Shigeru Fujihiro

Nocturia in men less than 50 years of age may be associated with obstructive sleep apnea syndrome.

OBJECTIVES To assess the prevalence of nocturia in association with other voiding symptoms in men with obstructive sleep apnea syndrome (OSAS). METHODS Seventy-three patients in whom OSAS was diagnosed at Gifu Red Cross Hospital during the period from October 2005 through April 2006 were assessed on the basis of the International Prostate Symptom Score (IPSS) and the Apnea-Hypopnea Index (AHI). Nocturia was defined as two or more voids per night. We classified patients by the presence versus absence of nocturia and by age (less than 50 years versus 50 years or more). Between-group differences in the AHI and IPSS were analyzed by Students t test or the Mann-Whitney U test. RESULTS Nocturia was found in 30 patients with OSAS (41.1%). The AHI was higher in patients with nocturia than in those without nocturia (P <0.01), especially in patients less than 50 years of age (P <0.005). However, other voiding symptoms were not associated with nocturia in the OSAS patients younger than 50 years. CONCLUSIONS The prevalence of nocturia is high among patients with OSAS. Our results suggest that OSAS may have some relationship to nocturia without other voiding symptoms in men less than 50 years of age.

Esophageal metastasis from prostate cancer: Diagnostic use of reverse transcriptase-polymerase chain reaction for prostate-specific antigen

An extremely rare case of esophageal metastasis from prostate cancer is reported. A 65-year-old man presented with anorexia and back pain. Upper gastrointestinal X-ray fluoroscopy and endoscopy revealed a shallow longitudinal ulcer, with converging mucosal folds, approximately 5 cm above the esophagogastric junction. The histological diagnosis of the biopsied specimen was adenocarcinoma. Blood biochemistry revealed elevated serum prostatespecific antigen (PSA) and γ-seminoprotein levels. Ultrasonography of the prostate disclosed a hypoechoic lesion in the left lobe, and needle biopsy led to the diagnosis of prostatic adenocarcinoma. Since there was no finding suggestive of a primary lesion, apart from that in the prostate, we conducted reverse transcriptase-polymerase chain reaction (RT-PCR) for PSA. PSA-positive mRNA was demonstrated in the tissue of the esophageal tumor. There are three reports on metastasis to the esophagus from prostate cancer, but this is the first case of esophageal metastasis from prostate cancer without any evidence of metastasis to other organs. The importance of RT-PCR for the diagnosis of primary lesions of metastatic cancer is discussed.

Adjuvant chemotherapy for uroepithelial transitional cell carcinoma

SummaryThe effectiveness of adjuvant chemotherapy in transitional cell carcinoma of the bladder (T1/G3 and >=T2) and the upper urinary tract were evaluated. Among a group of 136 patients (male 107, female 29) with such tumors, complete tumor resection was possible in 108, in whom durationof survival and disease-free interval with or without chemotherapy were compared. The combination of antineoplastic agents used was changed from 5-fluorouracil (5-FU)+vincristine (VCR)+bleomycin (BLM) or pepolomycin (PEP)+mitomycin C (MMC) or 5-FU+VCR+PEP+cyclophosphamide (CPM)+adriamycin (ADM) to CPM+ADM+cis-platinum (DDP) or methotrexate (MTX)+vinblastine (VBL)+ADM+DDP. Of the 59 patients in the chemotherapy group, 23 (39%) had side effects due to the treatment; however, fever and gastrointestinal symptoms were the chief adverse effects and were well tolerated. The 5-year survival rate and mean disease-free interval in the chemotherapy group were 76.3% and 24.6+ months, respectively, in bladder cancer patients, and 78.2% and 25.8+ months in those with upper urinary tract tumors. However, in the nonchemotherapy group (n=49) the corresponding values were 62.7% and 21.1+ months in patients with bladder cancer and 67.3% and 42.0+ months in those with upper urinary tract tumor. There was a statistically significant difference (P<0.05) in the disease-free intervals of the two treatment groups for bladder cancer patients. Recurrence, regardless of time, was observed in 25% of chemotherapy cases and in 65% of non-chemotherapy cases, and this difference was also statistically significant (P<0.001). These results suggest that adjuvant chemotherapy for uroepithelial transitional cell carcinoma may be effective in extending survival and significant by protracting the disease-free period, especially in cases of advanced bladder cancer.