Radiotherapy (RT) for prostate cancer increases the risk of bladder cancer. The genomic landscape of bladder cancer following RT for prostate cancer and its differentiation from bladder cancers that develop without a history of pelvic RT remains unclear. We examined gene mutations in bladder cancers that developed following RT and those that developed without prior RT. Fourteen patients who developed primary bladder cancer following brachytherapy were categorized into radiation-associated bladder tumor (RA-BT) group, whereas 33 patients diagnosed with primary bladder cancer without a history of pelvic RT were classified into the bladder tumor (BT) group. The frequency of TERT promoter mutations was 35.7% and 63.6% in the RA-BT and BT groups, respectively (p = 0.112). Among the other characteristic mutations, FGFR3 and TP53 were frequently observed in both groups (FGFR3: RA-BT vs. BT, 14.3 vs. 42.4%; TP53: RA-BT vs. BT, 50 vs. 33.3%). Rare mutations in bladder cancer were more frequently observed in the RA-BT group, including ADGRB3 (28.6%), CBL (21.4%), TGM7 (21.4%), and BTK (14.3%). There were significantly more C → T substitutions in the RA-BT group than in the BT group. In our study, the genetic mutations in the RA-BT group had distinct features from those in the BT group.

Gut microbiota plays a crucial role in the development and progression of prostate cancer, with previous studies indicating that certain bacterial taxa are more abundant in castration-resistant prostate cancer (CRPC) compared to hormone-sensitive prostate cancer (HSPC). Notably, the composition of gut microbiota can vary significantly by geographic region, and Japanese individuals have a distinct microbial profile. However, research exploring these differences within Japanese populations remains limited. This study investigated the gut microbiota differences between Japanese men with HSPC and CRPC and further validated these findings using a transgenic mouse model. Rectal swab samples were collected from 140 Japanese men diagnosed with HSPC (n = 84) or CRPC (n = 56) between September 2020 and July 2022. Gut microbiota composition was analyzed using 16S rRNA gene sequencing. Additionally, Pten-KO mice, which model the progression from HSPC to CRPC, underwent similar microbiota analysis. Results revealed significant differences in gut microbiota composition between HSPC and CRPC patients. Specifically, the CRPC group showed a higher abundance of Firmicutes, including Gemella and Lactobacillus, compared to the HSPC group. These differences were mirrored in the mouse model, where CRPC mice also showed an increase in these bacteria. This study identifies distinct microbial differences between HSPC and CRPC in Japanese men, suggesting that Gemella and Lactobacillus may be associated with the progression to castration resistance in prostate cancer. These findings suggest that gut microbiota differences may be associated with prostate cancer progression. Further research is needed to explore the potential of targeting the microbiota as a therapeutic strategy.

BACKGROUND: The efficacy of abiraterone acetate varies among patients with high-risk metastatic castration-sensitive prostate cancer (mCSPC). Both androgen receptor (AR) and cytokeratin 18 (CK18) are markers of the luminal lineage of prostate cancer, and their expression levels have been suggested to affect the response to androgen deprivation therapy (ADT). This study aimed to predict the efficacy of abiraterone acetate in high-risk mCSPC via immunohistochemical staining of biopsy specimens obtained at the time of prostate cancer diagnosis. METHODS: We retrospectively analyzed 44 patients treated with abiraterone acetate in combination with ADT. AR and CK18 expression in prostate biopsy specimens were assessed using immunohistochemical staining. RESULTS: AR and CK18 staining was not significantly associated with overall survival (OS). However, low AR staining was significantly associated with a shorter time to castration-resistant prostate cancer (TTCRPC) compared with high AR staining (log-rank test, p = 0.018). Similarly, low CK18 staining was significantly associated with a shorter TTCRPC compared with high CK18 staining (log-rank test, p = 0.037). CONCLUSIONS: Immunohistochemical analysis of AR or CK18 expression in biopsy specimens may serve as a predictive biomarker of high-risk mCSPC treated with abiraterone acetate. TRIAL REGISTRATION: None.

BACKGROUND/AIM: The therapeutic landscape for metastatic castration-resistant prostate cancer (mCRPC) has changed dramatically with the introduction of several novel agents. However, limited data are available to determine whether the introduction of novel agents affected patient characteristics, treatment patterns, and outcomes compared with the period when these agents were not available. The objective of this study was to evaluate the impact of the introduction of novel mCRPC agents on patient characteristics, treatment patterns, and outcomes. PATIENTS AND METHODS: Two cohorts of Japanese patients diagnosed with mCRPC between 2009 and 2014 (Epoch 1) and 2015 and 2019 (Epoch 2) were retrospectively analyzed. RESULTS: A total of 125 treatment-naïve mCRPC patients, consisting of 42 patients in Epoch 1 and 83 patients in Epoch 2, were evaluated. We obtained the following results: (i) a dramatic shift in the first-line treatment from docetaxel to androgen receptor axis-targeted agents (ARATs), (ii) an age range expansion for first-line treatment, and (iii) an overall survival (OS) advantage in Eopch 2 compared to Epoch 1. Multivariate analysis in the overall population showed that Epoch 2 and low prostate-specific antigen (PSA) levels at the start of first-line treatment were independent prognostic factors for OS. CONCLUSION: In real-world mCRPC practice, the introduction of novel agents has improved the prognosis of mCRPC while allowing more patients to receive mCRPC treatment across a broad age range. In addition, low PSA levels at the start of first-line treatment were associated with improved OS, indicating the importance of starting mCRPC treatment while PSA levels are low.

INTRODUCTION: Inflammatory myofibroblastic tumors are borderline malignant soft tissue tumors primarily affecting the lungs and pelvic organs. This report presents a rare case of an inflammatory myofibroblastic tumor originating from the prostate gland in a young male. CASE PRESENTATION: A 20-year-old man developed gross hematuria and dysuria, revealing a prostatic mass. Pathological examination of a biopsy displayed spindle-shaped myofibroblast proliferation and an infiltrate of inflammatory cells, leading to a diagnosis of inflammatory myofibroblastic tumor. Following fertility preservation measures, the patient underwent a robot-assisted laparoscopic total prostatectomy with bilateral nerve sparing, resulting in a postoperative diagnosis of inflammatory myofibroblastic tumor. No recurrence was observed in subsequent imaging, and urinary continence was maintained. CONCLUSION: Surgical resection appears effective in managing inflammatory myofibroblastic tumors of the prostate. This case underscores the importance of complete tumor resection due to the significant recurrence risk associated with inflammatory myofibroblastic tumors. Radical total prostatectomy emerges as a potential treatment strategy for prostate originating inflammatory myofibroblastic tumors.

BACKGROUND/AIM: Radium-223 treatment reduces the risk of death in patients with metastatic castration-resistant prostate cancer (CRPC). This study analyzed the prognostic factors in patients treated with radium-223 dichloride. PATIENTS AND METHODS: Patients who received radium-223 dichloride were retrospectively analyzed. Prostate-specific antigen (PSA) response and alkaline phosphatase (ALP) decline rates were analyzed. Overall survival (OS) was evaluated using Kaplan-Meier curves, and prognostic factors for OS were assessed using Cox proportional hazards analysis. RESULTS: Fifty-six patients were included in the study. The five-year OS rate in patients after diagnosis of CRPC was 62.2% [95% confidence interval (CI)=27.55-112.45], while the five-year OS rate in patients at the initiation of radium-223 treatment was 21.3% (95%CI=17.20-36.79). Six patients (11.1%) had a >50% PSA decline rate, and 10 (17.9%) had a >50% ALP decline rate. Cox proportional hazards analysis showed that PSA levels at the initiation of radium-223 treatment [hazard ratio (HR)=1.00; 95%CI=1.00-1.00; p=0.0054] and Gleason Pattern (GP) 5 (HR=5.42; 95%CI=1.08-27.27; p=0.0400) were associated with OS. Patients with GP 5 had a significantly poorer prognosis compared with patients with a GP ≤4. Early administration of radium-223 as a first- or second-line treatment was not associated with OS compared with late administration of radium-223 as a third-line or later treatment. CONCLUSION: GP 5 and high PSA levels at radium-223 initiation were associated with worse OS. Radium-223 as first- or second-line treatment was not associated with OS. Therefore, a treatment strategy for CRPC based on GP 5 is needed.

INTRODUCTION: Immune checkpoint inhibitor (ICI) therapy has significantly improved the prognosis of some patients with advanced urothelial carcinoma (UC), but it does not provide high therapeutic efficacy in all patients. Therefore, identifying predictive biomarkers is crucial in determining which patients are candidates for ICI treatment. This study aimed to identify the predictors of ICI treatment response in patients with platinum-refractory advanced UC treated with pembrolizumab. METHODS: Patients with platinum-refractory advanced UC who had received pembrolizumab at two hospitals in Japan were included. Univariate and multivariate analyses were performed to identify biomarkers for progression-free survival (PFS) and overall survival (OS). RESULTS: Forty-one patients were evaluable for this analysis. Their median age was 75 years, and the vast majority of the patients were male (85.4%). The objective response rate was 29.3%, with a median overall survival (OS) of 17.8 months. On multivariate analysis, an Eastern Cooperative Oncology Group performance status (ECOG-PS) ≥ 2 (HR = 6.33, p = 0.03) and a baseline neutrophil-to-lymphocyte ratio (NLR) > 3 (HR = 2.79, p = 0.04) were significantly associated with poor OS. Antibiotic exposure did not have a significant impact on either PFS or OS. CONCLUSIONS: ECOG-PS ≥ 2 and baseline NLR > 3 were independent risk factors for OS in patients with platinum-refractory advanced UC treated with pembrolizumab. Antibiotic exposure was not a predictor of ICI treatment response.

INTRODUCTION: The histological types of urethral cancer are mainly squamous cell or transitional cell carcinoma. Neuroendocrine tumor is extremely a rare type of urethral cancer. CASE PRESENTATION: A 72-year-old man visited with an erythema at the external urethral meatus. After 3 months, a 1-cm reddish solid tumor was found on the external urethral meatus. He had a history of bladder cancer (pTa with carcinoma in situ), including the prostatic urethra, and underwent radical cystectomy with urethrectomy and ileal conduit construction 11 years ago. After 3 months, a 1-cm reddish solid tumor was found on the external urethral meatus. The pathological diagnosis was a neuroendocrine tumor. Partial penectomy was performed. CONCLUSION: Small cell neuroendocrine tumor could occur on urethral remnant after radical cystectomy with urethrectomy for urothelial cancer. Inspection of the penis and urethral meatus is important during regular follow-up of patients after radical cystectomy.

PURPOSE: To investigate the risk of bladder cancer (BCa) in patients treated with brachytherapy for prostate cancer (PCa). METHODS: We retrospectively analyzed 583 patients with PCa who underwent brachytherapy with or without external beam radiotherapy (EBRT). We analyzed the disease-free survival (DFS) of BCa in patients with PCa who underwent brachytherapy with or without EBRT. We performed multivariate Cox regression analyses of DFS using age, EBRT, and Brinkman index (BI) score (number of cigarettes smoked per day × number of years smoking) ≥ 200 as variables for BCa after brachytherapy. RESULTS: Fourteen patients (2.4%) developed BCa after brachytherapy with or without EBRT. The percentage of high-grade urothelial carcinoma (UC) was 63.6%. A total of 85.7% of patients had non-muscle invasive BCa, and 14.3% of patients had muscle invasive BCa. DFS was longer in brachytherapy monotherapy than in combination therapy (brachytherapy + EBRT). Multivariate Cox regression analysis showed that a BI score ≥ 200 (Hazard Ratio (HR 8.61; 95% Confidence Interval (CI) 1.12-65.98) and EBRT combination (HR 3.29; 95% CI 1.03-10.52) were significantly associated with BCa development in patients with PCa treated with brachytherapy. Furthermore, patients with BI score ≥ 200 and EBRT combination had a significantly higher risk of BCa compared with patients with BI score < 200 (HR Log-rank test P = 0.010). CONCLUSION: Most cases of BCa after brachytherapy with or without EBRT are high grade and invasive. We hypothesized that the EBRT combination might be a risk factor for BCa in patients with PCa who underwent brachytherapy.

BACKGROUND/AIM: The treatment strategy for metastatic upper tract urothelial carcinoma (mUTUC) is currently based on the evidence from metastatic urinary bladder cancer (mUBC). However, some reports have shown that the outcomes of UTUC differ from those of UBC. Therefore, we retrospectively analyzed the prognosis of patients with mUBC and mUTUC treated with first-line platinum-based chemotherapy. PATIENTS AND METHODS: Patients who underwent platinum-based chemotherapy at the Kindai University Hospital and affiliated hospitals between January 2010 and December 2021 were included in the study. There were 56 patients with mUBC and 73 with mUTUC. Kaplan-Meier curves were used to estimate progression-free (PFS) and overall (OS) survival. Multivariate analyses were performed using Cox proportional hazards model to predict prognostic factors. RESULTS: The median PFS was 4.5 and 4.0 months for the mUBC and mUTUC groups, respectively (p=0.094). The median OS was 17.0 months for both groups (p=0.821). The multivariate analysis showed no prognostic factor for PFS. The multivariate analysis for OS showed that younger age at the initiation of chemotherapy and immune checkpoint inhibitor use after first-line therapy were significantly associated with better OS. CONCLUSION: Platinum-based chemotherapy had a similar effect on patients with mUTUC and mUBC.

BACKGROUND/AIM: Upper urinary tract urothelial carcinoma (UTUC) is a rare disease, often discovered at an advanced stage at diagnosis. Nectin-4 is expressed in a broad range of patients with UTUC and is associated with poor progression-free survival. The receptors of the erythroblastosis oncogene B (ErbB) family are potential therapeutic targets for urothelial carcinoma. Herein, we aimed to investigate the relationship of nectin-4 and ErbB family receptors, namely epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2) in patients with UTUC. Targeted therapies for these receptors could be used in sequence or in combination for increasing treatment efficiency. PATIENTS AND METHODS: We performed immunohisto-chemical analysis for HER2, EGFR, and nectin-4 using tissue microarrays. A total of 98 UTUC patients were included in the study. We investigated the impact of EGFR and HER2 expression status on recurrence-free survival (RFS) and cancer-specific survival (CSS) of all patients. RESULTS: The percentages of patients positive for HER2, EGFR, and nectin-4 were 97%, 70%, and 65%, respectively. The co-expression rates of HER2-EGFR, HER2-nectin-4, and EGFR-nectin-4 were 69%, 64%, and 47%, respectively. The number of patients positive for all three receptors was 47%. Higher HER2 levels were significantly associated with worse CSS and RFS. Higher EGFR levels were associated with a worse CSS. CONCLUSION: HER2, EGFR, and nectin-4 were highly expressed in UTUC. Combination of HER2-, EGFR-, and nectin-4-targeted therapy may be an effective option for the treatment of patients with UTUC.

PURPOSE: There is a discrepancy in the efficacy of abiraterone acetate for overall survival (OS) in patients with high-risk metastatic hormone-sensitive prostate cancer (mHSPC). This study aimed to identify predictive factors for the efficacy of abiraterone acetate for OS in high-risk mHSPC patients by analyzing them over a longer observation period. METHODS: Five hundred high-risk mHSPC patients were retrospectively identified at our hospital and affiliated hospitals in the Kindai Oncology Study Group and Kyoto Prefectural University of Medicine Oncology Study Group between December 2013 and March 2022. Two hundred patients were treated with abiraterone acetate (1000 mg/day) plus prednisolone (5 mg/day) combined with androgen deprivation therapy (ADT). A total of 300 patients were treated with bicalutamide (80 mg/day) in combination with ADT. RESULTS: OS was not significantly different between the two treatments in the overall cohort (p = 0.1643). In the subgroup without Gleason pattern 5 at the primary lesion, OS was significantly better in patients treated with abiraterone acetate than in those treated with bicalutamide (p = 0.0192). In the subgroup with Gleason pattern 5 at the primary lesion, no significant difference was found between the two treatments (p = 0.1799). Univariate and multivariate analyses in the subgroup without Gleason pattern 5 at the primary lesion suggested that abiraterone therapy may be an important and independent predictor of OS in high-risk mHSPC patients. CONCLUSION: The presence of Gleason pattern 5 at the primary lesion may be a predictor for high-risk mHSPC patients who could benefit from abiraterone acetate treatment.

PURPOSE: In this study, we aimed to elucidate the pathophysiology of post-micturition dribble (PMD) through analyzing several variables including pressure flow study (PFS) findings and symptoms questionnaire. METHODS: We retrospectively analyzed male patients who visited our department between 2010 and 2020. We used modified international prostate symptom score (m-IPSS), which consists of eight sub-score related to lower urinary tract symptoms (Incomplete Emptying, Frequency, Intermittency, Urgency, Weak Stream, Straining, Nocturia, and PMD) and one question related to quality of life (QOL). Multivariate regression analysis was conducted to evaluate the relationship between PMD and the variables, including age, prostate volume (PV), body mass index, bladder outlet obstruction index (BOOI), bladder contractility index, and bladder voiding efficiency, which were obtained by PFS. RESULTS: A total of 143 male patients were analyzed. The patients with PMD showed significantly larger PV and higher BOOI, and worse IPSS total and QOL score than those without PMD. Multivariate regression analysis showed that large PV and BOOI were significantly associated with PMD. In Spearman's correlation analysis, PMD and each m-IPSS sub-score except nocturia had significant positive correlation. Furthermore, Spearman's correlation analysis showed that PMD and QOL had significant strong positive correlation. CONCLUSION: PMD was significantly associated with large PV and BOO evaluated by PFS. Furthermore, PMD significantly exacerbated QOL. The severity of PMD and the other m-IPSS sub-score except nocturia could have intercorrelation with each other.

Enzalutamide, apalutamide, and darolutamide are currently recommended for patients with non-metastatic castration-resistant prostate cancer (nmCRPC), but cross-resistance of androgen receptor-axis-targeted therapies (ARAT) occurs. Because darolutamide has a distinct chemical structure to other non-steroidal antiandrogens, it may be effective for nmCRPC patients resistant to enzalutamide or apalutamide. We retrospectively evaluated the efficacy of switching to darolutamide in patients with nmCRPC. We included nine nmCRPC patients who experienced biochemical progression on enzalutamide or apalutamide and were switched over to darolutamide. Five patients (55.5%) had a PSA response >50% decline after starting darolutamide, with an average of 73% PSA decline. Median progression-free survival was 6 months. In conclusion, an ARAT switch from enzalutamide or apalutamide to darolutamide might be effective for nmCRPC. Although the validation in a large-scale cohort is necessary, the switch to darolutamide could be a promising therapeutic option after the progression of 1st line ARAT in nmCRPC patients.

PURPOSE: The therapeutic landscape for metastatic hormone-sensitive prostate cancer (mHSPC) has changed dramatically. Here, we provide the current status and future prospective of the management of mHSPC. METHODS: We reviewed recent literature of landmark studies on the managements of mHSPC. RESULTS: Upfront docetaxel or androgen receptor signaling inhibitor (ARSi) in addition to ADT has improved survival in mHSPC patients and has become the new standard of care. Triplet therapy with docetaxel, ARSi and ADT also improved survival. In the future, triplet therapy may become the standard of care. Oligometastatic mHSPC patients could benefit from local therapy. The inclusion of risk factors or the genetic biomarkers will provide the best treatment for individual mHSPC patients. CONCLUSION: Strong systemic therapy in the first-line treatment of mHSPC has been shown to improve survival and quality of life. Currently, several clinical trials are evaluating novel compounds such as PARP inhibitor, AKT inhibitor, and immune checkpoint inhibitor. The therapeutic landscape of mHSPC management will change dramatically.

Background: Several therapeutic agents are available for metastatic castration-resistant prostate cancer (CRPC). However, prognosis is still not well developed. The Gleason score (GS) is a prognostic factor available for patients with metastatic CRPC. GSs ranging from 6 to 10 and GSs ≥8 are usually categorized as single prognostic factors. In this study, we evaluated the prognosis of high-GS metastatic CRPC in Japanese men. Methods: Overall, 105 patients with metastatic CRPC with a GS ≥8 were retrospectively analyzed. Multivariate analyses of patient age, GS, and Eastern Cooperative Oncology Group performance status (ECOG-PS) were performed using Cox proportional hazards analysis to predict overall survival (OS). Results: GS 8 had all Gleason patterns of 4+4. Thirty patients (28.6%) had GS of 8, and 75 (71.4%) had GS of 9 or 10. As a first-line treatment for metastatic CRPC, 42 patients (40%) received abiraterone, 35 (33.3%) received enzalutamide, and 26 (24.8%) received docetaxel. The 5-year OS in patients with GS of 8 was 65.0% [95% confidence interval (CI): 43.07-86.82%], while the 5-year OS in patients with GS of 9 or 10 was 37.0% (95% CI: 24.41-56.11%). There was a significant difference in OS between the GS 8 and GS 9-10 groups (log-rank test, P=0.038). Multivariate analysis showed that GS and ECOG-PS were significant prognostic factors for OS. Conclusions: Patients with metastatic CRPC with GS 9-10 had poor prognoses, suggesting the need for additional treatment options.

Trophoblast cell surface antigen 2 (Trop-2, encoded by TACSTD2) is the target protein of sacituzumab govitecan, a novel antibody-drug conjugate for locally advanced or metastatic urothelial carcinoma. However, the expression status of Trop-2 in upper tract urothelial carcinoma (UTUC) remains unclear. We performed immunohistochemical analysis of 99 UTUC samples to evaluate the expression status of Trop-2 in patients with UTUC and analyze its association with clinical outcomes. Trop-2 was positive in 94 of the 99 UTUC samples, and high Trop-2 expression was associated with favorable progression-free survival (PFS) and cancer-specific survival (p = 0.0011, 0.0046). Multivariate analysis identified high Trop-2 expression as an independent predictor of favorable PFS (all cases, p = 0.045; high-risk group (pT3≤ or presence of lymphovascular invasion or lymph node metastasis), p = 0.014). Gene expression analysis using RNA sequencing data from 72 UTUC samples demonstrated the association between high TACSTD2 expression and favorable PFS (all cases, p = 0.069; high-risk group, p = 0.029). In conclusion, we demonstrated that Trop-2 is widely expressed in UTUC. Although high Trop-2 expression was a favorable prognostic factor in UTUC, its widespread expression suggests that sacituzumab govitecan may be effective for a wide range of UTUC.

BACKGROUND: Altered prostate-specific antigen (PSA) glycosylation patterns can be useful biomarkers in detecting high-grade prostate cancer (HGPC). The microfluidic immunoassay system can analyse α2,3-linked sialylated PSA (α2,3-Sia-PSA) and α1,6-linked fucosylated PSA (α1,6-Fuc-PSA) using different lectins, Mackkia amurensis agglutinin and Pholiota squarrosa lectin, respectively. Here, we investigated the diagnostic value of simultaneous analysis of α2,3-Sia-PSA and α1,6-Fuc-PSA for the detection of HGPC. METHODS: Men with serum PSA levels of 4-20 ng/mL who underwent prostate biopsy were included. The model to predict HGPC (Gleason grade ≥2) was constructed by multivariate logistic regression analysis, in combination with α2,3-Sia-PSA and α1,6-Fuc-PSA (SF index). RESULTS: In the development cohort (n = 150), the SF index showed good discrimination for HGPC (area under the receiver-operating curve (AUC) 0.842; 95% confidence interval (CI) 0.782-0.903), compared to the single PSA test (AUC 0.632, 95% CI 0.543-0.721), α2,3-Sia-PSA (AUC 0.711, 95% CI 0.629-0.793) and α1,6-Fuc-PSA (AUC 0.738, 95% CI 0.657-0.819). Decision-curve analysis showed the superior benefit of the SF index. In the validation cohort (n = 57), the SF index showed good discrimination for HGPC (AUC 0.769, 95% CI 0.643-0.895). CONCLUSIONS: The SF index could differentiate HGPC, providing useful information for decision making for prostate biopsy in men with abnormal PSA levels.

Recently, combination therapy including immune checkpoint inhibition (ICI) has proven to be effective as first-line therapy for patients with metastatic renal cell carcinoma. Although the first-line combination therapies with ICI have shown clinical benefit, a number of patients require second-line treatment. We report a 60-year-old man with metastatic renal cell carcinoma who was treated with pazopanib soon after nivolumab plus ipilimumab combination therapy. He experienced Grade 3 disseminated intravascular coagulation (DIC). We suspect that this was caused by an interaction between pazopanib and nivolumab even though ICI therapy was discontinued. He was treated with thrombomodulin and platelet transfusion and recovered from DIC. Treatment with pazopanib was subsequently restarted. No evidence of DIC was observed thereafter. This severe adverse reaction may have been induced by an interaction between activated proinflammatory immune cells and cytokines from an exacerbated inflammatory state and pazopanib. This report highlights the need to perform careful monitoring of patients who receive molecular targeted therapy after ICI-based immunotherapy.

Significant improvements with apalutamide, a nonsteroidal antiandrogen used to treat patients suffering from advanced prostate cancer (PCa), have prompted evaluation for additional indications and therapeutic development with other agents; however, persistent androgen receptor (AR) signaling remains problematic. We used autochthonous mouse models of Pten-deficient PCa to examine the context-specific antitumor activity of apalutamide and profile its molecular responses. Overall, apalutamide showed potent antitumor activity in both early-stage and late-stage models of castration-naïve prostate cancer (CNPC). Molecular profiling by Western blot and immunohistochemistry associated persistent surviving cancer cells with upregulated AKT signaling. While apalutamide was ineffective in an early-stage model of castration-resistant prostate cancer (CRPC), it tended to prolong survival in late-stage CRPC. Molecular features associated with surviving cancer cells in CRPC included upregulated aberrant-AR, and phosphorylated S6 and proline-rich Akt substrate of 40 kDa (PRAS40). Strong synergy was observed with the pan-AKT inhibitor GSK690693 and apalutamide in vitro against the CNPC- and CRPC-derived cell lines and tended to improve the antitumor responses in CNPC but not CRPC in vivo. Upregulation of signal transducer and activator of transcription 3 (STAT3) and proviral insertion in murine-1 (PIM-1) were associated with combined apalutamide/GSK690693. Our findings show that apalutamide can attenuate Pten-deficient PCa in a context-specific manner and provides data that can be used to further study and, possibly, develop additional combinations with apalutamide.

PURPOSE: We evaluated the predictive factors for completion of all six cycles of radium-223 (Ra-223) treatment in patients with metastatic castration-resistant prostate cancer (mCRPC). We also developed a novel prediction model for Ra-223 treatment completion using these predictors. METHODS: We retrospectively reviewed data from 122 patients with mCRPC who were treated with Ra-223. The predictive factors for the completion of six cycles of Ra-223 treatment were evaluated. Statistically significant predictive factors were then used to develop a prediction model for treatment completion. Finally, using this prediction model, we classified the overall survival (OS) of the entire cohort into three groups. RESULTS: We identified three significant variables as the predictive factors for treatment completion: baseline alkaline phosphatase (ALP) level, baseline hemoglobin (Hb) level, and baseline pain. The three groups generated using the prediction model were: group 1 (patients with three predictive factors, i.e., ALP < median, Hb ≥ median, and no pain), group 2 (patients with one to two predictive factors), and group 3 (patients without any predictive factors). The treatment completion rates differed between the three groups significantly. Furthermore, the OS also differed among the groups significantly. CONCLUSION: Our study suggested that the baseline ALP level, baseline Hb level, and baseline pain were the predictive factors of completion of all six cycles of Ra-223 treatment in patients with mCRPC. Our prediction model consisting of these factors could predict not only the completion of Ra-223 treatment, but also the post-treatment survival. This model can thus be useful for selection of patients for Ra-223 treatment.

症例は67歳男性で、数年前に左腎細胞癌に対して開腹下根治的左腎摘除術を施行し、病理診断はclear cell renal cell carcinoma、pT4、Fuhrman grade 2であった。単発の肺転移に対して胸腔鏡下右肺部分切除術を施行し、その後も二度単発の肺転移再発を認めたためそれぞれ肺部分切除術を施行した。その後、中縦隔に12mm大のリンパ節腫大と30mm大の脾転移を認め、脾転移出現後3ヵ月目には脾転移は60mm大まで増大した。スニチニブ投与12日目に38℃台の発熱がみられた。播種性血管内凝固症候群を合併するガス産生性脾膿瘍の診断にて、スニチニブを休薬の上、meropenem 1.5g/日とthrombomodulin 19200Uを開始した。入院5日目には、腹部単純CT画像で門脈ガス像は消失し脾内ガス像の減少も認めた。thrombomodulinの投与を終了し経過観察したが、38℃前半の発熱が持続し入院8日目に再度門脈ガス像が出現した。入院11日目に放射線科医師によりエコーガイド下経皮的脾臓ドレナージを施行した。その結果、排液培養からは嫌気性グラム陽性球菌(Anaerococcus属)が検出された。ドレナージを施行後は解熱傾向となり、入院15日目には肝内門脈内のガス像の消失を認めた。入院35日目ドレーンチューブを留置したまま、腹腔鏡下脾臓摘出術(術中高度癒着のため開腹へ移行)を施行した。病理学的所見より、内部に壊死組織を含む淡明細胞癌の脾転移と診断した。術後2日目より飲水・食事再開し、術後経過は良好であり術後7日目に退院となった。

A 67-year-old man underwent open radical left nephrectomy for left renal cell carcinoma [pT4N0M1 (right lower lobe of lung)] and thoracoscopic partial right lung resection for lung metastasis. The patient subsequently developed a solitary lung metastasis at 10 months and then at 26 months postoperatively. He underwent partial lung resection on each occasion. During the 28 months postoperatively, he was found to have a 12 mm middle mediastinal lymph node metastasis and a 30 mm splenic metastasis, which gradually increased in size. Three months after discovery, sunitinib was initiated at 37.5 mg 2 weeks on/1 week off. Twelve days later, the patient presented with complaints of fever. A gas-producing splenic abscess was diagnosed and he was admitted on the same day. His condition improved with antibiotics and splenic drainage. On day 35 of hospitalization, he underwent laparoscopic splenectomy. The patient's postoperative clinical course was uneventful and he was discharged 7 days after the surgery.

This study aimed to compare the effects of abiraterone acetate plus prednisone (AAP) with androgen deprivation therapy (ADT) with those of combined androgen blockade (CAB) therapy in patients with high-risk metastatic hormone-sensitive prostate cancer (mHSPC). This study retrospectively identified 163 patients with high-risk mHSPC at Kindai University and affiliated hospitals between January 2014 and December 2020. Kaplan-Meier analysis was used to summarize progression-free survival (PFS) and overall survival (OS). Multivariate Cox proportional hazard modeling was used to identify the prognostic factors in the overall cohort. Propensity score matching was used to adjust the clinical characteristics, and log-rank test was applied to these propensity score-matched cohorts. Seventy-four patients who received AAP with ADT and 89 patients who received CAB were included in this study. The median follow-up duration was 27 months (range, 2-89 months). The median PFS and OS were not reached by the AAP+ADT group and 15 and 79 months, respectively, in the CAB group. The Eastern Cooperative Oncology Group (ECOG) performance status (PS) score and AAP+ADT were significant prognostic factors for PFS, whereas ECOG PS score, visceral metastasis, and AAP+ADT were significant prognostic factors for OS. The 2-year PFS was 76.1% in the AAP+ADT group and 38.6% in the CAB group (P < 0.0001), and the 2-year OS was 90.2% in the AAP+ADT group and 84.8% in the CAB group (P = 0.015). In conclusion, AAP+ADT had better PFS and OS than CAB in patients with high-risk mHSPC.

Purpose: This study aimed to elucidate the relationship of psoas muscle atrophy and visceral obesity with lower urinary tract symptoms in geriatric female patients. Patients and Methods: We retrospectively reviewed the medical records of female patients aged ≥65 years. The psoas muscle index was defined, using computed tomography, as the cross-sectional area of the psoas muscle at the third lumbar vertebral level divided by the body surface area. We also measured visceral fat area at the umbilical level using computed tomography. We used logistic regression analysis to examine the relationships between the International Prostate Symptom Score (total score, voiding subscore, and storage subscore) and variables, such as age, body mass index, psoas muscle index, and visceral fat area. The International Prostate Symptom Score was categorized as mild, moderate, or severe. Results: One hundred thirty-nine patients were included in our study. In the logistic regression analysis, we found statistically significant relationships between severe (versus mild-to-moderate) International Prostate Symptom Score storage subscore and variables, including low and high levels of psoas muscle index and visceral fat area, respectively. We could not find any significant relationships between the International Prostate Symptom Score total score and voiding subscore and the variables. Conclusion: Psoas muscle atrophy and visceral fat accumulation are potential risk factors for severe storage symptoms in female patients aged ≥65 years.

Enfortumab vedotin is a novel antibody-drug conjugate targeting Nectin-4, which is highly expressed in urothelial carcinoma. However, the expression status of Nectin-4 in upper tract urothelial carcinoma (UTUC) remains unclear. The relationship between Nectin-4 and Programmed Death Ligand 1 (PD-L1) in UTUC is also ambiguous. We performed immunohistochemical analysis of 99 UTUC tissue microarray to assess the expression of Nectin-4 and PD-L1 in UTUC. Nectin-4-positivity was detected in 65 (65.7%) samples, and PD-L1 was detected in 24 (24.2%) samples. There was no correlation between the expression of Nectin-4 and PD-L1. Patients with strong Nectin-4-expressing tumors had a significantly higher risk of progression (p = 0.031) and cancer-specific mortality (p = 0.036). Strong Nectin-4 expression was also an independent predictor of disease progression in the high-risk group (pT3 ≤ or presence of lymphovascular invasion or lymph node metastasis) (Hazard ratio, 3.32 [95% confidence interval, 1.20-7.98; p = 0.027]). In conclusion, we demonstrated that Nectin-4 expression rate in UTUC was 65.7% and independent of PD-L1 expression. Strong Nectin-4 expression was associated with worse progression-free survival in high-risk UTUC. These findings suggested that enfortumab vedotin may be effective in a broad range of patients with UTUC, regardless of PD-L1 expression.

RATIONALE: Latent tuberculosis infection (LTBI) describes the dormant state of tuberculosis (TB), in which persistent immune-related interaction between TB and T-cells maintain its state. Cabazitaxel (CBZ) is reported to improve overall survival in patients with castration-resistant prostate cancer (CRPC) after progression observed in regimens including docetaxel. CBZ is known for severe myelosuppression; however there is no recommendation for the treatment of LTBI before CBZ treatment. To the authors' knowledge, this is the first report to describe reactivation of LTBI induced by CBZ. PATIENT CONCERNS: A 75-year-old Japanese male with a medical history of TB since 16 years of age had been treated for prostate cancer (PC) (initial prostate-specific antigen 532 ng/ml; cT4N1M1b; Gleason score4+4) with androgen deprivation therapy, abiraterone, and docetaxel. Calcified nodules and radiological findings of LTBI were present in the upper right lobe since the diagnosis of PC. After progression was observed during these treatments, CBZ was administered combined with pegfilgrastim, long-acting granulocyte colony-stimulating factor (G-CSF). Seven days after the third course of CBZ, he was admitted to the authors' hospital to treat febrile neutropenia (FN). High fever persisted even after myelosuppression had recovered. Computed tomography (CT) revealed distribution of small nodules in the bilateral lungs, for which miliary TB was included in the differential diagnosis. T-Spot, interferon-gamma-release assay, and bronchoscopy yielded no significant findings; however, sputum and urine culture confirmed the diagnosis of TB. DIAGNOSIS: CT, sputum and urine culture confirmed the diagnosis of miliary TB. INTERVENTIONS: The patient was treated with anti-bacterial therapy (cefepime) on hospital admission, which was not effective. After the diagnosis of miliary TB was confirmed, anti-TB drugs, including isoniazid, rifampicin, pyrazinamide and ethambutol, were administered. OUTCOMES: Despite anti-TB therapy, high fever persisted and radiological findings worsened. Fifty days after the third course of CBZ, the patient died of respiratory dysfunction caused by progression of miliary TB. LESSONS: Management of LTBI is needed in cases of radiographic findings of LTBI and medical history of TB before CBZ treatment, despite the rarity of LTBI reactivation in patients with PC.

2007年〜2017年の14例(平均年齢38.6歳)を対象とした。13例が気胸で発症し(気胸例)、1例が血痰で発症した(血痰例)。10例で月経2日前から月経開始5日目までの発症であった。患側は、気胸例が全例右側であり、血痰例は左肺上葉であった。全例胸腔鏡下手術を行い、肺表面や横隔膜にそれぞれ嚢胞性変化や小孔・瘢痕・血腫様所見を認め、気胸例13例中6例と血痰例は病理組織学的に子宮内膜を同定した。治療は、血痰例を含む9例にホルモン療法を施行し、気胸例1例で治療終了後再発をきたし胸膜癒着療法を追加した。その他の気胸例5例では挙児希望や副作用を理由にホルモン投与を行わなかったかあるいは早期に中断した。

Spinal intradural extramedullary inflammatory pseudotumor (IPT) is an extremely rare entity. Spontaneous shrinking of a spinal IPT has never been reported. A case of an IPT of the cauda equina that regressed spontaneously is presented. A 78-year-old woman presented with hypoesthesia of both lower legs in the L4 nerve root distribution and motor weakness of the right leg. Preoperative CT myelography and MRI showed two tumor-like lesions located at T12-L1 and L2-3. The lesion at the T12-L1 level appeared to encase several nerve roots. The preoperative diagnosis was ependymoma, schwannoma, or malignant lymphoma. The tumors were biopsied. In the operation, the lesion turned out to consist of swollen and adherent nerve roots. On histopathological examination of the biopsied nerve roots, they were diagnosed as IPT. The patient's symptoms improved gradually without any treatment after the operation. The IPTs regressed on the postoperative MR images and disappeared at one year. This is the first report of spontaneous regression of an IPT in the spinal region. IPT should be considered in the differential diagnosis of a tumor that appears to involve several nerve roots on preoperative imaging, but surgery is necessary for diagnosis. Complete resection is not absolutely required if an intraoperative pathological diagnosis of the frozen section reveals IPT.

Objectives : We compared sexual function by the expanded prostate cancer index composite (sexualdomains of EPIC), health-related quality of life (SF-8), and International Prostate Symptom Score (I-PSS) inpatients using tadalafil after prostate brachytherapy (PB). Forty-five patients who underwent PB between April 2011 and January 2014 were included in this study. Patients were divided into the tadalafil (20 mg, once/week or once/two weeks) treated and non-treated (NT) groups. Sexual function was assessed prior to PB treatment and followed up to 24 weeks after PB. SF-8, sexual domains of EPIC, IPSS and subjectivesymptoms were assessed pre-PB and at 4, 8, 16, and 24 weeks post-PB. Patients in the tadalafil groupachieved higher sexual function scores compared to NT group at all time points. For SF8, the patients inthe tadalafil group significantly improved in mental health by the eighth week, and significantly worsened inthe NT group (8 w ; p＝0.04). The voiding domains of EPIC score were found to worsen significantly after 4 weeks from PB in both groups, but the score tended to improve over 24 weeks. There was no significantdifference between two groups. The I-PSS total score was found to worsen significantly in both groups post-PB, but the tadalafil group had a tendency to worsen less. PB treatment of localized prostate cancer ispreferred for the preservation of sexual function. Management of sexual dysfunction with tadalafil after PB does not worsen sexual functions. We concluded that tadalafil might be applicable to mental health care inthe treatment of patients with a high interest in sexual function before PB.

The aim of our study was to identify risk factors that may influence outcomes for patients presenting with Fournier gangrene. Twelve patients hospitalized and treated between August 2007 and August 2013 were included in this study. Distinct features were noted after one or two weeks of hospitalization. We did not observe a significant correlation between death risk and the extent of necrosis in this patient set. However, the extent of necrosis tended to correlate with the duration of hospitalization in the survivors. We also compared the results of blood biochemical analyses between the surviving and non-surviving groups. A significant difference was noted in the levels of glucose (Glu) after two weeks. In the non-surviving group, Glu levels were increased. These findings suggest a relationship between glycemic control after the initiation of therapy and death. We also examined the results of blood biochemical analyses according to the duration of hospitalization. The lactate dehydrogenase (LDH) levels at admission and LDH levels after two weeks were significantly higher in the patients with a duration of hospitalization longer than the median duration of 61.5 days. These findings suggest a relationship between the duration of hospitalization and the extent of necrosis at diagnosis.

吉村 一宏（近畿大学医学部泌尿器科教授）Point 1前立腺癌の治療方針は診断時の癌の広がりや癌細胞の悪性度により異なるが、薬物療法で第一選択となるのはホルモン療法である。Point 2ホルモン療法の実施下でも病勢コントロールが困難になった前立腺癌を去勢抵…

【撤回論文】---当論文については「医学と薬学」72巻2号(2015年2月発行)の353ページに論文撤回のお知らせが掲載された。

We report a case of a patient with a fistula between the right ureter and external iliac artery. The patient was a 75-year-old woman who had undergone abdominal radical hysterectomy for uterine cancer, and whole pelvis radiotherapy for right external iliac lymph node metastasis. Her post-operative course was complicated by hydronephrosis of the right kidney, which was treated by the insertion of a double-J stent. While removing the frequently obstructed double-J stent after percutaneous nephrostomy, arterial hemorrhage occurred from the external urethral meatus. Computed tomographic scan demonstrated right ureteral external iliac artery fistula formation located adjacent to the pseudoaneurysm. The patient was treated successfully with endovascular stent grafting and has showed no episode of hematuria since then.

BACKGROUND: Anterior transarticular screw (ATS) fixation is a useful surgical option for atlantoaxial (AA) stabilization. This report presents a revised ATS method for AA fusion. METHODS: A 79-year-old male presented with AA instability attributed both to an old odontoid fracture and severe degeneration of the lateral atlantoaxial joints (LAAJs). ATS fixation was performed through the conventional anterior cervical approach. The longest screw trajectories were planned preoperatively using multiplanar reconstruction computed tomography (CT) scans, with entry points of the screws situated at the midpoint on the inferior border of the axial body. The surgical exposure was limited to opening at the entry points alone. Our retractor of choice was the Cusco speculum; it sufficiently secured space for utilizing the required instruments for screw placement while offering sufficient protection of soft tissues. Cannulated full-threaded bicortical screws stabilized the LAAJs. Screw insertion required a significant amount of coronal angulation up to the superior articular process of the atlas under open-mouth and lateral fluoroscopy image guidance. After ATS fixation, bone grafting was performed between the posterior laminae of the axis and the atlas through a conventional posterior approach. RESULTS: Bony fusion between the atlas and the axis was confirmed radiographically. Arthrodesis of the LAAJs occurred despite no bone grafting. CONCLUSIONS: Rigid fixation of the LAAJs was obtained by our ATS technique, indicating that it is an alternative method for AA fixation when posterior rigid internal fixation is not applicable.

Testicular tumors of ovarian epithelial types are rare, and their etiology is unknown. Moreover, a clear treatment policy has not become settled. Under the diagnosis of a testicular tumor, this patient underwent a high orchiectomy, and the pathology revealed testicular tumor of ovarian epithelial type. CA125 was elevated for three years post-operatively and a recurrence was discovered in the left inguinal region by positron emission tomography-computed tomography. Therefore, tumor extirpation was performed. The pathology result confirmed the recurrence of testicular tumor of ovarian epithelial type. After the surgery, the patient was given combined therapy with paclitaxel and carboplatin, which is a regimen of ovarian cancer, on a triweekly basis. After five courses of this therapy, the patient remains in remission.

We experienced a case of testicular cancer that was successfully treated by salvage chemotherapy comprised of methotrexate, actinomycin D and etoposide (MEA). A 25-year-old man was admitted to our hospital with a diagnosis of stage III B2 (JUA classification) testicular cancer. The patient had multiple lung metastases, and underwent a left orchiectomy. A histopathological examination revealed a choriocarcinoma, embryonal carcinoma, mature teratoma, and a yolk sac tumor. Tumor marker levels were elevated ; human chorionic gonadotropin β was 46 mIU/ml and alpha fetoprotein was 437 ng/ml. Although he was treated post-operatively with two courses of bleomycin, etoposide and cisplatin therapy, four courses of high-dose carboplatin, etoposide and iphosphamide (VIP) therapy, and two courses of CPT-11＋ cisplatin therapy, tumor maker levels remained elevated and lung metastases were stable. Accordingly, he received three courses of MEA therapy. MEA therapy is regimen used to treat gestational trophoblastic neoplasia. After MEA therapy, levels of the tumor markers normalized. He then underwent a partial resection of lung and enucleation of lung metastasis by the video assisted thoracoscopic surgery method. Histopathological examination of the lung metastasis revealed only necrotic tissue. Tumor recurrence has not been observed in the 14 months since the MEA therapy.

We experienced a case of testicular cancer that was successfully treated by salvage chemotherapy comprised of methotrexate, actinomycin D and etoposide (MEA). A 25-year-old man was admitted to our hospital with a diagnosis of stage III B2 (JUA classification) testicular cancer. The patient had multiple lung metastases, and underwent a left orchiectomy. A histopathological examination revealed a choriocarcinoma, embryonal carcinoma, mature teratoma, and a yolk sac tumor. Tumor marker levels were elevated ; human chorionic gonadotropin β was 46 mIU/ml and alpha fetoprotein was 437 ng/ml. Although he was treated post-operatively with two courses of bleomycin, etoposide and cisplatin therapy, four courses of high-dose carboplatin, etoposide and iphosphamide (VIP) therapy, and two courses of CPT-11＋ cisplatin therapy, tumor maker levels remained elevated and lung metastases were stable. Accordingly, he received three courses of MEA therapy. MEA therapy is regimen used to treat gestational trophoblastic neoplasia. After MEA therapy, levels of the tumor markers normalized. He then underwent a partial resection of lung and enucleation of lung metastasis by the video assisted thoracoscopic surgery method. Histopathological examination of the lung metastasis revealed only necrotic tissue. Tumor recurrence has not been observed in the 14 months since the MEA therapy.

A 61-year-old man visited our department with the complaint ofa palpable hard mass in the penile shaft which showed a significant uptake on fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT). He had undergone a surgery for local invasive esophageal cancer and had received adjuvant chemotherapy. Open biopsy revealed metastases in the carvenous body and the glans of the penis from esophageal squamous cell carcinoma. He died from the cancer 5 months after the biopsy in spite ofadditional chemotherapy.

OBJECTIVES: This study was conducted to examine the therapeutic efficacy and anti-inflammatory effect of ramelteon in elderly patients with insomnia associated with lower urinary tract symptoms (LUTS), who visited our urology department. METHODS: The study included 115 patients (102 men, 13 women) who scored ≥4 on the Athens Insomnia Scale and who wished to receive treatment. The assessment scales for therapeutic efficacy included the International Prostate Symptom Score (IPSS) for LUTS and the Insomnia Severity Index (ISI) for sleep disorders. The high-sensitivity C-reactive protein (hs-CRP) test was used to an objective assessment. The patients were treated with ramelteon (8 mg/day) for an average of 10 weeks and were then reexamined using the questionnaires and hs-CRP test to evaluate therapeutic efficacy. RESULTS: IPSS total scores declined significantly from 11.39 ± 8.78 to 9.4 ± 7.72. ISI total scores improved significantly from 11.6 ± 5.2 to 9.2 ± 5.3 (P < 0.0001). The levels of hs-CRP decreased significantly from 0.082 (standard deviation [SD] upper limit, 0.222; SD lower limit, -0.059) to 0.06 (SD upper limit, 0.152; SD lower limit, -0.032). The ISI scores ≥ 10 (n = 51) showed a weak correlation with the hs-CRP levels. CONCLUSION: Ramelteon had a systemic anti-inflammatory effect and improved sleep disorders and LUTS, suggesting that it may be a useful treatment for patients with LUTS-associated insomnia.

OBJECTIVES: This study examined the association between sleep disorders and lower urinary tract symptoms in patients who had visited urology departments. METHODS: This was an independent cross-sectional, observational study. Outpatients who had visited the urology departments at the Kinki University School of Medicine or the Sakai Hospital, Kinki University School of Medicine, between August 2011 and January 2012 were assessed using the Athens Insomnia Scale and the International Prostate Symptom Score. RESULTS: In total, 1174 patients (mean age, 65.7 ± 13.7 years), with 895 men (67.1 ± 13.2 years old) and 279 women (61.4 ± 14.6 years old), were included in the study. Approximately half of these patients were suspected of having a sleep disorder. With regard to the International Prostate Symptom Score subscores, a significant increase in the risk for suspected sleep disorders was observed among patients with a post-micturition symptom (the feeling of incomplete emptying) subscore of ≥1 (a 2.3-fold increase), a storage symptom (daytime frequency + urgency + nocturia) subscore of ≥5 (a 2.7-fold increase), a voiding symptom (intermittency + slow stream + hesitancy) subscore of ≥2 (a 2.6-fold increase), and a nocturia subscore of ≥2 (a 1.9-fold increase). CONCLUSION: The results demonstrated that the risk factors for sleep disorders could also include voiding, post-micturition, and storage symptoms, in addition to nocturia.

A 70-year-old man with the complaint of macrohematuria and hematospermia was admitted to our hospital for further examination of a cystic formation of the right seminal vesicle, 3.6 cm in diameter, detected by magnetic resonance imaging(MRI). Cystoscopy revealed no remarkable change, but urine cytology was class III. The serum concentration of prostate specific antigen (PSA) was within the normal range of 1.83 ng/ml. Transperineal needle biopsy of the prostate and cystic tumor of the seminal vesicle revealed adenocarcinoma of the prostate and seminal vesicle, but immunostaining for PSA was negative, so we diagnosed the case as primary adenocarcinoma of the seminal vesicle. Bloody fluid of the cyst was obtained by transperineal aspiration, but no cancer cells were detected by cytological examination. Total prostatectomy was performed, and pathological findings was infiltration of prostate cancer into the seminal vesicle (pT3b) because immunostaining of the PSA was positive.

70歳男性。肉眼的血尿を認め近医を受診、CTおよび膀胱鏡では異常はなかったものの、尿細胞診はclass IIIで、1ヵ月後には血精液症も出現した。更に3ヵ月後にはCTとMRIで右精嚢に3.6×3.0cm大の嚢胞性病変が確認され、翌月、精査加療目的で著者らの施設へ紹介となった。所見では直腸診で右葉に超胡桃大の表面が平滑な、弾性軟の腫瘤が触知された。腫瘍マーカーはいずれも正常範囲で、尿沈渣は赤血球30〜49/HPFであったが、MRIでは前立腺右葉背側に長径4cm大の前立腺、直腸に接するT1・T2強調像で低信号を示す嚢胞性腫瘍が認められ、右精嚢の出血性嚢胞が疑われた。そこで、TRUSガイド下経会陰式前立腺針生検および右精嚢嚢胞穿刺、右精嚢腫瘍針生検を行なったところ、前立腺から12ヶ所中1ヶ所、精嚢腫瘍4ヶ所中3ヶ所に腺癌が認められた。以後、画像上、右精嚢に限局した腫瘍であり、臨床的に原発性精嚢腺癌と診断され、順行性に前立腺精嚢摘出術が行われた。しかし術後の膀胱造影で吻合部6時方向から直腸にかけて造影剤の漏出がみられ、尿道直腸瘻と診断、そのため術後30日目にバルーン留置のまま退院となったが、術後1ヵ月半後には尿道直腸瘻はバルーン留置により瘻孔が徐々に縮小、直腸からの尿流出は減少している。

A 63-year-old man visited our hospital with body weight loss. Laboratory examination revealed a high serum level of carbohydrate antigen 19-9 (CA19-9) and LDH. There were no abnormal findings in the gastrointestinal tract. Enhanced abdominal computed tomography (CT) revealed a renal tumor, 5×3 cm in diameter, in the right lower pole and multiple lymph node swelling. The right renal tumor was not a typical renal cell carcinoma, so we considered the presence of bellini duct carcinoma and renal pelvis carcinoma, we performed right nephroureterectomy. Histopathological diagnosis was urothelial carcinoma with glandular differentiation of the renal pelvis. Post operation chemotherapy with GC (gemcitabine/cisplatin: 3-cycle), MVAC (methotrexate/vinblastine/doxorubicin/cisplatin: 1-cycle), TS-1 + CBDCA (tegafur-gimeracil-oteracil potassium/carboplatin: 3-cycle) was performed for lymph node metastasis, but he died of cachexia 18 months after operation.

症例は63歳男性で、体重減少で近医にてCA19-9高値を認め、CTで右腎下極に腫瘤性病変を指摘され紹介受診した。CRP、LDHの軽度上昇、CA19-9の異常高値が認められた。造影CTで右腎下部に早期造影効果の弱い5×3cm大の腫瘍を認め、腎盂への進展が認められた。また、多発リンパ節転移を認めたが、膀胱鏡では腫瘍性病変は認めず、尿細胞診は陰性であった。画像上非典型的な腫瘍であり、右腎尿管全摘除術を行った。摘出標本は腎盂下極から腎実質にかけた4cm大の腫瘤であった。病理所見では、大小不同の濃染核を持つ円柱状の異型細胞が乳頭腺管状、癒合腺管を形成して密に増殖し、一部に低分化な尿路上皮様の配列が認められた。CK7、CK20染色で陽性を示し、腎盂癌が腎実質に浸潤したものと考えられた。CA19-9染色は陽性、CEA染色は陰性であった。病理診断は腺上皮への分化を伴う原発性腎盂尿路上皮癌であった。術後は多発リンパ節転移に化学療法を行うも、術後約1年半に永眠された。

We report a case of prostate cancer in a 41-year-old male. The patient initially visited another institution with a chief complaint of left breech pain. He was referred to our hospital for further investigation. Serum level of PSA was 267ng/ml and multiple bone metastases were found on bone scintigram. Digital rectal examination revealed a stony-hard prostate. Computed tomography showed multiple lung and lymph node metastases. Transperineal needle biopsy of the prostate revealed moderately differentiated adenocarcinoma (Gleason score 4＋5) frombilateral lobes (the 3th Edition). The patient was diagnosed with cT4N1M1c prostate cancer and maximal androgen blockade therapy was commenced.

We report a case of intractable chronic low-back pain in a gymnast that was caused by ligamentopathia in the interspinous region of the lumbar vertebrae. Sprained interspinous ligaments are a common mechanical cause of acute low-back pain in athletes. Although conservative therapy is generally effective in such cases, in this case it was not. The patient experienced severe low-back pain during lumbar flexion with tension between the L5/S interspinous ligaments. We performed interspinous fixation by using a spinous process plate system, which has been developed for short in situ fusions, and following which the low-back pain resolved. Conservative therapy for low-back pain caused by ligamentopathia is first-line choice, but interspinous fixation with instrumentation might be recommended in intractable cases with conservative therapy.

A 59-year-old man was referred to our hospital with the chief complaint of painless left scrotal swelling. He was diagnosed with left hydrocele testis and underwent puncture of hydrocele. Radical hydrocelectomy wasperformed because of itsfrequent recurrence in a short period. A hard masswasfound acrossthe spermatic cord during the operation. The mass was removed, and histopathological examination revealed a well-differentiated liposarcoma. This was the 107th case of liposarcoma of the spermatic cord and the 3rd case with a hydrocele.

A 63-year-old man presented to our hospital suffering from dull pain in his right flank and general malaise.Abdominal computed tomography (CT) revealed a 21X14 cm retroperitoneal tumor adjacent to the right kidney. He underwent extirpation of the tumor,which weighed 2,900 g. Histopathological diagnosis was high-grade myxofibrosarcoma. Six months after initial surgery,CT revealed isolated metastasis in the upper lobe of the left lung,which was surgically treated. Eleven months after the original tumor excision, CT revealed lymph node metastasis dorsal to the inferior vena cava,which was also removed. Because he refused to receive adjuvant chemotherapy,he was observed for 2 months until CT revealed multiple liver metastases and para-aortic lymph node metastasis. He underwent 1 cycle of combined chemotherapy with doxorubicin and carboplatin,but metastatic lesions grew larger rapidly and his general state became too poor to continue chemotherapy. He is under best supportive care 17 months after the initial surgery.

We investigated the clinical efficacy and safety of administration of naftopidil at 75 mg for clinically benign hyperplasia patients who had moderate or severe urinary disturbance according to guidelines for clinical studies regarding urination disorder. Among patients with benign prostatic hyperplasia who were treated with a a1-adrenoceptor blocker, we administered naftopidil (75 mg/day) for 12 weeks to 85 patients in whom the global severity was evaluated as moderate or severe. This agent significantly reduced the international prostate symptom score (I-PSS) and residual urine volume, and improved the QOL index and maximum urine flow volume in comparison with the baselines. Concerning the global treatment response, a partial response or better was achieved in 83.8% of the patients. Neither blood pressure nor heart rate were changed in patients who continued to receive this therapy. Side effects included orthostatic hypotension (1 patient : discontinuation), dizziness (2 patients : discontinuation, 1 patient : continuation), and palpitation (1 patient : discontinuation). These results suggest that a once-a-day administration of naftopidil at 75 mg safely relieves urination/accumulated urine symptoms in patients with moderate or severe urination disorder related to prostatic hypertrophy.

A 78-year-old man had undergone transurethral resection of bladder tumor (TUR-Bt) 6 times since he was diagnosed as having bladder cancer. Past histology was urothelial carcinoma, pTa, G1-G2. During the follow-up, recurrent bladder cancer was found. Enhanced computed tomography and drip infusion pyelography revealed pelvic cancer with tumor embolus in the inferior vena cava. Therefore, TUR-Bt and total ureteronephrectomy with removal of the thrombus from the vena cava was performed. The histopathological diagnosis was urothelial carcinoma of the bladder and Bellini duct carcinoma of the kidney, but in immunohistostaining surgical specimen of both bladder and kidney showed some similarities. This disease is rare. Several reports indicate an association between Bellini and urothelial carcinoma. We describe the case of the Bellini duct carcinoma of the kidney during the follow-up for bladder cancer with possibility of the association between Bellini and urothelial carcinoma.

A 70-year-old Japanese man complained of a nodular, non-tender scrotal mass, which had been gradually increasing in size over the last 10 years. Excisional biopsy of the scrotal specimen revealed chondroid syringoma, a very rare benign tumor, more likely to occur in the head and neck region. This is the eighth such case reported, and is an important type of scrotal tumor.

Perforation of the bladder related to long-term indwelling urethral catheter is a rare and serious complication. A 85-year-old man with an indwelling urethral catheter presented severe hematuria, abdominal pain with rebound tenderness and muscular tension over the suprapubic area after the exchange of the urethral catheter. Computed tomography and cystogram revealed experitoneal bladder perforation due to indwelling catheter. Three weeks after the indwelling urethral catheter had been placed, the perforation was closed. In most cases, laparotomy and suprapubic cystostomy are performed. We describe the case of experitoneal bladder perforation successfully treated by urethral drainage.

A 78-year-old man visited our hospital with a chief complaint ofmacrohematuria in January 2006. Ultrasonography and computed tomography showed left hydronephroureter due to the enhanced tumor which was 10 mm in diameter in the lower ureter. Urine cytology was Class II. Retrograde pyelography could not be performed because of severe pain and hematuria. We considered the possibility of the malignant neoplasm and performed left total ureteronephrectomy in March 2007. The mucosa of the ureter was thickened and sclerosed. Microscopic appearance of the surgical specimen shows non-structural fibrosis and stained red with Congo-red stain. So amyloidosis of the ureter was suspected. After the systemic examination, the diagnosis was localized amyloidosis of the ureter. After 8 months, recurrence has not been pointed out.

A 69 year-old woman visited our hospital with a chief complaint of macrohematuria in April 2004. She was diagnosed with bladder tumor. She underwent transurethral resection ofbladdar tumor three times and right partial ureterectomy for ureteral tumor following primary bladder carcinoma. All pathological findings demonstrated that the tumor was urothelial carcinoma (UC), G1-G2, pT1 including right ureteral tumor. In spite of intravesical instillation of BCG, recurrent invasive bladder tumor was found in June 2006. In July 2006, we performed total cystectomy and construction of ileal conduit. Surgical specimen revealed small cell carcinoma and immunohistochemical staining with NSE and synaptophysin was positive. On day 67 after operation, the patient died of multiple metastases to liver and bone.

A 14-year-old girl was referred to our hospital for examination of a right adrenal tumor, incidentally found by abdominal ultrasound sonography. Computed tomographic scan and magnetic resonance imaging showed a 44 x 20 mm solid tumor in the right adrenal region. Endocrinological examination were within normal limits except for slightly increased serum aldosterone. Laparoscopic adrenalectomy was performed and the tumor was histologically diagnosed as ganglioneuroma originated from the right adrenal medulla.

BACKGROUND: Fibronectin (FN; 230 kDa) is a multifunctional alpha2-glycoprotein distributed throughout the extracellular matrix and body fluids. We recently reported that FN has a protective effect against injury of renal tubular cells by exposure to oxalate and calcium oxalate (CaOX) crystals and inhibits the adhesion of CaOX crystals to renal tubular cells. In the study presented here, we investigated whether FN has inhibitory effect on crystal endocytosis by renal tubular cells. METHODS: The inhibitory effect of FN on endocytosis of CaOX crystals by MDCK cells was examined by using a radioactivity uptake assay. Also, crystal endocytosis by cells was morphologically assessed by means of transmission electron microscopy (TEM). RESULTS: FN had inhibitory effects on CaOX crystal endocytosis by MDCK cells. The morphological TEM study showed that few crystals were taken into cells when FN was added compared to the number of crystals when FN was not added. CONCLUSION: We found that FN had the inhibitory effects on the interaction between crystals and renal tubular cells, including the adhesion or endocytosis of crystals by cells.

OBJECTIVES: To investigate whether hepatocyte growth factor (HGF) has a protective role against crystal-cell interaction and crystal deposits in a stone-forming rat model kidney. Crystal-cell interaction is an important step during the early stages of stone formation. High oxalate levels induce cell injuries and increase adhesion of calcium oxalate monohydrate (COM) crystals to renal tubular cells. HGF was initially identified as the most potent growth factor for hepatocytes and is well known as a mesenchyme-derived pleiotropic factor for various types of cells. HGF has mitogenic, morphogenic, and anti-apoptotic effects on renal tubular cells. METHODS: Madin-Darby canine kidney cells were exposed to potassium oxalate or COM crystals in the presence or absence of HGF. We measured lactate dehydrogenase activity in the medium and analyzed apoptosis by FACScan. COM crystal formation was induced by administration of 0.5% ethylene glycol in the drinking water and forced feeding of 0.5 microg of 1alpha-OH-D3 every other day to male Sprague-Dawley rats. Plasmid vector encoding HGF was transferred to stone-forming rats on day 1, and the kidneys were excised on day 8. RESULTS: Exposure of Madin-Darby canine kidney cells to both potassium oxalate (KOX) and COM crystals resulted in an increase in lactate dehydrogenase release and the proportion of apoptotic cells, but these effects were reduced by HGF. HGF had inhibitory activity against the adhesion of COM crystals to Madin-Darby canine kidney cells. HGF gene transfer significantly reduced crystal deposits on the renal tubules in stone-forming rats. CONCLUSIONS: These findings suggest that HGF might play an important role in stone formation.

PURPOSE: To assess the long-term outcome of patients with primary hyperaldosteronism who underwent laparoscopic adrenalectomy and to study hormone dynamics and differences between postoperative and preoperative blood pressure. PATIENTS AND METHODS: From December 1992 to February 2005, 60 patients with primary hyperaldosteronism underwent laparoscopic adrenalectomy at our institution. Their clinical and biochemical parameters were reviewed retrospectively. In 45 patients, it was possible to follow the hormone dynamics and blood pressure to compare the preoperative values with those >or=2 months after the operation. RESULTS: The average operating time was 261.7 minutes (range 95-835 minutes), and the average blood loss was 204.2 mL (range 10-3740 mL). The average time to ambulation was 1.7 days (range 1-7 days). Five patients (8.3%) had intraoperative hemorrhage that necessitated blood transfusion. Serum aldosterone in all 45 patients who were followed up was normalized postoperatively. At >or=2 months postoperatively, only 12 of the 45 patients (26.7%) needed antihypertensive drug(s). CONCLUSIONS: Laparoscopic adrenalectomy is a safe and effective way to treat primary hyperaldosteronism. Many of the patients in whom hypertension persisted postoperatively were men or elderly.

AIM: To determine whether urinary macromolecules (UMM), which are the high molecular weight substances in urine, can provide protection against the oxalate-associated injury to the renal tubular cells. METHODS: UMM were extracted from 24-h urine of 12 healthy adult male volunteers and 13 recurrent-stone-former male patients. Urine parameters in relation to urolithiasis were measured, including the level of glycosaminoglycans (GAG) in the UMM. Madin-Darby canine kidney (MDCK) cells were used to evaluate the protective activity of UMM from oxalate-induced cytotoxicity by LDH release measurement and methyl-thiazolyl tertrazolium (MTT) assay. RESULTS: Considering urinary parameters, citrate was significantly higher in urine from normal subjects than stone-former subjects; the other parameters show no differences between the groups. Total UMM and the level of GAG in the UMM were also significantly higher in the normal subject group. Compared with normal subject and stone-former subject UMM, after cells were treated with the UMM and then exposed to oxalate solution, LDH release was significantly higher in stone-former group. In the MTT assay, we found that more viable cells were observed after treatment with UMM compared to control in both groups. Moreover, UMM from the normal subjects showed higher protective activity against oxalate-related cytotoxicity than UMM from the stone-former subjects. CONCLUSION: UMM protected renal epithelial cells from oxalate-related injury. This protective activity was found to be higher in normal subject UMM than stone-former UMM. Among other factors, a higher concentration of GAG and citrate in normal subject UMM might affect some parts in this finding.

OBJECTIVES: We made a comparative study of laparoscopic nephroureterectomy (LNU) and standard open surgery (ONU) for upper urinary tract transitional cell carcinoma. METHODS AND METHODS: From July 2000 to February 2005, 49 patients underwent total nephroureterectomy for upper tract transitional cell carcinoma at Osaka University Medical Hospital. Of the 49 patients, twenty-five were treated with LNU, and twenty-four with ONU. Each group of cases was reviewed with respect to operative time, complications and postoperative convalescence. RESULTS: The average operative time of the LNU and ONU group was 305.9 min (range 190-480) and 271.2 min (range 135-480) respectively, and the average blood loss was 321.5 ml (80-1370) and 557.7 ml (range 100-1730), respectively. The average time until ambulation after LNU and ONU was 2.2 days (range 1-3) and 4.0 days (range 3-5), respectively. No major postoperative complications were observed in either group. CONCLUSION: ONU still represents the gold standard for the management of upper tract transitional cell carcinoma; however, for low stage cases, LNU offers the advantages of minimally invasive surgery.

A patient with paraganglioma of the urinary bladder is reported. A 65-year-old woman was referred to our hospital with the chief complaint of postvoiding headache, palpitation, and cold sweat. She had has no episodes of hematuria. On laboratory data, mild elevation was found in plasma neuron specific enolase (NSE), urinary noradrenaline and urinary metanephrine. The patient showed hypertension after urination with the elevation of plasma noradrenaline. 131I-MIBG scintigraphy showed abnormal accumulation in the bladder, and no abnormal accumulation in the other lesion. Pelvic magnetic resonance imaging (MRI) revealed a solid tumor of the urinary bladder, measuring 2 cm in diameter. Paraganglioma of the urinary bladder was diagnosed and the tumor was extirpated. The tumor measured 2 x 2 x 1.5 cm, and histopathologically diagnosed as paraganglioma. After extirpation, the patient became free of the postvoiding symptoms, and showed normal catecholamine levels. She has been followed up for 4 months after operation without any evidence of recurrence.

AIM: We performed robotic or robotically-assisted laparoscopic surgery for urological diseases, and evaluated the ef ficacy and safety of this surgery. METHODS: Between November 2003 and June 2004, we performed laparoscopic surgery with the Zeus system in eight cases. Three adrenalectomy cases of cortical adenoma presenting with Cushing syndrome and primary aldosteronism, and two cases of nephrectomy for renal cell carcinoma in dialyzed patients were performed solely with Zeus. In two cases of ureteral stenosis, Zeus was used for ureteral anastomosis after partial ureterectomy by manual laparoscopy. In one prostatectomy case, vesico-urethral anastomosis was performed with Zeus after extraperitoneal prostatectomy by manual laparoscopy. RESULTS: All of the cases were successfully treated without any complications during or after operation. All patients were discharged from hospital within 12 days postoperatively. As for adrenalectomy, nephrectomy and pyeloplasty, this may be the fi rst report in Japan. CONCLUSIONS: Our preliminary experiences suggest that such a robot system, which is being developed day by day, might become more beneficial in future in urological laparoscopic surgery.

PURPOSE: To determine whether living related retroperitoneoscopic donor nephrectomy (RDN) is a safe and effective procedure. PATIENTS AND METHODS: From September 2001 to May 2004, RDN was performed in 50 consecutive patients at our hospital. All patients were followed longitudinally with office visits. Perioperative and postoperative data for these RDNs, including operative time, blood loss, and complications, were compared with those of open donor nephrectomies (ODNs) performed between January 1999 and December 2001. RESULTS: The RDN was completed in all cases. The average warm ischemia times were 4.1 minutes (range 1.0-8.5 minutes) and 3.5 minutes (range 2.3-5.5 minutes) in the RDN and ODN groups, respectively (P = NS). The mean operative time for RDN was significantly longer than that for ODN (P < 0.001), but patients in the RDN group had significantly shorter hospital stays (P < 0.05). There was no significant difference between the groups in blood loss during operation or number of doses of analgesics administered after the operation. Perioperative and early postoperative complications occurred in 14 patients (28%) in the RDN group and consisted of subcutaneous emphysema in 9, wound infection in 3, and persistent headache in 2 patients. All kidneys removed retroperitoneoscopically functioned immediately. No recipients required post-transplant continuous hemodialysis. CONCLUSIONS: The RDN is a safe and effective procedure for both donor and recipient. Although the benefits of RDN have been demonstrated, further long-term studies of graft function and patient survival are needed.

We report a case of five metachronous primary cancers completely resected during 39 years. An 80-year-old woman had been diagnosed with and treated for bilateral breast cancers, gastric cancer, sigmoid colonic cancer, Bowen's disease and renal pelvic cancer. These cancers were found as metachronous cancers and were surgically treated. This is the first case of completely resected metachronous five cancers in Japan.

Surgical treatment for upper urinary stones has dramatically changed since extracorporeal shock wave lithotripsy (ESWL) was introduced in 1985 in Japan. Since then, the number of ESWL apparatus is increasing year by year, and there were about 800 ESWL apparatus available in Japan in 2001. On the other hand, the number of patients with upper urinary stones are also increasing in Japan, and the age-adjusted annual incidence of first-episode upper urinary tract stones in 1995 was estimated at 68.9 per 100,000 (100.1 in men and 55.4 in women), a steady increase from 54.2 in 1965. Under these circumstances, it would be very important to treat stone patients surgically even from an economical point of view, because the cost of ESWL is very expensive and more than 90% of the patients with urolithiasis are now treated by ESWL. In this paper, the medical economics of urolithiasis in Japan is discussed especially in the surgical treatment.

A 59-year-old woman presented with subarachnoid hemorrhage. Conventional angiography and three-dimensional computed tomography (3-D CT) angiography showed a saccular aneurysm at the junction of the azygos anterior cerebral artery (ACA) and the left A1 segment. This aneurysm was associated with a fenestration of the right hypoplastic A1 segment. The aneurysm neck was completely clipped, preserving the azygos ACA and other perforators. Aneurysm of the azygos ACA is almost always located at the distal bifurcation, and rarely at the proximal end. Proximal azygos ACA aneurysm can mimic anterior communicating artery aneurysm. Therefore, accurate preoperative diagnosis is critical using 3-D CT angiography as well as conventional angiography, and close follow up of patient is necessary to monitor for development of a de novo aneurysm at the distal bifurcation of the azygos ACA.

We recently reported that fibronectin (FN: 230 kDa) was oversecreted from the renal tubular cells as a result of the stimulation of COM crystals, and inhibited the adhesion of COM crystals to renal tubular cells. In the study presented here, we investigated whether FN can prevent injury to renal tubular cells caused by oxalate and COM crystals and tried to identify the relation with inhibition of crystal adhesion. The protective effect of FN against renal tubular cell injury by exposure to oxalate and COM crystals was examined by measuring the lactate dehydrogenase (LDH) activity and using a non-radioactive proliferation assay. Moreover, crystal-cell interaction was morphologically assessed by means of scanning electron microscopy (SEM). LDH was reduced significantly by the addition of FN in a dose-dependent manner. Cell viability increased significantly with the addition of FN, also in a dose-dependent manner. Moreover, the morphological SEM study showed that few crystals were attached to the surface of cells when FN was added compared to the number of adhering crystals when FN was not added. FN was found to have an inhibitory effect on renal tubular cell injury caused by exposure to oxalate and COM crystals. We speculate that the inhibitory effect of FN on the adhesion of COM crystals is related to the inhibitory effect of exposure to COM crystals on renal tubular cell injury.

PURPOSE: To determine whether laparoscopic splenectomy for ABO-incompatible living related renal transplantation is safe and effective. PATIENTS AND METHODS: From July 2000 to May 2002, laparoscopic splenectomy was performed on the day of transplantation in 10 patients undergoing ABO-incompatible living related renal transplantation. Perioperative and postoperative data, including operative time, blood loss, and complications, were evaluated. RESULTS: The mean operative time was 79 minutes. Intraoperative blood loss ranged from 25 mL to 600 mL (mean 130 mL). Transfusion was not required in any case. One patient required open conversion because of bleeding from the splenic hilum. The serum amylase value was slightly elevated postoperatively in four patients but normalized with conservative treatment. One patient had bleeding from a trocar port wound, which was likewise treated conservatively. No complications, including postoperative renal dysfunction or fatal infections, that were considered attributable to the laparoscopic procedure were noted. CONCLUSIONS: Laparoscopic splenectomy performed simultaneously with renal transplantation is a safe and efficacious procedure for ABO-incompatible living related renal transplantation.

We report a rare case of psoas abscess caused by Candida albicans. A 59-year-old man with diabetes mellitis presented with right flank mass. Computed tomography (CT) showed a psoas abscess. Needle aspiration of the right flank mass revealed pus which was proved to be C. albicans by culture. The literature is briefly reviewed.