Kouichi Kishimoto

Usefulness of tamsulosin hydrochloride and naftopidil in patients with urinary disturbances caused by benign prostatic hyperplasia: A comparative, randomized, two-drug crossover study

Background:  The aim of the study presented here was to stratify drug therapy for patients with benign prostatic hyperplasia (BPH) displaying various voiding symptoms.

Percutaneous MR-guided cryoablation for malignancies, with a focus on renal cell carcinoma

Cryosurgery is the oldest thermal ablation method, and was first performed in the mid-nineteenth century. Since the development of cryosurgical systems capable of delivering liquid nitrogen, organs in various regions have been treated with cryosurgery. However, the lack of an adequate monitoring modality during the freezing process did not allow the precise and complete destruction of lesions deep inside the parenchyma. This led to local recurrences caused by unsatisfactory results of treatment. Recently, a magnetic resonance (MR)-compatible argon-based cryoablation sytem has been developed, and a combination of this cryoablation system and MR imaging has been shown to be an effective method for treating malignant tumors. In this article, we describe our clinical experience of percutaneous MR-guided cryoablation for malignancies, focusing on renal cell carcinoma.

A comparative study of prostate specific antigen (PSA), C-terminal propeptide of blood type I procollagen (PICP) and urine type I collagen-crosslinked N telopeptide (NTx) levels using bone scintigraphy in prostate cancer patients

We compared the ability to diagnose skeletal metastasis between serum prostate specific antigen (PSA), C-terminal propeptide of blood type I procollagen (PICP), and urine type I collagen-crosslinked N telopeptide (NTx) in prostate cancer patients. In sixty-nine patients with prostate cancer, bone scintigraphy was performed, and serum PSA and PICP and urine NTx were measured. The median level of serum PSA in the osseous metastasis-negative group (n=33) was 0.80 ng/ml being significantly lower as compared to the osseous metastasis-positive group (n=36, 7.70 ng/ml) (p<0.0001). The serum PICP and urine NTx/Cr levels appeared lower in the osseous metastasis-negative group than the osseous metastasis-positive group, but there was no significant difference. Logistic regression analysis showed that ability to diagnose skeletal metastasis of serum PSA was 68.1% and superior to those of serum PICP (56.5%) and urine NTx/Cr (53.6%). Serum PSA improved the ability to diagnose skeletal metastasis when combined with serum PICP or urine NTx/Cr. When patients were grouped according to the extent of disease grade (EOD grade) nomenclature, Spearmans correlation coefficient by rank showed that serum PSA was most significantly correlated with EOD grade (p<0.0001). In 14 patients whose skeletal metastases progressed or regressed, the change of serum PSA more clearly separated the osseous metastasis-regression group and osseous metastasis-progression group than did serum PICP and urine NTx/Cr. Serum PSA was more reliable than bone resorption and formation markers produced by crosslinking of type I collagen.

T1 high grade膀胱癌の臨床的検討

OBJECTIVES We retrospectively evaluated characteristics of T1 high-grade bladder cancer in patients in our hospitals. PATIENTS AND METHODS Data was reviewed from 134 patients who were diagnosed with T1 high-grade bladder cancer and who underwent transurethral resection (TUR) in our hospitals between January 2006 and December 2012. The clinical course for each patient, the recurrence and progression rates, and the risk factors for recurrence and progression were evaluated. RESULTS The median follow-up was 31.5 months. A second TUR was performed in 55 patients (41.0%), and showed 32 cases of residual tumor (58.2%) and 4 cases of upstaging (7.3%). The recurrence rate was 41.5%. The risk factors for recurrence were (1) no muscle obtained in initial TUR, (2) no BCG, and (3) no second TUR. The progression rate was 10.5%; no significant risk factors were identified for progression. Within the T1 high-grade bladder cancer cohort, a total of 31 patients underwent radical cystectomy (RC). When we graphed cancer-specific survival (CSS) curves stratified by pathological T stage at the time of RC, and then compared findings from the upstage group (greater than pT2) and the non-upstage group (less than pT2), the CSS rate was significantly higher in the non-upstage group (p = 0.0027). CONCLUSION No muscle in initial TUR, no BCG, and no second TUR are factors associated with recurrence of T1 high-grade bladder cancer. Further investigation is needed for preventing recurrence and progression and for improving survival following radical cystectomy in T1 high-grade bladder cancer.