Aoki Y, Oshiro Y, Ga R
… +6 more, Kawashima M, Hasegawa C, Kawano Y, Ueda J, Nakamura Y, Yoshida H
J Nippon Med Sch
· 2025 Aug · PMID 40866216
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Mucinous cystic neoplasms of the liver (MCNs-L) are rare cystic tumors characterized by multilocular cysts lined with a mucin-producing epithelium and supported by ovarian-like stroma. These tumors account for <5% of all...Mucinous cystic neoplasms of the liver (MCNs-L) are rare cystic tumors characterized by multilocular cysts lined with a mucin-producing epithelium and supported by ovarian-like stroma. These tumors account for <5% of all cystic liver lesions and carry a potential risk of malignant transformation, necessitating early diagnosis and surgical resection. This report describes the successful laparoscopic partial liver resection of segments 4 and 5 for a large MCN-L in a woman in her 40s who presented with upper abdominal discomfort. Imaging studies revealed a multilocular cystic lesion measuring 11.9 × 8.5 × 13.0 cm in segments 4 and 5 of the liver. The primary challenges were the size of the lesion and the need to prevent cystic content spillage during surgery. Using meticulous techniques, including the use of a retrieval bag and controlled aspiration, we successfully excised the tumor laparoscopically and without contamination. Pathological analysis confirmed a diagnosis of mucinous cystic adenoma with no evidence of malignancy. The patient recovered uneventfully and was discharged on postoperative day 7. This case highlights the feasibility and safety of a laparoscopic approach for large MCNs-L. Furthermore, it underscores the importance of preoperative planning, precise surgical techniques, and measures to prevent cystic content dissemination. Minimally invasive surgery offers significant benefits, including reduced recovery time and improved cosmetic outcomes, and can be effectively applied to large hepatic cystic lesions by experienced surgical teams.
Imura S, Ogi Y, Ishimaru K
… +9 more, Koga S, Yoshida M, Akita S, Kikuchi S, Sugishita H, Kuwabara J, Matsumoto H, Goyo K, Oshikiri T
J Nippon Med Sch
· 2026 Jun · PMID 40866215
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Parastomal hernia of the ileal conduit (PHIC) is a long-term complication of radical cystectomy (RC) for bladder cancer. A systematic review reported an estimated incidence of PHIC after RC of 17%. Several surgical techn...Parastomal hernia of the ileal conduit (PHIC) is a long-term complication of radical cystectomy (RC) for bladder cancer. A systematic review reported an estimated incidence of PHIC after RC of 17%. Several surgical techniques have been reported for treating parastomal hernias. However, few studies have investigated treatment of PHIC, and there are no guidelines for the optimal approach for PHIC repair. Here, we describe a case in which good results were achieved using the laparoscopic Sugarbaker (LS) technique with a tailored mesh for PHIC. An 80-year-old Japanese woman underwent robot-assisted radical cystectomy for bladder cancer. Ten months after surgery, she was diagnosed as having bowel obstruction due to PHIC. The LS technique was performed using a tailored mesh. Severe small-intestinal adhesions from previous surgeries were safely divided using laparoscopic surgery. No hernia recurrence was observed at 2 years postoperatively. We used the LS technique to treat PHIC, and severe small-intestinal adhesions were safely treated using laparoscopic surgery. The LS technique appears to be a viable therapeutic option for such cases.
J Nippon Med Sch
· 2026 Jun · PMID 40866214
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We present a case of permanent bilateral lower limb paralysis after epidural anesthesia. A 71-year-old woman (height 159 cm; weight 48.5 kg; American Society of Anesthesiologists Physical Status 2) with a history of hype...We present a case of permanent bilateral lower limb paralysis after epidural anesthesia. A 71-year-old woman (height 159 cm; weight 48.5 kg; American Society of Anesthesiologists Physical Status 2) with a history of hypertension (treated with nifedipine), benign goiter (under surveillance), surgeries for appendicitis, and a previous left humerus fracture had received general anesthesia with epidural anesthesia during two surgical procedures, namely, laparoscopic-assisted low anterior resection with colostomy and laparoscopic-assisted colostomy closure. She developed left-predominant lower limb paralysis after the first epidural anesthesia (using ropivacaine and levobupivacaine). The symptoms had no identifiable cause, persisted after removal of the epidural catheter, and gradually resolved during rehabilitation. Her lower limb paralysis recurred and progressed, however, after the second epidural anesthesia (using levobupivacaine alone), and she has abnormal spinal reflexes and elevated myelin basic protein in cerebrospinal fluid. Although these findings suggested that bilateral lower limb paralysis was caused by a lesion in the central nervous system (thoracolumbar spinal cord), postoperative MRI scans of the vertebrae/spinal cord and head failed to identify the site of the damage. We concluded that permanent bilateral lower limb paralysis was likely caused by epidural anesthesia, but the mechanism could not be identified.
Sugimoto T, Kinoshita Y, Ito K
… +2 more, Saeki H, Ogita A
J Nippon Med Sch
· 2026 Jun · PMID 40866213
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Psoriasis is a condition characterized by chronic inflammation of the skin, epidermal hyperproliferation, and dysregulated differentiation driven by acceleration of the tumor necrosis factor-alpha/interleukin (IL)-23/IL-...Psoriasis is a condition characterized by chronic inflammation of the skin, epidermal hyperproliferation, and dysregulated differentiation driven by acceleration of the tumor necrosis factor-alpha/interleukin (IL)-23/IL-17 axis. Herein, we report a case of generalized pustular psoriasis initially managed with etretinate, apremilast, and risankizumab in a Japanese man. Because of side effects, a therapeutic transition was made to brodalumab at 7 months after the initial consultation. His dermatological symptoms improved; however, hemoglobin concentration decreased to 7.6 g/dL after 4 months of treatment. Diagnostic investigation revealed warm autoimmune hemolytic anemia (AIHA). To our knowledge, this is the first report of AIHA during treatment with brodalumab for generalized pustular psoriasis. The etiological association between AIHA and psoriasis is unclear. Future studies should investigate whether AIHA accompanies pustular psoriasis or results from drug-induced AIHA secondary to brodalumab administration. Our findings suggest that the risk of AIHA in patients with psoriasis treated with brodalumab warrants careful consideration.
BACKGROUND: In emergency interventional radiology (IR), patient motion and poor breath-holding often result in misregistration during digital subtraction angiography (DSA). As a countermeasure, digital angiography (DA) w...BACKGROUND: In emergency interventional radiology (IR), patient motion and poor breath-holding often result in misregistration during digital subtraction angiography (DSA). As a countermeasure, digital angiography (DA) without subtraction processing is used for observation; however, evaluation is limited to areas overlapping with low X-ray transmissivity structures, such as bone. Dynamic trace (DT) is capable of real-time background compression processing of peripheral blood vessels in DA images and ensures visibility of blood vessels in such areas, without being affected by body motion. We evaluated the image quality and visualization of peripheral vascularity of DA and DT images obtained from DSA of the trunk and examined the usefulness of DT. METHODS: Data from 13 patients who underwent emergency IR involving trunk DSA between October 2022 and June 2023 were analyzed. DA and DT images were created from these angiographic images, and two independent IR specialists used a 4-point scale to visually evaluate the contrast, sharpness, and peripheral vascular visibility of the proximal and distal portions of 42 arteries. The image quality scores for DA and DT images were compared using the Wilcoxon signed-rank test, and inter-rater agreement was evaluated using weighting coefficients. RESULTS: As compared with the DA images, the DT images were significantly better at all endpoints (P < 0.001). Inter-rater agreement was moderate for all assessment items. CONCLUSIONS: DT images are not affected by body motion and display better image quality and visualization of peripheral vascularity than DA images, making them useful for emergency IR of the trunk.
BACKGROUND: We investigated the association between the number of patients presenting to an emergency room (ER) with vertigo/dizziness (V/D) and seasonal variations, monthly trends, and weather factors. METHODS: We retro...BACKGROUND: We investigated the association between the number of patients presenting to an emergency room (ER) with vertigo/dizziness (V/D) and seasonal variations, monthly trends, and weather factors. METHODS: We retrospectively investigated age, sex, cause of V/D, emergency triage level (Japan Triage and Acuity Scale), month, and seasonality among patients with V/D transported to the ER of Nippon Medical School between October 2014 and September 2017. We examined weather data, including monthly average precipitation and humidity, with respect to the number of patients with V/D. RESULTS: Among 706 patients with V/D, 481 presented with vertigo and 225 with dizziness. The mean age was 59±18 years and 66% were female. Regarding triage level, emergent (level 2) and urgent (level 3) cases accounted for 86% of cases and were more frequent in June-September (p=0.012). Regarding seasonality, 158 (22%), 195 (28%), 183 (26%), and 170 (24%) patients presented in spring, summer, autumn, and winter, respectively (p=0.744). The monthly number of V/D emergency transports tended to be higher between June and October and was significantly associated with average temperature (r=0.648, p=0.023), precipitation (r=0.655, p=0.021), humidity (r=0.676, p=0.016), and vapor pressure (r=0.648, p=0.023). CONCLUSIONS: Although no apparent seasonality was observed in the monthly number of V/D-related emergency transports, the emergency triage level increased from the rainy season to early autumn. The monthly number of V/D cases transported by emergency services was significantly associated with average temperature, precipitation, humidity, and vapor pressure. These findings could inform public health policy and increase emergency preparedness.
BACKGROUND: The standard of care in Japan for preterm very low-birth-weight (VLBW) infants has long been at the highest level internationally, owing to advances in technology and the perinatal medical system throughout t...BACKGROUND: The standard of care in Japan for preterm very low-birth-weight (VLBW) infants has long been at the highest level internationally, owing to advances in technology and the perinatal medical system throughout the country. METHODS: To identify issues for further improvement of outcomes for preterm VLBW infants in our neonatal intensive care unit (NICU), perinatal care practice was reviewed by analyzing data from medical records on pregnancy complications and management and infant mortality and morbidity. RESULTS: Data from 250 preterm VLBW infants, excluding those with severe congenital anomalies, were analyzed. There were 49 cases (19.6%) of cumulative morbidity, including infants who died before discharge and those who had major complications such as bronchopulmonary dysplasia, intraventricular hemorrhage/periventricular leukomalacia, and retinopathy of prematurity. The prevalence remained constant throughout the study period. Infants born via medically indicated preterm birth had a higher cumulative morbidity rate than those born via spontaneous preterm birth. Small-for-gestational-age status was the only factor significantly associated with cumulative morbidity in multivariate analysis. Of all the infants, 69 (47.3%) completed a course of antenatal corticosteroids (ACS). CONCLUSIONS: The quality of neonatal intensive care for preterm VLBW infants in our NICU was consistent with outcomes for top-ranked NICUs in Japan. Critical issues in improving outcomes for these infants include determining the optimal timing of delivery by comprehensively assessing fetal well-being and promoting ACS.
BACKGROUND: Acoustic trauma is a common cause of acute sensorineural hearing loss associated with tinnitus; however, the underlying molecular mechanisms remain unclear. Extracellular signal-regulated kinase 2 (ERK2), a m...BACKGROUND: Acoustic trauma is a common cause of acute sensorineural hearing loss associated with tinnitus; however, the underlying molecular mechanisms remain unclear. Extracellular signal-regulated kinase 2 (ERK2), a member of the mitogen-activated protein kinase family, is crucial in cellular signaling, especially in the nervous system, where it helps regulate neuroprotection, neurogenesis, and neuronal plasticity. ERK2 is activated in the cochlea by acoustic stimuli and plays a protective role in cochlear hair cells (HCs), which are the primary sensory receptors for hearing. However, the significance of ERK2 expression in HCs associated with development and etiology of tinnitus is largely unexplored. METHODS: To investigate the role of ERK2 in tinnitus development, the gap detection test (GAP) was used to evaluate HC-specific ERK2-conditional knockout mice (HC-E2CKO) exposed to moderate acoustic stimuli. RESULTS: Both control and HC-E2CKO mice showed normal prepulse inhibition levels (<0.6) before and after auditory damage, indicating normal functioning of sensorimotor gating pathways, excluding gross sensorimotor deficits. This confirmed that the animals were eligible for the GAP. HC-E2CKO mice showed a transient increase in the GAP ratio, indicating tinnitus development, 1 week after noise exposure, although the hearing threshold was not significantly elevated. The GAP ratio returned to normal after 2 weeks. In contrast, control mice did not exhibit elevation in hearing threshold and the GAP ratio remained normal. CONCLUSION: Our findings suggest that ERK2 in the inner ear plays a role in tinnitus onset or perception after acoustic stress, potentially through inhibitory mechanisms.
BACKGROUND: Several studies have reported that persons with Parkinson's disease (PD) exhibit a preference for sweet foods. However, because many people favor such foods, this study investigated whether the preference for...BACKGROUND: Several studies have reported that persons with Parkinson's disease (PD) exhibit a preference for sweet foods. However, because many people favor such foods, this study investigated whether the preference for sweet foods was stronger among patients with PD than among those without PD. METHODS: We analyzed 150 patients treated in the neurology department of Nippon Medical School Hospital between July 2021 and November 2021. Forty-nine (33%) had PD and 101 patients (control group) did not. Participants were asked to rate three sweet foods, three salty foods, and three bitter foods (total, nine foods) on a questionnaire where a score of 3 indicated "like", 2 indicated "neutral", and 1 indicated "dislike". The score for each taste preference was defined as the sum of the scores for the three foods representing each taste. Differences in baseline characteristics and taste preference scores between patients with and without PD were then statistically analyzed. RESULTS: The PD group was significantly older than the control group. The PD group obtained a significantly higher sweetness score than the control group (8 [6-9] vs. 7 [3-9], p<0.01). There was no difference in scores for either saltiness (7 [3-9] vs. 7 [3-9], p=0.49) or bitterness (7 [4-9] vs. 7 [3-9], p=0.25). The sweetness score was not significantly correlated with L-dopa dose, L-dopa equivalent dose, or PD disease duration. CONCLUSION: Patients with PD were more likely than those without PD to prefer sweet foods. These results are important new information on the taste preferences of persons with Parkinson's disease.
The principles of hyperbaric oxygen therapy (HBOT) have been known since ancient times. Empirical knowledge regarding relief of decompression sickness (DCS) symptoms in divers re-entering a pressurized environment was re...The principles of hyperbaric oxygen therapy (HBOT) have been known since ancient times. Empirical knowledge regarding relief of decompression sickness (DCS) symptoms in divers re-entering a pressurized environment was reported as early as 4,500 BC. DCS was recognized as a disease after deep diving became possible because of diving helmets. DCS also occurs in high-pressure dry workspaces (caissons) developed to construct bridges and tunnels. After the discovery of oxygen in the 18th century, its administration was found to be beneficial in treating conditions that developed after rapid decompression, and HBOT is now established as a part of recompression therapy. This review describes the indications for HBOT in Japan and its effectiveness, as indicated by the author's experience with HBOT in the Department of Emergency Room and General Medicine at Nippon Medical School.
Cancers originating from the same tissue vary significantly in genetic mutations and patient drug response. Furthermore, tumor tissue is composed of diverse cancer cell clones. This phenomenon, known as "cancer cell hete...Cancers originating from the same tissue vary significantly in genetic mutations and patient drug response. Furthermore, tumor tissue is composed of diverse cancer cell clones. This phenomenon, known as "cancer cell heterogeneity," occurs among tumors (between patients) and within individual tumors and is an important mechanism driving resistance to cancer therapy. Therefore, an understanding of cancer cell heterogeneity is essential for the development and delivery of more effective personalized treatments. The cancer cell lines typically used in cancer research cannot accurately replicate this heterogeneity. However, patient-derived tumor organoids (PDTOs), three-dimensional cultures of tumor cells, can precisely replicate the histological, molecular, and cellular heterogeneity of the original tumor. PDTOs generated from human cancers are now widely used as innovative tools in cancer research, including in studies of the mechanisms of cancer development and progression and in screening of anti-cancer drug. This review summarizes recent advances in human tumor research that uses PDTOs.
Neuropsychiatric disorders such as multiple sclerosis, Alzheimer's disease, and autism spectrum disorder exhibit significant sex differences in prevalence, progression, and response to treatment. Emerging evidence sugges...Neuropsychiatric disorders such as multiple sclerosis, Alzheimer's disease, and autism spectrum disorder exhibit significant sex differences in prevalence, progression, and response to treatment. Emerging evidence suggests that oligodendrocytes (OLs) and oligodendrocyte precursor cells (OPCs) play pivotal roles in these pathologies via mechanisms involving neuroinflammation, energy metabolism, and hormonal modulation, resulting in distinct functional outcomes. Specifically, female OPCs display higher proliferative and migratory capacities, whereas male OPCs are more prone to differentiation and myelination, thus contributing to robust myelin integrity. Dysregulation of these cells disrupts myelination and exacerbates disease progression. Addressing sex-specific gene expression in OPCs and OLs is therefore considered crucial for the development of targeted therapeutic strategies. This review highlights the significance of sex differences in the proliferation and differentiation of OPCs, as well as gene expression changes in OPCs and OLs, and emphasizes their contribution to the pathophysiology of neuropsychiatric disorders. Improved understanding of these differences is vital for advancing personalized sex-specific treatments and improving the clinical outcomes of neuropsychiatric disorders.
Tsuji A, Miyagi N, Hirayama A
… +9 more, Murata T, Amitani R, Ueda H, Yamashita H, Sasaki T, Maruyama Y, Miyagi Y, Honda J, Ishii Y
J Nippon Med Sch
· 2025 Jun · PMID 40571585
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Surgical repair of thoracoabdominal aortic aneurysms (TAAA) is a complex procedure that is associated with marked morbidity and mortality. Endovascular TAAA repair, initially reserved for patients at high risk, has yield...Surgical repair of thoracoabdominal aortic aneurysms (TAAA) is a complex procedure that is associated with marked morbidity and mortality. Endovascular TAAA repair, initially reserved for patients at high risk, has yielded promising results and is performed on an increasing range of patients. This case report describes a hybrid approach-a combination of endovascular and open repair-for a patient with high-risk TAAA after aortic dissection. A 79-year-old man had undergone aortic replacement for chronic aortic dissection 20 years previously. His saccular TAAA, extending from the Th12 level to the renal artery origin, demonstrated progressive enlargement (56-60 mm) on computed tomography (CT) scans and compressed the celiac artery. In light of the patient' s age and thoracotomy history, a hybrid repair strategy involving total debranching thoracic endovascular aortic repair (TEVAR) with four-branch abdominal reconstruction was selected to minimize surgical risk. The surgery was performed via a midline abdominal incision. Bypass surgery was first performed using a quadrant artificial graft to restore left renal, right renal, superior mesenteric, and common hepatic artery blood flow. The celiac artery was coiled, and TEVAR was completed. Intraoperative contrast and postoperative CT showed no endoleak and a patent debranching graft. The patient recovered without complications and was discharged 10 days postoperatively. The findings for the present hybrid procedure indicate that debranching TEVAR is less invasive and yields better outcomes than open aortic replacement, particularly for patients at high risk.
Sano M, Yanagihara K, Yagi M
… +2 more, Nagata K, Takei H
J Nippon Med Sch
· 2026 Mar · PMID 40571584
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Metastatic breast tumors are rare and often misdiagnosed as primary breast cancer. Herein, we present a case of breast metastasis from malignant melanoma. A 46-year-old woman presented to our department with a lump in he...Metastatic breast tumors are rare and often misdiagnosed as primary breast cancer. Herein, we present a case of breast metastasis from malignant melanoma. A 46-year-old woman presented to our department with a lump in her left breast. Examination revealed a relatively soft mass measuring 4 cm in diameter in the left breast. A needle biopsy was performed, and immunostaining for S-100, human melanoma black-45, CD56/neural cell adhesion molecule, and Melan-A confirmed a diagnosis of malignant melanoma. The metastasis was confined to the breast and was thus treated by surgery to excise the tumor. Malignant melanoma is a rare disease in the Japanese population and is associated with a poor prognosis because of the risk of early metastasis to multiple organs and lymph nodes. However, when complete resection of distant metastases is feasible, curative resection may be indicated. Herein, we report a case of breast metastasis from malignant melanoma and review previously published case reports on this rare condition.
Kurihara M, Igarashi T, Ishii R
… +3 more, Tajima H, Hayakawa J, Migita M
J Nippon Med Sch
· 2026 Jan · PMID 40571583
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Periodic fever syndrome is diagnosed on the basis of duration of fever, associated symptoms, and blood and genetic test results. During a 6-month period, a 3-year-old girl experienced monthly fever (39°C) episodes persis...Periodic fever syndrome is diagnosed on the basis of duration of fever, associated symptoms, and blood and genetic test results. During a 6-month period, a 3-year-old girl experienced monthly fever (39°C) episodes persisting 5 to 12 days and two episodes of ankle arthralgia and skin rash during fever. No abdominal or chest pain was noted. Blood tests performed at the time of fever revealed elevated CRP levels and blood sedimentation rates. Urinalysis and bone marrow examination results were unremarkable. Genetic testing for hereditary autoinflammatory disease syndromes showed E84K MEFV gene mutations. After diagnosing atypical familial Mediterranean fever, oral colchicine alleviated the febrile attacks and improved family quality of life. Fever, arthralgia, and skin rash disappeared after oral colchicine, which is effective for atypical familial Mediterranean fever. During the 6 months before the diagnosis, periodic fever disrupted the daily lives of the entire family. The patient was absent from nursery school during fever. The patient's illness affected her mother's health. The mother was concerned about her child's unknown fever, which resulted in depression and the need for psychiatric medication. Colchicine resolved the febrile episodes, and resolution of the patient's symptoms alleviated her mother's depression. This case shows that genetic testing for periodic fever syndrome can improve family quality of life.
Yamamoto M, Ino Y, Mori K
… +4 more, Maruyama Y, Ishii Y, Ishikawa M, Sakamoto A
J Nippon Med Sch
· 2026 Jan · PMID 40571582
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The combination of initial Impella therapy, Impella-supported coronary artery bypass grafting (ISCAB), and postoperative Impella therapy providing antegrade perfusion in myocardial infarction can prove effective. We inve...The combination of initial Impella therapy, Impella-supported coronary artery bypass grafting (ISCAB), and postoperative Impella therapy providing antegrade perfusion in myocardial infarction can prove effective. We investigated strategies for Impella stabilization in ISCAB, particularly during peripheral circumflex branch anastomosis. Case 1 was a 70-year-old man treated with an Impella 2.5, followed by urgent ISCAB on the day of hospitalization, for a left main trunk lesion. Use of an apical suction device to position the heart to expose an obtuse marginal branch caused Impella obstruction by applying suction to the left ventricular wall, interrupting revascularization; however, one revascularization was achieved. Case 2 was a 79-year-old man treated with an Impella CP for a three-vessel lesion until ISCAB 4 days later. The Impella was stabilized with appropriate positioning by adjusting the bed angle, minimal heart compression with a deep pericardial stitch without pulling on the cardiac apex, and sufficient preload, even during posterolateral branch anastomosis. Four revascularizations were eventually achieved. Multiple innovations to prevent Impella contact with the left ventricle as described herein improve ISCAB safety, particularly during peripheral circumflex branch anastomosis.
Fulminant type 1 diabetes mellitus (fulminant T1DM) can progress rapidly to diabetic ketoacidosis (DKA). It can develop in pregnant women with no prior history of diabetes, and such cases are associated with severe perin...Fulminant type 1 diabetes mellitus (fulminant T1DM) can progress rapidly to diabetic ketoacidosis (DKA). It can develop in pregnant women with no prior history of diabetes, and such cases are associated with severe perinatal consequences. We report the detailed clinical course of a neonate born from a mother with DKA caused by fulminant T1DM. The male neonate weighed 3,024 grams and was born at 36 weeks of gestation. The patient's mother had an uneventful pregnancy until she visited the hospital on the day of delivery with headache, nausea, and decreased fetal movement. The APGAR score of the neonate was 8/8, but he was transferred to our hospital for further evaluation because umbilical cord blood gas analysis showed unexplained acidosis (pH = 6.92). We were later informed that the mother was diagnosed as having DKA due to fulminant T1DM after the neonate was born. On admission, laboratory testing of the neonate revealed hypoglycemia, hyperinsulinemia, and hyperkalemia, all of which were induced by the mother's metabolic condition. Intravenous glucose supplementation resolved the neonate's metabolic derangement, and he was discharged on day 10. He showed no neurological abnormalities, but magnetic resonance imaging showed lesions indicating hypoglycemic encephalopathy. Maternal fulminant T1DM and DKA should be considered in neonates with severe metabolic acidosis. Even a neonate who is asymptomatic at birth may rapidly develop severe disease.
BACKGROUND: Prostate cancer (PCa) significantly contributes to male cancer mortality. Triplet therapy shows promise for metastatic castration-sensitive prostate cancer (mCSPC), but real-world data are limited. This study...BACKGROUND: Prostate cancer (PCa) significantly contributes to male cancer mortality. Triplet therapy shows promise for metastatic castration-sensitive prostate cancer (mCSPC), but real-world data are limited. This study aimed to evaluate the clinical outcomes of triplet therapy in real-world patients with mCSPC at an academic hospital in Japan. METHODS: We retrospectively analyzed the efficacy and safety of triplet therapy, comprising androgen deprivation therapy, docetaxel, and darolutamide, in patients with mCSPC at Nippon Medical School Hospital. Clinical outcomes, adverse events (AEs), prostate-specific antigen (PSA) responses, and progression to castration-resistant prostate cancer were assessed. RESULTS: Between January 2023 and June 2024, we identified 14 Japanese patients with mCSPC who received triplet therapy. All patients presented with synchronous high-volume metastases as defined by the CHAARTED criteria. The median follow-up period was 7.9 months. In terms of efficacy, all 14 patients achieved PSA reduction of > 90%, while 13 of them achieved reductions of > 99%. AEs were reported in all patients, with grade 3 or higher AEs occurring in 10 patients. One patient permanently discontinued treatment and 4 patients temporarily interrupted therapy due to AEs. During follow-up, biochemical progression was observed in 2 patients and radiological progression in 2 patients. Subsequent therapies were selected based on each patient's clinicopathological and genetic characteristics, with considerable variability in treatment approaches following progression. CONCLUSIONS: While PSA responses were favorable and tolerability was generally high, progression patterns and subsequent therapies varied widely, highlighting the need for close monitoring and individualized treatment in patients with mCSPC receiving triplet therapy.