Haruaki Sasaki

JSSM Guidelines for erectile dysfunction

Department of Urology, Spinal Injuries Center, Fukuoka, Department of Urology, Toho University, Tokyo, Department of Urology, Showa University Fujigaoka Hospital, Yokohama, Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Department of Internal Medicine, Tokyo Women’s Medical University Medical Center East, Tokyo, Nishi Medical Clinic, Kagoshima, School of Allied Health Sciences, Faculty of Medicine, Osaka University, Osaka, and Marriage and Sex Counseling Center, Tokyo Japan

INITIAL EXPERIENCE OF THE ENZALUTAMIDE TREATMENT FOR CASTRATION-RESISTANT PROSTATE CANCER

(Objective) Enzalutamide is an oral androgen-receptor inhibitor that prolongs survival in men with castration-resistant prostate cancer (CRPC). We retrospectively evaluated clinical efficacy and safety of enzalutamide in CRPC. (Patients and methods) We reviewed clinical records of 73 patients who had received enzalutamide for the CRPC at Showa University and affiliated 7 hospitals. Enzalutamide was given at a dose of 160 mg/day, but some patients were treated at lower dose because of there age or poor performance status. Prostrate-specific antigen (PSA) response, prior docetaxel use and the previously administered agents were evaluated retrospectively. (Results) The median patients age was 77 years, the median Gleason score was 9 and the median PSA level at baseline was 26.9 ng/ml. The patients who had prior docetaxel use were 29 (39.7%) and the median of total docetaxel dose was 460 mg/body. The median number of total prior treatments (anti-androgens, Estramustine and steroid) was 3. Twenty seven (61.4%) patients with docetaxel-naïve achieved over 50% reduction of PSA level from baseline, but only 7 (24.1%) in patients previously treated with docetaxel. The most common adverse events included fatigue (24.7%), anorexia (24.7%) and the nausea (16.4%). We found a small proportion of responders to enzalutamide experienced a PSA flare. (Conclusion) Our results of the use of Enzaltamide for CRPC were similar with previous reports. PSA flare was found in some patients with CRPC who responded to enzaltamide. It should be noted that this possible PSA flare phenomenon.

Magnetic Resonance Imaging of a Urethral Caruncle and the Pathologic Correlation: A Report of 3 Cases

A urethral caruncle is the most common disease of the urethra in postmenopausal women. A definitive diagnosis can usually be reached based on physical examination. Cross-sectional imaging is performed when malignant urethral tumor is suspected, such as a urethral carcinoma. No articles have discussed the detailed imaging of urethral caruncles. We present 3 patients with symptomatic urethral caruncles who underwent magnetic resonance imaging preoperatively.

AB21. Association between vascular evaluation and erection hardness score in the patients with ED

Main causes of erectile dysfunction (ED) are attributed to vascular endothelial dysfunction and impaired blood flow due to arteriosclerotic changes. It is well known that vascular endothelial dysfunction has related to life-style related disease, as well as hypertension, diabetes mellitus, dyslipidemia and others. And it is widely accepted that ED is the good predictor of cardiovascular event. There are clinically some methods to evaluate the atherosclerosis in men such as FMD, pulse wave velocity (PWV) and carotid ultrasonography. In our study, we clinically examined the association among the erection hardness score (EHS), PWV, and the presence of carotid arterial plaques. PWV is a measure of arterial stiffness and a marker of vascular damages. Higher PWV means that the vessels are less elasticity. Because PWV is gradually increased by age, we evaluated the correct value which is PWV at the first examination minus reference PWV by age. Our study revealed that patients with lower score of EHS at the first visit had higher PWV and were more likely to have carotid arterial plaques, and therefore, a high possibility of organic ED. Patients with Organic ED were significantly higher than those with psychogenic ED in PWV. And also our study indicates that the hardness of the penis can be an easier, clearer and more sensitive index of atherosclerosis.

Complete response to low-dose sorafenib in a patient with metastatic renal cell carcinoma: A case report.

We present a case of a patient with metastatic renal cell carcinoma (mRCC) who was treated solely with low-dose sorafenib and achieved a complete response (CR). A 79-year-old man with cytokine-refractory mRCC involving the lung, abdominal wall and lymph nodes was treated with low-dose sorafenib (400 mg/day) as a second-line therapy. Five months into treatment, CR was confirmed by follow-up computed tomography. No severe adverse events were observed and sorafenib treatment was continued without appearance of new lesions. Although sorafenib has been approved for mRCC treatment, complete clinical recovery is uncommon and has rarely been described. In this case, low-dose sorafenib appears to be sufficient for achieving CR while suppressing toxicity. Furthermore, long-term continuous administration induces the patient to obtain disease stabilization. However, considering toxicity and treatment costs, it is debatable whether treatment should be discontinued or sustained after CR.

Clinical Evaluation of the Results of Open or Transurethral Surgery for Prostate Hypertrophy

We evaluated the outcome of surgery for prostate hypertrophy through measurement of the urine flow rate and the Boyarsky symptom score. The study covered 108 patients admitted to Showa University School of Medicine, Fujigaoka Hospital. Thirty–eight had been admitted for retropubic prostatectomy and the remaining 70 patients for transurethral resection of the prostate. Their ages ranged from 48 to 84 years, with an average age of 64.4 years. The urine flow rate was measured before and after prostatic operation using Dantec Urodyn 1000. The symptom scores were calculated according to the Boyarsky symptom score. The Students t test was used for statistical analysis. Frequency (daytime, nighttime) was the most common preoperative symptom (97.2%, 96.3%), followed by impairment of stream (88.0%), and intermittency (78.7%). Frequently observed symptoms tended to raise the symptom scores. The period of admission, age and prostatic size did not correlate with the preoperative urine flow rate and symptom score. Significant improvements in the urine flow rate occurred after the operation. Frequency (daytime, nighttime) was the most common postoperative symptom (82.7%, 81.1%), followed by urgency (37.0%), then terminal dribbling (32.2%). Of 39 patients who were evaluated by symptom score and urine flow simultaneously, 6 patients (15.1%) failed to show improvement in 1 of the 2 evaluations, while 9 (23.1%) patients failed to show improvement in either. The irritative symptoms (frequency, urgency) tended not to show significant postoperative improvement.