神戸大学大学院医学研究科腎泌尿器科学分野

Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine

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限局性前立腺癌に対する治療

限局性前立腺癌に対しては、腹腔鏡下手術を早期から導入し既に200例以上に実施している他、以前から施行してきた開腹手術の手技を改良した小切開前立腺全摘術にも積極的に取り組んでいる。更に、我々は単に新しい手技を導入するだけでなく、旧来の開腹手術との違いを、腫瘍学的および機能的側面から詳細に検討し報告している。また、放射線療法としては従来の外照射に加え、兵庫県粒子線センターと提携し陽子線治療を導入する一方、現在は小線源治療の実施に向けた準備も進めており間も無く当院においても提供可能となる見込みである。

膀胱全摘除術後の新膀胱造設術

当科では従来より腸管を用いた膀胱再建術に積極的に取り組み、術式の改良を含め多くの成果を挙げてきた。特に最近ではS状結腸を利用した新膀胱造設術を第一選択として採用し、排尿機能、性機能、QOL、合併症等の多方面にわたる解析を行っている。また、理想的な尿路変向術の確立に向けて、回腸利用新膀胱造設術等の他の術式との比較研究も併せて施行している。

進行癌に対する先進的治療

ホルモン非依存性前立腺癌に対しては抗アンドロゲン剤交替療法およびドセタキセルとエストラムスチンの併用療法等を実施し良好な成績を挙げている。転移性尿路上皮癌に対しては、MVAC療法に抵抗性の症例を対象にジェムシタビンとカルボプラチンの併用療法を行っている。転移性腎癌に対しては、IL-2およびIFN-α併用療法を積極的に施行しているが、今後はサイトカイン療法との併用も含め分子標的薬の使用を予定している。進行性精巣腫瘍に対しては、従来は大量化学療法を第一選択としてきたが、欧米の大規模臨床試験における否定的な結果を受け、現在はパクリタキセル、ネダプラチン、カンプトテシン等の新規抗癌剤を積極的に導入している。また、上記の各種治療を施行した症例数は、いずれも国内有数である。

その他

この他にも臨床研究としては泌尿器癌に対する各種治療とQOLの関係、骨盤内臨床解剖学、前立腺全摘除術中の電気刺激による勃起関連神経の走行様式、前立腺癌および膀胱癌における微小リンパ節転移の同定等の多彩な研究テーマの解析を行っている。更に基礎研究としては、前立腺癌のホルモン非依存性進展に重要な役割を果たす遺伝子を標的にしたアンチセンスオリゴ療法、アンドロゲンレセプターの変異とリガンド独立性刺激の関係、精嚢微小環境が前立腺癌進展に及ぼす影響、細胞周期関連遺伝子の発現制御による前立腺癌の抗癌剤耐性克服等のテーマの解明に向けて、大学院性を中心に分子生物学的および遺伝子工学的手法を駆使して取り組んでいる。

  • Miyake H, Hara I, Fujisawa M, Gleave ME. The potential of clusterin inhibiting antisense oligodeoxynucleotide therapy for prostate cancer. Expert Opin Investig Drugs. 2006; 15: 507-17.
  • Miyake H, Hara I, Fujisaw M, Gleave ME. Antisense oligodeoxynucleotide therapy for bladder cancer: recent advances and future prospects. Expert Rev Anticancer Ther. 2005; 5: 1001-9.
  • Miyake H, Fujisawa M. Promise of antisense oligodeoxynucleotide-based therapy for bladder cancer. Expert Rev Anticancer Ther. 2008; 8: 1851-4.
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  • Kumano M, Miyake H, Kurahashi T, Yamanaka K, Fujisawa M. Enhanced progression of human prostate cancer PC3 cells induced by the microenvironment of the seminal vesicle. Br J Cancer. 2008; 98: 356-62.
  • Kumano M, Miyake H, Terakawa T, Furukawa J, Fujisawa M. Suppressed tumour growth and enhanced chemosensitivity by RNA interference targeting Aurora-A in the PC3 human prostate cancer model. BJU Int. 2010; 106: 121-7.
  • Sakai I, Miyake H, Terakawa T, Fujisawa M. Inhibition of tumor growth and sensitization to chemotherapy by RNA interference targeting interleukin-6 in the androgen-independent human prostate cancer PC3 model. Cancer Science 2011; 102: 769-75.
  • Terakawa T, Miyake H, Kurahashi T, Furukawa J, Takenaka A, Fujisawa M. Improved sensitivity for detecting micrometastases in pelvic lymph nodes by real-time reverse transcriptase polymerase chain reaction (RT-PCR) compared with conventional RT-PCR in patients with clinically localized prostate cancer undergoing radical prostatectomy. BJU Int. 2009; 103: 1074-8.
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  • Miyake H, Kurahashi T, Hara I, Takenaka A, Fujisawa M. Significance of micrometastases in pelvic lymph nodes detected by real-time reverse transcriptase polymerase chain reaction in patients with clinically localized prostate cancer undergoing radical prostatectomy after neoadjuvant hormonal therapy. BJU Int. 2007; 99: 315-20.
  • Kusuda Y, Miyake H, Kurahashi T, Fujisawa M. Assessment of optimal target genes for detecting micrometastases in pelvic lymph nodes in patients with prostate cancer undergoing radical prostatectomy by real-time reverse transcriptase-polymerase chain reaction. Urol Oncol. in press
  • Miyake H, Muramaki M, Kurahashi T, Takenaka A, Fujisawa M. Expression of potential molecular markers in prostate cancer: correlation with clinicopathological outcomes in patients undergoing radical prostatectomy. Urol Oncol. 2010; 28: 145-51.
  • Sakai I, Miyake H, Takenaka A, Fujisawa M. Expression of potential molecular markers in renal cell carcinoma: impact on clinicopathological outcomes in patients undergoing radical nephrectomy. BJU Int. 2009; 104: 942-6.
  • Behnsawy HM, Miyake H, Abdalla MA, Sayed MA, Ahmed AI, Fujisawa M. Expression of cell cycle-associated proteins in non-muscle invasive bladder cancer: correlation with intravesical recurrence following transurethral resection. Urol Oncol. in press.
  • Kumano M, Miyake H, Muramaki M, Furukawa J, Takenaka A, Fujisawa M. Expression of urokinase-type plasminogen activator system in prostate cancer: correlation with clinicopathological outcomes in patients undergoing radical prostatectomy. Urol Oncol. 2009; 27: 180-6.
  • Kusuda Y, Miyake H, Behnsawy HM, Fukuhara T, Inoue T, Fujisawa M. Prognostic prediction in patients with metastatic renal cell carcinoma treated with sorafenib based on expression levels of potential molecular markers in radical nephrectomy specimens. Urol Oncol. in press
  • Terakawa T, Miyake H, Kusuda Y, Fujisawa M. Expression level of vascular endothelial growth factor receptor-2 in radical nephrectomy specimens as a prognostic predictor in patients with metastatic renal cell carcinoma treated with sunitinib. Urol Oncol. in press
  • Takenaka A, Soga H, Sakai I, Nakano Y, Miyake H, Tanaka K, Fujisawa M. Influence of nerve-sparing procedure on early recovery of urinary continence after laparoscopic radical prostatectomy. J Endourol. 2009; 23: 1115-9.
  • Terakawa T, Miyake H, Tanaka K, Takenaka A, Inoue T, Fujisawa M. Surgical margin status of open versus laparoscopic radical prostatectomy specimens. Int J Urol. 2008; 15: 704-7.
  • Hara I, Kawabata G, Tanaka K, Kanomata N, Miyake H, Takenaka A, Fujisawa M. Oncological outcome of laparoscopic prostatectomy. Int J Urol. 2007; 14: 515-2.0
  • Kumano M, Miyake H, Muramaki M, Kurahashi T, Takenaka A, Fujisawa M. Adverse prognostic impact of capsular incision at radical prostatectomy for Japanese men with clinically localized prostate cancer. Int Urol Nephrol. 2009; 41: 581-6.
  • Takenaka A, Soga H, Kurahashi T, Miyake H, Tanaka K, Fujisawa M. Early recovery of urinary continence after laparoscopic versus retropubic radical prostatectomy: evaluation of preoperative erectile function and nerve-sparing procedure as predictors. Int Urol Nephrol, 2009; 41: 587-93.
  • Miyake H, Furukawa J, Muramaki M, Takenaka A, Fujisawa M. Orthotopic sigmoid neobladder after radical cystectomy: assessment of complications, functional outcomes and quality of life in 82 Japanese patients. BJU Int. 2010; 106: 412-6.
  • Takenaka A, Soga H, Terakawa T, Kumano M, Furukawa J, Muramaki M, Kurahashi T, Miyake H, Tanaka K, Yamanaka N, Fujisawa M. Assessment of voiding function of orthotopic neobladders in elderly patients with long-term survival. BJU Int. 2009; 103: 927-30.
  • Miyake H, Furukawa J, Takenaka A, Inoue TA, Yamanaka N, Fujisawa M. Experience with various types of orthotopic neobladder in Japanese men: long-term follow-up. Urol Int. 2010; 84: 34-9.
  • Miyake H, Furukawa J, Muramaki M, Takenaka A, Fujisawa M. Orthotopic bladder substitution following radical cystectomy in women: comparative study between sigmoid and ileal neobladders Urol Oncol. in press.
  • Miyake H, Furukawa J, Muramaki M, Sakai I, Yamashita M, Inoue T, Fujisawa M. Orthotopic sigmoid versus ileal neobladders in Japanese patients: A comparative assessment of complications, functional outcomes and quality of life. Urol Oncol. in press.
  • Miyake H, Kurahashi T, Yamanaka K, Kondo Y, Muramaki M, Takenaka A, Inoue TA, Fujisawa M. Abnormalities of thyroid function in Japanese patients with metastatic renal cell carcinoma treated with sorafenib: A prospective evaluation. Urol Oncol. 2010; 28: 515-9..
  • Miyake H, Kurahashi T, Takenaka A, Inoue TA, Fujisawa M. Clinical outcome of combined immunotherapy with interferon-alpha and low-dose interleukine-2 for Japanese patients with metastatic renal cell carcinoma. Urol Oncol. 2009; 27: 598-603.
  • Miyake H, Kurahashi T, Yamanaka K, Kondo Y, Takenaka A, Inoue T, Fujisawa M. Impact of sorafenib on health-related quality of life in Japanese patients with metastatic renal cell carcinoma: a prospective evaluation. BJU Int. 2010; 106: 1643-7.
  • Kusuda Y, Miyake H, Terakawa T, Furukawa J, Muramaki M, Fujisawa M. Treatment of brain metastases from renal cell carcinoma with sunitinib and radiotherapy: our experience of 5 cases with a review of the literature. Int J Urol. 2011; 18: 326-9.
  • Miyake H, Kusuda Y, Harada K, Sakai I, Fujisawa M. Third-line sunitinib following sequential use of cytokine therapy and sorafenib in Japanese patients with metastatic renal cell carcinoma. Int J Clin Oncol. in press.
  • Hara I, Miyake H, Yamada Y, Yamanaka K, Furukawa J, Kumano M, Takenaka A, Fujisawa M. Feasibility and usefulness of high-dose chemotherapy (high-dose ifosfamide, carboplatin and etoposide) combined with peripheral blood stem cell transplantation for male germ cell tumor: a single-institute experience. Anticancer Drugs. 2006; 17: 1057-66.
  • Kumano M, Miyake H, Hara I, Furukawa J, Takenaka A, Fujisawa M. First-line high-dose chemotherapy combined with peripheral blood stem cell transplantation for patients with advanced extragonadal germ cell tumors. Int J Urol. 2007; 14: 336-8.
  • Kumano M, Miyake H, Hara I, Furukawa J, Takenaka A, Fujisawa M. Stable hematopoietic recovery after peripheral blood stem cell transplantation in patients receiving high-dose chemotherapy for advanced germ cell tumors. Anticancer Res. 2006; 26: 4965-8.
  • Terakawa T, Miyake H, Muramaki M, Takenaka A, Fujisawa M. Salvage chemotherapy with methotrexate, etoposide and actinomycin D in men with metastatic nonseminomatous germ cell tumors with a choriocarcinoma component: a preliminary report. Int J Urol. 2010; 17: 881-5.