This report describes the case of a 65-year-old man who presented with gross hematuria and a history of pelvic salvage radiotherapy for prostate cancer. Cystoscopy and transurethral resection of the bladder revealed urothelial carcinoma. Subsequently, disseminated bone metastases were detected with normal prostate-specific antigen (PSA) levels, and palliative radiotherapy and systemic chemotherapy were administered. Because gross hematuria can appear in both acute/chronic cystitis and bladder cancer in patients who have undergone pelvic radiotherapy for prostate cancer, close follow-up along with a detailed evaluation is needed. In addition, because prostate cancer disease progression with normal PSA levels may be associated with specific pathological findings, a detailed evaluation of symptoms and a careful review of pathologic reports are important.
Purpose: There have been few reports on comparison between sunitinib and pazopanib as first-line targeted therapy in Korean metastatic clear cell renal cell carcinoma (ccRCC). We sought to analyze the treatment trends of metastatic ccRCC by comparing the effects and adverse events of sunitinib and pazopanib.Materials and Methods: Data of 357 metastatic RCC patients who received the sunitinib or pazopanib as the first-line targeted therapy from the Daegyeong Oncology Study Group database was obtained and analyzed. Among these patients, patients who only clear cell type was confirmed after needle biopsy or nephrectomy were included, and patients who underwent target therapy for less than 3 months were excluded.Results: Of 251 patients who met the inclusion criteria, sunitinib and pazopanib group were identified in 156 (62%) and 95 patients (38%), respectively. Pazopanib group was older (66 years vs. 61 years, p=0.001) and more symptomatic (65% vs. 52%, p=0.037) and had more patients with Karnofsky performance status <80 (20% vs. 11%, p=0.048) and fewer number of organ metastases (p=0.004) compared to sunitinib group. There was no significant difference in disease control rate (88.5% vs. 87.3%, p=0.744), the median progression-free survival (19 months vs. 15 months, p=0.444) and overall survival (25 months vs. 19 months, p=0.721) between sunitinib and pazopanib. The most common grade 3/4 adverse events with sunitinib and pazopanib were anemia (5%) and hand-foot syndrome (3%), respectively. There was no significant difference between sunitinib and pazopanib in number of patients who experienced grade 3/4 adverse events (15% vs. 11%, p=0.275). However, there were more patients who discontinued treatment due to only adverse events in sunitinib group compared to pazopanib group (12% vs. 3%, p=0.020).Conclusions: In Korean metastatic ccRCC, pazopanib tended to be used in patients with poorer health status compared to sunitinib. Sunitinib and pazopanib had no significant difference in treatment effect and survival, but pazopanib had more tolerable adverse events.
Purpose To evaluate survival rates and prognostic factors related to treatment outcomes after bladder preserving therapy including transurethral resection of bladder tumor, radiotherapy (RT) with or without concurrent chemotherapy in bladder cancer with a curative intent. Materials and Methods We retrospectively studied 50 bladder cancer patients treated with bladder-preserving therapy at Keimyung University Dongsan Medical Center from January 1999 to December 2010. Age ranged from 46 to 89 years (median, 71.5 years). Bladder cancer was the American Joint Committee on Cancer (AJCC) stage II, III, and IV in 9, 27, and 14 patients, respectively. Thirty patients were treated with concurrent chemoradiotherapy (CCRT) and 20 patients with RT alone. Nine patients received chemotherapy prior to CCRT or RT alone. Radiation was delivered with a four-field box technique (median, 63 Gy; range, 48.6 to 70.2 Gy). The follow-up periods ranged from 2 to 169 months (median, 34 months). Results Thirty patients (60%) showed complete response and 13 (26%) a partial response. All patients could have their own bladder preserved. Five-year overall survival (OS) rate was 37.2%, and the 5-year disease-free survival (DFS) rate was 30.2%. In multivariate analysis, tumor grade and CCRT were statistically significant in OS. Conclusion Tumor grade was a significant prognostic factor related to OS. CCRT is also considered to improve survival outcomes. Further multi-institutional studies are needed to elucidate the impact of RT in bladder cancer. Keywords: Urinary bladder neoplasm, Bladder preservation, Concurrent chemoradiotherapy, Radiotherapy, Survival rate, Prognostic factor
Though prostate cancer (PCa) is the second most common cancer world widely, there exist substantial differences exist between Asia and the west. Genetic susceptibility and lifestyle may contribute to disproportionately lower incidences and mortalities of PCa in Asian countries, but the differences in diagnostic practices are also likely to contribute, and a large part of them may be explained by the lesser chance of prostate-specific antigen (PSA) testing. In the US, about half of men aged over 50 years had been exposed to the screening test in the early 2000s. The shifts in the risk stratification from the high-risk dominant disease in the late 1980s to the low-risk dominant disease in the early 2000s led to criticism regarding the unconditional nature of PSA-based screening. Based on the conflicting outcomes from the randomized clinical trials which investigated the benefit of PSA testing, US Preventive Study Task Force recommended ceasing mass screening in 2012. Accordingly, guidelines begin to emphasize shared decision-making on the PSA testing narrowing their scopes to men aged 55 to 69 years since 2013. Though most Asian countries have not begun to recognize PCa as a major agenda item until the 2010s, a clear trend of expanding incidence of it implies that the time to come to reconsider PSA testing as a higher priority in the public health sphere in the 2020s. Concerns regarding over-diagnosis and over-treatment of insignificant diseases are imperative. However, the distinctive epidemiologic characteristics of PCa in Asia areas, such as low exposure to the repetitive PSA testing, the recent increase in its incidence driven by the elderly and super-elderly, and racial differences should be considered when it comes to the establishment of screening policy utilizing PSA test.
The strength of Ni-base superalloys mainly depends on the γ' precipitates that improve the strength of the materials at high temperatures. The presence of γ' particles within the matrix restricts dislocation movement, and optimized heat treatments can tailor the size, shape, and volume fraction of γ'. In this study the effects of solidification rate and solution temperature on the tensile properties of IN738LC superalloy were investigated. The secondary dendritic arm spacing of casting materials with different diameters was measured and the solidification rate of the casting materials was derived by comparing the results of the solidification microstructure obtained from a directional solidification experiment. The D17 material, which had a faster solidification rate, showed higher values of tensile strength and yield strength than the D60 material, which had a slower solidification rate. The study also concluded that the monomodal γ' precipitates in the S80 material have higher tensile strength and yield strength at room temperature and 760℃ than the bimodal γ' precipitates in the S20 material. As for the deformation behavior at 760℃, an isolated stacking fault was observed in the S20 material only within the large γ’ precipitates. In the S80 material, the high dislocation density increased the yield strength due to the strong interaction between dislocations and fine γ’ precipitates.
Abstract Glycine decarboxylase (GLDC) is a mitochondrial enzyme that mediates the degradation of glycine as part of the glycine cleavage system; it is implicated as a tumor suppressor in hepatocellular carcinoma but as an oncogene in the lung cancer. Although GLDC expression in the kidney is second highest next to the liver, very little is known as to the role of GLDC in the kidney. Thus, this study was designed to determine the role of GLDC in the renal carcinoma. We found markedly increased expressions of GLDC in patients with renal cell carcinoma (RCC) classified as poor-risk group based on the Memorial Sloan Kettering Cancer Center prognostic model. In vitro studies revealed that cellular proliferation, colony formation, and migration were decreased in GLDC-deficient renal carcinoma cells while those were increased in GLDC-overexpressing renal carcinoma cells. In vivo xenograft studies with GLDC-deficient and -overexpressing cells also revealed that tumor sizes were noticeably decreased in GLDC-deficient cell-injected mice while those were increased in GLDC-overexpressing cell-injected mice. Mechanistically, we found GLDC regulates renal carcinoma progression via interferon (IFN) stimulated gene factor 3 (ISGF3)-mediated pathway. Poly-IC induced mRNA expression of IFN-α more strongly in GLDC-deficient cells. Expressions of IRF9 and STAT2 were increased in GLDC-deficient cells while those were decreased in GLDC-overexpressing cells. Interferon-responsive genes (IFIT1, IFI44, IFI44L, and IFI27) were also regulated by GLDC as evidenced by increased mRNA expressions in GLDC-deficient cells and increased mRNA expressions in GLDC-overexpressing cells. Knock-down of IRF9 and STAT2 in GLDC-deficient cells reversed decreased cellular proliferation, colony formation, and migration. In summary, the data in this study indicates that GLDC regulates renal carcinoma progression via ISFG3-medated pathway and lay a scientific foundation that could support a therapeutic strategy that targets GLDC for the treatment of renal carcinoma. Citation Format: Jin Young Kim, Mai Thi Tuyet Pham, Byung Hoon Kim, Ji Hae Seo, Sojin Shin, Eunyoung Ha. Glycine decarboxylase regulates renal carcinoma progression via interferon stimulated gene factor 3-mediated pathway [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2123.
We evaluated ultrasonography variables associated with the improvement of nocturia after administration of alpha adrenoceptor antagonist (alpha blocker) monotherapy. From February to October 2014, 679 men with lower urinary tract symptoms (LUTS) underwent ultrasonography including prostate volume, transitional zone volume, prostatic urethral length, the ratio between prostatic urethral length and prostate volume (RPUL), intravesical prostatic protrusion (IPP), and prostatic urethral angle (PUA). Among them, 108 men who had pre-treatment nocturia without nocturnal polyuria (nocturnal polyuria index < 33%) and were treated with alpha blocker monotherapy over 3 months were enrolled. Patients were divided into the improved (< 2 times of nocturia) and non-improved group (more than 2 times) after administration of alpha blockers. Along with ultrasonography, international prostate symptom score (IPSS) and uroflowmetry was assessed. After alpha blocker treatment, 25.0% of patients (27/108) showed improvement of nocturia. These patients were significantly younger (59.6 vs 68.0 years, P = < 0.001) with lower PUA (31.8 vs. 39.4°, P = 0.009) compared with the non-improved group. In ROC analysis, the area under the curve using the PUA was 0.653 (95% CI = 0.532–0.774, P = 0.018). Using 33.5° as a cut-off level, the sensitivity and specificity for predicting the improvement of nocturia after medication reached 67.9% and 55.6%, respectively. Patients with lower PUA (PUA < 33.5°) had more improvement of nocturia (36.6 vs. 17.9%, P = 0.030), lower IPSS score (14.2 vs. 18.3, P = 0.005), and better quality of life index (3.1 vs 3.8, P = 0.021). In the patients with lower PUA (particularly lower than 33.5°), nocturia was improved by administration of alpha blocker monotherapy.
To evaluate the detection rate of clinically significant prostate cancer (csPCa) in Magnetic resonance imaging and ultrasonography (MRI/US) fusion biopsy in patients with biopsy-naïve men for varying prostate-specific antigen (PSA) levels. Since MRI can efficiently detect csPCa compared to standard transrectal ultrasound (TRUS) guided biopsy; however, the optimal PSA threshold for its use is unclear.We retrospectively reviewed those who underwent MRI/US-fusion and standard biopsy from January 2016 to June 2018. Patients were divided into three groups: PSA <4, 4-10, >10 ng/mL. Propensity scoring was performed to balance the characteristics of the different biopsy groups, and the detection rate of csPCa was compared.Data from a total of 670 males were included in the analysis (standard TRUS, n = 333; MRI/US fusion, n = 337). Prior to matching, patients who received MRI/US-fusion biopsy had lower prostate volume. Propensity score matching balanced this characteristic and generated a cohort comprising 195 patients from each group. In the matched cohort, patients with PSA 4-10 ng/mL had a significantly increased risk of csPCa by MRI/US-fusion vs. standard biopsy (35.0% vs. 26.6%, P = 0.033). However, patients with PSA <4 ng/mL had csPCa found by MRI/US-fusion versus standard biopsy (12.0% vs. 16.0%, P = 0.342), whereas, patients with PSA >10 ng/mL had csPCa found by MRI/US-fusion versus standard biopsy (78.0% vs. 80.0%, P = 0.596). In multivariate logistic analysis among patients with PSA 4-10 ng/mL, MRI/US-fusion biopsy (odds ratio: 2.46, 95% confidence interval = 1.31-4.60, P = 0.005) were significantly associated with a detection of csPCa.Detection of csPCa by MRI/US-fusion biopsy is more efficient in patients with biopsy-naïve men with PSA 4-10 ng/mL. However, standard TRUS biopsy may identify csPCa in patients with PSA <4 ng/mL and ≥10 ng/mL, emphasizing the importance of performing a standard biopsy in conjunction with MRI/US-fusion biopsy in such populations.
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