Investigation of risk factors for prostate cancer patients with bone metastasis based on clinical data.

It has not yet been determined whether certain types of prostate cancer with bone metastasis (M1b PC) are associated with a poor outcome. The present study retrospectively assessed the potential significance of various clinical data in predicting the outcome of M1b PC. The subjects were 104 patients who attended our hospital and received a diagnosis of M1b PC between January 1998 and December 2006. The age of the subjects ranged from 51 to 91 years (median 74). The observation period ranged from 4 to 122 months (median 43). The parameters investigated were T classification, N classification, Gleason score (GS), pre-treatment prostate-specific antigen (PSA) level, extent of disease (EOD) grade, alkaline phosphatase (ALP), lactate dehydrogenase (LDH), calcium and hemoglobin (Hb) levels and platelet count. The 5-year cause-specific survival rate was 56.6% and the 10-year cause-specific survival rate was 34.9%. Log-rank test and Cox univariate analysis identified the following factors with statistically significant differences: pre-treatment PSA level ≥192, N1, GS ≥8, EOD grade 3+4, high LDH, high ALP and low Hb. Multivariate Cox proportional hazard analysis identified the factors GS ≥8 and high LDH with significant differences. The hazard ratio was 4.967 and 2.728, respectively, and the probability value (P) was 0.029 and 0.004, respectively. When the subjects with GS ≥8 and high LDH were classified as the high-risk group, the 5-year cause-specific survival rate was 24.6%. The outcome was significantly poorer in this group (P<0.0001) than in the other group, which had a 5-year cause-specific survival rate of 67.7%. The present study showed that patients with M1b PC with GS ≥8 and high LDH have a very poor outcome and thus should be treated as a high-risk group requiring close follow-up.

Potential for molecular targeted therapy of HER-2/neu for invasive bladder cancer: examination of gene amplification by fluorescence in situ hybridization.

Analysis of HER-2/neu gene amplification by fluorescence in situ hybridization was performed in 40 patients with invasive bladder cancer in order to evaluate the potential for molecular targeted therapy of HER-2 as a tailor-made treatment for patients with invasive bladder cancer. This study included 40 patients seen at the Aichi Medical University Hospital from January 2001 to December 2004 and were pathologically diagnosed with invasive transitional cell carcinoma of the bladder (pT2-pT4). The PathVysion kit was used to evaluate the status of HER-2/neu gene amplification, and a signal ratio > or =2.0 was considered positive for HER-2/neu gene amplification. In primary foci 5 patients (12.5%) were positive for HER-2/neu gene amplification. According to the classification of grade and stage, no statistically significant difference was observed. Lymph node metastasis was found in 10 patients, and 3 patients (30%) were positive for HER-2/neu gene amplification. In the patients with HER-2/neu gene-amplified metastatic lymph nodes, primary foci were also positive for gene amplification, showing a statistically significant difference. This study indicates that 12.5% of patients with invasive bladder cancer may benefit from molecular targeted therapy of HER-2, and that molecular targeted therapy can be expected to be effective even for patients with lymph node metastases as long as their primary foci are positive for HER-2/neu gene amplification.

Clinical experience of ureteroscopic treatment for ureteral transitional cell carcinoma using the Holmium:YAG laser.

The standard operative method for ureteral transitional cell carcinoma is nephrouterectomy with partial bladder excision of the ureteral orifice of the affected bladder. However, a conservative kidney operation and endoscopy are now being performed for low grade, low stage cases. We performed an operation using a Holmium: YAG laser, and examined its safety and efficacy. The patients were four men, and 1 woman aged from 68 to 87 (mean 78) years. There were 2 imperative cases (1 solitary kidney case, and 1 high-risk case), and 3 elective cases. The tumor size ranged from 8 to 25 (mean 14) mm. Urinary cytology was negative in all cases, and the tumors were pathologically diagnosed as grade 1 atypism on biopsy. A VersaPulse Select 80 laser generator, a 365 micro m SlimLine laser fiber, and an 8F rigid ureteroscope were used. A 6F double J catheter was indwelt for three weeks after the surgery. The pulse energy setting was 0.5-1.0 J, and the frequency was 10 Hz. The total amount of energy was 1.02-11.22 (mean 3.56) kJ, and the operation time was 20-97 (mean 50) min including the time for indwelling a ureteral stent. Neither urinary tract perforation nor ureteral stricture caused by the laser irradiation were observed. The patients have been followed by examining urine cytology once a month, and cystoscopy, retrograde pyelography, and urethroscopy once every 3 months. No recurrence has been observed as of 4-20 (mean 10) months postoperatively. Transurethral endoscopic resection using a Holmium: YAG laser is a safe and effective therapy for ureteral transitional cell carcinoma while preserving kidney and a good treatment outcome can be expected even in elective cases.

[A case of subcutaneous metastases from bladder cancer after radical cystouretherectomy].

A case of transitional cell carcinoma (TCC) of the bladder metastasizing subcutaneously to the right lower abdomen and to the left back approximately 2 years after radical cystouretherectomy is reported. A 65-year-old male underwent radical cystouretherectomy with the creation of ileal couduit after preoperative intraarterial chemotherapy and radiotherapy. At the out patient clinic two years postoperatively, a subcutaneous tumor was palpated in the right lower abdomen and the left back. The tumors were removed and histopathologically diagnosed as subcutaneous metastases of TCC. The patient received three courses of postoperative systemic chemotherapy. At 15 months after the last chemotherapy, the patient remains free of metastases and relapse.