Is Prostate Biopsy Essential to Diagnose Prostate Cancer in the Older Patient with Extremely High Prostate-Specific Antigen?

PURPOSE: The results of all prostate biopsies may be positive and suggestive of adenocarcinoma in patients with prostate-specific antigen (PSA) values higher than 100 ng/ml. We considered that the prostate cancer in patients with high PSA might be advanced disease and therefore that the treatment strategy should not be changed according to pathological reports. Thus, we assessed the role of prostate biopsy when diagnosing prostate cancer in patients with extremely high PSA levels. MATERIALS AND METHODS: We reviewed the records of 1,150 cases undergoing prostate biopsies. Patients with urinary tract infection and acute urinary retention were excluded. According to the pre-biopsy PSA level, patients were divided into 6 groups (group A, 4 to 20 ng/ml; B, 20 to 40 ng/ml; C, 40 to 60 ng/ml; D, 60 to 80 ng/ml; E: 80 to 100 ng/ml; and F, above 100 ng/ml). RESULTS: The calculated positive predictive value (PPV) for prostate cancer was 22% in group A, 54% in group B, 73% in group C, 75% in group D, 89% in group E, and 100% in group F, respectively. Pathological diagnosis was adenocarcinoma in all patients in group F (n=56). Among them, 38 patients (67.9%) had lymph node metastasis or extra-prostatic disease or both and 43 patients (76.8%) had bony metastasis. In group F, all cases were advanced prostate cancer (stage III or IV). All of them received hormonal therapy following diagnosis. CONCLUSIONS: We suggest the possibility for biopsy-free diagnosis of prostate cancer in patients with extremely high levels of serum PSA and evidence of advanced disease in imaging studies, especially in older patients with comorbid medical problems.

A Case of Robot-Assisted Laparoscopic Radical Prostatectomy in Primary Small Cell Prostate Cancer

Primary small cell carcinoma of the prostate is a rare and very aggressive disease with a poor prognosis, even in its localized form. We managed a case of primary small cell carcinoma of the prostate. The patient was treated with robot-assisted laparoscopic radical prostatectomy and adjuvant chemotherapy. Herein we report this first case of robot-assisted laparoscopic radical prostatectomy performed in a patient with primary small cell carcinoma of the prostate.

Differences in Circulating Dendritic Cell Subtypes in Pregnant Women, Cord Blood and Healthy Adult Women

Different subtypes of dendritic cells (DC) influence the differentiation of naive T lymphocytes into T helper type 1 (Th1) and Th2 effector cells. We evaluated the percentages of DC subtypes in peripheral blood from pregnant women (maternal blood) and their cord blood compared to the peripheral blood of healthy non pregnant women (control). Circulating DC were identified by flow cytometry as lineage (CD3, CD14, CD16, CD19, CD20, and CD56)-negative and HLA-DR-positive cells. Subtypes of DC were further characterized as myeloid DC (CD11c+/CD123+/-), lymphoid DC (CD11c-/CD123+++) and less differentiated DC (CD11c-/CD123+/-). The frequency of DC out of all nucleated cells was significantly lower in maternal blood than in control (P<0.001). The ratio of myeloid DC/lymphoid DC was significantly higher in maternal blood than in control (P<0.01). HLA-DR expressions of myeloid DC as mean fluorescence intensity (MFI) were significantly less in maternal blood and in cord blood than in control (P<0.001, respectively). The DC differentiation factors, TNF-alpha and GM-CSF, released from mononuclear cells after lipopolysaccharide stimulation were significantly lower in maternal blood than in control (P<0.01). The distribution of DC subtypes was different in maternal and cord blood from those of non-pregnant women. Their role during pregnancy remains to be determined.

Combined Chemoradiation of Advanced Pancreatic Cancer / 대한암학회지

PURPOSE: This study was designed to evaluate the survival rate and prognostic factor of patients with advanced pancreatic cancer who received chemoirradiation. MATERIAL AND METHODS: From March 1993 to November 1995, twenty patients with unresectable pancreatic cancer were treated at the Department of Therapeutic Radiology, St Mary's Hospital, Catholic University Medical College. There were 11 men and 9 women. Age at diagnosis ranged from 34 to 75 years. All patient were treated according to a protocol consisting of 40 Gy external radiation by split course concomitant with intravenous 5-fluorouracil (5-FU) 500 mg/m2 given in a bolus injection 4 hours before radiatian on each of the first 3 days of each treatment course. Among them, 5 patients received incomplete radiotherapy. The follow-up period ranged from 1.3 to 29 months. RESULTS: In all the patients, median survival is 5.0 months and one and two-year overall survival rate was 34.3% and 25.8%, respectively. Median survival was 9.0 months and one-year survival rate was 33.3% in 15 patients with complete radiotherapy. The significant prognostic factors were stage, tumor location, and completion of chemoradio- therapy(p < 0.05). CONCLUSION: A combination of radiotherapy and chemotherapy resulted in improved median survival. However, the significant prognostic factars affecting survival rate in this analysis need to be verified further through randomized trial.

Effects of Adjuvant Radiation Therapy and Chemotherapy Following Curative Surgery in Locally Advanced Rectal Cancer / 대한치료방사선과학회지

PURPOSE: To evaluate the effect of postoperative adjuvant radiation therapy and chemotherapy on the survival, pattern of failure and complication for locally advanced rectal carcinoma MATERIALS AND METHODS: From October 1992 to September 1995, twenty eight patients with rectal carcinoma were treated by postoperative adjuvant radiation therapy and chemotherapy. Radiation therapy was delivered with 6MV and 15MV linear accelerator, 180cGy fractions 5 day per week. Total radiation doses were 5040cGy in B2+3 and 5580cGy in C2+3. Within 4 weeks after radical surgery, 5-FU(400mg/m2/day) and Leucovorin(20mg/m2/day) were administered by intravenous injection for 4 days during the first and fifth week of radiation therapy. The median follow up was 19 months with a range 2 to 47 months. RESULTS: The 2 year overall survival and disease free survival rates were 78.6% and 70.8%, respectively. The 2 year overall survival was 93.0% in B2+3 and 76.2% in C2+3(p=0.11). The 2 year disease free survival was 79.4% in B2+3 and 69.2% in C2+3(p=0.13). The overall failure rate was 21.4%(6/28) including 10.7%(3/28) locoregional recurrence, 3.6%(1/28) distant metastasis and 7.1%(2/28) locoregional recurrence with distant metastasis. The overall locoregional recurrence rate was 17.9%(5/28). The 2 year locoregional recurrence rates were 13.3%(2/15) and 23.1%(3/13) for respectively for B2+3 and C2+3. The difference between the locoregional recurrence of B2+3 and C2+3 patients was not significant(p=0.07). Complications developed in 13 patients(46.4%), including 8 dermatitis, 7 loose stool, 6 leukopenia, 4 tenesmus, 2 diarrhea. In Univariate analysis, there was no statistically significant factor except for tumor grade in locoregional recurrence, disease free survival and overall survival rate(p=0.04, 0.05, 0.04). CONCLUSION: This study suggests that postoperative adjuvant radiation therapy and chemotherapy is effective in patients with locally advanced rectal cancer. Therefore these results need to be confirmed with a long term follow-up and larger number of patients with the further clinical trials including prospective controlled studies.

Effects of Postoperative Radiation Therapy for Prevention of Keloids and Hypertrophic Scars / 대한치료방사선과학회지

PURPOSE: To evaluate the effects of surgical excision followed by radiation therapy for prevention of keloids and hypertrophic scars. MATERIALS AND METHODS: From October 1987 to April 1995, radiation therapy was applied to 167 sites in 106 patients with surgical excision in an attempt to prevention of recurrence against keloids and hypertrophic scars. The main etiology of the keloids and hypertrophic scars were surgery in 49.2%, trauma in 25.0%, ear-piercing in 5.4%, and burn in 5.4%. The patients' ages ranged from 3 to 70 years with a median of 32 years. Radiation therapy used ranged from 6 to 8MeV electron beam. Radiation therapy was delivered within 24 hours of surgical excision. Several dose schedules were used, varing from 400cGy in 1 daily fraction to 1900cGy in 4 daily fractions. The average total dose was 1059cGy, and the average dose per fraction was 433cGy. All patients were followed up from 24 to 114 months with a median follow up of 49 months. RESULTS: The overall recurrence rate was 12.6% (21/167). The overall 1-year and 2-year recurrence rates were 10.2% and 11.4%, respectively. Among 21 recurrent sites, seventeen sites (81%) were confirmed within 12 months after surgical excision. Period to recurrence ranged from 1 month to 47 months with a median recurrence time of 9.6 months. The history of previous therapy was only a significant factor in recurrence. Twenty-four patients had history of previous therapy, recurrence rates was significantly higher in this group than those without history of previous therapy (22.6% vs. 11.0%, P=0.04). There was no serious complication related to radiation therapy. CONCLUSION: This study suggests that surgical excision followed by radiation therapy is an effective method of preventing keloids and hypertrophic scars.

The Result of Radiotherapy in Esophageal Carcinoma / 대한치료방사선과학회지

During the period between March 1983 and December 1990, 74 patients with esophageal carcinoma(EC) were treated with radiation therapy(RT) at the Department of Therapeutic Radiology, Kangnam St. Mary's Hospital, Catholic University Medical College. Of these, 6 patients were lost to follow-up, and 13 patients were interrupted. So the remaining 55 patients were analyzed, retrospectively. 32 patients were irradiated with curative aim, 12 patients with palliative intent, 10 patients postoperatively, and 1 patient pre- and post-operatively. Among these 55 patients, 28 patients were treated with chemoradiation modality, and 27 patients with RT alone. All patients were followed for a minimum of 20 months or Hntil death. of 32 patients irradiated by curative aim, 22 patients(69%) showed partial remission (PR), 6 patients(19%) complete remission(CR). Overall mean survival and two-year survival rate were 15.6 months and 22%. With respect to sex, age, pathologic differentiation, tumor location, tumor size, stage, RT aim, RT response, RT dose, use of chemotherapy and functional categories(FC) of dysphagia at initiation of RT and at finishing RT : Tumor size, stage, RT response had great influences on prognosis and FC at finishing RT had a slight influence on prognosis. Especially, the mean survival and 2-year survival rate in patients with postoperative RT were 24.7 months and 63%, which could be compared with 29.1 months and 43% in radically treated patients with CR. And the mean survival duration and 2-year survival rate in patients irradiated with doses more than 60 Gy were 22.4 months and 29%, and 50~60 Gy were 12.2 months and 12%, respectively. However, no significant difference was shown statistically. Among 12 patients treated with palliative intent, 9 patients (75%) had good improvement in dysphagia and the mean duration of palliative response was 10.6 months.