Yoshiharu Kato

Lactate dehydrogenase, Gleason score and HER-2 overexpression are significant prognostic factors for M1b prostate cancer

It has not been elucidated whether certain types of M1b prostate cancer (M1b PC) are associated with a poor outcome. The present study retrospectively identified predictive factors related to the outcome of M1b PC. The subjects were 104 patients who attended our hospital and received a diagnosis of M1b PC. The observation period ranged from 4 to 122 months (median, 43 months). The parameters investigated were: T classification, N classification, Gleason score (GS), pretreatment prostate-specific antigen (PSA) level, extent of disease (EOD) grade, alkaline phosphatase (ALP), lactate dehydrogenase (LDH), calcium, and hemoglobin (Hb) levels, platelet count, and the status of HER-2 overexpression as determined with a Hercep Test(TM) Kit using initial needle biopsy specimens for diagnosis. Log-rank test and Cox univariate analysis identified the following factors with statistically significant differences: pretreatment PSA ≥ 192, N1, GS ≥ 8, EOD grade 3+4, high LDH, high ALP, low Hb, and HER-2 overexpression. Multivariate Cox proportional hazard analysis identified the factors GS ≥ 8, high LDH, and HER-2 overexpression with significant differences. The hazard ratio was 5.962, 2.465, and 2.907, respectively, and the probability value was P=0.0218, P=0.0207 and P=0.0090, respectively. When the subjects with GS ≥ 8, high LDH, and HER-2 over-expression were classified as the high-risk group, the 5-year cause-specific survival rate was 51.2, 29.6, and 20.0%, respectively. The present study showed that M1b PC patients with GS ≥ 8, high LDH, and HER-2 overexpression have a very poor outcome and thus, should be treated as a high-risk group requiring close follow-up.

Comparative investigation on clinical outcomes of robot-assisted radical prostatectomy between experienced open prostatic surgeons and novice open surgeons in a laparoscopically naïve center with a limited caseload

To compare perioperative, oncological and functional outcomes of robot‐assisted radical prostatectomy between experienced and novice open radical prostatectomy surgeons in a laparoscopically naïve center with a limited caseload.

Chronic expanding hematoma with a significantly high fluorodeoxyglucose uptake on 18F-fluorodeoxyglucose positron emission tomography, mimicking a malignant soft tissue tumor: a case report

IntroductionChronic expanding hematoma is a rare persistent hematoma that can sometimes be misdiagnosed as a malignant tumor due to its clinical and radiological features.Case presentationA 42-year-old Japanese man with a large mass in his leg, suggestive of malignancy, presented to our hospital. He had been aware of the leg swelling for the last eight years. A magnetic resonance imaging scan demonstrated a large mass with two components. One was a large, well-defined cystic mass (13×9cm) showing high intensity on T1- and T2-weighted images, and the other was a solid mass (3.5×2.5cm, adjacent to the large mass) with high intensity on T1-weighted images. Two-[18F]fluoro-2 deoxy-D glucose positron emission tomography images revealed increased uptake with a maximum standardized uptake value of 15.8 in the solid mass. As these findings were considered suggestive of hematoma associated with a malignant lesion, an open biopsy was performed. A pathological examination demonstrated a hematoma with xanthogranuloma, and no malignant cells were evident. Therefore, we resected the tumor including both components, and the histological diagnosis was chronic expanding hematoma. Clinical diagnosis based on 2-[18F]fluoro-2 deoxy-D glucose uptake is sometimes limited by the fact that 2-[18F]fluoro-2 deoxy-D glucose is taken up by not only malignant tumor cells but also macrophages and tissues with granulation or inflammation.ConclusionsSignificantly increased standardized uptake value in the peripheral rim of the lesion on 2-[18F]fluoro-2 deoxy-D glucose positron emission tomography imaging, mimicking a soft tissue sarcoma, should be recognized as a potential diagnostic pitfall in cases of chronic expanding hematoma.

Inflammatory pseudotumors of the kidney and the lung presenting as immunoglobulin G4-related disease: a case report

IntroductionIt has been reported that immunoglobulin G4-related systemic disease can spread to nearly every organ, and often presents as an inflammatory mass or masses at those sites. In the kidney, this disease is often diagnosed after a radical or partial nephrectomy following the discovery of an inflammatory mass which is often suspected to be a malignant tumor. Here, we present a rare case of inflammatory pseudotumors of the kidney and the lung presenting as immunoglobulin G4-related disease, which were diagnosed by computed tomography-guided biopsies.Case presentationA 54-year-old Japanese man was referred to our hospital with suspected bilateral renal cancer, multiple lung metastases and autoimmune pancreatitis. His serum immunoglobulin G4 level was high. We used computed tomography-guided biopsies and histopathological examinations of the biopsied specimens to diagnose the tumors as immunoglobulin G4-related bilateral renal and lung inflammatory pseudotumors. Our patient was treated with oral prednisolone, and after one month of treatment, contrast-enhanced computed tomography demonstrated a general improvement, as noted by a reduction in size of the masses.ConclusionRenal masses that are formed due to immunoglobulin G4-related disease require comprehensive diagnosis to prevent unnecessary surgical resections from being performed. Further consideration should be paid to immunoglobulin G4-related diseases in the future.

A rare case of metastatic renal carcinoid

BackgroundCarcinoid is an endocrine cell tumor with low-grade atypia, which is generally a low-grade malignant cancer with a good prognosis. Metastatic renal carcinoid is even rarer than primary carcinoids.Case presentationWe present our experience of a patient with metastatic renal carcinoid from the gastrointestinal tract.ConclusionsThe carcinoid tumor of the kidney in our patient, who had a history of liver metastasis from rectal carcinoid, was considered metastatic based on the pathological findings.

Significant prognostic factor of immunohistochemical HER-2 expression using initial prostate biopsy specimens with M1b prostate cancer.

We examined whether human epidermal growth factor‐2(HER‐2) overexpression could be a useful marker of outcome after hormone therapy in patients with M1b prostate cancer (PC).

Treatment of upper urinary tract stones with extracorporeal shock wave lithotripsy (ESWL) Sonolith vision

BackgroundThe aim was to retrospectively assess the results of treatment of upper urinary tract stones with the Sonolith vision manufactured by EDAP, and purchased in 2004.MethodsThe subjects were 226 Japanese patients who underwent extracorporeal shock wave lithotripsy (ESWL) alone as an initial treatment and could be followed up for at least 3 months, selected from 277 candidate patients who underwent this therapy between 2004 and 2006. Treatment effect was evaluated by kidney, ureter, and bladder X-ray or renal ultrasonography at 1 and 3 months after treatment. A stone-free status or status of stone fragmentation to 4 mm or smaller was considered to indicate effective treatment.ResultsAt 3 months after treatment, the stone-free rate was 69.4% and the efficacy rate was 77.4% for renal stones, while these rates were 91.5 and 93.3%, respectively for ureteral stones. Assessment of treatment effect classified by the location of stones revealed a stone-free rate of 94.6% and an efficacy rate of 94.6% for lower ureteral stones (4.0 mm or smaller, 1 subject; 4.1-10.0 mm, 31 subjects; 10.1-20.0 mm, 5 subjects: number of treatment sessions, 1 or 2 sessions [mean: 1.03 sessions]). Complications of this therapy included renal subcapsular hematoma and pyelonephritis in 1 case each.ConclusionsESWL with the Sonolith vision manufactured by EDAP produced a treatment effect equivalent to those achieved with other models of ESWL equipment. ESWL seems to be an effective first-line treatment also in patients who have lower ureteral stones 10 mm or larger but do not wish to undergo TUL, if measures such as suitable positioning of the patient during treatment are taken.

Optimal method for measuring tumor extent in needle biopsy specimens to identify small-volume prostate cancer.

To compare various methods for measuring tumor extent in prostate biopsy specimens to identify small‐volume prostate cancer.

PD26-08 A LONG TERM COMPARISON OF ADHERENCE OF DRUG THERAPY IN 1,917 PATIENTS WITH OVERACTIVE BLADDER

INTRODUCTION AND OBJECTIVES: Antimuscarinic are the current pharmacological mainstay for overactive bladder (OAB). However, adverse events resulting from antimuscarinics are inevitable in some patients. Discontinuation rates of 70% to 90% within the first year of therapy have been reported for various OAB medications, because the therapy did not produce the treatment bene?t expected. Mirabegron, which acts as a subtype of relaxation of detrusor, appeared on the Japanese market in 2011, and it provides a new treatment option for OAB. Currently, there are few published studies on the long-term persistence with drug therapy among OAB patients. The purposes of this study were to evaluate OAB pharmacotherapy adherence. METHODS: Patients 18 years of age or older who received an OAB diagnosis and OAB medication prescription for one ß3-adrenoceptor and six antimuscarinics were identified from April 2013 to August 2016. The study cohort consisted of 1,917 OAB patients in Aichi Medical University Hospital. Medication status such as persistence, switching, adherence and the reasons for discontinuation were examined. Persistence was measured by the length of continuous medication with OAB drugs. Time to discontinuation was defined as the number of days between the first dispense date and the expected end date of the last refill. The cumulative incidence of medication persistence was estimated using Kaplan-Meier method. Patients who remained on treatment until the end of the follow-up were regarded as censored data, and the length of follow-up period was assigned as the time of persistence. The proportion of persistence was compared according to each drug using the log-rank test. RESULTS: The mean patient age and time of persistence were 72.0 years and 323.9 days, and the following drugs were prescribed to OAB patients for 245 of imidafenacin, 24 of oxybutynin, 747 of solifenacin, 17 of tolterodine, 67 of fesoterodine, 100 of propiverine hydrochloride, and 723 of mirabegron. The 1-year persistence rate of each drug were 31.6%, 17.4%, 35.9%, 12.5%, 21.9%, 36.5% and 41.7%, respectively. The median of time to discontinuation were 184 days, 112 days, 196 days, 182 days, 77 days, 189 days and 231 days, respectively. Patients taking mirabegron demonstrated statistically significantly greater adherence than those taking antimuscarinics in both sexes. CONCLUSIONS: Mirabegron was associated with higher levels of persistence and adherence than antimuscarinics in our large and long term cohort.

MP43-14 UTILITY OF A NOVEL BIOPSY INSTRUMENT WITH LONG SIDE-NOTCH NEEDLE IN THE SELECTION OF PATIENTS FOR ACTIVE SURVEILLANCE

Fig 1). After adjustment for confounders, the difference in bRFS between groups was no longer significant (HR 1⁄4 0.77; 95% CI, 0.41 to 1.46). CONCLUSIONS: AS patients that are reclassified to grade group 2 and above have a higher bRFS after surgery as compared to those undergoing IRP with similar grade disease. These differences are likely due to selection criteria for AS. Our findings help inform patient decisions regarding the risk of entering an AS program.