核医学と放射線治療

Purpose: We try to evaluate the influence of intravesical prostatic protrusion (IPP) in the postoperative continence of patient who received robotic assisted laparoscopic radical prostatectomy. Methods: A total 600 patients who underwent robotic assisted laparoscopic radical prostatectomy were included in the study. Preoperative MRI was performed in all patients and the vertical distance from the tip of the protruding prostate to the base of the urinary bladder was measured in all sagittal plane. The degree of intravesical prostatic protrusion were divided into three groups (IPP<5 mm, 5 mm<IPP<10 mm, 10 mm<IPP). Surgical procedure was mentioned. Continence was defined as no pad use or only one safety pad per day and assessed at 1, 3 and 12 months postoperatively. The result was examined. Results: The overall continence rate at 1, 3 and 12 month was 69.2%, 91.33% and 95.5%. Among the three groups, there is significant difference in 1 month, 3 months and 12 months continence rate (IPP<5 mm: 82.5%, 96.3%, 97.7%; 5 mm<IPP<10 mm: 61.9%, 89.4%, 94.4%; 10 mm<IPP: 30%, 75.6%, 88.9%, p<0.001). At first month, 415 patients achieved continence but 195 patients still incontinence and the length of IPP among the two groups were 4.43 mm ± 3.74 mm and 8.69 mm ± 6.63 mm, p<0.001. There is also significant difference in IPP length among continence and incontinence group. Conclusions: To our result, both of intravesical prostatic protrusion and prostate volume was correlated with recovery of early and one year continence after robotic assisted laparoscopic radical prostatectomy and with inferior outcome.

Occult primary breast carcinoma (OPBC) with axillary lymph node metastasis is a rare disorder accounting for 0.1% to 0.8% of all the cases of breast cancer in females. Such a presentation in males is even rarer with only isolated case reports noted in English literature. Magnetic resonance imaging (MRI) of the breast detects primary tumor in nearly 2/3rd patients. Role of mastectomy is considered controversial. There is no consensus on the role of adjuvant therapy owing to the rarity of these tumors. We are presenting an elderly man who presented with axillary lymph node metastasis of ductal carcinoma and was treated with surgery followed by adjuvant chemotherapy.

Experimental work where Tm-170 LDR seeds and one HDR source were used to treat cancer on rats is described. Experiments were done with Lewis rats, carrying tumor developed from implantation of CNS-1 Rat Brain Tumor Astrocytoma cells, under the thigh skin. 75% of both HDR and LDR treated rats were completely cured. I-125 seeds experiments were done as a control, only 8.3% were cured with a similar photon dose. The dose due to beta radiation is very significant and was the main reason for the treatment success. 

Purpose: To evaluate the identification of early prostate cancer by Ga-68 HBED-CC PSMA positron emission tomography/computed tomography (PET/CT) using the TNM classification for orientation. Method: Sixteen men with a mean age of 68 ± 6.8 years (range, 55-80 years) who underwent Ga-68 HBED-CCPSMA PET/CT for initial diagnostic evaluation of suspected prostate cancer and biopsy at our department betweenAugust 2013 and June 2015 were included. Cancer extent determined by PET/CT and CT was retrospectively assessed by two independent observers (O2, O3) without knowledge of clinical findings and compared with the initial diagnosis (O1). Histology of the prostate and of suspected metastatic lesions in conjunction with the interdisciplinary TNM diagnosis served as the gold standard. Results: The TNM staging based on morphologic imaging criteria agreed with the gold standard for O1/O2/O3 in 38%/31%/50% of cases for PET/CT and in 19%/13%/13% for CT. Detection rates for O1/O2/O3 were 38/44%/56% versus 19%/19%/13% for T-stage (PET/CT versus CT), 81%/75%/81% versus 75%/63%/75% for N-stage, and 100%/100%/100% versus 100%/88%/100% for M-stage. Compared with histopathology, the TNM stage was underestimated with PET/CT (42%) and even more so with CT alone (81%). Conclusion: Ga-68 HBED-CC PSMA PET/CT appears to be superior to CT alone in determining the TNM stage of prostate cancer, specifically with regard to the T-stage. Nevertheless, even Ga-68 HBED-CC PSMA PET/CT appears to be limited for characterization of the primary tumor and tends to underestimate the T-stage.