Prostatic Neoplasms: Naito S

Ito K, Kakehi Y, Naito S, Okuyama A, Anonymous00017. · Department of Urology, Gunma University Graduate School of Medicine, Gunma, Japan. · Int J Urol. · Pubmed #18786203 No free full text.

Abstract: The exposure rate of screening for prostate cancer using prostate-specific antigen (PSA) in Japan is still very low compared with that in the USA or Western Europe. The mortality rate of prostate cancer will increase in the future and in 2020 it will be 2.8 times higher than in 2000. Therefore, there is an urgent need to determine the best available countermeasures to decrease the rate of prostate cancer death.

Akaza H, Hinotsu S, Usami M, Ogawa O, Kagawa S, Kitamura T, Tsukamoto T, Naito S, Hirao Y, Murai M, Yamanaka H, Namiki M. · Department of Urology, Institute of Clinical Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8578, Japan. · J Urol. · Pubmed #17084166 No free full text.

Abstract: PURPOSE: We analyzed the outcome of primary androgen depletion therapy, which has gained more attention as a potential therapeutic option in patients with localized or locally advanced prostate cancer as it has been increasingly implemented despite limited data on its therapeutic impact in Japan and the United States. MATERIALS AND METHODS: We analyzed data from CaPSURE and the Japanese Prostate Cancer study. RESULTS: In Japan primary androgen depletion therapy has long been the treatment of choice for localized and locally advanced prostate cancer. Based on CaPSURE data the frequency of primary androgen depletion therapy being chosen to treat localized and locally advanced disease is also increasing in clinical practice in the United States. A study of the outcomes of endocrine therapy is currently being performed in Japan by the Japanese Prostate Cancer Study Group. CONCLUSIONS: It is important to obtain such information about the role of primary androgen depletion therapy for localized and locally advanced prostate cancer from studies of natural history and clinical trials. It is also important to update practical treatment guidelines.

Cheng C, Akaza H, Chen KK, Moore MA, Naito S, Song JM, Umbas R, Xia S, Anonymous00319. · UICC Asia Regional Office. · Asian Pac J Cancer Prev. · Pubmed #17059324 No free full text.

Abstract: Cancer of the prostate remains at relatively low incidence in Asia but rates are increasing rapidly in some countries and specific populations so that measures for control need our attention. Little is known about risk factors, although vegetables and phytoestrogens may be protective and fat, meat and dairy products may increase the risk. Physical exercise may have preventive effects, while tobacco and alcohol appear to have no consistent relationship. The lack of clear lifestyle targets means that emphasis needs to be placed on screening for various prostate specific antigen parameters and clinical treatment, whether hormonal, radio or surgical, alone or in combination. While there is a massive literature for the Western world, the limited literature available for Asia means that cooperation to obtain a standardized data base is a high priority if the most effective measures for the specific populations of Asian countries are to be identified and put into practice.

Naito S. · Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. · Jpn J Clin Oncol. · Pubmed #15976063 links to  free full text

Abstract: A radical prostatectomy has been established as one of the standard management options for localized prostate cancer. However, a substantial proportion of patients who undergo a radical prostatectomy develop prostate-specific antigen (PSA) recurrence which is commonly defined as a PSA cut-off point value of 0.2 ng/ml. Although the management of PSA recurrence after radical prostatectomy may depend on the site of recurrence, it is quite difficult to identify the recurrent lesion accurately based on the currently available imaging technology. Patients who have surgical margin involvement or a Gleason score < or =7 based on the radical prostatectomy specimens, who do not have nodal or seminal vesicle involvement, and who develop a PSA recurrence >1-2 years after surgery with a doubling time of >1 year, and whose pre-treatment PSA is < 1.0-1.5 ng/ml are considered to benefit from local treatment with at least 64 Gy of salvage radiotherapy. Patients with different characteristics are considered to have distant metastases or both local lesions and distant metastases, and thus may be candidates for hormonal manipulation rather than radiotherapy. Since local recurrent lesions are considered to be quite small at the early stage of PSA recurrence, hormonal manipulation may be sufficient to prevent disease progression instead of radiotherapy. However, the optimal type and timing of hormonal manipulation remain to be elucidated. As a result, no consensus regarding the treatment for PSA recurrence after radical prostatectomy has yet been reached.

Nakamura M, Naito S. · Department of Urology, Graduate School of Medical Sciences, Kyushu University. · Nippon Rinsho. · Pubmed #12166186 No free full text.

This publication has no abstract.

Naito S. · Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. · Int J Urol. · Pubmed #11442672 No free full text.

Abstract: Radical prostatectomy is the only potential modality for cure in patients with localized prostate cancer. However, the lack of reliable and accurate clinical staging frequently leads to incomplete excision of tumor, with the consequences of early local recurrence or distant metastasis. Thus, the role of neoadjuvant or adjuvant hormonal treatment has been investigated in improving disease-free or cause-specific survival. This review reports the current status and problems of such androgen deprivation in combination with radical prostatectomy for localized prostate cancer.

Koga H, Naito S. · Department of Urology, Graduate School of Medical Sciences, Kyushu University. · Nippon Rinsho. · Pubmed #11022711 No free full text.

This publication has no abstract.

Arai Y, Akaza H, Deguchi T, Fujisawa M, Hayashi M, Hirao Y, Kanetake H, Naito S, Namiki M, Tachibana M, Usami M, Ohashi Y. · Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan. · J Cancer Res Clin Oncol. · Pubmed #18491137 No free full text.

Abstract: PURPOSE: To assess quality of life (QOL) data from a double-blind Phase III study evaluating bicalutamide (Casodex) 80 mg as part of maximum androgen blockade (MAB) in patients with previously untreated advanced prostate cancer. METHODS: Patients with untreated stage C/D prostate cancer were randomized to MAB with bicalutamide plus a luteinizing hormone-releasing hormone agonist (LHRHa) or LHRHa monotherapy. QOL was evaluated at baseline and at weeks 1, 5, and 24 using the Japanese version of the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire. RESULTS: A total of 203 patients were assessed for QOL. The MAB group had more rapid and greater improvements in "emotional well-being" and "prostate cancer-specific issues" domain scores than the monotherapy group. Further analysis of "prostate cancer-specific issues" revealed that, compared with monotherapy, MAB provided a greater improvement in "micturition disorder"-related QOL. Complete improvement rates for items related to "pain and micturition disorder" were also higher with MAB. Item scores of "pain and micturition disorder" did not correlate strongly with prostate-specific antigen levels or tumor size. Fewer patients who had deterioration in their "pain and micturition disorder" item scores at week 1 in the MAB group than the monotherapy group. CONCLUSIONS: Maximum androgen blockade with bicalutamide plus LHRHa did not reduce the overall QOL of patients with previously untreated advanced prostate cancer. MAB was superior to monotherapy in achieving early improvement of QOL related to micturition disorder and pain.

Naito S, Tsukamoto T, Koga H, Harabayashi T, Sumiyoshi Y, Hoshi S, Akaza H. · Department of Urology, Faculty of Medicine, Kyushu University 71, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8585, Japan. · Jpn J Clin Oncol. · Pubmed #18417502 links to  free full text

Abstract: BACKGROUND: Docetaxel-based chemotherapy has been shown to be effective and well tolerated by Western patients with metastatic hormone-refractory prostate cancer (HRPC). This study was undertaken to assess the feasibility of docetaxel in combination with prednisolone in Japanese patients with HRPC. METHODS: Patients aged 50-74 years with measurable metastatic HRPC were included in this non-comparative Phase II study. Treatment consisted of docetaxel 70 mg/m(2) once every 3 weeks plus prednisolone 5 mg twice daily, for a maximum of 10 cycles. The primary endpoint was overall tumor response rate, assessed by Response Evaluation Criteria in Solid Tumors; secondary endpoints included prostate-specific antigen (PSA) response and toxicity. RESULTS: A total of 43 patients were evaluable for efficacy and toxicity. The response rate was 44.2% (90% CI, 31.2-57.8%), with partial responses in 19/43 patients. The median duration of response was 19.3 weeks. PSA responses were recorded in 44.4% of patients (95% CI, 27.9-61.9%). The most common non-hematological adverse events (of any grade) possibly related to treatment were alopecia (88.4%), anorexia (65.1%) and fatigue (53.5%). Grade 3/4 leukopenia and neutropenia occurred in 81.4 and 93.0% of patients, respectively; however, the grade 3/4 rates of febrile neutropenia (16.3%) and infection without fever (14.0%) were lower. CONCLUSION: The combination of docetaxel and prednisolone was feasible and active in Japanese patients with HRPC, with a manageable adverse-event profile similar to that observed in Western patients.

Usami M, Akaza H, Arai Y, Hirano Y, Kagawa S, Kanetake H, Naito S, Sumiyoshi Y, Takimoto Y, Terai A, Yoshida H, Ohashi Y. · Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. · Prostate Cancer Prostatic Dis. · Pubmed #17199134 No free full text.

Abstract: To compare combination therapy with bicalutamide 80 mg and a luteinizing hormone-releasing hormone agonist (LHRH-A) versus LHRH-A alone in Japanese men with untreated advanced prostate cancer. A total of 205 patients with stage C/D prostate cancer were randomized to either LHRH-A+once-daily oral bicalutamide 80 mg or placebo. Primary study variables have been reported previously. Secondary variables included: time to achieve prostate-specific antigen < or = 4 ng/ml, time-to-treatment failure (TTTF), time-to-disease progression (TTP), overall survival (OS), adverse events and adverse drug reactions. Following combination therapy with bicalutamide 80 mg, there were significant (P<0.001) advantages over LHRH-A alone in terms of TTTF and TTP, but the difference in the interim OS was not statistically significant. First-line combination therapy with bicalutamide 80 mg in Japanese patients with advanced prostate cancer offers significant benefits over LHRH-A alone, with respect to TTTF and TTP. Follow-up for OS continues.

Yokomizo A, Kawamoto H, Nihei K, Ishizuka N, Kakehi Y, Tobisu K, Naito S, Anonymous00028. · Department of Urology, Graduate School of Medical Science, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan. · Jpn J Clin Oncol. · Pubmed #15681602 links to  free full text

Abstract: A randomized controlled trial has started in Japan to evaluate radiotherapy and endocrine therapy for prostate-specific antigen (PSA) failure after radical prostatectomy. Patients who have PSA failure after radical prostatectomy for localized prostate cancer (T1-2N0M0) are randomized into treatment groups of either radiotherapy +/- endocrine therapy or endocrine therapy alone. The Urologic Oncology Study Group (UOSG) in the Japan Clinical Oncology Group (JCOG) composed of 36 specialized institutions will recruit 200 patients. The primary end-point is time to treatment failure (TTF) of bicalutamide, and secondary end-points are TTF of protocol treatment, progression-free survival, overall survival, adverse events and quality of life (QOL). The Clinical Trial Review Committee of the JCOG approved the protocol on April 13, 2004, and the study was activated on May 17, 2004.

Yamanaka H, Ito K, Naito S, Tsukamoto T, Usami M, Fujimoto H, Matsuoka N, Fukui I, Harada M, Ohashi Y, Kotake T, Kakizoe T. · Institute for Preventive Medicine, Kurosawa Hospital, Takasaki, Japan. · Prostate. · Pubmed #15468166 No free full text.

Abstract: PURPOSE: To clarify the optimal duration and methods for adjuvant endocrine therapy after external beam radiation therapy (EBRT) in patients with locally advanced prostate cancer. MATERIALS AND METHODS: Between 2001 and 2003, 215 patients with locally advanced prostate cancer were enrolled in the study. Patients were registered as primary candidates of the study and were treated with 6 months of LHRH agonist, with short-term of antiandrogen treatment for flare-up prevention. Patients with PSA levels below 10 ng/ml after the 6-month endocrine treatment were randomly divided into two arms. Then, a total dose of 72 Gy was given to the prostate. After 14 months of the protocol treatment, patients were treated with continuous androgen ablation (arm 1) or intermittent androgen ablation (arm 2). RESULTS: A total of 188 cases (87%) remained in the protocol. The median PSA level at entry was 25.3 ng/ml. The Gleason score was 2-6 in 32 cases (16%), 7 in 94 cases (48%), and 8-10 in 68 cases (35%). The median PSA level showed a remarkable decrease to 1.1, 0.2, and 0.1 ng/ml, after 6, 8, and 14 months of the protocol treatment, respectively. Of the 157 cases treated with EBRT, 153 cases (97.5%) had no biochemical failure in the mean follow-up of 17.3 months. CONCLUSIONS: The present study may reveal the possibilities of intermittent endocrine therapy after EBRT. However, the follow-up interval is short and little can be said about the results observed so far, exception of acute tolerance and patient acceptance of the protocol.

Akaza H, Yamaguchi A, Matsuda T, Igawa M, Kumon H, Soeda A, Arai Y, Usami M, Naito S, Kanetake H, Ohashi Y. · Department of Urology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan. · Jpn J Clin Oncol. · Pubmed #15020659 links to  free full text

Abstract: OBJECTIVES: To evaluate bicalutamide (Casodex) 80 mg as a component of maximum androgen blockade (MAB) in Japanese patients with previously untreated advanced prostate cancer. METHODS: 205 patients with previously untreated stage C/D prostate cancer were randomized (1:1) to receive once-daily bicalutamide 80 mg or placebo, each combined with a luteinizing hormone-releasing hormone (LHRH) agonist. Primary study variables were the 12 week prostate-specific antigen (PSA) normalization (i.e. PSA level <or=4 ng/ml) rate, the 12 week overall tumor response rate (proportion with a partial response or better) and the proportion of withdrawals due to adverse drug reactions (ADRs) at follow-up. This interim analysis was undertaken after a minimum of 6 months' follow-up (median 15 months). RESULTS: The 12 week PSA normalization rate was 79.4% for MAB and 38.6% for LHRH agonist monotherapy (P < 0.001). The 12 week overall tumor response rate was 77.5 and 65.3%, respectively (P = 0.063). The withdrawal rate due to ADRs was 8.8% and 10.9%, respectively. There were differences in favor of MAB over monotherapy with respect to time to treatment failure (TTTF) (P = 0.038) and time to progression (TTP) (P = 0.016). There have been too few deaths (n = 10) to analyze survival. The profiles of adverse events and ADRs were broadly similar in the two treatment groups. CONCLUSION: In Japanese patients with advanced prostate cancer, first-line treatment with bicalutamide 80 mg in combination with an LHRH agonist is superior to LHRH agonist monotherapy in terms of the antitumor response at 12 weeks, and also time to treatment failure and progression, and does not compromise treatment safety. The study is ongoing.

Koiso K, Akaza H, Naito S, Usami M, Tsukamoto T, Shimazaki J, Kotake T, Yamanaka H, Oohashi Y, Yoshinaka R, Onouchi H, Yokokawa K. · Senpo Tokyo Takanaka Hospital. · Hinyokika Kiyo. · Pubmed #12613016 No free full text.

Abstract: A randomized, multicenter, double-blind, parallel-group study was conducted in order to evaluate the hormonal kinetics, pharmacokinetics, efficacy and safety of TAP-144-SR (3M) a three-month sustained-release injectable preparation of leuprorelin acetate, a highly active luteinizing hormone-releasing hormone (LH-RH) derivative by comparing the treatment with two subcutaneous doses of the test medication TAP-144-SR (3M) and the treatment with six subcutaneous doses of the reference medication TAP-144-SR (1M), a 1-month sustained-release injectable preparation. Study participants were 103 patients with prostate cancer in whom a stable anti-tumor effect had been obtained with Leuplin Injection 3.75. The hormonal kinetics revealed that the proportion of the patients "maintaining the castration level of serum testosterone (maximum serum testosterone level during treatment below the castration level [100 ng/dl])" was 100% in both treatment groups. With regard to the efficacy, the proportions of the patients in whom the anti-tumor effects (> or = Stable) of the baseline treatment prior to the initiation of the treatment with the study medication were maintained during the study treatment period (6 months) were comparable; 84.0% with TAP-144-SR (1M) and 80.4% with TAP-144-SR (3M). On evaluation of the pharmacokinetics, the mean value of AUC1-12w of the serum TAP-144 concentration (including the metabolite M-I) for the treatment with TAP-144-SR (3M) was 77.0% that of the treatment with TAP-144-SR (1M). Adverse events were similar in the subjects on TAP-144-SR (3M) and in those on TAP-144-SR (1M). There existed no big differences in kind, incidence or time of occurrence of adverse events between two groups. TAP-144-SR (3M) showed no clinically relevant findings in particular. These results indicate that one dose of TAP-144-SR (3M) is comparable to three doses of the already approved Leuplin injection 3.75 in serum testosterone level-inhibitory effect, efficacy and safety. Hence, it is considered that TAP-144-SR (3M) is a drug suitable for treatment of prostate cancer over a prolonged period of time.

Kotake T, Akaza H, Usami M, Naito S, Kanetake H, Taguchi T, Tsukagoshi S, Koiso K. · Department of Medical Examination, Osaka Medical Center for Cancer and Cardiovascular Diseases. · Hinyokika Kiyo. · Pubmed #11433759 No free full text.

Abstract: Pharmacodynamics (PD), anti-tumor effects, safety and pharmacokinetics of a 3-month formulation of goserelin (Zoladex LA 10.8 mg depot: "10.8 mg depot") were investigated in a collaborative multicenter study. Study participants were 40 Japanese patients with prostate cancer comprising 20 untreated patients and 20 switch patients who had been receiving Zoladex 3.6 mg depot for 3 months or longer. Serum testosterone levels, serum LH levels, prostate-specific antigen (PSA) levels and drug concentrations were measured until 12 weeks after a single subcutaneous dose of 10.8 mg depot. Anti-tumor effects were evaluated by means of changes in the tumor lesions and the PSA levels at 12 weeks. After administration to the untreated patients, 10.8 mg depot reduced serum testosterone to the castrate range within 4 weeks and the reduction was maintained for up to 12 weeks. In the switch patients, serum testosterone suppression that had been produced by previous treatment with Zoladex 3.6 mg depot was maintained for up to 12 weeks following 10.8 mg depot administration. The anti-tumor effect at 12 weeks was 90.0% including partial response cases. The ratio of PSA normalization at 12 weeks was 75.0%. Fifty-seven adverse reactions were observed in 27 of the 40 patients (67.5%), but none were clinically significant. Although a disease flare presented as urinary retention in 1 of the untreated patients, all patients completed the study. Serum goserelin was detected up to 12 weeks after the administration of 10.8 mg depot. In conclusion a single dose of 10.8 mg depot showed a satisfactory PD-effect and brought about clinical efficacy persisting for at least 12 weeks and was well tolerated in patients with prostate cancer.

Kotake T, Usami M, Akaza H, Koiso K, Homma Y, Kawabe K, Aso Y, Orikasa S, Shimazaki J, Isaka S, Yoshida O, Hirao Y, Okajima E, Naito S, Kumazawa J, Kanetake H, Saito Y, Ohi Y, Ohashi Y. · Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan. · Jpn J Clin Oncol. · Pubmed #10678560 links to  free full text

Abstract: OBJECTIVE: The aims of this randomized, controlled study were to investigate the efficacy and safety of long-term monotherapy with the luteinizing hormone-releasing hormone agonist goserelin acetate compared with both short- and long-term combined androgen blockade. METHODS: Patients with advanced prostate cancer (n = 371) were randomized to treatment with goserelin acetate alone or a combination of goserelin acetate plus either long-term or short-term antiandrogen (chlormadinone acetate) or short-term estrogen (diethylstilbestrol diphosphate). RESULTS: There were no significant differences between the treatment groups with respect to objective progression, overall survival or disease-specific survival. Nevertheless, subgroup analysis suggested that patients with minimal disease or a good prognosis might benefit more from combined androgen blockade than other patients. Combined androgen blockade significantly reduced the incidence of disease flare compared with goserelin acetate treatment alone. CONCLUSIONS: Neither short- nor long-term combined androgen blockade had a survival advantage over goserelin acetate alone.

Shiota M, Izumi H, Tanimoto A, Takahashi M, Miyamoto N, Kashiwagi E, Kidani A, Hirano G, Masubuchi D, Fukunaka Y, Yasuniwa Y, Naito S, Nishizawa S, Sasaguri Y, Kohno K. · Department of Molecular Biology, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu, Japan. · Cancer Res. · Pubmed #19318582 No free full text.

Abstract: Programmed cell death protein 4 (PDCD4) has recently been shown to be involved in both transcription and translation, and to regulate cell growth. However, the mechanisms underlying PDCD4 function are not well understood. In this study, we show that PDCD4 interacts directly with the transcription factor Twist1 and leads to reduced cell growth through the down-regulation of the Twist1 target gene Y-box binding protein-1 (YB-1). PDCD4 interacts with the DNA binding domain of Twist1, inhibiting its DNA binding ability and YB-1 expression. Immunohistochemical analysis showed that an inverse correlation between nuclear PDCD4 and YB-1 expression levels was observed in 37 clinical prostate cancer specimens. Growth suppression by PDCD4 expression was completely recovered by either Twist1 or YB-1 expression. Moreover, PDCD4-overexpressing cells are sensitive to cisplatin and paclitaxel but not to etoposide or 5-fluorouracil. In summary, PDCD4 negatively regulates YB-1 expression via its interaction with Twist1 and is involved in cancer cell growth and chemoresistance.

Shiota M, Izumi H, Miyamoto N, Onitsuka T, Kashiwagi E, Kidani A, Hirano G, Takahashi M, Ono M, Kuwano M, Naito S, Sasaguri Y, Kohno K. · Department of Molecular Biology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan. · Cancer Sci. · Pubmed #19016754 No free full text.

Abstract: Peroxiredoxins (Prdxs) are thiol-specific antioxidant proteins that are highly expressed in human cancer cells. Prdxs have been shown to be involved in tumor cell proliferation under conditions of microenvironmental stress such as hypoxia. We hypothesized that Prdxs could be categorized into two groups, stress-inducible and non-inducible ones. In this study, we analyzed the promoter activity and expression levels of five Prdx family members in human cancer cells. We found that both Prdx1 and Prdx5 are inducible after treatment with hydrogen peroxide or hypoxia, but that Prdx2, Prdx3, and Prdx4 are not or are only marginally inducible. We also found that Ets transcription factors are the key activators for stress-inducible expression. High-mobility group protein HMGB1 was shown to function as a coactivator through direct interactions with Ets transcription factors. The DNA binding of Ets transcription factors was significantly enhanced by HMGB1. Silencing of Ets1, Ets2, Prdx1, and Prdx5 expression sensitized cells to oxidative stress. These data indicate that transcription of Prdx genes mediated by Ets/HMG proteins might protect cells from oxidative stress.

Naito S, Kuroiwa K, Kinukawa N, Goto K, Koga H, Ogawa O, Murai M, Shiraishi T, Anonymous00325. · Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. · J Urol. · Pubmed #18635221 No free full text.

Abstract: PURPOSE: We validated the 2001 Partin tables and developed an original nomogram for Japanese patients using the 2005 International Society of Urological Pathology consensus on Gleason grading. MATERIALS AND METHODS: Prostatectomy specimens from 1,188 Japanese men who underwent radical prostatectomy for clinically localized prostate cancer (cT1-2) between 1997 and 2005 were analyzed. Polychotomous logistic regression analysis was used to construct a nomogram to predict final pathological stage (organ confined disease, extraprostatic extension, seminal vesicle invasion and lymph node involvement) from 3 variables, including serum prostate specific antigen, clinical stage and biopsy Gleason score. The area under the ROC curve was used to compare the new nomogram with the Partin tables. RESULTS: Preoperative serum prostate specific antigen and biopsy Gleason score were higher in the Japanese cohort than in the Partin cohort. The distribution of clinical and final pathological stages was similar in the 2 cohorts. The AUC for predicting organ confined disease was 0.699 and 0.717 for data applied to the Partin tables and to the new nomogram, respectively. The AUC for predicting lymph node involvement was 0.793 and 0.863, respectively. CONCLUSIONS: To our knowledge this is the first preoperative nomogram developed for clinically localized prostate cancer in Japanese patients. Although the new nomogram predicted the pathological stage of prostate cancer in Japanese patients more accurately than the Partin tables, it did not satisfactorily predict organ confined disease. However, other predictive variables, such as more detailed pathological features of biopsy specimens or magnetic resonance imaging, may further improve prediction accuracy.

Yoshimitsu K, Kiyoshima K, Irie H, Tajima T, Asayama Y, Hirakawa M, Ishigami K, Naito S, Honda H. · Department of Clinical Radiology, Graduate School of Clinical Sciences, Kyushu University, Fukuoka, Japan. · J Magn Reson Imaging. · Pubmed #18050334 No free full text.

Abstract: PURPOSE: To elucidate the performance of apparent diffusion coefficient (ADC) map in localizing prostate carcinoma (PC) using stepwise histopathology as a reference. MATERIALS AND METHODS: Preoperative MR images of 37 patients with PC who had undergone radical prostatectomy were retrospectively evaluated. First, T2-weighted images (T2WI) alone were interpreted (T2WI reading), and then T2WI along with ADC map were interpreted (T2WI/ADC map reading). Sextant-based sensitivity and specificity, and the ratio of the detected volume to the whole tumor volume (% tumor volume) were compared between the two interpretations, and results were also correlated to Gleason's scores (GS). ADC values were correlated to histological grades. RESULTS: Sensitivity was significantly higher in T2WI/ADC map reading than in T2WI reading (71% vs. 51%), but specificity was similar (61% vs. 60%). By adding ADC map to T2WI, % tumor volume detected increased significantly in transitional zone (TZ) lesions, but not in peripheral zone (PZ) lesions. % tumor volume detected with T2WI/ADC map reading showed a positive correlation with GS of the specimens. Less differentiated PC were associated with lower ADC values and higher detectability. CONCLUSION: T2WI/ADC map reading was better than T2WI reading in PC detection and localization. This approach may be particularly useful for detecting TZ lesions and biologically aggressive lesions.

Hinotsu S, Akaza H, Usami M, Ogawa O, Kagawa S, Kitamura T, Tsukamoto T, Naito S, Namiki M, Hirao Y, Murai M, Yamanaka H, Anonymous00019. · Urology and Andrology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba City, Ibaraki prefecture, 305-8575, Japan. · Jpn J Clin Oncol. · Pubmed #17965423 links to  free full text

Abstract: BACKGROUND: Based on the data of current status of endocrine therapy for prostate cancer registered in the Japan Study Group of Prostate Cancer (J-CaP), we conducted an analysis of primary androgen deprivation therapy (PADT) and an interim analysis of the prognosis. METHODS: Of the 26 272 cases registered in the server of J-CaP, the 19 409 cases initially receiving PADT were included in this study. The initial therapy was divided into eight categories according to its features. RESULTS: Of the 19 409 patients, 1513 (7.8%) were given anti-androgen monotherapy, 955 patients (4.9%) surgical castration only, 1001 patients (5.2%) surgical castration + anti-androgen, 3015 patients (15.5%) LHRH monotherapy, 1658 patients (8.5%) LH-RH + short-term anti-androgen, 10 434 patients (53.8%) LH-RH + anti-androgen, 37 patients (0.2%) watchful waiting and 796 patients (4.1%) other therapy. In progression-free survival, the prognosis was slightly better following maximum androgen blockade (MAB) in each stage. CONCLUSIONS: The pattern of PADT is more typical in Japan compared with that in the United States. Patients who received MAB accounted for 59.0% of all the patients. MAB tends to be more often selected for patients who are rated as being at high risk on the basis of high Gleason score or PSA level upon diagnosis in each clinical stage of the disease. Investigations of the outcome are on-going and they will make clear the significance of this trend in Japan.

Nagata Y, Sonoda T, Mori M, Miyanaga N, Okumura K, Goto K, Naito S, Fujimoto K, Hirao Y, Takahashi A, Tsukamoto T, Akaza H. · Department of Public Health, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Hokkaido 060-8556, Japan. · J Nutr. · Pubmed #17634273 links to  free full text

Abstract: We examined associations between nutritional and other lifestyle factors and the prevalence of prostate cancer in a case-control study of Japanese men. Two hundred patients and 200 age-matched controls (+/-5 y) were selected from 3 geographic areas of Japan. BMI, physical activity, occupation, family history of prostate cancer, and medical history were not associated with prostate cancer risk. Isoflavones and their aglycones (genistein and daidzein) were significantly associated with decreased risk. The odds ratio for the highest category (> or = 89.9 mg/d) compared with the lowest category (<30.5 mg/d) of isoflavone intake was 0.42 (95% CI = 0.24-0.72) and the linear trend was significant (P < 0.01). PUFA, (n-6) fatty acids, and magnesium were significantly associated with decreased risk but not after adjustment for isoflavone intake. Isoflavone intake was correlated with the intake of PUFA (r = 0.68, P < 0.001), (n-6) fatty acids (r = 0.69, P < 0.001), and magnesium (r = 0.56, P < 0.001), because soy products contain high levels of these nutrients. On the other hand, isoflavone significantly decreased the risk of prostate cancer regardless of adjustment by PUFA, (n-6) fatty acids or magnesium. In conclusion, our findings indicate that isoflavones might be an effective dietary protective factor against prostate cancer in Japanese men.

Nishimura S, Arai Y, Usami M, Kanetake H, Naito S, Akaza H. · Kyoto University, Graduate School of Economics. · Gan To Kagaku Ryoho. · Pubmed #17431346 No free full text.

Abstract: Like other countries, Japan is facing the problem of rising medical costs associated with aging of the population, and therefore the cost-effectiveness of medicines has become increasingly important. Maximum androgen blockade (MAB) therapy, which is being widely used for advanced prostate cancer, has proved useful in clinical studies but it requires the additional use of an anti-androgen in contrast with luteinizing hormone releasing hormone agonist (LHRHa) monotherapy, raising a concern about the increase medical costs. Thus, based on the results of a Japanese Phase III study of bicalutamide we performed a cost-effectiveness analysis. We constructed a Markov model to express the changes in prognosis following MAB therapy and LHRHa monotherapy for advanced prostate cancer and the cost and effectiveness (survival) were simulated. As a result, the expected costs of MAB therapy and LHRHa monotherapy were 5,240,000 yen and 3,660,000 yen, respectively, with expected survival durations of 7.45 and 6.44 years. The incremental cost-effectiveness ratio for MAB therapy was 1,560,000 yen/life-year saved, lower than the established threshold (6,000,000 yen/life-year saved), and a sensitivity analysis confirmed the robustness of this result. Therefore, the incremental cost of bicalutamide was considered worth it in view of the therapeutic effect, suggesting that MAB therapy is a highly cost-effective therapy.

Seki N, Tatsugami K, Naito S. · Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. · J Endourol. · Pubmed #17338621 No free full text.

Abstract: PURPOSE: To review the outcomes associated with holmium laser enucleation of the prostate (HoLEP) to identify the efficacy and safety in relation to the prostate size in subjects with symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: A retrospective review was conducted of the data from 97 patients who had undergone HoLEP combined with mechanical morcellation. All patients completed both the preoperative and the 6-month postoperative assessment. The morbidity and improvement in the outcome variables were compared in groups classified according to the baseline prostate volume: <50 cm3 (group 1), >or=50 cm3-<100 cm3 (group 2), and >or=100 cm3 (group 3). RESULTS: The peak urinary flow rate (Qmax), postvoiding residual urine volume (PVR), International Prostate Symptom Score (IPSS) and quality of life (QoL) score all improved significantly after HoLEP, and no significant differences were observed among the groups. The mean total operation times were 70.3, 99.1, and 155.5 minutes for groups 1, 2, and 3, respectively (P < 0.0001 group 1 v group 2 v group 3). The mean times required to complete the enucleation and morcellation were 44.7 v 66.5 v 107.3 minutes (P < 0.0001) and 8.6 v 10.9 v 23.8 minutes (P < 0.0001), respectively. The efficacy for tissue enucleation and morcellation was 0.44 v 0.57 v 0.75 g/min (P < 0.0001) and 2.5 v 3.3 g/min (P = 0.016) v 3.2 g/min (P = 0.035). The mean hemoglobin loss after HoLEP was greater in group 3 than in group 1 (P = 0.036), but it was still low (1.8 g/dL). Major complications included bladder-muscle injury in one patient in group 2 and one in group 3 and long-lasting urinary incontinence in one patient in group 1 and one in group 2 (2.1%). No blood transfusion or transurethral resection syndrome was observed in any of the groups. CONCLUSIONS: Holmium laser enucleation is an effective treatment for symptomatic BPH independent of prostate size.

Noguchi M, Matsuoka K, Koga H, Kanetake H, Nakagawa M, Naito S. · Department of Urology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan. · Int J Clin Oncol. · Pubmed #17058137 No free full text.

Abstract: BACKGROUND: We surveyed urologists in the Kyushu and Okinawa regions of Japan regarding their standard approach to patient preparation and their prostate biopsy technique. METHODS: A total of 155 survey questionnaires were prepared and mailed to community and academic urologists in the Kyushu and Okinawa regions. Incidences were derived from the total numbers of responses, by item, divided by the total number of responses per practice type. RESULTS: There were 27 responses from clinics (17.4%), 115 from general hospitals (74.2%), and 13 from university hospitals or cancer centers (8.4%). Most urologists performed biopsy in patients with prostate-specific antigen (PSA) levels greater than 4 ng/ml when digital rectal examination (DRE) and/or transrectal ultrasound (TRUS) results were normal. Of the urologists, 83% reported performing the procedure with hospitalization; 51% of urologists do not advocate enema use, 69% performed the procedure under spinal anesthesia or a sacral block, 53% reported the combined administration of antibiotics orally and intramuscularly or intravenously, 70% used only the transrectal route for prostate biopsy, and 86.5% performed six or more biopsy cores at the initial prostate biopsy session. CONCLUSION: This survey shows substantial variation in the prostate biopsy protocols among urologists in the Kyushu and Okinawa regions in Japan, and suggests that national, evidence-based, guidelines are required, particularly as to antibiotic prophylaxis and the number of biopsy cores.