(Purpose) To develop a Japanese version of the Expanded Prostate Cancer Index Composite (EPIC): originally designed to measure the Quality of Life of localized prostate cancer patients, after careful assessments of cross-cultural equivalence, face validity and practically. (Methods) We translated the original version that consisted of 50 items into a preliminary Japanese version. This multi-stage procedure included a forward-translation, back-translation and discussion with the original developer. Additionally, we tested the preliminary Japanese version on 11 localized prostate cancer patients and identified problems with its cross-cultural equivalence, practicality. Based on the findings of this pretest, we revised the Japanese version. Consensus by discussion among all researchers was obtained through out this process. (Results) The original developer reviewed the back-translation of the preliminary Japanese version; some wording was revised. In the pretest, the average age of patients was 68.8 years old. Four of the sexual subscale showed over 10 percent missing data. In five items, all patients chose identical answers. We conducted an in-depth qualitative investigation of these items. The average response time was 11.7 minutes. We revised the Japanese to reflect patients' opinions as much as possible. Items which were showed problems in terms of cross-cultural adaptation included questions measuring ‘bother’ and two items of the sexual subscale. The wordings of these items were revised so that Japanese patients could easier understand them. We ensured that the original developer's intentions remained the same. The original developed approved all revisions. (Conclusion) We translated and adapted the original EPIC to the Japanese culture. The Japanese version of EPIC was found to be functional in the pretest.
(Purpose) The clinical benefit of propiverine hydrochloride against overactive bladder was evaluated, and the relationships between urinary voiding functions and the pharmacokinetics were investigated by means of clinical pharmacology with PK/PD approach. (Patients and Methods) Total 7 patients suffering urgency with urinary frequency and incontinence received propiverine hydrochloride in doses of 10mg qd or 20mg qd for 4 weeks, and then the doses were switched in cross-over manner to continue the treatment for further 4 weeks. The urody-namic measurements as well as pharmacokinetic samplings were done before the medication, 4 weeks and 8 weeks after the starting medication, to examine the dose-response and concentration-response relationships. (Results) The volume at first desire to void increased according to dose increased, and the volume at first involuntary contraction tended to increase according to both dose and drug concentration in plasma. However, no apparent dose-response relationships were observed for maximum urinary flow rate and the detrusor pressure at the maximum urinary flow rate. The PK/PD analysis using Emax model suggested that, approximately 75ng/mL of the propiverine concentration in plasma allowed the increase in the volume at first involuntary contraction for 50%. The urinary residual volume increased in dose-dependent manner only in the patients with severe grade of lower urinary tract obstruction, but scarcely increased in the patients with moderate grade or below. (Conclusion) Propiverine hydrochloride improved the urinary voiding functions with a tendency to depend on both dose and concentration in plasma. After the administration of propiverine hydrochloride, the concentration in plasma will immediately reach the level at which the drug can increase in the volume at first involuntary contraction for 50%, and then the concentration level will sustain the effect ranging from 10% to 50% increase in bladder volume. Furthermore, the lower urinary tract obstruction will be a predictor of increase in urinary residual volume.
(Purpose) We investigated retrospectively that change of serum testosterone and PSA concentrations following withdrawal of androgen ablation after combination of radiation and hormone therapy for prostate cancer. (Subjects and method) Among prostate cancer patients who were treated with combination of radiation and hormone therapy from 1992, 42 patients who were measured with time in the concentration of testosterone after withdrawal of androgen ablation were selected. Their median age was 76 years old (62-84), their median PSA was 13.2ng/ml (1.4-215.3), and clinical stage consisted of T1 (12 patients), T2 (12 patients) and T3 (18 patients). They were divided into three groups by recovery of testosterone after withdrawal of androgen ablation and examined with change of PSA. Three groups consisted of castration-level group (testosterone: less than 1.0ng/ml), low group (1.0-2.0ng/ml) and normal group (2.0ng/ml and more). (Results) There were 8 patients in castration-level group, 10 patients in low group and 24 patients in normal group. There were no significant differences in age, clinical stage and histological grade among each group. However, duration of hormone therapy in normal group was 4.7 months and shorter than durations in castration-level (38.5 months) and low group (26.6 months). The median time of the recovery to normal range of testosterone was 9.1 months. Only duration of hormone therapy influenced the recovery of testosterone in the multivariate analysis. Median changes of PSA after withdrawal of androgen ablation were 0ng/ml (0-0.029) in castration-level group, 0.118ng/ml (0-1.169) in low group and 0.427ng/ml (0.047-4.358) in normal group. Change of PSA in normal group was significantly higher than castration-level and low groups. If the patients were defined as failure in whom PSA was rising during follow-up, positive or negative predictive value to predict failure, when setting a cutoff value to 0.2ng/ml of PSA rise-width, were better than other cutoff values (0.1 or 0.3ng/ml). (Conclusion) Among prostate cancer patients treated with combination of radiation and hormone therapy, PSA is went up in some of them with recovery of testosterone after withdrawal androgen ablation. Rise-width of PSA may be important for one of the predictors of failure with measurement of testosterone.
(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 endocrine therapy with lowering of serum prostate specific antigen (PSA) level but later showing PSA relapse. (Materials and Methods) In prostate cancer patients newly diagnosed from January 1992 to December 2004 at our institution, there were 93 patients in that the PSA level of 10ng/ml or more before therapy initially dropped below 10ng/ml by endocrine therapy, but showed PSA relapse thereafter. We investigated the relationship between clinical stage, pathological differentiation, initial PSA, duration between initiation of therapy and PSA nadir, the value of PSA nadir, duration between initiation of therapy and PSA relapse, PSA doubling time (PSA-DT) at relapse, PSA response three months after initiation of second line therapy and prognosis after PSA relapse. (Results) In Kaplan-Meier method, between all or some categories investigated showed significant difference in prognosis after PSA relapse. In multivariate analysis, the factors that significantly affected prognosis after PSA relapse were clinical stage, pathological differentiation, PSA nadir value, duration between initiation of therapy and PSA relapse and PSA response three months after initiation of second line therapy. (Conclusion) We investigated the prognostic factors refractory to endocrine therapy. These results are useful in planning the therapy, and in explaining the status or future prospective of the disease to patients and families.
(Purpose) We examined the efficacy and safety of periprostatic nerve blockade during transrectal ultrasound guided prostate biopsy. (Materials and methods) Transrectal ultrasound guided 10 core biopsy of the prostate was performed in 116 consecutive men. From March 2002 to July 2003, 58 men underwent biopsy of the prostate without local anesthesia (control group). From August 2003 to March 2004, 58 men received periprostatic nerve blockade before prostate biopsies (anesthesia group). A 4-ml dose of 1% lidocaine was injected at 2 or 3 locations on each side of the prostate via a 23 gauge needle. Pain during biopsy was questioned using a 5-point Face scale and complications were also recorded. (Results) The average pain score during biopsy was 1.9 in the anesthesia group versus 3.1 in the control group (p<0.001). In the anesthesia group 20.7% of patients had a pain score 3 or greater than 3 versus 69% in the control group. The complication rate showed no significant difference between the two groups. (Conclusions) Periprostatic nerve blockade is a safe and effective method of anesthesia for transrectal prostate biopsy.
A 75-year-old male was diagnosed as prostate cancer (serum PSA: 4, 772ng/ml, Gleason score: 4+4=8) with multiple bone metastases. And he noticed a painless mass of the frontal neck a month before the diagnosis. Computed tomography of the neck showed a tumor in the thyroid cartilage. Biopsy of the neck tumor revealed metastasis of prostate cancer by positive PSA staining. Metastasis of malignant tumor to cartilaginous tissue is extremely rare because there are usually no vessels in it. Only 4 cases of the metastasis of prostate cancer to the thyroid cartilage have been reported. It was thought that tiny bone marrows were formed in the ossified cartilage and it caused hematogenous metastasis.
We report a patient with a refractory testicular non-seminomatous germ cell tumor (NSGCT) who developed therapy-related leukemia (TRL) after undergoing salvage chemotherapy and multiple operations for repeat recurrences. Fifty months after the initial therapy, pancytopenia and myeloblasts were observed in the patient's peripheral blood while the patient was undergoing salvage chemotherapy for a fifth recurrence. A bone marrow examination showed evidence of myelodysplastic syndrome (MDS) and refractory anemia with excess of blasts in transformation (RAEB in T) under French-America-British (FAB) classification. Cytogenetic 5q-/7q- abnormalities were also observed. The patient had received a total dose of 189g/m2 of Ifosfamide, 8, 250mg/m2 of Etoposide and 1, 450mg/m2 of Cisplatin; therefore, he was diagnosed as having TRL/MDS. The patient has received induction chemotherapy for TRL with Cytarabine, Daunorubicin and Fludarabine while a bone marrow transplantation has been scheduled. Recently, TRL associated with chemotherapy are being reported with increasing frequency in the literature. Since early detection and treatment are necessary for the management of TRL, peripheral blood examinations should be performed after a diagnosis of refractory germ cell tumor has been made. If pancytopenia is detected, bone marrow and cytogenetic examinations should be immediately performed to rule out TRL.
The first case is a 50-year-old female. She was consulted to our hospital for further examination of right hydronephrosis that was shown by ultrasonography. Cystoscopy revealed tumorous lesion around the right orifice. Bladder tumor was suspected and transurethral biopsy of the bladder was performed. The second case is a 54-year-old man. He was consulted to our hospital because right hydronephrosis was shown by counterized tomography. A tumorous or stenotic lesion in the lower end of ureter was suspected. Cystoscopy revealed yellowish and thickened tissue in the trigonal area. Bladder amyloidosis was suspected and transurethral biopsy of the bladder was performed. The histopathological diagnosis indicated amyloidosis and systemic amyloidosis was excluded. Both cases were treated by occlusive dressing technique therapy using Dimethyl sulfoxide (DMSO) successfully.
Some non-islet tumors can induce hypoglycemia. We report a case of a solitary fibrous tumor (SFT) as perivesical mass associated with hypoglycemia. A 61-year-old man was admitted to our department with recurrent hypoglycemic attack and lower abdominal discomfort, but no symptom of urination. Ultrasonography and magnetic resonance imaging demonstrated a giant heterogeneous mass in the pelvic and rightward shift of bladder, but the tumor's border was clear. Endocrinological analyses showed high serum levels of insulin-like growth factor II (IGF-II) and suppressed secretion of insulin. We removed perivesical tumor that weighted 720g on 30th January in 2003. After the removal, serum IGF-II levels returned to normal and hypoglycemic attacks ceased. Pathological examination revealed well-circumscribed nodular mass composed of uniform spindle cells arranged in bundles and fascicles with varying amounts of collagen and reticulin fibers. Almost all of the tumor cells were immunohystochemically positive for vimenntin and CD34, negative for cytokeratin.
A 62-year-old man was presented with a firm mass in right scrotum. Serum LDH and AFP were within normal range, but hCG-β was elevated (2.3ng/ml). Under the diagnosis of right testicular tumor, he underwent right radical orchiectomy. The specimen was a spermatic cord tumor with poorly differentiated adenocarcinoma. hCG-β was still elevated postoperatively and gastric fiber revealed adenocarcinoma of the stomach. Histochemical staining for hCG-β was positive in both tumor of the spermatic cord and stomach. Finally the tumor was diagnosed as metastatic tumor of spermatic cord from gastric cancer, causing the elevation of hCG-β.