Ryoichi Imamura

Introduction: Primary prostatic lymphoma is rare and may mimic prostate cancer clinically and radiologically. Case Presentation: A 66‐year‐old man was referred for evaluation of suspected advanced prostate cancer. Despite a normal prostate‐specific antigen level of 0.573 ng/mL, imaging revealed a prostatic mass with suspected bladder invasion and bilateral hydronephrosis. Prostate needle biopsy showed atypical lymphocytic infiltration but could not distinguish lymphoma from inflammatory changes. Additional transurethral biopsy provided sufficient tissue for histopathological and immunohistochemical evaluation, establishing a diagnosis of primary prostatic diffuse large B‐cell lymphoma. Conclusion: Primary prostatic lymphoma should be considered when clinical and imaging findings suggest prostate cancer despite a normal prostate‐specific antigen level. Additional tissue sampling should be considered when needle biopsy is inconclusive despite persistent clinical suspicion of lymphoma.

Objectives: To compare differences in clinical outcomes between dual immune checkpoint blockade and immunotherapy plus tyrosine kinase inhibitors (TKIs) as first‐line treatment for metastatic renal cell carcinoma in routine clinical practice. Patients and Methods: Retrospective multicenter cohort study including 311 patients with International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) intermediate or poor‐risk metastatic RCC who received first‐line immune checkpoint inhibitor (ICI)‐based combination therapy between 2018 and 2023. Patients were treated with either ICI + ICI or ICI + TKI. Inverse probability of treatment weighting (IPTW) was applied to reduce baseline imbalances. Progression‐free survival (PFS), second progression‐free survival (PFS2), overall survival (OS), objective response rate (ORR), and duration of response (DOR) were analyzed using weighted survival models. Results: After adjustment, ICI + TKI was associated with a trend toward longer PFS compared with ICI + ICI (median 28.7 vs. 16.6 months, HR 0.69, p = 0.050). No significant differences were observed in PFS2 (median 46.6 vs. 35.5 months, HR 0.84, p = 0.436) or OS (median 57.4 vs. 57.0 months, HR 1.01, p = 0.965). ORR (56.5% vs. 52.2%, p = 0.473) and DOR (median 54.6 vs. 44.9 months, HR 0.83, p = 0.502) were comparable. Subgroup analysis suggested more noticeable PFS benefit with ICI + TKI in intermediate‐risk patients and those without central nervous system or bone metastases, whereas OS was similar across all subgroups. The incidence of grade ≥ 3 adverse events was comparable between groups. Conclusion: In this real‐world cohort, TKI‐containing combinations were associated with improved initial disease control, whereas no statistically significant difference in long‐term survival was observed between treatment strategies. Given the retrospective design and potential for residual confounding despite IPTW adjustment, these findings should be interpreted with caution. Treatment selection should therefore be individualized according to therapeutic priorities, such as the need for initial tumor control versus the expectation of sustained immune‐mediated benefit.

Objectives: To evaluate the potential role of the pre‐procedural gamma‐glutamyltransferase‐to‐lymphocyte ratio (GLR) as an adjunctive biomarker for differentiating Hunner‐type interstitial cystitis (HIC) from bladder pain syndrome (BPS). Methods: Consecutive patients who underwent cystoscopic evaluation with hydrodistension for suspected interstitial cystitis/bladder pain syndrome between April 2016 and September 2025 were retrospectively analyzed. HIC and BPS were diagnosed by expert adjudication based on cystoscopic, clinical, and histopathological findings. GLR was calculated as serum gamma‐glutamyltransferase divided by peripheral lymphocyte count. Diagnostic performance was assessed using receiver operating characteristic analysis, and associations with HIC were evaluated using logistic regression. Results: Among 106 patients, 62 had HIC and 44 had BPS. GLR was significantly higher in HIC than BPS (21.4 ± 14.7 vs. 14.2 ± 15.2, p = 0.016) and correlated with total histological activity score ( ρ = 0.606, p < 0.001). GLR showed an AUC of 0.759, while GGT showed similar discrimination (AUC 0.776; p = 0.592 vs. GLR). Adding GLR to a clinical model did not improve discrimination (AUC 0.948 vs. 0.949; p = 0.879). In the covariate‐adjusted multivariable analysis, GLR remained associated with HIC (odds ratio 1.04, 95% confidence interval 1.01–1.10, p = 0.032). Conclusions: Pre‐procedural GLR may serve as a practical blood‐based adjunct reflecting bladder‐inflammatory histopathology and supporting early phenotyping across the IC/BPS spectrum, although prospective external validation is required.

Background and Objectives: Overactive bladder (OAB) has been associated with pelvic floor dysfunction, but the associations of vaginal pressure (VP) and transversus abdominis (TVA) thickness with OAB remain unclear. We examined these associations in women with lower urinary tract symptoms. Materials and Methods: This retrospective cross-sectional study included 213 women; 106 met the prespecified Overactive Bladder Symptom Score criteria and 107 did not. Maximal VP during voluntary pelvic floor contraction and ultrasonographic TVA thickness at rest, during maximal inspiration and maximal expiration, and during the abdominal drawing-in maneuver were compared between groups. Multivariable logistic regression adjusted for age, body mass index, number of deliveries, postmenopausal status, and hypertension. Results: Maximal VP and TVA thickness during the abdominal drawing-in maneuver were lower in the OAB group. In the continuous-variable model, higher VP (per 5-cmH₂O increase: OR = 0.704, 95% CI 0.576–0.845) and greater TVA thickness during the abdominal drawing-in maneuver (per 1-mm increase: OR = 0.500, 95% CI 0.343–0.708) were associated with lower odds of OAB. Neither measure showed a consistent stepwise relationship with OAB severity. Exploratory ROC analyses yielded moderate apparent AUCs, but the cohort-derived cutoffs require external validation and should not inform clinical decisions. Conclusions: Lower VP and lower TVA thickness during the abdominal drawing-in maneuver were associated with OAB in this selected cohort. Concurrent cross-sectional assessment cannot establish causality or temporal relationships and cannot exclude reverse causation. Prospective studies are required before considering predictive or preventive roles, and cohort-derived cutoffs require external validation before clinical use.

Background: Estimating glomerular filtration rate (GFR) is challenging due to its dependence on age and body composition, especially in pediatric and elderly populations. Recently, d -serine and d -asparagine, rare amino acid enantiomers, have been identified as GFR biomarkers characterized by their ideal kidney clearance and minimal impacts of body size. We investigated the impact of age and sex on GFR estimation using these d -amino acids. Methods: We analyzed data from a cross-sectional observational cohort: 366 adult Japanese living kidney transplant donors and recipients. Using a dataset of 244 patients, we developed GFR estimation formulae based on blood levels of d -Ser and d -Asn using linear regression analyses, and validated the formulas’ performance in 122 patients. Results: The d -amino aci d- based equation was established as 60.4 x d -Ser ^-0.450 x d -Asn ^-0.304 x 0.916 (if female), in which age did not significantly improve model performance and the impact of sex was minor. The performance of the established equations was equivalent to that of creatinine-based equations: bias (absolute difference), 9.1 [8.0-11.2], precision (interquartile range of bias), 11.1 [8.8-14.2], and accuracy (ratios of 30% different from measured GFR [P ₃₀ ]), 0.82 [0.73-0.89]. Conclusions: d -Amino acid-based estimation of GFR exhibits minimal empirical association with age and sex, offering a distinct advantage over models dependent on these demographic variables. This stability may support its broad clinical utility as a reliable diagnostic tool across all age groups and diverse populations.