Department of Urology

Hiroyuki Fujimoto, Motokiyo Komiyama, Yoshiyuki Matsui, Tomohiko Hara, Yasuo Shinoda, Aiko Maejima, Yuta Toyoshima

Introduction

In the Department of Urology, all urogenital malignant diseases, including kidney cancer, urothelial cancer, prostate cancer, testicular germ cell tumors, and retroperitoneal sarcomas, are the subject of diagnosis and treatment with comprehensive approaches, including radical surgery, irradiation, and chemotherapy.

Our team and what we do

The urology team consists of six staff physicians, one chief-resident, and one resident. In addition, with the participation of a radiation oncologist, multi-disciplinary treatments for advanced disease including renal cancer, urothelial cancer, hormone-refractory prostate cancer, and metastatic germ cell tumors are performed. Every morning clinical rounds are started at 7:30 a.m., and a weekly conference to discuss inpatient management is held on Monday evenings.

Major urological malignant diseases are treated according to the following strategies:

1)Renal cell carcinoma: M0, partial or radical nephrectomy; M1: chemotherapy with target drugs with TKI or mTOR with or without palliative nephrectomy. A selected small size (less than 3 cm) tumor: cyrothearpy

2)Bladder cancer. Carcinoma in situ: BCG instillation therapy. Ta, T1, transurethral resection of bladder cancer (TURBT), often combined with preoperative or postoperative BCG instillation. T2-T4, radical cystectomy with neoadjuvant chemotherapy by an M-VAC/GC regimen. N+, systemic chemotherapy, radiation; sometimes urinary diversion alone. M+,chemotherapy with a M-VAC or GC regimen.

3)Prostate cancer. Organ-confined disease, active surveillance, robotic-assisted or open radical prostatectomy, irradiation, or endocrine therapy. Specimen-confined disease, extended radical prostatectomy without neoadjuvant endocrine therapy, radiation therapy with endocrine therapy, or endocrine therapy alone. For high risk prostate cancer, extended pelvic lymph node dissection by robotic. M1 disease, endocrine therapy and palliative radiation if necessary. For castration refractory disease, docetaxel or cabazitaxel chemotherapy is indicated.

4)Testicular germ cell tumor (GCT):Stage I, careful observation regardless of a pathological element. Stage II or higher, EP (etoposide + CDDP) or BEP (BLM + etoposide + CDDP) chemotherapy as the 1st line. In nonseminomatous cases, a salvage operation is performed after induction chemotherapy. In seminoma cases, careful observation rather than surgery is selected.

Research activities

We are constantly seeking ways to improve the treatment for malignant urological tumors.

1)Urothelial cancer: The effectiveness of a phase III study to confirm the efficacy of BCG instillation for high grade T1 bladder cancer (JCOG 1019) is ongoing. For metastatic disease, a weekly CBDCA + PTX regimen has been indicated.

2)Prostate cancer: A phase II study to evaluate the efficacy of robotic assisted laparoscopic radical prostatectomy for T1c-T3a prostate cancer is ongoing. A new operative method to achieve a complete surgical margin (extended radical prostatectomy) has been developed, and its efficacy in patients with specimen-confined disease has been evaluated without neoadjuvant endocrine therapy. This method was introduced in robotic assisted laparoscopic radical prostatectomy with extended lymph node dissection. To provide a more precise preoperative diagnosis, a new imaging strategy using 3.0 Tesla MRI has been developed.

3)Testicular germ cell tumors: Advanced and/or refractory cases: A so-called "desperate operation", which was designed for patients whose tumor markers do not normalize after induction chemotherapy, has been shown to be both efficacious and of clinical significance. For CDDP-refractory germ cell tumors, a second line TIP/TIN regimen has completed enrollment.

Clinical trials

We are actively involved in the following mainly ongoing protocol studies;

1)A phase III study: BCG instillation for high grade T1 bladder cancer (JCOG 1019)

2)A phase III study : A single early intravesical instillation of pirarubicin in the prevention of bladder recurrence after radical nephroureterectomy for upper tract urothelial carcinoma (JCOG 1403)

3)A phase III study: Anti PD-L1 antibody(ATEZOLIZUMAB) for muscle invasive bladder cancer

4)A phase II study: Robotic assisted laparoscopic prostatectomy for intermediate or high risk prostate cancer

Table 1. Patients stastistics: Major treatment

List of papers published in 2016

Journal

1.Suzuki H, Inoue Y, Fujimoto H, Yonese J, Tanabe K, Fukasawa S, Inoue T, Saito S, Ueno M, Otaka A. Diagnostic performance and safety of NMK36 (trans-1-amino-3-[18F]fluorocyclobutanecarboxylic acid)-PET/CT in primary prostate cancer: multicenter Phase IIb clinical trial. Jpn J Clin Oncol, 46:152-162, 2016

2.Inokuchi J, Naito S, Fujimoto H, Hara T, Sakura M, Nishiyama H, Miyazaki J, Kikuchi E, Hinotsu S, Koie T, Ohyama C. Impact of multimodal treatment on prognosis for patients with metastatic upper urinary tract urothelial cancer: Subanalysis of the multi-institutional nationwide case series study of the Japanese Urological Association. Int J Urol, 23:224-230, 2016

3.Miyazaki J, Nishiyama H, Fujimoto H, Ohyama C, Koie T, Hinotsu S, Kikuchi E, Sakura M, Inokuchi J, Hara T. Laparoscopic Versus Open Nephroureterectomy in Muscle-Invasive Upper Tract Urothelial Carcinoma: Subanalysis of the Multi-Institutional National Database of the Japanese Urological Association. J Endourol, 30:520-525, 2016

4.Koie T, Ohyama C, Fujimoto H, Nishiyama H, Miyazaki J, Hinotsu S, Kikuchi E, Sakura M, Inokuchi J, Hara T, Fujisawa M, Uemura H, Suzuki K, Eto M, Hara I, Matsubara A, Nonomura N, Nakanishi H, Kanayama H, Miki T, Fukumori T, Naito S. Diversity in treatment modalities of Stage II/III urothelial cancer in Japan: sub-analysis of the multi-institutional national database of the Japanese Urological Association. Jpn J Clin Oncol, 46:468-474, 2016

5.Yoshimura K, Minami T, Nozawa M, Kimura T, Egawa S, Fujimoto H, Yamada A, Itoh K, Uemura H. A Phase 2 Randomized Controlled Trial of Personalized Peptide Vaccine Immunotherapy with Low-dose Dexamethasone Versus Dexamethasone Alone in Chemotherapy-naive Castration-resistant Prostate Cancer. Eur Urol, 70:35-41, 2016