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This article discusses the survival rates of patients with metastatic castration-resistant prostate cancer (mCRPC) who received treatment beyond cabazitaxel. Real-world data showed that patients who received additional treatment after cabazitaxel, such as androgen receptor signaling inhibitors (ARSI), radium-223, olaparib, or docetaxel rechallenge, had longer overall survival (OS) compared to those who did not receive subsequent therapy or alternative treatments. The optimal treatment sequence for mCRPC remains unknown, as there have been no randomized controlled trials comparing different treatments. Further research is needed to understand the role of each agent after cabazitaxel in prolonging OS. However, this study was retrospective and had a small sample size, so more evidence is needed from multiple centers. [Extracted from the article]

This article discusses a case study of a sperm extraction procedure performed on a hemodialysis patient with anejaculation, resulting in a successful pregnancy and delivery. The authors suggest that the sperm retrieval rate may be higher than usual in patients with suspected non-obstructive azoospermia and high follicle stimulating hormone (FSH) levels. The endocrine environment is known to be affected in end-stage renal failure, which can disrupt normal gonadotropin releasing hormone release and cause hypogonadism and hypospermatogenesis. The article also mentions the potential impact of kidney transplantation on spermatogenesis and the irreversible effects of end-stage renal failure in childhood or adolescence. The authors conclude that assisted reproductive technology is a viable option for patients with end-stage renal failure and that this information should be provided to dialysis patients of reproductive age. [Extracted from the article]

The authors reported the result of sperm cryopreservation for prostate cancer patients.[1] With improved outcomes in overall cancer treatment, quality of life after cancer treatment is becoming more important. Whether or not sperm preservation is actually performed, fertility preservation should at least be explained to all patients undergoing prostate cancer treatment, including total prostatectomy. When treatments that affect spermatogenesis, typically chemotherapy, are given, fertility preservation before treatment is becoming increasingly popular, especially among the Adolescent & Young Adult (AYA) generation. [Extracted from the article]

Introduction: The EXIST-2 (NCT00790400) study demonstrated the superiority of everolimus over placebo for the treatment of renal angiomyolipomas associated with tuberous sclerosis complex (TSC) or sporadic lymphangioleiomyomatosis (LAM). This post hoc analysis of EXIST-2 study aimed to assess angiomyolipoma tumor behavior among patients who submitted to continued radiographic examination following discontinuation of everolimus in the noninterventional follow-up phase. Methods: For patients who discontinued everolimus at the completion of extension phase for reasons other than angiomyolipoma progression, a single CT/MRI scan of the kidney was collected after 1 year of treatment discontinuation. Changes from baseline and from the time of everolimus discontinuation in the sum of volumes of target angiomyolipoma lesions were assessed in the non-interventional follow-up phase (data cutoff date, November 6, 2015). Results: Of the 112 patients who received ≥1 dose of everolimus and discontinued treatment by the end of extension phase, 34 (30.4%) were eligible for participation in the non-interventional follow-up phase. Sixteen of 34 patients were evaluable for angiomyolipoma tumor behavior as they had at least one valid efficacy assessment (i.e. kidney CT/MRI scan) after everolimus discontinuation. During the non-interventional follow-up phase, compared with baseline, two patients (12.5%) experienced angiomyolipoma progression (angiomyolipoma-related bleeding [n = 1], increased kidney volume [n = 1]). Five patients out of 16 (31.3%) experienced angiomyolipoma progression when compared with the angiomyolipoma tumor assessment at everolimus discontinuation. The median (range) percentage change in angiomyolipoma tumor volume (cm3) from baseline was −70.56 (−88.30; −49.64) at time of everolimus discontinuation (n = 11), and −50.55 (−79.40; −23.16) at week 48 (n = 7) after discontinuation of everolimus. One patient death was reported due to angiomyolipoma hemorrhage. Conclusions: Angiomyolipoma lesions displayed an increase in volume following discontinuation of everolimus in patients with renal angiomyolipoma or sporadic LAM associated with TSC, but there was no evidence of rapid regrowth. Trial registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

Abstract: The development of more specific biomarkers for prostate cancer and/or high‐risk prostate cancer is necessary, because the prostate‐specific antigen test lacks specificity for the detection of prostate cancer and can lead to unnecessary prostate biopsies. Urine is a promising source for the development of new biomarkers of prostate cancer. Biomarkers derived from prostate cancer cells are released into prostatic fluids and then into urine. Urine after manipulation of the prostate is enriched with prostate cancer biomarkers, which include prostate cancer cells, DNAs, RNAs, proteins and other small molecules. The urinary prostate cancer antigen 3 test is the first Food and Drug Administration‐approved RNA‐based urinary marker, and it helps in the detection of prostate cancer on repeat biopsy. The SelectMDx test is based on messenger RNA detection of DLX1 and HOXC6 in urine after prostate massage, and helps in the detection of high‐risk prostate cancer on prostate biopsy. Exosomes are extracellular vesicles with a diameter of 30–200 nm that are secreted from various types of cells. Urinary prostate cancer‐derived exosomes also contain RNAs and proteins specific for prostate cancer (e.g. PCA3 and TMPRSS2‐ERG), and could be promising sources of novel biomarker discovery. The ExoDx Prostate test is a commercially available test based on the detection of three genes (PCA3, ERG and SPDEF) in urinary exosomes. Advancement of comprehensive analysis (microarray, mass spectrometry and next‐generation sequencing) has resulted in the discovery of several urinary biomarkers. Non‐invasive urinary markers can help in the decision to carry out prostate biopsy or in the design of a therapeutic strategy. [ABSTRACT FROM AUTHOR]

On the other hand, about three quarters of current prostate cancer patients who undergo total prostatectomy do not have regular sexual intercourse. Editorial Comment to Limited impact of erectile function on health-related quality of life in Japanese men undergoing robot-assisted radical prostatectomy Tamura I et al i . reported that erectile function has a limited impact on postoperative health-related quality of life in Japanese patients with robot-assisted radical prostatectomy (RARP).1 Of course, in Japanese prostate cancer patients, erectile function is very important and plays an important role in treatment decisions, and efforts must be made to deal with the altered physical condition.2 On the other hand, it has been reported that fewer middle-aged Japanese men have regular sexual intercourse than men of other races or cultures. [Extracted from the article]

Wallerand I et al i . reported that mutations in I TP53 i , but not I FGFR3 i , in BCa are influenced by smoking.2 Recently, evidence has emerged regarding gene-environment interactions, particularly for smoking and occupational exposure. Carcinogenesis 2005; 26: 177 - 84. 3 Sung H, Siegel RL, Rosenberg PS, Jemal A. Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry. Bladder cancer (BCa) is the ninth most common cancer globally, with an estimated 430 000 new cases diagnosed in 2012.1 The highest incidence rates of BCa are observed in men in Europe, North America and Egypt. [Extracted from the article]

Tsujimura I et al i . showed low serum zinc concentrations in men with poor semen findings and clarify the significance of measuring serum zinc levels to assess male infertility.3 The reported association in this paper between low serum concentrations and poor semen quality could be useful information for men wishing to conceive. Zinc is considered to be an important factor in spermatogenesis,1 therefore, many studies have assessed the relationship between semen plasma and serum zinc concentrations and semen findings.2 Zinc concentrations in semen plasma are approximately 30 times higher than those in serum, and many studies have reported on the relationship between zinc concentrations in plasma and semen findings. Like zinc, folic acid is thought to improve semen findings, and there are many supplements on the market that contain both zinc and folic acid. [Extracted from the article]

Background: There are few reports of long-term treatment with docetaxel in castration-resistant prostate cancer (CRPC) because of the limit of a maximum of ten cycles of treatment in TAX327 showing a survival benefit. Therefore, this study, ARD6563, was conducted to evaluate the safety of more than ten cycles of docetaxel in metastatic CRPC. Methods: We enrolled patients who had received ten cycles of docetaxel in the preceding study, ARD6562. For ARD6563, patients received docetaxel every 3 weeks, at the last dose (70, 60, or 50 mg/m) received for cycle 10 in ARD6562, with prednisolone 5 mg orally twice daily. Results: The safety analysis set comprised 15 patients (median age, 64 years; performance status, 0 in 87%) out of 43 patients treated in ARD6562. The median initial dose of docetaxel was 60 mg/m, and the median number of additional cycles administered was 8 (range, 1-42). The relative dose intensity was 78.0% for docetaxel and 98.0% for prednisolone. Dose reduction was needed in 3 cycles because of grade 3 infection, febrile neutropenia, and grade 2 neuropathy. Administration delay was necessitated in 6 cycles because of grade 1-2 nonhematological toxicities. The major grade 3-4 toxicities were myelosuppression. Five patients who had an observed partial response or stable disease in ARD6562 maintained their clinical response in ARD6563. The study treatment was discontinued in 10 patients because of disease progression and in 4 patients for serious toxicities. There were no treatment-related deaths. Conclusions: Long-term docetaxel with prednisolone is feasible in selected Japanese patients with CRPC. [ABSTRACT FROM AUTHOR]

Quite a few epidemiological studies including meta-analyses indicate that prostate inflammation is associated with increased risk of prostate cancer. The cause of inflammation in the prostate is speculated to be several microorganisms that cause prostatitis or sexually transmitted infections. Other specific microorganisms, such as xenotropic murine leukemia virus-related virus, are also reported to relate to the development of prostate cancer; however, the contribution of this microorganism to prostate cancer development needs to be carefully interpreted. Environmental factors, especially dietary factors, might also be associated with prostate cancer development. Among related dietary factors, charred meat carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5- b]pyridine might be a link between environmental factors and inflammation, because 2-amino-1-methyl-6-phenylimidazo[4,5- b]pyridine has the potential to accelerate prostate inflammation through its estrogenic effect. In light of these findings, preventing or reducing prostate inflammation might be one strategy for chemoprevention of prostate cancer. [ABSTRACT FROM AUTHOR]

OBJECTIVE • To evaluate tumour-associated macrophage (TAM) infiltration in prostate biopsy specimens as a possible prognostic factor for prostate cancer (PCa) after hormonal therapy. PATIENTS AND METHODS • Immunostaining of TAMs in prostate biopsy specimens was performed using a monoclonal antibody CD68 for 71 patients having PCa treated with hormonal therapy. • Six microscopic ( × 400) fields around the cancer foci were selected for TAM counting. RESULTS • The median value of serum prostatespecific antigen (PSA) was 50.1 ng/mL, and the median TAM count was 22. • Recurrence-free survival was significantly better in patients with fewer TAMs ( < 22) than in those with higher numbers of TAMs ( = 22) ( P < 0.001). • TAM count was higher in those with higher serum PSA (PSA), higher Gleason score, clinical T stage or those with PSA failure. Cox multivariate analysis showed that TAM count is one of the prognostic factors for PCa treated by hormonal therapy ( P < 0.0001). CONCLUSION • TAM infiltration in prostate needle biopsy specimens is a useful predictive factor for PSA failure or progression of PCa after hormonal therapy. [ABSTRACT FROM AUTHOR]

Objectives: To review our series of testicular germ cell tumors with brain metastases and to establish an optimal treatment strategy for them. Methods: Twenty-seven cases of testicular germ cell tumors from three institutions were retrospectively reviewed. Results: Twenty-six were non-seminomatous tumors and only one was a seminoma. Based on the International Germ Cell Consensus Classification, two cases were classified as good prognosis, seven as intermediate prognosis and 18 as poor prognosis. Chemotherapy was carried out in all patients. Additionally, whole-brain radiotherapy was performed in 10 cases, stereotactic radiosurgery in six, whole-brain radiotherapy combined with stereotactic radiosurgery in three and complete surgical resection in five. Three patients received chemotherapy only. Cancer-specific 5- and 10-year survival rates were both 35.9%. The prognosis of those with brain metastases at the time of diagnosis tended to be better than those developing brain metastases during treatment. Those with a single brain metastasis showed significantly better survival than those with multiple brain metastases. No other significant prognostic factor was found at multivariate analysis. Conclusion: Testicular germ cell tumors with brain metastases can be managed with the combination of whole-brain radiotherapy, stereotactic radiotherapy, and/or surgical resection in combination with chemotherapy. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the regulation of interferon-α (IFN-α) receptor expression in metastatic renal cell carcinoma (RCC) after IFN-α administration. Methods: Blood sampling was carried out in eight patients with metastatic RCC and six healthy volunteers. Flow-cytometric analysis using a monoclonal antibody against the active subunit of the type-I IFN-α receptor (IFNAR2) was carried out to examine the circadian rhythm of IFNAR2 expression in peripheral blood mononuclear cells (PBMC) as well as its downregulation after IFN-α administration. Results: According to its circadian rhythm IFNAR2 in PBMC had a peak expression at night. Once IFN-α is administered, IFNAR2 levels in PBMC showed downregulation within 48 h and recovered within another 48 h. Conclusions: Our findings might support the establishment of an optimal schedule for IFN-α administration. [ABSTRACT FROM AUTHOR]

OBJECTIVE The aim of this study is to evaluate the expression of the macrophage scavenger receptor (MSR) in prostate needle biopsy specimens as a possible prognostic factor for prostate cancer. As MSR reportedly has a role in recognizing foreign pathogenic substances, MSR-positive inflammatory cells are often detected in solid tumours, and there is a correlation between the relative risk of prostate cancer and polymorphism of the MSR gene. PATIENTS AND METHODS MSR was evaluated by immunostaining in needle biopsies of the prostate from 135 patients who were confirmed to have prostate cancer. Among these men, 70 were treated by radical prostatectomy or by radiotherapy as definitive therapy; the other 65 were treated by hormonal therapy because of advanced disease or age. Needle-biopsy specimens were sectioned at 5 µm and immunostained with a monoclonal antibody against MSR. Six microscopic (×400) fields around the cancer foci were selected in each case for analysis. RESULTS The median number of MSR-positive cells (MSR count) in each case was 24. There was an inverse correlation between the MSR count and Gleason score and clinical stage. The MSR count was lower in patients with biochemical (prostate-specific antigen, PSA) failure than that in those with no PSA failure ( P < 0.001). In all patients, the recurrence-free survival (RFS) rate was significantly higher in those with a high MSR count (≥24) than that in those with low MSR count (<24, P < 0.001). Moreover, for patients treated by definitive or hormonal therapy, the RFS rates in those with a higher MSR count were higher than in those with a lower MSR count ( P < 0.001 and 0.014, respectively). Cox multivariate analysis showed that the MSR count was a prognostic factor for prostate cancer in addition to extraprostatic extension and Gleason score ( P = 0.002, 0.038 and 0.011, respectively). CONCLUSION The results of immunostaining of MSR in needle-biopsy specimens is a prognostic factor for prostate cancer. [ABSTRACT FROM AUTHOR]

Objectives: We performed a comparative study of laparoscopic radical nephrectomy (LRN) and open radical nephrectomy (ORN) for renal cell carcinoma, and a comparative study of transperitoneal (LRN-TP) versus retroperitoneal LRN (LRN-RP) for renal cell carcinoma. Materials and Methods: A total of 100 patients underwent radical nephrectomy for stage T1 and T2 disease. Of the 100 cases, 34 (34.0%) were treated with LRN-TP, 33 (33.0%) with LRN-RP, and 33 (33.0%) with ORN. Each group was reviewed with respect to complications, postoperative convalescence, and the relationship between body mass index and operative time. Results: Mean operative times of LRN-TP, LRN-RP and ORN were 305.7, 296.2, and 218.1 min, and mean blood losses were 236.3, 101.7, and 690.5 ml, respectively. Body mass index and mean operative time exhibited equilateral correlation in the three groups. In one case (1.5%) of LRN (67 cases), conversion to open surgery was necessary due to bleeding, and LRN-TP was performed. In one case (1.5%), intraoperative complications occurred but could be managed laparoscopically. Three cases (9.1%) of ORN required blood transfusion. Conclusions: LRN results in less blood loss, less postoperative pain, quicker oral intake, shorter hospitalization, and a more rapid recovery than ORN, although LRN requires longer operative time than ORN. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Recently, several kinase inhibitors have been reported to exert stronger growth inhibitory effects on metastatic renal cell carcinomas (RCCs) than cytokines such as interferons (IFNs) and interleukin-2 (IL-2). On the contrary, the adverse effects of these drugs are also severe. The aim of this study is to analyze the growth-inhibitory effects of DEXamethasone (DEX) on RCC in vivo and in vitro. Methods: The MTT assay was performed using three RCC cell lines, OUR-10, Caki-1, and NC65. OUR-10 cells were subcutaneously transplanted to the dorsal area of nude mice. The nuclear translocation of glucocorticoid receptor (GR) and NF-κ B was examined using appropriate antibodies. Concentrations of interleukin-6 (IL-6), IL-8, and vascular endothelial cell growth factor (VEGF) in the conditioned media and cytosol were measured by enzyme-linked immunosorbent assay (ELISA). Results: All three RCC cell lines responded to DEX treatment. The growth of OUR-10 xenografts was significantly inhibited by administration of DEX. GR was translocated into the nucleus on DEX treatment. Intracellular IL-6, as well as IL-6 in the conditioned medium, decreased in OUR-10 cells following treatment with increasing amounts of DEX. Concentrations of IL-8 and VEGF in the conditioned medium of OUR-10 and NC65 cells also decreased following DEX treatment, with the inhibition of nuclear translocation of NF-κ B. Conclusion: DEX treatment is a candidate for advanced RCC therapy by inhibiting the activation of NF-κ B and its downstream products such as IL-6, IL-8 and VEGF. [ABSTRACT FROM AUTHOR]

Background. Renal cell carcinoma (RCC) frequently occurs in patients with long-term dialysis. Long-term dialysis causes distinctive pathological changes in the kidney, which is known as acquired cystic disease of the kidney (ACDK). It is of great interest to know whether RCCs occurring in the dialytic kidneys harbour the same or similar mutations of the von Hippel–Lindau (VHL) gene as conventional dialysis-unrelated clear cell RCCs so often do. [ABSTRACT FROM PUBLISHER]

Background: The paclitaxel, ifosfamide, and cisplatin regimen has been used to treat metastatic testicular cancer with successful results. We investigated the usefulness of a paclitaxel, ifosfamide, and nedaplatin (TIN) regimen as salvage therapy for patients with advanced testicular germ cell tumors (GCTs). Methods: Eight patients with advanced GCTs were treated with TIN. The treatment was performed as salvage therapy for cases refractory to therapies, such as bleomycin, etoposide and cisplatin, and irinotecan with nedaplatin. The TIN regimen consisted of paclitaxel (200 mg/m2) by 24-h infusion on day 1, followed by ifosfamide (1.2 g/m2) infusions over 2 h on days 2–6, and nedaplatin (100 mg/m2) given over 2 h on day 2. Results: Seven out of eight patients achieved a disease-free status after chemotherapy, followed by surgical resection of the residual tumor. Six of the seven patients have continued to show no evidence of disease after salvage therapy, with a median follow-up period of 27 months, but one patient developed a ‘growing teratoma syndrome’ in the mediastinum 31 months after TIN chemotherapy. All patients developed grade 4 leukocytopenia. However, it could be managed by using granulocyte colony-stimulating factor. Only one patient developed grade 2 sensory neuropathy and no patient developed nephrotoxicity. Conclusion: The TIN regimen was efficacious and well-tolerated as salvage chemotherapy for Japanese patients with advanced GCTs. [ABSTRACT FROM AUTHOR]

Thymidine phosphorylase (TP), also known as platelet-derived endothelial cell growth factor, has been implicated in the angiogenesis of bladder cancer. The aim of this study is to investigate the association between TP expression and the clinicopathologic findings, and the prognostic value. TP immunohistochemical staining was performed in specimens from 71 patients (50 men and 21 women) with superficial bladder cancer (pTa or pT1). Thirty-nine patients had received intravesical instillation of tetrahydropyranyladriamycin (THP) after transurethral resection (TUR) and the other 32 had not. For immunohistochemistry, paraffin-embedded specimens were stained with mouse monoclonal antibody against TP. When more than 10% of tumor cells were positively stained, staining was defined as positive. The correlations between TP immunostaining and clinicopathological features were analyzed. Multivariate analysis, using the Cox proportional hazard model, was performed to determine the risk factors for intravesical recurrence. Specimens from 29 of the 71 patients (19 men and 10 women) were positive for TP. The expression of TP was not correlated with age, sex, histological grade, multiplicity, or morphology. Also, TP expression was not associated with whether the cases were primary or recurrent. Multivariate analysis demonstrated that the decreased expression of TP and the use of THP instillation could be independent predictors of a higher rate of intravesical recurrence-free bladder cancer. The present study suggests that immunohistochemical TP staining is useful for predicting the intravesical recurrence of superficial bladder cancer after Transurethral resection of bladder tumor (TUR-Bt). [ABSTRACT FROM AUTHOR]

Objectives: In a variety of cancers, several polymorphisms of the tumor necrosis factor (TNF) genes have been reported to result in different clinical outcomes. We investigated whether a polymorphism of the TNF gene is associated with a susceptibility to bladder cancer and its disease status. Methods: Polymorphisms in the TNF-α gene promoter (−308 bp) and the NcoI site in the first intron of the TNF-β gene were analyzed in 141 Japanese patients with bladder cancer and 173 Japanese controls by polymerase chain reaction-restriction fragment length polymorphism. The correlations between the polymorphisms of the TNF genes and the clinicopathological features were analyzed. Results: The number of cases and controls with TNF-α2 was too small to be assessable. In contrast, the TNF-β1/2 genotype at the NcoI site in the first intron conferred a 1.71-fold increased risk of bladder cancer compared to the TNF-β2/2 genotype. In the bladder cancer group, patients with the TNF-β1 allele had a significantly higher risk for a high-grade tumor (grade 3) or carcinoma in situ (CIS) than those without the TNF-β1 allele. Moreover, in the superficial bladder cancers, patients with the TNF-β1 allele showed a significantly higher intravesical recurrence rate than those without the TNF-β1 allele. Conclusion: This polymorphism in the TNF-β gene appears to be associated with tumor occurrence and disease status, such as the tumor grade and the presence of CIS. Further study with an increased sample size is warranted. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: We made a comparative study of laparoscopic nephroureterectomy (LNU) and standard open surgery (ONU) for upper urinary tract transitional cell carcinoma. Methods and methods: From July 2000 to February 2005, 49 patients underwent total nephroureterectomy for upper tract transitional cell carcinoma at Osaka University Medical Hospital. Of the 49 patients, twenty-five were treated with LNU, and twenty-four with ONU. Each group of cases was reviewed with respect to operative time, complications and postoperative convalescence. Results: The average operative time of the LNU and ONU group was 305.9min (range 190–480) and 271.2min (range 135–480) respectively, and the average blood loss was 321.5ml (80–1370) and 557.7ml (range 100–1730), respectively. The average time until ambulation after LNU and ONU was 2.2 days (range 1–3) and 4.0 days (range 3–5), respectively. No major postoperative complications were observed in either group. Conclusion: ONU still represents the gold standard for the management of upper tract transitional cell carcinoma; however, for low stage cases, LNU offers the advantages of minimally invasive surgery. [Copyright &y& Elsevier]

Abstract: We investigated the expression of KIT (product of c-kit oncogene), gain-of-function mutations, and activation of its downstream signal transduction in human testicular cancers. KIT was expressed in 88% (22/25) of seminomas and in 44.4% (4/9) of non-seminomas compared to adjacent normal testicular tissue. Nine of the KIT-expressing seminomas had mutations (40.9%; 9/22) in the c-kit gene; two cases in exon 11 and 7 cases in exon 17. Two of these mutations in exon 17 were novel, and the other seven mutations were identical to the already known gain-of-function mutations which cause activation of KIT without ligand stem cell factor. All of the mutant KIT and 53.8% (7/13) of wild-type KIT were phosphorylated (activated) and associated with phosphorylated phosphatidylinositol 3-kinase (PI3K). Akt was also phosphorylated in these seminomas, suggesting that the KIT–PI3K–Akt pathway is activated in seminoma. These findings suggest that the KIT–PI3K–Akt pathway is constitutively activated in testicular germ cell tumors, due to overexpression of KIT protein and/or gain-of-function mutations in the c-kit gene. [Copyright &y& Elsevier]

Abstract Background: Nerve-sparing techniques are commonly used in retroperitoneal lymph node dissection (RPLND) in patients with early stage testicular germ cell tumors to preserve postoperative ejaculation. The indications for nerve-sparing procedures have been extended to patients who have residual retroperitoneal tumor postchemotherapy with an increase in the incidence of local recurrence. Here, we report on 26 Japanese men with advanced testicular cancer who underwent nerve-sparing RPLND after partially successful chemotherapy. Methods: Between January 1995 and December 2000, 26 patients with metastatic or recurrent testicular cancer underwent nerve-sparing RPLND after chemotherapy. Eight patients had seminoma and 18 had non-seminoma. Three patients received high-dose chemotherapy with carboplatin (250 mg/m2 per day × 5 days), etoposide (300 mg/m2 per day × 5 days) and ifosfamide (1.5 g/m2 per day × 5 days) in combination with peripheral blood stem cell transplantation. Results: In all cases, lumbar splanchnic nerves were preserved macroscopically during the operation, at least unilaterally. Twenty-two patients (84.6%) achieved antegrade ejaculation during a mean follow-up at 3.9 months (range: 1–7 months). Three patients have fathered children. Only one patient suffered a retroperitoneal recurrence during a median follow-up at 25.8 months (range: 6–76 months). Conclusion: Nerve-sparing procedures for RPLND are appropriate for patients with metastatic testicular cancer, even after chemotherapy. The procedure preserves ejaculatory function in the majority of the patients without increasing the risk of local recurrence. Nerve-sparing RPLND improves the quality of life in patients who require postchemotherapy RPLND to treat residual tumor. [ABSTRACT FROM AUTHOR]

Abstract Background : Human prostate-specific Ets (hPSE) belongs to the Ets family. It regulates the proliferation, differentiation, and development of prostate epithelial cells. A recent study showed that hPSE can be detected in normal glands but not in cell lines established from prostate cancer (PCA), suggesting a translational disorder of hPSE from mRNA to protein in PCA. Immunohistochemical detection of hPSE could therefore be another method of differential diagnosis of PCA from other proliferative conditions in the prostate. Methods : An immunohistochemical detection of hPSE was carried out on the whole mounted prostatectomy specimen obtained from 19 cases with PCA. Results : Basal and secretory luminar cells showed a diffuse cytoplasmic staining for hPSE in normal glands, hyperplastic glands, and prostate intraepithelial neoplasia lesions. Whereas approximately 30% of PCA lesions showed a negative staining for hPSE, the positive rate for hPSE between PCA and benign glands or prostate intraepithelial neoplasia (PIN), was statistically significant (P < 0.05). Staining intensities in normal glands, hyperplastic glands, and PIN lesions were similar, but generally stronger than those in PCA lesions. Conclusions : Negative immunoreactivity for hPSE strongly suggests malignancy in the prostate glands. Decreased immunoreactivities of glands for hPSE could suggest PCA. [ABSTRACT FROM AUTHOR]

Background: Dexamethasone, a synthetic glucocorticoid, has clinical benefit in patients with hormone-refractory prostate cancer (HRPC), but the mechanisms responsible for its effects are unknown. The nuclear factor-kappaB (NF-kappaB)-dependent cytokine interleukin (IL) 6 (IL-6) is thought to stimulate growth of HRPC. Because dexamethasone interferes with NF-kappaB activation, we determined whether dexamethasone inhibits prostate cancer growth by working through the glucocorticoid receptor (GR) to interfere with NF-kappaB-IL-6 pathway.Methods: Three human prostate cancer cell lines (DU145, PC-3, and LNCaP) were assessed for GR expression and responsiveness to dexamethasone. Levels of GR, NF-kappaB, and the cytoplasmic NF-kappB inhibitor IkappaBalpha were determined by western blotting and of IL-6 by enzyme immunoassay. The subcellular localization of NF-kappaB was analyzed by immunofluorescence. The effects of dexamethasone (thrice weekly injections of 1 microg/mouse) on DU145 xenografts in nude and severe combined immunodeficient (SCID) mice were evaluated. GR expression in human prostate cancers was assessed by immunohistochemistry. All statistical tests were two-sided.Results: Dexamethasone dose dependently decreased GR levels and inhibited the growth of DU145 and PC-3 but not LNCaP cells (DU145 cells, P< .001; PC-3 cells, P = .009). Dexamethasone increased IkappaBalpha protein levels and the cytosolic accumulation of NF-kappaB in DU145 cells and decreased secreted IL-6 levels to 37 pg/mL (95% confidence interval [CI] = 33 pg/mL to 41 pg/mL), compared with 164 pg/mL (95% CI = 162 pg/mL to 166 pg/mL) secreted by ethanol-treated control cells. Dexamethasone inhibited the growth of DU145 xenografts in nude (P = .006) and SCID (P = .026) mice without affecting GR levels. Eight of 16 human prostate cancers expressed GR at high levels (>or=30% GR-positive cells).Conclusion: Dexamethasone inhibited the growth of GR-positive cancers, possibly through the disruption of the NF-kappaB-IL-6 pathway. [ABSTRACT FROM AUTHOR]

This fourth edition of the Japanese Clinical Practice Guidelines for Prostate Cancer 2023 is compiled. It was revised under the leadership of the Japanese Urological Association, with members selected from multiple academic societies and related organizations (Japan Radiological Society, Japanese Society for Radiation Oncology, the Department of EBM and guidelines, Japan Council for Quality Health Care (Minds), Japanese Society of Pathology, and the patient group (NPO Prostate Cancer Patients Association)), in accordance with the Minds Manual for Guideline Development (2020 ver. 3.0). The most important feature of this revision is the adoption of systematic reviews (SRs) in determining recommendations for 14 clinical questions (CQs). Qualitative SRs for these questions were conducted, and the final recommendations were made based on the results through the votes of 24 members of the guideline development group. Five algorithms based on these results were also created. Contents not covered by the SRs, which are considered textbook material, have been described in the general statement. In the general statement, a literature search for 14 areas was conducted; then, based on the general statement and CQs of the Japanese Clinical Practice Guidelines for Prostate Cancer 2016, the findings revealed after the 2016 guidelines were mainly described. This article provides an overview of these guidelines. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To evaluate comorbidities in Japanese testicular cancer (TC) survivors in a multi‐institutional, cross‐sectional study.This study enrolled TC survivors who visited any of the eight high‐volume institutions in Japan from 2018 to 2019. After obtaining informed consent, participants answered questionnaires about their comorbidities. We analyzed the impact of treatment on comorbidities rate in TC survivors.A total of 509 TC survivors responded to the comorbidity questionnaires. Median age at the time of response was 43 years (IQR 35–51 years) and median follow‐up period after treatment was 5.1 years (IQR 2.1–9.2 years). TC survivors were divided according to the number of cycles of chemotherapy into the following groups: None (n = 153); 1–2 cycles (n = 34); 3–4 cycles (n = 234); or ≥5 cycles (n = 88). The prevalence of kidney disease increased significantly with increasing number of cycles of chemotherapy (p < 0.05). The relative risk of cardiovascular disease in the groups with three or more cycles was 2.6 compared to the group without chemotherapy.The present study showed that the prevalence of kidney disease in TC survivors was increased with increasing number of cycles of chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Undetectable circulating tumor DNA (ctDNA) is an obstacle to performing comprehensive genomic profiling in daily practice to identify genomic alterations. We investigated the associations between clinicopathological factors and undetectable ctDNA using a commercially available comprehensive genomic profiling assay in metastatic prostate cancer. Patients and methods: Patients treated with systemic treatment for metastatic prostate cancer were included. ctDNA was analyzed by FoundationOne®Liquid CDx at enrollment. The associations between clinicopathological characteristics and ctDNA detection were analyzed. Results: The number of bone metastasis was associated with ctDNA detection (odds ratio [95% confidence interval], 13.6 [1.71–108], P = 0.014). An algorithm predicting ctDNA detection using clinicopathological parameters was created. If ≥ 4 bone metastases were observed, ctDNA detection was estimated to be 98.9%. Among the patients with < 4 bone metastases, if two or three features among ISUP grade group 5, PSA level ≥ 10 ng/ml, and castration resistance were present, the ctDNA detection rate was 96.7% while the ctDNA detection rate was 86.3% if no or only one feature was present. Conclusions: An algorithm created in this study is helpful in determining when to undertake comprehensive genomic profiling assay using blood. [ABSTRACT FROM AUTHOR]

Objective: To evaluate and compare the voting results of Japanese urologists with the global panel at the Advanced Prostate Cancer Consensus Conference (APCCC) 2022. Methods: Among the 198 questions discussed at the APCCC 2022, the APCCC‐JAPAN 2023 focused on 14 key questions related to the management of advanced prostate cancer with insufficient high‐level evidence based on their relevance to the Japanese cohort. A panel of six prostate cancer experts addressed these 14 questions and presented the latest evidence to Japanese urologists who voted on‐site using a web‐based system. The results were compared with those of APCCC 2022. Results: This study found significant differences in the voting results between Japanese urologists and the global panel regarding several crucial issues related to advanced prostate cancer management. These differences were those observed in treatment preferences, monitoring strategies, and treatment choices in specific clinical scenarios. These findings highlight the need for a nuanced approach tailored to the unique challenges with considerations of the Japanese healthcare environment. Conclusions: APCCC‐JAPAN 2023 provides valuable insights into the current clinical issues surrounding the management of advanced prostate cancer in Japan. The partial divergence in the consensus between Japanese urologists and the global panel underscores the importance of a context‐specific approach. The results of this study provide practical guidance for physicians facing complex challenges and should be used to inform decision‐making in the management of advanced prostate cancer. [ABSTRACT FROM AUTHOR]

Adjuvant immunotherapy with interferons and/or interleukin 2 (IL-2) is widely used for advanced kidney cancer. However, the results are not satisfactory so far. The purpose of this study is to evaluate the inducible activity of lymphokine-activated killer (LAK) cells against autologous human renal cell carcinoma. The effect of interleukin 7 (IL-7) on IL-2-induced LAK activity was assessed by the autologous assay system which we have established. Peripheral blood lymphocytes from patients with renal cell carcinoma were stimulated with IL-2 and/or IL-7, and tested for antitumor activity against autologous renal cell carcinoma. In all 10 cases tested, IL-7 alone induced LAK activity. Moreover, IL-2-induced LAK activity was augmented by the concomitant addition of IL-7. Flow cytometry revealed an increase in IL-2-receptor-positive lymphocytes following incubation with IL-7. These results suggest that combination therapy using IL-2 and IL-7 may be a useful treatment for patients with advanced renal cell carcinoma. [ABSTRACT FROM AUTHOR]

Background: This all-case post-marketing surveillance (PMS) evaluated the real-world safety and effectiveness of nivolumab monotherapy in Japanese patients with un-resectable or metastatic renal cell carcinoma (RCC). Methods: This multicenter, open-label, non-interventional, observational PMS study (registered from August 2016 to January 2017) was conducted in patients who were newly initiated on nivolumab monotherapy. Assessments included treatment-related adverse events (TRAEs) of special interest, patient characteristics affecting safety, and effectiveness over 12 months. Results: Overall, 580 patients were enrolled; 555 and 554 patients comprised the safety and effectiveness analysis sets, respectively. The median (range) age of the population was 66 (14–90) years. Nivolumab was initiated as 1st-, 2nd-, and ≥ 3rd-line treatment in 0.2%, 42.0%, and 57.8% of patients, respectively. TRAEs were reported in 275 (49.5%) patients. The most common TRAEs of special interest included thyroid dysfunction (9.5%), hepatic dysfunction (8.6%), and interstitial lung disease (6.7%). The incidence of TRAEs was significantly higher in elderly patients (≥ 65 vs < 65 years; ≥ 75 vs < 75 years); patients with lower C-reactive protein levels (< 5 vs ≥ 5 mg/dL); and patients with vs without a past medical history, including hepatic, thyroid, and autoimmune diseases. The 6- and 12-month survival rates were 71.8% and 57.9%, respectively. Conclusion: The safety profile of nivolumab monotherapy in Japanese patients with advanced RCC was similar to that in the phase 3 CheckMate 025 trial. No new safety signals were observed in this study. [ABSTRACT FROM AUTHOR]

Urothelial carcinoma presents significant treatment challenges, especially in advanced stages. Traditionally managed with platinum-based chemotherapy, the advent of immunotherapies, particularly immune checkpoint inhibitors, has revolutionized urothelial carcinoma treatment. This review explores the evolution of urothelial carcinoma management, focusing on the transition from immune checkpoint inhibitors monotherapy to innovative combination therapies. Pembrolizumab, following the KEYNOTE-045 trial, emerged as a pivotal ICI in pretreated metastatic urothelial carcinoma, outperforming traditional chemotherapy. However, limitations surfaced in untreated metastatic urothelial carcinoma patients, particularly in those with low PD-L1 expression, as evidenced by trials like IMvigor130 and KEYNOTE-361. These challenges led to the exploration of combination therapies, including immune checkpoint inhibitors with platinum-based chemotherapy, tyrosine kinase inhibitors, and antibody–drug conjugates. Notably, the CheckMate 901 trial demonstrated improved outcomes with a nivolumab–chemotherapy combination. A significant breakthrough was achieved with the combination of enfortumab vedotin, an antibody–drug conjugates, and pembrolizumab, setting a new standard in first-line treatment for locally advanced or metastatic urothelial carcinoma. Future directions involve further exploration of antibody–drug conjugates and immune checkpoint inhibitors, as seen in the TROPHY-U-01 and TROPiCS-4 trials. The review concludes that the locally advanced or metastatic urothelial carcinoma treatment landscape is rapidly evolving, with combination therapies offering promising avenues for improved patient outcomes, signaling a new era in urothelial carcinoma management. [ABSTRACT FROM AUTHOR]

Bone-modifying agents (BMA) are extensively used in treating patients with prostate cancer with bone metastases. However, this increases the risk of medication-related osteonecrosis of the jaw (MRONJ). The safety of long-term BMA administration in clinical practice remains unclear. We aimed to determine the cumulative incidence and risk factors of MRONJ. One hundred and seventy-nine patients with prostate cancer with bone metastases treated with BMA at our institution since 2008 were included in this study. Twenty-seven patients (15%) had MRONJ during the follow-up period (median, 19 months; interquartile range, 9–43 months). The 2-year, 5-year, and 10-year cumulative MRONJ incidence rates were 18%, 27%, and 61%, respectively. Multivariate analysis identified denosumab use as a risk factor for MRONJ, compared with zoledronic acid use (HR 4.64, 95% CI 1.93–11.1). Additionally, BMA use at longer than one-month intervals was associated with a lower risk of MRONJ (HR 0.08, 95% CI 0.01–0.64). Furthermore, six or more bone metastases (HR 3.65, 95% CI 1.13–11.7) and diabetes mellitus (HR 5.07, 95% CI 1.68–15.2) were risk factors for stage 2 or more severe MRONJ. MRONJ should be considered during long-term BMA administration in prostate cancer patients with bone metastases. [ABSTRACT FROM AUTHOR]

Although immune checkpoint inhibitors (ICIs) have gained approval for metastatic renal cell carcinoma (mRCC), the response rate is still limited. Therefore, it is urgent to explore novel markers of responses to ICIs that can help assess clinical benefits. Recently, it has been noted that peripheral blood eosinophil counts are an independent factor correlated with clinical outcome of ICIs in some types of cancer. We investigated peripheral blood absolute eosinophil counts (AECs) at baseline and 4 weeks after the initiation of nivolumab for mRCC patients between February 2016 and May 2022. In addition, we examined clinicopathological features including irAEs and analyzed the correlation between AECs and clinical efficacy of nivolumab. The median progression-free survival (PFS) and overall survival (OS) for all patients were 5.7 and 25.5 months, respectively. The median AECs in patients with irAEs were significantly higher at baseline and 4 weeks after the treatment compared to those without irAEs (p < 0.001 and p = 0.001). With the cutoff value of AECs of 329 cells/µL at 4 weeks after the treatment for prediction of irAEs, high-AECs groups had significantly higher number of responders compared with that in low-AECs group (p < 0.001). Accordingly, the PFS and OS were significantly better in patients with high-AECs group than those in low-AECs group (p = 0.03 and p = 0.009). High-AECs at 4 weeks after the treatment serve as the prominent surrogate marker associated with the incidence of irAEs and better clinical outcome in mRCC patients receiving nivolumab. [ABSTRACT FROM AUTHOR]

Forkhead box P3 (Foxp3)-expressing regulatory T (Treg) cells play essential roles in immune homeostasis but also contribute to establish a favorable environment for tumor growth by suppressing anti-tumor immune responses. It is thus necessary to specifically target tumor-infiltrating Treg cells to minimize effects on immune homeostasis in cancer immunotherapy. However, molecular features that distinguish tumor-infiltrating Treg cells from those in secondary lymphoid organs remain unknown. Here we characterize distinct features of tumor-infiltrating Treg cells by global analyses of the transcriptome and chromatin landscape. They exhibited activated phenotypes with enhanced Foxp3-dependent transcriptional regulation, yet being distinct from activated Treg cells in secondary lymphoid organs. Such differences may be attributed to the extensive clonal expansion of tumor-infiltrating Treg cells. Moreover, we found that TCF7 and LEF1 were specifically downregulated in tumor-infiltrating Treg cells both in mice and humans. These factors and Foxp3 co-occupied Treg suppressive function-related gene loci in secondary lymphoid organ Treg cells, whereas the absence of TCF7 and LEF1 accompanied altered gene expression and chromatin status at these gene loci in tumor-infiltrating Treg cells. Functionally, overexpression of TCF7 and LEF1 in Treg cells inhibited the enhancement of Treg suppressive function upon activation. Our results thus show the downregulation of TCF7 and LEF1 as markers of highly suppressive Treg cells in tumors and suggest that their absence controls the augmentation of Treg suppressive function in tumors. These molecules may be potential targets for novel cancer immunotherapy with minimum effects on immune homeostasis. [ABSTRACT FROM AUTHOR]

Objectives: To investigate preoperative patient factors that may predict the occurrence of perioperative complications following robot‐assisted radical cystectomy at a single center in Japan. Methods: From 2013 to 2022, 103 patients underwent RARC at our institution. Complications within 90 days after surgery were assessed using the Clavien–Dindo classification. Preoperative characteristics and surgical outcomes were compared between cohorts with and without complications ≥grade 3. Logistic regression analysis was used to identify the risk factors associated with perioperative complications. Results: Overall, 27% of patients (27/103) experienced grade 3 or higher complications. The cohort that developed complications ≥grade 3 exhibited significantly higher Charlson comorbidity index (p = 0.046) and significantly lower estimated glomerular filtration rate (p = 0.048). Charlson comorbidity index ≥2 (p = 0.037) and estimated glomerular filtration rate <53 (p = 0.008) were independent predictors for the occurrence of complications ≥grade 3. The incidence of complications ≥grade 3 was 61.5% in the group possessing both factors, which was significantly higher than those in the groups possessing neither factor nor only one of the two factors. Conclusions: Our results suggest that the Charlson comorbidity index and preoperative estimated glomerular filtration rate may be predictors of perioperative complications. It is important to evaluate the patient's preoperative characteristics and choose the surgical procedure accordingly. [ABSTRACT FROM AUTHOR]

This article is an English translation of the Clinical Practice Guidelines for Upper Tract Urothelial Carcinoma (2nd edition) published in June 2023. The Japanese Urological Association's (JUA) Guidelines Committee on Upper Tract Urothelial Carcinoma (UTUC) created a 2023 update guideline to support clinicians' current evidence‐based management of UTUC and to incorporate its recommendations into clinical practice. The new guideline adhered as closely as possible to the Minds Manual for Guideline Development 2020 ver. 3.0. Findings related to epidemiological, pathological, diagnosis, treatment, and follow‐up were reviewed. In addition, seven clinical questions (CQs) were set to determine the grade of recommendation and level of evidence. Preconceptions and biases were removed from the preparation process, the overall evidence was evaluated appropriately, and recommendations were made after fully considering the balance between benefits and harms. Although the evidence is still insufficient to be taken up as a CQ, the latest important information is described in seven columns, and clinical issues that should be resolved in the future related to the CQ are described as recommendations for tomorrow. We hope that these guidelines will help medical professionals, patients, and their families involved in the treatment of UTUC in their decision‐making, and hope that a critical review of these guidelines will lead to further refinements in the next edition. [ABSTRACT FROM AUTHOR]

Objectives: Nocturnal polyuria (NP) is one of the causes of nocturia that impairs quality of life. It is necessary to consider that NP is latent when the initial treatment for nocturia is unsatisfactory. Therefore, it is important to establish a treatment for NP based on the pathophysiology. We have previously reported the relationship between NP and fluctuation in blood pressure. The present study aimed to investigate the association between NP and 24‐h blood pressure fluctuations in a multicenter prospective study. Methods: This study included male patients with lower urinary tract symptoms. We categorized the patients into the nonnocturnal polyuria (non‐NP) group (≤0.33) and the NP group (>0.33) based on the nocturnal polyuria index from the frequency volume chart. We measured the 24‐h diurnal blood pressure and compared the two groups. Results: Among 90 patients, 46 in the non‐NP group and 44 in the NP group were included. There was no significant difference in the systolic and diastolic blood pressure during waking time between the two groups; however, the degree of systolic blood pressure reduction during sleep time in the NP group was significantly less than that in the non‐NP group (p = 0.039). In the multivariate analysis, systolic BP during sleep was significantly associated with NP (OR 0.970, p = 0.028). Conclusion: NP is associated with inadequate nocturnal blood pressure reduction in males, suggesting that reduction in nocturnal blood pressure may lead to improvement in nocturia. [ABSTRACT FROM AUTHOR]

Bladder cancer is a common urological cancer with a high recurrence rate that requires long‐term follow‐up, and early detection positively affects prognosis. To date, the initial diagnosis and follow‐up for bladder cancer rely on cystoscopy, which is an invasive and expensive procedure. Therefore, urinary markers for the detection of bladder cancer have attracted research attention for decades to reduce unnecessary cystoscopies. Urine, which is in continuous contact with bladder cancer, is considered a suitable fluid for providing tumor information. Urinary cytology is the only widely used urinary marker in clinical practice; however, it has poor sensitivity for low‐grade tumors; indicating the need for novel urinary markers. Considerable research has been conducted on this topic over the years, resulting in a complex landscape with a wide range of urinary markers, including protein‐, exfoliated cell‐, RNA‐, DNA‐, and extracellular vesicle‐based markers. Although some of these markers have been approved by the U.S. Food and Drug Administration and are commercially available, their use in clinical practice is limited. To facilitate clinical application, potential urinary markers must withstand prospective clinical trials and be easy for patients and clinicians to understand and utilize in a clinical context. This review provides a comprehensive overview of currently available and recently reported promising urinary markers for bladder cancer. Additionally, the challenges and the prospects of these urinary markers for clinical implementation in bladder cancer treatment were discussed. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including urinary biomarkers of prostate cancer, kidney cancers in end-stage renal disease and the correlation between urinary stones and pelvic organ prolapse in women.

An editorial is presented in which the author discusses various aspects of the journal "International Journal of Urology" including decline in impact factor, manuscript submission, and improves the quality of reports.

The author discusses the outcomes of everolimus treatment for renal angiomyolipoma (AML) related to tuberous sclerosis complex (TSC). Topics discussed by the author discusses mild adverse events cause by everolimus which include irregular menstruation, interstitial pneumonia, and stomatitis. The author also mentions the objectives of everolimus administration such as prognosis mprovement and quality of life of TSC patients with AML.

The author reflects on the efforts of the editorial staff of the "International Journal of Urology (IJU)" in improving the quality of the journal and mentions topics including the process of reviewing manuscripts submitted to "IJU," committee meetings and discussions and the impact factor of IJU.

With the widespread use of immune checkpoint inhibitors (ICIs), identifying predictive biomarkers is critical. Recently, serum fucosylated haptoglobin (Fuc-Hp) was thought to play an important role in tumour immunity in several types of cancer. Therefore, evaluating serum Fuc-Hp in the peripheral blood can potentially identify non-invasive predictive biomarkers for the clinical efficacy of ICIs. In this study, 31 patients with advanced renal cell carcinoma (RCC) treated with nivolumab were enrolled and defined as responders or non-responders according to RECIST criteria. Serum samples were collected before and 1 month after treatment initiation, and an ELISA assay was performed using Aleuria Aurantia Lectin (AAL) and 10-7G monoclonal antibodies that recognise Fuc-mature Hp (Fuc-mHp) and Fuc-pro Hp (Fuc-pHp), respectively. We first measured AAL-haptoglobin (Fuc-mHp) and total haptoglobin levels before nivolumab and found that neither value could predict the clinical response. Notably, serum 10-7G levels were significantly lower in the responder group (p = 0.035). We also confirmed the use of serum 10-7G levels for predicting progressive disease after nivolumab (area under the curve, 0.816). Accordingly, low 10-7G levels were significantly correlated with better progression-free survival (p = 0.041). In conclusion, serum Fuc-pHp analysis may identify patients with advanced RCC who benefit from ICIs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate sexual function after treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐Testicular Cancer 26 (EORTC QLQ‐TC26) questionnaire in Japanese testicular cancer (TC) survivors in a multi‐institutional, cross‐sectional study. Methods: This study enrolled TC survivors who visited any of eight high‐volume institutions in Japan from 2018 to 2019. After obtaining informed consent, participants completed the EORTC QLQ‐TC26 questionnaires. We evaluated sexual function after treatment for TC using the EORTC QLQ‐TC26 and analyzed the impact of treatment on sexual function in TC survivors. Results: A total of 567 TC survivors responded to the EORTC QLQ‐TC26. Median age at the time of response was 43 years (interquartile range [IQR] 35–51 years), and median follow‐up period after treatment was 5.2 years (IQR 2.2–10.0 years). Sexual function, particularly ejaculatory function, was significantly lower after post‐chemotherapy retroperitoneal lymph node dissection (PC‐RPLND) than after Surveillance or Chemotherapy groups (p < 0.05). In the PC‐RPLND group, nerve‐sparing procedure preserved postoperative ejaculatory function after RPLND compared with the non‐nerve‐sparing and offered improved ejaculatory function with time. On multivariate analysis, RPLND was a significant predictor of post‐treatment ejaculatory dysfunction, particularly without nerve‐sparing (odds ratio 3.0, 95% CI 1.2–7.7, p < 0.05). In addition, TC survivors with nerve‐sparing RPLND had higher sexual activity than those without. Conclusion: This survey of the EORTC QLQ‐TC26 showed that sexual function and activity in TC survivors after RPLND was reduced in the absence of nerve‐sparing techniques. [ABSTRACT FROM AUTHOR]

New clinical issues have been raised through an interval of 7 years from the previous version (2016). In this study, we update the "Clinical Practice Guidelines for tuberous sclerosis complex‐associated renal angiomyolipoma" as a 2023 version under guidance by the Japanese Urological Association. The present guidelines were cooperatively prepared by the Japanese Urological Association and Japanese Society of Tuberous Sclerosis Complex; committee members belonging to one of the two societies or specializing in the treatment of this disease were selected to prepare the guidelines in accordance with the "Guidance for preparing treatment guidelines" published by Minds (2020 version). The "Introduction" consisted of four sections, "Background Questions (BQ)" consisted of four sections, "Clinical Questions (CQ)" consisted of three sections, and "Future Questions (FQ)" consisted of three sections (total: 14 sections). Concerning CQ, an agreement was confirmed through voting by the committee members based on the direction and strength of recommendation, accuracy of evidence, and recommendation comments. The present guidelines were updated based on the current evidence. We hope that the guidelines will provide guiding principles for the treatment of tuberous sclerosis complex‐associated renal angiomyolipoma to many urologists, becoming a foundation for subsequent updating. [ABSTRACT FROM AUTHOR]