Publications by authors named "Wataru Fukuokaya"
Background: Despite the availability of advanced imaging technologies, it remains difficult to achieve sufficient staging accuracy to ensure a tailored treatment strategy for patients with upper tract urothelial carcinoma (UTUC). The aim of the study was to identify preoperative risk factors for tumor upstaging in patients with UTUC initially staged as clinical T2 or lower and to analyze these factors separately for renal pelvic cancer and ureteral cancer.
Methods: This retrospective study included data from patients with UTUC who underwent nephroureterectomy.
Ten-Year Outcomes of a Phase 3, Multicenter, Randomized Controlled Trial (SHIP0804) With 3-Month Neoadjuvant Androgen Deprivation Prior to I-Seed Transperineal Prostate Brachytherapy Followed by Nil Versus 9-Month Adjuvant Hormonal Therapy in Patients With Intermediate-Risk Prostate Cancer.
Int J Radiat Oncol Biol Phys
November 2024
Purpose: To analyze the effects of adjuvant hormonal therapy (AHT) on time to event after neoadjuvant androgen deprivation therapy (ADT) and I-transperineal prostate brachytherapy (TPPB), compared with neoadjuvant ADT and TPPB only, in patients with intermediate-risk prostate cancer (IRPC).
Methods And Materials: In this multicenter, open-label, phase 3 randomized controlled trial (SHIP0804), 421 patients with IRPC were randomly assigned to either 9-month AHT (AHT arm) or no AHT (non-AHT arm) after 3 months of neoadjuvant ADT and TPPB. The primary endpoint was biochemical progression-free survival, and secondary endpoints included overall survival and clinical progression-free survival.
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 PDFObjective: We determined the optimal timing for initiating androgen receptor signaling inhibitor (ARSI) therapy in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) and assessed its impact on oncological outcomes.
Materials And Methods: This retrospective study included 145 nmCRPC patients who received enzalutamide, apalutamide or darolutamide at the Jikei University Hospital or its affiliated institutions between May 2014 and November 2022. Patients were stratified based on prostate-specific antigen (PSA) doubling time (PSADT) at CRPC diagnosis and PSA levels at ARSI initiation.
Article Synopsis
- The study evaluated the effectiveness and safety of three androgen receptor pathway inhibitors (ARPI) — abiraterone, enzalutamide, and apalutamide — in treating patients with metastatic hormone-sensitive prostate cancer in a real-world setting.
- Records of 668 high-risk patients treated with these drugs were analyzed, comparing prostate-specific antigen (PSA) responses, overall survival, and the incidence of adverse events.
- Results showed no significant differences in overall survival or cancer-specific survival among the three drugs, although abiraterone demonstrated a higher rate of achieving a 99% PSA decline, and enzalutamide had the lowest treatment discontinuation rates.
Article Synopsis
- Androgen receptor signaling inhibitors (ARSIs) have significantly improved the treatment of metastatic castration-sensitive prostate cancer (mCSPC) by influencing prostate-specific antigen (PSA) dynamics, which are critical for assessing disease control.
- A retrospective study involving 552 mCSPC patients was conducted to analyze the impact of PSA nadir, PSA response rate, and time to PSA nadir on oncological outcomes like cancer-specific survival and overall survival.
- Results indicated that achieving a low PSA nadir (≤ 0.02 ng/mL) and a high PSA response rate (≥ 99%) were strong independent predictors of better clinical outcomes, underscoring the importance of monitoring PSA dynamics in patient treatment.
Article Synopsis
- This study looked at women with bladder cancer who had surgery to remove their bladder and other reproductive organs to see how many still had problems with their reproductive organs.
- Out of 417 women, some had their uterus and vaginal wall saved, but about 9% showed signs of cancer in their reproductive areas.
- The researchers concluded that doctors need to think carefully about whether to save these organs during surgery because there's a risk that cancer could still affect them.
Background: 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 PDFArticle Synopsis
- - This study aimed to create a prognostic model to estimate the risk of cancer-specific mortality in bladder cancer patients after radical cystectomy (RC), using data from 36 institutions in Japan.
- - Researchers analyzed patient data without adjuvant chemotherapy, splitting it into training and validation sets, and used a multivariable Cox regression model to predict outcomes based on 25 variables.
- - The final model, which included eight key variables, outperformed the existing CheckMate 274 classification, correctly reclassifying a significant portion of high-risk patients into a better prognosis group, enhancing potential treatment decisions.
Background: 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 PDFPurpose We recently released the multi-institutional real-world analysis about the difference in survival outcomes between abiraterone acetate and enzalutamide against chemo-naïve castration-resistant prostate cancer (CRPC) in a first-line setting. Although reduced dose induction cases were included in that analysis, induction dose reduction might correlate with reduced efficacy. In this study, we analyzed full-dose induction subgroups from our overall cohort and investigated the true difference in efficacy between these agents.
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- 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.
Article Synopsis
- - A study investigated the treatment outcomes for patients with metastatic hormone-sensitive prostate cancer (mHSPC) after the approval of upfront androgen receptor signaling inhibitors (ARSIs) from 2018 to 2023.
- - Researchers analyzed data from 829 patients, finding that those treated with ARSIs alongside hormone therapy had better survival times and lower rates of resistance compared to those on combined hormone blockade (CAB).
- - Despite fewer serious side effects with CAB, the study suggests that ARSIs with hormone therapy should be the preferred first-line treatment due to their improved oncological outcomes.
Purpose: Although docetaxel and ARSI are picked up as treatment options against chemo-naïve metastatic CRPC in clinical guidelines for prostate cancer, there is no clear evidence which agent should be introduced as first line treatment. Therefore, we investigated our CRPC cohort treated with docetaxel or ARSI as first-line agent against chemo-naïve CRPC to solve these clinical questions.
Patients And Methods: A total of 345 chemotherapy-naïve CRPC patients introduced to first-line docetaxel or ARSI (abiraterone or enzalutamide) between March 2006 and April 2017 at Jikei University Hospital and its affiliated institutions were included in this study.
Objectives: To determine the effects of prophylactic urethrectomy (PU) on oncological and perioperative outcomes in patients with bladder cancer (BC) undergoing radical cystectomy (RC).
Methods: This retrospective study analyzed data on 1976 evaluable patients with BC who underwent RC. Patients were drawn from 36 institutions within the Japanese Urological Oncology Group.
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
- - A study analyzed the effectiveness of two drugs, enzalutamide and apalutamide, in treating patients with non-metastatic castration-resistant prostate cancer (nmCRPC) to understand their efficacy and adverse event (AE) profiles.
- - The research involved 191 patients, revealing that both drugs led to similar oncological outcomes, with comparable PSA response rates and no significant differences in progression-free survival (PFS) or overall survival (OS).
- - However, the side effects varied, with enzalutamide causing more fatigue and apalutamide leading to more skin rashes, indicating their differential usage may depend on AE profiles despite similar efficacy.
Background: The effect of radical nephroureterectomy (RNUx) on postoperative renal function in patients diagnosed with upper tract urothelial carcinoma (UTUC) has not been thoroughly explored.
Methods: We conducted a retrospective analysis including 785 patients who underwent RNUx for UTUC. We assessed the preoperative and postoperative estimated glomerular filtration rates (eGFRs) and factors related to the decline in eGFR.
Article Synopsis
- In the context of metastatic castration-sensitive prostate cancer (mCSPC) treated with androgen deprivation therapy, the study aimed to clarify the relationship between prostate-specific antigen (PSA) progression and radiographic progression during apalutamide treatment.
- The analysis of data from the TITAN trial revealed that 52.2% of patients receiving apalutamide experienced radiographic progression without prior PSA changes, indicating a significant difference compared to the placebo group (27.5%).
- The findings suggest that relying solely on PSA levels may not effectively assess disease progression in mCSPC, highlighting the need for broader evaluation methods in clinical practice.
Background/aim: Evidence suggests that serum magnesium levels are associated with outcomes of immune checkpoint inhibitors (ICIs). However, this association remains under-explored in patients with metastatic urothelial carcinoma (UC) treated with ICIs.
Patients And Methods: This prognostic study used individual participant-level data from 1,281 patients with locally advanced or metastatic UC treated with atezolizumab (N=855) or chemotherapy (N=426) who participated in the IMvigor210 and the IMvigor211 trials.
Article Synopsis
- This study focuses on the importance of radiographic assessment when diagnosing castration-resistant prostate cancer (CRPC) and its implications for patient prognosis.* -
- Researchers analyzed data from 98 men to identify changes in metastasis between the diagnosis of metastatic hormone-sensitive prostate cancer (mHSPC) and CRPC, finding significant survival differences based on radiographic progression.* -
- Results indicated that patients with radiographic progression (rPD) had a median overall survival of 32 months post-CRPC, significantly shorter than those without progression, emphasizing the need for such assessments in treatment decisions.*
Background: The CheckMate274 trial has reported enhanced disease-free survival rates in patients with stage pT3-4/ypT2-4 or pN+ urothelial carcinoma (UC) undergoing adjuvant nivolumab therapy. This study compares prognostic differences between urothelial carcinoma of the bladder (UCB) and upper tract urothelial carcinoma (UTUC).
Methods: We retrospectively analyzed data from 719 patients with UC who underwent radical surgery, stratifying to patients at stage pT3-4 and/or pN+ without neoadjuvant chemotherapy (NAC) or at ypT2-4 and/or ypN+ with NAC (potential candidates for adjuvant immunotherapy), and to those who were not candidates for adjuvant immunotherapy.
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.