, his classification was poor risk with anemia, hypercalcemia, and poor performance status, according to the Memorial Sloan-Kettering Cancer Center criteria. He seemed unlikely to survive if radical nephrectomy, cavotomy with thrombectomy, and pancreatoduodenectomy were performed. To reduce the tumor burden and potential operative complications, we administered axitinib as first-line neoadjuvant therapy. Results Six weeks of treatment reduced the tumor burden without causing severe toxicities. Subsequently, radical right nephrectomy, cavotomy with thrombectomy, and pancreatoduodenectomy were performed successfully. The pathological treatment effect of axitinib was grade 2 (two-thirds necrosis). The resected tumor showed a heterogeneous reaction for phosphorylated Akt (Ser-473) by Western blotting and immunohistochemistry, indicating that parts of the tumor were sensitive to axitinib and other parts were not. Conclusion Axitinib might be promising as preoperative or neoadjuvant therapy for locally advanced RCC (>cT3b or >cTanyN1).

Objective Renal cell carcinoma (RCC) is a hypervascular tumour due to high constitutive production of vascular endothelial growth factor (VEGF), which is activated by hypoxia-inducible factor (HIF). Elevated levels of cardiovascular peptides, including brain natriuretic peptide (BNP), have been reported in patients with cancer, regardless of whether they have overt cardiovascular disease. Furthermore, it has been demonstrated that hypoxia stimulates BNP production by an HIF-dependent manner. However, the clinical implications of such cardiovascular peptides in patients with RCC have not been assessed. Methods In patients with clear cell RCC who underwent nephrectomy, we investigated the relationship between the serum level of BNP or N-terminal pro-BNP (NT-proBNP) and various clinicopathological characteristics, including serum VEGF and expression of BNP and HIF-2 alpha in the primary tumour. Results Elevated preoperative serum levels of BNP, NT-proBNP and VEGF, as well as increased tumour expression of HIF-2 alpha, were associated with a worse performance status, local invasion, distant metastasis and shorter overall survival. HIF-2 alpha expression showed a positive correlation with the preoperative serum VEGF level, while there was no relation between the serum levels of BNP/NT-proBNP and VEGF or tumour expression of HIF-2 alpha. BNP expression was very low in both tumour tissues and normal kidney tissues. Serum levels of BNP, NT-proBNP and VEGF all decreased significantly after nephrectomy. Conclusions Our findings suggested that the preoperative serum levels of BNP and NT-proBNP are markers of tumour progression, as well as indicators of subclinical functional and structural myocardial damage in patients with advanced RCC.

Cesarean hysterectomy for placenta previa percreta with bladder invasion often induces not only massive hemorrhage but also severe bladder/ureter injuries. A 37-year-old woman with previous cesarean delivery suffered placenta previa percreta with bladder invasion. At the 34th week, we performed cesarean hysterectomy. Without separating the bladder from the uterus/cervix, we incised the bladder lateral wall using an automatic stapling/cutting device, leaving the bladder posterior wall adhering to the uterus and resecting it with the uterus. The bladder was easily repaired without urological sequelae. We suggest a new, simple and safe technique for cesarean hysterectomy for this disease.

Background The relationship between the clinicopathological features and molecular changes associated with standardized uptake value (SUV) determined by Positron emission tomography (PET) with [18F] fluorodeoxyglucose (18F-FDG PET) in human renal cell carcinoma (RCC) has not been elucidated. On the other hand, overactivation of the phosphatidylinositol 3’kinase (PI3K), serine/threonine kinase Akt, and mammalian target of rapamycin (mTOR) pathway has been detected in a variety of human cancers, including RCC. So far, little is known about the relationship between the SUV and these proteins in human RCC. Thus, it is important to study the relevance of SUV with clinicopathological features in human RCCs from a molecular point of view. Methods Seventy-seven consecutive patients with RCC who underwent nephrectomy and pretreatment determination of the maximum SUV (SUVmax) by 18F-FDG PET were analyzed. We investigated the relationship between the SUVmax, phosphorylated-Akt (Ser-473) (pAkt(Ser-473)), phosphorylated-Akt (Thr-308) (pAkt(Thr-308), and phosphorylated-S6 ribosomal protein (Ser-235/236) (pS6) protein levels in the primary tumor and various clinicopathological features. Results The average SUVmax of the primary tumor was 6.9 (1.5 to 40.3). A higher SUVmax was correlated with higher expression of pAkt(Ser-473), pAkt (Thr-308), and pS6 protein in the primary tumor. A higher SUVmax and increased expression of pAkt (Ser-473), pAkt (Thr-308), and pS6 of the primary tumor was associated with less tumor differentiation, a higher pT stage, regional lymph node involvement, microscopic vascular invasion, and distant metastasis, as well as with early relapse following radical nephrectomy in patients who had localized or locally advanced RCC without distant metastasis (cTanyNanyM0) and with shorter overall survival in all patients. Conclusions A higher SUVmax on 18F-FDG PET is associated with elevated tumor levels of pAkt and pS6 protein and with aggressive behavior and metastatic potential of RCC, as well as with early relapse following radical nephrectomy and shorter overall survival. These findings suggest that SUVmax may be useful for predicting the biological characteristics of RCC.

Background Activation of Rho, one of the small GTPases, and its major downstream target Rho-kinase (ROCK) promotes the development and metastasis of cancer. We previously showed that elevation of Rho and ROCK expression was associated with tumor invasion, metastasis, and an unfavorable prognosis in patients with urothelial cancer of the bladder or upper urinary tract. Methods We investigated the effects of a ROCK inhibitor on the growth, migration, and apoptosis of bladder cancer cells. We also examined phosphorylation of RhoA (RhoA activity) by measuring its GTP-bound active form and assessed the expression of ROCK to explore the underlying molecular mechanisms. Results Lysophosphatidic acid (LPA) and geranylgeraniol (GGOH) induced an increase of cell proliferation and migration in association with promotion of RhoA activity and upregulation of ROCK expression. The ROCK inhibitor fasudil (HA-1077) suppressed cell proliferation and migration, and also induced apoptosis in a dose-dependent manner. HA-1077 dramatically suppressed the expression of ROCK-I and ROCK-II, but did not affect RhoA activity. Conclusions These findings suggest that ROCK could be a potential molecular target for the treatment of urothelial cancer.

To clarify the role of serum soluble T cell regulatory molecules in clear cell renal cell carcinoma (CCRCC), we measured the serum levels of soluble interleukin-2 receptor (sIL-2R), soluble B7-H3 (sB7-H3), and soluble cytotoxic T lymphocyte associated antigen-4 (sCTLA-4) in 70 CCRCC patients and 35 healthy controls. We investigated correlations between the serum levels of these soluble T cell regulatory molecules and the pathological grade, clinical stage, and prognosis of CCRCC. We also assessed the relations among each of these soluble molecules. As a result, the serum level of sIL-2R was significantly higher in CCRCC patients than in healthy controls (P<0.05). In addition, elevation of serum sIL-2R was significantly correlated with the clinical stage (P<0.001), and the survival of patients with high sIL-2R levels was shorter than that of patients with low sIL-2R levels (P<0.05). Furthermore, the serum level of sB7-H3 was also significantly correlated with the clinical stage (P<0.05), while the sIL-2R and sB7-H3 levels showed a positive correlation with each other (R=0.550,P<0.0001). These results indicate that the serum level of sIL-2R reflects tumor progression in CCRCC patients. In addition, the possibility was suggested that the IL-2/IL-2R and B7-H3 pathways may be involved in the progression of CCRCC.

Background The system L amino acid transporter (LAT) has an important role in the transport of various amino acids, and there have been reports about the relation of this system to cancer. Although LATs are highly expressed in the kidneys, little is known about their influence on human renal cancer. Methods To clarify the role of LATs in human clear cell renal cell carcinoma (RCC), we investigated the expression of mRNAs for LAT1, LAT2, LAT3, LAT4, and 4F2hc in clear cell RCC tissues. The mRNAs of these five genes were analyzed by the real-time reverse transcription polymerase chain reaction in matched sets of tumor and non-tumor tissues obtained at operation from 82 Japanese patients with clear cell RCC. We also measured phosphorylated S6 ribosomal protein (Ser-235/236) proteins levels in 18 paired tumor and non-tumor tissues of the patients by Western blotting. Results Expression of LAT1 mRNA was significantly increased in tumor tissue compared with non-tumor tissue, while expression of LAT2 and LAT3 mRNAs was reduced. There was no difference in the expression of LAT4 and 4F2hc mRNAs between tumor and non-tumor tissues. Increased expression of LAT1 mRNA was associated with less differentiated tumors, local invasion, microscopic vascular invasion, and metastasis. Kaplan-Meier survival analysis showed that a higher serum LAT1 mRNA level was associated with a shorter overall survival time. Phosphorylated S6 ribosomal protein levels were associated with metastatic potential. LAT1 mRNA levels positively correlated with phosphorylated S6 ribosomal protein proteins levels in primary tumors. Conclusions These findings suggest that LAT1 mRNA is related to the invasive and progressive potential of clear cell RCC.

A 41-year-old man underwent surgery for treatment of an intervertebral disk hernia and received urethral catheterization at another hospital. After insertion of the catheter, intermittent urethral bleeding occurred. He was brought to our hospital by ambulance because of massive urethral bleeding and urethral pain on the day after the operation. Laboratory tests showed a decrease of hemoglobin, and contrast computed tomography revealed intense enhancement of part of the urethra that resembled an aneurysm. Urethroscopy showed a pseudoaneurysm in the bulbar urethra and the arterial bleeding was stopped by transurethral coagulation.

A 30-year-old man underwent a left high orchiectomy because of stage I testicular tumor in December, 2006. A palpable nodule was noticed in the contralateral testicle in March, 2008. No tumor marker was elevated. Imaging studies including ultrasonography and magnetic resonance imaging showed a 13 mm tumor consisting of both a solid portion and a hemorrhagic cyst. A malignant tumor could not be ruled out completely based on examinations and his medical history. Tumor resection with partial orchiectomy was planned after informed consent. Preoperative serum concentration of free testosterone was 8.4 pg/ml, and motile sperm were found in the semen analysis. The tumor was resected while the spermatic cord was clamped transiently. The pathological diagnosis of frozen sections confirmed no malignancy, and the final pathological result was mature teratoma, no evidence of malignancy. No androgen substitution has been required. Furthermore, a few normal motile sperm were detected in the ejaculated semen after the surgery. Organ-sparing surgery for the contralateral testicular tumor following orchiectomy, can be considered to avoid infertility and hormonal substitutions.

A 75-year-old man visited our hospital with the complaint of lumbago due to bilateral hydronephrosis. Computed tomographic (CT) scan revealed a thick and homogeneous retroperitoneal soft-tissue mass with isodensity to the muscle, which extended from around the kidneys to the bladder. His serum IgG4 level was extremely high. He also had proptosis. He was diagnosed as having retroperitoneal fibrosis due to IgG4- related sclerosing disease, and treated with glucocorticoid and azathioprine. After 2 months, partial regression of the mass was observed.

A 39-year-old woman visited our hospital with a complaint of gross hematuria. Cystoscopy revealed a nodular tumor 3 cm in diameter in the posterior wall of the bladder. A transurethral resection was performed. This initial operation was complicated by unexpected intra-operative high blood pressure and visualization was obscured by bleeding. The histological diagnosis was paraganglioma. Therefore, a partial cystectomy was planned. Using cystoscopy, a 10 mm margin was identified and marked using electrocoagulation, followed by an open surgical procedure. After laparotomy, drainage veins were identified and ligated under the guidance of flexible cystoscopy lighting. Intra-operative blood pressure was stable during the operation, and the margin was negative for tumor.

Although renal cell carcinoma (RCC) is considered to be an immunogenic tumor, the role of immunogenicity in this tumor for predicting treatment response has been little investigated.Resected RCC specimens from 25 patients who received cytokine treatment for metastases were investigated using immunohistochemistry for CD83+ or S100+ dendritic cells (DCs), CD8+ T-cells, HLA-DR+ tumor cells, CD68+ tumor associated macrophages, microvascular density and vascular endotherial growth factor.Among the examined parameters, DCs status showed predictive value, that is, higher numbers of CD83+ or S100+ cells in tumors were associated with favorable treatment response. However, only higher CD83 status, which indicates mature and activated DCs, contributed to better survival (p = 0.0339).Increased tumor infiltration of mature DCs would be a predictor of treatment response and outcome in metastatic RCC patients, who receive immunotherapy.

A 56-year-old woman presented with bilateral hydronephrosis and moderate renal insufficiency. A diagnosis of bilateral ureteral obstruction and low-compliance bladder following pelvic irradiation was made by urological examinations. She underwent gastrocystoplasty to facilitate bilateral ureteral reimplantation with an uneventful postoperative course. We consider that the use of the stomach to reconstruct the urinary tract injured by pelvic irradiation is valuable to avoid an abdominal urinary stoma.

We report a case of ring-enhanced malignant meningioma mimicking a solitary brain metastasis in a patient with renal cell carcinoma. This misleading situation is rarely encountered and has not been documented previously. Considering the low incidence of brain metastases from a renal cell carcinoma staged T1–2 without systemic metastases, a clinical diagnosis requires circumspection, and both primary and metastatic tumors should be considered when a solitary brain lesion is encountered.

BACKGROUND Increases in neuroendocrine phenotype and secretory products are closely correlated with tumor progression and androgen independence in prostate cancer. In this study, we explored this correlation using serum progastrin-releasing peptide (ProGRP), a carboxy-terminal region common to three subtypes of precursors for gastrin-releasing peptide (GRP), which is released from the neuroendocrine phenotype to act as a growth factor. METHODS In 60 patients with benign prostatic hyperplasia (BPH) and 200 with prostate cancer, serum ProGRP levels were determined with an enzyme-linked immunosorbent assay (ELISA) kit and evaluated in relation to clinical stage, hormonal treatment, and prostate-specific antigen (PSA) values. Fourteen randomly selected patients were entered in the follow-up study. Additionally, expression of ProGRP as determined by immunohistochemical analysis was compared to that of chromogranin-A (CgA) in tissue samples from several subjects. RESULTS We found a positive correlation between PSA and ProGRP in patients with untreated prostate cancer; no correlation was found in the treated groups. The increases in the ProGRP value and in the percentage of patients with higher than normal values were significant (P

Objectives. To review our early experience with the use of a gastric segment for lower ureteral replacement in patients with bilateral ureteral stenosis after pelvic radiotherapy. Methods. Four adult patients (three women and one man) underwent bilateral ureteral substitution using stomach. All patients received whole pelvic irradiation for malignant disease and had undergone bilateral nephrostomy because of severe bilateral ureteral stenosis. The postoperative follow-up period was 11 to 50 months. Results. No major complication was recognized, and the bilateral nephrostomy tubes were removed in all patients. Three female patients could void urethrally without incontinence, and the male patient needed regular self-catheterization. The three women were alive with normal renal function at a follow-up of 11 to 50 months. The man had a vesicorectal fistula 8 months postoperatively, and colostomy was performed. He died of a cause unrelated to the operation 11 months after surgery. Conclusions. Stomach has not been used commonly for ureteral replacement. In patients with bilateral severe ureteral stenosis after pelvic radiotherapy, ureteral substitution with a gastric segment can be safely performed and will increase the patient’s quality of life.

We report a case of leiomyoma of the ureter, and the patient underwent partial ureteral resection. This is the 8th case reported after 1955, and the clinical features of ureteral leiomyomas of these 8 cases are discussed.

Purpose We investigated balanoposthitis caused by Streptococcus pyogenes following sexual intercourse to reveal an efficient diagnosis and treatment. Materials and Methods: Five male patients complaining of genital inflammation after sexual intercourse were diagnosed as balanoposthitis arising from Streptococcus pyogenes infection between 2008 and 2012. The clinical characteristics were retrospectively reviewed. Results Three cases presented with marked pyoedema of the glans and foreskin mimicking gonococcal or chlamydial urethritis. The remaining two cases presented with papules, scabs and erosions without discharge, which were similar to candidiasis or genital herpes. All cases were diagnosed as balanoposthitis arising from Streptococcus pyogenes infection, which was confirmed by cultures of genital area. Two of them underwent biochemical testing of rapid antigen detection (StatCheck Strep A II TM , Kainos Ltd., Japan) with bacterial culture examination, and identified as streptococcal balanoposthitis at the initial visit. Three cases were successfully treated with penicillin. Antibiotic susceptibility revealed that all cases were fluoroquinolone intermediate resistant patterns Conclusion Streptococcal balanoposthitis has rarely been reported, and has not been recognised as a sexually transmitted infection. Because of common appearances and symptoms, it may have a higher prevalence than previously considered. These cases could be divided into two categories in terms of clinical characteristics,“discharge dominant type” and “eruption dominant type”. Rapid antigen detection of Streptococcus pyogenes should be attempted to use as first diagnostic tool for male genital inflammation for proper antibacterial therapy.