Does the Time Interval from Biopsy to Radical Prostatectomy Affect the Postoperative Oncologic Outcomes in Korean Men?

BACKGROUND: Prostate cancer (PC) is the second most common type of cancer in men worldwide and the fifth most common cancer among Korean men. Although most PCs grow slowly, it is unclear whether a longer time interval from diagnosis to treatment causes worse outcomes. This study aimed to investigate whether the time interval from diagnosis to radical prostatectomy (RP) in men with clinically localized PC affects postoperative oncologic outcomes. METHODS: We retrospectively analyzed data of 427 men who underwent RP for localized PC between January 2005 and June 2016. The patients were divided into two groups based on the cutoff median time interval (100 days) from biopsy to surgery. The associations between time interval from biopsy to surgery (< 100 vs. ≥ 100 days) and adverse pathologic outcomes such as positive surgical margin, pathologic upgrading, and upstaging were evaluated. Biochemical recurrence (BCR)-free survival rates were analyzed and compared based on the time interval from biopsy to surgery. RESULTS: Pathologic upgrading of Gleason score in surgical specimens was more frequent in the longer time interval group and showed marginal significance (38.8% vs. 30.0%; P = 0.057). Based on multivariable analysis, an association was observed between time interval from biopsy to surgery and pathologic upgrading (odds ratio, 2.211; 95% confidence interval [CI], 1.342–3.645; P = 0.002). BCR-free survival did not differ based on time interval from biopsy to surgery, and significant association was not observed between time interval from biopsy to surgery and BCR on multivariable analysis (hazard ratio, 1.285; 95% CI, 0.795–2.077; P = 0.305). CONCLUSION: Time interval ≥ 100 days from biopsy to RP in clinically localized PC increased the risk of pathologic upgrading but did not affect long-term BCR-free survival rates in Korean men.

Do Positive Surgical Margins Predict Biochemical Recurrence in All Patients Without Adjuvant Therapy After Radical Prostatectomy?

PURPOSE: The objective was to study whether positive surgical margins (PSMs) predict biochemical recurrence (BCR) in all patients without adjuvant therapy after radical prostatectomy (RP). MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who underwent RP for prostate cancer at Veterans Health Service Medical Center from 2005 to 2011. BCR was defined by a prostate-specific antigen (PSA) value > or =0.2 ng/mL. The clinicopathological factors of the PSM group were compared with those of the negative surgical margin (NSM) group, and the predictive impact of a PSM for BCR-free survival were evaluated. In addition, we analyzed the prognostic difference for BCR-free survival between solitary and multiple PSMs. RESULTS: A PSM was noted in 167 patients (45.5%). BCR was reported in 101 men in total (27.5%). The BCR-free survival rate of the PSM group was lower than that of the NSM group (p<0.001). In a multivariate analysis for the total patients, PSM was significantly associated with BCR-free survival (p<0.001). After stratification by pathological T stage, Gleason score (GS), and preoperative PSA value, PSM was significantly predictive for BCR-free survival in men with pT2 and/or GS < or =6 or 7 and/or a PSA value <10 or 10-20 ng/mL (all p<0.05). Multiple PSMs were more predictive of BCR-free survival than was a solitary PSM (p=0.001). CONCLUSIONS: A PSM is a significant predictor of postoperative BCR in patients with pT2 and/or GS < or =7 and/or preoperative PSA <20 ng/mL. Multiple PSMs are considered a stronger prognostic factor for prediction of BCR than is a solitary PSM.

Results of Urine Culture and Antimicrobial Sensitivity Tests According to the Voiding Method Over 10 Years in Patients with Spinal Cord Injury

PURPOSE: We studied the results of urine cultures and antimicrobial sensitivity tests according to the voiding method used by spinal cord injury (SCI) patients over a recent 10-year period. MATERIALS AND METHODS: We retrospectively analyzed 1,236 urine samples and their antimicrobial sensitivity tests for 112 patients who had used only one voiding method between January 2000 and December 2009. The voiding methods were classified into four groups: clean intermittent catheterization (CIC), suprapubic catheterization, urethral Foley catheter, and spontaneous voiding. RESULTS: Of the 1,236 urine samples, 925 (74.8%) were positive and 279 (30.2%) had more than one bacteria. The CIC group showed the lowest rate of bacteriuria, colony counts, and polymicrobial infection (p<0.001). Causative organisms were mostly Gram-negative bacteria (84%), including Pseudomonas aeruginosa (22.9%), Escherichia coli (21.1%), Klebsiella species (6.7%), and Citrobacter species (6.3%). The rate of Gram-positive bacterial infection was 13.6%, and major pathogenic organisms were Streptococcus species (8.6%) and Staphylococcus species (2.6%). Major pathogenic organisms and the results of antimicrobial sensitivity tests differed according to the voiding method. CONCLUSIONS: Although the patient's condition and preferences are important when choosing the method of bladder management, CIC is the best voiding method for reducing urinary tract infections in SCI patients. When immediate use of antibiotics is needed for treatment of urinary tract infections, an appropriate antibiotic can be chosen according to the voiding method on the basis of our study and can be administered before the results of an antimicrobial sensitivity test are available.

Efficacy of Alternative Antiandrogen Therapy for Prostate Cancer That Relapsed after Initial Maximum Androgen Blockade

PURPOSE: We evaluated the effectiveness of second-line maximum androgen blockade (MAB) with an alternative antiandrogen in patients who relapsed after initial MAB. MATERIALS AND METHODS: We retrospectively analyzed 47 patients with prostate cancer who relapsed after initial MAB, including surgical or medical castration combined with antiandrogens, from January 1998 to December 2009. When the serum prostate-specific antigen (PSA) level was increased on three consecutive occasions, we discontinued the antiandrogen and then administered an alternative antiandrogen. Seven patients were assessed for antiandrogen withdrawal syndrome (AWS). The effect of the second-line MAB was evaluated by the serum PSA level, and response was subdivided into > or =50% and or =50% PSA reductions with a mean response duration of 13.4+/-5.4 months. Nine (19.2%) patients reached or =50% PSA reduction group, <50% PSA reduction group, and PSA elevation group was 15.6+/-12.9 months, 11.8+/-6.0 months, and 8+/-6.5 months, respectively. That is to say, it was significantly longer in the responder groups (p=0.038). CONCLUSIONS: Second-line MAB using an alternative antiandrogen is an effective treatment option before cytotoxic chemotherapy in patients who relapse after initial MAB.

Pathologic Results of Radical Prostatectomies in Patients with Simultaneous Atypical Small Acinar Proliferation and Prostate Cancer

PURPOSE: The incidence of adenocarcinoma on a subsequent biopsy following a diagnosis of atypical small acinar proliferation (ASAP) ranges from 34% to 60%. We reexamined radical prostatectomy (RP) specimens of patients diagnosed as having synchronous ASAP with prostate cancer (PCa) to evaluate pathological entities and the clinical significance of ASAP. MATERIALS AND METHODS: From January 2007 to December 2008, a total of 118 patients who had been diagnosed with adenocarcinoma on prostate needle biopsy underwent RP. Forty-six of the 118 patients (39%) were diagnosed as having synchronous ASAP with PCa on the prostate needle biopsy. Using whole-mount sections and prostate mapping, we evaluated the RP specimens that were close sections to the ASAP on prostate needle biopsy. All tissues were examined by immunohistochemistry with high molecular weight cytokeratin (34betaE12), p63, and AMACR/P504S added to initial H&E stains by one pathologist. RESULTS: Thirty-six of the 46 patients (78%) were diagnosed as having adenocarcinoma at sites of ASAP on the initial prostate needle biopsies. The Gleason score was 5 to 6 in 22 patients (61%), 7 in 3 (8%), and unknown due to multifocal and microfocal lesions in 11 (31%). The tumor volume of 14 of the 36 patients (39%) was 0.5 cc or less and was unknown due to multifocal and microfocal lesions in 8 (22%). CONCLUSIONS: Most ASAP on initial prostate needle biopsy was a true pathological entity, in other words, prostatic adenocarcinoma. Aggressive approaches including more extended repeat biopsy with additional biopsy of the site of the ASAP are needed to diagnose PCa in patients with ASAP.

Primary Squamous Cell Carcinoma of the Ureter after Reterocutaneoustomy / 대한비뇨기과학회지

Primary squamous cell carcinomas of the renal pelvis and ureter are rare tumors, accounting for less than 1% of all primary tumors of the upper urinary tract. The ratio of renal pelvis to ureter tumors is approximately 6:1. The pathogenesis is assumed to begin with an urothelial metaplasia, as a result of a reaction to chronic irritation and infection, which lead to dysplasia, and ultimately to a squamous cell carcinoma. Only one case of a squamous cell carcinoma of the ureter has been reported in the Korean literature. We report a case of a primary squamous cell carcinoma of the ureter, as a result of a reaction to chronic irritation and infection in a 48-year-old male patient.

Effect of Finasteride According to the Histological Types of Benign Prostatic Hyperplasia as Predicted by Transrectal Ultrasonography / 대한비뇨기과학회지

PURPOSE: Finasteride is being used as a medical therapy of benign prostatic hyperplasia (BPH), but there are no appropriate selection criteria for finasteride therapy. Our objective was to determine the usefulness of finasteride according to histological nature of the BPH, as determined by the transrectal ultrasonography (TRUS) findings. MATERIALS AND METHODS: Forty-two patients with symptomatic BPH were treated with finasteride (5mg/day) for more than 6 months. The patients were categorized into two groups of 21, according to their TRUS findings: the stromal, and the glandular, component dominant groups. The changes in prostate volume (PV), transition zone volume (TZV) and transition zone index (TZI) of each group, following at least 6 months of finasteride treatment, were evaluated and compared. RESULTS: In the stromal group the PV, TZV and TZI decreased from 69.3 11.5cc to 65.6 9.3cc, 43.5 13.2cc to 40.8 8.8cc and 0.63 to 0.62, respectively, but these changes were not statistically significant. While, in the glandular group, the PV, TZV and TZI decreased from 67.4+/-26.7cc to 56.2+/-25.2cc, 43.9+/-24.9cc to 32.4+/-19.9cc, and 0.63 to 0.54 (P<0.05), respectively. There was a linear correlation, only in the glandular group, between the TZI and TZV reductions following finasteride therapy (R=0.47, p=0.009). CONCLUSIONS: We suggest the prediction of the histological nature of BPH, by TRUS, would be helpful prior to the initiation finasteride treatment for effective reduction in the prostate volume with BPH. The effective reduction in the volume of the prostate in BPH would be possible only in glandular component dominant patients, as discriminated by TRUS.

Early Experience of Intravesical Instillation of Resiniferatoxin (RTX) for Treatment of Detrusor Hyperreflexia in Patients with Spinal Core Injury: Refractoryto Previous Oxybutynin Therapy / 대한비뇨기과학회지

No abstract available.

A Case of Granulomatous Prostatitis after Intravesical BCG Instillatio / 대한비뇨기과학회지

No abstract available.

A Case of Retroperitoneal Liposarcoma / 대한비뇨기과학회지

We report a case of retroperitoneal liposarcoma mimicking lipoma which was found on follow-up studies in a 67-year old man with stomach cancer. Preoperative computerized tomography of abdomen and biopsy confirmed the diagnosis of right retroperitoneal liposarcoma, which was treated with surgery and radiation therapy.