Nephrogenic diabetes insipidus (DI) secondary to chronic urinary tract obstruction is a rare disease. The exact cause is unknown but it is likely that increased collecting duct pressures cause damage to the tubular epithelium, resulting in insensitivity to the action of arginine-vasopressin (AVP). A 77-year-old man complaining of polyuria and polydipsia was treated with alpha glucosidase inhibitor under the impression of polyuria due to diabetes mellitus. But his symptoms did not improve. Water deprivation and AVP administration study revealed that the patient had nephrogenic DI. Urinary tract obstruction due to an enlarged prostate was suggested as a principal cause of nephrogenic DI. The patient underwent transurethral resection of the prostate and bilateral subcapsular orchiectomy. After surgery, the urine osmolarity was normalized and the patient became symptom-free. We report a case of nephrogenic DI due to obstructive uropathy which was cured by surgery eliminating obstruction.
Adenocarcinoma/ultrasonography ; Adenocarcinoma/radionuclide imaging ; Adenocarcinoma/pathology ; Adenocarcinoma/complications* ; Aged ; Case Report ; Constriction, Pathologic/etiology ; Diabetes Insipidus, Nephrogenic/etiology* ; Human ; Male ; Prostatic Neoplasms/ultrasonography ; Prostatic Neoplasms/radionuclide imaging ; Prostatic Neoplasms/pathology ; Prostatic Neoplasms/complications* ; Urologic Diseases/etiology*

Patient with osseous metastatic prostatic cancer can clinically be detected by bone scanning, which usually is sensitive and qualitative but is not specific and quantitative. For quantitative evaluation of skeletal lesions, we measured bone mineral density (BMD) in whole body, total spine and lumbar spine. All patients also were assessed with bone radiography, radionuclide bone scan, prostate specific antigen (PSA), and prostatic acid phosphatase (PAP). We compared mainly bone scan and BMD in monitoring tumor response between before hormonal treatment and 6 month after hormonal treatment. Fifteen patients with stage D2 prostate cancer and 25 controls were entered in this study. Of 8 patients whose scan showed response in 12 patients with metastatic lumbar spine lesion, they had either 7 responded or 1 unchanged BMD level in the lumbar spine. Of 9 patients whose scan showed response in 15 patients with metastatic total spine lesion, they had either 6 responded or 3 unchanged BMD level in the total spine. The alterations of BMD levels in total spine and lumbar spine closely correlated with the therapeutic responses assessed by the National Prostatic Cancer Project Criteria of bone scintigraphy in patients with prostatic cancer (spine: r=0.04, p<0.05; lumbar: r=0.1, p<0.05). In contrast, BMD changes in whole body (response rate: 20.0%, P<0.05) was less than that in total spin (response rate: 53.3%, P<0.01) and lumbar spine (response rate: 58.3%, P<0.01). In conclusion, when compare BMD to the hot spot region in bone scan, BMD may be helpful to the urologist for the accuracy of the staging and evaluation of the treatment response to androgen deprivation therapy in metastatic prostate cancer.
Acid Phosphatase ; Bone Density ; Densitometry* ; Evaluation Studies as Topic ; Humans ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Radiography ; Radionuclide Imaging ; Spine

Radical prostatectomy, external irradiation, and brachytherapy are currently available for the cure of early localized prostatic cancer. This report documents the first successful Iodine-125 seeds implant treatment of early prostatic cancer in Korea. Patient was 70-year-old man with mild urinary urgency and nocturia. Serum PSA (prostate specific antigen) was 6.51ng/ml. Transrectal ultrasonography showed a small, roundish, low echogenic lesion measuring 8mm in diameter in the left lower peripheral zone of the prostate. The volume of prostate was 27cc and biopsy revealed adenocarcinoma (Gleason score 7). MRI confirmed the presence of a small nodular lesion in the left peripheral zone without evidence of local invasion, and bone scintigraphy was unremarkable. The tumor was staged as T2a. We performed permanent implantation of Iodine-125 seeds using Mick procedure. The patient experienced immediate post-implant irritation of the bladder and urethra with hematuria. Follow up CT and radiography showed all seeds were remained in the same prostate as implanted. Follow up serum PSA was 1.85ng/ml at 3 months and 0.62ng/ml at 9 months after the procedure.
Adenocarcinoma ; Aged ; Biopsy ; Brachytherapy ; Follow-Up Studies ; Hematuria ; Humans ; Korea* ; Magnetic Resonance Imaging ; Nocturia ; Prostate ; Prostatectomy ; Prostatic Neoplasms* ; Radiography ; Radionuclide Imaging ; Ultrasonography ; Urethra ; Urinary Bladder

OBJECTIVETo investigate the indication of bone scan for patients with newly diagnosed prostate cancer.

METHODSThe clinical data of continual 95 patients with newly diagnosed prostate cancer was involved between January 2006 and December 2010. The relationship between age, PSA, Gleason scores, clinical stage and positive bone scans was respectively compared.

RESULTSThe 33 patients (34.7%) with positive bone scans and 62 patients (65.3%) with negative bone scans. The mean age was (74±7) years and (76±7) years respectively in 2 groups respectively. PSA was (70.7±38.1) ng/ml and (28.4±27.2) ng/ml respectively, the difference was significant (t=-5.499, P=0.000). Clinical stage had positive correlation with positive bone scan, the OR value was 4.684. If the Gleason score>7, the sensitivity, specificity, positive predictive value and negative predictive value of positive bone scan was 64%, 63%, 48% and 77% respectively. If PSA>50 ng/ml, sensitivity, specificity, positive predictive value and negative predictive value was 67%, 86%, 71% and 83% respectively. If Clinical stage>T2, sensitivity, specificity, positive predictive value and negative predictive value was 82%, 81%, 69% and 89% respectively.

CONCLUSIONSFor patients with PSA≤10 ng/ml or simultaneously PSA≤50 ng/ml and Gleason score≤7 and clinical stage≤T2, bone scan is not necessary. Patients with newly diagnosed prostate cancer and PSA>50 ng/ml or Gleason score>7 or clinical stage>T2 should undergo bone scan.

Aged ; Aged, 80 and over ; Bone Neoplasms ; diagnostic imaging ; secondary ; Bone and Bones ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prostatic Neoplasms ; diagnostic imaging ; pathology ; Radionuclide Imaging ; Retrospective Studies ; Sensitivity and Specificity

AIMSTo determine when a bone scan investigation is appropriate in asymptomatic men diagnosed with prostate cancer.

METHODSBetween November 2005 and July 2006, 317 men with prostate cancer underwent a bone scan study; 176 men fulfilled the inclusion criteria. Prostate-specific antigen (PSA) cut-offs as well as univariate and multivariate logistic regression analyses using digital rectal examination finding, biopsy Gleason scores and age were performed to determine when a bone scan study is likely to be of value.

RESULTSOnly 1/61 men (1.6%) with a serum PSA 20 ng/mL had a positive bone scan. However, 2/38 men (4.7%) with a serum PSA 20.1-40.0 ng/mL, 3/20 men (15%) with a serum PSA 40.1-60.0 ng/mL, 7/19 men (36.8%) with a serum PSA 60.1-100.0 ng/mL and 19/38 men (50%) with a serum PSA > 100.0 ng/mL had positive bone scans. Univariate and multivariate logistic regression analyses were uninformative in these groups.

CONCLUSIONBased on our findings, a bone scan is of limited value in asymptomatic prostate cancer patients presenting PSA =or< 20 ng/mL. Therefore, this investigation can be eliminated unless a curative treatment is contemplated. Furthermore, digital rectal examination finding, biopsy Gleason score and age are unhelpful in predicting those who might harbor bone metastasis.

Aged ; Aged, 80 and over ; Analysis of Variance ; Bone Neoplasms ; diagnostic imaging ; secondary ; Bone and Bones ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prostate-Specific Antigen ; analysis ; Prostatic Neoplasms ; diagnostic imaging ; pathology ; Radionuclide Imaging ; Radiopharmaceuticals ; Retrospective Studies ; Technetium Tc 99m Medronate

OBJECTIVETo investigate the relation of serum prostate-specific antigen (PSA) and alkaline phosphatase (ALP) levels to bone metastases in patients with prostate cancer.

METHODSWe made a retrospective study of 96 cases of prostate cancer with (29 cases ) and without (67 cases ) bone metastases and evaluated their initial levels of serum PSA and ALP as well as the radionuclide bone scan findings.

RESULTSThe median concentrations of serum PSA and ALP were both in the bone scan-positive patients statistically higher than in those the negative ones (P < 0.01). The percentages of the bone scan-positive patients with PSA > 20 microg/L or ALP > 90 U/L were also higher than those with PSA < 20 microg/L or ALP < 90 U/L (P < 0.01).

CONCLUSIONProstate cancer patients with bone metastases have higher levels of PSA and ALP than those without. Radionuclide bone scan is necessary when the serum PSA level is > 20 microg/L and/or ALP level > 90 U/L.

Aged ; Aged, 80 and over ; Alkaline Phosphatase ; blood ; Biomarkers, Tumor ; blood ; Bone Neoplasms ; diagnostic imaging ; secondary ; Humans ; Male ; Middle Aged ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; blood ; pathology ; Radionuclide Imaging ; Retrospective Studies ; Sensitivity and Specificity

OBJECTIVETo evaluate the therapeutic effects of strontium-89 on osseous metastases of prostate cancer by bone scanning and bone alkaline phosphatase (B-AKP) measurement.

METHODSOne week before and within 6 months after strontium-89 therapy, bone scanning and B-AKP measurement were performed in 73 patients with bone metastases of prostate cancer. 1. According to the number of osseous lesions on bone imaging, the patients were divided into Grade 0, 1, 2 and 3, and the numbers of bone lesions before and after therapy were compared by t-test. 2. Tumor to non-tumor ratios(T/NT) before and after treatment were calculated and compared. 3. Changes in B-AKP before and after therapy were compared.

RESULTS1. Among the 73 patients, bone scanning revealed 618 bone lesions, averaging 8.6 +/- 7.4 before treatment. The number decreased to 349, averaging 3.8 +/- 6.7 after treatment, which showed a significant reduction (t = 4.079, P < 0.01). 2. After therapy, T/NT of bone lesions decreased significantly (t = 7.907, P < 0.01) from 5.36 +/- 4.67 to 3.17 +/- 2.95. 3. B-AKP decreased significantly (t = 3.349, P < 0.002) from (28.4 +/- 14.8) microgram/L to (20.9 +/- 11.7) microgram/L. 4. By bone scanning combined with B-AKP measurement, 5 false positive cases and 6 false negative cases were corrected.

CONCLUSIONThere is certain complementarity between bone scanning and B-AKP measurement, and they should be used in a combined way to achieve accurate evaluation of the therapeutic effects of strontium-89.

Aged ; Alkaline Phosphatase ; analysis ; Bone Neoplasms ; enzymology ; radiotherapy ; secondary ; Bone and Bones ; diagnostic imaging ; enzymology ; Humans ; Male ; Middle Aged ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; radiotherapy ; Radionuclide Imaging ; Strontium ; therapeutic use

PURPOSE: To evaluate the oncologic outcomes and postoperative complications of high-intensity focused ultrasound (HIFU) as a salvage therapy after external-beam radiotherapy (EBRT) failure in patients with prostate cancer. MATERIALS AND METHODS: Between February 2002 and August 2010, we retrospectively reviewed the medical records of all patients who underwent salvage HIFU for transrectal ultrasound-guided, biopsy-proven locally recurred prostate cancer after EBRT failure (by ASTRO definition: prostate-specific antigen [PSA] failure after three consecutive PSA increases after a nadir, with the date of failure as the point halfway between the nadir date and the first increase or any increase great enough to provoke initiation of therapy). All patients underwent prostate magnetic resonance imaging and bone scintigraphy and had no evidence of distant metastasis. Biochemical recurrence (BCR) was defined according to the Stuttgart definition (PSA nadir plus 1.2 ng/mL). RESULTS: A total of 13 patients with a median age of 68 years (range, 60-76 years) were included. The median pre-EBRT PSA was 21.12 ng/mL, the pre-HIFU PSA was 4.63 ng/mL, and the period of salvage HIFU after EBRT was 32.7 months. The median follow-up after salvage HIFU was 44.5 months. The overall BCR-free rate was 53.8%. In the univariate analysis, predictive factors for BCR after salvage HIFU were higher pre-EBRT PSA (p=0.037), pre-HIFU PSA (p=0.015), and short time to nadir (p=0.036). In the multivariate analysis, there were no significant predictive factors for BCR. The complication rate requiring intervention was 38.5%. CONCLUSIONS: Salvage HIFU for prostate cancer provides effective oncologic outcomes for local recurrence after EBRT failure. However, salvage HIFU had a relatively high rate of complications.
Follow-Up Studies ; High-Intensity Focused Ultrasound Ablation ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis ; Postoperative Complications ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Radionuclide Imaging ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Salvage Therapy* ; Ultrasonography*

Radioiodide uptake in thyroid follicular epithelial cells, mediated by a plasma membrane transporter, sodium iodide symporter (NIS), provides a first step mechanism for thyroid cancer detection by radioiodide injection and effective radioiodide treatment for patients with invasive, recurrent, and/or metastatic thyroid cancers after total thyroidectomy. NIS gene transfer to tumor cells may significantly and specifically enhance internal radioactive accumulation of tumors following radioiodide administration, and result in better tumor control. NIS gene transfers have been successfully performed in a variety of tumor animal models by either plasmid-mediated transfection or virus (adenovirus or retrovirus) -mediated gene delivery. These animal models include nude mice xenografted with human melanoma, glioma, breast cancer or prostate cancer, rats with subcutaneous thyroid tumor implantation, as well as the rat intracranial glioma model. In these animal models, non-invasive imaging of in vivo tumors by gamma camera scintigraphy after radioiodide or technetium injection has been performed successfully, suggesting that the NIS can serve as an imaging reporter gene for gene therapy trials. In addition, the tumor killing effects of I-131, ReO4-188 and At-211 after NIS gene transfer have been demonstrated in in vitro clonogenic assays and in vivo radioiodide therapy studies, suggesting that NIS gene can also serve as a therapeutic agent when combined with radioiodide injection. Better NIS-mediated imaging and tumor treatment by radioiodide requires a more efficient and specific system of gene delivery with better retention of radioiodide in tumor. Results thus far are, however, promising, and suggest that NIS gene transfer followed by radioiodide treatment will allow non-invasive in vivo imaging to assess the outcome of gene therapy and provide a therapeutic strategy for a variety of human diseases.
Animals ; Breast Neoplasms ; Cell Membrane ; Epithelial Cells ; Gamma Cameras ; Genes, Reporter ; Genetic Therapy ; Glioma ; Heterografts ; Homicide ; Humans ; Ion Transport* ; Melanoma ; Mice ; Mice, Nude ; Models, Animal ; Molecular Imaging* ; Prostatic Neoplasms ; Radionuclide Imaging ; Rats ; Sodium Iodide* ; Sodium* ; Technetium ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Transfection