(Purpose) We retrospectively evaluated the efficacy and toxicity of modified M-VAC therapy for locally advanced or metastatic urothelial carcinoma. (Patients and method) From 1993 October to 2005 February, 28 patients were treated with modified M-VAC therapy and 25 of 28 patients had lesions suitable for the evaluation. The modified regimen was the combination of methotrexate at a dose of 30mg/m2 on day 1, vinblastine at a dose of 3mg/m2 on day 2, doxorubicin at a dose of 30mg/m2 on day 2, and cisplatin at a dose of 70mg/m2 on day 2 with courses repeated every three weeks. (Results) The median number of cycle was 3 (1-7 cycles). Six of 25 patients achieved complete response (CR) and six partial response (PR), resulting in a 48% response rate. With a median follow-up time of 65.6 months, the median survival was 9.3 months and the 1-year and 2-year survival rates were 33.5% and 9.6%, respectively. The median progression-free survival was 6.0 months. Grade 3 and 4 toxicities included neutropenia (84.4%), thrombocytopenia (40%), anemia (56%), febrile neutropenia (20%), nausea, vomiting (8%). (Conclusion) Although response rate of modified M-VAC therapy was similar to classic M-VAC therapy, but modified M-VAC therapy had shorter response duration and more frequent toxicities. We were not able to find the benefits of modified M-VAC therapy.
(Objectives) The perioperative management of radical prostatectomy in Japan has not been investigated previously. It would be significant to document present management practices. (Methods) A questionnaire survey of 1, 213 educational institutions of Japanese urological association was conducted by mail. (Results) Questionnaires were returned from 722 (60%) institutions and responses indicated that radical prostatectomy was performed in 657 of these institutions (91%). Admission to hospital was most frequently scheduled on preoperative day 2; walking was most frequently planned to be initiated on postoperative day (POD) 1; beginning of food intake on POD 2; termination of continuous drip infusion and drain removal on POD 3, removal of the Foley catheter on POD 7; intravenous antibiotics for three days; oral antibiotics for 7 days; and discharge from hospital on POD 14. However, the duration of the indwelling drain and Foley catheter, antibiotic administration and hospitalization varied widely. (Conclusion) There was great variety in the perioperative management of radical prostatectomy among hospitals. We need to obtain consensus on 1) the timing of drain removal, 2) duration of antibiotics, and 3) the timing of catheter removal, in order to uniformly provide medical care of good quality in Japan.
(Aim) Storage/filling symptoms caused by overactive bladder (OAB) are bothersome to patients. The aim of this study is to clarify if α1-blocker provides additional benefit in combination with anticholinergic treatment in patients with OAB. (Methods) In total, 100 patients (men/women: 43/57, mean age: 71.3 years) who had frequency (more than eight times a day) and urgency (more than three times a week) were prospectively randomized, and allocated to two groups (monotherapy group [n=52]: propiverine alone or combination group [n=48]: propiverine plus urapidil). The primary end point was to compare the improvement of storage symptoms (numbers of frequency, urgency, disappearance of urge incontinence) as well as patients' quality of life (QOL) assessed by King's Health Questionnaires (KHQ) at baseline, 2 weeks, and 6 weeks after the start of treatment in both groups. The second end point was to evaluate the safety of these agents. (Results) Statistically significant improvements in terms of urgency and frequency were observed in both groups at two-weeks after the start of treatment as compared with baseline (p<0.01 and <0.05, respectively), while no inter-group difference was observed between the two groups. Significant improvement of QOL was observed after six weeks treatment in overall mean score, general health perception, incontinence impact, sleep/energy domains in both groups as compared with baseline. No significant difference was observed in terms of toxic events between the two groups. (Conclusions) Although both groups showed identical improvement of storage symptoms and tolerability, no additional benefit of α1-blocker was observed.
(Purpose) We retrospectively evaluated the characteristics and long-term prognosis of incidentally detected renal cell carcinoma by health checkup. (Materials and Methods) From January 1987 to December 2005, 556 patients were treated for renal cell carcinoma in our department. Among them, 56 patients were detected by abdominal ultrasonography in health checkup of our health care center. We reevaluated the pathological stage according to 2002 TNM classification and tumor type of renal cell carcinoma according to 2004 World Health Organization histological classification. Survival analysis was determined by Kaplan-Meier's method and log-rank test. (Results) Of the patients, 50 were male and 6 were female. The age of the patients ranged 37 to 68 years old at diagnosis (median 54 years). The tumors were located in the right kidney in 22 patients and in the left kidney in 34. Pathologically T1a tumors were found in 40 patients (71%), T1b in 13 (23%), T2 in 2 (4%) and T3b in 1 patients (2%). One case of T3b had N2 and M1 disease. The follow up time after the operation ranged 3 to 215 months (median 121 months). Seven patients died of renal cell carcinoma. One of the 7 patients in T1a disease died at 64 months, 4 in T1b at 47, 91, 119, 163 months, 1 in T2 at 39 months and 1 in T3b at 13 months, postoperatively. The cause specific 10-year survival rate was 97% for T1a disease and 57% for T1b (p<0.01), respectively. (Conclusion) Most of renal cell carcinomas were T1a disease, which were detected incidentally by health checkup. The cause specific survival rate was significantly higher for T1a disease than for T1b. Our data suggested that early detection was important for good prognosis. The abdominal ultrasonography was only method for detection in routine health checkup and should be broadly implemented.
(Purpose) Since 2003, a basic health checkup has involved prostate cancer screening with prostate specific antigen (PSA) alone. We investigated the results between 2003 and 2005. (Subjects and Methods) Among males aged over 50 years who underwent a basic health checkup, the subjects were those who desired prostate cancer screening. Cancer screening with PSA alone was performed; mass screening or individual screening in hospitals in the city. We employed PSA with respect to age stratification. On the primary screening, written informed consent regarding the analysis of the screening results was obtained. (Results) In 2003, there were 15, 303 males aged over 50 years in Tatebayashi City. In 2003, 2004, and 2005, 11.8%, 12.2%, and 12.7% of the males underwent PSA screening, respectively. The rate of elevated PSA levels between 2003 and 2005 was 20.6%. Furthermore, 208, 165, and 179 males required secondary screening, and 80.3%, 61.2%, and 55.3% of the males underwent secondary screening, respectively. Of the males who underwent secondary screening, prostate biopsy was performed in 123 (73.2%), 54 (53.5%), and 38 (38.4%). Prostate cancer was detected in 60, 28, and 16 males, respectively. These values corresponded to 3.4%, 1.5%, and 0.8% of the males who underwent primary screening. The incidence of prostate cancer was 1.85% during the 3 years, and 3.2% in males who underwent the initial health checkup. Of 101 males in whom the stage was evaluated, the clinical stage was evaluated as B in 86 (85.1%), C in 9 (8.9%), and D in 6 (5.9%). Of the 101 males, endocrine therapy was performed in 46 (45.5%), surgery in 31 (30.7%), external irradiation in 5 (5.0%), and followup without treatment in 6 (5.9%). In addition, 7 (6.3%) desired treatment in another hospital, and 6 (5.9%) refused treatment. (Conclusion) Prostate cancer was detected in 1.85% of males who underwent primary screening between 2003 and 2005. Of 101 males in whom the stage was evaluated, the clinical stage was, evaluated as B in 86 (85.1%), and the early treatment of prostate cancer was achieved. This may lead to a future decrease in the mortality rate.
A left renal tumor which was 11cm in diameter and located at lower pole was founded in a 67 year-old male by CT scan for the examination of hypertension. The tumor extended in left renal vein slightly. Laparoscopic radical nephrectomy and partial colectomy were performed because the tumor adhered to mesentry firmly. The operative time was seven hours, and the estimated blood loss was about 30ml.
In this report we describe a case of late relapse non-seminomatous germ cell tumor eradicated after 9 years of initial onset. A 20-year-old man complaining of recent aches, vomiting and headaches was diagnosed with right testicular tumor with solitary brain and bilateral lung metastases. At presentation, human chorionic gonadotropin (HCG) was elevated to 22, 000mIU/ml, and alpha-fetoprotein to 79ng/ml. A right high orchiectomy was performed, followed by a right occipital osteoplastic craniotomy due to the presence of left hemiplesia and anisocoria prior to chemotherapy. Pathologically, the tumors were embryonal carcinoma and yolk sac tumor. The patient received 5 cycles of cisplatinbased PEP chemotherapy (cisplatin, etoposide and peplomycin) after which all the tumor markers fell to within the normal range. The remaining right lung tumor was removed surgically and the remnant lesion was found to be scar tissue. Four years after initial therapy, elevated serum HCG levels were detected. The tumor metastasis showed only HCG elevation responsive to chemotherapy each time followed by relapse and undetectable with all kinds of imaging examinations for 5 years. Finally when the tumor became chemorefractory, conventional computed tomography scan on bone window detected the occult tumor in L4 corporal body. After radiation therapy the tumor was removed by total spondylectomy and there was no viable tumor cells in the specimen pathologically. HCG fell to within normal range according to its half life period after the operation and there is no relapse of HCG after 18 months follow up. CT bone window photography may be sometimes useful to detect occult bone metastasis and salvage surgery combined with radiation therapy may be worth trying in patients with chemorefractory non-seminomatous germ cell tumors.
A 79-year-old man who had low grade fever and general malaise was referred to our hospital on January 27, 2004. Physical examination revealed a hard fixed painless mass, measuring 10cm in the left abdomen. Sarcoma of retroperitoneal origin was suspected preoperatively by abdominal ultrasonogram, CT, MRI and Angiography. Extended surgical treatment including left nephrectomy was performed. The tumor was histologically diagnosed as storiform-pleomorphic malignant fibrous histiocytoma (MFH) arising from perirenal tissue. Although we recommended adjuvant therapy after the excision, the patient refused. After a follow-up period of 11 months, he developed local recurrence in the left retroperitoneal space, and external irradiation was performed. He died 21 months after the operation. To our knowledge, this is the 10th case of MFH arising from perirenal tissue in Japan.
A 79-year-old man was consulted to our hospital for further examination of right adrenal tumor shown by computed tomography. Complete blood cell count, biochemical tests, hormonal examinations and urinalysis were normal. 131I-adosterol scintigram showed decreased uptake on the right adrenal. Right adrenalectomy was done in consider to adrenal cancer. By the pathological findings and the serological tests (ELISA, and Western Blot examination), the tumor was diagnosed as an adrenal multilocular echinococcosis. Mainly, Echinococcosis caused by echinococcus granulosus and echinococcus multilocularis. While E. granulosus is endemic in Europe and Mediterranean coast etc., E. multilocularis is endemic in Japan and North America etc. In E. multilocularis, about 98% of the primary cyst are localized in the liver and the cyst are localized in the lung and brain etc, are rare. In Europe, the primary hydatid cyst is found in the adrenal in only 0.05% of the total case. Moreover, adrenal multilocular echinococcosis is extremely rare case, and is not presented yet in the world. By the patient's residential history, echinococcosis shoud be considered to differential diagnosis of the adrenal tumor in urology.