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A slow-release formulation of the luteinizing hormone releasing hormone (LH-RH)analog(TAP-144-SR) was administered in 6 cases of prostatic cancer. Five were untreated cases, 3 of moderately-differentiated and 2 of poorly-differentiated cancers (four D2 and one C, NX), the other (D2) was under control by another LH-RH analog. The plasma level of luteinizing hormone and follicle stimulating hormone fell below normal, and the plasma testosterone was less than 1 ng/ml by four weeks after start of treatment. According to the National Prostatic Cancer Project Criteria, 2 of the untreated cases showed a partial response and 3 of the untreated ones showed a stable response, one of which underwent transurethral resection later. The pretreated case still continued controlled more than 4 months. No side effect was noticed.

Rat prostatic tumor (Dunning R 3327 tumor) is a well-differentiated adenocarcinoma of Copenhagen strain rat; its growth is extremely slow and androgen-dependent. Two new sublines (Chiba University A and B; CUA, CUB) were obtained during passages; CUA, squamous cell carcinoma, grew at moderate speed, and CUB grew rapidly, being composed of spindle-shaped cells and large bizarre polygonal cells. Growth of CUA was slightly androgen-dependent, while that of CUB was independent of sex hormones. Activities of acid phosphatase were increased in both CUA and CUB as compared with the original R 3327, so the less differentiated sublines of CUA and CUB showed unusual progression. In contrast, activities of alkaline phosphatase in CUA and CUB were diminished as compared with that of the original tumor. Both androgen and estrogen receptors were detected in the cytosol from R 3327, but there was no detectable amount of androgen and estrogen receptors in CUA. CUB did not show any androgen binding but estrogen binding was observed in the cytosol, though estrogen did not have any detectable effect on the growth of this tumor.

A case of traumatic renal artery thrombosis is reported. The patient is a 14-year-old girl with the chief complaint of hypertension. She was admitted to our hospital about a month after a traffic accident. An IVP demonstrated nonvisualization of the right kidney and complete occlusion of the right renal artery was revealed by aortography. Right nephrectomy was performed, because atrophy of the right kidney was marked. A week after the operation, her blood pressure became normal. We present our case and review the literature.

Prostatic specific antigen (PA) level was determined with a Wako test kit (Japan) for prostatic cancer and others. The incidence of abnormal values of PA in untreated prostatic cancer, was 50, 50, 80, and 100% for stage A1, C (pN0, NX), D1 and D2 cancers, respectively. Grade was not related to the level of PA. Prostatic hypertrophy, prostatitis and urinary stone showed a false positive rate of 52, 18 and 0%, respectively. The level of PA was not correlated to those of prostatic acid phosphatase (RIA). In 31% of the cases, the elevated PA decreased 4 weeks after start of endocrine treatment. Elevated PA in low grade cancer was not normalized as much as that in high and moderate grade cancers. The positive rate of PA in the serum of reactivated patients was significantly higher than that of the patients with cancer under good control by endocrine treatment.

Staging pelvic lymphadenectomy was performed on 21 patients with the prostatic cancer of stage A, B and C from January in 1981 to April in 1985. Twelve cases (57%) showed lymph node metastasis. Gleason's scores of the cases with lymph node metastasis proved lower than those of the cases without lymph node metastasis (p less than 0.05). There were no differences in grade between primary tumors and lymph node metastases. The percentage of metastasis to the external iliac, internal iliac and obturator lymph nodes was 55%, 83% and 82%, respectively. Two patients suffered from the delayed healing of the wound and the edema of the lower extremities, respectively, but the other patients had no complication.

A case of spontaneous rupture of the ureter with Cushing's syndrome is presented. The fragility of the tissue in Cushing's syndrome is thought to render the ureter more susceptible to rupture.

Testicular development was studied in prepubertal boys with retractile testes. Testicular volume, the diameter of the seminiferous tubules and the number of spermatogonia in the tubules were decreased in cases of unilateral retractile testis, when compared with values for the contralateral normally descended testis. On the other hand, in patients with a unilateral retractile testis and contralateral inguinal testis, there was no difference in the developmental parameters between the two testes. These results suggest that the retractile testis has developmental failures characteristic of a cryptorchid testis and therefore requires orchiopexy.

A case of primary amyloidosis of the bladder, which developed 4 years after primary treatment, is described. The patient is a 55-year-old male, who consulted our clinic with a complaint of asymptomatic gross hematuria on October 1, 1983. Cystoscopic examination showed a tumorous lesion involving right lateral wall of the bladder, which was resected transurethrally. No malignancy was found by histopathological examination. About 4 years later, he consulted our clinic again with a complaint of asymptomatic gross hematuria. There was a tumorous lesion involving left lateral wall of the bladder on cystoscopy. Transurethral resection of bladder tumor was performed under a diagnosis of bladder tumor. Histological examination revealed amyloidosis of the bladder, AL-type amyloid. Re-examination of the specimens resected 4 years ago showed the same findings. Biopsies from the tongue, skin and rectum disclosed no amyloid deposition. During these 19 months, he had no recurrence. This case was thought to be the first one of primary amyloidosis of the bladder showing new recurrence reported in Japanese literature.

A clinical observation was made on 25 cases of urogenital tuberculosis experienced at the urological department of Chiba Prefectural Sawara Hospital between January 1973 and December 1982. They accounted for 0.28% of the 8,945 outpatients. There were 17 cases of urinary tuberculosis and 13 cases of genital tuberculosis. In urinary tuberculosis, the age distribution showed a peak in the fifties. There was a predominance in males. The patients in their twenties and fifties comprised 60% of the cases of genital tuberculosis. The kidney affected was predominantly the left kidney. Bladder tuberculosis was found in 7 cases. The majority of the epididymal tuberculosis were found in the right side. Bladder and renal symptoms were the chief complaints for 41.2% and 17.6%, of the cases, respectively. Thirty two percent of the patients had a history of tuberculosis. In cystoscopy, typical findings of tuberculosis were found in only 25% of the cases. Mycobacterium in urine could be detected in 33.3%. Accelerated blood sedimentation rate was detected in 65% of the cases. Pyelography revealed ureteral abnormality in the majority of the cases. Three of the 16 patients with renal tuberculosis underwent nephrectomy, and orchiectomy was performed on 6 of the 13 patients with epididymal tuberculosis.

A 40-year-old male was referred to the Chiba University Hospital for hypogonadism. He showed many of the phenotypic features of Klinefelter's syndrome. Cytogenetic studies revealed a 48,XXYY karyotype. The significance of the association of this karyotype with incurable skin ulcer is discussed.

Blood was collected from 20 patients with varicocele (15 in the infertile group and 5 in the incidental varicocele group) at the time of high ligation by insertion of a catheter into the internal spermatic vein toward the renal side. Simultaneously, blood was obtained from the antecubital vein. The levels of cortisol, prostaglandin (PG)(A + B), PGE, and PGF in these blood samples were measured. Although no differences in cortisol and PG(A + B) levels were observed between internal spermatic and peripheral vein bloods in varicocele patients examined, PGE and PGF levels were higher in internal spermatic venous bloods than in peripheral venous bloods. Differences in PGF levels between the samples of blood from the internal spermatic vein and from the peripheral vein in cases of the infertile group were larger than those of the incidental varicocele group. PGE and PGF in internal spermatic vein blood samples were correlated. The possibility that PGE and PGF, refluxed from the renal vein to the testes via the internal spermatic vein in varicocele patients, disturbs spermatogenesis is discussed.

Between 1976 and 1987, sixty eight patients suffering from prostate cancer were treated with fast neutron radiotherapy at the NIRS hospital in Chiba, Japan. Tumor doses of TDF 100 were administered to the prostate gland, the regional lymphnodes, and the true pelvis, using the two opposing fields by fast neutron alone or with a boost. The overall local or regional tumor recurrence rate was found to be 10% and local control seemed to correlate with the histological differentiation of the cancer tissue, though there was no definite correlation with hormone treatment. A relatively high incidence of grade 3 and 4 radiation complications were observed, 21% for grade 3 and 7% for grade 4, due to subcutaneous fat necrosis caused by an inferior dose distribution of the fast neutron machine. The 5-year survival rate was seen to be 52% in total and 70% for patients in stage C. The modality of radiotherapy for prostate cancer is discussed.

Response rate of prostatic cancer to endocrine therapy is approximately 80%, but more than half of responders show relapse by five years. Factors influencing prognosis are histological grade, stage, effect of elevated acid phosphatase, and androphilic protein observed histochemically. Relapse may be attributable to progression and clonal selection.

The serum prostate specific antigen (PA) was determined with the Diagnostic Products Cooperation (DPC) PSA double antibody radioimmunoassay kit. The upper limit of the normal range was set at 4 ng/ml which was the mean + 3S.D. for males over 50 years old in a mass examination. For comparison, prostatic acid phosphatase (PAP), and gamma-seminoprotein (gamma-Sm) were determined using an Eiken kit and Chugai kit, and PA was also assayed using another kit (Eiken, Travenol). Positive rate of PA and PAP in the untreated prostatic cancer was 75 and 33% in Stage A, 100 and 0% in Stage B, 100 and 100% in Stage C, 100 and 67% in Stage D1, 100 and 80% in Stage D2 and 73 and 33% in benign prostatic hypertrophy (BPH), respectively. The level of PA determined during the follow-up of prostatic cancer showed the usefulness of simultaneous PA and PAP assays for monitoring the clinical course. The PA level using a DPC kit was highly correlated to that of PA using other kit, but the correlation with gamma-Sm and PAP was low. These results show that the DPC kit is useful for determining PA, and determination of PA and PAP is of great value both in diagnosis and in the follow-up of prostatic cancer, but the high positive rate in BPH remains a problem.