Objectives: To evaluate the efficacy of alteration from gonadotropin-releasing hormone (GnRH) agonist to antagonist in patients with castration-resistant prostate cancer (CRPC). Methods: Fourteen patients with CRPC we...Objectives: To evaluate the efficacy of alteration from gonadotropin-releasing hormone (GnRH) agonist to antagonist in patients with castration-resistant prostate cancer (CRPC). Methods: Fourteen patients with CRPC were switched from GnRH agonist to GnRH antagonist. CRPC was defined as 3 consecutive rises of PSA values under androgen deprivation therapy despite a testosterone level at the castration level. No patient underwent a change in oral anti-androgen agent or any additional therapy. Patients who showed increase of the PSA value within 10% or showed decrease in the PSA value compared to the baseline were defined as responders. We measured serum PSA, testosterone, follicular stimulating hormone (FSH), and leutenizing hormone (LH) at the time of alteration and 3 months after alteration. Results: The mean age at diagnosis was 74.8 ± 6.3 years with a mean initial PSA level of 537.3 ± 999.1 ng/mL. The mean age at alteration to GnRH antagonist was 81.4 years with a mean PSA level of 28.6 ng/mL. Two out of 14 patients (14%) were judged as responders based on PSA after alteration to GnRH antagonist, although they did not show any further reduction of the serum testosterone level (remain less than 0.03). Six patients showed further reduction of the serum FSH level after alteration;however, they showed no PSA response (from 46.4 ± 42.6 to 69.4 ± 70.3). Conclusions: The switch from GnRH agonist to GnRH antagonist affected 14% of the patients (2 out of 14 patients) with CRPC at 3 months based on PSA. Larger and longer-term studies are required to determine the efficacy of alteration to GnRH antagonist in patients with CRPC.展开更多
Purpose: Phimosis can be treated using topical steroid treatment effectively. Meanwhile, concealed penis has been required surgical correction because it was considered stubborn to conservative treatment. But there we...Purpose: Phimosis can be treated using topical steroid treatment effectively. Meanwhile, concealed penis has been required surgical correction because it was considered stubborn to conservative treatment. But there were few reports of conservative treatment using topical steroid treatment for concealed penis. The aim of the present study was to evaluate the effects of topical steroid treatment for concealed penis. Materials and Methods: From December 2006 to December 2011, 30 patients (mean age 9.3 years) with concealed penis were treated with topical 0.12% bethamethasone valerate cream. Patients or their parents continued to retract the prepuce gently without causing pain and to apply a topical 0.12% bethamethasone valerate cream to the prepuce twice daily for 6 weeks. When topical steroid treatment was ineffective, patients were surgically corrected. Results: The success rate of topical steroid treatment was low (10%). 27 of 30 patients required surgical repair. No patients showed complications associated with topical steroid or surgical intervention. Conclusions: Concealed penis is highly resistant to topical steroid treatment and should be corrected surgically.展开更多
Background:Radical cystectomy(RC)is the standard surgical treatment for patients with muscle-invasive bladder cancer,but the prognosis is not favorable,and new prognostic factors need to be discovered.We investigated ...Background:Radical cystectomy(RC)is the standard surgical treatment for patients with muscle-invasive bladder cancer,but the prognosis is not favorable,and new prognostic factors need to be discovered.We investigated the potential of depth of invasion(DOI)as a prognostic factor in patients with muscle-invasive bladder cancer who underwent RC.Furthermore,we examined the association between preoperative levels of circulating cell-free DNA and DOI.Materials and methods:We retrospectively reviewed patients who underwent RC between January 2007 and December 2017;those who received neoadjuvant chemotherapy were excluded.Depth of invasion was measured using hematoxylin-eosin-stained RC specimens.Results:Of the 121 patients selected,41(33.9%)were eligible for analysis.The median follow-up period was 14 months and mean DOI was 17 mm(range,2-75 mm).Long DOI(>17 mm)was significantly associated with shorter progression-free survival(hazard ratio,14.5;95%confidence interval,3.9-53.97,p<0.0001)and cancer-specific survival(hazard ratio,18.97;95%confidence interval,4.04-88.99,p=0.0002)compared with short DOI.Multivariate analysis revealed that DOI was an independent risk factor for cancer-specific survival.The levels of circulating cell-free DNA were significantly higher in patients with a longer DOI than in those with short DOI(65 vs.20 ng/mL,respectively;p=0.028).Conclusions:Depth of invasion predicted with levels of circulating cell-free DNA and thus could be a useful prognostic factor.展开更多
文摘Objectives: To evaluate the efficacy of alteration from gonadotropin-releasing hormone (GnRH) agonist to antagonist in patients with castration-resistant prostate cancer (CRPC). Methods: Fourteen patients with CRPC were switched from GnRH agonist to GnRH antagonist. CRPC was defined as 3 consecutive rises of PSA values under androgen deprivation therapy despite a testosterone level at the castration level. No patient underwent a change in oral anti-androgen agent or any additional therapy. Patients who showed increase of the PSA value within 10% or showed decrease in the PSA value compared to the baseline were defined as responders. We measured serum PSA, testosterone, follicular stimulating hormone (FSH), and leutenizing hormone (LH) at the time of alteration and 3 months after alteration. Results: The mean age at diagnosis was 74.8 ± 6.3 years with a mean initial PSA level of 537.3 ± 999.1 ng/mL. The mean age at alteration to GnRH antagonist was 81.4 years with a mean PSA level of 28.6 ng/mL. Two out of 14 patients (14%) were judged as responders based on PSA after alteration to GnRH antagonist, although they did not show any further reduction of the serum testosterone level (remain less than 0.03). Six patients showed further reduction of the serum FSH level after alteration;however, they showed no PSA response (from 46.4 ± 42.6 to 69.4 ± 70.3). Conclusions: The switch from GnRH agonist to GnRH antagonist affected 14% of the patients (2 out of 14 patients) with CRPC at 3 months based on PSA. Larger and longer-term studies are required to determine the efficacy of alteration to GnRH antagonist in patients with CRPC.
文摘Purpose: Phimosis can be treated using topical steroid treatment effectively. Meanwhile, concealed penis has been required surgical correction because it was considered stubborn to conservative treatment. But there were few reports of conservative treatment using topical steroid treatment for concealed penis. The aim of the present study was to evaluate the effects of topical steroid treatment for concealed penis. Materials and Methods: From December 2006 to December 2011, 30 patients (mean age 9.3 years) with concealed penis were treated with topical 0.12% bethamethasone valerate cream. Patients or their parents continued to retract the prepuce gently without causing pain and to apply a topical 0.12% bethamethasone valerate cream to the prepuce twice daily for 6 weeks. When topical steroid treatment was ineffective, patients were surgically corrected. Results: The success rate of topical steroid treatment was low (10%). 27 of 30 patients required surgical repair. No patients showed complications associated with topical steroid or surgical intervention. Conclusions: Concealed penis is highly resistant to topical steroid treatment and should be corrected surgically.
基金funded by JSPS KAKENHI,Grant Number:16K20159 and 26861290Nara Medical University Grant-in-Aid for the Collaborative Research Projects.
文摘Background:Radical cystectomy(RC)is the standard surgical treatment for patients with muscle-invasive bladder cancer,but the prognosis is not favorable,and new prognostic factors need to be discovered.We investigated the potential of depth of invasion(DOI)as a prognostic factor in patients with muscle-invasive bladder cancer who underwent RC.Furthermore,we examined the association between preoperative levels of circulating cell-free DNA and DOI.Materials and methods:We retrospectively reviewed patients who underwent RC between January 2007 and December 2017;those who received neoadjuvant chemotherapy were excluded.Depth of invasion was measured using hematoxylin-eosin-stained RC specimens.Results:Of the 121 patients selected,41(33.9%)were eligible for analysis.The median follow-up period was 14 months and mean DOI was 17 mm(range,2-75 mm).Long DOI(>17 mm)was significantly associated with shorter progression-free survival(hazard ratio,14.5;95%confidence interval,3.9-53.97,p<0.0001)and cancer-specific survival(hazard ratio,18.97;95%confidence interval,4.04-88.99,p=0.0002)compared with short DOI.Multivariate analysis revealed that DOI was an independent risk factor for cancer-specific survival.The levels of circulating cell-free DNA were significantly higher in patients with a longer DOI than in those with short DOI(65 vs.20 ng/mL,respectively;p=0.028).Conclusions:Depth of invasion predicted with levels of circulating cell-free DNA and thus could be a useful prognostic factor.
