(Purpose) There is one of the big problems that endocrine therapy for prostate cancer causes to induce secondary osteoporosis. The risk factors and future treatments for osteoporosis were investigated. (Materials and Methods) 31 patients treated with luteinizing hormone releasing hormone agonists (LHRH-a) or combination of chlormadinone acetate (CMA) and LHRH-a, and 19 patients with no treatments for prostate cancer were included in the analysis. Lumber spine bone mineral density (BMD) was measured by quantitative computed tomography. (Results) Aging had much influence on decreases of BMD than the other risk factors (p<0.01). There were statistically decreases of BMD in the patients with CMA+LHRH-a compared with no treatments (p<0.05). Adrenal androgen which had an important role of maintenance in BMD was statistically decreased by the administration of CMA (p<0.01). (Conclusions) Measurement of BMD before endocrine therapy is necessary for the patients with prostate cancer. It is important for the patients with decreases of BMD that CMA is not combined or the therapy for osteoporosis is preventively employed.
(Purpose) The early diagnosis of bladder cancer allows for effective local treatment and optimizes the success of surgical therapy. Basic fetoprotein (BFP), measured using a rapid latex immuno-agglutination method, was introduced for the detection of transitional cell carcinoma. The objective of this study was to determine whether there was a correlation between urine BFP level and the grade or stage of bladder cancer, and whether the level could serve as a biochemical marker of bladder cancer. (Materials and Methods) Single voided specimens were obtained from 66 patients with confirmed or suspicious bladder cancer on cystoscopy, urine cytology or BFP. Each sample was divided into 3 aliquots of which 1 was for urine analysis, 1 was tested for BFP according to latex immunoagglutination method and 1 was sent for cytological examination. All patients subsequently underwent bladder biopsy. (Results) There were 54 (82%) patients with biopsy confirmed bladder cancer and 12 (18%) with benign conditions of the bladder. Overall sensitivity with BFP and urine cytology was 38.9% and 48.1% respectively. Specificity was 58.3% and 75.0%, and positive predictive value was 80.8% and 89.7%, respectively. The positive rate of BFP and cytology was higher in invasive cancer (75% and 100%, respectively) than in superficial cancer (36% and 28%). There was no correlation between BFP level and tumor grade, while cytology had a strong association. Linear regression analysis showed the significant correlation between BFP level and tumor size (r=0.695, p<0.0001). The detection rate of bladder cancer was higher by the combination of BFP and cytology than by using alone. (Conclusions) BFP in conjunction with urine cytology can increase the detection rate of bladder cancer. But BFP alone cannot be used as a screening test for bladder cancer.
(Purpose) The PSA level of prostate cancer patients generally declines after endocrine therapy, but elevates when the cancer relapses in most cases. However, the rate of elevation differs with the case. We investigated the PSA doubling time (PSA-DT) of the prostate cancer patients whose PSA declined after endocrine therapy and later re-elevated, and investigated the relationship with other parameters. (Patients and methods) We investigated 55 prostate cancer patients who underwent endocrine therapy between 1991 and 1998. Their PSA re-elevated continuously after their PSA fell below 10 ng/ml after the endocrine therapy as the first line treatment. First, the correlation coefficients with time and PSA were calculated in order to decide whether their PSA elevation was exponential or linear. PSA-DT was calculated thereafter, and compared with the clinical stage, pathological differentiation, clinical relapse style, time from the beginning of the therapy to PSA relapse, pre-treatment PSA value, and prognosis. The relationship between PSA-DT and each clinical parameter was tested using the Kruskal-Wallis test. Differences in survival rates and PSA-DT were calculated using the logrank test. (Results) PSA elevated exponentially after cancer relapsed. PSA-DT in all cases ranged from 0.5 to 26.3 months, with an average of 4.4±4.8(S. D.) months and the median was 2.5 months. PSA-DT was significantly (p<0.01) short when the pre-treatment clinical stage was high, the time from the beginning of the therapy to PSA relapse was short, or the pre-treatment PSA value was high. PSADT tended to be short when the pre-treatment pathological differentiation was low, but not signifi-cantly. PSA-DT tended to be short when the cancer relapsed as distant metastasis rather than regional relapse, but not significantly. Prognosis from the initial treatment and PSA relapse was significantly poor when the PSA-DT was short. (Conclusions) PSA elevated exponentially in the relapsed prostate cancer patients after the endocrine therapy. PSA-DT was distributed in a very wide range, and this value was considered to reflect the malignant potential and prognosis of the cancer. PSA-DT may be useful for determining the strategy after relapse.
(Background) TESE-ICSI has been used very successfully in the treatment of the patients with non-obstructive azoospermia but its indication is still controversial. We performed retrospective study concerning parameters to predict successful recovery of testicular sperm from the patients and outcomes of ICSI. (Patients and Methods) 44 patients with non-obstructive azoospermia who underwent TESE-ICSI from July, 1997 to September 1999 were studied retrospectively. (Results) 1) Testicular sperm were retrieved from 32 patients (72.7%). ICSI was performed in 29 patients and the partner of 15 patients (46.9%) got pregnant. From 10 patients with histology of Sertoli-cell-only, we could retrieve sperm in 3 patients (30%). 2) Testicular volume, Johnsen's score count (JSC), and FSH were significant parameter to predict the recovery of testicular sperm from the patients, but if we see only the patients with JSC less than 7, there were no significant parameter. Chromosomal abnormality was not a significant parameter. 3) The partner' s age, motility of recovered sperm and testicular volume correlated with fertilization rate. Chromosomal abnormality was not significant parameter to predict fertilization. (Conclusions) There was no absolute parameter to predict the recovery of testicular sperm from the patients with non-obstructive azoospermia. All patients with non-obstructive azoospermia can be the indication of TESE-ICSI.
75 year old female who was hospitalized for abdominal pain and fever up on 12th May 1998. She had been followed as a polycystic kidney patient since few years. The swelling of the right kidney and her general condition became gradually worse. On 18th May, the embolization to the right kidney using pure alcohol and gelatin sponge was performed. Within a month, CT scan showed the reduced volume of the right kidney and her blood examination data as well as her general condition became gradually well. And on 17th June, she left our hospital without any complication.
The pharmacokinetics of intravenously administrated cisplatin and etoposide were studied in a patient with seminoma (stage IIIA) receiving hemodialysis for chronic renal failure. The treatment schedule was as follows: 7mg/m2 of cisplatin at day 1, 3, 5; 14mg/m2 of cisplatin at day 2, 4; 70mg/m2 of etoposide at day 1-5; hemodialysis at day 2, 4. After the treatment myelosuppression was very strong. So the patient were recieved another treatment of smaller doses of cisplatin and etoposide in three courses. The other schedule was as follows: 14mg/m2 of cisplatin at day 1, 3, 5; 35mg/m2 of etoposide at day 1-5; hemodialysis at day 1, 3, 5. The area under the blood concentrationtime curve (AUC) of free-cisplatin was 6.82μg·hr/ml in first course, 4.07μg·hr/ml in second course. The peak concentration of peripheral blood free-cisplatin was 0.58μg/ml in first course, 0.43μg/ml in second course. The AUC of etoposide was 241.9μg·hr/ml in first course, 216.9μg·hr/ml in second course. After treatment CR was observed and there was no recurrence for five years. In conclution, it was considered that cisplatin and etoposide could be given to the patient receiving hemodialysis for chronic renal failure and smaller doses should be given to prevent side effects.