Bcl-2 as a Predictive Factor for Biochemical Recurrence after Radical Prostatectomy: An Interim Analysis / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The objective of this study was to determine Bcl-2 expression in localized prostate cancer and its potential role as a predictive factor for biochemical recurrence (BCR). MATERIALS AND METHODS: This study included 171 Korean patients with newly diagnosed adenocarcinoma of the prostate who underwent radical prostatectomy (RP) without neoadjuvant therapy at a single center between February 2005 and May 2009. RP specimens obtained from these patients were analyzed for the expression of Bcl-2 using tissue microarray. The values of Bcl-2 and other clinicopathologic factors were evaluated. Statistical analysis was performed with contingency table analysis, chi-square tests, and a Cox proportional hazard model. RESULTS: Bcl-2 expression was immunohistologically-confirmed in 42 patients (24.6%). Bcl-2 expression was not associated with conventional clinicopathologic factors. Bcl-2 negative patients had a significantly longer mean BCR-free survival than Bcl-2-positive patients (p=0.036). Among several variables, a high Gleason score in the RP specimen (> or =8), extraprostatic extension, seminal vesicle invasion (SVI), lymphovascular invasion (LVI), and Bcl-2 expression were significant predictors of BCR based on univariate analysis. Multivariate Cox proportional hazards analysis revealed that BCR was significantly associated with a high prostate specific antigen level (p=0.047), SVI (p<0.001), a positive surgical margin (p=0.004) and Bcl-2 expression (p=0.012). CONCLUSION: Bcl-2 expression in RP specimens is associated with a significantly worse outcome, suggesting a potential clinical role for Bcl-2. Post-operative Bcl-2 could be a significant predictor of outcome after RP.

Prostate Specific Membrane Antigen mRNA in Blood as a Potential Predictor of Biochemical Recurrence after Radical Prostatectomy

We investigated whether the detection of prostate specific membrane antigen (PSMA) in blood preoperatively has predictive value for biochemical recurrence (BCR) after radical prostatectomy in patients with prostate cancer. All 134 patients scheduled to receive radical prostatectomy for prostate cancer were prospectively enrolled. The authors used nested reverse transcriptase-polymerase chain reaction (RT-PCR) assay to detect PSMA mRNA-bearing cells in peripheral blood, and analyzed the ability of PSMA mRNA positivity to predict BCR after surgery. PSMA-mRNA was detected in 24 (17.9%) patients by RT-PCR. Over a median follow-up of 20 months (range, 3 to 46 months), BCR developed in 15 patients (11.2%) and median time to BCR was 7 months (range, 3 to 25 months). Kaplan-Meier analysis revealed a significant difference between those positive or negative for PSMA in terms of recurrence-free actuarial probability (log rank P=0.0039). Multivariate analysis showed that positivity for PSMA mRNA (HR: 3.697, 95% CI 1.285-10.634, P=0.015) and a biopsy Gleason score of > or =7 (HR: 4.500, 95% CI 1.419-14.274, P=0.011) were independent preoperative predictors of BCR. The presence of PSMA mRNA in peripheral blood can be used to predict BCR after radical prostatectomy.

Efficacy of the Stone Cone for Treatment of Proximal Ureteral Stones: an Initial Clinical Experience / 대한비뇨기과학회지

PURPOSE: Due to the recent trend of performing ureteroscopic removal of stone (URS) for treating upper ureter stones, stone migration into renal pelvis and calices has increased the morbidity and the need for auxillary procedures. The Stone Cone is a device that prevents stone migration during URS. We report here our initial experience of using the Stone Cone during the treatment of upper ureteral stones. MATERIALS AND METHODS: From February 2005 till May 2005, we treated fifteen consecutive patients who were suffering with upper ureteral stones by using the Stone Cone and performing semi-rigid ureteroscopy and pneumatic lithoclast. Pneumatic lithotripsy was done in 11 patients and the remaining 4 cases were treated by using a stone basket and forceps. RESULTS: The Stone Cone was successfully placed in all 15 cases. In 13 patients, it was placed via cystoscopy under fluroscopic guidance, while 2 patients with 2 impacted stones required ureteroscopic placement. No patients had residual fragments greater than 3mm and they didn't require auxiliary procedures. CONCLUSIONS: The Stone Cone is a new device that prevents stone migration and allows safe extraction of fragments during URS. This study shows that the success rate of URS for proximal ureteral stones was 100% with using the Stone Cone.

The Varying Success of Ureteroscopic Removal of Stone (URS) in Relation to the Different Locations and Sizes of Upper Ureter Stones / 대한비뇨기과학회지

PURPOSE: There has been a recent trend of using ureteroscopic removal of stone (URS) for treating upper ureter stones, due to its safety and success rate; therefore we attempted to find the varying success of URS for different locations and sizes of upper ureter stone. MATERIALS AND METHODS: 107 patients with upper ureter stones, who were treated with URS in our hospital, between January 2000 and May 2005, were retrospectively reviewed. The patients were classified into three groups according to the locations (named L3, L4 and L5) and sizes ( or=10mm) of the upper ureter stones. RESULTS: The overall success rate of URS was 71.0%. With regard to the three locations, L3 had a 46.3% success rate, while L4 and L5 had success rates of 76.9 and 92.5%, respectively. The success rates of URS were significantly higher in L4 and L5 locations compared with that in L3 (p<0.05). In addition, the success rates of URS for stones equal to or larger than 10mm and less than 10mm were 59.5 and 78.5%, respectively, with the former being significantly lower than the latter (p=0.036). CONCLUSIONS: The success rates of URS were significantly higher when the location of upper ureter stones was lower than L4 and when the size of the stone was less than 10mm. Therefore, both the location and size of the stones are important factors potentially influencing the outcome of URS for upper ureter stones.

Primary Localized Amyloidosis of the Ureter Associated with Osseous Metaplasia / 대한비뇨기과학회지

Since localized amyloid deposits of the ureter were first described by Lehmann in 1937, approximately 90 cases have been reported. Isolated primary amyloidosis of the ureter is a rare disease, and its diagnosis cannot be made by radiologic findings. Because of radiographic similarity to transitional cell carcinoma, these lesions are often clinically mistaken for malignancies, and nephroureterectomy is usually performed. Here, we report a case of localized ureteral amyloidosis with osseous metaplasia, which was managed successfully by renal sparing segmental resection with the bladder Boari flap.

Multiple Organ Involvement of Lymphoepithelioma-Like Carcinoma in the Kidney and the Ureter / 대한비뇨기과학회지

A lymphoepithelioma-like carcinoma is a tumor with morphological features identical to an undifferentiated nasopharyngeal carcinoma that occurs outside the nasopharynx. This kind of tumor has been found in the salivary gland, stomach, lung, thymus, bladder, prostate, vagina and skin, but is particularly rare in the urinary tract. We report a case of a lymphoepithelioma-like carcinoma, which are usually found simultaneously in the kidneys and ureter. This is the first case of multiorgan involvement of this tumor.

Primary Transitional Cell Carcinoma of Female Urethra Treated with Anterior Pelvic Exenteration / 대한비뇨기과학회지

Primary urethral carcinoma in females is a relatively rare disease representing only 0.02% of all types of cancer in women. Primary transitional cell carcinoma of the female urethra is about 20% of all female urethral cancer. We report a case of primary transitional cell carcinoma of the female urethra treated with anterior pelvic exenteration in an 80-year-old woman.