Shigeo Horie

This chapter outlines a detailed methodology for the analysis of androgen receptor splice variant-7 (AR-V7) expression in circulating tumor cells (CTCs) using the AdnaTestProstate CancerSelect and ProstateCancerDetect system. The method incorporates immunomagnetic enrichment, mRNA isolation, and reverse transcription PCR to detect AR-V7, a key marker associated with treatment resistance in castration-resistant prostate cancer (CRPC). The protocol includes step-by-step instructions for sample preparation, magnetic bead-based enrichment, and gene expression analysis, providing a robust platform to investigate the molecular characteristics of CTCs and their roles in therapy resistance.

Background Cancer cachexia is characterized by progressive skeletal muscle loss and systemic inflammation. Although sarcopenia is a known prognostic factor in bladder cancer, the prevalence and prognostic significance of cancer cachexia defined by standardized criteria remain unclear. Methods We retrospectively analyzed patients receiving first-line systemic chemotherapy for urothelial carcinoma at three institutions. Cancer cachexia was defined using the 2011 European Palliative Care Research Collaborative (EPCRC) criteria based on weight loss, body mass index, and CT-derived L3 skeletal muscle index. Patients were categorized by onset timing: no cachexia, baseline cachexia (pre-treatment), and acquired cachexia (developed during treatment). Survival outcomes and prognostic factors were analyzed using Kaplan–Meier methods, logistic regression, and Cox proportional hazards models. Results Among 150 eligible patients, 45 (30.0%) had baseline cachexia, and 67 (44.7%) developed acquired cachexia during the observation period, resulting in a cumulative prevalence of 74.7%. Cachexia was significantly associated with advanced disease stage and sarcopenia. Overall survival (OS) significantly differed among the three groups (log-rank test, P = 0.005). The median OS was not reached in the no cachexia group, 836 days in the acquired cachexia group, and 742 days in the baseline cachexia group. Multivariable Cox analysis identified acquired cachexia, baseline cachexia and elevated C-reactive protein (CRP) (≥ 0.4 mg/dL) as independent predictors of poor OS. Conclusion Cancer cachexia is highly prevalent in patients with bladder cancer receiving first-line chemotherapy and is independently associated with reduced survival, regardless of onset timing. Early identification may improve risk stratification and guide supportive interventions.

UNSTRUCTURED This feasibility study of daily voice-based AI health monitoring among 14 elderly Japanese adults (mean age 71 years) within an 8-week group-based longevity intervention demonstrated 73% median daily engagement and generation of 4,876 qualitatively rich conversational messages, suggesting voice AI succeeds not by replacing human connection but by mediating it within social support structures.

Background Cancer cachexia is a multifactorial syndrome characterized by progressive skeletal muscle loss and systemic inflammation. Although sarcopenia has been reported as a prognostic factor in bladder cancer, the prevalence and prognostic significance of cancer cachexia defined by standardized criteria remain unclear. Methods We retrospectively analyzed patients who received first-line systemic chemotherapy for urothelial carcinoma at three institutions. Cancer cachexia was defined according to the 2011 European Palliative Care Research Collaborative (EPCRC) criteria based on weight loss, body mass index, and CT-derived L3 skeletal muscle index. Baseline cachexia was assessed within 6 months prior to treatment initiation, and follow-up cachexia was evaluated during treatment. Survival outcomes and prognostic factors were analyzed using Kaplan–Meier methods, logistic regression, and Cox proportional hazards models. Results Among 150 eligible patients, 30% met the criteria for cachexia at treatment initiation. The cumulative prevalence increased to 57.3% within 3 months and reached 74% at some point during the observation period. Cachexia was significantly associated with advanced disease stage and sarcopenia. Overall survival was significantly shorter in patients who developed cachexia, with a median survival of 827 days (95% confidence interval 586–1098). Multivariate Cox analysis identified cancer cachexia and elevated C-reactive protein (CRP) (> 0.4 mg/dL) as independent predictors of poor overall survival. Conclusion Cancer cachexia is highly prevalent in patients with bladder cancer receiving first-line chemotherapy and is independently associated with reduced survival. Early identification of metabolic deterioration may improve risk stratification and guide supportive interventions.

Objectives To evaluate whether bedside bioimpedance analysis and simple functional tests can identify muscle function impairment associated with overall survival in chemotherapy-treated metastatic urothelial carcinoma.Materials Retrospective single-center observational cohort study.Methods We reviewed 56 consecutive patients treated with systemic chemotherapy between January 2014 and February 2021. Skeletal muscle index was estimated using bioimpedance analysis. Handgrip strength and walking speed were assessed in routine care. Sarcopenia-related categories were defined using sex-specific Asian Working Group for Sarcopenia thresholds. The prespecified primary comparison was reference (normal plus pre-sarcopenia) versus muscle function impairment (dynapenia plus sarcopenia). Overall survival was evaluated using Kaplan-Meier analysis and Cox models with minimal age adjustment.Results Muscle function impairment was associated with shorter overall survival compared with the reference group. The association remained after age adjustment. Baseline characteristics suggested greater vulnerability in the impairment group, including lower body weight and serum albumin and higher inflammatory burden.Conclusions A pragmatic bedside phenotype based on bioimpedance analysis and simple functional testing may help identify chemotherapy-treated metastatic urothelial carcinoma patients at higher risk of poor survival.

Water vapor thermal therapy (WVTT) is an emerging minimally invasive therapy for benign prostatic hyperplasia (BPH). This umbrella review and updated meta-analysis aims to evaluate the comprehensive outcomes of WVTT for the management of BPH. Materials and Methods: Materials and Methods: Up to January 2025, randomized clinical trials and observational studies were included in the updated meta-analysis, while systematic reviews and meta-analyses were included in the umbrella review. Both were conducted in accordance with PRISMA criteria. The umbrella review protocol was pre-registered under registration identifier CRD42024514038. The research compared outcomes including International Prostate Symptom Score (IPSS), peak urinary flow (Qmax), postvoid residual volume (PVR), sexual function, retreatment rates, adverse events and cost-effectiveness. Outcomes were analyzed using a random effects meta-analysis model. The source of heterogeneity was identified by meta-regression. Results: Results: The umbrella review comprised 6 systematic reviews and the updated meta-analysis included 25 primary studies involving 3,308 patients. The meta-analysis revealed, at 3 months post-operation, a mean reduction of 10.96 points in IPSS (95% confidence interval [CI], 9.71 to 12.20; I 2 =89%), a mean increase of 4.70 mL/s in Qmax (95% CI, 4.22 to 5.19; I 2 =31%), and a mean reduction of 69.52 mL in PVR (95% CI, 52.15 to 86.89; I 2 =84%). At 12 months, the analysis revealed a mean reduction of 12.35 points in IPSS (95% CI, 10.74 to 13.95; I 2 =94%), a mean increase of 5.27 mL/s in Qmax (95% CI, 4.46 to 6.07; I 2 =84%), and a mean reduction of 37.07 mL in PVR (95% CI, 18.29 to 55.85; I 2 =97%). Our umbrella review showed that WVTT also resulted in low retreatment rates and preserved sexual function. Adverse events were mostly mild and self-limiting. Conclusions: Conclusions: WVTT is an effective and safe treatment for BPH leading to symptom relief with low retreatment rates and wide application scenarios. Clinicians should consider WVTT as a viable minimally invasive alternative for BPH patients who are not suitable for more invasive therapies.

Background: Robot-assisted partial nephrectomy (RAPN) is a standard approach for localized renal cell carcinoma (RCC), emphasizing renal functional preservation. The Minimum Layer Resection (MLR) method, guided by 3D virtual partial nephrectomy (3DvPN) planning, was developed to balance oncological safety with parenchymal preservation. This study evaluated functional and oncological outcomes of RAPN with MLR and identified predictors of renal functional decline. Methods: We retrospectively analyzed 237 patients (after screening 312 cases) who underwent RAPN between 2012 and 2022 with ≥36-month follow-up. 3DvPN planning was used to guide MLR when feasible; both MLR and non-MLR were available and applied throughout the study period according to predefined indications. The primary endpoint was the percentage of estimated glomerular filtration rate (eGFR) preservation at 36 months; a ≥10% decline was clinically significant. Secondary endpoints included perioperative outcomes, acute kidney injury (AKI), and oncological outcomes such as margin involvement and recurrence. Results: The median age was 60 years, tumor size 29 mm, and warm ischemia time 21 min, with selective or superselective clamping achieved in 62.8% of cases. Postoperative AKI occurred in 25.0% (no patient required dialysis). At 3 years, the median eGFR preservation rate was 84.4%, and 28.5% of patients experienced a ≥10% decline. Independent predictors of short-term decline (14 days) were BMI > 25 kg/m², AKI, and WIT > 25 min, whereas long-term decline (36 months) was associated with tumor size > 30 mm and WIT > 25 min. Margin involvement was 1.7%, recurrence 3.8%, and major complications (Clavien–Dindo ≥IV) occurred in 1.7%. Conclusions: In conclusion, RAPN with the MLR technique under 3DvPN guidance demonstrated favorable perioperative outcomes, acceptable oncologic safety, and good mid-term renal functional preservation (up to 36 months). The approach provides a reproducible surgical strategy that maximizes parenchymal preservation while maintaining negative surgical margins. Prospective multicenter studies with longer follow-up are warranted to confirm long-term durability and to define the role of MLR in routine practice.

Background: This study aimed to develop and evaluate machine learning (ML) models to predict biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP). Methods: We retrospectively analyzed clinical data from 1125 patients who underwent RARP between July 2013 and December 2023. The dataset was divided into a training set (70%) and a testing set (30%) using a stratified sampling strategy. Five ML models were developed using the training set. Model performance was evaluated on the testing set using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, and F1 scores. Additionally, model interpretability was assessed using SHapley Additive exPlanations (SHAP) values to determine the contribution of individual features. Results: Among the five ML models, the LightGBM model achieved the best prediction ability with an AUC of 0.881 (95%CI: 0.840–0.922) in the testing set. For model interpretability, SHAP values explained the contribution of individual features to the model, revealing that pathological T stage (pT), positive surgical margin (PSM), prostate-specific antigen (PSA) nadir, initial PSA, systematic prostate biopsy positive rate, seminal vesicle invasion (SVI), pathological International Society of Urological Pathology Grade Group (pGG), and perineural invasion (PI) were the key contributors to the predictive performance. Conclusions: We developed and validated ML models to predict BCR following RARP and identified that the LightGBM model with 8 variables achieved promising performance and demonstrated a high level of clinical applicability.