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Elderly people are at a high risk of experiencing problems with drug therapy due to age- related changes in the body, as well as exposure to many medications owing to multiple health problems. Medication-related adverse events are common amongst the elderly. Pharmacotherapy for benign prostatic hyperplasia or overactive bladder can generally im- prove lower urinary tract symptoms, whilst also improving the quality of life. However,;these drugs also have the potential to cause dangerous adverse events. For this reason, a great deal of caution should be taken when prescribing medication for elderly patients who are suffer- ing from lower urinary tract symptoms.

Prostate cancer, one of the most common malignant tumors among men, is closely associated with obesity and, thus far, several studies have suggested the association between obesity and aggressive pathological characteristics in the United States. However, the effect of obesity on prostate cancer mortality is controversial, and it remains unclear whether obesity contributes to the aggressiveness of prostate cancer in Asian patients. The aim of the present study was to investigate the association between body mass index (BMI) and the clinicopathological characteristics of prostate cancer in 2,003 Japanese patients who underwent radical prostatectomy. There was a significant association between higher BMI and higher Gleason score (GS). The multivariate analysis also revealed that BMI was an independent indicator for GS ≥8 at surgery. Moreover, among patients with lower prostate-specific antigen levels, biochemical recurrence-free survival was significantly worse in those with higher BMI. These results suggest that BMI may be a classifier for predicting adverse pathological findings and biochemical recurrence after radical prostatectomy in Japanese patients.

Background: The insulin-like growth factor (IGF) system, which is composed of two ligands (IGF-I and IGF-II), two receptors (IGFR-I and IGFR-II) and six binding proteins (IGFBP-1 to -6), plays an important role in cell biology. To identify the main components in the IGF system that contribute to human prostate cancer progression after hormone therapy, mRNA expression of the IGF system in human prostate cancer tissue was systematically examined. Methods: Expression of the IGF system in 24 carcinomas obtained from total prostatectomies after hormone therapy was examined. Expression levels of mRNA of each component of the IGF system were analyzed by quantitative reverse transcription–polymerase chain reaction procedures and compared with clinicopathologic parameters. Results: Expression of the IGF system, except IGFBP-1, was detected in all prostate cancer tissue samples. The expression of IGF-II and IGFBP-2 significantly correlated with pathologic stage, lymph node metastasis, histologic differentiation and serum prostate-specific antigen (PSA) levels after hormone therapy. However, expression of IGF-I was significantly lower in locally advanced prostate cancer tissue than in tissue from the early stage. Expression of IGFBP-5 was significantly related to only serum PSA levels after hormone therapy. Conclusions: In the IGF system, IGF-II and IGFBP-2 play a role in human prostate cancer progression and their increased expression is a possible candidate for a prognostic indicator in hormone-treated prostate cancer patients.

PURPOSE A survey of stage I testicular tumors in the Chugoku-Shikoku district was taken in order to explore the clinical characteristics. PATIENTS AND METHODS Three hundred and forty eight cases of stage I testicular tumor treated at 46 facilities in the Chugoku-Shikoku district between 1984 and 1992 were collected. Subjects' background factors, treatment methods and prognosis were studied. RESULTS Tissue types were 249 (71.6%) seminoma and 99 (28.4%) non-seminoma. Adjuvant therapy for seminoma cases included 138 post-operative radiotherapy (4 recurrences, 3 cancer deaths), 57 chemotherapy (no recurrences, 2 contralateral testis tumor cases) and 48 were under surveillance (no recurrence). Adjuvant therapy for non-seminoma cases included 47 chemotherapy (1 recurrence) and retroperitoneal lymph node dissection was performed on 6 cases. Forty cases were under surveillance (1 recurrence). Of 8 (2.3%) cases with recurrence, 6 showed onset within two years and 2 after two years. Four of the 8 cases with recurrence were seminoma (1.1% of seminoma cases) and the other 4 were non-seminoma (4.0% of non-seminoma cases). All 3 (0.9% of all cases) of the cancer death cases were seminoma that received post-operative radiotherapy, while there were no cancer deaths in non-seminoma cases. CONCLUSION Prognosis of stage I testicular tumor is good. Although the recurrence rate was higher in non-seminoma cases, cancer deaths were only observed in seminoma cases.

A case of penile replantation is reported in which a 37-year-old man suffered a self-inflicted complete penile amputation. Replantation was successfully performed; at 3 months after surgery, a urethrocystogram demonstrated the absence of urethral stricture. Although complete erection has yet to be obtained, no other functional impairments have been encountered at 7 months after replantation. Reconstruction of the venous system is considered to be one of the most important factors in achieving a successful penile replantation.

We herein report a case of primary lymphoma of the prostate, which arose in an 85-year-old male with dysuria. CT and MRI examinations demonstrated a large mass in the prostate. A transrectal ultrasound-guided biopsy of the prostate was performed. The histological examination showed diffuse large B-cell lymphoma. The large lesion in the prostate showed spontaneous regression. Spontaneous regression of primary lymphoma of the prostate has not been reported previously. The spontaneous regression of primary lymphoma of the prostate observed in this patient suggests that observation may represent a viable treatment option following a biopsy that has provided a histopathological diagnosis.

To investigate prognostic factors for prostatic cancer, 110 patients who had received hormonal treatment (HT) and 43 patients who had received radiotherapy (RT) were studied. Age of the patients ranged from 49 to 92 years old (median 71 years old) and follow-up period ranged from 3 to 164 months (median 50 months). Survival rate was calculated by Kaplan-Meier method with statistical analysis based upon Cox's proportional hazards regression model. This analysis identified performance status as the most important factor for al patients, followed by histological grade for patients HAVING received HT, and lymph node metastasis for patients received having RT. The result suggests that routine clinical data provide a good indicator as to the prognosis of prostatic cancer.

A permanent cell line of the rat dorsolateral prostate epithelium was established after transformation of primary cultured cells with simian virus 40 (SV40). The established cells had SV40 T-antigen in their nuclei but lacked such typical characteristics of transformed cells as piled-up growth. They grew in a monolayer with an epithelial morphology, were stained with antikeratin antisera, and also retained an ability to form dome-like structure at a confluent state.

We report a rare disorder, horseshoe kidney accompanied by retrocaval ureter and ureteropelvic junction obstruction, in a 42-year-old man. This is the third case in the world literature.

Fibroblast growth factor-1 (FGF-1) and FGF-2 are broad spectrum mitogens. The expression of FGF-1, FGF-2, and their receptor, FGF receptor-1 (FGFR-1), was examined in malignant salivary gland tumours and normal salivary glands, using immunohistochemical methods. In seven cases of adenoid cystic carcinoma (ACC), both duct-like cells and modified myoepithelial cells were apparently immunopositive for FGF-1, FGF-2, and FGFR-1. In five cases of mucoepidermoid carcinoma (MC), all three types of tumour cells including epidermoid cells, mucous cells, and intermediate cells expressed immunoreactive FGF-1, FGF-2, and FGFR-1. In these malignant salivary gland tumours, increased expression of FGFR-1 correlated with the intensity of both FGF-1 and FGF-2 immunoreactivity. In contrast to malignant salivary gland tumours, eight cases of normal salivary gland showed negative immunostaining for FGF-1, FGF-2, and FGFR-1 while four cases were weakly immunoreactive for FGF and its receptor. These results demonstrate that malignant salivary gland tumours overexpress FGF-1, FGF-2, and FGFR-1 compared with normal salivary glands and suggest that these growth factors may play an important role in facilitating neoplastic progression in human salivary glands.

To evaluate the risk factors related to the long-term outcome of endourologic treatment of urinary calculi, we examined rates of recurrence and regrowth in 167 renal units. The following risk factors were examined: age; previous stone; location, number, size, and composition of stone; and procedures. In our study sample, the overall recurrence and regrowth rates were 17% and 10%, respectively. The earliest recurrence and regrowth appeared at 3 months after treatment, and 71% occurred within 2 years. In 22% of renal units that were estimated to be stone-free, stones appeared later, and 45% of inadequately fragmented stones enlarged. Stones located in a renal calix and pelvis, multiple stones, large stones (more than 20 mm), stones composed of calcium oxalate or calcium phosphate or both, and struvite stones were likely to be risk factors, but there were no significant differences statistically. Although the possibility of several risk factors was suggested in our study, thorough fragmentation of stones and complete removal of fragments, combined with extracorporeal shock wave lithotripsy or chemolysis if needed, is ultimately responsible for successful treatment of urinary calculi.

Heparin-binding fibroblast growth factors (HBGF) have been implicated in the regeneration of both parenchymal and nonparenchymal cells of the liver. The response to and phenotype of hepatocyte receptors for HBGF-1 (acidic fibroblast growth factor) and HBGF-2 (basic fibroblast growth factor) were compared to keratinocytes, fibroblasts, and endothelial cells. HBGF-1 stimulated DNA synthesis in hepatocytes, keratinocytes, fibroblasts, and endothelial cells whereas activity of HBGF-2 was limited to fibroblasts and endothelial cells. HBGF-2 antagonized the mitogenic activity of HBGF-1 for hepatocytes and keratinocytes. Hepatocytes and keratinocytes exhibited both high- and low-affinity, nonmatrix receptor sites for HBGF-1, but only low-affinity sites for HBGF-2. The mesenchymal cells displayed only high-affinity sites for both HBGF-1 and HBGF-2. Northern blot and immunochemical analysis revealed that the expression of HBGF receptor genes bek and flg are partitioned between normal hepatocytes and nonparenchymal cells, respectively. Expression of epithelial cell-specific, mesenchymal cell-derived HBGF-7 (keratinocyte growth factor) mRNA in regenerating liver tissue was undetectable relative to HBGF-1. The results support a multifunctional role of HBGF-1 acting through different receptor phenotypes in hepatocyte and nonparenchymal cells during liver regeneration.

The immunological properties of human serum testosterone-estradiol binding globulin (TeBG) which was purified by affinity chromatography and hydroxyapatite column chromatography were investigated and a specific radioimmunoassay (RIA) for human TeBG was established. The purified TeBG here obtained was 86,000 in molecular weight and the antibody prepared against this TeBG slightly cross-reacted with human immunoglobulin G (IgG). The human TeBG labeled with 125I had a high binding activity to the antihuman TeBG antibody, and the sensitivity of the RIA thus obtained was enough to detect the TeBG in 2 μl of the serum.

Stereological analysis of Leydig cell ultrastructure in aged humans was performed by a point-count method on testicular tissues fixed by perfusion with buffered glutaraldehyde. In six aged human males (74 yr old on the average), interstitial tissue occupied 38.9% of decapsulated testis volume, and Leydig cells constituted 3.1% to total tests volume. One cubic centimeter of the testis contained about 7.7 x 10(6) Leydig cells, each of which had a volume of 4,080 micrometer3 on average. Smooth endoplasmic reticulum of Leydig cells occupied 13.4% of cell volume and had a surface area of 2,474 cm2/cm3 testis tissue or 32,000 micrometer2/cell, which was 70.7% of the total membrane area of the cell. Occupying 5.8% of the cell volume, mitochondria had an inner membrane surface area of 434 cm2/cm3 tissue or 5,600 micrometer2/cell, which was 12.4% of the total membrane area of the cell. Relating these stereological values to published data on testosterone (T) secretion rate, an average human Leydig cell would secrete about 20 pg T/day. Each cm2 of smooth endoplasmic reticulum and mitochondrial inner membranes of human Leydig cells would produce 70 ng and 400 ng T/day, respectively.

Bovine serum TeBG was purified by 17 alpha -carboxyethynyl-17-hydroxy-4-androsten-3-one sepharose 4B affinity chromatography (T-sepharose) and hydroxylapatite column chromatography. The chemical and immunological properties of the purified TeBG were surveyed and the following results were obtained. 1) The procedures yielded 400 microgram of protein from 1 L of bovine serum with an overall purification of about 7,560 fold. 2) The purified TeBG was homogenous and was about 80,000 in molecular weight based on sucrose density gradient ultracentrifugation and polyacrylamide gel electrophoresis. 3) The antibody prepared against the purified bovine TeBG did not cross-react with dog and human sera, suggesting the species specificity of TeBG. 4) 125I-bovine TeBG, labelled by the lactoperoxidase method, had a high binding capacity to the anti-bovine TeGB antibody. These results indicate the applicability of purified TeBG and the antiserum for TeBG RIA.

The localization of the testosterone-estradiol-binding globulin (TeBG) in prostate, liver and metastatic lymph node cells of a patient with hormone-independent prostatic carcinoma was studied by the t

The measurement of androgen receptor and 5α-dihydrotestosterone (DHT) levels in prostatic carcinoma may be of value in predicting responsiveness to anti-androgenic therapy. A sufficient amount of prostatic carcinoma tissue must be removed for measuring androgen receptor and DHT levels. We have studied the usefulness of Kaplan cold punch-resection compared with electroresection for obtaining tissue in 29 cases of enucleated benign prostatic hyperplasia. DHT level in electroresected specimens was similar to controls. However, following low, moderate, and high-power electroresection an average of total R1881 binding sites (Bmax) of electroresected specimens was reduced to 82.2, 71.9, and 52.1 per cent of corresponding controls, respectively. In contrast, the per cent decrease of Bmax of Kaplan cold punch-resected specimens was only 10 per cent of the control. From our data, Kaplan cold punch-resection of the prostate appears to be a useful tool for obtaining tissue suitable for measuring androgen receptor levels.