Yoichi Arai

Tohoku University, Japan

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Publications (571)1347.02 Total impact

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    ABSTRACT: Treatment for ruptured renal angiomyolipoma in pregnancy requires immediate and appropriate decision-making based on the condition of the mother and fetus, and gestational age. A 37-year-old woman at 25 weeks of pregnancy presented with severe right flank pain. Computed tomography showed a ruptured right renal angiomyolipoma (8 cm in diameter). The maternal and fetal conditions were stable. Transcatheter arterial embolization was carried out electively 4 days after the rupture. Minimization of radiation exposure to the fetus was achieved by X-ray shielding for the fetus, low-dose-rate fluoroscopy, minimal angiography imaging and a color Doppler ultrasonography-guided procedure. Although threatened premature labor occurred because of post-embolization syndrome, the pregnancy was continued until cesarean section at 37 weeks of pregnancy. © 2015 The Japanese Urological Association.
    International Journal of Urology 04/2015; DOI:10.1111/iju.12775 · 1.80 Impact Factor
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    ABSTRACT: The pre-B lymphocyte protein 3 (VPREB3) is expressed during B-cell differentiation and in subsets of mature B-lymphocytes and is mainly found in bone marrow and lymphoid tissue germinative centers. So far, its function in B-cells remains to be clarified. The mRNA of VPREB3 was previously detected in aldosterone-producing adenomas (APA), however further information about this protein in human adrenocortical cells and tissues is currently unavailable. Therefore, in the present study we for the first time investigate the protein expression of VPREB3 in human adrenocortical tissues. In addition, we approach the previously suggested similarities in expression patterns of aldosterone-producing cells and Purkinje neurons. Immunohistochemical analysis of VPREB3 was performed in 13 non-pathological adrenals (NA), 6 adrenal glands with idiopathic hyperaldosteronism (IHA), 18 APA, 5 cortisol-producing adenomas (CPA) and 5 non-pathological human cerebellum specimens. The mRNA levels of VPREB3, steroidogenic-enzymes and other aldosterone biosynthesis markers were detected in 53 APA samples using real-time RT-PCR (qPCR) and compared to the clinical data of APA patients. In our results, the VPREB3 protein was diffusely detected in APA, partially or weakly detected in CPA, and immunolocalized in the zona glomerulosa of NA and IHA, as well as in the cytoplasm of cerebellar Purkinje cells. In APA, VPREB3 mRNA levels were significantly correlated to plasma aldosterone (P=0.026; R=0.30), KCNJ5 mutations (P=0.0061; mutated 34:19 wild-type), CYP11B2 (P<0.0001; R=0.65), Purkinje cell protein 4 (PCP4; P<0.0001; R=0.53) and voltage-dependent calcium channels CaV1.3 (P=0.023; R=0.31) and CaV3.2 (P=0.0019; R=0.42). Based on our data, we hypothesize a possible role for VPREB3 in aldosterone biosynthesis, and present ideas for future functional studies.
    Endocrine Pathology 04/2015; DOI:10.1007/s12022-015-9366-7 · 1.64 Impact Factor
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    ABSTRACT: We previously reported the pharmacokinetic profile and preliminary tolerability of cabazitaxel in a phase I study in Japanese patients with metastatic castration-resistant prostate cancer (mCRPC). Here we report the final safety profile and anti-tumor activity of cabazitaxel in a larger population, including all patients enrolled in the expansion cohort of the study. Japanese patients with mCRPC previously treated with docetaxel received cabazitaxel intravenously every 3 weeks plus daily prednisolone. In patients treated with the maximum tolerated dose of 25 mg/m(2) we evaluated adverse events including treatment-related neutropenia, prostate-specific antigen (PSA) response and objective response. In total, 44 patients were treated with the maximum tolerated dose. The most frequent adverse events (any grade) were neutropenia (100 %), febrile neutropenia (54.5 %), fatigue (54.5 %), nausea (52.3 %) and diarrhea (50.0 %). There were no deaths due to treatment-related adverse events. Neutropenia with prior docetaxel did not appear to influence the probability of febrile neutropenia with cabazitaxel. Most patients received therapeutic granulocyte colony-stimulating factor (G-CSF; cycle 1: 86.4 %; cycle 2 or later: 81.8 %). In the efficacy population, two of 12 patients with measurable disease had partial response (objective response rate: 16.7 %), while 10 had stable disease. PSA response rate was 29.3 % (12/41 patients). Median time to PSA progression was 3.68 months (95 % confidence interval 1.35-4.63). In this heavily pretreated Japanese population, the occurrence of neutropenia and febrile neutropenia was high, suggesting G-CSF prophylaxis may be required as part of toxicity management. However, the efficacy of cabazitaxel was consistent with global studies. ClinicalTrials.gov identifier: NCT01324583.
    International Journal of Clinical Oncology 03/2015; DOI:10.1007/s10147-015-0820-9 · 2.17 Impact Factor
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    ABSTRACT: Adrenal venous sampling is currently the only reliable method to distinguish unilateral from bilateral diseases in primary aldosteronism. In this study, we attempted to determine whether peripheral plasma levels of 18-oxocortisol (18oxoF) and 18-hydroxycortisol could contribute to the clinical differentiation between aldosteronoma and bilateral hyperaldosteronism in 234 patients with primary aldosteronism, including computed tomography (CT)-detectable aldosteronoma (n=113) and bilateral hyperaldosteronism (n=121), all of whom underwent CT and adrenal venous sampling. All aldosteronomas were surgically resected and the accuracy of diagnosis was clinically and histopathologically confirmed. 18oxoF and 18-hydroxycortisol were measured using liquid chromatography tandem mass spectrometry. Receiver operating characteristic analysis of 18oxoF discrimination of adenoma from hyperplasia demonstrated sensitivity/specificity of 0.83/0.99 at a cut-off value of 4.7 ng/dL, compared with that based on 18-hydroxycortisol (sensitivity/specificity: 0.62/0.96). 18oxoF levels above 6.1 ng/dL or of aldosterone >32.7 ng/dL were found in 95 of 113 patients with aldosteronoma (84%) but in none of 121 bilateral hyperaldosteronism, 30 of whom harbored CT-detectable unilateral nonfunctioning nodules in their adrenals. In addition, 18oxoF levels below 1.2 ng/dL, the lowest in aldosteronoma, were found 52 of the 121 (43%) patients with bilateral hyperaldosteronism. Further analysis of 27 patients with CT-undetectable micro aldosteronomas revealed that 8 of these 27 patients had CT-detectable contralateral adrenal nodules, the highest values of 18oxoF and aldosterone were 4.8 and 24.5 ng/dL, respectively, both below their cut-off levels indicated above. The peripheral plasma 18oxoF concentrations served not only to differentiate aldosteronoma but also could serve to avoid unnecessary surgery for nonfunctioning adrenocortical nodules concurrent with hyperplasia or microadenoma. © 2015 American Heart Association, Inc.
    Hypertension 03/2015; DOI:10.1161/HYPERTENSIONAHA.114.04453 · 7.63 Impact Factor
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    ABSTRACT: Abscess of corpus cavernosum penis is a rare infection condition. A 69-year-old-man was referred toour hospital with gradual development of penis swelling. T2-weighted magnetic resonance imaging of the pelvis showed abscess formation in the corpus cavernosum. There was no apparent cause of his penile abscess from either history or clinical examination. Open drainage improved his clinical symptoms transiently. However, severe penile pain relapsed, and abscess progressively extended in the corpus cavernosum and spongiosum, necessitating total penectomy. The surgical specimen revealed intensive inflammation and his condition improved immediately after penectomy.
    Hinyokika kiyo. Acta urologica Japonica 03/2015; 61(3):109-114.
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    ABSTRACT: Background:Bilateral Wilms tumours (BWTs) occur by germline mutation of various predisposing genes; one of which is WT1 whose abnormality was reported in 17-38% of BWTs in Caucasians, whereas no such studies have been conducted in East-Asians. Carriers with WT1 mutations are increasing because of improved survival.Methods:Statuses of WT1 and IGF2 were examined in 45 BWTs from 31 patients with WT1 sequencing and SNP array-based genomic analyses. The penetrance rates were estimated in WT1-mutant familial Wilms tumours collected from the present and previous studies.Results:We detected WT1 abnormalities in 25 (81%) of 31 patients and two families, which were included in the penetrance rate analysis of familial Wilms tumour. Of 35 BWTs from the 25 patients, 31 had small homozygous WT1 mutations and uniparental disomy of IGF2, while 4 had large 11p13 deletions with the retention of 11p heterozygosity. The penetrance rate was 100% if children inherited small WT1 mutations from their fathers, and 67% if inherited the mutations from their mothers, or inherited or had de novo 11p13 deletions irrespective of parental origin (P=0.057).Conclusions:The high incidence of WT1 abnormalities in Japanese BWTs sharply contrasts with the lower incidence in Caucasian counterparts, and the penetrance rates should be clarified for genetic counselling of survivors with WT1 mutations.British Journal of Cancer advance online publication, 17 February 2015; doi:10.1038/bjc.2015.13 www.bjcancer.com.
    British Journal of Cancer 02/2015; 112(6). DOI:10.1038/bjc.2015.13 · 4.82 Impact Factor
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    ABSTRACT: The optimal treatment for high-risk prostate cancer (Pca) remains to be established. We previously reported favorable biochemical recurrence-free survival (BRFS) in high-risk Pca patients treated with a neoadjuvant therapy comprising a luteinizing-hormone-releasing hormone (LHRH) agonist plus low dose estramustine phosphate (EMP) (LHRH+EMP) followed by radical prostatectomy (RP). In the present study, we used a retrospective design via propensity score matching to elucidate the clinical benefit of neoadjuvant LHRH+EMP for high-risk Pca. The Michinoku Urological Cancer Study Group database contained data for 1,268 consecutive Pca patients treated with RP alone at 4 institutions between April 2000 and March 2011 (RP alone group). In the RP alone group, we identified 386 high-risk Pca patients. The neoadjuvant LHRH+EMP group included 274 patients with high-risk Pca treated between September 2005 and November 2013 at Hirosaki University. Neoadjuvant LHRH+EMP therapy included LHRH and EMP administration at a dose of 280 mg/day for 6 months before RP. The outcome measures were overall survival (OS) and BRFS. The propensity score-matched analysis indicated 210 matched pairs from both groups. The 5-year BRFS rates were 90.4 and 65.8 % for the neoadjuvant LHRH+EMP and RP alone groups, respectively (P < 0.0001). The 5-year OS rates were 100 and 96.1 % for the neoadjuvant LHRH+EMP and RP alone groups, respectively (P = 0.110). Although the present study was not randomized, neoadjuvant LHRH+EMP therapy followed by RP appeared to reduce the risk of biochemical recurrence. A prospective randomized study is warranted to determine the clinical implications of the neoadjuvant therapy described here.
    International Journal of Clinical Oncology 02/2015; DOI:10.1007/s10147-015-0802-y · 2.17 Impact Factor
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    ABSTRACT: Objective To perform a longitudinal investigation of the correlation between functional recovery and sex hormone levels after radical prostatectomy (RP).Patients and methodsA total of 72 consecutive men undergoing RP between January 2012 and June 2013were prospectively included and serially followed postoperatively for comparative analysis. They underwent measurements of luteinizing hormone (LH) and total testosterone (TT) levels prior to surgery and 3 and 12 months postoperatively.They filled out a health-related quality of life questionnaire before and at 1, 3, 6, and 12 months after surgery.ResultsThe mean LH level increased from 4.28 U/L at baseline to 5.53 U/L at 3 months and remained high at 12 months after RP (both p<0.001).No significant changes were observed in the TT level after RP. LH at baseline correlated negatively with the urinary function score at 3 and 12 months after RP. (p=0.030 and 0.032, respectively).After RP, subjects with high baseline LH levels (n=37) were more likely than those with low LH levels to report lower urinary function scores (p=0.014).Multivariate analysis of variance in an interaction of time x LH level for urinary function scores indicated a significant relationship between changes in urinary function score and the LH level (p=0.004).ConclusionsRP affects sex hormones by increasing LH levels, while TT levels remain stable after surgery.Baseline LH levels are significantly associated with the recovery of urinary outcomes after RP.This article is protected by copyright. All rights reserved.
    BJU International 02/2015; DOI:10.1111/bju.13083 · 3.13 Impact Factor
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    ABSTRACT: CYP19 catalyzes the conversion of androgens to estrogens and is a critical enzyme affecting the sex hormone milieu. In this study, we investigated the functions of CYP19A1 polymorphisms and their associations with prostate cancer risk and clinical outcome. This case-control study evaluated the effects of three single nucleotide polymorphisms (SNPs) in CYP19A1 on the risk of prostate cancer in 330 prostate cancer patients and 354 normal controls. The associations between each SNP and sex hormone levels were evaluated in 164 healthy male patients. The functions of the SNPs were determined by reporter gene assays in PC3 and DU145 cell lines. Prostate-specific antigen nadir was evaluated in 142 patients with metastatic prostate cancer treated with androgen deprivation therapy. Cancer-specific survival (CSS) was determined in 166 patients with metastatic prostate cancer, to evaluate the influence of the three SNPs. Each variant allele of the three SNPs significantly decreased the risk of prostate cancer. Haplotype analysis showed that the T-A-G haplotype (corresponding to rs2470152-rs10459592-rs4775936) increased the risk of prostate cancer, while the C-C-A haplotype decreased the risk. The estrone/androstenedione ratio was significantly higher in men with the C allele of rs2470152, the C allele of rs10459592, and the A allele of rs4775936 in a gene-dosage-dependent manner. Patients with the variant allele at rs4775936 had significantly shorter CSS. These results indicate that CYP19A1 polymorphisms may influence prostate cancer risk and survival by modifying promoter activity, with subsequent effects on the sex hormone milieu. © 2014 Wiley Periodicals, Inc.
    International Journal of Cancer 01/2015; 136(1). DOI:10.1002/ijc.28952 · 5.01 Impact Factor
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    ABSTRACT: About one third of renal cell carcinoma (RCC) patients exhibit metastasis upon initial presentation. However, the molecular basis for RCC metastasis is not fully understood. A ganglioside, disialosyl globopentaosylceramide (DSGb5), was originally isolated from RCC tissue extracts, and its expression is correlated with RCC metastatic potential. DSGb5 is synthesized by GalNAc α2,6-sialyltransferase VI (ST6GalNAcVI) and is expressed on the surface of RCC cells. Importantly, DSGb5 binds to sialic acid-binding Ig-like lectin-7 (Siglec-7) expressed on natural killer (NK) cells, thereby inhibiting NK-cell cytotoxicity. However, the role of DSGb5 in RCC progression remains obscure. To address this issue, we used ACHN cells derived from malignant pleural effusion of a patient with metastatic RCC. Using the limiting dilution method, we isolated three independent clones with different DSGb5 expression levels. Comparison of these clones indicated that the cloned cells with high DSGb5 expression levels exhibited greater migration potential, compared to the clone with low DSGb5 expression levels. In contrast, DSGb5 expression levels exerted no significant effect on cell proliferation. We then established the ACHN-derived cell lines that stably expressed siRNA against ST6GalNAcVI mRNA or control siRNA. Importantly, the ST6GalNAcVI-knockdown cells expressed low levels of DSGb5. We thus demonstrated the significantly decreased migration potential of the ST6GalNAcVI-knockdown cells with low DSGb5 expression levels, compared to the control siRNA-transfected cells expressing high DSGb5 levels, but no significant difference in the cell proliferation. Thus, DSGb5 expression may ensure the migration of RCC cells. We propose that DSGb5 expressed on RCC cells may determine their metastatic capability.
    The Tohoku Journal of Experimental Medicine 01/2015; 236(1):1-7. DOI:10.1620/tjem.236.1 · 1.28 Impact Factor
  • Shinichi Yamashita, Yoichi Arai
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    ABSTRACT: Androgen deprivation therapy has been the standard treatment for the patients with advanced prostate cancer. Androgen deprivation therapy initially suppresses the growth of prostate cancer. However, most patients eventually progress to castration-resistant prostate cancer. Novel drugs, including enzalutamide and abiraterone acetate, are recently able to be used for the patients with castration-resistant prostate cancer. Even so, the therapeutic options for castration-resistant prostate cancer are not enough. Interestingly, androgen receptor degradation enhancer ASC-J9 is reported to degrade the androgen receptor, resulting in the suppression of the growth in castration-resistant prostate cancer cells. In this chapter, ASC-J9 for prostate cancer is reviewed.
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    ABSTRACT: To investigate the effect of the percentage of free prostate-specific antigen (%fPSA) on future prostate cancer risk. We examined serum total PSA (tPSA) and %fPSA annually in a prostate cancer-screening cohort between July 2001 and June 2011. Men with tPSA >4.0 ng/mL or tPSA of 2.0-4.0 ng/mL with %fPSA ≤12% were screened as positive and were recommended to undergo a biopsy. The study population consisted of 6368 men, aged 40-79 years, who had tPSA ≤4.0 ng/mL at initial screening and who subsequently underwent 1 or more screenings. We calculated the cumulative risk and hazard ratio of prostate cancer stratified by the initial %fPSA groups as quartiles of prostate cancer patients. During a median follow-up of 36 months, 119 men were diagnosed with prostate cancer. The lowest quartile of %fPSA (<13.3%) was associated with a 21.2-fold higher risk of having prostate cancer compared with the highest quartile (>22.2%). For the subset with an initial tPSA ≤1.0 ng/mL, all men diagnosed with cancer had an initial %fPSA ≤33.3% (median). For the subset with tPSA >1.0 ng/mL, men with %fPSA ≤23.0% (median) had significantly higher risk for cancer than those with %fPSA >23.0% (P <.0001). Of the 114 men with prostate cancer in whom pathologic findings were available, 79 (69.3%) had a Gleason score ≥3 + 4 = 7. A low %fPSA is a strong predictor of a subsequent diagnosis of prostate cancer among men with tPSA levels ≤4.0 ng/mL. Measurement of %fPSA might enhance the detection of high-grade cancer that warrants aggressive treatment. Copyright © 2014 Elsevier Inc. All rights reserved.
    Urology 11/2014; 84(5):1163-7. DOI:10.1016/j.urology.2014.04.055 · 2.13 Impact Factor
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    ABSTRACT: Three-dimensional (3D) imaging systems have been introduced worldwide for surgical instrumentation. A difficulty of laparoscopic surgery involves converting two-dimensional (2D) images into 3D images and depth perception rearrangement. 3D imaging may remove the need for depth perception rearrangement and therefore have clinical benefits.
    Surgical Endoscopy 11/2014; DOI:10.1007/s00464-014-3925-8 · 3.31 Impact Factor
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    ABSTRACT: It has become important to evaluate the possible involvement of 3β-hydroxysteroid dehydrogenase type 1 (HSD3B1) and 2 (HSD3B2) isoforms in aldosterone-producing adenoma (APA). In this study, we studied 67 and 100 APA cases using real-time quantitative PCR (qPCR) and immunohistochemistry, respectively. Results of qPCR analysis demonstrated that HSD3B2 mRNA was significantly more abundant than HSD3B1 mRNA (P<0.0001), but only HSD3B1 significantly correlated with CYP11B2 (aldosterone synthase) (P<0.0001) and plasma aldosterone concentration (PAC) of the patients (P<0.0001). Results of immunohistochemistry subsequently revealed that HSD3B2 immunoreactivity was detected in the great majority of APA but a significant correlation was also detected between HSD3B1 and CYP11B2 (P<0.0001). In KCNJ5 mutated APA, CYP11B2 (P<0.0001) and HSD3B1 (P=0.011) were significantly higher than wild type APA. These results suggest that HSD3B1 is involved in aldosterone production, despite its lower levels of expression compared to HSD3B2, and also possibly associated withKCNJ5mutation in APA.
    Molecular and Cellular Endocrinology 10/2014; In Press(Online first). DOI:10.1016/j.mce.2014.10.008 · 4.24 Impact Factor
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    ABSTRACT: BACKGROUND:The significance of lymphovascular invasion (LVI) remains controversial, and the association of LVI with biochemical relapse was investigated in men treated with radical prostatectomy according to pathological results.METHODS:Data from 1268 patients undergoing radical prostatectomy between 2000 and 2009 were retrospectively reviewed. Clinicopathological variables were compared between LVI-negative and LVI-positive patients. Multivariate analyses by Cox proportional hazard model and Kaplan-Meier method were performed to identify risk factors for biochemical relapse in all patients, patients with pT2N0 and pT2N0 negative resection margin (RM).RESULTS:LVI information was available in 1160 cases, and LVI was seen in 121 cases (10.4%). Clinicopathological variables were significantly worse in LVI-positive patients than in LVI-negative patients. On multivariate analyses, PSA⩾10 ng ml(-1), pathological Gleason score ⩾8, pathological T stage ⩾3, lymph node metastasis, positive RM and LVI were independent predictors for biochemical relapse in all patients. In patients with pT2N0, PSA⩾10 ng ml(-1), pathological Gleason score ⩾8, positive RM and LVI were independent predictors for biochemical relapse. In patients with pT2N0 negative RM, LVI and pathological Gleason score ⩾8 were independent predictors for biochemical relapse (LVI; hazard ratio 3.809, 95% confidence interval 1.900-7.635, P-value<0.001, Gleason score ⩾8; hazard ratio 2.189, 95% confidence interval 1.199-3.999, P-value=0.011). With a median follow-up of 50 months, 5-year biochemical relapse-free survival in patients with pT2N0 negative RM was 95.7% in those with negative LVI in comparison to 85.3% in those with positive LVI (P<0.001, log rank).CONCLUSIONS:LVI was consistently a significant predictor for biochemical relapse after radical prostatectomy in not only all patients but also in patients with pT2N0 and pT2N0 negative RM. These results strongly support the significance of LVI as a predictor for biochemical relapse.Prostate Cancer and Prostatic Disease advance online publication, 21 October 2014; doi:10.1038/pcan.2014.40.
    Prostate Cancer and Prostatic Diseases 10/2014; 18(1). DOI:10.1038/pcan.2014.40 · 2.83 Impact Factor
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    ABSTRACT: Usually, benign tumors are not associated with an increased F-18 fluorodeoxyglucose (F-18 FDG) uptake on positron emission tomography (PET), although some exceptions have been reported in adrenal neoplasms. We present a rare case of adrenocortical oncocytoma associated with markedly increased FDG uptake, demonstrating a maximum standardized uptake value of 46.8. Histological examination demonstrated diffuse proliferation of tumor cells with eosinophilic and granular cytoplasm that were diffusely immunopositive for mitochondria and glucose transport protein 1, with focal and weak immunopositivity for 3β-hydroxysteroid dehydrogenase. Ultrastructural examination also revealed abundant mitochondria in the tumor cells. The tumor was diagnosed as adrenocortical oncocytoma and was considered benign according to Lin-Weiss-Bisceglia criteria. Diagnosis of adrenocortical oncocytoma can pose difficulties during both preoperative radiological and postoperative histopathological investigations.
    Endocrine Pathology 10/2014; DOI:10.1007/s12022-014-9337-4 · 1.64 Impact Factor
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    ABSTRACT: Objectives To assess long-term health-related quality of life in patients undergoing radical prostatectomy.MethodsA total of 120 patients with at least 5 years of follow up after radical prostatectomy were included in the present study. Health-related quality of life outcomes were assessed using three questionnaires, the Short Form 36-Item Health Survey, the University of California, Los Angeles Prostate Cancer Index and the International Prostate Symptom Score.ResultsA total of 91 patients (73%) responded at a median follow-up time of 102 months (range 85–123 months). Among general health-related quality of life domains, mental and role composite summary score remained stable throughout the follow-up period. At the final survey, no significant differences were observed in any of the domains compared with the age-matched average score of the Japanese population. Although the slight decrease in urinary function scores and International Prostate Symptom Score beyond 5 years postoperatively compared with 5 years, the differences were not significant. The sexual function summary score showed a substantially lower score just after radical prostatectomy and remained at a deteriorated level (P < 0.001). Responders at the final survey were more likely to report favorable general, urinary and sexual outcomes at 60 months compared with non-responders.Conclusions When taking age-related changes into account, general health-related quality of life seems to remain stable in the long term after radical prostatectomy: patients with favorable health-related quality of life outcomes during the first 5 years after radical prostatectomy maintain favorable outcomes thereafter.
    International Journal of Urology 09/2014; 21(12). DOI:10.1111/iju.12586 · 1.80 Impact Factor
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    ABSTRACT: Objective To determine whether the currently available pretreatment risk classification systems are applicable in Japanese prostate cancer patients.Methods Using data obtained from 1264 consecutive patients with prostate cancer treated with radical prostatectomy at four hospitals in Japan, biochemical recurrence-free survival rates were estimated and compared between the D'Amico, the National Institute for Health and Clinical Excellence, the Cancer of the Prostate Strategic Urological Research Endeavor, the National Comprehensive Cancer Network, and the European Society of Medical Oncology risk groups by using the Kaplan–Meier method and log–rank test.ResultsThe 5-year biochemical recurrence-free survival rates in the D'Amico low-, intermediate-, and high-risk groups were 88.3%, 84.7% and 66.9%, respectively (low and intermediate risk vs high risk, P < 0.001). The 5-year biochemical recurrence-free survival rates in the National Institute for Health and Clinical Excellence, National Comprehensive Cancer Network, and European Society of Medical Oncology low-, intermediate- and high-risk groups were 88.3%, 84.3%, and 60.3%, respectively (low and intermediate risk vs high risk, P < 0.001). The 5-year biochemical recurrence-free survival rates in the Cancer of the Prostate Strategic Urological Research Endeavor low-, intermediate-, and high-risk groups were 90%, 83.5% and 60.3%, respectively (low and intermediate risk vs high risk, P < 0.001). Low- and intermediate-risk groups according to any of the risk stratification systems did not show significant differences in biochemical recurrence-free survival.Conclusion Current risk stratification systems do not discriminate between low- and intermediate-risk groups in the Japanese population. A novel, pretreatment risk stratification system including other prognostic factors is necessary for an adequate prostate cancer risk assessment in the Japanese population.
    International Journal of Urology 09/2014; 22(1). DOI:10.1111/iju.12597 · 1.80 Impact Factor
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    ABSTRACT: Abstract Objective. Prostate cancer (PCa) may be a multifocal and bilateral disease. Patients with low-risk PCa and a low number of positive biopsy cores may choose to undergo active surveillance or focal therapy. The aim of this study was to determine the correlation between a solitary positive prostate biopsy core and the pathological outcome after radical prostatectomy (RP). Material and methods. The Michinoku Japan Urological Cancer Study Group database contains data, including preoperative and postoperative information, on 1268 consecutive patients with PCa treated with RP alone at four institutions. This study focused on 151 patients with a single positive biopsy core, preoperative prostate-specific antigen (PSA) level less than 10 ng/ml, biopsy Gleason score less than 8, and clinical stage T1c/T2a/T2b disease. Potential preoperative predictors of unilateral PCa were age, preoperative PSA level, biopsy Gleason score and clinical T stage. Results. The median age and preoperative PSA level were 65 years (range 47-76 years) and 6.00 ng/ml (range 0.50-9.80 ng/ml), respectively. Unilateral PCa was identified in 41% of the patients. Extraprostatic extension or seminal vesicle invasion was observed in 26% of all patients. Conclusion. Serum PSA levels were significantly higher in the bilateral PCa group than in the unilateral PCa group in the current study. For patients with PCa having a solitary positive prostate biopsy core, definitive therapy such as RP should be considered.
    08/2014; DOI:10.3109/21681805.2014.951959
  • Koji Mitsuzuka, Yoichi Arai
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    ABSTRACT: The incidence of prostate cancer in Japan is increasing due to both the spread of screening and the rapid aging of the population. Most of this increase is expected to be attributable to the increase in the elderly male population. The management of various types of cancers in elderly patients is of growing interest, but several problems are encountered when evaluating elderly patients with localized prostate cancer, especially when radical prostatectomy (RP) is under consideration. First, life expectancy, health status, lifestyle, and available treatment modalities differ between regions, countries, and individuals, which potentially affects the choice of treatment options by both physicians and patients. Second, life expectancy is key when considering indications for RP. Many tools are available for predicting life expectancy, but their utilization varies greatly among physicians. Third, the malignant potential of latent or incidentally detected prostate cancer in Japanese men might be higher than those in other countries, and elderly men with prostate cancer are likely to have high-risk or locally advanced tumors, which may in turn support the more frequent use of radical treatments in elderly men. Fourth, patients treated with RP are likely to have fewer and less severe comorbidities than those treated with other treatments, which would complicate the comparison of outcomes. Fifth, the balance between survival benefits and adverse effects is an important influence on indications for RP. If robot-assisted laparoscopic RP can reduce the risk of adverse effects, indications for RP could be altered. Sixth, although several general health status screening tools such as the Geriatric 8 are available, no screening tools specialized for localized or Japanese prostate cancer patients exist. In conclusion, further study is needed to clarify the management of elderly Japanese patients with localized prostate cancer, because prostate cancer often requires different considerations to other types of cancer.
    International Journal of Clinical Oncology 08/2014; 19(5). DOI:10.1007/s10147-014-0738-7 · 2.17 Impact Factor

Publication Stats

6k Citations
1,347.02 Total Impact Points

Institutions

  • 2002–2015
    • Tohoku University
      • Department of Urology
      Japan
    • Kagawa University
      • Department of Urology
      Takaishi, Osaka-fu, Japan
  • 2014
    • Hirosaki University
      Khirosaki, Aomori, Japan
  • 2011
    • Zhejiang Cancer Hospital
      Hang-hsien, Zhejiang Sheng, China
    • The Jikei University School of Medicine
      • Department of Internal Medicine
      Edo, Tōkyō, Japan
  • 1994–2011
    • Kurashiki Central Hospital
      Kurasiki, Okayama, Japan
  • 2009
    • CSU Mentor
      Long Beach, California, United States
  • 2008
    • University of California, Los Angeles
      • Department of Urology
      Los Angeles, CA, United States
  • 1988–2008
    • Kyoto University
      • Department of Urology
      Kyoto, Kyoto-fu, Japan
  • 2007
    • University of Pittsburgh
      • Department of Urology
      Pittsburgh, PA, United States
  • 2000–2006
    • Akita University
      Akita, Akita, Japan
  • 1999–2005
    • Kitasato University
      • Department of Urology
      Edo, Tōkyō, Japan
  • 2003–2004
    • Sendai University
      Sendai, Kagoshima, Japan
  • 1991–2000
    • Rakuwakai Otowa Hospital
      Kioto, Kyōto, Japan
  • 1996–1999
    • Saitama Cancer Center
      Saitama, Saitama, Japan
  • 1997
    • Shizuoka Hospital
      Sizuoka, Shizuoka, Japan
  • 1996–1997
    • Osaka Medical Center for Cancer and Cardiovascular Diseases
      Ōsaka, Ōsaka, Japan
  • 1988–1997
    • Shiga University of Medical Science
      • Department of Urology
      Ōtu, Shiga, Japan
  • 1995
    • Kusatsu General Hospital
      Susatsu, Shiga, Japan