Nishimura K

Hyperbaric oxygen therapy for radiation-induced hemorrhagic cystitis

Abstract:  Hyperbaric oxygen (HBO) therapy has recently emerged as a potential primary option for the management of hemorrhagic cystitis. We review our experience treating hemorrhagic cystitis with HBO. Between January 2001 and May 2007, eight patients with radiation‐induced hemorrhagic cystitis underwent HBO therapy. There were five men and three women with a mean age of 64.3 years (47–73). Radiation was given for local disease, and the mean dosage delivered was 56.6 Gy (42–70). The mean duration between the onset of hematuria and the beginning of HBO therapy was 8.9 months (3–34). Mean follow‐up period was 15.5 months (2–31). Hematuria resolved completely in six of the eight patients, one of whom suffered recurrence of hematuria and was treated with HBO until the hematuria resolved again. The response rate was 75%, compatible with the previous reports, and no side‐effects of HBO were noted. HBO treatment should be attempted for radiation‐induced hemorrhagic cystitis.

Vascular endothelial growth factor receptor 1 expression in pelvic lymph nodes predicts the risk of cancer progression after radical prostatectomy

Recent studies suggest that vascular endothelial growth factor receptor (VEGFR) 1‐positive hematopoietic progenitor cells precede the arrival of tumor cells and form clusters that may portend sites of future metastatic disease. The aim of the present study was to clarify whether VEGFR1 expression in pelvic lymph nodes predicts the risk of prostate cancer progression after radical prostatectomy. VEGFR1 expression in pelvic lymph nodes was examined by immunohistochemistry in 95 patients who underwent radical prostatectomy for prostate cancer. A cluster of VEGFR1‐positive cells was considered positive. Expression of VEGFR1 in pelvic lymph nodes and biochemical recurrence after radical prostatectomy were examined by univariate survival analysis and multivariate Cox proportional hazards regression analysis. Thirty‐seven of 79 lymph node‐negative patients (46.8%) were found to have VEGFR1‐positive cells in their pelvic lymph nodes, whereas 16 of 16 lymph node metastasis‐positive patients (100%) had VEGFR1 clusters. There was a significant correlation between pathological stage and VEGFR1 staining (P = 0.002). Univariate analysis showed that pathological stage ≥pT3 and VEGFR1 expression in pelvic lymph nodes were each significantly associated with biochemical recurrence after radical prostatectomy. Multivariate analysis showed VEGFR1 expression to be an independent predictor of biochemical recurrence after radical prostatectomy (risk ratio = 5.715, P = 0.010), as was preoperative prostate‐specific antigen (PSA) level ≥10 ng/mL. Although larger validation studies are required, our results suggest that VEGFR1 expression in pelvic lymph nodes predicts the risk of biochemical PSA recurrence after radical prostatectomy. (Cancer Sci 2009; 100: 1047–1050)

Mucinous Adenocarcinoma of the Male Urethra

We report a case of primary mucinous adenocarcinoma arising in the bulbomembranous urethra. The patient underwent radical cystectomy and total penectomy, followed by systemic chemotherapy. Metastases in lungs, skin, and lymph nodes (inguinal, iliac, para-aortic, and tracheobronchial) were found within 2 months after operation. We reviewed 37 cases of primary adenocarcinomas of the male urethra.

Postoperative prostate-specific antigen monitoring interval for radical prostatectomy patients with low recurrence risk.

Biochemical recurrence (BCR) exists in up to 40% of patients 15 years after undergoing prostatectomy (RP) for prostate cancer (PCa). Although BCR does not guarantee cancer recurrence, systemic progression and death, patients with BCR are at greater risk for developing PCa-related distant metastases, leading to death. Salvage radiotherapy is common after BCR; prostate-specific antigen (PSA) is a significant predictor of BCR, even at an early salvage setting (PSA ≤0.5 ng/mL). Early BCR detection leads to a higher recurrence-free survival rate in men treated with salvage radiotherapy. We reported that low PSA levels 3months post-RP (3M-PSA) were associated with a low risk for BCR and was an independent prognostic factor for BCR, irrespective of clinicopathological factors, such as preoperative PSA level, pathological T stage, pathological Gleason score or surgical margin status. The 5-year BCR-free survival rate of patients with 3M-PSA <0.010 ng/mL was 92.6%. In the present study, to enable early detection of BCR in this patient group, we propose a postoperative PSA monitoring protocol. We studied 225 patients with at least 3 years’ post-RP follow up for clinically localized PCa; 204 received 3M-PSA testing. 3M-PSA was greater than 0.1 ng/mL in eight patients. A total of 61 patients showed a 3M-PSA value between 0.010 and 0.100 ng/mL. A total of 135 patients (66.2%) showed 3M-PSA <0.010 ng/mL. BCR was defined as two consecutive PSA levels ≥0.2 ng/mL or secondary treatment. During follow up (median 74months, range 36–126months), BCR existed in 13 patients (9.6%). As shown in Figure 1, 5-year BCR-free survival rate was 92.6%. Median time to BCR was 45months. In four men, BCR was identified <36months after surgery. All of the patients with late BCR (>3 years post-RP) had reached PSA >0.030 ng/mL more than 12months before BCR. At the latest examination of 122 patients without BCR, PSA level of <0.010 ng/mL was seen in 77 (63.1%) and PSA level of <0.030 ng/mL in 107 (87.7%). We propose that early BCR detection by PSA measurement is possible every 3months in the first postoperative year, every 6months during the second year and annually thereafter. Besides patients in cities, this protocol applies to rural areas not served by urologists. Should a rural patient’s postoperative PSA level reach 0.030 ng/mL, his family physician can opt to consult with a urologist. Measurement of PSA level is standard during post-RP follow up. BCR almost always precedes clinical recurrence, in some cases by many years. BCR within 3 years after surgery is reportedly a significant risk factor for eventual clinical progression and cancer-related mortality. The PSA level before salvage radiotherapy is a highly significant predictor of disease progression, and more favorable outcomes are observed at low PSA levels. Accordingly, postoperative PSA level should be carefully monitored to facilitate the early detection of BCR. Our postoperative data suggest that PSA measurement every 3months during the first year, biannually during the second year and then annually is appropriate for PCa patients with low recurrence risk, defined as 3M-PSA level <0.010 ng/mL.

2289 GENETIC POLYMORPHISMS OF CYP17A1 MAY PREDICT EARLY PROGRESSION AFTER PRIMARY ANDROGEN DEPRIVATION THERAPY IN JAPANESE MEN WITH PROSTATE CANCER

Masashi Nakayama*, Osaka-city, Osaka, Japan; Takeshi Yamada, Tomohito Shimizu, Shinpei Nonen, Suita, Osaka, Japan; Kensaku Nishimura, Sakai, Osaka, Japan; Kazuo Nishimura, Osaka-city, Osaka, Japan; Tsuneo Hara, Ikeda, Osaka, Japan; Go Tanigawa, Toshiaki Yoshioka, Osaka-city, Osaka, Japan; Koji Hatano, Yasutomo Nakai, Hitoshi Takayama, Yasushi Fujio, Junichi Azuma, Suita, Osaka, Japan; Akihiko Okuyama, Osaka-city, Osaka, Japan; Norio Nonomura, Suita, Osaka, Japan