Validation of TNM classification for metastatic prostatic cancer treated using primary androgen deprivation therapy

Purpose: The current tumor–node–metastasis (TNM) classification system has been used for many years. The prognosis of patients with metastatic prostate cancer (mPC) treated using primary androgen deprivation therapy (PADT) was analyzed according to the TNM classification. Methods: A total of 5618 cases with lymph node metastases only (N1M0), non-regional lymph node metastasis (M1a), bone metastasis (M1b), and distant metastasis (M1c) were selected from the Japanese Study Group of Prostate Cancer database. Overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) rates were calculated using Kaplan–Meier analysis. The influence of clinical variables on patient prognosis was evaluated using the Cox proportional hazard regression model. Results: The 5-year OS, CSS, and PFS were 76.0, 83.2, and 38.8 % in N1M0, 57.5, 69.0, and 23.0 % in M1a, 54.0, 63.1, and 23.0 % in M1b, and 40.0, 51.5, and 16.6 % in M1c, respectively. OS, CSS, and PFS worsened as the stages progressed. OS, CSS, and PFS were all significantly worse in N1M1b compared with N0M1b. Multivariate analysis revealed that OS and CSS were worse in patients with a Gleason score ≥8 and that combined androgen blockade (CAB) treatment provided better OS than non-CAB treatments at any tumor stage. However, OS and CSS were worse in individuals with a prostate-specific antigen >100 ng/ml only in M1b. Conclusions: Patient prognosis worsened with stage progression; therefore, current TNM classification system of mPC for PADT was shown to be trustworthy. Each PC cell that develops bone or lymphoid metastasis may exhibit different characteristics. © 2015, Springer-Verlag Berlin Heidelberg

Report of the third Asian Prostate Cancer study meeting.

The Asian Prostate Cancer (A-CaP) study is an Asia-wide initiative that was launched in December 2015 in Tokyo, Japan, with the objective of surveying information about patients who have received a histopathological diagnosis of prostate cancer (PCa) and are undergoing treatment and clarifying distribution of staging, the actual status of treatment choices, and treatment outcomes. The study aims to clarify the clinical situation for PCa in Asia and use the outcomes for the purposes of international comparison. Following the first meeting in Tokyo in December 2015, the second A-CaP meeting was held in Seoul, Korea, in September 2016. This, the third A-CaP meeting, was held on October 14, 2017, in Chiang Mai, Thailand, with the participation of members and collaborators from 12 countries and regions. In the meeting, participating countries and regions presented the current status of data collection, and the A-CaP office presented a preliminary analysis of the registered cases received from each country and region. Participants discussed ongoing challenges relating to data input and collection, institutional, and legislative issues that may present barriers to data sharing, and the outlook for further patient registrations through to the end of the registration period in December 2018. In addition to A-CaP-specific discussions, a series of special lectures were also delivered on the situation for health insurance in the United States, the correlation between insurance coverage and PCa outcomes, and the outlook for robotic surgery in the Asia-Pacific region. Members also confirmed the principles of authorship in collaborative studies, with a view to publishing original articles based on A-CaP data in the future

Tests for profile analysis based on two-step monotone missing data

In this paper, we consider profile analysis for the observations with two-step monotone missing data. There exist three interesting hypotheses - the parallelism hypothesis, level hypothesis, and flatness hypothesis - when comparing the profiles of some groups. The T²-type statistics and their asymptotic null distributions for the three hypotheses are given for two-sample profile analysis. We propose the approximate upper percentiles of these test statistics. When the data do not have missing observations, the test statistics perform lower than the usual test statistics, for example, as in [8]. Further, we consider a parallel profile model for several groups when the data have two-step monotone missing observations. Under the assumption of non-missing data, the likelihood ratio test procedure is derived by [16]. We derive the test statistic based on the likelihood ratio. Finally, in order to investigate the accuracy for the null distributions of the proposed statistics, we perform a Monte Carlo simulation for some selected parameters values

2-ステップ単調欠測データのもとでのプロフィール分析と平均ベクトルに対する検定

東京理科大学2020年

Primary aortoduodenal fistula in testicular cancer: A fatal complication associated with retroperitoneal lymph node metastasis

A primary aortoduodenal fistula (PADF) has rarely been reported as a complication of testicular cancer. A 48-year-old Japanese male with relapsed retroperitoneal lymph node metastases received four courses of paclitaxel, ifosfamide, and cisplatin (TIP). On day 19 of the fourth cycle of TIP, he developed hematochezia and hypovolemic shock. Angiography confirmed the presence of a PADF, and we then deployed an endovascular stent graft in the aorta. Although the bleeding improved, the patient died of re-bleeding that developed 18 days later. It is important to recognize this severe complication in order to achieve its early diagnosis and optimal surgical intervention

Background factors and short-term health-related quality of life in patients who initially underwent radical prostatectomy or androgen deprivation therapy for localized prostate cancer in a Japanese prospective observational study (J-CaP Innovative Study-1)

Background: This prospective observational study elucidated the usefulness of hormonal therapy for localized prostate cancer. Background factors and the health-related quality of life in patients who initially underwent radical prostatectomy (RP) or primary androgen deprivation therapy (PADT) for localized prostate cancer are summarized. Materials and methods: Patients aged 67–76 years with clinical stage T1c or T2 localized prostate cancer treated with PADT or RP, a prostate-specific antigen concentration of <20 ng/mL, and Gleason score of ≤7 were included. Health-related quality of life results estimated by the Medical Outcomes Study 8-Item Short-Form Health Survey (SF-8) and the Expanded Prostate Cancer Index Composite (EPIC) were investigated. Results: In total, 850 patients who underwent RP and 370 patients who underwent PADT were enrolled. The proportion of patients with comorbidities of hypertension, cardiovascular disease, and/or cerebrovascular disease was greater in the PADT group than in the RP group. The proportion of patients deciding on treatment was significantly higher in the PADT group than in the RP group. In the RP group, the scores of many SF-8 and EPIC domains decreased at 3 months following surgery and returned to baseline levels at 1 year. In the PADT group, several domains gradually decreased during the year after treatment initiation. The proportion of patients with decreased satisfaction scores at 1 year compared with baseline was lower in the PADT group than that in the RP group. Conclusion: Treatment risk influenced decisions on primary treatment for localized prostate cancer. Although there was a selection bias, short-term overall satisfaction in the PADT group was superior to that in the RP group in this clinical study

Successful treatment with low‐dose oral steroids for contracted bladder after intravesical instillation of Bacillus Calmette–Guérin

Introduction Contracted bladder is a rare adverse effect of intravesical Bacillus Calmette–Guérin instillation, with an incidence of 0.2–3.3%. This report aimed to present a case of contracted bladder successfully treated with a low‐dose oral steroid. Case presentation A 78‐year‐old man underwent a third transurethral resection of a bladder tumor. The pathological diagnosis was urothelial carcinoma in situ. After the fifth instillation of the second‐line induction therapy of Bacillus Calmette–Guérin, the patient discontinued treatment because of increased urinary frequency and a continuous mean voiding volume of 80 mL. The patient was diagnosed with a contracted bladder based on computed tomography findings and a urination chart. After initiating oral prednisolone (20 mg/day), the patient experienced significant recovery within 2 weeks for both urinary frequency and mean voiding volume of 226 mL. Conclusion A patient with a contracted bladder after Bacillus Calmette–Guérin instillation was successfully treated with low‐dose oral steroid therapy

Serum adiponectin concentration in 2,939 Japanese men undergoing screening for prostate cancer

Background: Recent investigations suggest that serum adiponectin levels are negatively associated with the development of aggressive prostate cancer, however, not all epigenetic studies support the inverse association. Methods: We analyzed serum adiponectin levels, prostate-specific antigen (PSA) levels, and outcomes of prostate cancer screening of 2,939 participants of a PSA-based screening program conducted by a single institute in Japan. Results: The median body mass index (BMI) of the participants was 23.9 kg/m2, and 31% had a BMI ≥ 25 kg/m2. The adiponectin levels were significantly and negatively correlated with BMI (r =  −0.260, P < 0.0001). However, a significant and positive correlation was observed between adiponectin levels and PSA levels (r = 0.054, P = 0.0061). After screening, 24 (0.82%) patients were diagnosed with prostate cancer. Interestingly, the adiponectin levels of the 24 prostate cancer patients (average 9.86 μg/mL) were significantly higher than those of the 2,817 participants with PSA levels < 4 ng/mL (average 7.63 μg/mL) (P = 0.0049). However, when restricted to the eight high-risk prostate cancer patients, the adiponectin levels did not differ from those of the participants with PSA levels < 4 ng/mL. The age-adjusted cancer detection rate of the participants was calculated by stratifying the BMI (cut-off level 25 kg/m2) and adiponectin levels (cut-off level 6.7 μg/mL). The cancer detection rate in the high-BMI and high-adiponectin group was 1.67%, which was the highest among all groups. Conclusions: There was a significant positive correlation between adiponectin levels and PSA levels. The present findings also suggest that the incidence of low- or intermediate-risk prostate cancer might be increased in overweight men with high serum adiponectin levels