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Objective: We retrospectively evaluated the efficacy of combining the SpaceOAR (SOAR) hydrogel with prostate brachytherapy, using colonoscopy findings to assess for radiation proctitis. Methods: Among 731 patients undergoing iodine‐125 low‐dose‐rate prostate brachytherapy (LDR‐BT), SOAR was utilized in 394 patients (53.9%). Colonoscopy was performed for 97 patients (13.3%) to assess the presence, location, condition, and treatment of radiation proctitis. We also investigated treatment factors associated with the occurrence of radiation proctitis. Results: Radiation proctitis was observed in 57 patients (7.8%) and 17 (2.3%) were treated with argon plasma coagulation (APC). The incidence of radiation proctitis was 12.2% in the non‐SOAR and 4.1% in the SOAR group (p < 0.001). In the non‐SOAR group, the incidence of radiation proctitis was 6.6% for LDR‐BT monotherapy and increased to 22.0% when combined with external beam radiation therapy (EBRT) (p = 0.001). However, in the SOAR group, these rates significantly decreased to 3.3% and 5.7% for monotherapy and combination therapy, respectively (p = 0.035, p < 0.001). With SOAR, inflammation was observed directly above the DL in most patients (87.5%), and only one patient (6.3%) required APC. The absence of SOAR (p < 0.001, HR = 0.29) and the concurrent use of EBRT (p = 0.018, HR = 2.87) were identified as significant risk factors for the occurrence of radiation proctitis. Conclusion: The use of SOAR significantly reduced the incidence of radiation proctitis in patients undergoing LDR‐BT monotherapy and combined EBRT. Inflammation primarily occurred directly above the DL; further examination is necessary to clarify its cause. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to report on our early experience with hydrogel spacer (SpaceOAR) placement in combination with iodine‐125 low‐dose‐rate brachytherapy for prostate cancer. Methods: From April 2018, SpaceOAR hydrogel spacer was placed in 100 consecutive patients undergoing iodine‐125 low‐dose‐rate brachytherapy. Complications and the status of the placement were evaluated. Deformation of the prostate by the spacer was examined measuring prostate diameters and evaluating the change from preoperative status. The position of the prostate was similarly examined by evaluating the change in distance between the pubic symphysis and the prostate. Post‐plan dosimetric data were compared with 200 patients treated without a spacer. Results: No complications were found during either the intraoperative or perioperative periods. The mean displacement distance of 11.64 mm was created, the mean value before spacer placement was 0.28 mm (P < 0.0001). The change of the prostate diameters showed a positive increase in all directions, with no significant negative change in any one direction. Regarding the change in distance between pubic symphysis and the prostate, no significant shortening trend was observed between the two groups (P = 0.14). Whereas the dosimetric parameters showed means of 0.001 and 0.026 cc for RV150 and RV100 in the spacer group, they were 0.025 and 0.318 cc, respectively, in the non‐spacer group, showing a significant decrease in both parameters (P < 0.001). Conclusions: Prostate deformation secondary to hydrogel placement might adversely affect dosimetric parameters in patients undergoing low‐dose‐rate brachytherapy. However, a significant reduction in the rectal dose can be adopted without adversely affecting the other parameters related to treatment outcome. [ABSTRACT FROM AUTHOR]

In spite of clinical practice guidelines such as the National Cancer Institute (NCI)-Physician Data Query (PDQ), in which primary androgen deprivation therapy (PADT) is not recommended at all as the primary treatment for localized prostate cancer, many such patients have actually been treated with PADT in Japan. The reasons are probably that medical treatment such as PADT is more acceptable than more invasive treatments such as surgery for many Japanese patients, and that urologists themselves have also conform to their patient's wishes for the treatment, because they know the effectiveness of PADT in their experiences. In this review, we note clinical trials in which the efficacy of PADT for localized or locally advanced prostate cancer is demonstrated. Then, we discuss which patients are candidates for PADT, and show that more than 30% of low- or intermediate-risk localized prostate cancer can be controlled long term with PADT. Although the duration of PADT is also discussed, short-term or intermittent PADT cannot be recommended, because cancer cells which can be controlled for a long-term period or cancer that may appear to be cured by appropriate PADT may progress to cancer cells with more malignant potential with incomplete androgen ablation. We propose algorithms for the treatment of localized prostate cancer not only in low- and intermediate-risk groups but also in the high-risk group. Although the side effects of PADT affecting the healthy status of prostate cancer patients may not be serious, as reported in several studies, adverse effects caused by ADT on physical and mental conditions, such as osteoporosis and anemia, should be overcome by adequate treatment. Ideally, new hormonal compounds targeted only for prostate cancer will be developed. [ABSTRACT FROM AUTHOR]

Objective: Although primary care practitioners (PCP) take an active role in diagnosis of prostate disorders in Western countries, how PCP take part in management of prostate disease still differs worldwide by country. We investigated practice and referral patterns concerning prostate disease among Japanese PCP and compared these with reported patterns in the West. Methods: A 26-question multiple-choice questionnaire was mailed to 935 PCP in Tokyo for anonymous completion. Most items involved prostate cancer screening or management of benign prostatic hyperplasia (BPH). Results: The survey was completed by 281 non-urological practitioners, among whom digital rectal examination was performed by 43%. Prostate-specific antigen (PSA) was determined in serum by 89%. For asymptomatic men older than 50, serum PSA was determined routinely each year by only 17%. When PSA was 4.1–10.0 ng/mL, 70% of respondents immediately referred patients to urologists, while 18% did not make a referral unless PSA exceeded 10.0 ng/mL. Seventy-four percent prescribed medication for benign prostate hypertrophy; among these respondents, 87% reported common use of α-blockers. Although 31% of respondents were aware of the International Prostate Symptom Score (IPSS), only 2% used it. Conclusions: Although Japanese PCP were involved increasingly in diagnosis and management of prostate disease, degree and proficiency of involvement were too limited and less than in Western countries. Continuing medical education appears desirable for PCP in Japan regarding prostate disease. [ABSTRACT FROM AUTHOR]

A giant cystic formation was found behind the prostate of a 69-year-old man who presented with urinary retention. Ultrasonography, computed tomography scans and magnetic resonance imaging revealed a large cystic intrapelvic mass and biopsy of the cyst wall diagnosed papillary cyst adenocarcinoma. Immunohistochemically, the tumor originated from the prostate. [ABSTRACT FROM AUTHOR]