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Shiro Saito

Publications and source records attributed to Shiro Saito.

At least 19 recordsLinked to original sources
PubMed2006

Predictive factors of acute urinary retention requiring catheterization following 125I prostate brachytherapy.

OBJECTIVE: To analyze predictive factors of acute urinary retention requiring catheterization after (125)I prostate brachytherapy. METHODS: A group of 227 consecutive patients with localized prostate cancer were treated with (125)I prostate brachytherapy between September 2003 and December 2004. The clinical, treatment-related and dosimetric factors were evaluated for the need for catheterization owing to urinary retention. RESULTS: Twelve patients (5.3%) required catheterization. The median time to onset was 2 days after implantation (range 1-7 days). Univariate analysis demonstrated that pre-implant ultrasound prostate volume, number of seeds, number of needles and neoadjuvant hormonal manipulation were predictive for catheterization. In multivariate analysis, the number of needles and neoadjuvant hormonal manipulation were significant independent predictive factors for catheterization (P = 0.002 and 0.025, respectively). The risk of catheterization in the cluster in which the number of needles was >24 was 4.07 times as high as that in the cluster in which the number of needles was < or =24 [11.3% versus 3.0%, P = 0.020; 95% confidence interval (CI) 1.24-13.36], and the risk in the hormonally manipulated patients was 7.05 times as high as that in the hormone-naïve patients (7.7% versus 1.2%, P = 0.034; 95% CI 0.89-55.64). CONCLUSION: Our data suggest that the number of needles and hormonal manipulation might be the strongest predictors for catheterization.

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PubMed2006

Serial changes of international prostate symptom score following I-125 prostate brachytherapy.

BACKGROUND: This study was conducted to assess serial changes in the International Prostate Symptom Score (IPSS) within the first 12 months after iodine-125 (I-125) prostate brachytherapy. METHODS: Between September 2003 and June 2004, a group of 103 patients with localized prostate cancer was treated with I-125 prostate brachytherapy, either alone (monotherapy; 60 patients) or in combination with external-beam radiotherapy (combined therapy; 43 patients). The IPSS was obtained at preimplant, and at 1, 6, and 12 months after treatment. The minimum IPSS follow-up for this study was 12 months. Dosimetry was based on computed tomography (CT) scan 1 month postimplant. Clinical, treatment-related, and dosimetric factors were assessed for correlations with the maximum IPSS increase (the peak IPSS minus the preimplant IPSS). RESULTS: The median preimplant IPSS was 7.0, with a median peak of 16 at 1 month. The IPSS returned to baseline in 42 patients (40.8%) and it returned to within 3 points of the baseline in 64 (62.1%) at 1-year follow-up. On univariate and multivariate analyses, the maximum IPSS increase was best predicted by lower preimplant IPSS, in both the monotherapy and combined therapy groups. CONCLUSION: In our series, IPSS after prostate brachytherapy peaked at 1 month and gradually returned to approximately baseline at 12 months.

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PubMed2006

Three-year results of treatment for prostate cancer with low-dose rate temporary iridium-192 brachytherapy.

AIM: To report the 3-year treatment results of definitive irradiation by using a temporary interstitial implant with low-dose rate iridium-192 with or without external beam radiotherapy in the treatment of localized prostate cancer. METHODS: One-hundred and forty-three patients with pathologically defined prostate carcinoma were treated from December 1997 to April 2003. The patients were classified into a low-risk group (T2, PSA 20 ng/mL or Gleason score>or=7). Low-risk patients were treated with low-dose-rate iridium brachytherapy as monotherapy delivering 70 Gy. High-risk patients were treated with the combination of brachytherapy and external beam radiotherapy delivering 40 Gy and 36 Gy, respectively. Kaplan-Meier estimates of prostate-specific antigen (PSA) progression-free survival rate were analysed. To assess the treatment quality in different periods, PSA progression-free survival rates in late era (year of 2000 and after) and in early era (before 2000) were compared. Morbidity was graded according to the Radiation Therapy Oncology Group grading scale. RESULTS: One hundred and nineteen patients were analysed, of which 86 patients underwent monotherapy with an iridium implant, and 33 were treated with the combination of external beam radiotherapy. Twenty-four patients were excluded from the analysis because the classification of risk group did not suit the criteria. The total (n=119) PSA progression-free survival rate at 3 years was 80.3%. The PSA progression-free survival rate at 3 years for the monotherapy group (n=86) and the combination therapy group (n=33) were 78.2% and 86.9%, respectively. There were 23 patients who were followed for more than 36 to 63 months, and, during this period, only 1 patient who received the monotherapy was diagnosed as PSA failure at 50 months. The 3-year PSA progression-free survival rate of monotherapy in late era was significantly higher than that in early era; however, no significant difference was seen in the combination treatment. Morbidity for the combination treatment was low; however, for the monotherapy, three patients developed severe rectal ulcers, and colostomies were made. CONCLUSIONS: The PSA progression-free survival rate after low-dose rate iridium-192 brachytherapy with or without external beam radiotherapy can be satisfactory and longer follow up is necessary to compare the efficacy of other treatments.

Adenocarcinoma↗
PubMed2006

[Questionnaire survey of peri-operative management of transurethral prostate resection in Japan].

OBJECTIVES: We investigated perioperative management for transurethral resection of the prostate (TURP) in Japan. METHODS: The questionnaire survey was conducted in 1,213 educational institutions for urology. RESULTS: The questionnaires were returned from 722 (60%) institutions. Admission to hospital was most frequently scheduled on preoperative day 1; termination of continuous drip infusion, starting meal intake and walking on postoperative day 1; intravenous antibiotics for three days; removal of Foley catheter on postoperative day 4; oral antibiotics for 7 days; and discharge from hospital on postoperative day 7. CONCLUSION: Although hospitalization was 14 days or less at most institutions, several procedures, especially the administration of prophylactic antibiotics, were fairly varied. Discussions from various perspectives might be needed to standardize the perioperative management of TURP in Japan.

Critical Pathways↗
PubMed2006

[Influence of androgen deprivation therapy on prostate volume in patients with prostate cancer undergoing prostate brachytherapy with permanent seed implantation].

OBJECTIVE: Enlarged prostate often causes pubic arch interference during needle insertion on transperineal interstitial permanent prostate brachytherapy. Pre-treatment hormonal therapy is necessary for downsizing the prostate gland in such cases. The degree of prostate downsizing with anti-androgen treatment before iodine 125 permanent seed implant brachytherapy and its relation to clinical as well as pathological parameters were assessed. METHODS: From September 2003 to March 2005, 110 patients underwent permanent seed implantation and 86 patients of all received antiandrogen depriviation prior to the treatment at our institute. Prostate volume was measured using transrectal ultrasound at the time of cancer diagnosis and before the seed implant. Correlations between prostate downsizing and clinical as well as pathological parameters were evaluated. RESULTS: Mean percent volume of the prostate after the size reduction with average of 6.0 months antiandrogen monotherapy, 7.7 months LHRH agoniost and 8.2 months maximum androgen blockage (MAB) was 83%, 63%, and 60%, respectively. Mann-Whitney U test revealed that the degree of prostate downsizing is significantly correlated with the prostate volume in patients with prostate cancer utilizing LHRH agonists. CONCLUSIONS: Antiandrogen monotherapy can be an alternative for prostate downsizing before interstitial brachytherapy. Utilizing LHRH agonists or MAB is recommended for cases with larger gland volume.

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PubMed2006

[Brachytherapy for prostate cancer].

This review article aims to overview modern prostate brachytherapy in Japan. Permanent transperineal prostate brachytherapy with I-125 started in September, 2003 in Japan. Brachytherapy has several advantages: the dose is adapted precisely to the tumor shape and size, and the long-lived isotope gives a higher tumor dose with less damage to normal tissue; less-time consuming for patients and staff: long-term results comparable to surgery or external beam series in the USA; and quality of life after brachytherapy also appealing. These advantages have brought about increasing use in Japan as well. Patients with a high probability of organ-confined disease and a low-risk group are appropriately treated with brachytherapy. Brachytherapy candidates with a significant risk of extraprostatic extension should be treated with supplemental external beam radiation therapy. High-dose-rate (HDR) brachytherapy with Ir-192 has preceded seed implants in Japan. HDR has some theoretical advantages. Long-term results of brachytherapy in the USA are comparable with surgery or external beam irradiation so far. We should develop more sophisticated brachytherapy techniques in Japan.

Brachytherapy↗
PubMed2005

Acute urinary morbidity following I-125 prostate brachytherapy.

BACKGROUND: In Japan, iodine-125 (I-125) prostate brachytherapy has been legally approved since July 2003, and this method is becoming more popular. The purpose of the present study was to assess acute urinary morbidity within the first 6 months after I-125 prostate brachytherapy. METHODS: A group of 130 consecutive patients with localized prostate cancer was treated with I-125 prostate brachytherapy between September 2003 and June 2004,either alone (monotherapy; 66 patients) or in combination with external-beam radiotherapy (combined therapy; 64 patients). Urinary morbidity was evaluated using the National Cancer Institute - Common Terminology Criteria for Adverse Events, version 3.0. RESULTS: During the follow-up, 111 patients (85.4%) developed some degree of urinary symptoms such as frequency, retention, dysuria, incontinence, or hematuria. Urinary frequency (73.1%) and retention (66.9%) were the most common, and showed no significant differences between the monotherapy group and combined therapy group (P = 0.352 and P = 0.630, respectively). Six patients (4.6%) required catheterization for urinary obstruction; the median time to onset was 1.5 days (range, 1-192 days). Five of these 6 patients received monotherapy and the other received combined therapy. CONCLUSION: Manifestations of acute urinary morbidity, especially frequency and retention, are relatively common but acceptable events after I-125 prostate brachytherapy.

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PubMed2005

A retrospective study of the treatment of locally advanced prostate cancer by six institutions in eastern and north-eastern Japan.

OBJECTIVE: To investigate patients with locally advanced prostate cancer treated at six academic institutions in eastern and north-eastern Japan from 1988 to 2000, to facilitate the establishment of Japanese guidelines for the diagnosis and treatment of locally advanced prostate cancer. PATIENTS AND METHODS: The study included 391 eligible patients with locally advanced prostate cancer who were treated by radical prostatectomy (RP), radiotherapy and/or primary hormone therapy. Disease-specific survival rates for these patients were assessed in relation to their clinicopathological characteristics and the types of treatment they received. The Mann-Whitney U-test, Kruskal-Wallis, chi-square and log-rank test were used for statistical analysis, as appropriate. RESULTS: In all, 128 patient with lower prostate-specific antigen levels (P = 0.023) and/or better performance status (P = 0.001) had RP. Neoadjuvant hormone therapy before RP was the treatment in 68 (53%) of these 128 patients; 66 (52%) received immediate adjuvant hormone therapy. Of 87 patients treated with radiotherapy, 75 (86%) had external beam radiotherapy (EBRT) as the primary treatment with no brachytherapy, and 12 (14%) had brachytherapy as the primary method. Neoadjuvant hormone therapy was given to 56 of the 87 patients (64%); 48 (55%) received immediate adjuvant hormone therapy. Of the 176 patients treated with primary hormone therapy alone, combined androgen blockade and surgical or medical castration was the treatment in 76 (43%) and 85 (48%), respectively. Disease-specific survival rates at 5 years for patients treated with RP, EBRT and primary hormone therapy were 90%, 98%, and 89%, respectively. CONCLUSION: The treatments provided by the participating institutions did not differ significantly from those set out in European and American guidelines, and short-term disease-specific survival rates for each treatment did not differ significantly from those of historical controls. Further investigation may facilitate the establishment of Japanese guidelines for the diagnosis and treatment of locally advanced prostate cancer.

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PubMed2005

[Seed loss through the urinary tract and retrieval after prostate seed implant].

This study describes our experience with seed loss and retrieval through the urinary tract following seed implants for prostate cancer, and offers Japanese guidelines for safety and management. Two hundred consecutive patients were analyzed. All patients were preplanned with a modified peripheral loading technique and implanted with a Mick applicator under ultrasound guidance. All patients were instructed to return excreted seeds, if any, to our center. Seed loss occurred in 6% of patients and 0.13% of seeds. Seed loss tended to occur in the early period through either urine or ejaculation.

Brachytherapy↗
PubMed2005

[Experience of brachytherapy using I-125 seed permanent implants for localized prostate cancer].

PURPOSE: We report here our experience of brachytherapy using I-125 seeds for localized prostate cancer in 100 patients. MATERIALS AND METHODS: We carried out brachytherapy with I-125 seed permanent implants in 100 patients with localized prostate cancer between September 2003 and October 2004. Preplanning dosimetry was done using transrectal ultrasonic images obtained three or four weeks prior to treatment. Using transrectal ultrasound, we inserted I-125 seeds in the prostate through needles according to the preplanning diagram. We then examined the results on prostate CT performed one month later. RESULTS: It was necessary to describe transrectal ultrasonic image such as preplanning. There were several cases in which the source arrangement of the schedule was corrected immediately before the operation. In the examination after one month, the numerical value at the start of treatment initially was not satisfactory, but we eventually obtained a result that could to be evaluated. CONCLUSION: We carried out permanent implant brachytherapy for localized prostate cancer using I-125 seeds and reported our experience.

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PubMed2005

[Neoadjuvant chemotherapy using TS-1 and CDDP against large type 3/Type 4/Bulky N 2 advanced gastric cancer].

This study was conducted to assess therapeutic results following neoadjuvant chemotherapy (NAC) for large type 3/type 4/Bulky N 2 advanced gastric cancer having a poor prognosis following resection. The subjects consisted of cases (< or = 75 y.o.) having large type 3 (diameter > or = 8 cm), type 4 or Bulky N 2 gastric cancer curable by resection based on preoperative imaging diagnostics. The NAC regimen consisted of TS-1 at 80-120 mg/body on days 1-21 p. o. and CDDP at 60 mg/m2 on day 8 divided. Upon completion of two courses of 4 weeks per course, gastrectomy with > or = D2 lymph node dissection was carried out on days 21-34. The average age of the subjects was 60.7 years, and the therapy completion rate was 80% (8/10 cases). Five of ten cases were responders diagnosed as grade 2 by histopathological examination of excised specimens (response rate 50%). Two of five responders were histopathologically evaluated as down-staging as a result of NAC (Stage III A--> f Stage I A, Stage IV--> f Stage I A). Three of the five non-responders have relapsed, and the relapse-free interval was an average 238 days. In the five responders,one has relapsed at 331 days,while the other 4 responders have shown no relapse yet. Although NAC consisting of TS-1 and CDDP is considered to be effective against advanced gastric cancer, a phase III study with surgical treatment only will be necessary to confirm its true value.

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PubMed2004

Metanephric adenoma treated with laparoscopic nephrectomy.

A 31-year-old-female presented with a left renal mass detected incidentally during an abdominal ultrasound examination. Computed tomography and angiography revealed a hypovascular solid tumor 4.5 cm in diameter at the middle portion of the left kidney. Laparoscopic left nephrectomy was performed and macroscopic examination of the specimen revealed encapsulated tumor with grayish yellow cut surface. Histological examination demonstrated that the tumor cells were small scant cytoplasms, containing round and regular nuclei, forming a glomerular-like structure. There was no mitosis nor cellular atypia indicating a malignant structure. The histological diagnosis was metanephric adenoma.

Adenoma↗
PubMed2004

[Implementation of a common clinical path for transurethral resection of prostate (TURP) in multiple hospitals].

PURPOSE: To investigate the length of hospitalization and medical charges when a common clinical path for TURP (transurethral resection of prostate) was implemented in multiple hospitals. PATIENTS AND METHODS: This study included 310 patients in 2001 and 298 in 2002, who were diagnosed with benign prostatic hyperplasia and who underwent TURP in seven hospitals in Japan. While the patients were treated according to the managing methods of each hospital in 2001, the patients were managed using a common clinical path in 2002, on which we conferred and established in 2001. We investigated the change of various outcome indicators before and after implementation of the common clinical path. RESULTS: The background of patients and surgical outcome in 2002 were equal to those in 2001, except in incidence of preoperative urinary tract infection, general anesthesia and blood transfusion, and number of surgeons. Implementation of a common clinical path shortened the pre- and postoperative hospital stay, duration of bed rest, administration of antibiotics and Foley catheter indwelling, and reduced the standard deviation of these indicators. The total medical charge decreased from 515,439 to 491,935 yen. However, outcomes were considerably different among the seven hospitals. Multivariate analyses identified the hospitals, cognitive impairment, preoperative indwelling catheter and preoperative variance as the factors affecting preoperative hospital stay, and the hospitals, co-existing disease, blood transfusion, postoperative urinary tract infection and postoperative variance as factors affecting postoperative stay. Based on these analyses, we determined four exclusion criteria against using a common clinical path: 1) patients requiring examination or surgery other than TURP simultaneously, 2) patients whose ADL disturbance, cognitive impairment, past history and/or coexisting disease are expected to affect postoperative convalescence, 3) patients with a preoperative indwelling catheter just before operation, and 4) patients with preoperative urinary tract infection. By excluding 122 (39.4%) and 129 (43.3%) patients fulfilling the above criteria in 2001 and 2002, respectively, there were reduction in the length of pre- and postoperative hospital stay, and the total admission fee. Furthermore, there were decrease in their standard deviations. CONCLUSIONS: A common clinical path was valid for reducing variance of the critical indicators affecting the clinical course of TURP and shortening the pre- and postoperative stay in the multiple hospitals. It is mandatory to establish the standard perioperative management for TURP from the viewpoint of urologists, under the circumstances of the impending introduction of the Diagnosis Procedure Combination (DPC).

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PubMed2004

[A questionnaire survey for TURP hospitalization by clinical path].

PURPOSE: We conducted a questionnaire survey to elucidate the rating of the patients who underwent transurethral resection of the prostate (TURP) and were managed by a common clinical path during hospitalization. PATIENTS AND METHODS: At the day of discharge from seven hospitals in Japan, the questionnaires were handed to 298 patients who underwent TURP in 2002. In the path, it was determined that the patients should be admitted one day before surgery and discharged on the seventh postoperative day. RESULTS: The questionnaires were returned by 240 (80.5%) patients. Of the 212 patients answering a question regarding the desirable preoperative hospital stay, 58 (27.4%), 85 (40.1%) and 46 (21.7%) considered 1, 2 and 3 days as a desirable preoperative stay, respectively. Of the 206 answering a question about the desirable postoperative hospital stay, 54 (26.2%), 28 (13.6%) and 60 (29.1%) considered 7, 8 and 9-10 days as a desirable postoperative hospital stay, respectively. Of the 240 patients, 229 (95.4%) received the path for the patients, 234 (97.5%) understood the treatment methods well and 229 (95.4%) understood the schedule during hospitalization well. Two hundred thirty-six (98.3%) and 218 (90.8%) patients answered that as scheduled, they started to have meals and started to walk, respectively. Continuous drip infusion was terminated in 219 (91.3%) as scheduled, and indwelling catheters were removed in 215 (89.6%) as scheduled. CONCLUSIONS: This questionnaire survey elucidated that approximately 70% of the patients who underwent TURP wanted to stay 1 or 2 days before surgery and 7 to 10 days after surgery. We consider it very important that patients understand well the treatment methods, complications, schedules during hospitalization and criteria for discharge when they are managed using the clinical path, so they will accept better a length of hospital stay that is shorter than that which they had desired.

Critical Pathways↗
PubMed2003

Prognostic implication of microvascular invasion in biochemical failure in patients treated with radical prostatectomy.

INTRODUCTION: Micrometastasis before radical prostatectomy (RP) is considered to be related to the biochemical failure after surgery in patients with prostate cancer. To predict the biochemical failure, we evaluated microvascular (lymphatic/vascular) invasion and other pathological findings as prognostic factors for biochemical failure after RP. MATERIALS AND METHODS: Eighty-two men who underwent RPs and received neither preoperative nor postoperative adjuvant therapy were analyzed. Pathological findings of each patient were carefully reviewed to determine pathological factors predicting biochemical failure. The influence of pathological findings on the biochemical failure was evaluated. RESULTS: The overall biochemically assessed disease-free survival rate was 55.7% at 3 years. By univariate analysis, Gleason sum, capsular penetration, and microvascular invasion were significantly associated with the rate of biochemical failure. Microvascular invasion was strongly correlated with Gleason sum, capsular penetration, surgical margin, perineural invasion, and pathological stage. By multivariate analysis, Gleason sum, capsular penetration, and microvascular invasion were independent predictors of biochemical failure. CONCLUSION: This study suggests that in addition to Gleason grade and capsular penetration, microvascular invasion is one of independent prognostic factors in patients with prostate cancer treated with RPs.

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PubMed2003

[Neuroendocrine differentiation in adenocarcinoma of the prostate with progression of disease during hormonal treatment: a report of two cases].

Prostatic neuroendocrine (NE) carcinoma is a rare situation and the NE differentiation in the prostate adenocarcinoma appears to be characterized as poor prognosis, rapid tumor progression and the androgen-independent state, for which there is currently no successful therapy. We report two cases of NE differentiated prostatic carcinoma, which were diagnosed adenocarcinoma initially and the tumors progressed universally with NE differentiation during androgen suppression therapy.

Adenocarcinoma↗
PubMed2003

[A case of synchronous triple primary carcinomas of the kidney, bladder and prostate].

A case of synchronous triple carcinomas arising in the kidney, bladder and prostate is reported. An 82-year-old man had gross hematuria. Urine cytology was positive and intravenous pyelography showed right hydronephrosis with a filling defect in the bladder. Computed tomography revealed a 4 cm mass in the bladder, enlarged prostate and 6 cm renal mass at the left kidney. Cystoscopy demonstrated a papillary broadbased tumor with some small satellite tumors in the bladder, and magnetic resonance imaging revealed muscle invasion of the bladder tumor. This patient underwent left radical nephrectomy and total cystoprostatectomy with ileal conduit urinary diversion as radical treatment. Histological diagnosis was renal cell carcinoma, transitional cell carcinoma of the bladder. Furthermore, well-differentiated adenocarcinoma was found incidentally in the prostate. Immunohistochemical staining with anti-p53 antibody for the three tumors showed positive staining only for the bladder cancer.

Adenocarcinoma↗