Tatsuo Tochigi

Prospective Randomized Phase II Trial of a Single Early Intravesical Instillation of Pirarubicin (THP) in the Prevention of Bladder Recurrence After Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma: The THP Monotherapy Study Group Trial

PURPOSE We evaluated the efficacy of a single early intravesical instillation of pirarubicin (THP) in the prevention of bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma (UUT-UC). PATIENTS AND METHODS From December 2005 to November 2008, 77 patients clinically diagnosed with UUT-UC from 11 institutions participating in the Tohoku Urological Evidence-Based Medicine Study Group were preoperatively enrolled in this study. Patients were randomly assigned to receive or not receive a single instillation of THP (30 mg in 30 mL of saline) into the bladder within 48 hours after nephroureterectomy. Cystoscopy and urinary cytology were repeated every 3 months for 2 years or until the occurrence of first bladder recurrence. RESULTS Seventy-two patients were evaluable for efficacy analysis, 21 of whom had a subsequent bladder recurrence. Significantly fewer patients who received THP had a recurrence compared with the control group (16.9% at 1 year and 16.9% at 2 years in the THP group v 31.8% at 1 year and 42.2% at 2 years in the control group; log-rank P = .025). No remarkable adverse events were observed in the THP-treated group. Based on multivariate analysis, THP instillation (hazard rate [HR], 0.26; 95% CI, 0.07 to 0.91; P = .035) and open surgery (HR, 0.28; 95% CI, 0.09 to 0.84; P = .024) were independently predictive of a reduced incidence of bladder recurrence. CONCLUSION In this prospective randomized phase II study, a single intravesical instillation of THP seemed to reduce bladder recurrence after nephroureterectomy. A phase III, large-scale, multicenter study is needed to confirm these observations.

Quality of life after radical prostatectomy in Japanese men: a 5-Year follow up study.

Objectives:  To measure health‐related quality of life (HRQOL) after radical prostatectomy (RP) in Japanese men with localized prostate cancer.

Psychological distress in Japanese men with localized prostate cancer

Objective:  To investigate: (i) the level of psychological distress; and (ii) the relationships between the level of psychological distress and general or disease‐specific HRQOL of Japanese men with localized prostate cancer following surgery or radiotherapy.

Pathological and biochemical outcomes after radical prostatectomy in men with low-risk prostate cancer meeting the Prostate Cancer International: Active Surveillance criteria.

Active surveillance has been widely accepted as a treatment tool for low‐risk prostate cancer, and use of the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria can select smaller and less aggressive tumours in low‐risk disease. The study shows the pathological outcomes of radical prostatectomy for patients with low‐risk disease who met the PRIAS criteria. It found that ∼20% had unfavourable pathological features and only 30% satisfied insignificant cancer criteria with pT2 stage, a Gleason score ≤6 and tumour volume <2.5 mL. It concludes that close follow‐up including repeat biopsy or MRI is necessary to minimize unexpected progression of disease.

Sexual function following radical prostatectomy: a prospective longitudinal study of cultural differences between Japanese and American men

We conducted a cross-cultural comparison of the recovery of sexual function and bother during the first 2 years after radical prostatectomy (RP) between American and Japanese men. A total of 275 Japanese and 283 American men who underwent RP alone were prospectively enrolled into longitudinal cohort studies of health-related quality of life outcomes. Sexual function and bother (distress) were estimated with English and validated Japanese versions of the UCLA Prostate Cancer Index before RP and 1, 2–3, 4–6, 12, 18 and 24 months after RP. Each subject served as his own control. Japanese men reported lower sexual function scores at baseline, even after adjusted for age, prostate-specific antigen (PSA) and comorbidity (38 vs 61, P<0.001). The two groups had similar baseline sexual bother (70 vs 69, P=0.84). Japanese men had a smaller improvement in sexual function (β=0.8 vs β=5.3) and bother (β=0.2 vs β=2.9) over time than did the American men postoperatively, after adjusting for baseline score, age, baseline PSA and nerve-sparing. American men were more likely than Japanese men to regain their baseline sexual function by 24 months after surgery (hazard ratio (HR)=1.60; 95% confidence interval (CI)=1.06–2.42). In contrast, American men were less likely than Japanese men to return to baseline sexual bother (HR=0.57; 95% CI=0.44–0.75). This study demonstrates that Japanese and American men experience different patterns of recovery of their sexual function and bother after RP. Ethnicity may be a contributing factor.

Mass screening for prostate cancer: a comparative study in Natori, Japan and Changchun, China

OBJECTIVES To study the natural background of prostate cancer in Japan and China, mass checks with prostate-specific antigen (PSA)-based screenings were performed using identical procedures in Natori, Japan and Changchun, China. METHODS For 7 years (1995 to 2001) in Natori, Japan, and for 3 years (1998 to 2000) in Changchun, China, 2212 Japanese and 3566 Chinese men older than 55 years were mass checked by PSA-based screening (serum PSA cutoff value 4.1 ng/mL). RESULTS The PSA-positive rates (PSA 4.1 ng/mL or greater) and cancer detection rates in the screened persons of Natori and Changchun were 8.5% and 5.2% (P <0.0005) and 2.1% and 0.8% (P <0.0001), respectively. When the number of cancer cases detected was adjusted to a 100% biopsy rate for men who were PSA positive in both cities, the cancer detection rate was estimated at 2.3% and 1.3% in Natori and Changchun, respectively. This difference was also significant (P <0.01). CONCLUSIONS The results indicate that the percentage of PSA-positive men 55 years or older in Changchun was lower than that in Natori. The analysis of the results suggests that the prostate cancer incidence and prevalence in Changchun, China are lower than those in Natori, Japan.

Five-year Follow-up of Health-related Quality of Life after Intensity-modulated Radiation Therapy for Prostate Cancer

OBJECTIVE We evaluated health-related quality of life (HRQOL) in patients with localized prostate cancer who underwent intensity-modulated radiation therapy (IMRT) or three-field conformal radiotherapy (3DCRT). METHODS A total of 97 patients underwent 3DCRT and 36 underwent IMRT for localized prostate cancer between 2002 and 2004. We measured the general and disease-specific HRQOL with the Medical Outcomes Study 36-Item Health Survey and University of California, Los Angeles Prostate Cancer Index, respectively. RESULTS There were no significant differences in the pre-operative characteristics of the two groups. The patients in the 3DCRT group were more likely to receive hormonal therapy compared with the IMRT group before and after radiation therapy (P < 0.001 and P = 0.011, respectively). With regard to general HRQOL domains, both the 3DCRT and IMRT group scores showed no significant difference between baseline and any of the observation periods. At 60 months after treatment, the 3DCRT group had significantly worse bowel function and bother scores than baseline (both P < 0.001). On the other hand, there were no significant differences between the baseline and any of the post-treatment time periods in the IMRT group. In the 3DCRT group, sexual function remained substantially lower than the baseline level (P = 0.023). The IMRT group tended to show a decrease in sexual function, which was not statistically significant (P = 0.11). CONCLUSIONS IMRT can provide the possibility to deliver a high irradiation dose to the prostate with satisfactory functional outcomes for long-term periods.

Health related quality of life in Japanese men after radical prostatectomy or radiation therapy for localized prostate cancer

Abstract  Background:  We performed a retrospective survey of general and disease specific health‐related quality of life (HRQOL) after radical prostatectomy (RP) and external beam radiotherapy (XRT) in Japanese men.

Recovery of health related quality of life after radical prostatectomy in Japanese men: A longitudinal study

Abstract Background: We performed a longitudinal survey of health related quality of life (HRQOL) after radical retropubic prostatectomy (RP) in Japanese men with localized prostate cancer.

The Relationships Between Preoperative Sexual Desire and Quality of Life Following Radical Prostatectomy: A 5‐Year Follow‐Up Study

INTRODUCTION There were few studies about the relationship between sexual desire (SD) and radical prostatectomy (RP). AIMS We assessed the relationships between RP and quality of life (QOL) according to the preoperative SD. MAIN OUTCOME MEASURE General QOL was measured with Short Form 36. Sexual function and bother were measured with the University of California, Los Angeles Prostate Cancer Index (PCI). Changes of postoperative SD were also evaluated using PCI. METHODS We analyzed data from 285 men who underwent RP and were prospectively enrolled into a longitudinal cohort study. Patients were divided into two groups according to whether they had SD at baseline, which is addressed in the PCI questionnaire: a low SD (LSD) group and a high SD (HSD) group. The assessments were completed before treatment and 3, 6, 12, 24, and 60 months after RP. RESULTS Of the 244 men, 52% had high or a fair level of SD before RP, whereas 48% reported that the level of their SD was low. The HSD group reported better sexual function and sexual bother scores than the LSD group at baseline (both P < 0.001). Fifty-one percent of the HSD group reported that SD at 3 months was poor or very poor, which did not return to the preoperative level at all postoperative time points. Nearly 20% of the LSD group regained higher SD after RP than the baseline level. The HSD group showed worse sexual bother scores than the baseline throughout the postoperative follow-up (P < 0.001). However, the LSD group demonstrated equivalent sexual bother scores after RP compared with the baseline. CONCLUSIONS RP adversely affected SD as well as sexual function and sexual bother. The patients who had HSD experienced greater distress concerning their sexual dysfunction postoperatively than those with LSD.