(Purpose) We reviewed reduced intensity stem cell transplantation (RIST) in metastatic renal cell cancer (RCC). (Patients and method) Two cases of lung metastasis of immunotherapy invalidity. Six days of fludarabine 30mg/m2 and 2 days of busulfan 4mg/kg were given as conditioning for mini-SCT. CyA and short-term MTX were used as immunosuppressive agents. (Results) Size reduction of tumor was observed with dose reduction of CyA. Following steroid therapy for the treatment of GVHD, the tumor progressed. No serious complications except for GVHD. (Conclusion) These results suggested that RIST might be considered as salvage therapy in patients metastatic RCC.
(Purpose) With the aim of evaluating the clinical significance of systematic prostate biopsy before transurethral resection of the prostate (TUR-P), clinical data were reviewed retrospectively in patients who had underwent prostate biopsy prior to scheduled TUR-P. (Patients and Methods) Between July, 1994 and June, 2000, TUR-P was scheduled in a total number of 456 patients with clinically diagnosed benign prostatic hyperplasia (BPH). (Results) In 218 (47.8%) out of 456 cases, prostatic biopsy was conducted prior to TUR-P due to abnormally elevated serum prostate specific antigen (PSA) levels of 4.0ng/ml or more, revealing only 22 (10.1%) cases of prostatic cancer. Between these 22 cases with biopsy proven prostatic cancer and 189 cases with BPH confirmed both by biopsy and following TUR-P, statistically significant differences were noted in age (p<0.05), prostate volume (p<0.0001) and PSA density (p<0.01). (Conclusion) Considering the low positive rate of preoperative prostatic biopsy, it might be suggested that a considerable number of biopsy could be avoided in patients with clinically diagnosed BPH. Based on the results obtained from this study, prostatic biopsy might be unnecessary before TUR-P for those with prostate volume greater than 60ml or PSA density less than 0.15.
(Purpose) Screening with prostate specific antigen (PSA) only to detect prostate cancer was started in Tokushima City from 2001 as one of health check lists. We evaluated the first year result. (Materials and Methods) Fifty-five years old or elder men living in Tokushima City who wants to measure serum PSA level to screen for prostate cancer were entered to screening program. The men whose PSA levels detected as over normal range were recommended to visit to urologists for further examination to detect prostate cancer include prostate biopsy. The results of further examination were reported to Tokushima City and evaluated. (Results) The population of fifty-five or elder men in Tokushima City was 25, 416 and 9, 019 (35.5%) men were measured serum PSA levels. In 801 (8.9%) men, PSA levels were over normal range, and recommended further examination to detect prostate cancer. 451 (56.3%) men visited to urologists for further examination, and prostate biopsy was performed in 231 (51.2%) men. Finally, 121 men were diagnosed as prostate cancer, 52.1% of 231 men performed prostate biopsy, 26.7% of 451 men visited to urologist for further examination, 1.34% of 9, 019 men measured serum PSA levels. Patient number for each clinical stages were 49 in B0, 16 in B1, 16 in B2, 29 in C, one in D1, and 10 in D2. Patients number in each age range were 3 in 55-59, 11 in 60-64, 22 in 65-69, 37 in 70-74, 33 in 75-79, 15 in 80 or elder. Patient number of Stage B and 74 years old or younger was 48 (39.7%). (Conclusion) Prostate cancer was detected in 1.34% of 9, 019 men who measured serum PSA levels, and early stage B was two thirds. PSA screening to detect prostate cancer as one of health checklists in Tokushima City was useful to detect early prostate cancer.
(Purpose) We prospectively assessed the safety and efficacy of periprostatic local anesthesia before transrectal ultrasound (TRUS)-guided prostate biopsy. (Materials and methods) A total of 178 consecutive men undergoing transrectal prostate biopsy at our institution were enrolled in this study. From January to June 2001, 84 men underwent prostate biopsy without anesthesia (control group). From July to December 2001, 94 men received local anesthesia before prostate biopsies (anesthesia group). A 5-ml dose of 1% lidocaine was injected into the periprostatic nerve plexus on each side via a 22 gauge needle at 3 minutes before the procedure. Pain during and after biopsy was assessed using a 10-point visual analog scale (VAS). Complications were evaluated with a self-administered questionnaire. (Results) The average pain score during biopsy was 3.18 in the anesthesia group versus 4.16 in the control group (p=0.0067), while average pain score on the next day was 2.12 and 2.25, respectively (p=0.7451). In the anesthesia group 13% of patients had a pain scor>5 versus 34% in the control group (p=0.0043). The complication rate showed no significant difference between the two groups. (Conclusion) Periproatatic lidocaine injection is a safe and effective method of anesthesia for transrectal prostate biopys.
(Purpose) We described the temporarily increase phenomenon in prostate-specific antigen level (PSA bounce) after transperineal interstitial permanent prostate brachytherapy (TIPPB) for localized prostate cancer. (Materials and Methods) From December 1998 to May 2003, 500 consecutive patients with localized prostate cancer were treated with TIPPB using iodine-125 or palladium-103. We examined 200 patients who have more than 2-year PSA follow-up. Median follow-up length was 1, 069 days (range, 712-1, 411 days). No patient received neoadjuvant or adjuvant hormone therapy. PSA determinations were performed every 3 months for the first 2 years after procedure, and every 6 months hereafter. PSA bounce was defined as an increase of 0.1ng/ml or greater above the preceding PSA level after implant followed by a subsequent decrease below that level. The American Society for Therapeutic Radiology and Oncology (ASTRO) consensus panel criteria 1996 were used to define biochemical failure. (Results) PSA bounce was observed in 40% (80/200) of the cases receiving TIPPB. The median time to PSA bounce was 13 months from the day of implant. The median magnitude of the PSA bounce was 0.3ng/ml from the pre-bounce level. Twelve cases demonstrated biochemical failure according to the ASTRO consensus guidelines of three consecutive rises in PSA. Ten of these subsequently showed a drop in PSA, consistent with biologic control of their disease. Two cases remain classified as apparent biochemical failures. (Conclusions) A transient rise in the PSA following TIPPB, the so-called “bounce” is a common occurrence. The apparent PSA control of ten of twelve cases failing by the ASTRO criteria raises some concern. Further observation will be necessary to determine ways to discriminate these from true disease progression.
A case of complete type and two cases of incomplete type of epispadiac urethral duplication are reported. In the complete one, the accessory urethra (14cm in length) opened 1.5cm proximal to the dorsum of the penis. In two cases of incomplete type, the epispadiac openings located at the base of the penis or higher. The sinuses were lined with transitional epithelium proximally, and with squamous cells on the distal half of the accessory urethra, which suggests a developmental origin. We conclude that these sinuses may etiologically represent the identical origin without regard to complete type or incomplete type.
A 28-year-old man, who had undergone right orchiectomy and prophylactic irradiation for stage I seminoma 6 years ago, developed left testicular tumor. Since the secondary tumor was localized in the lower pole of the testis, partial orchiectomy was performed with an attempt to preserve the testicular function. The pathological finding of the surgical specimen was a mixed type testicular tumor consisting of seminoma, embrional carcinoma and teratoma elements. Postoperative chemotherapy with 3 coueses of BEP regimen resulted in azoospermia, but the impaired spermatogenesis recovered to a normal range within 18 months with no evidence of tumor recurrence and his wife delivered a healthy baby 2 years later. For the synchronous or metachronous bilateral testicular tumors, the combination of organ sparing surgery and chemotherapy could be a treatment of choice.
A 20-year-old man was referred to our hospital for investigation of left scrotal swelling. CT scan showed intrascrotal fluid collection and calcification. Surgical exploration was performed, and histopathological diagnosis was serous papillary adenocarcinoma of the tunica vaginalis. Since it was believed that the carcinoma originated from the tunica vaginalis, left radical orchiectomy and hemiscrotal resection was performed. Patient survives without recurrence for 38 months after the surgery. Müllerian-type tumors such as serous papillary adenocarcinoma occurring in male are quite rare. In the literature, only 2 cases of serous papillary adenocarcinoma of the tunica vaginalis have been reported; ours is the 3rd case.
The patient was a 77-year-old man who underwent radical cystectomy and ileal conduit urinary diversion due to bladder cancer in 1989. A stenosis of the right uretero-ileal anastomosis occurred in 1992, and of the left uretero-ileal anastomosis in 1999. These were treated with indwelling of a ureteral stent and percutaneous nephrostomy, respectively. He was admitted to our hospital for progressive renal dysfunction due to frequent pyelonephritis. We performed a reconstruction of the ileal conduit urinary diversion and after the removal of the bilateral ureteral stent he complained of nausea and general malaise. The laboratory data showed hyponatremia, hyperkalemia and azotemia, which were diagnosed as complication liked jejunal conduit syndrome. He was treated with hydration and salt supplementation. With regard to this case, we considered that a long ileal conduit close to the jejunum and renal dysfunction caused the complication liked jejunal conduit syndrome. Careful observation and follow-up laboratory examination should be performed if the patient has renal dysfunction and a long conduit near the jejunum is used for the ileal conduit.
We treated 6 patients with non-seminomatous extragonadal germ cell tumor (NSEGCT) by VP-16+ifosfamide+cisplatin (VIP) chemotherapy as an induction therapy to investigate the effectiveness and safety. Primary lesions were located at the mediastinum in 4 patients and the retroperitoneum in 2 patients. As a rule, all patients were treated with VIP chemotherapy of 4 courses with or without second-line treatment such as chemotherapy, residual tumor resection and/or radiation. Following the induction therapy (VIP), 4 of 6 patients (67%) achieved complete or partial responses. After salvage therapy, 4 patients (67%) achieved complete responses and two other patients also achieved partial responses. However, only 2 of the 5 patients who had been follow-up for more than 2 years have remained disease free. The effects of VIP chemotherapy on non-seminomatous extragonadal germ cell tumor appeared to be similar to those of the conventional chemotherapies though the number of patients was small in the current study. It appears to be necessary to design more effective regimen.