Pathological Characteristics of Prostate Cancer in Men Aged < 50 Years Treated with Radical Prostatectomy: a Multi-Centre Study in Korea

BACKGROUND: Recently, younger prostate cancer (PCa) patients have been reported to harbour more favourable disease characteristics after radical prostatectomy (RP) than older men. We analysed young men (< 50 years) with PCa among the Korean population, paying attention to pathological characteristics on RP specimen and biochemical recurrence (BCR). METHODS: The multi-centre, Severance Urological Oncology Group registry was utilized to identify 622 patients with clinically localized or locally advanced PCa, who were treated with RP between 2001 and 2017. Patients were dichotomized into two groups according to age (< 50-year-old [n = 75] and ≥ 50-year-old [n = 547]), and clinicopathological characteristics were analysed. Propensity score matching was used when assessing BCR between the two groups. RESULTS: Although biopsy Gleason score (GS) was lower in younger patients (P = 0.033), distribution of pathologic GS was similar between the two groups (13.3% vs. 13.9% for GS ≥ 8, P = 0.191). There was no significant difference in pathologic T stage between the < 50- and ≥ 50-year-old groups (69.3% vs. 68.0% in T2 and 30.7% vs. 32.0% in ≥ T3, P = 0.203). The positive surgical margin rates were similar between the two groups (20.0% vs. 27.6%, P = 0.178). BCR-free survival rates were also similar (P = 0.644) between the two groups, after propensity matching. CONCLUSION: Contrary to prior reports, younger PCa patients did not have more favourable pathologic features on RP specimen and showed similar BCR rates compared to older men. These findings should be considered when making treatment decisions for young Korean patients with PCa.

Suppression of Oxidative Stress of Modified Gongjin-Dan (WSY-1075) in Detrusor Underactivity Rat Model Bladder Outlet Induced by Obstruction / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the anti-oxidative stress and preventive effect of modified Gongjin-dan (WSY-1075) in a detrusor underactivity rat model.</p><p><b>METHODS</b>Rats were randomly allocated to three groups: shamoperated (control), bladder outlet obstruction-induced detrusor underactivity (BOO-DU), and BOO-DU with WSY-1075 (WSY) groups. WSY-1075 was orally administrated to rats 200 mg daily for 2 weeks prior to the operation and 4 weeks after the operation. Bladder outlet obstruction was surgically induced in rats by ligation around the urethra avoiding total obstruction. Cystometrography was conducted on rats in each group for examination of bladders.</p><p><b>RESULTS</b>Compared with the control group, bladder outlet obstruction led to a significant increase in oxidative stress with consequent changes to molecular composition, and decrease in maximal detrusor pressure (P<0.05). WSY-1075 treatment significantly suppressed oxidative stress and prevented degenerative and dysfunctional changes in bladder, as compared with BOO-DU group (P<0.05).</p><p><b>CONCLUSION</b>WSY-1075 had beneficial effect on prevention of BOO-DU.</p>

Clinical Efficacy and Safety of Naftopidil Treatment for Patients with Benign Prostatic Hyperplasia and Hypertension: A Prospective, Open-Label Study

PURPOSE: To investigate the efficacy and safety of naftopidil for benign prostatic hyperplasia (BPH) patients, mainly focusing on changes in blood pressure (BP). MATERIALS AND METHODS: Of a total of 118 patients, 90 normotensive (NT) and 28 hypertensive (HT) patients were randomly assigned to be treated with naftopidil 50 mg or 75 mg for 12 weeks, once-daily. Safety and efficacy were assessed by analyzing changes from baseline in systolic/diastolic BP and total International Prostate Symptom Score (IPSS) at 4 and 12 weeks. Adverse events (AEs), obstructive/irritative subscores, quality of life (QoL) score, maximum urinary flow rate (Qmax), and benefit, satisfaction with treatment, and willingness to continue treatment (BSW) questionnaire were also analyzed. RESULTS: Naftopidil treatment decreased mean systolic BP by 18.7 mm Hg for the HT 50 mg group (p86% of all patients agreed to continue their current medications. CONCLUSION: Our results suggest that naftopidil treatment in BPH patients with hypertension allows for optimal management of BP within the normal range.

Effects of Post Biopsy Digital Rectal Compression on Improving Prostate Cancer Staging Using Magnetic Resonance Imaging in Localized Prostate Cancer

PURPOSE: To evaluate the effectiveness of digital rectal-compression immediately after transrectal prostate biopsy (P-bx) for improving the accuracy of prostate cancer (PCa) staging. MATERIALS AND METHODS: Between July 2008 and June 2010, 94 consecutive patients who had a radical prostatectomy were included in our retrospective analysis. The exclusion criteria included a history of previous P-bx and surgery, a biopsy performed in another hospital, a number of biopsy cores different from 12, or a condition interfering with bleeding assessment. The subjects were divided into two groups, compression and non-compression. All enrolled patients took magnetic resonance imaging (MRI) for PCa staging. RESULTS: The compression and non-compression groups were comparable with respect to several baseline characteristics. However, the total hemorrhage score of intraprostatic bleeding was significantly different between the groups, even with adjustment for the time from biopsy to MRI (compression:15.4+/-2.32, non-compression: 24.9+/-2.43, p<0.001). The intra-prostatic cancer location matching rate was higher in the compression group (78.0%) than in the non-compression group (70.2%) (p=0.011). Overall accuracy of staging in compression and non-compression groups was 84.7% and 77.3%, respectively. CONCLUSION: Our results demonstrate that digital rectal compression performed immediately after prostate biopsy to reduce intraprostatic hemorrhage improves the accuracy for detection of PCa using MRI.

The Change of Prostate Cancer Treatment in Korea: 5 Year Analysis of a Single Institution

PURPOSE: We analyzed changes to the trends of prostate cancer management and patient characteristics at a single institute during 5 years due to the significant increase of the prostate cancer incidence and the robotic equipment in Korea. MATERIALS AND METHODS: Prostate cancer patient data from a single institute recorded from 2006 to 2010 were analyzed. Cancer stage, initial treatment modalities, and the pattern of outpatient clinical management were reviewed. RESULTS: Between 2006 and 2010, 386 prostate cancers were newly diagnosed at the institute. The proportion of localized and locally advanced cancer cases increased from 67% in 2006 to 79% in 2010 respectively. Among the treatment choices during follow-up in the out-patients clinic, the proportion of radical prostatectomies increased from 43% in 2006 to 62% in 2010. In contrast, the proportion of hormone therapies decreased from 58% to 37%. For initial treatment choice, radical prostatectomy was chosen for 59% of the patients who were newly diagnosed with cancer during the study period. However, hormone therapy alone was administrated as a primary therapy to 26%. Analysis of the radical prostatectomy subgroup showed that a robot-assisted technique was used in 83% of the patients, and the remaining 17% underwent an open radical prostatectomy. CONCLUSION: As the prostate cancer incidence increased in Korea, the proportion of localized and locally advanced cancer also increased. In addition, the main treatment modality changed from non-surgical treatment to radical prostatectomy.

Is Small Prostate Volume a Predictor of Gleason Score Upgrading after Radical Prostatectomy?

PURPOSE: We aimed to analyze the relationship between prostate volume and Gleason score (GS) upgrading [higher GS category in the radical prostatectomy (RP) specimen than in the prostate biopsy] in Korean men. MATERIALS AND METHODS: We retrospectively analyzed the medical records of 247 men who underwent RP between May 2006 and April 2011 at our institution. Transrectal ultrasound (TRUS) volume was categorized as 25 cm3 or less (n=61), 25 to 40 cm3 (n=121) and greater than 40 cm3 (n=65). GS was examined as a categorical variable of 6 or less, 3+4 and 4+3 or greater. The relationship between TRUS volume and upgrading of GS was analyzed using multivariate logistic regression. RESULTS: Overall, 87 patients (35.2%) were upgraded, 20 (8.1%) were downgraded, and 140 (56.7%) had identical biopsy and pathological Gleason sum groups. Smaller TRUS volume was significantly associated with increased likelihood of upgrading (p trend=0.022). Men with prostates 25 cm3 or less had more than 2.7 times the risk of disease being upgraded relative to men with TRUS volumes more than 40 cm3 (OR 2.718, 95% CI 1.403-8.126). CONCLUSION: In our study, smaller prostate volumes were at increased risk for GS upgrading after RP. This finding should be kept in mind when making treatment decisions for men with prostate cancer that appears to be of a low grade on biopsy, especially in Asian urologic fields.

Easily Removable Ureteral Catheters for Internal Drainage in Children: A Preliminary Report

PURPOSE: We review our experience using a new and easily removable ureteral catheter in patients who underwent complicated ureteral reimplantation. Our goal was to shorten hospital stay and lower anxiety during catheter removal without fear of postoperative ureteral obstruction. MATERIALS AND METHODS: Between April 2009 and September 2010, nine patients who underwent our new method of catheter removal after ureteral reimplantation were enrolled. Patients who underwent simple ureteral reimplantation were excluded from the study. Following ureteral reimplantation, a combined drainage system consisting of a suprapubic cystostomy catheter and a ureteral catheter was installed. Proximal external tubing was clamped with a Hem-o-lok clamp and the rest of the external tubing was eliminated. Data concerning the age and sex of each patient, reason for operation, method of ureteral reimplantation, and postoperative parameters such as length of hospital stay and complications were recorded. RESULTS: Of the nine patients, four had refluxing megaureter, four had a solitary or non-functional contralateral kidney and one had ureteral stricture due to a previous anti-reflux operation. The catheter was removed at postoperative week one. The mean postoperative hospital stay was 2.4 days (range 1-4 days), and the mean follow-up was 9.8 months. None of the patients had postoperative ureteral obstructions, and there were no cases of migration or dislodgement of the catheter. CONCLUSION: Our new method for removing the ureteral catheter would shorten hospital stays and lower levels of anxiety when removing ureteral catheters in patients with a high risk of postoperative ureteral obstruction.

Practice Patterns of Korean Urologists for Screening and Managing Prostate Cancer according to PSA Level

PURPOSE: There are still debates on the benefit of mass screening for prostate cancer (PCA) by prostate specific antigen (PSA) testing, and on systemized surveillance protocols according to PSA level. Furthermore, there is a paucity of literature on current practice patterns according to PSA level in the Korean urologic field. Here, we report the results of a nationwide, multicenter, retrospective chart-review study. MATERIALS AND METHODS: Overall 2122 Korean men (>40 years old, PSA >2.5 ng/mL) were included in our study (from 122 centers, in 2008). The primary endpoint was to analyze the rate of prostate biopsy according to PSA level. Secondary aims were to analyze the detection rate of PCA, the clinical features of patients, and the status of surveillance for PCA according to PSA level. RESULTS: The rate of prostate biopsy was 7.1%, 26.3%, 54.2%, and 64.3% according to PSA levels of 2.5-3.0, 3.0-4.0, 4.0-10.0, and >10.0 ng/mL, respectively, and the PCA detection rate was 16.0%, 22.2%, 20.2%, and 59.6%, respectively. At a PSA level >4.0 ng/mL, we found a lower incidence of prostate biopsy in local clinics than in general hospitals (21.6% vs. 66.2%, respectively). A significant proportion (16.6%) of patients exhibited high Gleason scores (> or =8) even in the group with low PSA values (2.5-4.0 ng/mL). CONCLUSION: We believe that the results from this nationwide study might provide an important database for the establishment of practical guidelines for the screening and management of PCA in Korean populations.

Are Men Who Undergo Radical Prostatectomy with Lower Urinary Tract Symptoms at an Increased Risk for Aggressive Prostate Cancer?

PURPOSE: We aimed to determine whether prediagnostic lower urinary tract symptoms (LUTS) are associated with the aggressiveness of nonmetastatic prostate cancer (PCa) and compared the clinicopathologic features of PCa patients with and without preexisting LUTS. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 295 prostate cancer patients who underwent a radical prostatectomy (RP) by a single surgeon from 2006 to 2010. A total of 205 patients were assigned to two groups according to whether they showed preoperative LUTS (International Prostate Symptom Score [IPSS]> or =8). Clinical, operative, pathologic, and postoperative functional data were collected. RESULTS: The mean age at RP was 62.7 years in the no LUTS group (group A, n=108) and 64.7 in the LUTS group (group B, n=97). The baseline mean IPSS score was 6.1 in group A and 14.6 in group B (p=0.029). The incidence of pathologic T3a stage or above was significantly higher in group B than in group A (p=0.036). The mean postoperative follow-up period was 16.8 months (range, 4 to 38 months). The mean time to biochemical recurrence was 16.9 and 18.2 months in groups A and B, respectively (p=0.148). The median time to recovery of urinary incontinence was 3.6 and 3.3 months in groups A and B, respectively. CONCLUSIONS: PCa patients without baseline LUTS had a favorable result of pathologic T stage even though there were no significant differences in biochemical recurrence or recovery of postoperative incontinence compared with patients with baseline LUTS.

Clinical Features of Familial or Hereditary Prostate Cancer in Korean Men: A Pilot Study

PURPOSE: There are few data regarding the epidemiology of hereditary or familial prostate cancer (PCa) in East Asians, especially in Korean men. Therefore, we evaluated the incidence of familial and hereditary PCa and the relation between socioeconomic status and the incidence of nonsporadic prostate cancer (NSPC). MATERIALS AND METHODS: We collected data from all patients who were treated for PCa at our center between November 2009 and January 2010. All patients were either newly diagnosed or had been diagnosed with PCa and seen as outpatients during the study period. RESULTS: In a sample of 218 patients with PCa; 25 (11.5%) were NSPC patients, and 193 (88.6%) were sporadic PCa sporadic prostate cancer (SPC) patients. Overall, 11.5% of the patients had a positive family history. There was one hereditary PCa family (three patients, 1.4%) and 11 familial PCa families (22 patients, 10.1%). Patients were divided into three different age groups. Of these, 18 (9.3%) SPC patients and 6 (24%) NSPC patients were diagnosed with the disease at the age of 55 years or younger (p=0.02). Prostate-specific antigen (PSA) levels in the NSPC group were significantly higher than in the SPC group (7.2+/-3.2 versus 6.3+/-4.9 ng/ml, p=0.042). SPC patients had larger waist circumferences than did NSPC patients (p=0.041). There were no significant differences between the SPC and NSPC groups in terms of socioeconomic status, Gleason score, pathological stage, or pathologic Gleason grade. CONCLUSIONS: East Asian NSPC patients are diagnosed at earlier ages than are SPC patients, even though the incidence of NSPC in the East Asian population is lower than in Western men.

Incidentally Detected Inguinoscrotal Bladder Hernia

The bladder is involved in less than 4% of inguinal hernias. Inguinoscrotal bladder hernias are difficult to diagnose, and less than 7% are diagnosed preoperatively. Inguinoscrotal bladder hernias are usually asymptomatic. However, they can result in significant complications, such as bladder necrosis or acute renal failure. Accurate diagnosis is crucial to avoid bladder injury during surgery and other complications. Here we report the case of a 64-year-old man who presented with a scrotal mass. Ultrasonography of the scrotal mass showed a nonspecific cystic mass. During surgery, the mass was revealed to be a herniated bladder.

Impact of a Retrotrigonal Layer Backup Stitch on Post-Prostatectomy Incontinence

PURPOSE: To evaluate the impact of a retrotrigonal layer backup stitch (RTBS) during robot-assisted laparoscopic radical prostatectomy (RALP) on post-prostatectomy incontinence. MATERIALS AND METHODS: We compared the difference in continence recovery between 94 patients (group 1, as historical controls) and 57 patients (group 2). The only technical difference between our two groups was the incorporation of the retrotrigonal layer into the posterior aspect of the vesicourethral anastomosis (group 1: without RTBS; group 2: with RTBS). Postoperative continence recovery was defined as the use of no absorbent pads. RESULTS: In group 1, the continence rate at 3, 6, and 12 months postoperatively was 40.4%, 70.2%, and 90.4%, respectively;in group 2, the continence rate was 42.1%, 70.1%, and 89.7%, respectively. The median (95% confidence interval) time to continence recovery was four months (range, 1 to 12 months) in group 1 and four months (range, 1 to 9 months) in group 2. Kaplan-Meier curves showed no significant difference in the recovery of continence between the two groups (log rank test, p=0.629). CONCLUSIONS: A RTBS does not appear to improve urinary incontinence after RALP. Further anatomical study and prospective randomized studies will be needed to confirm this.