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We evaluated the clinical course of patients with localized prostate cancer in whom long-term successful androgen deprivation therapy (ADT) was ceased. Study subjects were 24 patients with stage B prostate cancer who were initially treated with ADT for a median duration of 93 months. The median age at the cessation of ADT was 84 years. The median nadir serum prostate specific antigen (PSA) level was 0.022 ng/ml. The median duration of follow-up from the cessation of ADT was 31 months. During follow-up, five patients showed PSA elevation of ≥2 ng/ml from the nadir. Serum testosterone level was tested in 20 patients, and five showed testosterone recovery ≥0.5 ng/ml. Seven patients died from diseases other than prostate cancer, but there were no deaths caused by prostate cancer. This study demonstrated that long-term successful ADT for localized prostate cancer could be ceased with adequate follow-up evaluation.

A 72-year-old man underwent a bilateral nerve-sparing radical retropubic prostatectomy (RRP) with pelvic lymph node dissection 11 years earlier. His prostate specific antigen (PSA) value at diagnosis was 61.024 ng/ml. Bone scans and computed tomographic (CT) scans showed no metastasis. Pathological findings and stage were adenocarcinoma, Gleason score 4+3, positive surgical margin, pT3b, and no lymph node metastasis. The postoperative PSA nadir was 0.218 ng/ml, and salvage radiotherapy (SRT, total 66 Gy) was performed six months after RRP. However, the PSA value continued to rise after SRT. Therefore, androgen deprivation therapy (ADT) was started 11 months after SRT. Nine years postoperatively, the PSA value showed a continuous rise despite ADT, and prostate cancer was considered to be castration-resistant. Although he was taking enzalutamide, his PSA value rose to 18. 271 ng/ml. Repeated bone scans and CT scans were negative. Eleven years after RRP, the fluoro-2-deoxy-D-glucosepositronemissiontomography (FDG-PET) revealed a nodule lesiondorsal to the left pubic bone. The patient underwent a resection of the lesion. Three months after the resection, his PSA level declined to 0.038 ng/ml, thus ADT was discontinued. Thirteen months after the resection, PSA re-elevation was absent, and follow-up without ADT is ongoing.

A 49-year-old male with untreated diabetes mellitus type 2 experienced eyesight deterioration and general malaise, and was treated for uveitis and orbital cellulitis. Later, he was taken to a local hospital via ambulance for a consciousness disorder and was diagnosed with bilateral infectious endophthalmitis, a right ureteral stone, and emphysematous pyelonephritis. He was then referred to our hospital for further examination and treatment. We immediately initiated intravenous antibiotic therapy with meropenem and glycemic control with continuous subcutaneous insulin infusion, and placed a ureteral and percutaneous drain tube into the right ureter and the emphysema, respectively. We performed a diagnostic and therapeutic vitrectomy on the patient's left eye. Urinary, blood, and vitreous cultures were positive for Klebsiella aerogenes. Abdominal contrast-enhanced computed tomography showed bilaterally comparable renal contrast enhancement. On the 60th hospital day, we performed endoscopic combined intrarenal surgery (ECIRS) and completely removed the urinary stone. Although he lost light sensitivity in his right eye, his left eyesight improved, and his blood glucose level was adequately managed by oral medication. Three months after the surgery, he was discharged from our hospital and he showed no sign of recurrence of the infection at ten months after surgery.

A 66-year-old man had undergone multiple treatments for metastatic renal cell carcinoma, including 11 cycles of nivolumab, which was discontinued because of disease progression. About three weeks after discontinuing nivolumab, he reported suffering from worsening of dyspnea. Pulse oximetry showed no desaturation. His cardiovascular and pulmonary functions were normal. His dyspnea slowly worsened with no underlying diagnosis. Two months after symptoms developed, he was diagnosed with isolated adrenocorticotropic hormone deficiency. His dyspnea disappeared soon after receiving hydrocortisone. Nivolumab-induced isolated adrenocorticotropic hormone deficiency may not present with typical symptoms, and can occur even after discontinuing nivolumab. Cortisol levels should be routinely monitored in patients who receive nivolumab.

Neurovascular bundle (NVB) preservation is a mandatory procedure to maintain erectile function of localized prostate cancer patients after radical prostatectomy (RP). However, in terms of cancer control, indications to select appropriate patients for nerve-sparing RP are still controversial. In this study, we examined the pathological findings of RP specimens to develop a preoperative criterion for NVB preservation during RP. The study included 76 patients who underwent RP at our institution from 2006 to 2008, and we retrospectively analyzed RP specimens pathologically. The distance between NVB and foci of prostate cancer was measured in 135 prostate sides, and preoperative factors which predict the distance of ≤2 mm was evaluated. Univariate analysis showed that side-specific positive biopsy core rate ≥33.3%, sidespecific maximum tumor length in biopsy core ≥5 mm and side-specific tumor involvement rate in biopsy core ≥50% was associated with the risk of the distance of ≤2 mm. Multivariate analysis revealed that sidespecific positive biopsy core rate ≥33.3% was the only significant predictor of the ipsilateral NVB-tumor distance ≤2 mm (p＝0.0055, odds ratio 3.49). Based on this study, a nerve-sparing criterion of ＜33.3% side-specific percent positive biopsy core was developed at our institution. Prospective data on patients who were applied this criterion are needed to evaluate its clinical safety and feasibility.

This study aimed to investigate factors taken into account when considering the indication of partial nephrectomy (PN). In October 2011, a questionnaire prepared with reference to the American Urological Association small renal mass survey and RENAL nephrometry score, and focusing on the factors taken into account when considering the use of PN, such as differences among candidates for open PN or laparoscopic PN was sent to 40 institutions. We received replies from 32 of the 40 institutions (average 611 beds) to which the questionnaire was sent. The total number of surgeries performed for renal tumors at the 32 institutions was 844 in 2009 and 889 in 2010. The number of PNs performed was 174 in 2009 (open : 61, laparoscopic : 113), and 241 in 2010 (open : 103, laparoscopic : 138), which represents a 38.3% increase. All respondents reported that renal function prior to PN was considered to be important, followed by tumor size, tumor number, and hereditariness. There were significantly more indications for open PN than for laparoscopic PN, and they were based on tumor size, degree of protrusion, and distance from the renal sinus. In addition, a clear tendency toward avoiding laparoscopic PN for cystic renal cancer was found. In addition, the institutions with a larger number of PNs tended to indicate more complicated cases including larger tumor size or entirely endophytic cases. This study has a limitation in that it was intended for a relatively large hospital, but these results can be useful information for institutions that are considering the introduction of open or laparoscopic PN.

A cohort of patients with castration-resistant prostate cancer (CRPC) that were treated with docetaxel (DOC) were retrospectively analyzed in order to examine the factors for continuing DOC therapy. In total, 26 patients treated with DOC at our hospital from August 2007 to August 2011 were recruited into the study. The participants were divided into two groups ; the first comprising 13 patients who received short-term DOC therapy (less than 5 cycles) and the second comprising 13 who received long-term DOC therapy (5 or more cycles). There was no significant difference in the indicators including age, prostate specific antigen level (at initial diagnosis), clinical stage and Gleason score between the groups. Patients with pain or poor performance status were more likely to be found in the short-term DOC group. The Hemoglobin-level was significantly higher in the long-term DOC group. In contrast, alkaline phosphatase, lactate dehydrogenase and C-reactive protein levels were significantly higher in the short-term DOC group. The period from the start of primary endocrine therapy to CRPC diagnosis was significantly longer in the long-term DOC group (p=0.0008). This latter finding suggests that DOC therapy can be continued for a longer time, in CRPC cases which have a long-term response to endocrine therapy, and may be associated with a more favorable survival outcome. However, to validate this suggestion, further investigation with a larger cohort of cases is necessary.

A 78-year-old woman was referred to our hospital with chief complaint of colicky right flank pain. Computed tomography (CT) demonstrated right hydronephrosis and a wall thickening in the right ureteropelvic junction. Right nephroureterectomy was performed under a clinical diagnosis of invasive ureteral cancer. Histological examination revealed immunoglobulin light chain (AL) amyloidosis of the ureter. Although amyloid deposition seemed to be localized to the ureter alone, bone marrow biopsy revealed primary macroglobulinemia. After 23 months, no signs or symptoms suggesting the progression of amyloidosis or macroglobulinemia have been pointed out. AL amyloidosis arising secondarily to plasma cell disorder is called immunocytic amyloidosis. In general, immunocytic amyloidosis accompanies deposition of the amyloid protein to various organs of the whole body, and causes multiple clinical symptoms related to amyloid deposition. Even though the clinical manifestation indicates the localized disease like the presented case, close examination of immunocytic amyloidosis is important.