Recent progressions in stem cell research: breakthroughs achieved and challenges faced.

Stem cell studies have been conducted to study characteristics of stem cells, to develop better techniques for patient-specific stem cell lines generation, and to explore the therapeutic potential of stem cells. Techniques that enable efficient generation of new stem cell lines would facilitate research and allow generation of patient-specific stem cell lines for transplantation therapy. Somatic-Cell Nuclear Transfer (SCNT), which involves injection of donor cell nucleus into enucleated ovum, is the standard technique for new embryonic stem (ES) cell lines generation; presently its efficiency is low. A newer technique, pluripotent stem cell induction, reprograms somatic cells into induced pluripotent stem (iPS) cells by introducing certain factors into somatic cells. While certain adult stem cell treatments have been investigated on human participants, most ES cell or iPS cell treatments were still experimented on animal models. Recently, therapeutic potential of stem cell for several disorders was demonstrated. Researchers demonstrated stem cell's potential for treating hematologic disorders by correcting sickle cell anemia in rat model with iPS cells. Its potential role in treating cardiovascular disorder was demonstrated as injection of damaged rat heart with human ES cells derived cardiomyocyte plus "prosurvival" cocktail improved heart function. It might also treat nervous system disorders; injected into brain, ES cells derived neurons replace some loss cells in stroke rats and iPS cells derived neurons improved Parkinsonian syndrome in rats. Progress was also seen in other aspects of regenerative medicine. To overcome controversies caused by embryo destruction for obtaining ES cells, single blastomer stem cell derivation, Cdx2-inactivation, and parthenogenesis were proposed. All ES cell, iPS cell, and adult stem cell research should be continued with support from all sides.

Metastasis of testicular carcinoma in the inguinal region.

A standard protocol for the management of inguinal metastasis from testicular cancer still has not yet been established. Metastasis of testicular cancer to inguinal lymph node rarely occurs, particularly in patients without any prior surgery in inguinal and scrotal region. Daugaard reported 2% incidence of inguinal metastasis for stage 1 testicular cancer in 5-year period. We reported a case of inguinal metastasis from residual testicular cancer with a large size of mass. The case had also been counted as advanced stage since it had further metastasis to the lungs. For this case, surgical treatment of residual tumor excision had been performed prior to the chemotherapy considering a quite large size of tumor mass, which may easily bleed and causing anemia to the patient. Furthermore, we considered that chemotherapy treatment prior to surgical excision will only provide partial effect on the tumor. After the surgery, a 4-cycle combined chemotherapy was administered despite the delay of chemotherapy treatment resulting in residual mass in inguinal region. In fact, the post-surgical chemotherapy treatment in this case has demonstrated relatively good response.

Comparison of efficacy between oral morphine sulphate and diclofenac suppository for analgesia during transrectal ultrasound-guided prostate biopsy.

AIM: to prospectively evaluate degree of pain during transrectal ultrasound-guided prostate biopsy after receiving analgesics treatment of oral morphine sulphate compared to suppository sodium diclofenac. METHODS: the study group comprised 60 consecutive men subjects (median age 67.8 years) undergoing transrectal prostate biopsy. They were randomized into two groups; group 1 received oral analgesic of morphine sulphate 10 mg and group 2 received suppository analgesic of sodium diclofenac 100 mg 1 hour before biopsy. Biopsy was taken using a gun biopsy 18 G needle with total 10 biopsies (5 at each lobe). Immediately after the procedure patients were asked to indicate the degree of pain based on visual analogue scale (VAS) from 0 (no pain) to 10 (unbearable pain) scale. RESULTS: the mean VAS score was 3.83 in oral morphine sulphate group and 4.10 in sodium diclofenac group. According to subdividing of VAS score, low degree of pain was found in 17 patients (56.7%) of morphine sulphate group and in 14 patients (46.7%) of sodium diclofenac group. There was no statistically significant difference in pain between the two groups (P>0.05). CONCLUSION: oral analgesic of morphine sulphate 10 mg has the same efficacy with sodium diclofenac suppository 100 mg to decrease pain during transrectal prostate biopsy.

The 5th Conference on Asian Trends in Prostate Cancer Hormone Therapy.

The Conference on Asian Trends in Prostate Cancer Hormone Therapy is an annual forum for Asian urologists now in its 5th year. The 2006 conference, held in Bali, Indonesia, was attended by 27 leading urologic oncologists from China, Indonesia, Japan, Korea, Singapore, and Taiwan and featured a packed program of presentations and discussions on a wide range of topics such as relationships among clinicians and the newly opened Asia Regional Office for Cancer Control of the International Union Against Cancer (UICC), detection rates of prostate cancer by biopsy in each of the 6 Asian countries, and favored treatment modalities for hormone-refractory prostate cancer (HRPC) in each country. The first session of the conference kicked off with a keynote lecture entitled "Activities of the UICC ARO". UICC's new office will be the nerve center for its activities in the Asia region. Along with the Asian Pacific Organization for Cancer Prevention (APOCP), UICC aims to shift the focus of attention to cancer control. As such APOCP's long-running publication the APJCP is to be re-launched as the Asian Pacific Journal of Cancer Control. Although UICC is primarily concerned with cancer, several risk factors for cancer are common also to other non-communicable diseases such as diabetes and heart disease, and an important strategy is to implement measures to control these various pathologic conditions as a whole. Apart from contributing to an Asian prostate cancer registry the UICC-ARO will provide training courses, working groups, and assistance in collecting and processing data. The keynote lecture was followed by a roundtable discussion on possible ways in which clinicians from each Asian country can work with UICC. A number of suggestions were put forth including better registration, epidemiology research, possible implementation of UICC prostate cancer guidelines, early detection and screening, and roles of diet and phytotherapy. The underlying reasons for the large but dwindling difference in incidence rates of prostate cancer in various regions of Asia should be studied while the opportunity lasts. Session 2 was devoted to 6 presentations on detection rates by biopsy in each country. Although biopsy is the gold standard for detecting prostate cancer in most areas, indications for conducting biopsy are different in each country. For example, in Indonesia doctors may use PSAD 0.15 as the cutoff level. TRUS-guided biopsy is most widely used in Asian countries. Traditional sextant biopsy is often performed, although multiple-core biopsy is commonly available and associated with better detection rates, especially in men with large prostate volume. Positive DRE, high PSA, and older age were identified as factors associated with high biopsy detection rate, although elevated PSA has limited specificity. First biopsy in men with elevated PSA had a positive detection rate of approximately 30% in all countries. Community-based screening in some countries has an overall detection rate of approximately 1%.The favorable treatment modality for HRPC was the subject of the final session. First priority for doctors in all 6 countries is to maintain serum testosterone at castration level. Many therapeutic options are available, from cytotoxic drugs to traditional herbal medicines Chemotherapeutic agents such as estramustine, docetaxel, cyclophosphamide, and mitoxantrone are often given to patients with HRPC although not all are available in every country. Prednisone and dexamethasone are used for secondary hormonal therapy. External beam radiotherapy, radioisotopic drugs such as strontium 89, and bisphosphonates are common choices to control bone pain.

Prostate cancer control--aims of the UICC Asia Regional Office Consortium.

Cancer of the prostate remains at relatively low incidence in Asia but rates are increasing rapidly in some countries and specific populations so that measures for control need our attention. Little is known about risk factors, although vegetables and phytoestrogens may be protective and fat, meat and dairy products may increase the risk. Physical exercise may have preventive effects, while tobacco and alcohol appear to have no consistent relationship. The lack of clear lifestyle targets means that emphasis needs to be placed on screening for various prostate specific antigen parameters and clinical treatment, whether hormonal, radio or surgical, alone or in combination. While there is a massive literature for the Western world, the limited literature available for Asia means that cooperation to obtain a standardized data base is a high priority if the most effective measures for the specific populations of Asian countries are to be identified and put into practice.

Ability of prostate specific antigen to predict bone scan result in prostate cancer patients.

The objective of this study is to assess the relation between serum prostate specific antigen (PSA), clinical tumor stage, tumor grade, and bone scan result in an attempt to seek the ability of serum PSA to predict bone metastases in newly diagnosed prostate cancer patients. A retrospective analysis was conducted on clinical files of prostate cancer patients which were diagnosed in our institutions between January 1995 and December 2003. Patients on which initial serum PSA were obtained after urethral manipulation or after receiving therapy were excluded. The results of bone scans were related to levels of serum PSA, clinical tumor stage, and tumor grade. Of 103 patients who were included in this investigation, 61 patients (59.2%) had a positive bone scan and 42 patients (40.8%) had a negative bone scan with mean PSA value 471.13 ± 853.34 ng/ml and 61.00 ± 124.47 ng/ml respectively (p < 0.05). The risk of having a positive bone scan increased with advancing serum PSA levels, clinical tumor stage, and tumor grade (p < 0.05). Using receiver operating characteristic curves, PSA had the best correlation with bone scan results (the area under curve was 0.812). Bone scan results were predicted best by the combination of serum PSA, clinical tumor stage, and tumor grade. Bone scans were positive in 5 of 19 patients with PSA level < 10 ng/ml. None of 8 patients with PSA levels < 10 ng/ml, clinical tumor stage T1 or 2 and tumor grade 1 or 2 had a positive bone scan. In conclusion, we suggest that routine bone scan examination may not be necessary in patients with newly diagnosed, untreated prostate cancer, who have serum PSA level < 10 ng/ml with clinical tumor stage T1 or 2 and tumor grade 1 or 2.