Search

Total retropubic prostatectomy was performed on 31 patients with prostatic cancer (median age; 70 years). The accuracy of staging was 55% (17 patients). In 11 patients (35%) the staging had been underestimated, and in 3 patients (10%) overestimated. The pathological stage and grade were stage B in 14 patients, stage C in 4 patients, stage D1 in 13 patients (pN1; 8 patients, pN2; 5 patients), well differentiated adenocarcinoma (WDA) in 8 patients moderately differentiated adenocarcinoma (MDA) in 7 patients, and poorly differentiated adenocarcinoma (PDA) in 16 patients. The WDA were all stage B, and 85% of the PDA were stage D1. The positive surgical margin rate was 21% in stage B, 50% in stage C, 85% in stage D1, 13% in WDA, 43% in MDA, and 75% in PDA. Five of the patients died, and the causes of death were prostatic cancer in 2 patients (pN2/PDA), and others in 3 patients (1 patient; stage B/PDA, 2 patients; pN2/PDA). The 5-year survival rate (Kaplan-Meier) was 84% on the whole, 83% for stage B, 100% for stage C, 83% for stage D1, 100% for WDA, 100% for MDA, 71% for PDA, 86% for pN0, 100% for pN1, and 38% for pN2.

A 49-year-old male with left renal cell carcinoma and urothelial cancer (bladder and residual left ureter), which asynchronously occurred, was reported. He had received radical nephrectomy due to renal cell carcinoma 12 years earlier. He was followed up by his local physician for 7 years postoperatively, during which time no metastatic lesion was detected. However, he presented with macroscopic hematuria on January 7, 1992, and a diagnosis of urinary bladder cancer was made at our hospital. Computerized tomography demonstrated a non-papillary, broad-based tumor on the left wall of the urinary bladder, which histologically was transitional cell carcinoma (grade 3). Radical cystectomy, ureterectomy of the left residual ureter and ileal conduit were performed. Histological examinations showed that the urinary bladder tumor was transitional cell carcinoma, grade 3, pT-3b, and CIS (transitional cell carcinoma, grade 3) was found in the residual left ureter. Chemotherapy containing cis-platinum was performed as an adjuvant therapy, but multiple lung metastatic lesions appeared 2 months postoperatively, the histology of which was transitional cell carcinoma, suggesting metastasis from the urothelial cancer. Chemotherapy was ineffective, and he died of the disease 9 months after the operation. If this patient had been under long-term follow-up, the urothelial cancer may have been resected completely by transurethral resection. Our report indicated the importance of examination of the urinary tract in patients with such cancers, as well as the necessity of long-term follow-up.

Serum prostate specific antigen (PSA) values detected by DELFIA PSA were evaluated for usefulness in the diagnosis and follow-up of patients with prostate cancer. The system is time-resolved fluoroimmunoassay using europium as a tracer, which has a detectable range of 0.10-500 ng/ml with a small sample volume (25 microliters) and reliable quality control data. Furthermore, serum PSA values detected by the assay were equivocal to those detected by Tandem-R PSA. From the mean +3 S.D. of serum PSA values obtained on 227 normal males, 1.98 ng/ml was decided as an upper normal level. Serum PSA values in benign prostatic hyperplasia (BPH) (n = 69) and prostate cancer (n = 86) patients were statistically higher than those in normal males. However, when 1.98 ng/ml was used as a cut-off value, the false positive rate in BPH cases elevated up to 80%. Therefore, in the differential diagnosis of prostate cancer and BPH, we recommend 11.7 ng/ml (mean + S.D. in BPH cases) as a cut-off value, in which sensitivity is 72.1%, 88.4% are true negative in BPH, and efficacy is 79.4%. Serially determined serum PSA values in following up the patients with prostate cancer were confirmed to be highly effective for diagnosing recurrence and evaluating treatment responses. These findings suggest that DELFIA PSA is a useful tool for determination of serum PSA values.

Twenty-four patients with advanced genitourinary cancer were treated with cis-diamminedichloroplatinum (II ) (CDDP) alone or three combination regimens. Three regimens were used: CBV regimen; CDDP, bleomycin (BLM) and vincristine (VCR), ACE regimen; adriamycin(ADM), CDDP and cyclophosphamide (EDX), CMF regimen; CDDP, mytomycin C (MMC) and 5-Fu. In treatment with CDDP alone, one patient with testicular tumor achieved complete response, and in three no change including one rena! cell carcinoma and two prostatic carcinomas and in a patient with bladder tumor, progressive disease were noted. In the combination regimens with CDDP and other agents, four of seven patients with testicular tumor achieved complete response and three patients showed partial response. Among six patients with renal cell carcinoma except 1 no evaluable case, one patient achieved complete response, and three no change and one progressive disease were noted. In two of three showing no change was observed significant subjective improvement. Four of five patients with urothelioma obtained partial response and the other showed progressive disease. A case of prostatic carcinoma was no change and a case of penile cancer showed partial response. Gastrointestinal toxicity occurred in all patients. Leucopenia less than 2, 000/mm3 was seen in 4 patients (17%) and renal dysfunction in 4 (17%). These side effects were transient except 1 patient.

Combination intensive therapy of cis-diamminedichloroplatinum (CDDP), bleomycin (BLM) and vincristine (VCR) was administered to 5 patients with stage IV renal adenocarcinoma, all of whom had received nephrectomy. Following this 2-3-month intensive therapy, maintenance therapies consisting of CDDP.BLM.VCR and CDDP.VCR were given. Two patients achieved objective responses (I patient: complete remission), and 1 patient achieved a subjective response. One patient died of side effects. Renal dysfunction with elevation of serum creatinine was seen in 2 patients, a leucocyte count of less than 1000/mm3 in I patient, and pulmonary fibrosis in 2 patients.

A case of papillary cystoadenoma of the epididymis is reported. On August 14, 1981, a 34-year-old man presented with the chief complaint of the wish to father a baby. A thumb-sized tumor was palpable as a firm and non-tender mass at the left epididymis-head. Left orchiectomy was performed on September 10. Histopathologically, the diagnosis was papillary cystoadenoma of the epididymis. We discuss this case and review the cases reported in Japan.

Chemotherapy with anticancer agents was tried against total 5 cases of Stage D adenocarcinoma of the prostate, of which 4 were hormone resistant and I had no estrogen therapy due to side effects. The following results could be obtained. 1) General therapy was adopted for treating 4 patients with 700 mg to 1, 000 mg of endoxan (EDX) at an interval of 3-4 weeks on out-patient basis. More or less clinical effects were attained in all the patients comprising 1 with 1-B, 2 with 1-A, and 1 with 0-B according to Karnofsky's efficacy evaluation standards. 2) Combination chemotherapy of EDX, adriamycin (ADM) and FT-207 or cis-platinum, ADM and EDX was tried to 2 patients, but the therapy could not be continued to the end due to seriously suppressed bone marrow functions and gastrointestinal symptoms.

Cyclophosphamide (Endoxan) 700-1000mg was administered by drip infusion on an outpatient basis, at an interval of 3-4weeks to 13 patients confirmed to have clinical stage D prostatic cancer. All of the cancers were progressing and had failed to respond to endocrine therapy or were relapse cases. The following results were obtained. According to Karnofsky's efficacy evaluation standards, 1 case was 1-B, 4 cases were 1-A, 1 case was 0-B, 2 cases were 0-A, and 5 cases were 0-0. Five cases (38.5%) showed objective responses, and 3 cases showed subjective responses. According to NPCP efficacy evaluation standards, there was partial regression in 1 case and progression in 5 cases; and, 7 cases were stable. The effective rate was 61.5% (8 out of 13), when stable or better was judged as effective. As to the principal toxicity of Endoxan, reduction of WBC to 3000-4000/mm3 was noted in 5 cases, and gastrointestinal symptoms were seen in 11 cases. But these were mild; and, no treatment was considered necessary.

In order to examine effectiveness, safety and usefulness of, KW-l062, a new aminoglycoside antibiotic, it was compared with gentamicin (GM) for treatment of chronic complicated urinary tract infection in a double-blind trial. KW-I062 was administered to hospitalized adult patients at the dosage of 120 mg b.i.d. for five days. GM was administered to hospitalized adult patients at the dosage of 60 mg b.i.d. for five days. The number of evaluable cases was 105 for KW-1062 and 95 for GM, and the results obtained were as follows. 1) No significant difference was observed between the KW-1062 group and GM group in various background factors related to the characteristic of patients. 2) KW-l062 showed a significantly higher rate of efficacy on bacteriuria and overall clinical efficacy (p<0.05). 3) Side effects and abnormal laboratory findings occurred at a low frequency in both treatment groups, and there were no significant differences between both groups.

Serum prostatic acid phosphatase (PAP) was measured for 239 males and 10 females by RIA-Quant PAP Test kit (DRL-9I7). Significant correlation was seen between enzymatic assay and RIA (r=0.963, p<0.01) and RIA was more specific to prostatic cancer than enzymatic assay. The average PAP values were, 0.29±0.27 ng/ml in 48 normal males, 0.79±0.55 ng/ml in 34 BPH, 15.1±26.1 ng/ml in 20 untreated prostatic cancer (PC), 1.1±2.1 ng/m1 in 62 treated PC without metastases, and 22.5±36.3 ng/ml in 25 treated PC with metastases. Higher values, than 2.0 ng/ml of PAP were seen, in 95% of untreated PC, in 11.3% of treated PC without metastases in 56% of treated PC with metastases and in the other three patients having prostatitis, BPH or lung cancer. Higher values than 3.0 ng/ml of PAP were seen in 80% of untreated PC, in 65% of treated PC without metastases, in 52% of treated PC with metastases and in one lung cancer patient. This RIA was more diagnostic than enzymatic assay and a higher value than 2.0 or 3.0 ng/ml of PAP is strongly suggestive of prostatic cancer.

Clinical studies were made on 46 cases of renal adenocarcinoma seen over the past 10 years (1956 to 1975) in Urological Department of Kobe University l1edical School, and the following results were obtained. 1. The sixth and fifth decades accounted for 63% of all cases, and the sexual ratio was 1.7: 1 with male patients predominating over female patients. 2. Subjective symptoms included gross hematuria (63%), flank pain (39%), fever (9%), fatigue(7%), tumor mass, neurotic disturbance and bone pain (4%, each). 3. Objective findings included anemia (51 %), raised ESR (50%), hypertension (40%), fever (24%), raised alkaline phosphatase (23%), abnormal liver function (11%), and erythrocytosis (2%). 4. Metastasis was seen in 14 cases (30%), of which lung metastasis being the highest incidence accounting for 20% of all cases. 5. The stage of cancer, hemoglobin level on admission and tumor weight closely related to the prognosis, whereas ESR could not be factor proved to have any appreciable correlation with the prognosis.

Futraful was administered to 36 patients with tumor of the bladder. Four out of 10 patients who received Futraful before resection or were inoperable improved in subjective or objective symptoms. Out of 26 patients who were given Futraful in order to maintain remission, only one patient showed relapse. Side effects occurred in 33.3% of patients, and the therapy was ceased in 22.2%.

Dermal protective stomahesive was used as skin barrier to 20 patients suffering from urine leakage and skin irritation around abdominal stoma under ileal or ileocecal conduit. The following results were obtained from this study: 1. As to the II cases in terms of skin irritation around stoma, effective improvement was observed in all cases among them. 2. As to the 14 cases in terms of urine leakage, effective improvement; more than 5 days duration, was observed in 13 cases among them. 3. As to the comparison of pre-using versus post-using period under enterostomal therapy, remarkable improvement was observed such as the duration extended from 1-2 days to 5 days. As an average duration: from 3.2 days to 5.8 days. 4. No side effects necessitating stop of the use was observed. 5. 85% of all patients estimated to continue using. Accordingly it is expected that stomahesive may exert a potent skin barrier around stoma.

Statistical observations on outpatients, inpatients and operations during the past 10 years in our department revealed the following results: 1) Total number of outpatients through these 10 years was 23, 521 and there was tendency of gradual increase. In various diseases, non-specific inflammation was 25%, and sexual diseases was 16%, urolithiasis and urological tumor was 11 % respectively. Year by year, sexual diseases tended to increase and urogenital tuberculosis tended to decrease, 2) Total number of inpatients was 3, 037 and urogenital tumor was 42% and followed by urolithiasis 21 %. Number of each year did not change so particulaly. 3) In the statistics of operations, prostatectomy occupied the highest percentage and was followed by nephrectomy and ureterolithotomy. Year by year partial cystectomy tended to decrease, and total cystectomy tended to increase.

Varicare(R) System 2 Urostomy is consisted of the dermal protective stomahesive flange, urostomy bag and a belt. This System 2 urostomy was used as skin barrier to 20 ostomists suffering from urine leakage and/or skin irritation around abdominal stoma under ileal or ileocecal conduit. The following results were obtained from this study: 1. Stomahesive (Varicare(R)) has proved effective in the prevention of skin excoriations around an abdominal stoma. 2. The wearing time of this System 2 varied between 4 and 11 days with a mean value of 6.1 days from all patients. 3. 95% of all patients estimated to continue using this System 2. 4. No side effects necessitating stop of the use was observed. Accordingly, it is expected that Varicare(R) System 2 Urostomy may be useful in managing the abdominal stoma as the potent skin barrier.

Serum AFP is one of the useful markers for testicular tumor. Biological decline of serum AFP by metabolism and actual change of serum AFP of testicular tumor patients are compared. Biological metabolic half life of AFP in human serum is 5 days. If testicular tumor is resected completely, serum AFP level of the patient is calculated by following equation. 10gXt = 10gXo - 0.139t X log e ............... (1) (X0 : initial marker concentration, X t : the concentration at time t in days) Four testicular tumor patients with predetermined histology and stage are investigated. Xo in equation (I) is the serum AFP immediately before orchiectomy or retroperitoneal Iymphnode dissection. The straight line drawn by equation (I) on a hemilogarithm:ic section paper is called theoretical decay curve (TDC) and the line drawn by actual AFP data points is named actual decay curve (ADC). In stage I testicular tumor, ADC slope approximately agrees with TDC in early post orchiectomy period. While, the slope of ADC is milder than that of TDC in stage II after orchiectomy, and in stage III ADC shows also milder slope than TDC after retroperitoneal Iymphnode dissection. Consequently, the results and the theory go well hand in hand, so mild slope of ADC (in comparison with that of TDC) after operation means the existence of the residual tumor tissue. In other words, this method is thought to be useful for the staging and prognostic evaluation of testicular tumors. It is also suggested to be useful for judgement of the effect of therapies that ADC is drawn by data before, during and after chemotherapy and/or radiation therapy and compared with TDC. It is considered to be necessary to draw ADC and TDC also for hCG, another marker of the testicular tumor, but as hCG's half life is very short, more frequent measurements of the marker (hCG) are essential.

A case of bilateral interstitial cell tumor of the testis was reported. The patient was 23 years old who complained bilateral swelling of scrotal contents. On laboratory examination after admission, urinary 17-KS was 63.1mg/day, and the tumors were supposed of having high endocrine activity. On physical examination, the patient was hursuite, but with no sexual abnormality and gynecomastia. Bilateral orchiectomy was performed, and the histological diagnosis was interstitial cell tumor on both sides with the tubular destruction of the seminiferous tubuli due to massive increase of tumor cells. After orchiectomy, urinary 17-KS was still in high level, and the enlarged para-aortic lymphnodes were found on lymphangiogram. Because metastasis was strongly suspected the transperitoneal retroperitoneal lymphadenectomy was done. But the resected lymphnodes revealed no metastasis. The retroperitoneal pneumography and adrenal scintigram carried out postoperatively suggested bilateral adrenal hypertrophy, but after then the urinary 17-KS gradually reduced. Postoperatively sustained level of the urinary 17-KS was thought to be caused by the transient reaction of the adrenals. Interstitial cell tumor were reported over 100 cases in foreign literature• and eleven cases in Japan up to date. We discussed about its malignancy, endocrine activity and treatment of this disease.

Eight patients with metastatic transitional cell carcinoma of the urinary tract were treated with the MVP-CAB regimen. All of them had bidimensionally measurable lesions. The MVP-CAB regimen consisted of cyclophosphamide 500 mg/m2, methotrexate 20 mg/m2, adriamycin 20 mg/m2, bleomycin 30 mg/body, and vincristine 1 mg/body on day 1, cis-platinum 50 mg/m2 on day 2, and prednisolone 20 mg/body on days 1-3, given every 3-4 weeks. A partial response was seen in five patients, minor response in one patient and no change in two patients. The response rate was 63% (5/8). The main toxic effect of the MVP-CAB regimen was leucopenia. In 75% of the patients there was a decrease in white blood cell count by not more than 2, 000/mm3, but no severe complication was noted. In addition, mild nausea, vomiting, mild anorexia, alopecia and fever were found. However, these symptoms were transient. One patient died of pulmonary fibrosis induced by bleomycin after 3 cycles.

Eleven patients with newly diagnosed stage D prostate cancer between June, 1984 and June, 1985, were administered 300 mg/day of Honvan in 3 divided portions, 4 capsules/day of Estracyt in 2 divided portions, or 100 mg/day of Prostal in 2 divided portions was administered orally, concomitantly with large-dose intermittent treatment of 1 g/m2/3 weeks of cyclophosphamide. According to the NPCP criteria, of the 5 cases given Honvan 1 case was PR and 4 cases were stable: all 3 cases given Estracyt were stable: and in 3 cases given Prostal, 1 case was stable, 1 case had progression and 1 case dropped out. The response duration of this combination therapy was 3 to 16 months (average: 9.9 months), and obvious improvements in the subjective symptoms and performance status were noted in the cases that responded to the treatment. As for side effects, gastrointestinal symptoms were observed in 9 cases, leucopenia in 3 cases, and thrombocytopenia in 1 case. All these cases, however, were slight and transient. In 1 case, jaundice and an elevation in GOT and GPT were detected, but these changes were also temporary.

Statistical observations on operations performed in our department from 1976 to 1980 were reviewed, especially in comparison with the statistics for the preceding 10 years. Operations on the kidney were the most frequent, as they were in the preceding 10 years, but operations on the bladder have increased remarkably, in 1980 accounting for more than those on the kidney. During this period, operations for benign diseases such as lithotomy of the upper urinary tract and prostatectomy tended to decrease. On the other hand, operations for malignant diseases of kidney, bladder and scrotal contents steadily increased. Transurethral operations are still increasing, especially for bladder tumors. It has been established that bladder tumors should be treated by either TUR-BT or total cystectomy and not by partial cystectomy. As to urinary diversion, ileal conduit was the main procedure used during this 5-year period instead of cutaneous ureterostomy.

Recurrence rate and symptoms after chemotherapy against acute uncomplicated cystitis (AUC) were studied. Upon completion of a 7-day treatment with two regimens, one of CEX alone (Group C) and the other of a combination of CEX with Lysozyme (Neuzym) (Group L), at a dose of 1 g CEX daily, efficacy of the drugs was assessed according to the criteria established by the UTI Study Group. The forty one cases in Group C and 38 cases in Group L showing an excellent response were evaluated for recurrence. The rates of recurrence were 12.2% in Group C and 21.1% in Group L during the first 7 days after treatment. In recurrent cases, bacteriuria was seen in 84.6% (11/13), pyuria in 53.8% (7/13) and miction pain in 30.8% (4/13). Thus, bacteriuria and pyuria should be the items of the criteria for AUC recurrence.

The efficacy and safety of Norfloxacin were studied in the treatment of 20 patients with acute epididymitis. Norfloxacin was orally administered at a dose of 200 mg 3 times a day for 14 days. Clinical efficacy rate on the 7th day was 95% (19/20), excellent in 9 cases, moderate in 10 cases and poor in 1 case, and on the 14th day was 95% (18/19), excellent in 12 cases, moderate in 9 cases and poor in 1 case. On the 14th day, fever, pain and swelling had disappeared in 8 cases (in 2 cases on the 7th day). The efficacy on the 14th day was further investigated compared to that on the 7th day. Before treatment with Norfloxacin, in 13 of the 20 patients, pyuria was observed. Cultivating the bacteria was isolated in 4 of the 13 patients. Norfloxacin remarkably affected the treatment of these patients with pyuria and bacteriuria. In the treatment with Norfloxacin, the count of leukocytes, erythrocyte sedimentation rate and CRP were obviously improved. Side effects and abnormal clinical laboratory findings were not observed. From these results, Norfloxacin 600 mg/day, t.i.d was considered useful and safe in the treatment of acute epididymitis.