High-normal Glucose Levels in Non-diabetic and Pre-diabetic Men Are Associated with Decreased Testosterone Levels / 가정의학회지

BACKGROUND: Testosterone levels are decreased in diabetic patients and recent studies have suggested that high-normal fasting glucose is a risk factor for cardiovascular disease. To further elucidate the relationship between plasma glucose and testosterone, we investigated the association between fasting plasma glucose (FPG) and endogenous sex hormones (serum total testosterone, sex hormone binding globulin, estradiol, and the ratio of testosterone to estradiol) in non-diabetic and pre-diabetic men. METHODS: This study included 388 men (age > or = 40 years) who visited the health promotion center of a university hospital from May 2007 to August 2008. The subjects were divided into quartiles based on their FPG levels and correlation and multiple linear regression analyses were performed. Q1 (65 mg/dL or = 88 mg/dL) had significantly decreased testosterone levels when compared with subjects in the normal FPG group (Q1 with FPG < 88 mg/dL, P < 0.005). Sex hormone binding globulin, estradiol and the ratio of testosterone to estradiol were not correlated with FPG. CONCLUSION: Our study indicates that high-normal fasting glucose levels are associated with decreased testosterone levels in non-diabetic and pre-diabetic men.

The Significance of Repeat Prostate Biopsy for the Detection of Prostate Cancer / 대한비뇨기과학회지

PURPOSE: To evaluate the results of serial prostate biopsy in men with elevated prostate-specific antigen (PSA) levels, where the initial biopsies were negative for cancer. MATERIALS AND METHODS: Between January 2000 and December 2003, 750 men with a serum PSA level of 4.0ng/ml or greater underwent transrectal ultrasound guided needle biopsy of the prostate, with 218 (29.1%) diagnosed as having prostate cancer. Of the other 532 men, 104 (19.5%), whose follow-up PSA level was persistently elevated beyond the normal range, underwent a second biopsy, with 26 (4.9%) undergoing third and subsequent biopsies for the same reason. The cancer detection rates after each biopsy session, and reliable predictors for prostate cancer after the 2nd biopsy in those whose PSA level was in the gray zone, were evaluated. RESULTS: The cancer detection rates of the 1st, 2nd and 3rd biopsies were 29.1, 16.3 and 30.7%, respectively, with 10.3% of the prostate cancers detected in this study missed on the initial biopsy. The detection rate of the second biopsy in gray zone patients was 13.1%, which was comparable to the first biopsy result (12.7%) for the same range group. The median PSA, % free PSA and PSA density were significantly different between the prostate cancer and non-cancer groups after the second biopsy in gray zone patients (p<0.05). CONCLUSIONS: 10.3% of the prostate cancers detected in this study were missed on the initial biopsy. The median PSA, % free PSA and PSA density are reliable predictors of prostate cancer after the second biopsy in gray zone patients.

Malignant Myopericytoma Originated in the Urinary Bladder / 대한비뇨기과학회지

A myopericytoma is a rare benign neoplasm, which shows perivascular growth of the spindle cells and their differentiation to perivascular myoid cells. Several tumors, showing such histological findings, including myopericytomas, glomangiopericytomas, solitary myofibromas and infantile hemangiopericytomas, were previously named hemangiopericytomas. However, they are now regarded as the same group of disease, with similar histological findings. Such tumors usually originate in the subcutaneous tissue of the extremities, but very rarely originate in visceral organs. Until now, only 7 cases originating in the urinary bladder have previously been reported as hemangiopericytomas. Although macroscopically the aspect is benign, it has a recognized ability for local invasion and distant dissemination. Radical surgical excision is the treatment of choice, as adjuvant chemotherapy and radiation therapy offer limited success in this malignancy. A case of a 57 year-old woman with a malignant myopericytoma, originating in the urinary bladder, with extensive lung metastasis, is reported.

Influences of Neoadjuvant Androgen Ablation before Radical Prostatectomy on Positive Surgical Margin and Biochemical Recurrence Rate / 대한비뇨기과학회지

PURPOSE: For patients with a localized prostate cancer, the effects of neoadjuvant hormonal therapy are controversial. We evaluated the resection margin status and progression-free survival in high-risk patients (clinical stage T3 or greater, and/or Gleason score 8 to 10, and/or serum PSA greater than 20ng/ml) who did and did not receive neoadjuvant hormonal therapy prior to radical prostatectomy. MATERIALS AND METHODS: Between May 1995 and May 2003, among patients who underwent radical retropubic prostatectomy for clinically confirmed adenocarcinoma, follow-ups were performed on 110 patients. Twentyeight patients of these received preoperative neoadjuvant hormonal therapy. Sixteen patients received neoadjuvant hormonal ablation among the 43 high-risk patients who were enrolled. Follow-up evaluations measured serum PSA every 3 months for 1 year postoperatively and every 6 months thereafter. Biochemical recurrence was defined as a level of serum PSA of 0.2ng/ml or greater on 2 consecutive evaluations. RESULTS: Thirty-nine patients (35.5%) had positive surgical margins, and 23 patients (20.9%) showed biochemical recurrence. Positive surgical margins were less common in the neoadjuvant hormonal therapy arm (17.9% versus 41.5 %, p=0.019). However, there was no difference in the biochemical recurrence rate during the last follow-up (17.9% versus 22%, p=0.642). Positive surgical margins were less common in the high-risk patients with a neoadjuvant hormonal therapy arm than in the high-risk patients with a radical prostatectomy alone arm (25% versus 66.7%, p=0.008). Also, there was no difference in the biochemical recurrence rate during the last follow-up (45.4% versus 48.1%, p=0.2922). CONCLUSIONS: Although androgen deprivation before radical prostatectomy resulted in an apparently significant decrease in positive surgical margins, there was no difference between the biochemical recurrence rates.

The Efficacy and Safety of Doxazosin GITS in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The doxazosin-gastrointestinal therapeutic system (GITS) greatly minimizes the need for titration by changing the drug-delivery rate and pharmacokinetic profiles. This multi-center study was designed to evaluate the efficacy and safety of doxazosin GITS in patients with BPH when used under the standard usage conditions. MATERIALS AND METHODS: A total of 487 men, aged 40 years or over, with clinical evidence of BPH were enrolled. Demographic profiles were gathered at the baseline and the patients followed up at 4 and 8 weeks for dose adjustment and final assessment of the efficacy, respectively. The efficacy, measured in terms of the International Prostate Symptom Score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax) and post-voiding residual volume were assessed on each visit. RESULTS: On completion of the study, the mean change in the IPSS and QOL from the baseline were -6.9+/-5.7 (p<0.01) and -1.4+/-1.1 (p<0.01), respectively. The Qmax and post-voiding residual volume were significantly improved compared to the baseline (p<0.01). Decreases in the mean systolic and diastolic blood pressures from the baseline in hypertensive patients (n=139) were significantly greater than in normotensive patients (n=309). There were 25 cases (5.1%) among 487 patients in which adverse events, such as dizziness, impotence, dryness of mouth and postural hypotension, were reported. CONCLUSIONS: In treating BPH, doxazosin GITS significantly improved the IPSS, QOL, Qmax and post-voiding residual volume. Doxazosin GITS is a safe and effective drug for the treatment of BPH in Korean men when used in a standard clinical setting.