Issei Takizawa

Granulomatosis with Polyangiitis (Wegener’s Granulomatosis) Accompanied by Dysuria

A 65-year-old male visited us with complaints of retarded urination, dysuria, gross hematuria, and fever. Urinalysis showed pyuria. Prostatic tumor with lung metastasis was suspected from computed tomography and magnetic resonance imaging. Transurethral prostatic biopsy and bronchoscopic biopsy only revealed fibrinoid necrosis and inflammatory infiltration. Right lateral maxillary sinusitis was also found by MRI. ANCA testing was positive with specificity for anti-PR3 (PR3-ANCA). On the basis of these results, Granulomatosis with polyangiitis (GPA) was diagnosed. GPA involving the prostate gland is unusual, and only a few cases have previously been reported.

Basal Cell Proliferation Induced by Chlormadinone Acetate Suggests Stem Cell Transformation of Prostatic Cells

Introduction and Objective: Epithelial to Mesenchymal transition (EMT) at the first hormonal therapy is thought to play an essential role in obtaining castrate resistance for hormone naive prostate cancer. So we studied EMT of prostatic cells after exposing various hormonal agents using transurethral resection (TUR) specimens. Patients and Methods: TUR specimens without hormonal use (4 cases), specimens after three weeks of chlormadinone acetate (CMA) (9 cases), specimens after average six months of dutasteride (3 cases), and specimens two weeks after initial use of degarelix (3 cases) were studied using HE and immunohistochemical staining with prostate specific antigen (PSA), prostatic stem cell markers such as CD44, CD117, CD133 and Vimentin. Results: Specimens treated with CMA showed acinar dilatation and atrophy of glandular cells. Specimens treated with dutasteride showed marked decrease of gland and specimens treated with degarelix showed decrease of glandular cells. PSA was stained all of the prostatic glandular cells in all specimens. CD44 was stained at basal cells in normal prostatic tissue without hormones, however in hormone treated specimens, basal cells elongate and some glandular cells were also stained by CD44, especially in CMA treated specimens. Only small numbers of infiltrating cells in interstitial tissue positively stained with CD 117 and CD 133 in all specimens. Vimentin was stained in all mesenchymal interstitial cells. Conclusion: Elongation of basal cells and increased sensitivity to CD44 in glandular cells, especially treated with CMA, were thought to the result of EMT of prostatic glandular cells.

Development of a Nomogram for Predicting Severe Neutropenia Associated With Docetaxel-Based Chemotherapy in Patients With Castration-Resistant Prostate Cancer.

&NA; We analyzed 112 patients with castration‐resistant prostate cancer (CRPC) treated with docetaxel‐based chemotherapy to identify risk factors for severe neutropenia (SN) in the first cycle of chemotherapy. Age and baseline neutrophil counts were significant independent risk factors. Based on the risk factors, we developed a nomogram for predicting SN in the first cycle of docetaxel‐based chemotherapy for patients with CRPC. Background: Neutropenia is a major adverse event of docetaxel‐based chemotherapy. The present study was undertaken to evaluate the incidence of neutropenia and to develop a nomogram for predicting Grade 4 neutropenia during the first cycle of docetaxel‐based chemotherapy in patients with castration‐resistant prostate cancer (CRPC). Patients and Methods: This study included 112 patients with CRPC treated with docetaxel‐based systemic chemotherapy. We evaluated the incidence and risk factors for Grade 4 neutropenia in the first cycle of chemotherapy. Results: Sixty‐two of 112 patients (55.4%) developed Grade 4 neutropenia in the first cycle of docetaxel‐based chemotherapy. There were significant differences in age, baseline white blood cell count, and baseline neutrophil count between patients with non‐Grade 4 neutropenia and those with Grade 4 neutropenia in univariate analyses. The serum prostate‐specific antigen level, hemoglobin level, creatinine, albumin, Eastern Cooperative Oncology Group performance status, metastatic sites, extent of disease, and history of external beam radiotherapy to the prostate were not significantly different between the 2 groups. Multivariate logistic regression analysis showed that age (odds ratio [OR], 1.08; P = .019) and baseline neutrophil counts (OR, 0.79; P = .045) were significant independent risk factors for severe neutropenia. A nomogram and a calibration plot on the basis of these results were developed from a multivariate logistic regression analysis to predict the probability of Grade 4 neutropenia. Conclusion: Age and baseline neutrophil counts were significant independent risk factors for Grade 4 neutropenia. The nomogram to predict it provides useful information for the management of patients with CRPC treated with docetaxel chemotherapy.

Preoperative prediction of malignant involvement of resected ureters in patients undergoing radical cystectomy for bladder cancer

To investigate preoperative predictors of ureteral involvement of bladder malignancy and to develop a novel preoperative model for the prediction of ureteral involvement in bladder cancer patients undergoing radical cystectomy.

761 PREDICTION OF LEUKOPENIA AFTER DOCETAXEL CHEMOTHERAPY IN PATIENTS WITH CASTRATION-RESISTANT PROSTATE CANCER

outcomes when compared to similar patients treated with salvage cryotherapy alone. METHODS: Using the Cryo On-Line Data Registry (COLD), the records of 567 men treated with cryotherapy for biopsy proven recurrent prostate cancer following full dose radiation therapy were reviewed. The patients were stratified into two groups, those who received ADT prior to cryotherapy and those who did not receive ADT. Patients who received post-treatment ADT were excluded. Pre-treatment parameters, complications, functional outcomes, and biochemical failure using the Phoenix criteria were analyzed. The patients were stratified using D Amico criteria into low, intermediate and high-risk groups. RESULTS: 222 patients received ADT prior to salvage cryotherapy and 345 patients did not receive ADT. Freedom from biochemical failure at 5 years using the Phoenix criteria was 41.5% vs. 41.0% (p 0.47) for ADT and no ADT patients, respectively. Stratification into low, intermediate, and high-risk groups also showed no significant difference between ADT and no ADT groups using the Phoenix criteria (p 0.27, 0.38, 0.87; respectively). Functional outcomes comparing ADT and no ADT at 12 months demonstrated decreased urine retention (3.6% vs. 15.4%; p 0.04) and incontinence (4.8% vs.7.3%; p 0.04) in the ADT group. Potency rates were not significantly different between the two groups (38.4% vs. 39.6%; p 0.07). Fistula rates were similar yet slightly lower in the group that did not receive ADT (1.8% vs. 1.4%; p 0.58l). CONCLUSIONS: This retrospective study of salvage cryotherapy found no difference in biochemical free survival between the pre-treatment ADT and no ADT groups, even when stratified by risk. There was significantly less risk of retention and incontinence with ADT, probably due to prostate size reduction. No statistically significant difference was found in potency or fistula rates.