What Affects the Visualization of Prostate Cancer Using MRI in Patients Treated with RARP?

Aim：To assess the index lesions（the largest and clinically significant ones）in cases of surgically confirmed prostate cancer（PCa）using a multi-parametric MRI at 3 tesla and to evaluate the relationships between the clinical-pathological features of index PCas and cancer visualization. Materials and Methods：This retrospective study included 67 patients who had undergone roboticassisted radical prostatectomy. Two radiologists reviewed the MRIs（axial and coronal T2-weighted imaging, diffusion-weighted imaging（DWI）with apparent diffusion coefficient mapping and dynamic contrast enhancement MRI（DCEI））. The patients were divided into 4 groups as follows：detected on all 3 sequences（A）, on 2 of 3 sequences（B）, on 1 of 3 sequences（C）, and on none of them（D）. In all groups, all PCa characteristics were assessed, including the PSA level, Grade Group（GG）based on the Gleason score（GS）, the D’Amico criteria, and the maximum tumour length（TL）of the biopsy specimen. Results：Of the 67 patients, 16 were high-risk according to the D’Amico criteria, and 15 of these 16 high-risk patients（94％）belonged to either Group A or Group B. In addition, the mean TL and GG were longer and higher, respectively, in Group A than in the other groups（p＜0.05）. Furthermore, in Group B, 3 of the 4 high-risk patients（75％）were detected using DWI and DCEI. The lesions detected using DWI and DCEI had higher GSs and were in a higher GG. Conclusion：PCas of pathologically higher grades and clinically higher risk were more readily detectableusing multiple parameters

Clinical Significance of Serum Soluble T Cell Regulatory Molecules in Clear Cell Renal Cell Carcinoma

To clarify the role of serum soluble T cell regulatory molecules in clear cell renal cell carcinoma (CCRCC), we measured the serum levels of soluble interleukin-2 receptor (sIL-2R), soluble B7-H3 (sB7-H3), and soluble cytotoxic T lymphocyte associated antigen-4 (sCTLA-4) in 70 CCRCC patients and 35 healthy controls. We investigated correlations between the serum levels of these soluble T cell regulatory molecules and the pathological grade, clinical stage, and prognosis of CCRCC. We also assessed the relations among each of these soluble molecules. As a result, the serum level of sIL-2R was significantly higher in CCRCC patients than in healthy controls ( < 0.05). In addition, elevation of serum sIL-2R was significantly correlated with the clinical stage ( < 0.001), and the survival of patients with high sIL-2R levels was shorter than that of patients with low sIL-2R levels ( < 0.05). Furthermore, the serum level of sB7-H3 was also significantly correlated with the clinical stage ( < 0.05), while the sIL-2R and sB7-H3 levels showed a positive correlation with each other ( = 0.550, < 0.0001). These results indicate that the serum level of sIL-2R reflects tumor progression in CCRCC patients. In addition, the possibility was suggested that the IL-2/IL-2R and B7-H3 pathways may be involved in the progression of CCRCC

Transperitoneal laparoscopic umbilical resection of urachal remnants: a feasible surgical method

Abstract Background To date, there is no standard established laparoscopic surgical method for managing urachal remnants because of their rarity, and several questions remain unanswered. Are there any problems for considering the operative indications about patients’ factors for example, body mass index and so on? This study aimed to determine the feasible surgical method for managing urachal remnants and presents the operative outcomes of our cases in relation to the findings from the existing literature. Methods We analyzed the data of 16 patients (7 women and 9 men; age range, 19–48 years) who underwent surgery for urachal remnants between January 2013 and March 2019 at our institution. Results In our cases, all urachal remnants were urachal sinuses, and the primary complaints were umbilical pain and pus discharge. Most of these symptoms were controlled using umbilical drainage and oral antibiotic intake; however, incisional drainage was required in two cases. In all cases, we performed a laparoscopic resection of the urachal remnants; one patient underwent an open conversion due to a very thick abdominal wall. Therefore, “peri-umbilical distanse” was proposed as an index to verify the periumbilical abdominal wall thickness. This index may clear the difficulties of the laparoscopic resection of the urachal remnunts. A postoperative complication—local infection that was treated using re-suturing—was observed in one patient. No adverse events occurred in the other cases. Our method was appropriate because it allowed for complete urachal resection with good cosmetic results, i.e., a small and natural scar appearance. Additionally, if bladder injury occurred, bladder re-suturing was easily possible because of the laparoscopic port’s position. Conclusions We present an feasible method for laparoscopic urachal resection. This method may be recommended for young patients with an peri-umbilical distanse of < 2 cm

Plasma progastrin‐releasing peptide level shows different predictive profiles for treatment response by androgen receptor axis‐targeted agents in patients with metastatic castration‐resistant prostate cancer

Abstract Background The neuroendocrine (NE) pathway cannot be ignored as a mechanism for castration‐resistant prostate cancer (CRPC) progression. The neuromediator, gastrin‐releasing peptide (GRP) may be involved in the aberrant activation of the normal androgen receptor (AR) and increased AR variants. This study focused on plasma levels of progastrin‐releasing peptide (ProGRP) and examined the treatment outcomes with androgen receptor axis‐targeted (ARAT) agents. Methods One hundred patients with metastatic CRPC were enrolled. Enzalutamide (ENZ) or abiraterone acetate/prednisone (AA/P) were administered to 50 patients each in a nonrandomized manner as a first‐line or later choice. Plasma ProGRP levels were determined using a chemiluminescent enzyme immunoassay, and data were collected prospectively. The study endpoints were prostate‐specific antigen (PSA) response and survival estimates. Results In the ENZ series, ProGRP levels correlated with the maximum PSA change from baseline (high ProGRP: −34.5% vs. low ProGRP: −85.7% p = .033). PSA progression‐free survival (PFS), radiographic/symptomatic (r/s) PFS, and overall survival (OS) in patients with high ProGRP were significantly worse than those in patients with low ProGRP (median PSA‐PFS: 3.3 vs. 10.0 months, p = .001, r/s PFS: 5.0 vs. 15.0 months, p < 0.001, and OS 17.5 vs. 49.0 months, p < .001, respectively). In addition, ProGRP showed an independent predictive value for all survival estimates in multivariate analyses. In the AA/P series, ProGRP levels did not correlate with the PSA change or predict PSA‐PFS and r/s PFS, but they maintained a significant difference in OS (19.0 vs. 48.0 months, p = .003). Conclusions Plasma ProGRP provides a consistent predictive value for OS in metastatic CRPC patients who underwent therapy with ARAT agents. Meanwhile, ProGRP showed different predictive profiles for PSA‐ and r/s PFS between ENZ and AA/P. These findings clinically suggest a mechanism for CRPC progression involving the NE pathway via the GRP. The underlying mechanism of different predictive profiles by the ARAT agent should be explored in future research

Clinical Significance of Serum Soluble T Cell Regulatory Molecules in Clear Cell Renal Cell Carcinoma

To clarify the role of serum soluble T cell regulatory molecules in clear cell renal cell carcinoma (CCRCC), we measured the serum levels of soluble interleukin-2 receptor (sIL-2R), soluble B7-H3 (sB7-H3), and soluble cytotoxic T lymphocyte associated antigen-4 (sCTLA-4) in 70 CCRCC patients and 35 healthy controls. We investigated correlations between the serum levels of these soluble T cell regulatory molecules and the pathological grade, clinical stage, and prognosis of CCRCC. We also assessed the relations among each of these soluble molecules. As a result, the serum level of sIL-2R was significantly higher in CCRCC patients than in healthy controls (P<0.05). In addition, elevation of serum sIL-2R was significantly correlated with the clinical stage (P<0.001), and the survival of patients with high sIL-2R levels was shorter than that of patients with low sIL-2R levels (P<0.05). Furthermore, the serum level of sB7-H3 was also significantly correlated with the clinical stage (P<0.05), while the sIL-2R and sB7-H3 levels showed a positive correlation with each other (R=0.550, P<0.0001). These results indicate that the serum level of sIL-2R reflects tumor progression in CCRCC patients. In addition, the possibility was suggested that the IL-2/IL-2R and B7-H3 pathways may be involved in the progression of CCRCC