Ikuya Iwabuchi

Low-Dose Instillation Therapy with Bacille Calmette-Guérin Tokyo 172 Strain After Transurethral Resection: Historical Cohort Study

OBJECTIVES To evaluate the effectiveness and side effects of prophylactic low-dose bacille Calmette-Guérin (BCG) Tokyo 172 strain. METHODS We conducted a historical cohort study to compare the clinical usefulness of standard-dose versus low-dose BCG Tokyo 172 strain. A total of 156 patients with superficial bladder cancer (Stage Ta-T1) were historically allocated to either 40 or 80 mg of BCG after transurethral resection. Of the 156 patients, 89 had received standard-dose (80 mg) BCG from 1988 to 2000 and 67 had received low-dose (40 mg) BCG from 1996 to 2005. BCG was instilled into the bladder once a week for 6 consecutive weeks. We excluded 6 patients who did not complete the BCG treatment course. The median follow-up period was 66.9 months (range 2 to 176). RESULTS Tumor recurrence developed in 21 (32.3%) of 65 patients in the 40-mg group and 29 (34.5%) of 85 patients in the 80-mg group. No significant difference was found in the incidence of tumor recurrence between the two groups (P = 0.6377). Tumor progression was found in 4 (6.2%) of 65 patients in 40-mg group and 9 (10.6%) of 85 patients in the 80-mg group. No significant difference was found in tumor progression between the two groups (P = 0.5010). The overall incidence of side effects and severity of pollakisuria were significantly lower in the 40-mg group than in the 80-mg group (P = 0.012 and P = 0.013, respectively). CONCLUSIONS The low-dose BCG Tokyo 172 strain achieved identical recurrence-free and progression-free survival as the standard dose with reduced toxicity.

Risk factors for erectile dysfunction in healthy Japanese men.

The aim of this study was to identify risk factors for erectile dysfunction (ED) in healthy men. A comprehensive risk factor investigation was carried out in a Japanese community. The subjects were 280 healthy male volunteers with an average age of 56 years (range: 20-83 years) who participated in the Iwaki Health Promotion Project in 2006. They were residents of Iwaki district, Hirosaki City, in northern Japan. The participants completed the five-item version of the International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (I-PSS) surveys at the site of examination. We measured blood pressure and brachial-ankle pulse wave velocity (baPWV). We also measured risk factors for metabolic syndrome and sex hormones. We compared these risk factors with the IIEF-5 scores. Ninety-five participants (34%) scored 11 points or fewer on the IIEF-5 survey (severe/moderate ED), 154 (55%) scored 12-21 points (mild ED) and 31 (11%) scored 22 points or more (no ED). The prevalence of ED in the Japanese rural community was 89% (249/280). The severe/moderate ED group had significantly higher total I-PSS scores (p = 0.001), baPWV values (p < 0.001) and systolic blood pressure (p < 0.001) than the mild/no ED group. The same group had significantly lower free testosterone (p < 0.001) and dehydroepiandrosterone sulphate (p < 0.001) than the mild/no ED group. Logistic regression analysis revealed significant differences in baPWV (p = 0.003), total I-PSS (p = 0.015) and free testosterone (p = 0.003). Lower urinary tract symptoms, baPWV and free testosterone are independent risk factors for ED in healthy Japanese men.

Risk-stratified surveillance protocol improves cost-effectiveness after radical nephroureterectomy in patients with upper tract urothelial carcinoma

Objectives To develop a surveillance protocol with improved cost-effectiveness after radical nephroureterectomy (RNU), as the cost-effectiveness of oncological surveillance after RNU remains unclear. Results Of 426 patients, 109 (26%) and 113 (27%) experienced visceral and intravesical recurrences, respectively. The pathology-based protocol found significant differences in recurrence-free survival in the visceral recurrence but not in the intravesical recurrence. The medical costs per visceral recurrence detected were high, especially in normal-risk (≤ pT2N0, LVI-, SM-) patients. We developed a risk score associated with visceral recurrence using Cox regression analysis. The risk score-based protocol was significantly more cost-effective than the pathology-based protocol. Estimated cost differences reached

MP34-04 POST-CHEMOTHERAPY PD-L1 EXPRESSION CORRELATES WITH CLINICAL OUTCOMES IN JAPANESE BLADDER CANCER PATIENTS TREATED WITH TOTAL CYSTECTOMY.

747,929 per recurrence detected, a suggested 55% reduction. Materials and Methods We retrospectively evaluated 426 patients with RNU for upper tract urothelial carcinoma (UTUC) without distant metastasis at 4 hospitals. Patients with routine oncological follow-up were stratified into normal-, high- and very high-risk groups according to a pathology-based protocol utilizing pathological stage, lymphovascular invasion (LVI) and surgical margin (SM). Cost-effectiveness of the pathology-based protocol was evaluated, and a risk score-based protocol was developed to optimize cost-effectiveness. Risk scores were calculated by summing up risk factors independently associated with recurrence-free survival. Patients were stratified by low-, intermediate- and high-risk score. Estimated cost per recurrence detected by pathology-based and risk score-based protocols was compared. Conclusions A risk score-stratified surveillance protocol has the potential to reduce over investigation during follow-up, making surveillance more cost-effective.

Cauda Equina Symptoms Are Closely Related to Male Lower Urinary Tract Symptoms

Programmed cell death ligand-1 (PD-L1) is a key target molecule of immunotherapy that is frequently overexpressed in bladder cancer. In the present study, we examined whether PD-L1 expression is associated with clinical outcomes in bladder cancer patients. We enrolled 102 bladder cancer patients treated with cystectomy at the Aomori Prefectural Hospital between April 2004 and May 2014. We conducted an immunohistochemical examination of PD-L1 expression using the SP142 assay. PD-L1 expression was scored at three diagnostic levels (0/1/2). Of the 102 patients, 82 were men (81.0%) and 20 were women (19.0%) (mean age 60 years, range 43–84 years). Sixty-six patients (64.8%) had previously undergone neoadjuvant chemotherapy [neoadjuvant (+) group]. During the mean observation period of 54.5 months, 42 patients had recurring disease (41.1%) and 34 died (33.3%). The 5-year cause-specific survival (CSS) rate was 66.6%; the 5-year disease-free survival (DFS) rate was 59.7%. In the neoadjuvant (+) group, the 5-year DFS rate was 65.0% for PD-L1 (−) patients and 31.7% for PD-L1 (+) patients (log-rank p = 0.006). In the neoadjuvant (+) groups, the 5-year CSS rate was 69.6% for PD-L1 (−) patients and 48.1% for PD-L1 (+) patients. Differences in CSS and DFS rates between PD-L1 (−) and PD-L1 (+) patients in both treatment groups were statistically significant (log-rank p = 0.006 and 0.039, respectively.) Despite the small study size, our data suggest that post-chemotherapy PD-L1 expression is associated with poor prognosis in patients receiving neoadjuvant chemotherapy who had previously undergone cystectomy.

Protein profiling of post-prostatic massage urine specimens by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry to discriminate between prostate cancer and benign lesions

Introduction: To determine the impact of cauda equina symptoms on male lower urinary tract function, we investigated the related risk factors in healthy Japanese men. Methods: Subjects included 345 healthy males (average age 56 years; range 26–83) who participated in the Iwaki Health Promotion Project in 2006. They were residents of Iwaki district, Hirosaki City, northern Japan. Using a self-administered, self-reported questionnaire for lumbar spinal stenosis and International Prostate Symptom Score (IPSS), we investigated the prevalence of cauda equina symptoms. We also measured body mass index; blood pressure; and triglyceride, cholesterol, glucohemoglobin, and prostate-specific antigen levels. Results: Nineteen participants (5.5%) were positive for cauda equina symptoms; 270 participants (78.3%) scored 0–7 points on the total IPSS survey, 65 (18.8%) scored 8–19, and 10 (2.9%) scored 20–35. The total IPSS, and storage and voiding symptom scores of participants negative for cauda equina symptoms were significantly lower than those who were positive. Multiple logistic regression analysis revealed that age and cauda equina symptoms were independent significant risk factors for total IPSS and storage symptoms. Conclusions: Cauda equina symptoms are closely related to lower urinary tract symptoms in healthy Japanese men.