(Purpose) There were few studies which reported the longitudinal quality of life (QOL) for Japanese men who received endocrine therapy for advanced or metastatic prostate cancer. A pilot randomized trial was conducted to assess QOL and the incidence of hot flash following endocrine therapy using luteinizing hormone-releasing hormone (LH-RH) agonist goserelin acetate 1-month or 3-month depot alone in patients with advanced or metastatic prostate cancer. (Material and methods) A total of 28 patients with advanced or metastatic prostate cancer who received LH-RH analogue goserelin acetate depot alone for 12 months were randomized (1:1) to two different formulations. Fifteen patients received the 1-month depot and thirteen patients received 3-month depot, namely Zoladex® 3.6mg depot and Zoladex LA®10.8 mg depot, respectively. We measured health related QOL using European Organization for Research and Treatment of Cancer (EORTC) and EuroQol (EQ-5D) questionnaire and evaluated the incidence of hot flashes between the two groups for one year after diagnosis. Moreover, we evaluated the incidence of hot flashes between the 1M and 3M depot. A baseline interview was conducted before treatment. Follow-up interviews were conducted in person at scheduled study visits of 3, 6, 9 and 12 months after treatment. (Results) Five (18%) patients dropped out of the study. Thus, we analyzed 23 eligible patients (11 in the 1M arms and 12 in the 3M arms). No significant differences between the two treatment arms were detected in categories of age, average pre- PSA values, Gleason scores and clinical T stage. According to EORTC, each treatment group showed similar QOL scores in all domains before and after treatment. With regard to EQ-5D, the 1M-treatnent arm reported better utility scores than 3M treatment arm, which was no significant statistically. The overall incidence of hot flash was 61% (58% in 1M group and 64% in 3M group). (Conclusion) There were no differences with regard to general and disease specific HRQOL between the both formulations of goserelin acetate. Hot flashes are the major adverse effects of endocrine therapy for Japanese patients with prostate cancer.
(Aims) Folic acid is one of water-soluble Vitamin B group and plays an important role in proliferating cells of the fetus. A multicentered, randomized control trial proved in 1991 that folic acid supplements of 4mg per day periconceptionally administered to 1031 women who were recruited from 7 countries and had afflicted prior pregnancy successfully prevented 72% of recurrence of neural tube defects. As a primary prevention method, the Government has recommended to take 400 microgram of folate supplements per day from 4 weeks before and 12 weeks after conception. Because of huge amount of folate being demanded in the first trimester, this vitamin is called as “vitamin for women” or “vitamin for fetuses”. We herewith report results of questionnaire study performed among urologists. (Materials and methods) A questionnaire was sent July 2007 to 400 urologists randomly selected from the Membership Directory of the Japanese Urological Association 2006 whether they are aware of the role of folic acid and how they guide young women or pregnant women on their life style. One hundred sixty-one responses were obtained (40%). (Results) Thirty-six percent of urologists were aware of the important role of folic acid in the critical stage of fetal development, which was significantly elevated compared to 26% observed in 2002 (p=0.037). Fifty-seven percent of urologists acquired this information through Japanese Urological Association or medical journals, 17% through mass media, and 7% through Internet. Those who guided young women or pregnant women to refrain from smoking, to abstain from alcohol, to take well-balanced meals and to take folate supplements were 73%, 62%, 67% and 7%, respectively. Ninety-two percent of urologists agreed to provide this information to young women or pregnant women. (Conclusion) Birth incidence of spina bifida has been increasing in Japan. In order to suppress incidence of this congenital anomaly, Urologists are requested to send young women a message that maternal periconceptional intake of folate will suppress the risk of congenital anomalies.
(Objective) To evaluate the usefulness of the ADAM questionnaire and aging males' symptoms' (AMS) rating scale for Japanese middle-aged men, we analyzed the results of these tests. We also examined the range of serum testosterone levels of these individuals. (Material & methods) Answers to these tests were obtained from 187 healthy Japanese men (from 46 to 64 years old) who visited for medical check-up. Serum total (TT) and free (FT) testosterone were also examined, and calculated free (cFT) and bioavalable (cBT) testosterone levels were obtained. (Result) According to the ADAM questionnaire, 140 (77.8%) men were judged to be PADAM. Mean AMS total, psychological, somatovegetative, and sexual symptom scores were 29.4, 7.5, 12.9, and 9.0, respectively. Although 32 (17.5%) men had more than moderate symptoms on AMS total score, 119 (65.0%) men complained of more than moderate sexual symptoms. In contrast, the testosterone levels of these people were not always low. Mean values of TT, FT, cFT, and cBT were 5.50ng/ml, 14.7pg/ml, 116.1pg/ml, and 292.3ng/dl, respectively. None of these testosterone levels was significantly correlated with age or AMS score. Only sexual symptom score among AMS subscales was significantly correlated with age. (Conclusion) The borderlines for the ADAM questionnaire and AMS rating scale appear too stringent for healthy Japanese middle-aged men. The sexual activity of Japanese middle-aged men appears less than that of Westerners. Criteria of these tests in Japanese middle-aged men, especially sexual function, should be changed.
A 67-year-old woman was referred to our hospital in April 2003 because of a bladder tumor. Cystoscopy revealed a thumb tip size and wide based papillary tumor. TUR-Bt was performed. Histologically, the tumor was UC, G3 and pT1. There was no recurrence of tumor in bladder after that. 3 years later, she was referred again with high serum levels of CA19-9 and CEA. Computed tomography showed bilateral lymph node swelling in the pelvis. An open biopsy of the lymph node was done and it contained UC with a micropapillary component. Radiation therapy achieved completely response. Serum levels of CA19-9 and CEA were within normal limits. She has never had a recurrence of tumor until July 2007.
Malignant sertoli cell tumor is a rare disease and only a few cases have been described previously. We report a terminal case of malignant sertoli cell tumor. A 38-year-old male visited a hospital with a complaint of swelling his left testis. He underwent high left orchiectomy. His pathologic diagnosis was suspected seminoma, and all tumor markers (LDH, HCG, AFP) were negative, and CT imaging confirmed clinical stage 1 (pT1NOMOSO). One year later, a CT scan showed a small retroperitoneum lymph node swelling. Four months later, these lesions increased to 55×45×70mm in diameter. He received 3 courses of chemotherapy with BEP (bleomycine, etoposide, cisplatin), but, lymph node size did not change. After he underwent a CT guided lymph node biopsy, his pathologic diagnosis was viable embryonal carcinoma. He then came to our hospital. We selected CPT-11 and nedaplatin for his salvage chemotherapy, but lymph node lesions did not change. After he received 3 courses of chemotherapy, we performed retroperitoneal lymphadenectomy. His pathologic diagnosis was viable sertoli cell tumor, malignant type. After 30 days, he had multiple liver metastases ane died 27 months after orchiectomy. All tumor markers were negative in his all clinical courses.
Zoledronic acid is reported to significantly reduce skeletal morbidity and prolong time to bone lesion progression in patients with bone metastases from various malignant tumors including renal cell carcinoma. Due to renal uptake and elimination of zoledronic acid, however, it is difficult to control dose alignment in patients with kidney dysfunction. We reviewed significance of hemodialysis and monitoring of serum creatinine and calcium in patients with ESRD. (Cases) We experienced two cases of end-stage renal disease (ESRD) with bone metastases from advanced renal cell carcinoma. Zoledronic acid was given to both patients by 15 minutes intravenous infusion followed by hemodialysis 24 hours later. Systemic cytokine infusion and oral thalidomide were also given to both patients. Level of serum calcium reduced in one case two weeks later, and treated by calcium administration. No other adverse effects were noted for more than six months of combination therapy. Both cases maintained stable disease not only for bone metastases but also for the systemic condition without any organ failure. Even in patients under maintenance hemodialysis, zoledronic acid can be given with certain safety and efficacy by hemodialysis 24 hours after administration and intense monitoring of serum calcium level. We think this is the first report of zoledronic acid treatment to ESRD patients with bone metastases from malignant tumors.