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A 62-year-old man was treated for castration-resistant prostate cancer (CRPC) ; however, his condition progressed. The patient planned to visit our department for treatment, including palliative care. However, he visited the emergency room with a complaint of a persistent nose bleed just before visiting our department. He had an active nose bleed, disseminated intravascular coagulation (DIC), and leukoerythroblastosis upon admission. After hospitalization, we performed a bone marrow puncture and biopsy to investigate the cause of the DIC, which revealed a dry tap and hypoplastic bone marrow. This was believed to be due to the progression of CRPC. He developed wheals upon receiving repeated platelet transfusions for the DIC. Although we administered antihistamine and steroids to control these side effects, he additionally developed chills and fever. Because of the difficulty in controlling side effects, we decided to use washed platelets. Thereafter, blood transfusions of washed platelets were performed without the occurrence of side effects. However, the patient died because of the worsening of his condition.

Introduction Prostate cancer is the most prevalent urological cancer for older men. However, there is still a possibility that a few prostate cancer patients may still wish to have children. Case presentation A 49-year-old male was diagnosed with low-risk prostate cancer. Combined anti-androgen blockade therapy was performed for 8 months prior to radiation therapy. However, he suffered from ejaculatory dysfunction and wished to conceive with his partner. Hormonal therapy was discontinued and he was referred to our clinic for sperm preservation. His ejaculatory function did not recover after 4 months discontinuation of hormonal therapy, subsequently micro-testicular sperm extraction for sperm preservation was successfully performed. Conclusion Sperm preservation in patients with prostate cancer is unusual but it should be considered if the patient's fertility is an issue.

It is well known that there is a reduction of circadian rhythm in blood testosterone levels with aging. Our previous report revealed that 3 mg of short-acting testosterone ointment (Glowmin: GL) elevated serum testosterone levels to within the physiological range for 4-6 h. The aim of this study was to clarify the clinical efficacy and safety of GL used topically once every morning, to enhance the circadian rhythm of testosterone, for late-onset hypogonadism (LOH).A total of 61 LOH patients received 3 mg of GL topically once a day in the morning on scrotal skin for 24 weeks. The clinical efficacy of GL was evaluated by the aging males symptoms (AMS) scale, and blood sampling tests were measured before and after GL treatment.Mean patients age was 55.3 ± 9.2 years old. Total AMS scores at 4, 12, and 24 weeks after GL treatments significantly decreased. The results of sub-analysis of AMS, including psychological, physical, and sexual factors also significantly improved after GL treatments. No severe adverse reactions or abnormal laboratory data were reported.This study shows that TRT for LOH with once daily GL treatment supports testosterone circadian rhythm and should be considered to be an effective and safe therapy for LOH.

Tadalafil is a promising phosphodiesterase (PDE) 5 inhibitor prescribed for erectile dysfunction (ED). Daily low dose (5 mg) of tadalafil has also been used for the treatment of male lower urinary tract symptoms (LUTS) associated with benign prostate hyperplasia (BPH). PDE5 inhibitors induce relaxation of smooth muscle cells in the urethra, prostate, bladder neck, and blood vessels. The aim of this study was to investigate the efficacy of tadalafil on vessels endothelial function, in patients with male LUTS symptoms associated with BPH.The Institutional Review Board (IRB) approved this clinical study and informed consents had been obtained from 81 BPH patients. The following male LUTS parameters: international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), voiding volume, max and mean voiding flow on voiding flowmetry examination and post-voiding residual urine (RU) were compared at 0, 1, 3, 6, and 12 months after a daily dose of 5 mg tadalafil. In addition, erectile function was evaluated by the sexual health inventory for men (SHIM) score and vessels endothelial function and peripheral neuropathy were assessed by the brachial-ankle pulse wave velocity (baPWV), ankle brachial index (ABI), and vibration perception threshold (VPT) at 0, 3, 6, and 12 months after treatment.The mean age of 81 patients was 66.4 ± 11.4 years old. Their prostate size was 30.2 ± 22.1 ml. Male LUTS parameters including IPSS, OABSS, and RU showed significant improvement from 1 to 12 months after tadalafil administration. Max and mean voiding flow was significantly increased at 6 months after tadalafil treatment. The SHIM score showed significant improvement after 3 months. Whilst, the results of baPWV also showed significant improvement from 3 to 12 months. ABI was also significantly improved at 6 months. However, there was no change in the VPT at any time point.Tadalafil is effective for both male LUTS and ED. It is also shown that tadalafil improves baPWV, which we can conclude that higher vessels elasticity has been obtained. This major finding of this study shows that tadalafil has the potency to improve vessels endothelial dysfunction in patients with BPH.

Several studies have indicated that erectile dysfunction (ED) patients also suffer from lower urinary tract symptoms (LUTS). We investigated a group of men with LUTS and assessed their sexual function with the aim of being able to predict ED risk factors and introduce ED treatments earlier for this patient group.International Prostate Symptom Score (IPSS), Overactive Bladder Symptoms Score (OABSS) and Sexual Health Inventory for Men (SHIM) score were obtained from 236 men with LUTS at their first out-patients visit. Clinical parameters such as body mass index, prostate volume, residual urine volume and prostate specific antigen were also evaluated. The relationship between the SHIM score and other clinical data was analyzed.According to the SHIM score, ED in men with LUTS was severe 15%, moderate 19%, moderate to mild 28%, mild 17%, normal 7% and data was incomplete in 14%. Based on the results of a multivariate analysis, aging (p 0.001) and OAB severity (p = 0.024) were significantly correlated to severe and moderate ED. Furthermore, among OAB symptoms score items, urge urinary incontinence was a risk factor for severe and moderate ED (p = 0.005).Aging and OAB (notably urinary urge incontinence) are risk factors for severe and moderate ED in men with LUTS.

The purpose of this study was to investigate andrological aspects, including male infertility and androgen deficiency, after treatments of bilateral testicular tumors.Five subjects with bilateral testicular cancer were clinically analyzed between April 1996 and March 2013.The mean age at initial treatment was 29.4 ± 3.3 years old. In the 4 metachronous cases, a contralateral tumor occurred after 79.0 ± 50.0 months. Histologically, bilateral seminoma occurred in 3 cases and seminoma and nonseminoma was combined in 2 cases. All subjects underwent bilateral orchiectomy, with additional chemotherapy, radiation therapy, and surgery for metastasis. No tumor recurrence was observed in the 5-34 years following initial treatment. Two subjects married following bilateral orchiectomy after receiving informed consent from their wives. One had two children before contralateral testicular treatment. The other was single and had undergone micro-testicular sperm extraction at contralateral orchiectomy, although no sperm was found. The other one was unknown because long-term followup failed. Androgen replacement therapy (ART) was applied for 4 subjects, and relieved physical and psychological symptoms due to testosterone deficiency without adverse reactions.ART safely and effectively relieves symptoms in subjects with bilateral testicular tumors. However, male infertility treatment is insufficient, and more aggressive management may be required.

Background: Male post-coital gross hematuria is an unsettling condition, and various causes have been reported. However, despite the clinical investigation of this disease, many questions remain unresolved. The objective of this study was to analyze clinical features of male patients displaying post-coital massive hematuria. Materials and Methods: From 2002 to 2010, 15 males complaining of massive hematuria following sexual intercourse presented to our clinic. Backgrounds and general conditions were analyzed. Furthermore, medical findings and clinical course were evaluated. Results: The mean age of the 15 patients was 45.0 ± 15.1 (range = 26–70) years. Three patients exhibited bladder tamponade, which necessitated the removal of blood clots from the urinary bladder by trans-urethral irrigation. Hematospermia was observed in four subjects. Anti-coagulation agents were administered in three cases. Benign prostatic hyperplasia and cystic lesion of the prostate were diagnosed in three and one patient...

In addition to hormone replacement therapy, non-hormonal therapy, particularly Japanese traditional herbal medicine (Kampo), has been used to alleviate the various symptoms of female menopause. The efficacy and safety of Japanese traditional herbal medicine for male late-onset hypogonadism (LOH) are investigated.One hundred fifty-one patients with LOH were treated via the administration of Japanese traditional herbal medicine. The most appropriate Japanese traditional herbal medicine was administered to patients according to their pathogenic alteration. After 4 weeks, the clinical efficacy was evaluated based on improvement of LOH symptoms and the score of the simplified menopausal index (SMI). Additionally, predictive factors of efficacy of Japanese traditional herbal medicine were analyzed.Among 151 patients with LOH, 63 (41.8%) achieved both relief from LOH symptoms and normalized SMI score (Excellent response group), whereas 44 (29.1%) achieved either relief from LOH symptoms or normalized SMI score (Fair). However, 44 (29.1%) patients displayed neither relief from LOH symptoms nor normalized SMI score (Poor). Adverse reactions were observed only in four (2.6%) patients. Patients displaying excess conditions and mild LOH symptoms appeared to be superior candidates for Japanese traditional herbal medicine.Japanese traditional herbal medicine is an effective and safe treatment for LOH.

OBJECTIVE: The efficacy and safety of two types of phoshodiestrase type 5 ( PDE 5) inhibitors (sildenafil (sil) and vardenafil (var)) were investigated for multi-centric study. SUBJECTS AND METHODS: One hundred and twenty five patients (55.9 +/- 10.9 years old) with erectile dysfunction (ED) were treated by both of sil and var. The patients were administered a pair of 25 mg of sil and 5 mg of var, or 50 mg of sil and 10 mg of var. The efficacy for ED and safety of these 2 drugs were evaluated after administration of each drugs at least 2 times. RESULTS: The results showed that the score of international index of erectile function 5 (IIEF5) were elevated from 8.87 +/- 4.10 to 17.24 +/- 6.17 after treatments (p< 0.0001, Student' s t test). The efficacy rates for ED were 81.6% in sil and 81.6% in var, respectively. The adverse reactions rates such as headache, burning, palpitation, etc. were 13.6% in sil and 5.6% in var, which is significantly higher in sil (p = 0.032; chi2 test). These side effects were not serious at all, and there were no cases that gave up to use PDE5 inhibitors because of adverse reactions. According to individual patients experiences, 40.7% of patients preferred sil, 45.4% choose var. In addition, associated effects for quality of life (QOL) of ED patients treated by PDE5 inhibitors were analyzed. The results revealed that encouraging in life 46.5%, rejuvenation feeling 45.1%, self care for their health 28.2%, improvement of depression 12.7%, improvement of voiding dysfunction 5.6%, intimacy with partner 38.0%, good conversation with partner 18.3%, and so on. CONCLUSION: The treatments of ED by sil and var were very effective and safety. Furthermore, associated effects for QOL of ED patients were also improved with these treatments.

BACKGROUND. Among recipients of renal transplants, the incidences of renal cancer and gastrointestinal cancer are higher and that of skin cancer is much lower in Japan than in Europe and North America. METHODS. The risk factors for the development of malignant tumors were examined in Japanese recipients of renal transplants. A total of 556 patients underwent renal transplantation at the Department of Urology, Osaka University Faculty of Medicine between March 1, 1965, and April 31, 2004. Of these patients, 366 were retrospectively studied in whom risk factors potentially related to the development of malignancy could be evaluated on the basis of medical records. The incidence of malignancy, survival rate, and risk factors for malignancy were examined. RESULTS. The overall incidence of malignancy was 6.8% (25/366 patients). Six of the 25 patients with malignancy died of cancer, but there was no correlation between the occurrence of malignancy and the survival rate (P = .8058, log-rank test). A Cox proportional-hazards model identified treatment with tacrolimus (hazard ratio [HR] = 4.376; 95% confidence interval [CI]: 1.647–11.627; P = .0031) and age at transplantation (HR = 1.562; 95% CI: 1.089–2.240; P = .0155) as risk factors for malignancy. CONCLUSIONS. The results of multivariate analysis suggested that age at transplantation and the use of tacrolimus were independent risk factors for the development of malignancy in recipients of renal transplants. Cancer 2007. © 2007 American Cancer Society.

Background: The critical events in the clinical course of prostate cancer are the occurrence of metastasis and the induction of the hormone-refractory status of the disease. In order to investigate the factors responsible for these events, we need appropriate in vivo models. Materials and methods: Orthotopic and intratesticular models were created by the injection of LNCaP cells or PC-3 cells into the prostate or testis of severe combined immunodeficient mice. Results: LNCaP cells in the intratesticular model showed a higher incidence of tumor formation and lymph node metastasis when compared with those in the orthotopic model, while PC-3 cells were highly tumorigenic and metastastic in both models. A high concentration of androgens might play a role in tumor aggressiveness of LNCaP cells, given that enhanced mRNA expressions of integrin αV and vascular endothelial growth factor was induced by dehydrotestosterone administration in vitro. The high expression of metastasis-related genes, including the urokinase plasminogen activator system, metalloproteinases and vascular endothelial growth factor-C, might be attributed to the high metastatic potential in both models. Interestingly, testicular xenografts of LNCaP cells were able to survive on the subcutis back of castrated male mice as well female mice. Conclusions: Intratesticular models of prostate cancer appear to be suitable for studying the mechanisms of metastasis and for evaluating various treatment strategies.

Background: Although a correlation between microvessel density (MVD) and tumor aggressiveness has been established for several malignancies, the data for renal cell carcinoma (RCC) is conflicting. In order to clarify the significance of MVD, we investigated the relationships between MVD and tumor stage, grade, size, occurrence of metastasis and patient survival. Methods: Tumor specimens from 70 patients with primary renal cell carcinoma were examined by immunohistochemical staining for CD34. Results: There was a tendency for MVD to decrease from G1 to G3 tumors or from stage T1 to T3 tumors, although this was not statistically significant. However, the MVD for 56 non-metastatic and 14 metastatic tumors were significantly different (P = 0.005) at 109 ± 67 and 58 ± 35 per ×400 field (mean ± SD), respectively. Microvessel density for 36 large and 34 small tumors was also significantly different (P

We investigated the feasibility and validity of the sentinel lymph node concept for patients with prostate cancer.A total of 24 patients (mean age 68.1 years) with prostate cancer but without detectable distant metastases were enrolled in this study. Radioactive tracer (technetium labeled phytate) was injected into the prostate 5 to 6 hours before surgery. Preoperative lymphoscintigraphy was viewed, and in vivo and ex vivo gamma probing was performed during the surgery, which included backup extended lymph node dissection. Radioactivity of the excised lymph nodes was measured and validated with an autowell scintillation counter.Radioactive positive (hot) nodes were identified in 17 of the 24 (70.8%) patients by lymphoscintigraphy, in 21 of 24 (87.5%) patients by in vivo probing and in 23 of 24 (95.8%) patients by ex vivo probing. On an individual basis the numbers of hot nodes identified by lymphoscintigraphy and in vivo probing were low (40% and 36%, respectively) compared to the high detection rate for ex vivo probing (91%).Although sentinel lymph nodes can be used for prostate cancer, detailed lymph node mapping and extended dissection backup are currently needed. It is also important to establish novel procedures for accurate and complete removal of all hot nodes.

To establish a suitable experimental model of bone and liver micrometastases from human prostate cancer for evaluating antitumor agents.PC-3 cells, an androgen-independent prostate cancer cell line, were inoculated into the chorioallantoic membrane vein of 10-day-old chick embryos (10(6) cells/egg). The polymerase chain reaction product for the human beta-globin gene in chick embryo femur and liver was quantified at various time points after inoculation, when immunohistochemical staining was done for Ki-67 antigen and cytokeratin. The antitumor effect of suramin was evaluated using the model, as was regional blood flow after thallium injection.Micrometastases were identified in bone and liver 1 day after inoculation and grew to form established metastatic foci in all embryos. Suramin showed significant antitumor effect for liver metastases, but not for those in bone where blood flow was relatively low.The chick embryo system provides a highly reproducible model for bone and liver micrometastases from human prostate cancer, suitable for evaluating antineoplastic agents at an early stage of the metastatic process.

Background: Although testicular germ cell tumor is one of the most curable cancers, approximately 20% of advanced cases remain incurable. In this study we investigate factors that may predict a poor response to standard chemotherapeutic regimens and thus allow earlier initiation of more aggressive measures. Methods: We analyzed the records of 79 patients with metastatic testicular germ cell tumors (8 seminomas and 1 1 nonseminomas). Sixteen patients underwent surgical exploration for residual tumors following chemotherapy, and the histological findings on the resulting specimens were correlated with reductions in tumor size observed on computed tomography and with changes in tumor marker levels. Results: Complete necrosis was obtained in 10 of 12 lesions that shrank by at least SO%, while continued existence of teratoma or cancer was confirmed in 9 of 1 1 lesions with smaller size reductions. An initial human chorionic gonadotropin-l) subunit (HCG-P) level more than 100 times the upper limit of normal appeared to predict poor histological response (teratomdcancer) to chemotherapy. Slow fall (prolonged half-life) of tumor markers during chemotherapy also correlated with poor histological response. Conclusion: Factors which predict poor histological response of tumors to chemotherapy include size reduction less than 80%, initial HCG-l) levels more than 100 times the upper limit of normal, and prolonged half-life of tumor markers (placental alkaline phosphatase, a-fetoprotein and HCG-P). Int J Uro! 1998;5:74-79

We report a case of melanotic neuroectodermal tumor that originated in the right epididymis of a 4-month-old Japanese male and review reports of similar cases. Since we could not exclude malignant disease preoperatively, we performed a radical orchiectomy. Histopathological and immunohistochemical studies revealed features characteristic of a melanotic neuroectodermal tumor. Imaging studies showed no distant metastases.

We report two cases of infected nonfunctioning kidney due to ureteropelvic junction (UPJ) stenosis treated by laparoscopic surgery. Patient 1 : A 78-year-old woman was referred to our clinic complaining of left flank pain and high fever up. Asymptomatic UPJ stenosis with mild hydronephrosis was diagnosed 9 years ago at our clinic. Therefore we followed her up with no treatment. Computed tomography (CT) scan revealed left severe hydronephrosis. Antibiotic chemotherapy was performed without percutaneous nephrostomy. Laparoscopic nephrectomy was performed with the resected renal size of 10 cm in greatest diameter and the operative time of 262 min. The pathological diagnosis was atrophic kidney with pyelonephritis. Patient 2 : A 28-year-old man was referred to our clinic complaining of left flank pain and high fever up. CT scan revealed a left severe hydronephrosis due to UPJ stenosis. Following percutaneous nephrostomy,antibiotic chemotherapy was performed. Laparoscopic nephrectomy was performed with the resected renal size of 6 cm in greatest diameter and the operative time of 140 min. The pathological diagnosis was atrophic kidney with pyelonephritis. Laparoscopic nephrectomy for infected nonfunctioning kidney due to UPJ stenosis is feasible and safe. With dense perinephric adhesions and failure to progress,we should consider early open conversion to reduce morbidity.

Retroperitoneal schwannoma is a rare tumor. Only 19 cases have been reported to be treated by laparoscopic surgery. We performed successful laparoscopic excision of retroperitoneal schwannoma using the four-trocar in three patients who had a left retroperitoneal mass. The patients were two women and one man. They were 62, 60 and 57 years old. The tumor was 70, 45 and 50 mm in greatest diameter and operative time was 204, 243 and 254 min. respectively. The pathological diagnosis of the tumor was schwannoma. There was no morbidity or mortality. Preoperative diagnosis of schwannoma is very difficult. However schwannoma is a benign tumor with a good prognosis. This laparoscopic excision for retroperitoneal schwannoma is effective and rather safe.

A 63-year-female was referred to our department for close examination and treatment of a left adrenal tumor found by positron emission tomography and computed tomography. She underwent abdominal total hysterectomy and bilateral salpingo-oophorectomy for uterine leiomyosarcoma 19 years ago. After the operation, she received 2 resections for peritoneal recurrence and 7 resections for pulmonary metastases. Magnetic resonance imaging showed a heterogeneous mass with a diameter of 7 cm at the left adrenal grand. We carried out open adrenalectomy and pathological findings were a metastatic adrenal tumor from uterine leiomyosarcoma. No signs of recurrence or metastasis have been observed for 6 months after the operation.

A 44-year-old man suffered from sleep disturbance, headache, lack of energy and appetite loss. His local doctor recommended he consult our clinic for further examination of late-onset hypogonadism. His aging males' symptoms (AMS) and international index of erectile function (IIEF-5) scores were 62 and 1, respectively. His biochemistry revealed 0.29 mIU/ml luteinizing hormone (LH), 1.36 mIU/ml follicular stimulating hormone (FSH), 0.16 ng/ml total testosterone (TT) and＜0.6 pg/ml free testosterone (FT). Male hypogonadotropic hypogonadism was suspected from these results, He was then referred to a neurosurgeon for discrimination of intracranial disease where magnetic resonance imaging (MRI) revealed multiple intracranial tumors. An open brain biopsy was performed, and germinoma was diagnosed. After 4 courses of anti-cancer chemotherapy, complete remission was achieved. He was followed up endocrinologically by administration of testosterone injections along with other endocrinology replacement treatments. However, MRI 3 months later revealed tumor recurrence in the left lateral ventricle, and he has been receiving radiation therapy.

among men with and without diabetes mellitus Men with ED Progressed beyond first line therapy Patient Status N n % Odds Ratio (95% CI) Second line therapies* Non-diabetic 11707

Introduction: The aim of this study is to clarify the relationship of erectile dysfunction (ED) and diabetes mellitus (DM) parameters (referred to with ‘1’), including peripheral neuropathy (referred to with ‘2’). Methods: (1) The DM parameters including age, serum levels of blood sugar, hemoglobin A1c, duration of DM and number of DM complications were obtained from 145 patients at a general DM clinic. (2) The peripheral neuropathy examinations by vibration perception threshold (VPT) and Achilles tendon reflex were performed in 97 DM patients. Erectile functions in DM patients were evaluated by the International Index of Erectile Function (IIEF 5). The DM patients’ parameters were compared with the IIEF 5 scores. Results: (1) The data showed IIEF 5 scores were significantly correlated with patient age, duration of DM and number of DM complications. (2) IIEF 5 scores were significantly correlated with VPT time. Furthermore, multiple regression analysis revealed that patient age and VPT time were independent risk factors for predicting ED in DM patients. Conclusions: The severity of ED in DM patients depended on age, duration of DM, number of DM complications and VPT. Significantly, the age of DM patients and the measurement of VPT are considered to be simple and useful indicators to diagnose ED in DM patients.

A 31-year-old female presented to a gynecological clinic complaining of amenorrhea and virilism over a 2-month period. Blood tests revealed high serum total testosterone and free testosterone levels. A left adrenal tumor was identified following computed tomography and she was referred to our clinic where a laparoscopic left adrenalectomy was performed. The tumor weighed 98 g and the pathological diagnosis according to Weiss’ criteria was adrenocortical carcinoma. The post-operative course was uneventful; her serum free testosterone level normalized and regular menstruation was observed 1 month post-operatively. The patient became pregnant 1 year later, resulting in the normal delivery of a girl.

Patients with late onset hypogonadism (LOH) also suffered from lower urinary tract symptoms (LUTS) and LOH symptoms. The objects of this study are to evaluate the efficacy of testosterone replace therapy (TRT) by testosterone ointment (Glowmin: GL) for LUTS in LOH patients.The Aging Male Symptom (AMS) scale, Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey (SF-36), International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS) were obtained from patients with LOH. A total of 41 patients with LOH have been treated with TRT using 6 mg/day of GL for 3 months. Serum free testosterone levels (FT) and these four scores were compared before and after TRT.Serum FT levels and the scores for the four parameters of AMS, six of eight domains in SF-36, IIEF-5 and total IPSS improved significantly after 3 months TRT. In addition, all IPSS domains also improved significantly, and voiding disturbance seems to have improved more than storage disturbance (P = 0.0280 vs. 0.0483).TRT by administration of GL is considered to be effective in the improvement of not only ED and LOH symptoms, but also LUTS (especially voiding disturbance) of patients with LOH.

A 43-year-old woman was referred to our clinic for evaluation of a left retroperitoneal mass. She presented to our internal medicine department complaining of back pain. Computed tomography (CT) scan revealed a left retroperitoneal mass 55 mm in size in the hilum of the left kidney. Enhanced CT scan and magnetic resonance imaging (MRI) disclosed a poorly staining mass. Metaiodobenzylguanidine scintigraphy demonstrated no accumulation in the mass; moreover, endocrinologic examination was normal. Laparoscopic resection of the left retroperitoneal tumor was attempted; however, strong adhesion between the tumor and the left renal vein was encountered. Thus, left nephrectomy after open conversion was performed. Histological findings indicated leiomyosarcoma originating from the left renal vein. The postoperative course has been uneventful; neither recurrence nor metastasis is evident 2 years postsurgery.

A 67-year-old man was referred to our clinic with a complaint of macroscopic hematuria. He had been treated for schizophrenia in a psychology ward. Computed tomography (CT) scan revealed a left renal tumor 7 cm in size, well enhanced in early phase. Doppler ultrasonography indicated hypervascular left renal tumor. Laparoscopic radical left nephrectomy was performed under the diagnosis ofrenal cancer. Histopathlogical results showed a renal solitary fibrous tumor (SFT) with a hemangiopericytoma-like pattern. Renal SFT is an uncommon tumor. The present case is the 11th reported case of SFT with hemangiopericytoma-like pattern in the Japanese literature.

A 19-year-old male, who had undergone bilateral orchiopexy at 5 years of age in the Department of Pediatric Surgery, was referred to our clinic presenting with bilateral small testes. Bilateral testis volume was 4 ml involving a small penis and scant pubic hair per Tanner Stage 2. Serum luteinizing hormone, follicle stimulating hormone and testosterone levels were low. Results of hormonal loading tests, including luteinizing hormone-releasing hormone (LH-RH) and human chorionic gonadotropin (HCG), were positive. Brain computed tomographic scan revealed no abnormal findings. The diagnosis of male hypogonadotropic hypogonadism was rendered based on these data. Administration of LH-RH for 1 year was ineffective. Subsequently, HCG and human menopausal gonadotropin (HMG) treatments were initiated. The symptoms of male insufficiency improved; moreover, sperm formation was apparent following HCG and HMG treatments. The patient has received HCG and HMG injections for eight years; furthermore, his wife delivered a boy consequent to the first intracytoplasmic sperm injection.

The most basic treatment for late-onset hypogonadism (LOH) is hormone replacment therapy (HRT). In Japan, intra-muscular injection of testosterone (T) has been used for LOH treatment as HRT. Testosterone ointment (Glowmin) has been available for HRT from 1965 as an over-the-counter drug, and the profile of serum T levels and efficacy of testosterone ointment for LOH patients has been reported. In this study, we analyzed the relationship between the efficacy of testosterone ointment and LOH severity. Fifty LOH patients were treated with 6 mg of testosterone ointment per day. After 12 weeks of treatment, they were divided into 2 groups according to the severity of their LOH, serum total T and free T levels, measured by such means as total aging males' symptoms (AMS) score. The improvements of total AMS score, international index of erectile function 5 score and MOS 36-Item Short-Form Health Survey (SF-36) score were observed and analysis of variation was performed. Results showed that the symptoms in the more severe patients had a total AMS score improvement in 4 domains, AMS (psychological), SF-36 body pain (BP), social function (SF), role-emotion, compared to patients with slight LOH. While patients with normal serum T levels felt BP improvement as opposed to patients with low serum T levels, there was no significant difference in the other domains. In conclusion, testosterone ointment is considered to be effective in improving several elements of AMS and SF-36 in patients with a high AMS score.

The role of step section and immunohistochemistry for diagnosing sentinel node micrometastases and the sentinel node concept in patients with prostate cancer was investigated. In patients administered neoadjuvant hormone therapy its influence on the sentinel node concept and metastasis diagnosis was also investigated.Of 62 patients without metastasis enrolled in our study 42 were eligible for analysis. The prostate was injected with the radioactive tracer (99m)technetium phytate 5 to 6 hours before surgery. A planar image and a fusion image with x-ray computerized tomography and single photon emission computerized tomography were obtained 3 hours after tracer injection. Extended lymph node dissection and lymphatic mapping were performed to verify the sentinel node concept. Lymph node metastasis was histologically confirmed by routine hematoxylin and eosin, and thereafter by immunohistochemistry using 250 mum step-sectioned slides.The mean number of dissected lymph nodes was 26.3 per patient. Hot nodes were noted in 41 of 42 patients. The sensitivity and specificity of hot node prediction of lymph node metastasis were 92.3% and 100%, respectively. On routine hematoxylin and eosin examination lymph node metastases were found in 4 of 27 patients with and in 4 of 15 without neoadjuvant hormone therapy. Step section and immunohistochemistry identified micrometastasis in 5 more patients with neoadjuvant hormone therapy.The validity of the sentinel node concept in conjunction with the detection of micrometastases was considered to be high. Furthermore, it was suggested that the efficacy of metastasis diagnosis may also be enhanced, especially in patients receiving neoadjuvant hormone therapy.

A sentinel node (SN) validation study using a radioactive tracer and back-up extended pelvic lymph node (LN) dissection was performed in 40 patients with non-metastatic prostate cancer (PCa). The results of the study were favorable with sensitivity, specificity, and accuracy of SN biopsies revealed 90%, 100% and 97.5%, respectively. Based on our promising results to date, we examined the utility of SN navigation surgery (SNNS) in patients with LN metastasis probability of 10% or less on Partin tables. Endoscopic mini-laparotomy surgery was applied to our SN biopsies in 9 patients with clinically localized PCa. SNs were successfully resected in 7 of these patients. Endoscopic minilaparotomy SNNS is a less invasive form of radical surgery for prostate cancer with accurate diagnosis of LN status.

Background: Although the aim of chemosensitivity tests is to predict the efficacy of anticancer agents for individual patients, no generally accepted assay has been established. Methods: A chemosensitivity test was conducted for solid tumors with an organ culture system using collagen gel matrix (CGM). Seventy-five samples of transitional cell carcinoma (TCC), 20 of germ cell tumor (GCT) and 13 of renal cell carcinoma (RCC) were used for the chemosensitivity test, and 20 patients were treated with anticancer drugs on the basis of the test results. Results: Positive rates of anticancer drugs for the 75 TCC samples were 64.9% for carboplatin, 63.4% for cisplatin, 32.1% for etoposide, 19.7% for THP-adriamycin, 16.7% for vinblastine, and 12.3% for methotrexate, indicating that positive rates of the latter three agents consisting of an MVAC regimen were unexpectedly low. The GCT had higher positive rates than the other cancers while RCC had the lowest. In 20 eligible patients (seven patients with bladder tumors and 13 with GCT), the true positive and true negative rates were 42% (5/12) and 75% (6/8), respectively, and the sensitivity and specificity were 71% (5/7) and 46% (6/13), resulting in a 55% (11/20) accurate predictive value. Conclusion: Although predictive accuracy was moderate when combination chemotherapy was used, information about chemosensitivity may have some beneficial effect on the treatment of patients with invasive bladder cancer or advanced GCT, because insensitive drugs detected by the test could be deleted or replaced with more sensitive ones.

Background: The present study was conducted to investigate how patients with clinically localized prostate cancer were treated in the Hokuriku District, Japan. Methods: Medical records of 536 patients with stage B prostate cancer were retrospectively reviewed. The patients were diagnosed and treated at four university hospitals and 32 collaborating hospitals in the Hokuriku District. Results: Because their medical records were incomplete and/or they not available for follow up, 79 cases were excluded from this study. Conservative treatment with hormone therapy was used for 248 cases. Radical prostatectomy was performed in 199 cases, only 27 of whom underwent surgical monotherapy. There was no significant difference in disease-specific survival rates between the hormone (69.0%) and surgery group (83.2%) after 110 months. Results of the analysis of disease-specific survival rates according to histologic grade showed that patients with poorly differentiated cancers treated with hormone therapy were the only subset with significant differences when compared against the other patients. Conclusion: The value of prostatectomy alone or added was marginal in terms of survival. Only patients with poorly differentiated cancer might benefit from prostatectomy.

Twenty-three patients (6 men and 17 women) with renal angiomyolipoma (AML) were analyzed. They were divided into two groups; 9 patients in the operated group and 14 patients in the surveillance group. The operations for AML were performed on 3 patients suspected of having renal cancer or 6 patients with an AML more than 5 cm in size who had some symptoms as a result of the presence of the tumor. The patients in the surveillance group had tumor less than 4 cm in diameter, and did not have any symptoms. No changes in tumor size were observed during the intervals between observation checkups. The male to female ratio, the average age and the location of AML were not significant in either group. However, the tumor size was significantly larger in the operated group. Thus, the tumor size is considered to be an important factor when deciding the necessity of surgical treatments for AML. Pre-operative diagnosis and treatment strategies, including thin-section computed tomography and selective arterial embolization for AML were discussed.

A 55-year-old man with prostate cancer received a total prostatectomy. Two days after the operation, he suffered from high fever and shaking chilliness, followed by skin eruption, hypotension, diarrhea and chest pain. The results of blood bacterial culture and endotoxin were negative. Toxic shock syndrome was suspected, and the administration of vancomycin (VCM) and continuous hemodialysis-filtration (CHDF) were performed. The steroid pulse therapy for adult respiratory distress syndrome (ARDS) and the treatments for DIC were also done, and they were effective. The desquamation of the extremity was observed on 10 days after the operation. MRSA was finally identified from pus discharge of the operation wound 13 days after the operation. The prevention and treatments for toxic shock syndrome were discussed.

To evaluate the ability of an anti-placental alkaline phosphatase (PLAP) monoclonal antibody (MAb) to localize to PLAP-expressing tumors, we established a model of testicular tumor with metastasis to lymph nodes and liver in severe combined immunodeficient (SCID) mice. 131I-labeled or 125I-labeled MAb was simultaneously administered via the intravenous or lymphatic route, respectively. Preferential accumulation of MAb in PLAP-expressing tumors at primary as well as metastatic sites was demonstrated. The percentage of the injected dose of MAb found in the tumor was generally higher when MAb was administered intravenously. Identical tumor/blood ratios were found with the two routes of administration. These data suggest that intravenous administration of a radiolabeled MAb is superior to lymphatic administration for tumor imaging and radioimmunotherapy.

To establish a prostate cancer model expressing prostate-specific antigen (PSA) with metastatic potential, LNCaP or PC-3 cells were inoculated into the testis of SCID mice, resulting in a 100% rate of tumor formation. A significant increase in serum PSA was found in mice with LNCaP xenografts. Circulating tumor cells and micrometastases to organs such as lung, liver, spleen, and omentum were detected for both cell lines by PCR of the human beta-globin gene. Lymph node metastases occurred more frequently with PC-3 than LNCaP cells. This is the first report showing stable growth of LNCaP cells in mice with metastases to the regional lymph nodes. This model of prostate cancer should help to assess treatment strategies targeting PSA.