Who needs further evaluations to diagnose upper urinary tract urothelial cancers among patients with abnormal findings by enhanced CT?

Objective:We evaluated who would need further evaluations such as retrograde pyelography(RP)and/or ureteroscopy to diagnose upper urinary tract urothelial cancers(UUTUCs)when abnormal findings for the upper urinary tract(UUT)were detected by enhanced computed tomography(CT).Methods:We retrospectively analyzed 125 patients who underwent enhanced CT for various reasons and had abnormal findings for the UUT.Patients whose tumors were suspected to be of extraureteral origin were excluded.All patients received RP and/or ureteroscopy to evaluate the UUTUCs.Results:The median age of the 125 patients was 70 years and gross hematuria(26.4%)was the most frequently observed symptoms.RP,ureteroscopy and both were performed for 121,59 and 55 patients,respectively.CT revealed tumor-like lesions in 58 patients and the other patients had non-tumor-like lesions.UUTUCs were found in 43(34.4%)of the 125 patients.All of them had tumor-like lesions on CT.In 58 patients who had tumor-like lesions on CT,univariate and multivariate analyses revealed that tumor diameter and tumor enhancement were significant predictive factors for UUTUCs.ROC curve analysis of enhanced CT to diagnose UUTUCs revealed that a tumor diameter of 18 mm was the best cutoff point.The sensitivity,specificity and accuracy were 90.0%,98.8% and 92.7% for RP and 95.5%,100% and 97.1%for ureteroscopy,respectively.Both of them had high sensitivity,specificity and accuracy.Conclusion:We should decide to evaluate the UUT according to the tumor diameter on enhanced CT.When we evaluate the UUT in patients with tumor diameters of less than 20 mm,ureteroscopy is recommended.

Which characteristics are associated with changes in medication status for lower urinary tract symptoms among patients with prostate cancer receiving external beam radiotherapy?

Background:We clarified the predictive factors for changes in the status ofmedications for lower urinary tract symptoms(LUTS)2 years after local radiotherapy for nonmetastatic prostate cancer.Materials and methods:We retrospectively included patients who underwent local external radiotherapy for nonmetastatic prostate cancer in 8 institutions between April 2001 and March 2016.Patients were divided into themedication and no-medication group based on the use of drugs for LUTS before radiotherapy.We defined improvement of LUTS as when the patient did not require medication for LUTS at 24 months after radiotherapy in the medication group and as deterioration whenmedication was required in the no-medication group.Logistic regression analysis was used to evaluate predictive factors for changes in medication status.Results:Altogether,505 patients were divided into a no-medication group(n=352)and a medication group(n=153).The number of patients with deterioration and improvement in LUTS was 49(14%)and 36(23%),respectively.In the multivariate analysis,the predictive variables for deterioration were the International Prostate SymptomScore(≥8;odds ratio[OR],2.21;p=0.014)and the biopsy Gleason score(≤3+4=7;OR,2.430;p=0.008)in the no-medication group,whereas those for improvement were age(<75 years old;OR,5.81;p=0.002),the quality of life score(<3;OR,3.15;p=0.028),and a positive biopsy core rate(≥50%;OR,2.530;p=0.027)in the medication group.Conclusions:These predictive factors for changes in the status ofmedications for LUTS at 2 years after external radiotherapymay help determine the definitive therapy for nonmetastatic prostate cancer.