Hiroshi Ohe

Preoperative Evaluation of Localized Prostatic Carcinoma by Transrectal Ultrasonography

We evaluated 31 patients with clinically localized prostatic carcinoma by transrectal ultrasonography before radical prostatectomy. Results of ultrasonography were reviewed without previous knowledge of the extent of the disease and were compared to the pathological staging obtained by step section of the prostate. Preoperative transrectal ultrasonography was sensitive in detecting capsular and seminal vesicle involvement (89 and 100 per cent, respectively). However, the specificity of the method was low for capsular involvement (50 per cent), probably owing to the inability of this method to detect microscopic disease. This method is a valuable tool in the preoperative evaluation of patients with clinically localized prostatic carcinoma.

Transrectal ultrasonography of the prostate.

Transrectal prostatic ultrasonography has been performed in 203 patients within the last year. This new diagnostic modality has proven reliable in quantitating decrease in volume of the primary tumor following therapy in 71% of patients with prostatic carcinoma (10 of 14 patients) in whom long‐term follow‐up is available. In 12 patients staged prior to radical prostatectomy, prostatic ultrasonography was extremely valuable in detecting capsular involvement. This new diagnostic modality has significantly enhanced the staging capabilities in patients with localized prostatic carcinoma. Cancer 53:1369‐1372, 1984.

Long-term results of intravesical chemoprophylaxis of superficial bladder cancer: experience of the Japanese Urological Cancer Research Group for Adriamycin.

SummaryLong-term results were analyzed in terms of tumor progression and survival in patients with superficial bladder cancer who were enrolled in the second intravesical chemoprophylactic study of the Japanese Urological Cancer Research Group for Adriamycin, which was started in July 1982. This study was a prospective, randomized, controlled trial conducted on primary tumors treated with a long-term instillation regimen that involved control versus intravesical instillations of Adriamycin or mitomycin C given once a week for the first 2 weeks, once every other week for 14 weeks, once a month for 8 months, and once every 3 months for 1 year, for a total of 21 instillations in 2 years. An analysis of the prophylactic effects of such treatment on bladder tumors after TUR has previously been performed, and the results have been published elsewhere. The present study represents a follow-up of the above trial. Of the 671 cases previously analyzed with regard to tumor prophylaxis, 158 cases (23.5%) were eligible to be followed for tumor progression and survival. A detailed comparison of the background factors between these 158 patients and the other 513 cases revealed no statistically significant difference. Thus, the 158 evaluable cases might reasonably be considered to represent all patients enrolled in the second study, and the results were thought to be reasonable enough to reflect the long-term efficacy of the long-term instillation regimen adopted in this study. The median follow-up for these 158 cases was 6.6 years. Tumor progression in terms of the disease stage and/or grade occurred in 43 of 127 patients who received prophylactic instillations and in 12 of 31 control cases. No significant difference in the incidence of tumor progression was found between the treatment and the control groups. In addition, no difference in survival was observed between the treatment group and the control group. Survival was also compared between patients who showed tumor progression and those who did not. All patients whose tumors did not progress survived, whereas the 7-year survival of those exhibiting tumor progression was <90%.

Dynamic Study of Nervous Control on Prostatic Contraction and Fluid Excretion in the Dog

The effect of the section or stimulation of various nerves on prostatic contraction and fluid excretion was investigated dynamically in the dog using an apparatus devised in our laboratory. Prostatic contraction could be classified into two types from the pattern of the contracting wave. One was a prominent tonic contraction, designated as H-type contraction, observed typically after hypogastric nerve stimulation and followed always by prostatic fluid excretion. The other was a weak clonic contraction, designated as P-type contraction, occurring typically after pelvic nerve stimulation and accompanied by no fluid excretion. The periodical contraction of these two types was noticed even at rest. The H-type contraction was associated with fluid excretion with a mean rate of 0.3 ml./hr. The denervation both of the hypogastric and pelvic nerves showed no distinct influence on contraction and excretion in the resting condition. The pudendal nerve was demonstrated to have no significant effect on prostatic contraction and fluid excretion. From these results, it was considered that dynamic fluid excretion followed by prostatic contraction was regulated chiefly by sympathetic fibers from the hypogastric nerve and the physiological role of parasympathetic fibers from the pelvic nerve was something other than fluid excretion.

Kinetic analysis of prostatic volume in treating prostatic cancer and its predictability for prognosis

Prostatic volume in patients with prostatic cancer diminished remarkably after castration according to measurements by transrectal sonography. These kinetic changes in prostatic volume were analyzed and a formula was applied to the regression curve. The reduction time (r) in the formula, which is a constant representing the time interval required for the effective portion of the prostate to be reduced to one tenth, was thought to be a good index to predict the prognosis of the patients.

The 4th study of prophylactic intravesical chemotherapy with Adriamycin in the treatment of superficial bladder cancer: the experience of the Japanese urological cancer research group of Adriamycin

SummaryA multicentric randomised trial was conducted for the purpose of investigating the efficacy of intravesical chemoprophylaxis of superficial bladder cancer. A total of 443 patients (number of evaluable patients, 284) were registered from July 1987 to December 1989 and randomised into 3 groups. Group A received 21 intravesical instillations of Adriamycin (ADM) at 20 mg/40 ml physiological saline for 2 years after undergoing transurethral resection (TUR); group B was given the same dose as group A but received 6 intravesical instillations for 2 weeks before undergoing TUR; and group C served as a control and underwent TUR only. Better prophylactic effects were obtained in group A. The overall non-recurrence rates calculated for groups A and B differed significantly (P<0.05) on day 240, and those determined for groups A and C were also significantly different (P<0.01) on day 480. No benefit was obtained using intravesical instillation prior to TUR (group B). The major side effects encountered were pollakisuria and miction pain, which occurred in 32% of the patients in group A and in 52% of those in group B.

Ultrasound findings in urolithiasis in the lower ureter

Thirty-two cases of urolithiasis in the lower ureter, difficult to detect by ordinary X-ray studies, were diagnosed accurately by ultrasound. Stonelike echoes were easily detected on the ultrasonograms when the ureter of the affected side was dilated. Patients should be examined by ultrasound prior to invasive retrograde pyelography.

Clinical utility of ursodeoxycholic acid in preventing flutamide-induced hepatopathy in patients with prostate cancer: A preliminary study

The present study was designed to ascertain retrospectively the validity of ursodeoxycholic acid (UDCA) in the treatment of prostate cancer in terms of prophylactic effects on the occurrence of flutamide‐induced hepatopathy in a large number of patients surveyed in a multi‐center cooperative study.

Staging of bladder tumors by transrectal ultrasonotomography and U.I. Octoson.

The staging of bladder tumors was performed in 100 cases by transrectal ultrasonotomography and in 44 cases by U.I. Octoson. Complete agreement between histology and ultrasound was obtained in 80% of the cases by the former method and in 73% by the latter method for tumors arising from the corpus of the bladder. However, agreement was obtained in only 38% of the cases by the former method and in 59% by the latter method for tumors arising from the apex and fundus of the bladder. The possibility of improving the agreement for tumors in the apex and fundus by introducing real-time transrectal linear scanning is suggested.

Prophylactic chemotherapy with intravesical instillation of Adriamycin and oral administration of 5-fluorouracil after surgery for superficial bladder cancer

The Japanese Urological Cancer Research Group for Adriamycin has conducted a series of clinical trials to investigate the efficacy and safety of prophylactic intravesical chemotherapy for superficial bladder cancer. In the third trial, reported herein, patients with recurrent bladder cancer or multiple primary cancer were selected and randomized to one of four groups using the envelope method after complete resection of the original tumors. Group A was given Adriamycin alone, group B received oral 5-fluorouracil (5-FU), group C was given Adriamycin and oral 5-FU, and group D served as the control group. Of the 544 patients registered, 331 were evaluable for the purpose of this study. The administration of 5-FU (group B) failed to prevent the recurrence of bladder tumors. Although group C (both Adriamycin and 5-FU) did not fare better than group A (Adriamycin only), Adriamycin was effective in preventing the recurrence of tumors, especially in high-risk patients with recurrent and multiple tumors. The risk of recurrence was reduced to 0.21 (95% confidence interval, 0.10–0.44) relative to the control group. There was no indication of a synergistic effect between 5-FU and Adriamycin. As side effects, cystitis syndrome was observed in 23%–30% of the patients in the Adriamycin groups and mild myelosuppression was observed in the 5-FU groups.