(Purpose) To investigate if timing of first visit, ages, sex, family history of cancer, and smoking history would cause any differences in patients' attitude toward cancer disclosure. (Subjects and methods) Subjects were 10,552 patients who first visited Urology Department of Nihonkai Hospital between 1993 and 2007, and were asked to fill in the questionnaire. The questionnaire contents are as follows; "If you were diagnosed as having cancer, would you like to be informed about the diagnosis of your disease?", and "If your families were diagnosed as having cancer, would you like to inform them about the diagnosis of their disease?". The subjects were asked to select their answers from the following options: 1) "fully informed", 2) "informed only when it is curable", 3) "not informed", and 4) "can not decide now". The relation of patients' attitude toward cancer disclosure with the timing of first visit, ages, sex, family history of cancer, and smoking history was investigated. (Results) The response rate was approximately 80%. If the subjects would have cancer, 71.5% preferred to be informed ("fully informed" or "informed if it is curable"), and 9.2% did not. If the subjects' family would have cancer, 55.5% preferred their family to be informed ("fully informed" or "informed if it is curable"), and 14.9% did not. As it became more recent, both the rate of subjects who did not prefer to be informed (11.5% in 1993-1995, and 8.0% in 2005-2007) and the rate of those who did not prefer their family to be informed (18.6% in 1993-1995, and 11.0% in 2005-2007) decreased. Young subjects, men, and smokers more preferred to be informed. The subjects who had family history of cancer more preferred to inform them, but less to inform their family. (Conclusions) As it became more recent, both the subjects who did not prefer to be informed and those who did not prefer their family to be informed decreased. The idea that cancer disclosure was necessary to select the treatment methods based on each patient's preference and decision had been pervasive.
(Purpose) The aim of this study is to analyze the incidence of involvement of ipsilateral adrenal gland from renal cell carcinoma and assess the actual significance of ipsilateral adrenalectomy at nephrectomy. (Patients and methods) From 1981 to 2007, 588 patients were diagnosed as having renal cell carcinoma pathologically at our institution. Of those patients, we retrospectively reviewed the clinicopathologic data in the 426 renal cell carcinoma patients who were eligible for evaluation. Of the 426 patients, 193 (AD group) and the remaining 233 (AS group) underwent radical or partial nephrectomy with or without adrenalectomy, respectively. (Results) Five patients (2.6%) of AD group had adrenal involvement and all of them presented T4 and/or M1 disease. The three patients presented direct involvement of adrenal gland, while metastasis in the remaining 2. All the 5 patients had disease progression after surgery and 4 of them died of disease. The remaining one patient, in whom interferon showed a remarkable response, has been alive with disease for 31 months. The ipsilateral adrenal gland was abnormal on preoperative computed tomography (CT) in 8 patients (1.8%), of whom, 4 had adrenal involvement. One of the five adrenal involvements was overlooked by CT. Thus, in this study, CT showed 80% sensitivity, 98% specificity, 99% negative predictive value and 50% positive predictive value. The 18 patients (7.7%) in AS group later developed nodal and/or visceral metastasis, while no solitary ipsilateral adrenal recurrence was observed in this group. (Conclusions) Ipsilateral adrenal involvement from renal cell carcinoma is rare, especially after the adrenal-sparing surgery. It is concluded that concomitant adrenalectomy appears to give a very limited therapeutic benefit in this study.
(Purpose) Advanced prostate cancer responds well to endocrine therapy initially, but soon becomes refractory and has a poor prognosis. We analyzed the prognostic factors of prostate cancer responding well initially to maximal androgen blockade (MAB) but later showing PSA relapse and treated with estrogen. (Materials and methods) In prostate cancer patients newly diagnosed from January 1992 to December 2008 at our institution, there were 85 patients in that the PSA level dropped below 10ng/ml by MAB, but showed PSA relapse thereafter and treated with estrogen. We investigated the relationship between age at diagnosis, clinical stage, pathological differentiation, initial PSA, the value of PSA nadir, duration between diagnosis and initiation of estrogen therapy, duration between PSA failure and initiation of estrogen therapy, the value of PSA at estrogen therapy, PSA doubling time (PSA-DT) at estrogen therapy, PSA response three months after initiation of estrogen therapy, use of diethylstilbestrol diphosphate (DES-P) at the initial stage of therapy, local radiotherapy to prostate, type of estrogen and prognosis after estrogen therapy. (Results) In Kaplan-Meier method, factors which showed poorer prognosis were stage B and D, poorly differentiated, PSA 11.9ng/ml or higher at estrogen therapy, PSA-DT shorter than 2.3 months before estrogen therapy and PSA response without CR three months after initiation of estrogen therapy. In multivariate analysis, the factor that most significantly affected prognosis after estrogen therapy was PSA response three months after initiation of estrogen therapy (hazard ratio: 12.61), followed by PSA-DT at estrogen therapy (hazard ratio: 2.59). (Conclusion) We investigated the prognostic factors refractory to MAB and treated with estrogen. These results are useful in planning the therapy, and in explaining the status or future prospective of the disease to families and patients.
(Purpose) The objective of our study was to compare T2-weighted magnetic resonance imaging (T2WI), combined T2-weighted and dynamic imaging (Dynamic), and combined T2-weighted and diffusion-weighted imaging (DWI) in the identification of the site of prostate cancer. (Materials and methods) Before radical prostatectomy, 85 patients with prostate cancer underwent magnetic resonance imaging using a 1.5-T endorectal coil; we excluded 3 patients treated with neoadjuvant hormonal therapy. The sites of prostate cancer in 82 patients were predicted by T2WI alone, T2WI+Dynamic, and T2WI+DWI, and the results were compared with the step-section analysis of radical prostatectomy specimens. The peripheral zone (PZ) and the transition zone (TZ) of the prostate were divided into left and right halves. Only tumors with a diameter of more than 5mm were considered significant. (Results) The sensitivity, specificity, positive predictive value (PPV), and the area under the receiver operating characteristic (ROC) curve (Az) for the prediction of the site of prostate cancer in the PZ of the prostate were as follows: 42%, 94%, 93%, and 0.76 for T2WI alone; 48%, 96%, 96%, and 0.78 for T2WI+Dynamic; and 50%, 96%, 96%, and 0.81 for T2WI+DWI. The sensitivity, specificity, PPV, and Az for the prediction of the site of prostate cancer in the TZ of the prostate were as follows: 31%, 92%, 76%, and 0.66 for T2WI alone; 46%, 82%, 67%, and 0.65 for T2WI+Dynamic; and 48%, 94%, 85%, and 0.71 for T2WI+DWI. (Conclusion) The Az value for the prediction of prostate cancer in the PZ and those in the TZ of the prostate was the highest for the combined T2WI and DWI approach.
(Purpose) To compare the usefulness of the World Health Organization (WHO) 1973 classification with the WHO/International Society of Urological Pathology (ISUP) classification in pTa bladder tumors. (Materials and methods) A retrospective analysis was performed on 132 patients (107 men and 25 women; mean age 69 years) with a initial diagnosis of pTa bladder carcinoma. Median follow-up were 67months. On the WHO 1973 classification, histopathological evaluation of initial diagnostic specimens revealed 51 cases with grade1, 68 cases with grade2, 13 cases with grade3. All histological slides were examined by one genitourinary pathologist blinded with respect to clinical outcome and were classified according to the WHO/ISUP classification. Disease progression was defined as up stage (≥pT1). Actual probability of progression-free and recurrence-free survival rate were estimated using the Kaplan-Meier method. The Log rank test was used to determine statistical difference between actual curves. Univariate and multivariate analyses were done using Cox regression analysis. The independent variables were multiplicity, histopathological grade, and adjuvant intravesical therapy. The dependent variable was disease progression and recurrence. (Results) The tumors were reclassified as low grade carcinoma in 77 and high grade carcinoma in 55. During the follow-up, 68 patients experience recurrence, 14 patients experienced disease progression. On the WHO 1973 classification, the risk of recurrence was significantly lower in patients with grade 1 compared to those with grade3 (p=0.007). On the WHO/ISUP classification, the risk of recurrence and disease progression were significantly lower in patients with low grade compared to those with high grade (p=0.003, P=0.01). After adjustment for tumor multiplicity and adjuvant therapy, the relative risks of recurrence and progression in the low grade carcinoma versus the high grade carcinoma was 2.0 (95% confidence intervals 1.26-3.31), 5.6 (95% confidence intervals 1.54-20.48). (Conclusion) In pTa bladder carcinoma, the WHO/ISUP classification was more useful prognostic factor than the WHO 1973 classification.
A 31-years-old woman was diagnosed as pheocromocytoma by the various endocrine testings and 131I-MIBG scintigraphy. The CT scan and bone scintigraphy showed right adrenal tumor, along with liver metastasis, lymph nodes swelling around aorta and multiple bone metastases. She underwent chemotherapy consisting with Cyclophosphamide, Vincristine, Dacarbazine (CVD) and α-methyl-p-tyrosine (αMT), resulting in stable disease for 27 months. However, catecholamine levels increased gradually four weeks later. We would have planned 131I-MIBG therapy, but bone marrow suppression did not allow us to do it. She died of DIC.
A 24-year-old man was referred to our department for urinary retention and urinary tract infection. He was pointed out a bladder diverticulum in childhood. Computerized tomography (CT) scanning and magnetic resonance imaging (MRI) showed a bladder diverticulum, 10 by 8cm in size, which was located posteriorly in the bladder. He underwent resection of the bladder diverticulum and left ureterovesiconeostomy. The histopathologic finding showed a bladder wall with thin muscular layer. The operation made urination possible with successful resolution of voiding symptoms. Herein we report this rare case of congenital bladder diverticulum which was treated in adulthood, and present a review the literature.