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Background: While semiannual 60 mg denosumab is a common treatment for osteoporosis, the impact of monthly 120 mg denosumab, the common treatment protocol for bone metastases from solid tumors, on bone metabolism is unclear. Materials and Methods: We reviewed 15 patients with bone-metastatic prostate cancer who initiated monthly 120 mg denosumab in conjunction with androgen deprivation therapy between 2013 and 2014. Bone mineral density (BMD) was measured at the lumbar spine and femoral neck using dual-energy X-ray absorptiometry (DXA), before treatment and annually thereafter. Bone metabolism markers, including urine N-terminal telopeptide (uNTx) and bone type alkaline phosphatase (BAP), were monitored monthly. Results: Twelve of 15 (80%) patients had evaluable DXA before treatment, and of them, eight underwent DXA after a year of initiation without discontinuation of denosumab. Percent changes in BMD from baseline were +6.2% at the lumbar spine and +7.6% at the femoral neck, both of which were significant ncreases (both P

More than 95% of prostate cancers are adenocarcinoma, and neuroendocrine carcinomas (NECs) are very rare, representing less than 1% of prostate cancers. Among NECs of the prostate including small cell carcinoma (SmCC), carcinoids, and large cell neuroendocrine carcinoma (LCNEC), LCNEC is extremely rare. Only 15 cases have been reported to date and their prognoses were very poor. Here, we report a patient with de novo LCNEC of the prostate that was successfully treated with radical surgery and adjuvant androgen deprivation therapy (ADT).

Several prognostic models predicting survival of patients with metastatic urothelial carcinoma (UC) have been developed; however, of them, the first model by Bajorin in 1999 is still the most representative and widely used, and validations of newer models are lacking. This study aimed to validate three major prognostic models for metastatic UC constructed based on clinical trials.We reviewed 200 patients with metastatic UC who received first-line chemotherapy at our five affiliate institutions between 2003 and 2011. Using this multi-institutional cohort, we validated the following models: the "Bajorin model," a model consisting of visceral metastasis and performance status; the "Apolo model," a nomogram including visceral metastasis, performance status, albumin and hemoglobin; and the "Galsky model," a nomogram including leukocyte count, number of sites of visceral metastases, site of primary tumor, performance status and lymph node metastasis. Harrell's c-index was calculated for each model. Cox proportional hazards regression model was used for multivariate analysis.Among 200 patients, 171 (85.5%) died during the follow-up, with a median survival of 12.0 months. Multivariate analysis demonstrated ECOG performance status, visceral metastasis and leukocyte count to be independent predictors of overall survival. C-index results (95% confidence interval) were Bajorin: 0.86 (0.74-0.95); Apolo: 0.89 (0.78-0.98); and Galsky: 0.82 (0.69-0.93).All models were demonstrated to have high external validities in real-world patients, and of them, the "Apolo model" achieved the highest c-index in the present population. Further studies with larger populations are needed for establishment of the next standard model.

Objectives To evaluate the prognostic significance of the pretreatment neutrophil-to-lymphocyte ratio in patients with metastatic urothelial carcinoma who underwent salvage chemotherapy. Methods We reviewed 200 metastatic urothelial carcinoma patients who received salvage chemotherapy at our five affiliate institutions between 2003 and 2011. The associations of pretreatment clinicopathological factors, including neutrophil-to-lymphocyte ratio, with cancer-specific survival and overall survival from the start of chemotherapy were assessed. Cox proportional hazards model was used for multivariate analysis. Results A total of 15 cases with missing data were excluded. Among the remaining 185 patients, 157 died during follow up, with a median survival of 13.0 months. Multivariate analysis showed that the pretreatment neutrophil-to-lymphocyte ratio ≥3, Eastern Cooperative Oncology Group performance status ≥2 and liver metastasis were independent poor prognostic factors, both for cancer-specific survival and overall survival. A prognostic model predicting overall survival was constructed based on the number of these three variables (0, 1 and ≥ 2). The classified patients showed significantly different overall survival (each P

Erdheim-Chester disease (ECD) is a rare form of non-Langerhans cell histiocytosis, which is known to affect various organs; however, there have been no reports of its intrapelvic involvement. We herein describe the case of 69-year-old man who died of a rapidly-growing intrapelvic tumor, which was finally diagnosed as ECD at autopsy. Immunohistochemically, the tumor cells were positive for CD68 and BRAF V600E, and negative for CD1a. Since BRAF V600E has recently been reported to be specific to ECD, it can be a useful biomarker for diagnosis, especially in atypical cases.

CASE REPORT A 45-year-old man came to our hospital with a chief complaint of occipital pain followed by gait disturbance and developing hypohidrosis on the right side 6 days after the onset. Brain MRI revealed an acute infarction in the dorsolateral part of right medulla. Bladder catheter was inserted because of dysuria. 8 days after the onset, the bladder contraction and desire to urinate were normal, by cystometry. However, micturition was still impossible without a catheter. His dysuria was considered to be due to Detrusor-Sphincter Dyssynergia (DSD). 19 days after the onset, he was able to urinate without a catheter. We found only 5 reported cases of lateral medullary infarction with dysuria, all of which had abnormal bladder contraction. This is the first case report of lateral medullary infarction with dysuria in spite of normal bladder contraction.

INTRODUCTION AND OBJECTIVES: Urinary bladder cancer is the fourth most commonly diagnosed malignancy in males in the United States, accounting for 6.7% of all cancer cases. In muscle invasive tumor, radical cystectomy is the recommended treatment. It is clinically relevant to identify muscle invasive patients who were more likely to benefit from radical cystectomy. Recent studies showed that neutorophil-to-lymphocyte ratio (NLR) is a useful predicting prognosis score in several cancers. In bladder cancer, no reliable bio-marker to predict prognosis before surgery. This study was aimed to assess the usefulness of NLR in bladder cancer. METHODS: A total of 37 patients underwent laparoscopic radical cystectomy in Yokohama City University Hospital (Yokohama, JAPAN) from 2008 to 2014. In baseline patients characteristics, laboratory data were collected before radical cystectomy and pathological features were collected from the radical cystectomy specimens. NLR was calculated using neutrophils and lymphocytes counts obtained 2 or 3 days before surgery. Cut-off points were determined using ROC. Overall survival (OS) and progression free survival (PFS) were estimated using Kaplan-Meier methods and differences were compared using log-rank tests. RESULTS: The median and mean age were 67 (64.9 i A 10.1) and the follow-up dates were 726 (88.3 i A 727.4). 5 of 37 (13.5%) patients were dead from bladder cancer and 9 of 37 (24.3%) patients were progressed in bladder cancer. ROC showed the NLR value of 2.38 showed the largest area under the curve. The high NLR group (NLR iÝ 2.38) showed a significantly poor prognosis both in OS and PFS comparing to the low NLR group (NLR < 2.38) (p 1⁄4 0.018 and 0.014, respectively). CONCLUSIONS: NLR might be a new bio-marker to predict prognosis for the patients who receive radical cystectomy. Source of Funding: none

To evaluate the prognostic significance of the pretreatment neutrophil-to-lymphocyte ratio in patients with metastatic urothelial carcinoma who underwent salvage chemotherapy.We reviewed 200 metastatic urothelial carcinoma patients who received salvage chemotherapy at our five affiliate institutions between 2003 and 2011. The associations of pretreatment clinicopathological factors, including neutrophil-to-lymphocyte ratio, with cancer-specific survival and overall survival from the start of chemotherapy were assessed. Cox proportional hazards model was used for multivariate analysis.A total of 15 cases with missing data were excluded. Among the remaining 185 patients, 157 died during follow up, with a median survival of 13.0 months. Multivariate analysis showed that the pretreatment neutrophil-to-lymphocyte ratio ≥3, Eastern Cooperative Oncology Group performance status ≥2 and liver metastasis were independent poor prognostic factors, both for cancer-specific survival and overall survival. A prognostic model predicting overall survival was constructed based on the number of these three variables (0, 1 and ≥ 2). The classified patients showed significantly different overall survival (each P 0.0001, log-rank test), with Harrell's concordance index as high as 0.81.Pretreatment neutrophil-to-lymphocyte ratio elevation was an independent poor prognostic factor for metastatic urothelial carcinoma undergoing salvage chemotherapy. Our newly constructed prognostic model including the pretreatment neutrophil-to-lymphocyte ratio proved to be an excellent discriminator of overall survival.

Silicate urinary calculi are rare in humans, with an incidence of 0.2% of all urinary calculi. Most cases were related to excess ingestion of silicate, typically by taking magnesium trisilicate as an antacid for peptic ulcers over a long period of time; however, there also existed unrelated cases, whose mechanism of development remains unclear. On the other hand, zonisamide, a newer antiepileptic drug, is one of the important causing agents of iatrogenic urinary stones in patients with epilepsy. The supposed mechanism is that zonisamide induces urine alkalinization and then promotes crystallization of urine components such as calcium phosphate by inhibition of carbonate dehydratase in renal tubular epithelial cells. Here, we report a case of silicate urolithiasis during long-term treatment with zonisamide without magnesium trisilicate intake and discuss the etiology of the disease by examining the silicate concentration in his urine.