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.

Oncologic Outcomes of Patients With Gleason Score 7 and Tertiary Gleason Pattern 5 After Radical Prostatectomy

PURPOSE: We evaluated oncologic outcomes following radical prostatectomy (RP) in patients with a Gleason score (GS) of 7 with tertiary Gleason pattern 5 (TGP5). MATERIALS AND METHODS: We retrospectively reviewed the medical records of 310 patients who underwent RP from 2005 to 2010. Twenty-four patients who received neoadjuvant or adjuvant antiandrogen deprivation or radiation therapy were excluded. Just 239 (GS 6 to 8) of the remaining 286 patients were included in the study. Patients were classified into four groups: GS 6, GS 7 without TGP5, GS 7 with TGP5, and GS 8. We analyzed preoperative clinical factors, postoperative pathological outcomes, and biochemical recurrence (BCR). RESULTS: TGP5 in GS 7 was an independent predictor of primary Gleason pattern 4, tumor volume larger than 10%, positive surgical margin, and lymphovascular invasion. The presence of TGP5 in GS 7 was not associated with BCR-free survival. Subgroup analyses revealed that BCR-free survival did not differ significantly between patients with GS 7 with TGP5 and those with GS 8 (p=0.120). In addition, time to BCR in patients with a higher percentage of TGP5 was shorter than that in patients with a lower percentage of TGP5. TGP5 in GS 7 was not a significant predictive factor for BCR, whereas prostate-specific antigen density and a positive surgical margin were shown to be independent predictors of BCR. CONCLUSIONS: TGP5 in GS 7 was an independent predictor of unfavorable pathologic outcomes. The rate of BCR was similar in GS 7 disease with TGP5 and in GS 8 disease, even though TGP5 was not a significant predictive factor for BCR in Cox proportional hazards models.

Differences in Postoperative Pathological Outcomes between Prostate Cancers Diagnosed at Initial and Repeat Biopsy

PURPOSE: We evaluated the differences in pathological outcomes between prostate cancers (PCas) diagnosed at initial and repeat biopsy. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 287 patients who underwent radical retropubic prostatectomy from 2005 to 2010. We investigated preoperative factors, such as age, serum prostate-specific antigen (PSA), prostate volume (PV), digital rectal examination (DRE) results, biopsy schema, clinical stage, and number of prior biopsies, and postoperative pathological outcomes, including specimen volume, percent tumor volume, Gleason score (GS), tumor bilaterality, pathological stage, positive surgical margin (PSM), lymphovascular invasion (LVI), and perineural invasion (PNI). Patients were then classified into two groups by the number of prior biopsies (initial biopsy vs. repeat biopsy). We compared preoperative factors and postoperative pathological outcomes between the two groups. RESULTS: Of the 287 patients, 246 (85.7%) were diagnosed with cancer at the initial biopsy and 41 (14.3%) at the repeat biopsy. The repeat biopsy group was older (p=0.048), had a larger PV (p=0.009), had a significantly different biopsy schema (p<0.001), and had a lower (<10%) percentage tumor volume (p=0.016). In the multivariate analysis (after adjustment for biopsy schema, age, serum PSA, PV, and DRE), repeat biopsy was not an independent predictor of GS, tumor bilaterality, pathological stage, PSM, LVI, or PNI (p=0.212, 0.456, 0.459, 0.917, 0.991 and 0.827, respectively), but repeat biopsy could predict lower percentage tumor volume (p=0.037). CONCLUSIONS: The pathological outcomes of PCas detected at repeat biopsy were not significantly different from those of PCas detected at initial biopsy except for a lower (<10%) percentage tumor volume.

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.

Prostate Cancer Detection Rate of Rebiopsy in Patients with an Initial Diagnosis of Atypical Small Acinar Proliferation of the Prostate

PURPOSE: Atypical small acinar proliferation (ASAP) denotes the presence of suspicious glands with insufficient cytological architecture for a definitive prostate cancer diagnosis. We evaluated the subsequent prostate cancer detection rate of rebiopsy in patients with an initial diagnosis of ASAP. MATERIALS AND METHODS: Between January 2003 and December 2006, 1,416 men with suspected prostate cancer underwent a transrectal ultrasound-guided prostate biopsy, and 214 (15.1%) were diagnosed as having ASAP. Ninety-five of the 215 patients underwent at least one more biopsy. We evaluated the cancer detection rates after rebiopsy. RESULTS: In men with ASAP, 36 patients (37.9%) had prostate cancer. The cancer detection rates of the 1st, 2nd, and 3rd rebiopsies were 30.5%, 23.8%, and 40%, respectively. Mean patient age and prostate-specific antigen did not differ significantly between the prostate cancer and noncancer groups after rebiopsy. Prostate volume, however, was significantly smaller in the cancer group (p<0.05). CONCLUSIONS: Our results showed a detection rate for prostate cancer of 37.9% after an initial diagnosis of ASAP, which indicates that an initial diagnosis of ASAP mandates rebiopsy.

Docetaxel Chemotherapy of Korean Patients with Hormone-refractory Prostate Cancer: Comparative Analysis between 1st-line and 2nd-line Docetaxel

PURPOSE: This study was undertaken to investigate the outcomes associated with docetaxel treatment of Korean patients with hormone-refractory prostate cancer (HRPC) and to compare its clinical efficacies in 1st and 2nd-line settings. PATIENTS AND METHODS: This study was retrospectively performed and included 47 patients with HRPC. The 1st-line group consisted of 19 patients who had not undergone prior chemotherapy, and the 2nd-line group consisted of 28 patients who underwent prior chemotherapy. All patients were treated with 75mg/m2 IV docetaxel every 3 weeks and 5mg of prednisone twice daily with a continuous androgen blockade. RESULTS: Of 47 study subjects, 14 patients (29.8%) had > or = 50% PSA decline from baseline. PSA response was more common in the 1st-line group, but this was not statistically different (42.1% vs. 21.4%, p = 0.114). After a median follow up of 11 months (range, 6-24 months), the 1st-line group showed a longer time to PSA progression (4 vs. 2 months, p = 0.015) and survival (17 vs. 10 months, p = 0.037) than the 2nd-line group. In terms of toxicities, no difference was apparent between the 2 groups. CONCLUSION: In a 1st-line setting, docetaxel is an effective and tolerable agent for Korean HRPC patients, and that its efficacy is limited, although 2nd-line docetaxel is tolerable.

Partial Nephrectomy using Parenchymal Compression without Renal Pedicle Clamping / 대한비뇨기과학회지

PURPOSE: The hemostasis and closure of the collecting system are still problems to be overcome during a partial nephrectomy. Herein, our initial experience of a parenchymal compression technique, without clamping of the renal pedicle during an open partial nephrectomy, is reported. MATERIALS AND METHODS: Between May 2000 and August 2005, 10 patients underwent an open partial nephrectomy, without pedicle clamping, for a renal mass. The open partial nephrectomy was performed under regional ischemia, which was achieved by parenchymal compression using a long curved vascular clamp. Several parameters were retrospectively assessed, including the tumor size, location, pathology, estimated blood loss, preoperative and postoperative serum creatinine, complications, and tumor recurrence. RESULTS: The mean mass size was 23.8mm, ranging between 12 and 55mm, and the tumors were located in the upper, mid and lower poles in 2, 3 and 4 cases, respectively. Pathological examinations revealed renal cell carcinomas in 6, an angiomyolipoma in 1, and complicated renal cysts in 3 patients. In all the patients with renal cell carcinoma, the frozen and permanent sections analyses confirmed negative margins. There were no differences between the preoperative and postoperative creatinine levels, with no significant complications observed, including urinary leak and bleeding, during the recovery period. No patient developed a local recurrence or distant metastasis during the mean follow-up period of 17.2 months. CONCLUSIONS: This technique is simple, and can be easily practiced by any urological surgeon, without concerns relating to the ischemic time and complications. It is suggested that the regional parenchymal compression is an efficient technique for hemostasis and repair of the collecting system during an open partial nephrectomy.

Adult's Wilms' Tumor Mimicking Renal Pelvis Tumor / 대한비뇨기과학회지

Wilms' tumor is a rare malignant renal tumor in adults and it usually presents as a parenchymal mass that resembles renal cell carcinoma. The authors observed one case of adults Wilms' tumor developing in the renal pelvis and the initial diagnosis was renal pelvis tumor. The patient underwent radical nephroureterectomy with bladder cuff excision and adjuvant chemotherapy with the combination of vincristine and actinomycin. The patient has remained healthy and was without evidence of tumor recurrence on a follow-up CT scan at 18 months postoperatively.

Analysis of Changes in the Total Lymphocyte and Eosinophil Count during Immunotherapy for Metastatic Renal Cell Carcinoma: Correlation with Response and Survival

The aims of this study were to analyze lymphocyte and eosinophil counts in consecutive peripheral blood samples taken during immunotherapy for metastatic renal cell carcinoma (mRCC) and to correlate the findings with objective response and survival. A total of 40 patients with mRCC who received immunotherapy with interleukin-2, interferon-alpha, and 5-fluorouracil were analyzed. Objective responses were observed in 14 patients, including 2 (5%) who showed a complete response (CR) and 12 (30%) who showed a partial response (PR). Eleven patients (27%) achieved stable disease (SD), and 15 patients (38%) had progressive disease (PD). Changes from baseline in the total lymphocyte counts were significantly higher in the responding patients (CR+PR+SD) than in the non-responding patients (PD) (p=0.017), but no difference was seen in the total eosinophil counts (p=0.275). Univariate analysis identified the Eastern Cooperative Oncology Group (ECOG) performance status (p=0.017), the presence of a primary renal tumor (p<0.001) and the peripheral lymphocyte counts at week 4 (p=0.034) as prognostic factors, but a low ECOG performance status (p=0.003) and the presence of a primary renal tumor (p=0.001) were identified as independent poor prognostic factors by multivariate analysis. This study provides further evidence that changes in blood lymphocyte counts may serve as an objective indicator of objective responses.

Comparison of Vaginal Wall Sling and Pubovaginal Fascial Sling in Management of Genunine Stress Urinary Incontinence

No abstract available in English.

A Case of Malignant Pheochromocytoma in Child / 대한비뇨기과학회지

No abstract available.

The Correlation of Valsalva Leak Point Pressure Maximum Urethral Closure Pressure and Urethral Hypermobility according to Symptom Grade in the Diagnosis of Genuine Stres Incontinence

PURPOSE: We evaluated the correlation of Valsalva leak point pressure, maximum urethral closure pressure, and urethral hypermobility in the diagnosis of genuine stress incontinence. MATERIALS AND METHODS: From January 1997 to January 1999, one hundred thirteen patients with genuine stress incontinence had undergone three measures determined in a standardized fashion. We compared three parameters with symptom grades of genuine stress incontinence. RESULTS: Of the total 113 patients, genuine stress incontinence were grade I in 39, II in 43 and III in 31. There were significant difference in the incidence between grade III and grade I or II in Valsalva leak point pressure, maximum urethral closure pressure, and urethral hypermobility(p<0.05). Valsalva leak point pressure was the most significnat correlation with symptom grade(r=0.4), but there were not correlation among Valsalva leak point pressure, maximum urethral closure pressure, and urethral hypermobility in grade III geniune stress incontinence patients and 66.7% of grade III genuine stress incontinence patients had urethral hypermobility. CONCLUSIONS: With these results, Valsalva leak point pressure is good indicator for intrinsic sphincter deficiency. But intrinsic sphincter deficiency should be diagnosed by composites of historic, urodynamic, anatomic, and other clinical factors.

Comparative Evaluation of Abdominal, Transvaginal and Laparoscopic Burch Colposuspension for Genuine Stress Incontinence / 대한비뇨기과학회지

PURPOSE: Burch colposuspension has been used for the treatment of stress urinary incontinence (SUI) with effectiveness. The purpose of this retrospective study was to compare the efficacy among abdominal, transvaginal and laparoscopic Burch colposuspension. We also compared the clinical course and complications after each procedure. MATERIALS AND METHODS: Sixty seven patients underwent Burch colposuspension were evaluated according to their approach methods. All patients were assessed for detailed history, physical examination, urodynamic study, transperineal ultrasonography, operative time, catheter indwelling period, hospital stays, success rate, and complications. RESULTS: The success rates of abdominal, transvaginal and laparoscopic Burch were 90, 86 and 76% respectively, at 26 months follow up. There was no significant complication except for a case of bladder injury in the laparoscopy group. Laparoscopic Burch operation had advantages of less invasive approach, less morbidity, shorter hospital stays and provided successful outcomes in patients with stress urinary incontinence. CONCLUSIONS: With these results, we could conclude that open, transvaginal or laparoscopic Burch operations were effective and safe for SUI with no significant differences of efficacy according to approach methods.

A Case of Low Grade Endometrial Stromal Sarcoma / 대한산부인과학회잡지

A low grade endometrial stromal sarcoma is a rare malignant tumor in woman. We experienced this infrequent malignant tumor in a 36 years old woman showing metas- tasis to both ovaries, omentum, rectum and mesenteric lymph nodes, and she was treated by total abdominal hysterectomy with bilateral salpingo-oophorectomy followed by VAC(vincristi n, actinomycin, cyclophoshamide) chemotherapy. The authors report this case with the clinicopathologic findings and brief review of literature.