Takeo Hiraoka

Identification of lymphatic pathway involved in the spreading of prostate cancer by fluorescence navigation approach with intraoperatively injected indocyanine green

OBJECTIVE : The objective of this study was to identify lymphatic vessels draining from the prostate by using a fluorescence navigation (FN) system. METHODS : Fourteen subjects were candidates for radical retropubic prostatectomy (RRP) and pelvic lymph node dissection (PLND). After an indocyanine green solution was injected into the prostate during RRP, lymphatic vessels draining from the prostate were analyzed using a FN system. After PLND based on lymphatic mapping by the FN system (in vivo probing) was performed in the external iliac, obturator and internal iliac regions; the fluorescence of the removed lymph nodes (LNs) was analyzed on the bench (ex vivo probing). RESULTS : Under in vivo and ex vivo probing, the fluorescence intensity of internal iliac nodes was greater than that of external iliac or obturator nodes. CONCLUSION : The current study suggests that using a FN system after injecting indocyanine green is a safe and rational approach for detecting the lymphatic channel draining from the prostate. The major lymphatic pathway involved in the spreading of prostate cancer appears to relate to internal iliac LNs, which would mean that the standard PLND covering external iliac and obturator regions would not keep the cancer from spreading.

Indocyanine green (ICG)-based fluorescence navigation system for discrimination of kidney cancer from normal parenchyma: application during partial nephrectomy

PurposeTo determine the definite border between normal and tumor kidney tissues during partial nephrectomy (PN) procedures using intraoperative indocyanine green (ICG)-based fluorescence imaging.MethodsSixteen potential candidates for PN with organ-confined, small renal masses treated between July 2008 and June 2011 at Shimane University Hospital were enrolled. An ICG-based fluorescence navigation (FN) system was used to evaluate the border between the tumor and normal kidney parenchyma (step 1), the cavity following tumor excision (step 2), and the negative surgical margin of resected tissues (step 3). The R.E.N.A.L nephrometry score (RNS) was applied to evaluate the correlation between tumor anatomy and ICG-based fluorescence imaging.ResultsIn step 1, in vivo probing revealed 14 tumors with a mean RNS of 7 points that showed quite low ICG fluorescence signals in the tumor mass as compared with normal kidney parenchyma. In step 2, in vivo probing around the bed revealed highly fluorescent signals with no remnant tumor residing in 10 cases with a mean RNS of 6 points. In step 3, ex vivo probing revealed cancer tissues involving normal parenchyma that were completely excised with minimum amounts of normal parenchyma in all 16 resected specimens.ConclusionsICG-based FN system was very helpful for confirming negative margin status in even the most complex cases. Further evaluations may open the door for widespread use of this ICG-based FN system as a feasible and attractive alternative during a PN procedure.

Five‐year longitudinal effect of radical perineal prostatectomy on health‐related quality of life in Japanese men, using general and disease‐specific measures

To investigate the longitudinal alteration of health‐related quality of life (HRQL) up to 5 years after radical perineal prostatectomy (RPP) among Japanese patients with localized prostate cancer.

Tumor Suppressor Function of PGP9.5 Is Associated with Epigenetic Regulation in Prostate Cancer—Novel Predictor of Biochemical Recurrence after Radical Surgery

Background: The expression level of protein G product 9.5 (PGP9.5) is downregulated because of promoter CpG hypermethylation in several tumors. We speculated that impaired regulation of PGP9.5 through epigenetic pathways is associated with the pathogenesis of prostate cancer. Methods: CpG methylation of the PGP9.5 gene was analyzed in cultured prostate cancer cell lines, 226 localized prostate cancer samples from radical prostatectomy cases, and 80 benign prostate hyperplasia (BPH) tissues. Results: Following 5-aza-2′-deoxycytidune treatment, increased PGP9.5 mRNA transcript expression was found in the LNCaP and PC3 cell lines. With bisulfite DNA sequencing, partial methylation of the PGP9.5 promoter was shown in LNCaP whereas complete methylation was found in PC3 cells. After transfection of PGP9.5 siRNA, cell viability was significantly accelerated in LNCaP but not in PC3 cells as compared with control siRNA transfection. Promoter methylation of PGP9.5 was extremely low in only one of 80 BPH tissues, whereas it was found in 37 of 226 prostate cancer tissues. Expression of the mRNA transcript of PGP9.5 was significantly lower in methylation (+) than methylation (−) prostate cancer tissues. Multivariate analysis of biochemical recurrence (BCR) after an radical prostatectomy revealed pT category and PGP9.5 methylation as prognostically relevant. Further stratification with the pT category in addition to methylation status identified a stepwise reduction of BCR-free probability. Conclusion: This is the first clinical and comprehensive study of inactivation of the PGP9.5 gene via epigenetic pathways in primary prostate cancer. Impact: CpG methylation of PGP9.5 in primary prostate cancer might become useful as a molecular marker for early clinical prediction of BCR after radical prostatectomy. Cancer Epidemiol Biomarkers Prev; 21(3); 487–96. ©2012 AACR.

Case report of a ureteral obstruction by Candida albicans fungus balls detected by magnetic resonance imaging in kidney transplant recipient.

In kidney transplant recipients, acute renal failure resulting from a ureteral obstruction by fungus balls is uncommon. We report a 60-year-old man diagnosed with ureteral obstruction caused by Candida albicans fungus balls early after transplant. Diagnosis was made by a T2-weighted magnetic resonance image, which demonstrated fungus balls as a low-intensity mass in the pelvis and microscopic examination findings in the urine. The patient was treated successfully with an antifungal agent and direct irrigation. It should be noted that fungus balls may cause ureteral obstruction of transplanted kidneys, possibly resulting in graft failure. Imaging of the kidneys and collecting system and aggressive debridement that adds to systemic therapy are necessary for early diagnosis and are central to a successful outcome.

Simultaneous implantation of bilateral ureters into bladder acellular matrix graft after partial cystectomy in a porcine model

Whats known on the subject? and What does the study add?

Choroidal and Cutaneous Metastasis from Urothelial Carcinoma of the Bladder after Radical Cystectomy: A Case Report and Literature Review

Bladder cancer is the second most common genitourinary malignancy and has variable metastatic potential; however, choroidal and cutaneous metastases are extremely rare. Generally, a patient with these uncommon metastases has a very poor prognosis. We present a bladder cancer patient with a visual disorder in the right eye and multiple nodules on head and lower abdomen that developed 17 months after a radical cystectomy. These symptoms were determined to be caused by choroidal and cutaneous metastasis of bladder cancer. Although two cycles of combination chemotherapy were performed, the patient died 5 months after diagnosis of multiple metastases.

A case of primary retroperitoneal serous adenocarcinoma.

Primary retroperitoneal serous adenocarcinoma (PRSA) is an extremely rare malignancy, of which only six cases have been reported in the literature. Here, we describe a PRSA in a 75‐year‐old woman treated with surgical excision and adjuvant chemotherapy. The pathological features of PRSA resemble those of ovarian serous carcinoma, which suggests that a combination of surgical excision with adjuvant chemotherapy may be the best option.

Retrospective analysis of the distance between the neurovascular bundle and prostate cancer foci in radical prostatectomy specimens: its clinical implication in nerve-sparing surgery

To analyse the distance between the ipsilateral neurovascular bundles (NVBs) and foci of prostate cancer (N‐T distance) in specimens removed by radical prostatectomy (RP) and identify the predictor for N‐T distance for preserving the ipsilateral NVB, as an accurate understanding of the anatomical relationship between prostate cancer foci and the NVB is necessary for establishing the indications for the appropriate use of nerve‐sparing (NS) modifications of RP.

MP11-06 RESULTS OF TARGETED BIOPSY WITH REAL-TIME BALLOON INFLATION ELASTOGRAPHY OF PROSTATE.

INTRODUCTION AND OBJECTIVES: Efficacy in the prostate cancer detection of real-time tissue elastogarpahy (RTE) has been reported. But RTE has a major problem that RTE is highly operator dependent procedure. We hypothesized that the pressure device might decrease the operator dependency and increase the prostate cancer detection rate of RTE. The pressure device run with water pressure was developed for this study, called this procedure real-time balloon inflation elastography (RBIE). The results of targeted prostate biopsy with RBIE was studied for detection of prostate cancer. METHODS: 233 patients and 1978 were enrolled in this study with abnormal findings of digital rectal examination (DRE), PSA and/ or TRUS. Median age was 73 year-old (range 54e89), median PSA was 7.6 ng/mL (range 0.8-2606.0), and median number of biopsy cores taken on each patient was 8 (range 8e10). All of 233 patients were examined with MRI prior to prostate needle biopsy. A total of 1978 specimens obtained by systemic biopsy were studied. The findings of RBIE, RTE, TRUS, PDUS and MRI (T2WI, dynamic contrast enhanced images (DCEI) and diffusion weighted image (DWI)) were compared to the histopathological findings of biopsy specimens. RESULTS: The prostate cancer was detected in 113 of 233 patients (48.5%), and 412 of 1978 specimens (20.8%). Gleason score of 5 to 6, 7 and 8 to 10 tumors was 110, 166 and 138 specimens respectively. Clinical stages of T1c, T2a-c, T3a-b, and T4 were 20, 60, 22 and 11 cases. The sensitivity of RBIE, RTE, TRUS, PDUS, T2WI, DCEI and DWI were 72.1%, 72.1%, 74.5%, 72.8%, 78.2%, 77.2% and 77.2%, the specificity were 94.3%, 93.6%, 85.4% 90.5%, 92.0%, 93.7% and 92.6%, respectively. Both of the sensitivity and the specificity of RBIE were not significantly inferior to those of MRI. The results of targeted biopsy (PPV) of RBIE, RTE, TRUS, PDUS, T2WI, DCEI and DWI were 76.7%, 74.8%, 57.4%, 67.0%, 72.0%, 76.4% and 73.3%. PPV of RBIE was also comparable to those of MRI. CONCLUSIONS: RBIE was low cost and low invasive procedure. The prostate cancer detection capability of RBIE might be not inferior to that of MRI, expensive and time consuming procedure. Furthermore, RBIE reveals prostate in real-time, so RBIE could enhance the prostate cancer detection as a biopsy guidance image.