(Objective) Recurrence is not rare after radical prostatectomy for localized prostate cancer. The treatment results of radical prostatectomy for localized prostate cancer was evaluated in this retrospective study. (Methods) A total of 36 patients with localized prostate cancer (clinical stage: A, B) were treated with radical prostatectomy. Kaplan-Meier product limit method analyzed from biochemical failure was used to study the treatment results of radical prostatectomy, and Cox's proportional hazards model was used to analyze the influence of pathological findings at surgery on biochemical failure. (Results) Of all 36 patients, 24 (67%) had pT3 (N0-2) disease, and these patients received adjuvant hormonal therapy after surgery. Overall freedom from biochemical failure at 5 years after surgery was 53% (pT1-2N0; 83%, pT3N0-2; 40%). No significant difference was seen in the freedom from biochemical failure between patients grouped by pathological classification (p=0.106), tumor grade (p=0.476), proximal and distal margin involvement (p=0.095) and regional lymph node metastasis (p=0.482), but a significant difference was seen between patients grouped by capsule involvement (freedom from biochemical failure at 5 years in cases with positive capsule: 30%, p=0.023) and seminal vesicle involvement (freedom from biochemical failure at 5 years in cases with positive seminal vesicles: 26%, p=0.014). Cox's proportional hazards model, on the other hand, showed only that seminal vesicle involvement significantly influenced on biochemical failure (p=0.031). (Conclusion) We confirmed a high likelihood of biochemical failure and presumably less favorable prognosis in patients with seminal vesicle involvement. These results indicated that candidates for surgery should be selected pathologically by excluding those with seminal vesicle involvement in the preoperative evaluation.
(Purpose) The aim of the present study was to compare sialic acid concentrations of serum and urine specimens in both calcium (Ca)-containing urinary stone formers and non-stone formers. Moreover, we studied inhibitory activity of sialic acid upon the calcium oxalate (CaOx) crystal aggregation and growth. (Materials and Methods) Sialic acid determinations were done on fresh serum and urine samples of 35 Ca-containing urinary stone formers (stone formers group) and 20 non-stone formers (patient controls group). Inhibitory activity of sialic acid upon the CaOx crystal aggregation and growth was studied by using in vitro assay method of seed crystal system. (Results) Serum sialic acid concentrations were found to be similar in the two groups. Urinary sialic acid concentrations were significantly lower in the urine specimens of stone formers than in their patient controls. Sialic acid showed a dose dependent inhibitory activity upon the CaOx crystal aggregation and growth into seed crystal method. (Conclusion) It is suggested that urinary sialic acid may play some role during the phase of stone formation from the results of the present study, because sialic acid shows marked inhibitory activity upon the CaOx crystal aggregation and growth at concentrations higher than 100mg/dl.
(Background) Although renal cell carcinoma (RCC) is often heterogeneous, the histological classification of RCC in Japanese Urological Association (JUA) is designed to select only the dominant histological components. We evaluated whether this system could provide an adequate information concerning the prognosis of the patients. (Methods) Histological slides of 130 cases with RCC were microscopically evaluated. We classified these cases according to the JUA classification, and also checked the presence or absence of each histological components (3 cell types and 5 histological architectures) regardless of whether or not they were dominant. Univariate and multivariate analysis were then performed to determine the histological components which have prognostic impact on patient survival. (Results) Multivariate analysis demonstrated that only spinde/pleomorphic cells and solid architecture were the significant prognostic parameters. The presence of these histological components was not correctly shown in the JUA classification. (Conclusion) The histological classification of RCC in JUA did not provide enough information about the presence of the important prognostic parameters. This system should be modified to describe all the histological components regardless of whether they are dominant or not.
(Background) The object of the study is to observe the influence of laser on the prostate tissue and to evaluate the efficiency as well as safety. (Methods) Ten canine prostates were irradiated by Nd: YAG laser with a lateral firing fiber. The lasing was carried out either spot or running irradiation on the free beam method. Laser energy was applied for 30, 40 and 60 seconds at 50 watts power output. On the basis of the animal experiments, clinical application was performed in patients with BPH. (Results) Immediately after the irradiation, the prostate became swollen by the edema. But the irradiated tissue became necrotic and sloughed resulting in a big cavity of the prostatic urethra by two weeks. The higher the energy density with spot irradiation, the larger the tissue effect as well as the risks. Therefore, it would be important to combine spot with running irradiation for optimal energy density. Clinically, subjective and objective improvements were noted significantly after treatment. (Conclusion) Thus, the endoscopical laser prostatic therapy proved to be useful and safe from the present fundamental and clinical investigations.
(Background) Extracapsular extension is commonly seen in patients undergoing radical prostatectomy for localized prostate cancer due to understaging of disease. One possible approach to reduce the likelihood of extracapsular disease is androgen deprivation prior to radical prostatectomy, neoadjuvant therapy. However, adequate application is not clear. We analyzed the outcome of neoadjuvant therapy and radical prostatectomy in an attempt to expand our understanding on indications of neoadjuvant therapy. (Methods) Forty-six selected patients with clinical T1 or T2 prostate cancer were retrospectively reviewed. Twenty-two patients underwent neoadjuvant therapy (group N) that mainly consists of LH-RH agonist. The duration of neoadjuvant therapy, varied from 1 to 12 months with the mean being 4 months. Twenty-four underwent radical prostatectomy alone (group S). (Results) In the group N and group S, 59% and 33% had either organ confined disease (OCD) or specimen confined disease (SCD) respectively. When the patients had OCD or SCD, they were defined as surgically cured patients. In the patients with clinical stage T1b, T1c, and T2 disease, likelihood of surgical cure were 100%, 50%, 46.7% in group N, 100%, 20%, 11%, in group S respectively. In the patients with initial serum PSA less than 10ng/ml and more than 10.1ng/ml, likelihood of surgical cure were 83.3% and 50% in group N, 63.6% and 15.4% in group S, respectively. Likelihood of surgical cure was higher in the patients with well differentiated carcinoma both in group N and group S. All the patients with serum PSA less than 0.1ng/ml after neoadjuvant therapy had OCD. (Conclusion) Neoadjuvent therapy could be beneficial either in the patients with moderately or in the poorly differentiated adenocarcinoma of prostate especially in the group with initial serum PSA more than 10.1ng/ml. However, in patients both with well differentiated adenocarcinoma and the initial serum PSA less than 10ng/ml, no evidence of beneficial effect on the likelihood of OCD or SCD was observed. PSA after neoadjuvant therapy could be useful predictor for the pathological outcome.
(Background) Polyamines are recognized as cell growth factors. We attempted to determine whether alterations in the levels of tissue and blood polyamines were useful biochemical makers for monitoring the efficacy of the chemotherapy for bladder tumors. (Methods) The concentrations of three polyamines of diamine, spermidine and spermine in urinary bladder and blood were determined in male F344 rats with urinary bladder carcinoma induced by N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN), following chemotherapy with cisplatin, methotrexate and pirarubicin. (Results) Bladder carcinoma was observed in 5 of 20 rats of the chemotherapeutic group, and 16 of 20 rats of the control group given saline alone. The levels of spermidine, spermine and total polyamine in both bladder and blood of the treated rats were significantly lower than those of the control rats. (Conclusion) The study suggested that the levels of tissue and blood polyamines could be used as biochemical markers for monitoring the efficacy of the chemotherapy for bladder tumors.
(Background) There have been no epidemiological studies on the relationship between the prostatic weight and blood examination data. This study was carried out to evaluate this relationship. (Subjects and Methods) Blood examination (β-carotene, GOT, GPT, total cholesterol, etc.) and measurement of the prostatic weight were performed in 432 subjects aged 50 years or more of a town in Japan, and the possible relationship between blood analysis data and the prostatic weight was evaluated. The prostates were examined by transrectal ultrasonography (TRUS) and classified into the normal prostate and benign prostatic hypertrophy (BPH). The prostatic weight was measured by Watanabe's method based on TRUS images. In addition, the possible association between the prostatic weight and smoking, drinking, height, body weight, or age was evaluated. (Results) Analysis by the logistic procedure and the general linear models procedure showed a significant positive correlation between the normal prostatic weight and β-carotene, height, as well as body weight and a significant negative correlation between the normal prostatic weight and smoking. Comparison between subjects with the normal prostate and those with BPH suggested that serum β-carotene is a significant positive risk for BPH, and HDL-cholesterol, drinking, and smoking are negatie risks by logistic procedure analysis. (Conclusion) It was thought that serum β-carotene and smoking are associated with the development of BPH.
A 42-year-old man who complained progressive enlargement of an intrascrotal mass visited to our hospital. Preoperative sonography revealed multiple cystic massess adjacent to the left testis. Total surgical excison was performed. The cystic masses were arising from tunica vaginalis testis. Histopathologically, a cystic lymphangioma was diagnosed because of the morphological features and the immunohistochemical stainings of CD34 and Factor VIII related antigen which were observed positive reactions in endothelial cells of the cysts.
A case of angiomyolipoma arising from the renal capsule is reported. A 49-year-old female was admitted to our hospital with a complaint of abdominal mass pointed out by ultrasonography during her yearly health check. The tumor was 10cm in size. On abdominal enhanced CT, the tumor was existed behind the left kidney. The capsule of the tumor was enhanced and the septums were seen inside of the tumor. MRI revealed a hemorrhage in the tumor and selective renal angiography showed the tumor was fed by the renal capsular artery. A tumor of the renal capsule was suspected and a laparotomy was done. Pathological results by the frozen section suggested malignancy and radical nephrectomy was performed. Angiomyolipoma was diagnosed histologically. Tumors of the renal capsule are uncommon and angiomyolipoma of the renal capsule is extremely rare. We have found only two cases in Japanese medical literature.