前立腺癌における血清γ-セミノプロティンの測定

前立腺癌の新しいマーカーとして, γ-セミノプロテイン(γ-Sm)と前立腺性酸性ホスファターゼ(PAP)とを比較評価した.未治療前立腺癌におけるγ-SMおよびPAPのsensitivityは, それぞれ81%, 67%であった.γ-Smはすべての病期で前立腺肥大症と比較して陽性率が高かった.前立腺癌ではγ-SmとPAPは相関を示さなかった.γ-SmとPAPを同時に測定することにより, 感度が上昇した.γ-SmおよびPAPのspecificityはそれぞれ87%と90%であった.内分泌療法を施行した病期D2において, γ-SmはPAPよりもより多く正常化した.以上より, γ-Smは前立腺癌のもう1つの有用なマーカーであるといえるSerum gamma-seminoprotein (gamma-Sm) was evaluated as a new marker for prostatic cancer in comparison with prostatic acid phosphatase (PAP). The sensitivity of gamma-Sm and PAP for untreated prostatic cancer was 81% and 67%, respectively. gamma-Sm showed a higher positive rate over all stages than in benign prostatic hypertrophy (BPH). There was no correlation between gamma-Sm and PAP in prostatic cancer. Improved sensitivity was obtained by simultaneous measurement of gamma-Sm and PAP. Specificity of gamma-Sm and PAP for BPH was 87% and 90%, respectively. gamma-Sm normalized after endocrine therapy for stage D2 more often than did PAP. These results indicate that gamma-Sm is another useful marker to evaluate prostatic cancer

Hormonal therapy for prostate cancer: Current topics and future perspectives: Editorial

金沢大学附属病院泌尿器

Five-year quality of life assessment after carbon ion radiotherapy for prostate cancer

The aim of this study was to prospectively assess 5-year health-related quality of life (HRQOL) of patients treated with carbon ion radiotherapy (C-ion RT) for clinically localized prostate cancer. A total of 417 patients received carbon ion radiotherapy at a total dose of 63–66 Gray-equivalents (GyE) in 20 fractions over 5 weeks, and neoadjuvant and adjuvant androgen deprivation therapy (ADT) were administered for intermediate and high-risk patients. A HRQOL assessment was performed at five time points (immediately before the initiation of C-ion RT, immediately after, and at 12, 36 and 60 months after completion of C-ion RT) using Functional Assessment of Cancer Therapy (FACT) questionnaires. FACT-G and FACT-P scores were significantly decreased; however, the absolute change after 60 months was minimal. The transient decreases in the Trial Outcome Index (TOI) score returned to their baseline levels. Use of ADT, presence of adverse events, and biochemical failure were related to lower scores. Scores of subdomains of FACT instruments indicated characteristic changes. The pattern of HRQOL change after C-ion RT was similar to that of other modalities. Further controlled studies focusing on a HRQOL in patients with prostate cancer are warranted

Significant impact of biochemical recurrence on overall mortality in patients with high-risk prostate cancer after carbon-ion radiotherapy combined with androgen deprivation therapy

BACKGROUNDWhether biochemical recurrence (BR) is a significant predictive factor of mortality after definitive radiation therapy for prostate cancer remains unknown. The aim of the current study was to investigate the relation between BR and overall mortality (OAM) in high-risk prostate cancer patients who were treated with carbon-ion radiotherapy (CIRT) and had long-term follow-up in 2 prospective trials.METHODSIn the 2 phase 2 clinical trials, which involved 466 prostate cancer patients who received 63.0 to 66.0 Gy of CIRT (relative biological effect) in 20 fractions between 2000 and 2007, 324 patients who were deemed to be at high risk on the basis of the modified D\u27Amico classification criteria and received CIRT along with androgen-deprivation therapy (ADT) were examined. The OAM rate was adjusted for the ADT duration, and multivariate analyses using a Cox proportional hazards model were performed for OAM with BR as a time-dependent covariate.RESULTSThe median follow-up period was 107.4 months, and the 5- and 10-year OAM rates after adjustments for the ADT duration were 7.0% (95% confidence interval [CI], 4.0%-9.4%) and 23.9% (95% CI, 16.4%-26.2%), respectively. A multivariate analysis revealed that the presence of BR (hazard ratio, 2.82; 95% Cl, 1.57-5.08; P = .001) was one of the predictive factors for OAM. On the other hand, the duration of ADT had no impact on OAM.CONCLUSIONSBR after CIRT combined with ADT is an independent predictive factor for OAM in high-risk prostate cancer patients. The results of this study could be applied to other high-dose radiation therapies

陰嚢線維性偽腫瘍の1例

32歳男性.患者は陰嚢の無痛性腫瘤を自覚するも放置していたが, 数ヵ月前より腫瘤の増大を認めたため著者らの施設へ受診となった.精索の良性腫瘍を疑い摘除術を施行したところ, 術中所見として陰嚢固有鞘膜内面に多発する結節状腫瘤を認めた.主病変と思われる3cm大の腫瘤を摘除し術中迅速病理にて悪性所見は否定され, そののち精巣, 精巣上体, 精管を温存し可及的に腫瘤を摘除した.腫瘤は多発性結節状, 表面平滑, 弾性硬, 割面は白色充実性であった.病理組織学的には線維性偽腫瘍と診断された.腫瘤は線維性組織よりなりリンパ球や形質細胞の浸潤が見られた.悪性細胞は認められなかった.尚, 線維性偽腫瘍は炎症や外傷を契機に反応性肉芽腫性増殖により形成される腫瘤性病変で, 肺や消化器, 皮膚など全身に認められる疾患であるが陰嚢内に発生する腫瘤性病変としては比較的稀であるといえるA 32-year-old man presented with a complaint of painless palpable mass of the left scrotal content. Based on the preoperative diagnosis of scrotal or spermatic cordal benign tumor, local excision was performed. The histological diagnosis was scrotal fibrous pseudotumor. In Japan, only 35 cases of fibrous pseudotumor of the scrotum have been reported including our case. Orchiectomy was performed in 15 cases. Fibrous pseudotumor is a benign fibroproliferative lesion with dense hyalinization and sometimes focal calcification. It may be induced by previous intrascrotal inflammatory events such as epididymitis, an infected hydrocele, prior surgery or trauma. Although a relatively rare disease, a fibrous pseudotumor should be considered in the differential diagnosis of testicular and testicular tunica tumors. Our case was of a benign pseudotumor and orchiectomy could have been avoided

The continuing role of PSA in the detection and management of prostate cancer

Despite being used extensively for the diagnosis and management of prostate cancer, prostate-specific antigen (PSA) testing remains controversial. Doubts have been raised over the continued use of PSA in the detection of clinically significant prostate cancer because many men now present with early-stage, small-volume tumours. This article examines the limitations of using a single PSA value in diagnosis and discusses alternative approaches to PSA testing, in particular PSA velocity and PSA doubling time, which are now emerging as valuable pretreatment disease predictors. A clinical scenario is also presented to illustrate the use of PSA kinetics in identifying candidates for biopsy. (c) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved

Intermittent Androgen Suppression: Estimating Parameters for Individual Patients Based on Initial PSA Data in Response to Androgen Deprivation Therapy.

When a physician decides on a treatment and its schedule for a specific patient, information gained from prior patients and experience in the past is taken into account. A more objective way to make such treatment decisions based on actual data would be useful to the clinician. Although there are many mathematical models proposed for various diseases, so far there is no mathematical method that accomplishes optimization of the treatment schedule using the information gained from past patients or "rapid learning" technology. In an attempt to use this approach, we integrate the information gained from patients previously treated with intermittent androgen suppression (IAS) with that from a current patient by first fitting the time courses of clinical data observed from the previously treated patients, then constructing the prior information of the parameter values of the mathematical model, and finally, maximizing the posterior probability for the parameters of the current patient using the prior information. Although we used data from prostate cancer patients, the proposed method is general, and thus can be applied to other diseases once an appropriate mathematical model is established for that disease