Jun Nakashima

Prostate cancer screening: the clinical value of diffusion-weighted imaging and dynamic MR imaging in combination with T2-weighted imaging.

To evaluate the clinical value of diffusion‐weighted imaging (DWI) and dynamic MRI in combination with T2‐weighted imaging (T2W) for the detection of prostate cancer.

Age-related prevalence of erectile dysfunction in Japan : Assessment by the International Index of Erectile Function

Abstract Background: The effects of age and concomitant chronic illness on male sexual function were investigated to obtain insight into the prevention of erectile dysfunction (ED).

Differential Diagnosis of Primary Benign and Malignant Retroperitoneal Tumors

Background:

Gemcitabine and paclitaxel chemotherapy for advanced urothelial carcinoma in patients who have received prior cisplatin-based chemotherapy

BackgroundThe objective of this study was to evaluate the efficacy and toxicity of combination chemotherapy with gemcitabine and paclitaxel as a second-line regimen in patients with advanced urothelial carcinoma.MethodsTwenty patients with advanced urothelial carcinoma who were resistant to an M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin) chemotherapy regimen were administered chemotherapy consisting of intravenous gemcitabine 2500 mg/m2 and paclitaxel 150 mg/m2 (GP) every 2 or 3 weeks.ResultsThe patients received a median of 7.7 cycles of treatment (range, 2–20 cycles). Six of the 20 patients (30%; 95% confidence interval [CI], 10%–50%) had a major response to treatment (a complete response [CR] in 5% and a partial response [PR] in 25%). Seven patients (35%) had stable disease (SD). The median duration of response was 4.5 months (range, 1–9 months) and the disease control rate (CR + PR + SD) was 65%. The median survival was 11.5 months (range, 2–22 months) and the 1-year survival rate was 35%. The patients tolerated this regimen well, with only grade 3–4 neutropenia being observed in 6 patients (30%), anemia in 3 (15%), and thrombocytopenia in 1 (5%). The response rate to M-VAC in the first-line chemotherapy was significantly associated with the response to GP as the second-line chemotherapy.ConclusionThe combination of gemcitabine and paclitaxel is active and well tolerated as a second-line treatment in patients with advanced urothelial carcinoma.

Prediction of bone metastases by combination of tartrate‐resistant acid phosphatase, alkaline phosphatase and prostate specific antigen in patients with prostate cancer

Objective:u2003 The clinical value of serum tartrate‐resistant acid phosphatase (TRACP), prostate specific antigen (PSA), alkaline phosphatase (ALP), and prostatic acid phosphatase (PACP) for the prediction of bone metastases in prostate cancer were investigated.

Antitumor effect of a novel nuclear factor-kappa B activation inhibitor in bladder cancer cells.

Nuclear factor (NF)-κB is a transcription factor that not only induces and controls various genes, including those of inflammatory cytokines, but also activates genes which suppress apoptosis. It has been clearly demonstrated that certain advanced human bladder cancer cells constitutively acquire the ability to activate NF-κB, which not only protects cancer cells from apoptotic cell death, but also upregulates the production of various cytokines that may increase the malignant potential of the disease and cause paraneoplastic syndromes. The NF-κB inhibitors may therefore be useful as anticancer agents. An NF-κB function inhibitor, a dehydroxymethyl derivative of epoxyquinomicin C (DHMEQ), has recently been designed and synthesized. The effectiveness of DHMEQ against advanced human bladder cancer cell line KU-19-19, in which NF-κB is constitutively activated, has been investigated. The DNA-binding activity of NF-κB was completely inhibited following 2-6-h exposure to 10 μg/ml of DHMEQ. Marked levels of apoptosis were observed 48 h after DHMEQ administration. These results confirmed that NF-κB activation maintains the viability of KU-19-19 cells, that DHMEQ inhibited constitutively activated NF-κB, and, consequently, apoptosis was induced. However, it was still possible that DHMEQ caused apoptotic cell death through some other mechanism which has not yet been fully investigated. The authors conclude that DHMEQ could represent a new treatment strategy against advanced bladder cancer.

Management of incidentally discovered adrenal masses

Abstract The incidental discovery of adrenal masses in radiologic imaging studies is becoming increasingly common. Herein we present our experience with 59 cases of incidentally discovered and surgically removed adrenal masses. Of 59 adrenal incidentalomas, 15 cases were hypersecretory tumors, including 11 pheochromocytomas; only 3 were adrenocortical carcinomas. The prevalence of incidentally discovered adrenal masses and their differential diagnosis and management are discussed in a review of the literature.

N-Acetylcysteine Modifies cis-Dichlorodiammineplatinum-induced Effects in Bladder Cancer Cells

We previously demonstrated a role of reactive oxygen species (ROS) in cytotoxicity induced by cis‐dichlorodiammineplatinum (CDDP) in combination with glutathione (GSH) depletors in bladder cancer cells. However, the relationship between CDDP and ROS is still unclear, although many mechanisms of drug resistance have been well characterized. The present study was undertaken to investigate the effects of N‐acetylcysteine (NAC), a GSH precursor, on the CDDP‐induced effects in bladder cancer cells (KU1). The cytotoxic effects of CDDP were significantly blunted by NAC (1 mM) in KU1 cells. The IC50 of CDDP only (10.2±1.2 μM) is significantly lower than that of CDDP with NAC (IC50: 20.3±1.6 μM) in KU1 cells. NAC also significantly increased the intracellular concentration of GSH in KU1 cells (37.2±1.6 nmol/106 cells), compared to controls (15.9±7.6 nmol/106 cells). While CDDP produced a significant increase in ROS as measured in terms of dichlorofluorescein (DCF) production in KU1 cells in a time‐dependent manner, pretreatment with NAC significantly reduced CDDP‐induced intracellular DCF in KU1 cells. Moreover, TdT‐mediated dUTP‐biotin nick‐end labeling (TUNEL) assay showed that CDDP‐induced apoptosis (31.1±3.8%) was significantly inhibited by pretreatment with NAC in KU1 cells (11.2±2.6%). These results demonstrated that NAC scavenges CDDP‐induced ROS and inhibits CDDP‐induced cytotoxicity, suggesting that ROS mediate the CDDP‐induced cytotoxicity in bladder cancer cells.

The Predictors of Local Recurrence after Radical Cystectomy in Patients with Invasive Bladder Cancer

OBJECTIVESnTo examine the association between local recurrence and distant metastasis or disease-specific survival and identify independent factor predictors for local recurrence.nnnMETHODSnWe identified a study population of 146 consecutive patients treated surgically for invasive bladder cancer at our institution between 1987 and 2003. We clarified the relationship among local recurrence, distant metastasis and disease-specific survival and identified significant predictors for local recurrence.nnnRESULTSnLocal recurrence developed in 26 (17.8%) of the 146 patients at a median of 10 months (range, 1-73 months) after cystectomy. It was independently associated with distant metastasis in addition to the number of retrieved lymph nodes. The 2- and 5-year metastasis-free rates were 86.7 and 76.5% in patients without local recurrence and 26.5 and 0% in those with local recurrence (P < 0.001), respectively. The presence or absence of local recurrence and tumor grade were independent predictors of disease-specific survival. The 2- and 5-year disease-specific survival rates were 93.5 and 88.3% in patients without local recurrence and 55.1 and 35.4% in those with local recurrence (P < 0.001). The presence of concomitant adenocarcinoma component, pathological nodal involvement and the number of retrieved lymph nodes were independent predictors of local recurrence.nnnCONCLUSIONSnLocal recurrence was independently associated with distant metastasis and disease-specific survival. Patients who have the predictive factors described above may benefit from integrated surgical therapies with post-operative adjuvant chemotherapy.

Preoperative Prognostic Nomogram (Probability Table) for Renal Cell Carcinoma Based on TNM Classification

PURPOSEnRecently several prognostic nomograms have been developed to predict the prognosis of malignant diseases, including renal cell carcinoma. However, to our knowledge a preoperative prognostic nomogram that predicts survival in patients with renal cell carcinoma is not available. We developed a preoperative nomogram based on the TNM classification that predicts cause specific survival in patients with renal cell carcinoma.nnnMATERIALS AND METHODSnA total of 545 patients with renal cell carcinoma, including metastatic disease, who underwent radical nephrectomy or nephron sparing surgery at our institution were included in the study. Cases were staged according to the 2002 UICC TNM system, 6th edition. T, N and M factors were used as prognostic factors and a Cox proportional hazards regression model was developed to predict cause specific survival. A nomogram to predict cause specific survival was developed by repeating the analysis on 200 bootstrap samples. To validate the nomogram a concordance index was estimated and calibration was also examined by plotting the predictions made by the nomogram.nnnRESULTSnOverall 1, 3 and 5-year patient survival was 95.2%, 92.0% and 89.9%, respectively. T, N and M factors were significant prognostic factors in the Cox proportional hazards regression model. Using the combined TNM factors we developed a nomogram predicting 1, 3 and 5-year cause specific survival rates. The nomogram had excellent ability to discriminate, as evidenced by a concordance index of 0.81, and it was generally well calibrated.nnnCONCLUSIONSnThe preoperative information shown by this nomogram may be important for obtaining informed consent from patients with renal cell carcinoma who have indications for surgery.