Abstract Purpose: Older men have higher prostate-specific antigen levels than younger men. However, the current Japanese Urological Association guidelines recommend secondary screening at a cutoff value of 4.0 ng/mL, even in older men. Here, we reexamined the cutoffs for older men using a prostate screening cohort in Japan, and first performed an analysis to determine the indication cutoffs for detecting positive biopsies. Methods: Data from 68,566 prostate cancer screenings in the city in 2018 were combined with cancer registration data. The optimal prostate-specific antigen levels to predict prostate cancer in different age groups were calculated using receiver operating characteristic curves after determining whether a cancer was registered within one year of screening. Results: At the conventional prostate-specific antigen threshold of 4.0 ng/mL, the sensitivity, specificity, and negative predictive value were 94.9%, 91.7%, and 91.7%, respectively. The optimal prostate-specific antigen cutoff values for patients aged 50–59 years, 60–69 years, 70–79 years, and over 80 years were 3.900 ng/mL, 4.014 ng/mL, 4.080 ng/mL, and 4.780 ng/mL, respectively. Conclusions: The sensitivity and specificity of prostate cancer screening in the city were high, indicating a highly accurate screening. The prostate-specific antigen threshold was 4.78 ng/mL in patients older than 80 years. A higher prostate-specific antigen threshold may be useful in men over 80 years to avoid excess biopsy and reduce costs. Our results suggest that the Japanese current method of using PSA 4.0 ng/mL as a cutoff regardless of age may not be preferable in the older men.
Abstract Background Few studies have reported reliable prognostic factors for immune checkpoint inhibitors (ICIs) in renal cell carcinoma (RCC). Therefore, we investigated prognostic factors in patients treated with ICIs for unresectable or metastatic RCC. Methods We included 43 patients who received ICI treatment for RCC between January 2018 and October 2021. Blood samples were drawn before treatment, and 73 soluble factors in the plasma were analyzed using a bead-based multiplex assay. We examined factors associated with progression-free survival (PFS), overall survival (OS), and immune-related adverse events (irAE) using the Chi-squared test, Kaplan–Meier method, and the COX proportional hazards model. Results Patients exhibited a median PFS and OS of 212 and 783 days, respectively. Significant differences in both PFS and OS were observed for MMP1 (PFS, p < 0.001; OS, p = 0.003), IL-1β (PFS, p = 0.021; OS, p = 0.008), sTNFR-1 (PFS, p = 0.017; OS, p = 0.005), and IL-6 (PFS, p = 0.004; OS, p < 0.001). Multivariate analysis revealed significant differences in PFS for MMP1 (hazard ratio [HR] 5.305, 95% confidence interval [CI], 1.648–17.082; p = 0.005) and OS for IL-6 (HR 23.876, 95% CI, 3.426–166.386; p = 0.001). Moreover, 26 patients experienced irAE, leading to ICI discontinuation or withdrawal. MMP1 was significantly associated with irAE (p = 0.039). Conclusion MMP1 may be associated with severe irAE, and MMP1, IL-1β, sTNFR-1, and IL-6 could serve as prognostic factors in unresectable or metastatic RCC treated with ICIs. MMP1 and IL-6 were independent predictors of PFS and OS, respectively. Thus, inhibiting these soluble factors may be promising for enhancing antitumor responses in patients with RCC treated with ICIs.
A 35-year-old man was diagnosed with stage IIIC non-seminoma with paralysis of the lower half of his body due to 8th thoracic spine metastasis. The patient received bleomycin, etoposide, and cisplatin (BEP) therapy. On day 4 of the second course of BEP, the patient developed a fever and was diagnosed with coronavirus disease (COVID-19). COVID-19 was suspected to worsen because of cancer and chemotherapy-induced immunosuppression. However, the benefits of continuing BEP therapy outweighed these risks. After obtaining fully informed consent, BEP therapy was continued from day 5, while sotrovimab (anti-COVID-19 drug) was administered. The second course of BEP was completed without worsening severe COVID-19 or bleomycin-induced lung injury. The patient completed four courses of BEP, with normalization of tumor markers, partial response on imaging, and improvement in lower body paralysis. In this case, we successfully treated a patient with testicular germ cell tumor with chemotherapy while having COVID-19 without treatment delay. During the COVID-19 pandemic, concomitant chemotherapy and COVID-19 treatment are warranted because delaying treatment will decrease the efficacy of highly curative diseases such as germ cell tumors.
Doege-Potter syndrome, characterized by solitary fibrous tumors and non-islet cell tumor hypoglycemia, is rare. Here, we report a case of Doege-Potter syndrome in which retroperitoneal tumor resection was performed with continuous intraoperative blood glucose monitoring.
Abstract Background: Doege-Potter syndrome presents as solitary fibrous tumors and non-islet cell tumor hypoglycemia (NICTH). Here, we report a case of Doege-Potter syndrome in which retroperitoneal tumor resection was performed with continuous intraoperative blood glucose monitoring. Case Presentation: The patient was a 37-year-old healthy man with no relevant medical history. They were brought to the emergency room because of defecation difficulties and incontinence caused by hypoglycemia, and a tumor measuring 10 × 12 × 9 cm was found in the right kidney. High-molecular-weight insulin-like growth factor-II (IGF-II) was detected in the blood, indicating an IGF-II-producing tumor with NICTH. The patient underwent tumor resection, and the pathological results indicated a solitary fibrous tumor of retroperitoneal origin. Thus, retroperitoneal primary Doege-Potter syndrome was diagnosed. Continuous blood glucose monitoring was performed intraoperatively, and no hypoglycemic attacks occurred; insulin secretory abnormalities improved immediately after surgery. Previous studies suggest that IGF-II is metabolized in a few hours. Therefore, serum IGF-II levels were analyzed one week and one month postoperatively; the levels were within the normal range at both time points. Two years have passed since the surgery without recurrence. Conclusions: Doege-Potter syndrome of retroperitoneal primary origin is rare. Furthermore, continuous intraoperative blood glucose monitoring was performed during surgery; thus, we report blood glucose level trends for the first time. This case highlights that this type of surgery can be performed safely without special blood glucose adjustments and that insulin secretion resumes soon after surgery.
Background This study compared the surgical and urinary functional outcomes in patients with muscle-invasive bladder cancer (MIBC) who underwent robot-assisted radical cystectomy (RARC) followed by intracorporeal ileal neobladder reconstruction (ICNB) to those in patients who underwent minimum incision endoscopic radical cystectomy (MIE-RC) followed by extracorporeal ileal neobladder reconstruction (ECNB). Materials and Methods This study reviewed the clinical records of 153 consecutive MIBC patients who underwent neoadjuvant chemotherapy followed by radical cystectomy and ileal neobladder reconstruction. Results The operative time in the ICNB group was significantly longer than that in the ECNB group. The median estimated blood loss was significantly less in the ICNB group than in the ECNB group. The neobladder capacity gradually increased in both groups. The maximum neobladder pressure and urethral closure pressure gradually improved in both groups. Conclusion Our initial experience with ICNB was favourable, with acceptable surgical and urinary functional outcomes.
ABSTRACT Background Lymph node (LN) metastasis is a poor prognostic factor in patients with prostate cancer. Elucidating the mechanisms underlying cancer progression in the metastatic microenvironment of LNs is crucial to establishing novel therapies. Adipocytes interact with cancer cells and regulate cancer progression. In this study, we aimed to clarify the clinicopathological significance of extranodal adipose tissue invasion in metastatic LNs and preoperative adipokine concentration in patients with prostate cancer exhibiting metastatic LNs. Methods We examined the pathological findings of primary and metastatic nodes and clinical information of 66 specimens from 46 patients with prostate cancer. A sub‐analysis was performed to assess the relationship between preoperative adiponectin/leptin concentrations and clinical/pathological findings in the blood samples of 56 patients with prostate cancer who either did or did not show LN metastasis. Results The number of metastatic LNs in patients correlated with the involvement of adipose tissue and lymphovascular invasion ( p = 0.039 and < 0.001, respectively). Preoperative adiponectin concentration was lower in patients with resected margin‐positive and extraprostatic extension‐positive primary cancers ( p = 0.0071 and 0.02, respectively). Preoperative adiponectin concentrations were significantly lower in patients with metastatic LNs than in patients without LN metastasis ( p < 0.001). Moreover, leptin concentrations were significantly higher in patients with metastatic LNs than in patients without LN metastasis ( p < 0.001). In patients with metastatic LNs, preoperative adiponectin concentrations were significantly lower in patients with biochemical recurrence than in patients without biochemical recurrence ( p = 0.031). There was no correlation between biochemical recurrence and pathological findings. Conclusions This is the first report on the detailed histopathological characteristics of prostate cancer with LN metastases and the significance of preoperative adiponectin concentration in predicting the pathological features of primary cancers. Also, adipokines are a significant prediction factor of LN metastases for prostate cancer patients. Adipose tissue and adipose‐secreting factors may be involved in the progression of metastatic and primary prostate cancer.
Abstract Purpose: Long-term survival can be achieved in patients with localized prostate cancer (PCa) treated with radical prostatectomy (RP) or radiotherapy (RT). However, secondary bladder cancer (BCa) development remains poorly understood. We investigated the effect of primary PCa treatment on the subsequent risk of developing a second primary BCa. Methods: We compared men who underwent RT for PCa with those who underwent RP. In total, 60195 patients with PCa were registered in the Kanagawa Cancer Registry between 1959 and 2017. Our primary objective was to investigate the effects of RT and RP on the incidence of secondary BCa. Cumulative incidence plots and multivariable Cox regression models were tested for second BCa rate differences according to the treatment type (RT vs. RP). Cumulative incidence was calculated as the competing risk of mortality. Hazard ratios were calculated using the fine-gray proportional hazards regression model. Results: Of the 60195 individuals included in the study, 8090 were treated with RT, and 12387 were treated with RP. Median follow-up was 69.3 months (1.0-486.4 months). The cumulative incidence of secondary BCa did not differ between patients treated with RT (3.78%) and those treated with RP (1.39%, p < 0.05). There was an increased risk of BCa (hazard ratio 1.70, 95% confidence interval 1.24 to 2.31) after RT compared with the risk in individuals after RP. Conclusions: Patients treated with RT are at an increased risk of developing a second primary BCa compared with those treated with RP.
