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Objective: To achieve patient‐centricity in metastatic renal cell carcinoma (mRCC) treatment, it is essential to clarify the differences in perspectives between patients and physicians. This cross‐sectional analysis of a web survey aimed to clarify the differences in expectations and concerns between mRCC patients and physicians regarding systemic mRCC therapy in Japan. Methods: Surveys from 83 patients and 165 physicians were analyzed. Results: The top three most significant differences in expectations of systemic therapy between patients and physicians (patient‐based physician value) were "Chance of achieving treatment‐free status" (−30.1%, p < 0.001), "Longer survival" (+25.8%, p < 0.001), and "Chance of eliminating all evidence of disease" (−25.6%, p < 0.001). The top three most significant differences in concerns for systemic therapy between patients and physicians (patient‐based physician value) were "Lack of efficacy" (+36.1%, p < 0.001), "Lack of knowledge of treatment" (−28.2%, p < 0.001), and "Daily activities affected by side effects" (+22.3%, p < 0.001). Diarrhea, fatigue/malaise, and nausea/vomiting were patients' most distressing adverse events; 50.6% of patients had difficulty telling their physicians about adverse events such as fatigue, anxiety, and depression. Conclusions: This study demonstrated a gap between patients with mRCC and physicians in their expectations and concerns for systemic therapy. Japanese patients with mRCC suffer from a number of adverse events, some of which are not shared with physicians. This study highlights the importance of communicating well with patients in clinical practice to achieve patient‐centricity in systemic treatment for mRCC. [ABSTRACT FROM AUTHOR]

Simple Summary: We investigated financial toxicity in Japanese patients with metastatic renal cell carcinoma using the COST tool. Despite universal coverage, patients in Japan had similar levels of financial toxicity as in other countries. There was a positive correlation between the FACT-G total score and the COST score. Age < 65 years and not having private health insurance were associated with higher financial toxicity. Information on the financial toxicity experienced by Japanese patients with metastatic renal cell carcinoma (mRCC) is lacking, even though Japan has its own unique public health insurance system. Thus, a web-based survey was conducted to evaluate the financial toxicity experienced by Japanese mRCC patients using the COmprehensive Score for financial Toxicity (COST) tool. This study enrolled Japanese patients who underwent, or were undergoing, systemic therapy for mRCC. The outcomes evaluated were the distribution of COST scores, the correlation between COST and quality of life (QOL) assessed by the Functional Assessment of Cancer Therapy-General (FACT-G) scale, and demographic factors associated with financial toxicity. The median (range) COST score was 19.0 (3.0–36.0). The Pearson correlation coefficient for COST and FACT-G total scores was 0.40. Univariate analysis revealed that not having private health insurance and lower household income per year were significantly associated with lower COST scores. Multivariate analyses showed that age < 65 years and not having private health insurance were significantly associated with lower COST scores. This study revealed that Japanese mRCC patients experience adverse financial impacts even under the universal health insurance coverage system available in Japan, and financial toxicity negatively affects their QOL. [ABSTRACT FROM AUTHOR]

IO-TKI therapies share some characteristics, including a relatively high objective response rate and a low progressive disease rate, suggesting that IO-TKI combination may benefit a larger patient population than IO-IO, at least in the short term. 2021; 4: 755 - 65. 2 Harada K, Miyake H, Furukawa J, Fujimoto N, Fujisawa M. Comprehensive assessments of immuno-oncology drug-based combination therapies as first-line treatment for advanced renal cell carcinoma. The rise of immune checkpoint inhibitors has dramatically changed the treatment paradigm for metastatic renal cell carcinoma (mRCC). [Extracted from the article]

Abstract: An accurate prediction of progression is critically important in the management of non‐muscle‐invasive bladder cancer. At present, three risk models are widely known for prediction of the risk of tumor recurrence and progression of non‐muscle‐invasive bladder cancer: the European Organization for Research and Treatment of Cancer, Club Urológico Español de Tratamiento Oncológico, and new European Organization for Research and Treatment of Cancer models. Bladder neck involvement has been shown to be one of the significant predictors for progression in non‐muscle‐invasive bladder cancer, and a new scoring model (Tokyo Medical and Dental University model) consisting of bladder neck involvement, tumor grade, and stage has been developed and externally validated. However, the predictive abilities of these models are still unsatisfactory, and more precise models are necessary for accurate individual prediction of prognosis. Until now, time‐fixed analysis has been used for most studies predicting the prognosis and outcome of non‐muscle‐invasive bladder cancer patients. In order to predict progression more precisely, time‐dependent models should be developed using multiple‐event analytical techniques, as non‐muscle‐invasive bladder cancer often progresses to muscle‐invasive bladder cancer after multiple recurrences and changes in tumor characteristics over a long natural history. Integration of molecular markers is also a promising approach. A validated model that accurately predicts the risk of progression would help urologists and patients decide whether and when to choose radical cystectomy on an individual basis. [ABSTRACT FROM AUTHOR]

Given the heterogeneous tumor responses to ICIs even in individual patients, surgical removal of the lesions remaining after ICI therapy might further expand the chance of "cure." The treatment paradigm for metastatic renal cell carcinoma (mRCC) has been dramatically changed by the rise of immune checkpoint inhibitors (ICIs). Besides the advancement of systemic anticancer therapy, surgical resection of the primary tumor or metastases remains an important option in the management of mRCC. [Extracted from the article]

Objectives To develop a stepwise diagnostic algorithm for fat-poor angiomyolipoma in small renal masses. Methods Two cohorts of small renal masses <4 cm without an apparent fat component that was pathologically diagnosed were included: 153 cases (18 fat-poor angiomyolipomas/135 renal cell carcinomas) for model development and 71 cases (seven fat-poor angiomyolipomas/59 renal cell carcinomas/5 oncocytomas) for validation. Dynamic contrast-enhanced computed tomography, magnetic resonance imaging and clinical findings were analyzed. Based on multivariate analysis, we developed two prediction models for fat-poor angiomyolipoma, the computed tomography model and the computed tomography + magnetic resonance imaging model, and a stepwise algorithm that proposes the sequential use of computed tomography and magnetic resonance imaging. Results The computed tomography model, which was composed of female aged <50 years, high attenuation on unenhanced computed tomography, less enhancement than the normal renal cortex and homogeneity in the corticomedullary phase, differentiated tumors with none of the factors as the low angiomyolipoma-probability group, and the others were candidates for the computed tomography + magnetic resonance imaging model. The computed tomography + magnetic resonance imaging model, consisting of the first three factors of the computed tomography model, low signal intensity and absence of pseudocapsule on T2-weighted magnetic resonance imaging, re-stratified the tumors into low, intermediate and high angiomyolipoma-probability groups. The incidence of fat-poor angiomyolipoma in each group was 0%, 26% and 93%, respectively (area under the curve 0.981). External validation by two readers showed a high area under the curve (0.912 and 0.924) for each. The interobserver agreement was good (kappa score 0.77). Conclusions The present algorithm differentiates fat-poor angiomyolipoma in small renal masses with high accuracy by adding magnetic resonance imaging to computed tomography in selected patients. [ABSTRACT FROM AUTHOR]

In their Urological Note, Miyoshi B (Yokohama, Japan) b and his colleagues reported their experience of perm cryopreservation before definitive therapy for early-stage prostate cancer (PC). Peyronie's disease induces several symptoms including pain during erection, penis shortening, penile curvature, and erectile dysfunction, and the affected patients often complain of sexual intercourse disorders. The authors recommend that the physician should inform about the possibility of male-infertility due to PC treatment and should discuss about sperm cryopreservation before PC treatment with patients who hope male-fertility preservation. [Extracted from the article]

This meta-analysis clarified the significance of a cut-off point of 3 for good sensitivity and a cut-off point of 4 for good specificity in assessing the likelihood of muscle invasion in bladder cancer. Editorial Comment from Dr Yoshida and Dr Fujii to Role of Vesical Imaging-Reporting and Data System in predicting muscle-invasive bladder cancer: A diagnostic meta-analysis Multiparametric magnetic resonance imaging (mpMRI), which combines T2-weighted MRI (T2WI), a morphologic sequence with high contrast resolution, with diffusion-weighted imaging (DWI) and dynamic contrast-enhanced imaging (DCE), which are functional sequences, has been shown to be highly diagnostic in differentiating muscle invasion in bladder cancer. [Extracted from the article]

Purpose: The purpose of the study is to assess longitudinal changes in general and disease-specific health-related quality-of-life (HRQOL) indices after intensity-modulated radiotherapy (IMRT) monotherapy for patients with localized prostate cancer (PCA). Methods: Between 2006 and 2010, 91 patients with localized PCA underwent IMRT monotherapy and were enrolled into this prospective study. At baseline, and at 3, 6, 12, and 24 months after IMRT, the general and prostate-specific HRQOL were estimated using physical (PCS) and mental component summaries (MCS) calculated using the Medical Outcomes Study 8-Item Short Form Health Survey and Expanded Prostate Cancer Index Composite (EPIC). Results: For 2 years, there were no significant changes in EPIC scores in all subscales of urinary domain, hormonal function, and bother. Bowel and sexual function scores decreased after IMRT and did not return to those at baseline ( p = 0.006 and < 0.001, respectively). PCS began to decrease at 3 months after IMRT and then returned to the baseline score at 24 months. In contrast, the MCS score began to significantly increase after IMRT, and thereafter the score remained constant until 24 months ( p < 0.001). On multivariate logistic regression analysis, urinary ( p = 0.003) and sexual functions ( p = 0.0005) at baseline were identified as significant predictors of EPIC urinary irritative/obstructive score and sexual function at 24 months after IMRT. Conclusion: Urinary function, including irritative/obstruction symptoms and hormonal function, was not affected by IMRT. However, bowel and sexual function decreased after IMRT. These findings will provide important information for PCA patients considering IMRT. [ABSTRACT FROM AUTHOR]

Objectives To develop and validate predictive models for postoperative estimated glomerular filtration rate and risk of chronic kidney disease after radical nephrectomy in Japanese patients. Methods The present retrospective study included a development cohort of 209 patients without preoperative chronic kidney disease who underwent radical nephrectomy between 1994 and 2008, and were followed up for longer than 3 years, and a validation cohort of 144 similar such patients. Univariate and multivariate linear regression or logistic regression analyses were carried out to identify the independent predictors of estimated glomerular filtration rate or chronic kidney disease 3 years after radical nephrectomy. Incorporating all independent predictors, predictive models for postoperative renal function were developed and externally validated. Results Age, the presence of diabetes mellitus, and preoperative estimated glomerular filtration rate were independent predictors of both postoperative estimated glomerular filtration rate and chronic kidney disease. A formula for predicting the postoperative estimated glomerular filtration rate and a nomogram for predicting the risk of postoperative chronic kidney disease were developed. The adjusted R2 of the formula and area under the receiver operating characteristic curves of the nomogram were 0.446 and 0.865 in the development cohort, and 0.396 and 0.787 in the validation cohort, respectively. Conclusions We developed and validated novel predictive models for the postoperative renal function 3 years after radical nephrectomy in Japanese patients. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the long-term effect of the processus vaginalis transection method, which we previously developed to prevent postradical prostatectomy inguinal hernia. Methods: Our hernia prevention procedure is designed to prevent postoperative indirect hernias. The procedure is performed in the following order: (1) the spermatic cord is isolated and mobilized in the pelvis, (2) the vas deferens is isolated from the spermatic cord and ligated, and (3) the processus vaginalis is dissected free of the other spermatic cord elements, mainly spermatic vessels, ligated near the peritoneum, and transected. Between February 2006 and August 2008, 435 consecutive patients underwent the inguinal hernia prevention procedure concurrently with open radical retropubic prostatectomy. The control group comprised 433 patients who had undergone radical retropubic prostatectomy without hernia prevention immediately before the introduction of this hernia prevention procedure was introduced (between January 2001 and January 2006). Results: No significant complications associated with the hernia prevention procedure were observed, except for a few minor peritoneal injuries that were easily repaired during surgery. An inguinal hernia developed postoperatively in 109 of the 433 control patients (25.2%) during the median follow-up of 68 months. In contrast, 4 of the 435 patients (0.9%) who underwent the hernia prevention procedure developed an inguinal hernia during the median follow-up of 42 months. Conclusion: The processus vaginalis transection method is safe and effective in the long-term prevention of postradical prostatectomy inguinal hernia. [ABSTRACT FROM AUTHOR]

Background: Bisphosphonates play an indisputable role in preventing skeletal-related events (SREs) secondary to bone metastases, and also have a direct effect on tumor cells. However, it remains unclear whether bisphosphonates improve overall survival (OS) for renal cell carcinoma (RCC) patients with bone metastases. Methods: Between 1978 and 2010, a total of 45 patients who had RCC metastatic to bone and were classified as intermediate risk according to Memorial Sloan-Kettering Cancer Center criteria were included in this retrospective study. In this cohort, 23 patients received zoledronic acid (ZOL) treatment (ZOL-treated group) whereas the other 22 did not (non-ZOL-treated group). The primary endpoint was OS and the secondary endpoint was the SRE rate defined as the total number of SREs divided by the total years under study. Results: For the cohort of 45 patients, the median OS from diagnosis of bone metastases was 27.2 months. Multivariate analysis showed that lower serum calcium ( p = 0.0083) and ZOL treatment ( p = 0.0013) were independent factors predicting longer survival. The ZOL-treated group had significantly longer OS than the non-ZOL-treated group ( p = 0.0034). Patients in the ZOL-treated group experienced a lower SRE rate than patients in the non-ZOL-treated group ( p = 0.0453). In particular, none of the patients in the ZOL-treated group developed spinal compression whereas 6 (28 %) in the non-ZOL-treated group did ( p = 0.0479). Conclusions: The current study indicates that ZOL not only reduces SREs but possibly improves OS in these patients. [ABSTRACT FROM AUTHOR]

Study Type - Prognosis (retrospective cohort analysis) Level of Evidence 2b What's known on the subject? and What does the study add? The additional use of anti-androgen (deferred combined androgen blockade [CAB] therapy) for patients with castration-resistant prostate cancer (CRPC) initially treated with androgen deprivation monotherapy (ADMT) can provide a clinical response, although the reported response rates vary widely. Our previous study, which reported a response rate of 66% to deferred CAB therapy, suggested that deferred CAB responders would also respond better to subsequent therapies than non-responders because the difference in cancer-specific survival between the deferred CAB responders and the non-responders was much larger than the progression-free survival rates for the responders. The present study showed that PSA response to deferred CAB therapy predicts clinical outcomes after subsequent oestrogen and docetaxel therapy. We propose that PSA response to deferred CAB be used for planning individualized treatment that includes secondary hormonal therapy and chemotherapy. OBJECTIVE To evaluate whether there is any association between prostate-specific antigen (PSA) response to deferred combined androgen blockade (CAB) therapy using bicalutamide in patients with castration-resistant prostate cancer (CRPC), initially treated with castration monotherapy, and the clinical outcomes after subsequent oestrogen and docetaxel therapies., PATIENTS AND METHODS Fifty-six patients with advanced prostate cancer, who were refractory to both initial castration monotherapy and subsequent deferred CAB, received oestrogen therapy (estramustine phosphate 140 or 280 mg/day in 50 patients, diethylstilbestrol diphosphate 100 mg/day orally in six patients). Of the 56 patients, 33 underwent docetaxel therapy (median dose 55 mg/m2, every 4-8 weeks, median 6 courses) when they became refractory to oestrogen therapy., A deferred CAB response was defined as a decrease of >50% in PSA levels after the addition of bicalutamide. The difference in cancer-specific survival (CSS) after confirmation of resistance to initial castration monotherapy between the deferred CAB responders and the non-responders was evaluated, and outcomes after oestrogen and docetaxel therapies were also compared between the two groups., RESULTS A response to deferred CAB was observed in 27 (48%) of the 56 patients. There was no significant difference between the responders and the non-responders in pretreatment clinical variables, including Gleason score, metastatic sites, PSA level at diagnosis, and PSA nadir during castration monotherapy., A deferred CAB response was a significant predictor of CSS after confirmation of resistance to initial castration monotherapy., The deferred CAB responders had significantly longer progression-free survival (PFS) (median 3.2 months in the responders, 2.1 month in the non-responders, P= 0.04) and CSS (median 3.0 years in the responders, 1.5 years in the non-responders, P= 0.04) after oestrogen therapy. Likewise, PFS (median 8.2 months in the responders, 2.2 months in the non-responders, P < 0.01) and CSS (median not reached in the responders, 1.4 years in the non-responders, P < 0.01) after docetaxel therapy was significantly longer in the deferred CAB responders., CONCLUSION PSA response to deferred CAB predicts clinical outcomes after subsequent oestrogen and docetaxel therapies in patients with CRPC, and provides useful information for planning individualized optimum treatment courses that include secondary hormonal therapy and chemotherapy. [ABSTRACT FROM AUTHOR]

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? In bladder-sparing approach incorporating TURBT and chemoradiotherapy (CRT) to MIBC, patients who clinically achieve complete response to induction CRT enjoy favourable prognosis and quality of life with preserved functioning bladder, whereas those with persisting disease have poor prognosis despite salvage radical cystectomy. Risk factors for cancer death among the non-responders remain fully unknown. The current study showed that survival of the non-responders is clearly stratified into low- and high-risk groups based on pathology of cystectomy specimens; 5-yr CSS rates for low- (pTO-2pNO) and high-risk (pT3-4a or pN+) patients were 85% and 20%, respectively. OBJECTIVE To stratify patients with a clinical non-complete response (CR) after induction chemoradiotherapy (CRT) according to their risk of death from cancer, based on pathology of cystectomy specimens., PATIENTS AND METHODS From 1997 to 2009, 170 patients with cT2-4aN0M0 bladder cancer underwent transurethral resection followed by induction CRT (40 Gy with cisplatin). Clinical response was evaluated 4-6 weeks after completion of CRT., Patients who met partial cystectomy (PC) criteria underwent PC plus pelvic lymph node dissection for bladder preservation. Otherwise, radical cystectomy (RC) was recommended., PC criteria were unifocal tumours, intact bladder neck and trigone, and CR (defined as no evidence of residual disease) or minimal amounts of residual non-muscle-invasive bladder cancer after induction CRT., Pathological variables associated with cancer death were analysed in patients who underwent PC or RC using a multivariate Cox proportional hazard model., RESULTS Of 170 patients, 81 (48%) achieved a CR and 62 (36%) met the PC criteria. After CRT, 122 patients (72%) ultimately underwent PC ( n= 44, 26%) or RC ( n= 78, 46%)., The 5-year cancer-specific survival (CSS) rate was 96% for the patients with a CR and 50% for patients with non-CR ( P < 0.001, median follow-up for survivors: 48 months)., In the 122 patients who underwent cystectomy, pT3-4a (hazard ratio [HR] 8.3 versus pTO-2, P < 0.001) and pN+ (HR 3.0 versus pNO, P = 0.037) were identified as significant and independent risk factors among variables including pT stage, lymph node yield at cystectomy, pN stage, and Iymphovascular invasion. A similar result was obtained through analysis of a sub-cohort of 69 patients with non-CR., Patients with non-CR were stratified according to their risk factors into low- (pT0-2pN0, 5-year CSS rate 85%) and high-risk (pT3-4a or pN+, 5-year CSS rate 20%) groups., CONCLUSION In CRT-based bladder-sparing approaches, patients with a clinical non-CR after induction CRT can be stratified into low- and high-risk groups for death from cancer based on pathology of cystectomy specimens. Patients at high risk are potential candidates for intensive adjuvant therapy including clinical trials. [ABSTRACT FROM AUTHOR]

We present an application of a new three-dimensional head-mounted display system that combines a high-definition three-dimensional organic electroluminescent head-mounted display with a high-definition three-dimensional endoscope to minimally invasive surgery, using gasless single-port radical nephrectomy procedures as a model. This system presents the surgeon with a higher quality of magnified three-dimensional imagery in front of the eyes regardless of head position, and simultaneously allows direct vision by moving the angle of sight downward. It is also significantly less expensive than the current robotic surgery system. While carrying out gasless single-port radical nephrectomy, the system provided the surgeon with excellent three-dimensional imagery of the operative field, direct vision of the outside and inside of the patient, and depth perception and tactile feedback through the devices. All four nephrectomies were safely completed within the operative time, blood loss was within usual limits and there were no complications. The display was light enough to comfortably be worn for a long operative time. Our experiences show that the three-dimensional head-mounted display system might facilitate maneuverability and safety in minimally invasive procedures, without prohibitive cost, and thus might mitigate the drawbacks of other three-dimensional vision systems. Because of the potential benefits that this system offers, it deserves further refinements of its role in various minimally invasive surgeries. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the prognostic effect of age in patients with localized renal cell carcinoma (RCC) and investigate the incidence of Xp11 translocation RCC in young patients who developed recurrence. Methods: From 1990 to 2007, 2403 Japanese patients underwent nephrectomy for presumed RCC at 9 institutions. Of those, 1143 patients had localized RCC (Stage pT1-2N0M0). Their clinical data were retrospectively reviewed. In the present study, 131 patients (11%) were considered young (≤45 years at diagnosis). In the young patients with recurrence, the nephrectomy specimens were immunostained with TFE3 to determine the incidence of Xp11 translocation RCC. Results: During the median follow-up of 47 months, 3 cancer deaths (2.2%) occurred among young patients and 51 (5.0%) among older patients. The 5-year cancer-specific survival (CSS) rate was significantly better for the younger patients than for the older patients (P = .049). Multivariate analysis showed that age was significantly associated with CSS, as were the pathologic T stage, tumor grade, and symptoms at diagnosis. The hazard ratio of young age was 0.31 (95% confidence interval 0.077-0.87). The recurrence-free survival curves revealed no difference between these 2 groups. Of the 74 patients with recurrence, the CSS after recurrence was significantly better in the younger patients than in the older patients (P = .0010). Of the 8 young patients with recurrence, 4 had Xp11 translocation RCC, and 3 survived for >5 years after recurrence. Conclusions: Compared with the older patients, the young patients with RCC had similar recurrence-free survival rates but better CSS rates. This might have been because significant numbers of the young patients had Xp11 translocation RCC. [ABSTRACT FROM AUTHOR]

Objectives: To present a novel technique to prevent inguinal hernias after radical retropubic prostatectomy (RRP). The incidence of inguinal hernia after RRP has been reported to occur in the range 12%-21%. Indirect hernias are more common than direct hernias after RRP. Methods: A total of 569 Japanese patients with prostate cancer underwent antegrade RRP between January 2001 and February 2007. Since February 2006, 138 patients underwent procedures for concurrent inguinal hernia prevention at the time of RRP. For hernia prevention, the processus vaginalis was ligated close to the peritoneal cavity and transected. The remaining 431 patients who underwent the same RRP procedures without hernia prevention were considered control group. The incidence rates of postoperative inguinal hernia in the 2 groups were statistically compared. Results: An inguinal hernia developed postoperatively in 105 (24%) of the 431 control patients during follow-up of median 42 months. Hernia-free survival rates were 87%, 81%, and 77%, for 1-, 2-, and 3-year, respectively. By contrast, 2 of the 138 patients (1.4%) who underwent hernia prevention developed an inguinal hernia during follow-up of median 24 months. Hernia-free survival rates were both 99% for 1- and 2-year (P <.0001). The hernia prevention procedure added approximately 10 minutes to the surgery time. There were no significant complications associated with the hernia prevention procedure. Conclusions: Our results suggest that this prophylactic measure is safe and effective to prevent post-RRP inguinal hernias. However, a longer follow-up period is needed to confirm the results. [Copyright &y& Elsevier]

OBJECTIVE To investigate the rate of objective response and the skeletal-related event (SRE)-free survival after combined therapy with radiotherapy (RT) and zoledronate in patients with bone metastases from renal cell carcinoma (RCC). PATIENTS AND METHODS In all, 23 patients with RCC metastatic to bone were included in this retrospective study, of whom 13 had RT to bone metastases with no bisphosphonate therapy between 2000 and 2006, while the remaining 10 had combined therapy with RT and zoledronate (RT + Z) in 2006 and 2007. Significant calcifications of osteolytic metastases and/or shrinkage of bone lesions, as measured by computed tomography, were defined as a partial response. SREs were defined as any of pathological fracture, spinal cord compression, bone surgery, or additional RT to the bone. RESULTS In the RT + Z group, six patients had a partial response, showing evidence of calcification of their osteolytic bone metastases, while in the RT group, only one patient did ( P = 0.019). One patient in the RT + Z group had an SRE, while 10 in the RT group had SREs ( P = 0.003). The median SRE-free survival time was not reached in the RT + Z group, but in the RT group it was 18.7 months ( P = 0.046). CONCLUSION Combined therapy as RT + Z achieved a higher objective response rate (six of 10) and prolonged SRE-free survival than RT alone in patients with bone metastases from RCC. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the efficacy and toxicity of perioperative combination chemotherapy with ifosfamide, 5-fluorouracil, etoposide and cisplatin (IFEP) in bladder cancer patients with regional lymph node metastases treated by radical cystectomy. Methods: We reviewed the medical records of 183 consecutive patients who underwent radical cystectomy for invasive urothelial carcinoma of the bladder. Of those, 26 patients with regional lymph node metastasis who were regarded as being rendered surgically disease-free (pT1-4, N1-2, cM0) and treated with perioperative IFEP chemotherapy were the subjects of the present study. Results: Median follow-up of 26 patients was 49 months (range 4–150). Grade 3 and 4 bone marrow toxicities were seen in 15 and four patients, respectively. Neither chemotherapy-related death nor febrile neutropenia occurred. The 5-year overall and cancer-specific survival rate was 60% and 68%, respectively. The overall survival rate of the patients with pT4 disease was significantly worse than that of patients with pT1-3. There were four N2 patients who survived for over 5 years free of disease. Conclusions: Perioperative IFEP therapy appeared to be effective in the treatment of lymph node positive bladder cancer patients who underwent radical cystectomy. Further study may be warranted. [ABSTRACT FROM AUTHOR]

We investigated a Cu-loss problem after dual-damascene patterning during manufacturing; that is, more than a dozen wafers were stored in a FOUP. We found that a decreased yield due to the Cu-loss strongly depended on the wafer position in a FOUP and on the queue time between etching and wet cleaning. We developed a Cu-oxidation model to explain what happens in a FOUP during the queue time; that is, the F content, which catalyze Cu-oxidation, in the post-etch residue gradually evaporate into the slot-to-slot space. The ambient gas analysis in a FOUP showed that F-containing gas evaporates from the post-etch wafers, and that the evaporation is gradual, which is consistent with our model, On the basis of our model, we controlled ambient gas in the slot-to-slot space. The increased yield showed that the Cu-loss problem was successfully suppressed. [ABSTRACT FROM AUTHOR]

Objectives: To determine the incidence of benign pathologic findings at elective partial nephrectomy for renal masses thought to be renal cell carcinoma (RCC) on preoperative imaging in Japanese patients. Methods: From 1993 to 2007, 176 patients (46 women and 130 men) underwent elective partial nephrectomy for presumed RCC masses in 2 Japanese centers. The mean size of the resected lesions was 2.3 cm (range 0.3-5.8). Overall, 97 and 79 patients had a renal mass of ≤2 cm and >2 cm, respectively. Of the 176 patients, 100%, 89%, and 32% had preoperatively undergone computed tomography, ultrasonography, and magnetic resonance imaging, respectively. Results: Of the 176 masses resected, the pathologic examination revealed benign findings in 19 (11%), angiomyolipoma in 10 (5.7%), oncocytoma in 5 (2.8%), complicated cysts in 2 (1.1%), and a solitary fibrous tumor and scar of the kidney 1 each (0.6%). Of the 46 women, 12 (26.1%) had benign lesions compared with 7 of the 130 men (5.3%; P = .0003). Of the 10 angiomyolipomas diagnosed, 8 were diagnosed in women (P = .0004). Tumor size was not associated with benign histologic findings. The incidence of benign lesions was equivalent (10% and 12%) between the 2 centers. Conclusions: The present incidence (11%) of benign lesions in presumed RCC masses at surgery in Japanese patients was lower than the incidence of 20%-30% previously reported from Western countries, probably because of the low incidence of oncocytomas in Japanese patients. Women had almost 5 times the likelihood of having a benign lesion compared with men, because of the high incidence of angiomyolipomas in women. [Copyright &y& Elsevier]

The objective was to investigate cardiovascular complications in long-term survivors treated by high-dose chemotherapy. We analyzed 13 previously successfully treated metastatic germ cell cancer patients. The patients ranged in age from 16 to 38 years (median: 27 years). Patients were treated by high-dose ifosfamide, carboplatin and etoposide (ICE) or high-dose etoposide, ifosfamide and cisplatin (VIP). In a minimal follow-up of 48 months, the incidence of cardiovascular events and the accumulated doses of platinum were analyzed from the total amounts of cisplatin and/or carboplatin. The calculated accumulated doses of platinum ranged from 487 to 4302 mg (median: 2297 mg). Cardiovascular events were observed in two patients who received cumulative doses of more than 3000 mg of platinum. Survivors of high-dose chemotherapy may have a risk of developing cardiovascular complications during the early phase of follow-up. In particular, patients who have received carboplatin-based high dose chemotherapy require careful observation. [ABSTRACT FROM AUTHOR]

OBJECTIVE To compare the effects of leuprolide acetate and goserelin acetate for suppressing serum testosterone levels in Japanese patients with prostate cancer, as several recent studies suggested that serum testosterone is not always suppressed below the upper limit of the castration range in patients using luteinizing hormone-releasing hormone (LH-RH) agonists, especially leuprolide acetate. PATIENTS AND METHODS In all, 232 patients with prostate cancer, whose serum testosterone levels were measured before and during treatment using a 1- or 3-monthly formulation of leuprolide or goserelin, were enrolled in a retrospective study. The mean age of the patients was 69.8 years and the mean testosterone level before the LHRH treatment was 4.54 ng/mL. The patients had their testosterone levels assessed a mean (range) of 5.4 (1–35) times during the LHRH treatment. A castrate serum testosterone level was defined as ≤0.5 ng/mL. RESULTS The mean maximum testosterone level during 1-monthly leuprolide (40 patients), 3-monthly leuprolide (68), 1-monthly goserelin (50), or 3-monthly goserelin (74) treatment was 0.22, 0.20, 0.19 and 0.20 ng/mL, respectively (not significant). Four patients, including two treated with 1-monthly leuprolide, one with 3-monthly leuprolide and one with 3-monthly goserelin, had serum testosterone above the castrate level, with a maximum of 0.5–0.65 ng/mL. Three of these patients had elevated testosterone only once or twice during the follow-up, and the remaining patient had serum testosterone fluctuating at 0.4–0.6 ng/mL throughout the follow-up. CONCLUSIONS One- and 3-monthly formulations of leuprolide and goserelin have equivalent and sufficient effects to suppress serum testosterone levels in men with prostate cancer. There were testosterone levels just outside the castrate range in a few patients during treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVE To assess the effect of adding bicalutamide on serum prostate-specific antigen (PSA) levels in patients with hormone-refractory prostate cancer (HRPC) during androgen deprivation monotherapy (ADMT). PATIENTS AND METHODS Forty-four patients with HRPC were treated with deferred combined androgen blockade (CAB) therapy, administering bicalutamide 80 mg once daily. HRPC was defined biochemically as three consecutive rises in PSA level during ADMT. The treatment response was defined as a ≥ 50% decline in PSA levels. Prognostic values of various pretreatment variables for responsiveness to deferred CAB were determined statistically. When the disease relapsed during deferred CAB, bicalutamide was discontinued and the patients were evaluated for the antiandrogen withdrawal syndrome (AWS). RESULTS Of the 44 patients, 29 (66%) had a PSA response; the median PSA failure-free survival was 9.2+ months. Biopsy Gleason score was the only pretreatment variable predictive of a PSA response (mean Gleason score 7.9 in responders and 8.7 in nonresponders). The PSA doubling time (PSA-DT) was the only statistically significant variable of PSA failure-free survival in a multivariate analysis. The 1- and 2-year PSA failure-free survival rates were 43% and 31% in patients with a PSA-DT of >4 months, while it was 21% and none, respectively, in those with a PSA-DT of <4 months. Responders to deferred CAB had a statistically longer cancer-specific survival than nonresponders. None of 20 patients who were evaluated for AWS had the condition. CONCLUSIONS Deferred CAB therapy using bicalutamide is effective in patients with progression during ADMT, particularly in those with lower Gleason score tumours or a longer PSA-DT. AWS after deferred CAB is uncommon. [ABSTRACT FROM AUTHOR]

Metastatic renal cell carcinomas (RCC) remain highly resistant to systemic therapy. RCCs are highly vascular tumors, which overproduce angiogenic peptides such as vascular endothelial growth factor (VEGF) even under normoxic conditions. A potential suggested role of antiangiogenic therapeutic strategies is the treatment of RCC by inhibiting VEGF production. The down-regulation of VEGF expression by glucocorticoids has recently been demonstrated in several cells. In this study, the direct effects of glucocorticoids on VEGF production by RCC cells were evaluated. Four RCC cell lines A498, RCC270, Caki1, and ACHN were treated with dexamethasone (DEX), hydrocortisone (HC), 5-α-dihydrotestosterone (DHT), or estradiol (E2). RU486 was used as a glucocorticoid receptor (GR) antagonist. Cell growth was studied with MTS assays. VEGF mRNA and protein were evaluated with quantitative real-time RT-PCR and ELISA, respectively, and GR expression was examined using RT-PCR and immunocytochemistry. All four RCC cell lines expressed GR. DEX at 100nM down-regulated VEGF secretions by more than 50% in three lines (A498, RCC270, and Caki1) and had a weak inhibitory effect on ACHN cells. The effect of DEX on reducing VEGF mRNA levels in A498 cells was concentration-dependent and maximal at 100nM (80% inhibition). HC had similar but weaker effects on VEGF production in the RCC cells, but E2 and DHT had no effect. RU486 reversed the effects of DEX. DEX at 1–1000nM did not affect cell growth in any of the four RCC cell lines. This is the first study showing that glucocorticoids, at concentrations achievable in vivo by oral administration of low doses of DEX, have an inhibitory effect on VEGF mRNA expression and protein secretion of RCC cells possibly through the GR pathway. Furthermore, DEX might have a potential role in antiangiogenic therapeutic strategies by inhibiting VEGF production during metastatic RCC treatment. [Copyright &y& Elsevier]

Activins are multifunctional growth and differentiation factors and stimulate FSH-β gene expression and FSH secretion by the pituitary gonadotropes. Follistatins bind activin, resulting in the neutralization of activin bioactivity. The activin-follistatin system is present in the prostate tissue. Prostatespecific antigen (PSA) plays an important role in male reproductive physiology as well as being very important as a tumor marker for prostate cancer. Thus the regulation of PSA has important clinical implications. Previous studies showed that PSA is primarily regulated by androgens. In the present study, we evaluated the direct effects of activin A on the proliferation and PSA production of prostate cancer LNCaP cells, which express functional activin receptors and androgen receptor and PSA. LNCaP cells were treated with activin A and 5α dihydrotestosterone (DHT) with or without their antagonists (follistatin or the nonsteroidal anti-androgen bicalutamide). Activin A decreased cell growth of LNCaP cells in a dose-dependent manner, whereas DHT increased it in a biphasic manner. In contrast to their opposing actions on cell growth, both activin A and DHT unregulated PSA gene expression and increased PSA secretion by LNCaP cells. The effects of activin A and DHT to increase PSA production were synergistic or additive. Follistatin or bicalutamide was without effect on cell growth or PSA production. The effects of activin A on LNCaP cells were blocked by follistatin, not by bicalutamide, whereas effects of DHT were prevented by bicalutamide, not by follistatin. Activin A upregulates PSA production, and the effect is through an androgen receptor-independent pathway. The activin/follistatin system can be a physiological modulator of PSA gene transcription and secretion in the prostate tissue, and activins may cooperate with androgen to upregulate PSA in vivo. [ABSTRACT FROM AUTHOR]

Abstract A 47-year-old male patient underwent surgery for a 10-cm adrenal cortical carcinoma. A large invasive adrenal mass was surgically removed en bloc with the right kidney and the lower lobe of the liver. Two months postoperatively, a 7-cm recurrent mass developed in the right psoas muscle. After a partial response was achieved by irradiation (40 Gy) and high-dose chemotherapy (carboplatin and etoposide) with peripheral blood stem cell transplantation, the patient underwent surgery with a wide excision of the psoas muscle. Twelve months after the initial surgery, an 8-cm rib metastasis developed and the patient again underwent surgery after a combination of irradiation (50 Gy) and chemotherapy (cisplatin and etoposide). The patient has been doing well without any evidence of recurrence for 5 years. Refractory or metastatic adrenal cortical carcinomas have been thought to be lethal, therefore, the present case provides support for multimodal treatments of refractory adrenocortical cancers. [ABSTRACT FROM AUTHOR]

Pituitary adenylate cyclase-activating polypeptide (PACAP) stimulates α-subunit transcription and lengthens LH-β mRNA transcripts, but reduces FSH-β mRNA levels in rat pituitary cell cultures. PACAP also stimulates follistatin transcription, an effect which may explain the decrease in FSH-β mRNA. To begin to investigate the cells in which PACAP activates the follistatin gene, quantitative in situ hybridization for follistatin mRNA combined with immunostaining for LHβ and S100 protein was performed. In control cultures, follistatin mRNA was expressed in 70% of gonadotrophs and in 47% of folliculostellate cells (S-100+). PACAP increased (P<0.001) both the number of follistatin-expressing cells as well as the number of grains per cell in both gonadotrophs and folliculostellate cells, while GnRH only affected (P=0.01) gonadotrophs. Follistatin and FSH-β gene expression in rat pituitary cultures were also measured by competitive quantitative RT-PCR and northern analysis, respectively. Both PACAP and GnRH increased (P<0.05) follistatin gene expression and suppressed (P<0.05) FSH-β mRNA, and the effect of PACAP together with GnRH on follistatin exceeded that of GnRH alone. PACAP regulation of follistatin and FSH-β gene expression was studied further in LβT2 cells that were found to express receptors for the specific PACAP receptor, PAC1. Follistatin mRNA was undetectable in cultures exposed to control media, or stimulated with PACAP, GnRH or rh-activin-A. In contrast to the results in primary pituitary cultures, PACAP increased FSH-β mRNA in these follistatin-deficient cells. Moreover, using transient transfection, PACAP stimulated transcription of ovine-FSH-β-luciferase. GnRH likewise increased FSH-β mRNA and stimulated FSH-β gene transcription in LβT2 cells. Activin-A increased FSH-β gene expression dose-dependently, and activin induction of FSH-β mRNA was blocked completely by 3-fold excess follistatin. These results indicate that PACAP stimulates follistatin gene expression in both gonadotrophs and folliculostellate cells, and provide further evidence that follistatin is required for PACAP or continuous GnRH to down-regulate FSH-β mRNA. These experiments suggest a mechanism by which PACAP influences FSH production selectively by an autocrine effect on gonadotrophs and by a paracrine mechanism through folliculostellate cells that involves follistatin. [Copyright &y& Elsevier]

Objective: To assess the contribution of the carbohydrate antigens, sialyl-Lewis X (sLe[sup x] ) and sialyl-Lewis A (sLe[sup a] ), which are known to be ligands for E-selectin, to the adhesion between human urothelial cancer cells and cytokine-activated human endothelial cells. Materials and Methods: We studied the expression of sLe[sup x] and sLe[sup a] antigens of three bladder cancer cell lines (JTC 30, JTC 32, and T24) by flow cytometry and the adherence to interleukin 1β-activated human umbilical vein endothelial cells (HUVEC). Results: JTC 30 and JTC 32 cells expressed both sLe[sup x] and sLe[sup a] antigens, and showed adhesion to activated HUVEC, which was completely abolished by anti-E-selectin antibody. T24 cells expressed neither sLe[sup x] nor sLe[sup a] antigen, and did not adhere to activated HUVEC. Each of anti-sLe[sup a] or anti-sLe[sup x] antibody partially blocked the attachment of JTC 30 cells to activated HUVEC, and combination of these antibodies almost completely blocked the adhesion. The combination of antibodies did not significantly influence the adhesion of JTC 32 cells. Conclusion: These results indicate that both sLe[sup a] and sLe[sup x] carbohydrate antigens are involved in E-selectin-mediated adhesion of some urothelial cancers, and that there might be unknown ligands for E-selectin on urothelial cancer cells.Copyright © 2000 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Editorial Comment to Long-term clinical outcomes of external beam radiation therapy for oligometastatic prostate cancer: A combination of prostate-targeted treatment and metastasis-directed therapy Long-term clinical outcomes of external beam radiation therapy for oligometastatic prostate cancer: a combination of prostate-targeted treatment and metastasis-directed therapy. In recent years, multiple studies have reported the efficacy of targeted therapy for oligometastatic prostate cancer (OMPCa).1,2 Based on the results of these studies, targeted therapy for OMPCa has received much attention. [Extracted from the article]

Objectives: To validate the diagnostic accuracy of a stepwise algorithm to differentiate fat‐poor angiomyolipoma (fp‐AML) from renal cancer in small renal masses (SRMs). Methods: We prospectively enrolled 223 patients with solid renal masses <4 cm and no visible fat on unenhanced computed tomography (CT). Patients were assessed using an algorithm that utilized the dynamic CT and MRI findings in a stepwise manner. The diagnostic accuracy of the algorithm was evaluated in patients whose histology was confirmed through surgery or biopsy. The clinical course of the patients was further analyzed. Results: The algorithm classified 151 (68%)/42 (19%)/30 (13%) patients into low/intermediate/high AML probability groups, respectively. Pathological diagnosis was made for 183 patients, including 10 (5.5%) with fp‐AML. Of these, 135 (74%)/36 (20%)/12 (6.6%) were classified into the low/intermediate/high AML probability groups, and each group included 1 (0.7%)/3 (8.3%)/6 (50%) fp‐AMLs, respectively, leading to the area under the curve for predicting AML of 0.889. Surgery was commonly opted in the low and intermediate AML probability groups (84% and 64%, respectively) for initial management, while surveillance was selected in the high AML probability group (63%). During the 56‐month follow‐up, 36 (82%) of 44 patients initially surveyed, including 13 of 18 (72%), 6 of 7 (86%), and 17 of 19 (89%) in the low/intermediate/high AML probability groups, respectively, continued surveillance without any progression. Conclusions: This study confirmed the high diagnostic accuracy for differentiating fp‐AMLs. These findings may help in the management of patients with SRMs. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the utility of magnetic resonance imaging (MRI) and MRI‐ultrasound fusion targeted biopsy (TB) for predicting unexpected extracapsular extension (ECE) in clinically localized prostate cancer (CLPC). Methods: This study enrolled 89 prostate cancer patients with one or more lesions showing a Prostate Imaging‐Reporting and Data System (PI‐RADS) score ≥3 but without morphological abnormality in the prostatic capsule on pre‐biopsy MRI. All patients underwent TB and systematic biopsy followed by radical prostatectomy (RP). Each lesion was examined by 3‐core TB, taking cores from each third of the lesion. The preoperative variables predictive of ECE were explored by referring to RP specimens in the lesion‐based analysis. Results: Overall, 186 lesions, including 81 (43.5%), 73 (39.2%), and 32 (17.2%) with PI‐RADS 3, 4, and 5, respectively, were analyzed. One hundred and twenty‐two lesions (65.6%) were diagnosed as cancer on TB, and ECE was identified in 33 (17.7%) on the RP specimens. The positive TB core number was ≤2 in 129 lesions (69.4%) and three in 57 lesions (30.6%). On the multivariate analysis, PI‐RADS ≥4 (p = 0.049, odds ratio [OR] = 2.39) and three positive cores on TB (p = 0.005, OR = 3.07) were independent predictors of ECE. Lesions with PI‐RADS ≥4 and a positive TB core number of 3 had a significantly higher rate of ECE than those with PI‐RADS 3 and a positive TB core number ≤2 (37.5% vs. 7.8%, p < 0.001). Conclusions: Positive TB core number in combination with PI‐RADS scores is helpful to predict unexpected ECE in CLPC. [ABSTRACT FROM AUTHOR]

Transurethral procedures such as direct vision internal urethrotomy and urethral dilation have been the traditional treatments for urethral strictures. However, transurethral procedures are associated with high recurrence rates, resulting in many uncured cases and prompting major international urological societies to recommend urethroplasty as the standard treatment owing to its high success rate. In contrast, many Japanese general urologists have little doubts about treating urethral strictures with transurethral treatment. Therefore, urethral stricture treatments in Japan are not in line with those used in other countries. To address this, the Trauma, Emergency Medicine, and Reconstruction Subcommittee of the Japanese Urological Association has developed guidelines to offer standardized treatment protocols for urethral stricture, based on international evidence and tailored to Japan's medical landscape. These guidelines target patients with a clinically suspected urethral stricture and are intended for urologists and general practitioners involved in its diagnosis and treatment. Following the Minds Clinical Practice Guideline Development Manual 2020, the committee identified eight critical clinical issues and formulated eight clinical questions using the “patient, intervention, comparison, and outcome” format. A comprehensive literature search was conducted. For six clinical questions addressed by the existing guidelines or systematic reviews, the level of evidence was determined by qualitative systematic reviews. Quantitative systematic reviews and meta‐analyses were performed for the two unique clinical questions. The recommendation grades were determined using the Delphi method and consensus by the committee. These guidelines will be useful to clinicians in daily practice, especially those involved in the care of urethral strictures. [ABSTRACT FROM AUTHOR]

The Gleason score (GS) grading system is one of the strongest predictors of prostate cancer outcomes and plays a significant role in choosing a treatment modality. Routine head CT during systemic therapy for metastatic RCC detected brain metastases more in the asymptomatic phase, leading to avoiding craniotomy. However, the incidence of brain metastases was relatively low, even in these patients (16 of the 152 patients, 11%), and routine use of head CT was not significantly associated with improved brain metastasis prognosis. [Extracted from the article]

A quick-freezing and deep-etching (QF-DE) method was employed with whole-mount strips of rat duodenal muscle walls to exhibit the cytoskeletons of the myenteric plexus. Nerve fibers in the myenteric plexus, which contained fewer neurofilaments than other types of neurons examined, had many varicosed contours, and were bundled by enteroglial cells. Cytoskeleton arrays were rarely observed in the varicosed regions, where synaptic vesicles were often seen, although other nerve regions contained many neurofilaments running almost in parallel with the nerve fiber bundle. Enteroglial cells had short cytoskeletons predominantly across the cytoplasm, becoming thinner the around varicosed regions of the nerve bundles. Such enteroglial extruded areas were often in close association with neighboring nerve fibers, indicating intercommunications between the nerve fibers. In distal parts of enteric nerve processes, there were numerous synaptic vesicles, but few neurofilaments. Smooth muscle cells were closely associated with the enteric nerve processes. Fine network structures, responsible for the extracellular matrix, were present between the smooth muscle cells and the enteric nerve processes. These specific structures of the myenteric plexus could be important for signalling or for the transportation of neurotransmitters involved in gut motility. [ABSTRACT FROM AUTHOR]

The shapes of acanthocytic erythrocytes have been thought to be related to changes of the organization of the membrane components. In this study, acanthocytes from a patient with chorea-acanthocytosis and a patient with McLeod syndrome were examined. These acanthocytes had a greater tendency to form spikes than normal erythrocytes in an incubation culture system, indicating their weakness against membrane tension. The membrane skeletons of erythrocytes from both patients were examined by our erythrocyte-splitting method followed by the quick-freezing and deep-etching method. The ultrastructural organization of the membrane skeletons was heterogeneous even in individual erythrocytes, indicating regional changes in the compactness of their meshworks. In the process of erythrocyte splitting, some erythrocyte membranes became reversed and protruded into the cytoplasmic side. In these regions, there were fewer filamentous structures. The focal membrane skeletal changes, which are probably one of the factors that induce the phenotype of an acanthocytic erythrocyte, were demonstrated for the first time by this method. [ABSTRACT FROM AUTHOR]

Lymph node dissection (LND) is widely acknowledged as a standard surgical procedure in conjunction with radical cystectomy (RC). From this aspect, LND specimens are highly informative for disease management after surgery, and adjuvant chemotherapy is generally recommended for patients with pathologically positive LNs, which predict a significant risk of cancer recurrence. A multi-institutional analysis of outcomes of patients with clinically node positive urothelial bladder cancer treated with induction chemotherapy and radical cystectomy. [Extracted from the article]

Objectives: To evaluate the feasibility of discarding antimicrobial prophylaxis (AMP) for transurethral resection of bladder tumor (TURBT). Methods: One-hundred and sixty-two patients undergoing TURBT, with no risk factors for infectious complications were included in this prospective study between April 2006 and April 2008. Forty-four patients received single oral dose of 200 mg levofloxacin for AMP (LVFX group), and the remaining 118 received no AMP (no AMP group). Rates of postoperative infectious complications were compared between the two groups. Results: There was no significant difference between the two groups in terms of baseline characteristics, including age, sex, history of TURBT, number of tumors, duration of operation and days of catheterization. Symptomatic urinary tract infections (UTIs) occurred in four patients (3.4%) in the no AMP group and one patient (2.3%) in the LVFX group ( P = 0.61). All patients having UTIs were men, and were successfully treated by immediate administration of antibiotics. No patients developed extra-urinary tract infections. Conclusions: Based on our findings, AMP for TURBT in patients with no risk factors for infectious complications is not necessary. The use of antibiotics might be deferred until postoperative infections develop. [ABSTRACT FROM AUTHOR]

We report three cases of metastatic renal cell carcinoma (RCC) in which combination treatment of cimetidine, cyclooxygenase-2 inhibitor and renin-angiotensin system inhibitor (angiotensin converting enzyme inhibitor or angiotensin II type 1 receptor antagonist) (CCA therapy) was effective. Case 1: A 47-year-old man who had a 12-cm right renal tumor with multiple pulmonary and hepatic metastases refused cytokine therapy for economic reasons and received CCA therapy. All of the metastases showed partial remission, which continued for 12 months. Case 2: A 62-year-old man with multiple pulmonary and mediastinal lymph node metastases from clear cell RCC refractory to interferon-α and interleukin-2 started CCA therapy. Partial remission has been maintained for 16 months. Case 3: A 64-year-old man with pulmonary metastases from clear cell RCC discontinued interferon-α treatment due to its side effects after six months and received CCA therapy. Pulmonary metastases showed partial remission for 31 months. The CCA therapy could be an alternative treatment for metastatic RCC patients unfit for cytokine therapy. [ABSTRACT FROM AUTHOR]

B Sekido I et al. i (Tokyo, Japan) b presented an abridged English translation of the Japanese clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury updated as of July 2019. Do gonadotropin-releasing hormone antagonists just suppress serum testosterone levels more quickly than agonists without causing testosterone flare? The patients who received antagonists showed no change in brain natriuretic peptide levels, whereas those who received agonists showed a significant increase, suggesting the selection of androgen deprivation therapy modality might affect the cardiovascular outcomes. [Extracted from the article]

Radical cystectomy is the established standard of care for muscle-invasive or high-risk bladder cancer. Such efforts resulted in the development of laparoscopic radical cystectomy (LRC), which has become a viable alternative to open radical cystectomy, although robot-assisted radical cystectomy is now partially replacing it. Final pathological stage after neoadjuvant chemotherapy and radical cystectomy for bladder cancer-does pT0 predict better survival than pTa/Tis/T1?. [Extracted from the article]

Editorial Comment to Does asymptomatic bacteriuria affect the response to intravesical bacillus Calmette-Guérin? Although the recent advent of immune checkpoint inhibitors resulted in a paradigm shift in immunotherapy for bladder cancer, intravesical bacillus Calmette-Guérin (BCG) therapy still has an important therapeutic role in non-muscle-invasive bladder cancer (NMIBC). Given that pre-existing BCG-specific immunity can be a key mediator of enhanced antitumor responses to BCG, urinary microbiota might elicit it, possibly due to the presentation of antigens with similar structures to BCG by some bacteria. [Extracted from the article]

Currently, tyrosine kinase inhibitors are a treatment option for metastatic papillary RCC as both first-line and second-line agents, whereas both tyrosine kinase inhibitors and mammalian target of rapamycin inhibitors can be applicable for metastatic chromophobe RCC. (Tokyo, Japan) b investigated biopsy-proven recurrence rates and risk factors for immunoglobulin A nephropathy recurrence in 299 kidney transplant recipients. Related-donor transplantation and post-transplant increased proteinuria were identified as potential risk factors for recurrence. [Extracted from the article]

It includes technologies, such as virtual reality (VR), augmented reality (AR) and mixed reality (MR).[1] VR technology allows users to immerse fully into computer-simulated reality and interact with digital information. The authors report that VR technology can provide new opportunities to understand the spatial relationships between the various tissue and tumors, based on a patient-specific VR-based surgical model. Unlike VR, which is completely immersive, MR technology allows the users to interact with and manipulate the overlaid virtual objects and the physical environment. [Extracted from the article]

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: To analyze the incidence and risk factors of intraoperative hypotension related to photodynamic diagnosis‐assisted transurethral resection of bladder tumor (PDD‐TURBT) with oral 5‐aminolevulinic acid (5‐ALA). Methods: We retrospectively analyzed 487 patients with bladder tumors who underwent PDD‐TURBT (n = 184) or conventional TURBT (conv‐TURBT) (n = 303) between 2018 and 2021. Intraoperative hypotension was defined as hypotension requiring vasopressors during TURBT, and its incidence was compared between the two groups. Potential risk factors of intraoperative hypotension, including preoperative change in mean arterial pressure (MAP), were further investigated in patients receiving PDD‐TURBT. Results: The median age was 72 years, 392 patients (81%) were male, and 203 (42%) had hypertension. TURBT was performed under general and spinal anesthesia in 76 (16%) and 411 (84%) patients, respectively. The incidence of intraoperative hypotension was significantly higher in PDD‐TURBT compared to conv‐TURBT (43% vs. 17%, respectively). The median change in MAP until the induction of anesthesia was +6.5 mmHg (range: −29.0 to +46.3) in the PDD‐TURBT group and +14.7 mmHg (range: −35.3 to +67.7) in the conv‐TURBT group, showing a significantly smaller increase in the PDD‐TURBT group (p < 0.001). In the multivariable analysis for PDD‐TURBT patients, advanced age, general anesthesia, and lower MAP change (<+6.5 mmHg) until anesthesia induction were significantly associated with intraoperative hypotension (p = 0.0104, <0.001, and <0.001, respectively). Conclusions: Intraoperative hypotension occurred more frequently in patients who underwent PDD‐TURBT than in those who underwent conv‐TURBT. Using oral 5‐ALA decreases preoperative blood pressure elevation and may be responsible for intraoperative hypotension. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the incidence and risk factors of a 20% decrease from new baseline (NB)‐estimated glomerular filtration rate (eGFR) within 2 years after radical nephrectomy (RN) and partial nephrectomy (PN) and to examine the difference in the incidence of end‐stage renal disease (ESRD) with or without the 20% decrease. Methods: This retrospective study included 238 patients undergoing RN and 369 undergoing PN for cT1a‐cT3a renal cancer. The incidence of a 20% decrease from NB‐eGFR within 2 years after RN/PN was examined and its potential risk factors including surgery type were assessed by multivariate logistic regression analysis. The development of ESRD was analyzed as an endpoint and its incidence was compared according to the presence or absence of the 20% decrease from NB‐eGFR within 2 years. Results: Overall, the 20% decrease from NB‐eGFR within 2 years was observed in 37 patients (6.1%), including 10 (4.2%) and 27 (7.3%) after RN and PN, respectively (p = 0.117). Diabetes mellitus, proteinuria, and perioperative complications were shown to be independent risk factors for the 20% decrease from NB‐eGFR, while surgery type was not. During the median follow‐up of 65 months, the ESRD‐free survival rate at 6 years was 75.5% and 99.6% in patients with and without the 20% decrease from NB‐eGFR, respectively (p < 0.001), while no significant difference was observed between patients undergoing RN and PN (98.1% and 98.7%, p = 0.561). Conclusions: Because the incidence of ESRD after the 20% decrease from NB‐eGFR within 2 years was as high as 24.5% at 6 years, these patients should be followed with utmost care. [ABSTRACT FROM AUTHOR]

This article discusses the significance of atypical nodules upgraded to category 3 in the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) for prostate cancer diagnosis. The study evaluated real-world data from 321 patients who underwent MRI/ultrasound-fusion targeted biopsy for category 2 or 3 lesions in the transition zone. The results showed that atypical nodules upgraded to category 3 were more likely to harbor clinically significant prostate cancer (csPC) compared to nonupgraded atypical nodules. The detection rates of csPC in upgraded atypical nodules were similar to those of conventional category 3 lesions. However, the study was conducted retrospectively in a single institution, and further research is needed to confirm these findings. [Extracted from the article]