Publications by authors named "Kiyoshi Takahara"
Objective: The aim of this study was to compare prognostic outcomes of administering first- or second-generation androgen receptor signaling inhibitors in non-metastatic castration-resistant prostate cancer and to find prognostic indicators.
Methods: This retrospective study included 198 patients with non-metastatic castration-resistant prostate cancer from 14 institutions associated with Tokai Urologic Oncology Research Seminar. Forty-two patients were treated with combined androgen blockade using first-generation inhibitors (bicalutamide or flutamide), and 156 were treated with second-generation inhibitors (abiraterone/enzalutamide or apalutamide/darolutamide) after primary androgen deprivation therapy failure.
Background: Androgen-receptor signaling inhibitors (ARSIs) become the new standard of care for metastatic hormone-sensitive prostate cancer (mHSPC). It is unknown whether time to castration resistance (TTCR), when using the first-line ARSIs, offers predictive value in mHSPC. We sought to assess the clinical outcomes for mHSPC patients treated with first-line ARSIs focusing on the TTCR.
View Article and Find Full Text PDFBackground: Upfront androgen receptor signaling inhibitor (ARSI) along with androgen deprivation therapy is the current standard of care for metastatic castration-sensitive prostate cancer. However, evidence on second-line therapy after upfront ARSI is scarce. We aimed to evaluate the oncological outcome of ARSI versus docetaxel (DOC) after upfront ARSI therapy in a real-world clinical practice.
View Article and Find Full Text PDFHyper progressive disease (HPD) is a paradoxical phenomenon characterized by accelerated tumor growth following treatment with immune checkpoint inhibitors. However, the pathogenic causality and its predictor remain unknown. We herein report a fatal case of HPD in a 50-year-old man with metastatic bladder cancer.
View Article and Find Full Text PDFIntroduction And Hypothesis: Robot-assisted sacrocolpopexy (RASC) is increasingly common due to the increased uptake of surgical robot systems. The aim of this retrospective study was to assess the perioperative outcomes of the first patient cohort to undergo RASC using a brand-new surgical robot system, the hinotori surgical system (robot-assisted sacrocolpopexy with hinotori surgical system [h-RASC]). This study also aimed to compare the outcomes of this group with those of the group of patients who had undergone RASC with the da Vinci surgical system (d-RASC).
View Article and Find Full Text PDFBackground: Metastatic nonclear cell renal cell carcinoma (nccRCC) is a heterogeneous disease with poor prognosis. The clinical characteristics and prognostic factors of immuno-oncology (IO) combination therapy for nccRCC are not well known. This study analyzed patients with metastatic nccRCC treated with IO combination therapy.
View Article and Find Full Text PDFArticle Synopsis
- Recent changes in treating non-metastatic castration-resistant prostate cancer (nmCRPC) led to an observational study assessing the effectiveness of androgen receptor signaling inhibitors (ARSIs) as a first-line treatment for Japanese patients.
- The study included 160 participants, with a median follow-up of 23 months, showing promising results: patients experienced a median progression-free survival of 26 months, but median overall survival was not reached.
- Key factors affecting overall survival included time to castration-resistant prostate cancer (CRPC), prostate-specific antigen (PSA) levels at treatment initiation, and Geriatric Nutritional Risk Index (GNRI), helping to categorize patients into three prognostic groups with significantly different outcomes.
Article Synopsis
- Immune checkpoint inhibitor (ICI) combination therapies are standard treatments for metastatic renal cell carcinoma (mRCC), but there are limited comparative studies using real-world data to assess their effectiveness.
- The study analyzed records from 320 clear cell RCC patients to compare outcomes between those treated with ICI+ICI versus ICI+tyrosine kinase inhibitor (TKI) combinations.
- Results showed that while overall survival was similar for both treatments, the progression-free survival was significantly longer for ICI+TKI, and patients on ICI+ICI had a higher rate of progressive disease, although treatment-related side effects varied between the two groups.
Objectives: The optimal indication and survival benefits of prophylactic urethrectomy (PU) during radical cystectomy remain unclear. Therefore, this study aims to evaluate the impact of urethra-preserving surgery (UPS) on oncological outcome including its recurrence patterns, and to establish an optimal urethral management strategy with a novel UPS technique in the robotic era.
Patients And Methods: We retrospectively analyzed 281 male patients with bladder cancer who received radical cystectomy (RC) (115 with and 166 without PU) at our institutions between 2010 and 2023.
Background: Recently, various novel robotic systems have been put into clinical use. The aim of the present study was to assess the perioperative outcomes of robot-assisted radical prostatectomy (RARP) using the Hugo™ RAS system, one of brand-new robot-assisted surgical platforms.
Methods: We performed RARP with the Hugo™ RAS system in 13 cases of localized prostate cancer (PCa) between August 2023 and February 2024 at our hospital.
Background: Enfortumab vedotin (EV), an antibody-drug conjugate that targets Nectin-4, is used for patients with metastatic urothelial carcinoma who have experienced progression on platinum-based chemotherapy and checkpoint inhibitors. Despite the widespread use of the drug, evidence remains scarce regarding clinical indicators that can predict the response to EV treatment.
Objective: We aimed to explore the predictive value of clinical indicators derived from peripheral blood tests for treatment responses to EV.
Article Synopsis
- The study aimed to compare the outcomes of metastatic castration-sensitive prostate cancer patients receiving standard androgen deprivation therapy (ADT) versus those receiving ADT combined with a new androgen-receptor signaling inhibitor (ARSI) in Japan.
- A retrospective analysis of 581 patients revealed that those on the combination therapy had longer prostate-specific antigen-progression-free survival (PSA-PFS), especially among high-risk patients, although overall survival rates were similar between both groups.
- Key factors like high Gleason score and certain blood marker levels indicated worse PSA-PFS outcomes, allowing researchers to categorize patients into risk groups based on these predictors.
Article Synopsis
- Postoperative pneumonia is uncommon but can occur, as demonstrated by a 71-year-old man who developed it after prostate surgery.
- He experienced chills and a high fever five days post-surgery, with chest imaging confirming pneumonia and leading to the start of antibiotic treatment.
- As his condition progressed, blood tests indicated further complications, and he was given additional antibiotics, ultimately leading to an improved recovery.
Background: Chemotherapy-induced thrombocytopenia is often a use-limiting adverse reaction to gemcitabine and cisplatin (GC) combination chemotherapy, reducing therapeutic intensity, and, in some cases, requiring platelet transfusion.
Objective: A retrospective cohort study was conducted on patients with urothelial cancer at the initiation of GC combination therapy and the objective was to develop a prediction model for the incidence of severe thrombocytopenia using machine learning.
Methods: We performed receiver operating characteristic analysis to determine the cut-off values of the associated factors.
Aim: The aim of the third Asia-Pacific Advanced Prostate Cancer Consensus Conference (APAC APCCC 2023) was to discuss the application in the Asia-Pacific (APAC) region of consensus statements from the 4th Advanced Prostate Cancer Consensus Conference (APCCC 2022).
Methods: The one-day meeting in July 2023 brought together 27 experts from 14 APAC countries. The meeting covered five topics: (1) Intermediate- and high-risk and locally advanced prostate cancer; (2) Management of newly diagnosed metastatic hormone-sensitive prostate cancer; (3) Management of non-metastatic castration-resistant prostate cancer; (4) Homologous recombination repair mutation testing; (5) Management of metastatic castration-resistant prostate cancer.
Article Synopsis
- Enfortumab vedotin (EV) is an antibody-drug conjugate used for treating metastatic urothelial carcinoma (UC) in patients who previously underwent immune checkpoint inhibitor (ICI) treatment, specifically avelumab or pembrolizumab.
- A study involving 100 patients revealed that while progression-free survival (PFS) was better for those treated with EV after avelumab, overall survival (OS) rates were not significantly different between the two treatment groups.
- Key prognostic factors affecting outcomes included histological variants, liver metastasis, low serum albumin, and high serum CRP levels, with cachexia patients experiencing particularly poor prognosis.
Article Synopsis
- - Enfortumab vedotin (EV) is an antibody-drug conjugate used for patients with metastatic urothelial carcinoma (mUC) who have progressed on checkpoint inhibitors (CPIs); however, there's limited evidence comparing EV directly with re-challenging chemotherapy in real-world settings.
- - In a study of 350 mUC patients, those treated with EV showed an objective response rate (ORR) of 48% and a median overall survival (OS) of 29 months, compared to 14 months for re-challenging chemotherapy and 8 months for continuing CPIs beyond progression.
- - While there was no significant difference in overall survival or progression-free survival between EV and re-challenging chemotherapy, the duration
Article Synopsis
- * Results showed that the ERAS protocol significantly shortened hospital stays, improved bowel recovery, and reduced POI in non-frail patients, but it did not have the same benefits for frail patients.
- * The findings suggest that while ERAS is effective for non-frail patients, frail patients might require additional strategies, like prehabilitation, to better manage POI post-surgery.
Background: Recently, robot-assisted surgery has been widely used to treat several urological cancers. Robot-assisted radical nephrectomy (RARN) was approved by the health insurance system in April 2022; however, RARN with inferior vena cava tumor thrombectomy (IVCTT) is still challenging. Also, its safety and feasibility have not yet been established owing to lack of literature, especially in Japan.
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- The study aimed to assess the safety and effectiveness of robot-assisted radical cystectomy with an intracorporeal ileal conduit in older patients (≥75 years) compared to younger patients (<75 years).
- A total of 122 patients were analyzed, showing no major differences in perioperative outcomes except for a longer hospital stay for older patients (19 days vs. 16 days).
- Despite some complications being more frequent in older patients, there were no significant differences in cancer recurrence or survival rates, suggesting that the procedure is safe and effective for older individuals.
Article Synopsis
- - Bladder cancer (BC) patients can experience shrinkage due to radiation-induced fibrosis, and specific microRNAs (miRNAs) are linked to this injury and overall survival.
- - In a study of three Japanese BC patients, certain miRNAs (such as hsa-miR-130a and hsa-miR-200c) were highly expressed in those with fibrotic bladder shrinkage compared to patients with intact bladder function.
- - Analysis of 409 BC patients revealed that high expression of specific miRNAs correlated with significantly longer median survival, indicating a potential role for these miRNAs in predicting patient outcomes and targeting profibrotic cytokines.
Objectives: To explore the characteristics of patients and assess the effectiveness of enfortumab vedotin (EV) in those with treatment-resistant advanced urothelial cancer in a real-world setting.
Patients And Methods: A multicenter observational study was conducted on 103 evaluable patients with advanced urothelial cancer who received EV. Outcomes were assessed by radiographic response, progression-free survival (PFS), and overall survival (OS), with treatment-related adverse events (trAEs).
Article Synopsis
- Malnutrition impacts cancer prognosis, and the Geriatric Nutritional Risk Index (GNRI) is used as a screening tool to assess nutrition in cancer patients.
- A study involving 175 patients with high-risk metastatic hormone-sensitive prostate cancer (mHSPC) revealed that those classified with a low GNRI had significantly worse overall survival than those with a high GNRI.
- The findings suggest that GNRI can serve as a practical prognostic indicator for evaluating survival outcomes in patients undergoing treatment for high-risk mHSPC.
Article Synopsis
- There is currently limited understanding of how alterations in fibroblast growth factor receptor 3 (FGFR3) affect bladder cancer (BLCA) and its tumor microenvironment (TME).
- A study involving multi-omics analysis of BLCA tissues showed that aFGFR3 alterations are found in 44% of non-muscle invasive cases and 15% of muscle-invasive cases, affecting their immune response and tumor characteristics.
- Notably, the LumP subtype in aFGFR3 cases responded significantly better to checkpoint inhibitors compared to their intact FGFR3 counterparts, suggesting that FGFR3 status influences treatment outcomes in bladder cancer.