Pathologic and Prognostic Outcomes of Very Low- and Low-Risk Prostate Cancer According to the National Comprehensive Cancer Network Guidelines in Japanese Patients with Radical Prostatectomy

Background: The purpose of this study was to validate the treatment strategy for a cohort of Japanese patients with very low-risk (VLR) and low-risk (LR) prostate cancer according to the National Comprehensive Cancer Network (NCCN) guidelines. Methods: We studied 751 patients with T1- 3N0M0 prostate cancer treated with radical prostatectomy at our institution between 2000 and 2012. Patients with neoadjuvant treatments were excluded. We retrospectively reviewed the clinical and pathological outcomes for patients with VLR or LR prostate cancers that were classified by NCCN guidelines. Results: We identified 45 patients with VLR and 137 with LR prostate cancer. Non-biochemical recurrence rate at 5-year for 45 patients with VLR was 86.9% and 81.2% for 137 patients with LR (p = 0.56). However, none of the 19 patients >65 years old with VLR progressed, while 19% of 26 patients ≤65 years old with VLR cancer, 14% of patients >65 years old with LR cancer, and 17% of patients ≤65 years old with LR cancer progressed during the follow-up period (p = 0.04, p = 0.04 and p = 0.05, respectively). In analyses of prostatectomy specimens, both VLR and LR had similarly favorable outcomes, but patients >65 years old with VLR had the smallest tumors, with a mean of 5 mm in diameter. Conclusions: Our results support the treatment strategy of the NCCN that patients with VLR cancer and age >65 years old are good candidates for active surveillance, and that other treatment options—including active surveillance and aggressive treatments—can be applied to the remaining patients with VLR or LR cancers.

Basal Cell Proliferation Induced by Chlormadinone Acetate Suggests Stem Cell Transformation of Prostatic Cells

Introduction and Objective: Epithelial to Mesenchymal transition (EMT) at the first hormonal therapy is thought to play an essential role in obtaining castrate resistance for hormone naive prostate cancer. So we studied EMT of prostatic cells after exposing various hormonal agents using transurethral resection (TUR) specimens. Patients and Methods: TUR specimens without hormonal use (4 cases), specimens after three weeks of chlormadinone acetate (CMA) (9 cases), specimens after average six months of dutasteride (3 cases), and specimens two weeks after initial use of degarelix (3 cases) were studied using HE and immunohistochemical staining with prostate specific antigen (PSA), prostatic stem cell markers such as CD44, CD117, CD133 and Vimentin. Results: Specimens treated with CMA showed acinar dilatation and atrophy of glandular cells. Specimens treated with dutasteride showed marked decrease of gland and specimens treated with degarelix showed decrease of glandular cells. PSA was stained all of the prostatic glandular cells in all specimens. CD44 was stained at basal cells in normal prostatic tissue without hormones, however in hormone treated specimens, basal cells elongate and some glandular cells were also stained by CD44, especially in CMA treated specimens. Only small numbers of infiltrating cells in interstitial tissue positively stained with CD 117 and CD 133 in all specimens. Vimentin was stained in all mesenchymal interstitial cells. Conclusion: Elongation of basal cells and increased sensitivity to CD44 in glandular cells, especially treated with CMA, were thought to the result of EMT of prostatic glandular cells.

Problems in Japan’s Aging Society from the Perspective of Lichen Sclerosus

We encountered 12 elderly patients with lichen sclerosus (LS), a relatively high percentage of whom were living with their families. There is a tendency to assume that elderly people living alone or older facility users with paralysis are more likely to require social care, but we note that elderly people living with their families are also likely to develop LS.