Shin Egawa

The Jikei University School of Medicine, Edo, Tokyo, Japan

Are you Shin Egawa?

Claim your profile

Publications (25)65.52 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Incidence of prostate cancer (PCa) is reported to be increasing in Asia including Japan. Although this trend has been attributed partly to a more westernized diet, this assumption may involve variable confounders. To have more insight, we examined histological features of contemporary versus historical latent PCa. Methods: Prostatic specimens from a consecutive autopsy series (n=127, Present study, 2008 to 2013) were examined. Each prostatic gland was fixed and sliced in step-sections. The findings were compared to those from another autopsy series (n=501, Wada study, 1983 to 1987) at our institution. Results: The mean age of subjects in the Present study was 68.9 years, while the mean age was not available from the original paper of Wada study. However, the mean age of the 566 entrants in the expanded database (1983-1989) was 63.5 years (P=0.0001). Prostatic weights were significantly higher in the Present study (P<0.0001). Latent PCa was found more frequently in the Present study than Wada study (43.3% and 20.8%, respectively, P<0.0001). No distinct difference was seen in the proportion of tumor grade between groups. Increasing trend of moderately to poorly-differentiated tumors with advancing age was more evident in the Present study. Index cancer volume was greater in the Present study; with 25.5% measuring ≥500mm3, compared to only 9.6% of cancers in Wada study (P=0.008). Conclusions: Chronological changes in histological characteristics of Japanese latent PCa were noted; it is more frequent and larger in the contemporary series. Our data may reflect a worldwide trend in the increasingly aging societies.
    No preview · Article · Dec 2015 · The Journal of urology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Degarelix is a gonadotropin-releasing hormone (GnRH) antagonist that is approved for the treatment of prostate cancer. GnRH antagonists bind directly to and block GnRH receptors, without causing the initial testosterone surge associated with GnRH agonists. A pivotal phase III study indicated that degarelix induced significantly faster reduction of testosterone and prostate-specific antigen level than GnRH agonist does. In addition, its 5-year extension trial suggested that patients could be safely switched from GnRH agonist to degarelix treatment with sustained efficacy, as measured by biochemical markers. Possible benefits of GnRH antagonists over agonists were suggested especially in patients with advanced prostate cancer with metastatic and symptomatic disease. Moreover, the recent reports including pooled data analyses on degarelix suggest improved disease control, quality of life, and lower urinary tract symptoms and decreased risk of cardiovascular diseases when compared with GnRH agonists. However, interpretation of these reports should be conducted cautiously because of the potential biases involved. This article critically reviews the results of the clinical trials and subsequent analyses and evaluates the points and counterpoints of the conclusions. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jul 2015 · Urologic Oncology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate antimicrobial susceptibility patterns of various bacterial pathogens isolated from complicated urinary tract infection (UTI) cases, the Japanese Society of Chemotherapy, the Japanese Association of Infectious Disease, and the Japanese Society of Clinical Microbiology conducted the second nationwide surveillance from January to September 2011. With the cooperation of 42 medical institutions throughout Japan, 1036 strains belonging to 8 clinically relevant bacterial species were collected. Among methicillin-resistant Staphylococcus aureus (MRSA) strain, the vancomycin (VCM) MIC for 5.5% (3/55) of the strains was 2 μg/mL. Ampicillin, VCM, and linezolid were relatively active against 209 Enterococcus faecalis strains. The proportion of fluoroquinolone (FQ)-resistant strains was >20%. The MIC90 of FQs against the 382 Escherichia coli strains was 2-64 mg/L and the proportion resistant to FQs was approximately 30%. However, susceptibility of E. coli to sitafloxacin was still high (MIC90 = 2 mg/L). Fifty-eight (15.2%) of 382 E. coli, 6 (4.5%) of 132 Klebsiella pneumoniae, 1 (2.4%) of 41 Klebsiella oxytoca and 4 (6.8%) of 59 Proteus mirabilis strains were suspected of producing extended-spectrum beta-lactamase. Of 93 Pseudomonas aeruginosa strains, the proportions resistant to imipenem, amikacin, and ciprofloxacin were 21.5%, 4.3%, and 20.4%, respectively. Four strains (4.3%) were found to be multidrug-resistant. In complicated UTI cases, all of MRSA and E. faecalis were susceptible to all anti-MRSA agents. Sitafloxacin was active against other FQ-resistant E. coli strains. The isolation of extended-spectrum beta-lactamase-producing and multidrug-resistant strains increased. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Jun 2015 · Journal of Infection and Chemotherapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: Well-trained clinicians may be able to provide diagnosis and prognosis from very short biomarker series using information and experience gained from previous patients. Although mathematical methods can potentially help clinicians to predict the progression of diseases, there is no method so far that estimates the patient state from very short time-series of a biomarker for making diagnosis and/or prognosis by employing the information of previous patients. Here, we propose a mathematical framework for integrating other patients' datasets to infer and predict the state of the disease in the current patient based on their short history. We extend a machine-learning framework of "prediction with expert advice" to deal with unstable dynamics. We construct this mathematical framework by combining expert advice with a mathematical model of prostate cancer. Our model predicted well the individual biomarker series of patients with prostate cancer that are used as clinical samples.
    No preview · Article · May 2015 · Scientific Reports
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The Gleason grading system represents the cornerstone of the management of prostate cancer. Gleason grade 4 (G4) is a heterogeneous set of architectural patterns, each of which may reflect a distinct prognostic value. We determined the prevalence of the various G4 architectural patterns and intraductal carcinoma (IDC) in latent prostate cancer in contemporary Russian (n = 220) and Japanese (n = 100) autopsy prostates and in cystoprostatectomy (CP) specimens (n = 248) collected in Italy. We studied the association of each G4 pattern with extraprostatic extension (EPE) and tumor volume to gain insight into their natural history. Presence of IDC and nine architectural features of Gleason grade 4 and 5 cancer were recorded. The prevalence of Gleason score ≥7 PC was higher in the autopsy series (11%) compared to the CP series (6.5%, P = 0.04). The prevalence of IDC and carcinoma with a cribriform architecture was 2.2% and 3.4% in the autopsy series and 0.8% and 3.6% in the cystoprostatectomy series, respectively. In multivariable analysis, cribriform architecture was significantly associated with increased tumor volume (P < 0.001) and EPE (OR:11.48, 95%CI:2.30-57.16, P = 0.003). IDC was also significantly associated with EPE (OR:10.08, 95%CI:1.58-64.28, P = 0.014). Small fused glands had a strong negative association with EPE in the autopsy series (OR:0.06, 95%CI:0.01-0.58, P = 0.015). Our study revealed that in latent prostate cancer both cribriform architecture and IDC are uniquely associated with poor pathological outcome features. In contrast, Gleason score 7 (3 + 4) cancers with small-fused gland pattern might possibly include some prostate cancers with a more indolent biology. Prostate © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    Full-text · Article · May 2015 · The Prostate
  • [Show abstract] [Hide abstract]
    ABSTRACT: Primary aldosteronism characterized by the overproduction of aldosterone by the adrenal glands, is sometimes accompanied by autonomous cortisol secretion. In this study, we retrospectively analyzed 8 cases of primary aldosteronism (PA) with subclinical Cushing's syndrome (SCS). A total of 71 patients with PA underwent surgery at Jikei University Hospital from 2004 to 2013, and 8 of them were diagnosed with coexistent SCS. Four patients were male and four were female. The mean patient age was 56.9 years. One of the patients also had pheochromocytoma in the adrenal gland on the ipsilateral side. All patients had hypertension, 6 had hypokalemia, 5 had diabetes mellitus, and 3 had hyperlipidemia. All patients had autonomous cortisol secretion as shown in 1mg- or 8mg-dexamethasone suppression tests even though baseline cortisol levels were normal. Adrenal venous blood sampling with adrenocorticotropic hormone (ACTH) stimulation was performed on 5 patients, but the localization of PA could not be detected in 1 patient. Adrenocortical scintigraphy revealed suppression of the contra-lateral adrenal uptake in all 7 patients. Six patients including one patient who showed complete suppression of the contra-lateral adrenal uptake in adrenocortical scintigraphy, and 2 patients, whose ACTH levels were less than the detection limit, received postoperative steroid hormone replacement. In the literature, SCS co-existed in approximately 8. 6% of the patients with PA. In our study, SCS co-existed in approximately 11.3%. The degree of the autonomous secretion of cortisol varied with the patient, and some cases are accompanied by Cushing's syndrome. Therefore, it is important to analyze the autonomous cortisol secretion even in patients with PA.
    No preview · Article · May 2015 · Hinyokika kiyo. Acta urologica Japonica
  • [Show abstract] [Hide abstract]
    ABSTRACT: (Objectives): We retrospectively evaluated characteristics of Tl high-grade bladder cancer in patients in our hospitals. (Patients and methods): Data was reviewed from 134 patients who were diagnosed with Tl high-grade bladder cancer and who underwent transurethral resection (TUR) in our hospitals between January 2006 and December 2012. The clinical course for each patient, the recurrence and progression rates, and the risk factors for recurrence and progression were evaluated. (Results): The median follow-up was 31.5months. A second TUR was performed in 55 patients (41.0%), and showed 32 cases of residual tumor (58.2%) and 4 cases of upstaging (7.3%). The recurrence rate was 41.5%. The risk factors for recurrence were (1) no muscle obtained in initial TUR, (2) no BCG, and (3) no second TUR. The progression rate was 10.5%; no significant risk factors were identified for progression. Within the Tl high-grade bladder cancer cohort, a total of 31 patients underwent radical cystectomy (RC). When we graphed cancer-specific survival (CSS) curves stratified by pathological T stage at the time of RC, and then compared findings from the upstage group (greater than pT2) and the non-upstage group (less than pT2), the CSS rate was significantly higher in the non-upstage group (p = 0.0027). (Conclusion): No muscle in initial TUR, no BCG, and no second TUR are factors associated with recurrence of Tl high-grade bladder cancer. Further investigation is needed for preventing recurrence and progression and for improving survival following radical cystectomy in Tl high-grade bladder cancer.
    No preview · Article · Apr 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: A case of vesico-appendiceal fistula caused by appendiceal cancer is reported. A 37-year-old male was admitted with the chief complaint of suspended dust in the urine. Under cystoscopy, a tumor (1 cmdiameter) was found in the right posterior wall of the bladder. Transurethral resection of the bladder tumor was performed. The pathological outcome was intestinal metaplasia without malignancy. Preoperative abdominal computed tomography suggested vesico-appendiceal fistula, retrospectively. Therefore, appendectomy with partial cystectomy was attempted. However, the appendix was adhered to the sigmoid mesocolon, therefore, appendectomy, partial cystectomy, and sigmoid colectomy were performed. We diagnosed the tumor as mucinous adenocarcinoma. The patient has been receiving adjuvant chemotherapy with tegafur-gimeracil-oteracil potassium for 17 months, because he refused right hemicolectomy. Therewas no evidence of recurrence after 58 months of follow-up. Vesico-appendiceal fistula caused by appendiceal cancer is very rare. Our case is the 21st case reported in Japan.
    No preview · Article · Mar 2015 · Hinyokika kiyo. Acta urologica Japonica
  • [Show abstract] [Hide abstract]
    ABSTRACT: To investigate contemporary rates of variation in the biopsy Gleason grading in prostate cancer, between local and central pathologists, based on central review of the pathological slides from Seed and Hormone for Intermediate-risk Prostate Cancer (SHIP) 0804, a phase III, multicenter, randomized, controlled study. From April 2008 to May 2011, 18 Japanese institutions participated. All H&E slides were reviewed independently, without clinical information, and a tumor grade was assigned according to the modified Gleason grading system proposed by the International Society of Urological Pathology (ISUP). Prostate biopsy specimens of 642 cases were available for evaluation. An exact concordance rate of Gleason score (GS) between local and central pathologists was determined to be 65.3%; with the under-grading and over-grading of grades to be 14.6% and 20.1%, respectively. The central review resulted in numbers of tumor-bearing cores reassigned in 99 of 616 cases in which such information by the local pathologists was available (16.1%). Discordance in biopsy Gleason grading was still found in one third of the cases in the SHIP0804 study. This information is valuable in extrapolating the diagnostic error range in contemporary clinical studies conducted without central pathological review. © 2015 Japanese Society of Pathology and Wiley Publishing Asia Pty Ltd.
    No preview · Article · Mar 2015 · Pathology International
  • [Show abstract] [Hide abstract]
    ABSTRACT: Small cell carcinoma of the prostate is known to have a poor prognosis. We report a case of a large pelvic tumor with small cell carcinoma, which responded well to docetaxel. A 72-year-old man who was receiving androgen-deprivation therapy for prostatic adenocarcinoma presented with constipation. Although the prostate specific antigen level had decreased, a large pelvic tumor was detected between the prostate and the rectum, which caused bowel obstruction. A biopsy of the pelvic tumor revealed small cell carcinoma of the prostate, and chemotherapy with docetaxel and prednisolone was administered. Five months after the administration of docetaxel, the pelvic tumor disappeared completely. At the time of the last follow up, the response was still maintained.
    No preview · Article · Dec 2014 · Hinyokika kiyo. Acta urologica Japonica
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose If a prostate cancer patient treated with 125I brachytherapy dies within 12 months after the treatment, prostate removal before cremation is recommended to avoid problems related to radioactivity in the ashes, such as inhalation of airborne particulate matter by crematorium staff or nearby residents. To provide guidance for such cases, a manual prepared under the editorial supervision of several professional associations was issued in 2008 in Japan. Herein, we investigated the incidence and causes of death, and the actions taken subsequent to death, among prostate cancer patients who died within 12 months after 125I brachytherapy over a 10-year period in Japan; and we compared the results before and after the manual was issued. Methods and Materials Data extracted from the Japan Radioisotope Association database for the period from September 2003 to the end of December 2013 were used. Results Of 27,976 patients who underwent 125I brachytherapy during the specified period, 79 died within 12 months after implantation, including 3 who died in the 2011 earthquake and tsunami. The prostate and brachytherapy source were retrieved at autopsy from 69 of the 79 patients. Autopsy could not be performed on the other 10 patients, 2 of whom died in the earthquake. Autopsy and retrieval of the brachytherapy source were significantly more common after issuance of the manual than before (22/28 cases before; 47/49 cases after; p = 0.021). Conclusion In most cases of early death after 125I brachytherapy in Japan, the brachytherapy source was retrieved.
    No preview · Article · Sep 2014 · Brachytherapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: In order to clarify the clinical efficacy of sitafloxacin (STFX) against the female patients with acute uncomplicated cystitis (AUC), we tried 3-day regimen of STFX, 200 mg daily, against 56 female patients with AUC. The clinical efficacy of STFX for AUC was evaluated according to the Japanese guidelines of clinical trial for genitourinary tract infections (1st Ed, 2011). As a result, the bacteriological outcome 4-9 days after administration of STFX was 78.6% with eradication in 44 cases, and failure in 12 cases (6 cases with persistence and 6 cases with replaced). Also, the clinical outcome was 96.4% (54 cases with cure, 2 cases with failure). Among 32 cases that were available for recurrent evaluation, bacteriological response rate was 71.9% (23 cases with eradication, positive in 9 cases (relapse in 5 cases and reinfection in 4 cases), and the clinical response rate was 93.8% (30 cases with cure and 2 cases with failure). Thirty-nine of 44 (88.6%) isolated strains of Escherichia coli were eradicated, and MIC50 and MIC90 of STFX were lower than 0.06 μg/mL and 1 μg/mL, respectively. Against 4 strains in 6 persisted strains of E. coli, the MICs of STFX was 1 μg/mL or lower. Sixteen strains of Enterococcus faecalis were isolated, and their sensitivity rate, MIC50 and MIC90 of STFX were 93.8%, 0.12 μg/mL and 0.25 μg/mL, respectively. From these results, the efficacy of STFX against the female patients with AUC due to E. coli was moderately low in this study. Therefore, the longer regimen of STFX might be necessary for AUC.
    No preview · Article · Jul 2014 · Japanese Journal of Chemotherapy
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to determine periplakin expression in normal urothelium and blad-der cancer tissues and the relationship to clinicopathological findings. Immunohistochemical staining for periplakin was carried out in 92 archival radical cystectomy specimens, with immunoreactivity being stratified on a 0–6 scale. Immunohistochemical staining for periplakin was shown to be sig-nificantly lower in bladder cancer tissues compared to non-cancerous tissues including inflamma-tion, hyperplasia and normal urothelium. Loss of periplakin expression was associated with pathological stage (P = 0.04). In multivariate Cox regression analysis, loss of periplakin expres-sion and positive lymph node status were independent prognostic factors for cancer-specific sur-vival (P = 0.03 and 0.015; odds ratio = 2.29 and 2.66; 95% confidence interval = 1.085–4.814 and 1.214–5.845, respectively). This new molecular marker may aid in identifying and selecting blad-der cancer patients undergoing radical cystectomy who may potentially benefit from neoadjuvant or adjuvant therapy.
    Full-text · Article · Jun 2014 · Biomedical Research
  • [Show abstract] [Hide abstract]
    ABSTRACT: We report here on a case of condyloma acuminatum in the neourethra after urethroplasty for hypospadias. A 37-year-old male visited an other clinic with the chief complaint of a meatal tumor. He had undergone a urethroplasty for hypospadias in his childhood. He was diagnosed as having condyloma acuminatum of the urethral meatus, and was referred to our hospital. Some other lesions in the neourethra were recognized under urethroscopy. We firstly resected the meatal tumor, and diagnosed it as condyloma acuminatum, pathologically. Thereafter, we performed transurethral resection of the urethral condyloma acuminatum. Recurrence of the condyloma acuminatum was noted after 6 months, postoperatively, so we performed TUR again. No recurrence has been seen to date.
    No preview · Article · May 2014 · Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases

  • No preview · Article · Apr 2014 · The Journal of Urology

  • No preview · Article · Apr 2014 · International Journal of Urology

  • No preview · Article · Apr 2013 · The Journal of Urology

  • No preview · Article · Apr 2013 · The Journal of Urology

  • No preview · Article · Apr 2013 · The Journal of Urology
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: To clarify the differences in clinical features and treatments of prostate cancer among 12 institutions, including The Jikei University Hospital and its affiliated hospitals, we examined the results of prostate needle biopsy and the therapeutic strategy for newly diagnosed cases of prostate cancer to standardize the method of diagnosis and treatment. METHODS: The results of prostate needle biopsy and the therapeutic strategy for newly diagnosed prostate cancer in 2007 were compared among the institutions. RESULTS: A total of 1590 transrectal prostate needle biopsies were performed and 682 cases (42.9%) of prostate cancer were diagnosed. A total of 819 patients with newly diagnosed prostate cancer were treated. Of these patients, 275 (33.6%) were treated with hormonal therapy, 243 (29.7%) were treated with radical prostatectomy;RP and 218 (26.6%) were treated with radiotherapy. CONCLUSION: The survey suggests that the patient characteristics and therapeutic strategies differ somewhat among 12 institutions. Further investigation is required regarding whether the difference in therapeutic strategy affects outcomes.
    No preview · Article · Jan 2013