Tomohiro Fujii

Optimal Approach for Prostate Cancer Detection as Initial Biopsy: Prospective Randomized Study Comparing Transperineal Versus Transrectal Systematic 12-Core Biopsy

OBJECTIVES Transperineal and transrectal prostate biopsy are both used for prostate cancer detection. However, which approach is superior remains unknown. In this study, we performed a prospective randomized study to compare the efficacy of transperineal versus transrectal 12-core initial prostate biopsy. METHODS From May 2003 to October 2005, a prospective randomized study of transperineal versus transrectal 12-core biopsy (126 and 120 patients, respectively) was conducted in 246 patients with a prostate-specific antigen level of 4.0 to 20.0 ng/mL. All procedures were performed with the patient in the lithotomy position, with the transperineal and transrectal approach performed with spinal anesthesia (0.5% bupivacaine) or a caudal block (1% lidocaine), respectively. With both approaches, eight biopsy specimens were obtained systematically from the peripheral zone, including the apex, and four from the transition zone. RESULTS The cancer detection rate was 42.1% (53 of 126 patients) with the transperineal approach and 48.3% (58 of 120 patients) with the transrectal approach (P = 0.323). For all patients undergoing transperineal and transrectal biopsy, the cancer core rate (cancer core number/biopsy core number) was 13.7% (207 of 1512 cores) and 14.4% (208 of 1440 cores), respectively (P = 0.566). Apart from headache, presumably related to the spinal anesthesia, no significant differences were found in the complications between the two groups. CONCLUSIONS No significant differences were found in the cancer detection rate, cancer core rate, or complications between the two approaches. We believe that the preferred approach as an initial prostate biopsy is the transrectal approach, which does not require spinal anesthesia or another burdensome process.

A prospective randomized comparison of diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy.

The aim of this study is to elucidate the diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy for prostate cancer. We prospectively randomized 200 consecutive men into two groups to undergo systematic prostate biopsy. Overall positivity for cancer was similar (47% by transperineal and 53% by transrectal; P=0.480). However, in case with ‘gray zone’ PSA (from 4.1 to 10.0 ng/ml), significantly more cores were positive when approach was transperineal, especially among transition zone cores. Therefore, urologist preferences are sufficient for choosing an approach, except for a possible small advantage of transperineal biopsy when PSA is in gray zone.

Effects of three types of alpha‐1 adrenoceptor blocker on lower urinary tract symptoms and sexual function in males with benign prostatic hyperplasia

Objectives:  The aim of the present study was to explore the effects of three different types of alpha‐1 adrenoceptor blockers (α1‐blocker) on lower urinary tract symptoms (LUTS), erectile dysfunction (ED) and ejaculatory dysfunction (EjD) in patients with benign prostatic hyperplasia.

Transperineal extended biopsy improves the clinically significant prostate cancer detection rate: a comparative study of 6 and 12 biopsy cores.

Background:  We evaluated the improvement in the rate of prostate cancer detection when using a 12‐core transperineal biopsy protocol including transitional zone biopsy.

Salvage high-dose-rate brachytherapy for local prostate cancer recurrence after radiotherapy – preliminary results

Study Type – Prognostic (case series)

Anti-HER2-antibody enhances irradiation-induced growth inhibition in head and neck carcinoma.

To explore the antiproliferative effects of rhumAbHER2 on head and neck squamous carcinoma cell (HNSCC) lines and breast cancer cell lines (BCCLs) and to evaluate the combined effects with irradiation, 2 human HNSCC lines and 2 BCCLs were exposed to rhumAbHER2 with or without irradiation. The results showed that combined treatment enhanced the growth and colonization inhibitory effects of rhumAbHER2 or irradiation. Interestingly, the apoptotic cell fraction produced by irradiation disappeared on combined treatment. This disappearance was associated with repression of p53 and Bax upregulation induced by irradiation, but conservation of the upregulation of p27. Based on these results, rhumAbHER2 and irradiation may be a new strategy for treating HNSCC and breast cancers. In addition, the upregulation of cyclin‐dependent kinase inhibitors by rhumAbHER2 may occur upstream of irradiation‐induced p53 upregulation.

Prognostic factors for survival and bladder recurrence in transitional cell carcinoma of the upper urinary tract.

Abstract Background: Prognostic factors for survival in transitional cell carcinoma of the upper urinary tract have been extensively evaluated, but detailed analyses of patterns of bladder recurrence after surgery have been rare.

Ejaculatory dysfunction caused by the new α1‐blocker silodosin: A preliminary study to analyze human ejaculation using color Doppler ultrasonography

Objectives:  In order to clinically investigate the mechanism of ejaculatory dysfunction attributable to the α1‐blocker silodosin, a real‐time observation of ejaculation by healthy males was performed.

IL-10 in myeloma cells.

In addition to interleukin (IL)-6, IL-10 is considered as one of the most important cytokines regulating the proliferation and cellular characteristics of myeloma cells. It is still unclear from the clinical data how serum IL-10 levels of various stages of myeloma, are related to clinical manifestations of this disease. Several studies have reported that IL-10 affects myeloma cells by stimulating secondary signals for cell proliferation through oncostatin M (OSM) and IL-11. In experiments using human myeloma cell lines established at our laboratory, IL-10 seemed to be expressed in half of myelomas simultaneously with OSM, and to be correlated with c-maf, a transcription factor, which has been known to be overexpressed in myelomas with t(14;16)(q32;q23). In addition, IL-10 abolishes all trans retinoic acid (ATRA)-induced growth inhibition of myeloma cells. The expression and production of IL-10 in myeloma patients may be important for sub-categorization and the establishment of a case-oriented therapy.

Preclinical Cushing's syndrome: report of seven cases and a review of the literature.

Background : Adrenal adenomas showing autonomous cortisol secretion without specific endocrine symptoms are sometimes discovered in patients with adrenal incidentalomas. This entity has been described as subclinical or preclinical Cushing’s syndrome (PCS), but the endocrine data of reported cases have varied and the diagnostic criteria of PCS have been uncertain.