Initial Biopsy Outcome Prediction in Korean Patients-Comparison of a Noble Web-based Korean Prostate Cancer Risk Calculator versus Prostate-specific Antigen Testing

We developed and validated a novel Korean prostate cancer risk calculator (KPCRC) for predicting the probability of a positive initial prostate biopsy in a Korean population. Data were collected from 602 Koreans who underwent initial prostate biopsies due to an increased level of prostate-specific antigen (PSA), a palpable nodule upon digital rectal examination (DRE), or a hypoechoic lesion upon transrectal ultrasound (TRUS). The clinical and laboratory variables were analyzed by simple and multiple logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was computed to compare its performance to PSA testing alone. Prostate cancer was detected in 172 (28.6%) men. Independent predictors included age, DRE findings, PSA level, and prostate transitional zone volume. We developed the KPCRC using these variables. The AUC for the selected model was 0.91, and that of PSA testing alone was 0.83 (P < 0.001). The AUC for the selected model with an additional dataset was 0.79, and that of PSA testing alone was 0.73 (P = 0.004). The calculator is available on the website: http://dna.korea.ac.kr/PC-RISC/. The KPCRC improved the performance of PSA testing alone in predicting the risk of prostate cancer in a Korean population. This calculator would be a practical tool for physicians and patients.

Effect of Testosterone Replacement Treatment in Testosterone Deficiency Syndrome Patients with Metabolic Syndrome

PURPOSE: This study was conducted to investigate the effect of testosterone replacement treatment (TRT) in testosterone deficiency syndrome (TDS) patients with metabolic syndrome. MATERIALS AND METHODS: We reviewed the data of 200 men who were diagnosed with TDS and were undergoing TRT between August 2006 and August 2009. The 200 patients were divided into two groups (group 1: 71 patients with metabolic syndrome, group 2: 129 patients without metabolic syndrome) depending on metabolic syndrome, which was diagnosed according to the NCEP III criteria for Asians. Age, BMI (body mass index), waist circumference, serologic tests, AMS (the Aging Males' Symptoms scale), and IIEF (International Index of Erectile Function) were measured. RESULTS: In group 1, waist circumference and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the somatovegetative scale score of the AMS, the total AMS score, the erectile function score of the IIEF, the overall satisfaction score of the IIEF, and the total IIEF score were significantly improved after TRT. On the other hand, in group 2, waist circumference, BMI, total cholesterol, LDL, and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the 2 subscale scores of the AMS (psychologic and somatovegetative), the total AMS score, all subscale scores of the IIEF, and the total IIEF score were significantly improved after TRT. CONCLUSIONS: Overall, the patients who had TDS with metabolic syndrome showed less improvement in AMS, IIEF, and serum variables. Therefore, the correction of metabolic syndrome, such as diabetes, obesity, and hypertension, should be considered during TRT.

Effect of Testosterone Replacement Treatment in Testosterone Deficiency Syndrome Patients with Metabolic Syndrome

PURPOSE: This study was conducted to investigate the effect of testosterone replacement treatment (TRT) in testosterone deficiency syndrome (TDS) patients with metabolic syndrome. MATERIALS AND METHODS: We reviewed the data of 200 men who were diagnosed with TDS and were undergoing TRT between August 2006 and August 2009. The 200 patients were divided into two groups (group 1: 71 patients with metabolic syndrome, group 2: 129 patients without metabolic syndrome) depending on metabolic syndrome, which was diagnosed according to the NCEP III criteria for Asians. Age, BMI (body mass index), waist circumference, serologic tests, AMS (the Aging Males' Symptoms scale), and IIEF (International Index of Erectile Function) were measured. RESULTS: In group 1, waist circumference and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the somatovegetative scale score of the AMS, the total AMS score, the erectile function score of the IIEF, the overall satisfaction score of the IIEF, and the total IIEF score were significantly improved after TRT. On the other hand, in group 2, waist circumference, BMI, total cholesterol, LDL, and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the 2 subscale scores of the AMS (psychologic and somatovegetative), the total AMS score, all subscale scores of the IIEF, and the total IIEF score were significantly improved after TRT. CONCLUSIONS: Overall, the patients who had TDS with metabolic syndrome showed less improvement in AMS, IIEF, and serum variables. Therefore, the correction of metabolic syndrome, such as diabetes, obesity, and hypertension, should be considered during TRT.

The Effect of the Partial Obstruction Site of the Renal Vein on Testis and Kidney in Rats: Is the Traditional Animal Model Suitable for Varicocele Research?

One of the authors' names was included by mistake. The author list should be corrected as follows. Corrected Author List: Ki Won Ko, Soo Woong Kim, Du Geon Moon, Je Jong Kim, Duck Ki Yoon, Jae Young Park

The Effect of the Partial Obstruction Site of the Renal Vein on Testis and Kidney in Rats: Is the Traditional Animal Model Suitable for Varicocele Research?

PURPOSE: We investigated the influence of the location of the partial renal vein obstruction on the left kidney, the bilateral testes, and cauda epididymal sperm quality and determined whether this animal model is suitable for varicocele study. MATERIALS AND METHODS: A total of 25 adult male Sprague-Dawley rats were assigned to three groups: group 1 (experimental varicocele by partial ligation medial to the internal spermatic vein for 8 weeks, n=8), group 2 (partial ligation lateral to the internal spermatic vein for 8 weeks, n=10), and group 3 (sham operation for 8 weeks, n=7). Rats in groups 1, 2, and 3 underwent a left nephrectomy and bilateral orchiectomy at 8 weeks after the operation. Histological changes and Johnsen score in both testes were analyzed. Fibrotic changes in the left kidney were assessed by quantitative image analysis. Numbers of sperm and proportions of motile sperm in the cauda epididymides were determined. RESULTS: Significant histological abnormalities and Johnsen score changes were observed in the testes in group 1. Renal fibrosis did not differ significantly among the groups. The proportions of motile sperm were significantly lower bilaterally in group 1 than in groups 2 and 3. However, the mean bilateral epididymal sperm count in group 1 was not significantly lower than in groups 2 and 3. CONCLUSIONS: Our results showed that experimental varicocele in the rat, induced by partial ligation medial to the internal spermatic vein, influences epididymal sperm quality without harmful effects on the left kidney. The present study certifies that this traditional animal model is suitable for varicocele research.

Efficacy of Parenchymal Compression in Open Partial Nephrectomies: A Comparison with Conventional Vascular Clamping

PURPOSE: We evaluated the efficacy of parenchymal compression in open partial nephrectomies (OPNs) compared with that of the conventional vascular clamping method. MATERIALS AND METHODS: OPNs were conducted by means of the parenchymal compression technique at our institution from April 2006. Among these, the operative outcomes of 20 consecutive patients with normal preoperative renal function (Group 1) were matched with those of 20 control patients from the database of previous operations who underwent OPN with a conventional vascular clamping method (Group 2). RESULTS: All preoperative characteristics were similar in both groups. The operative time was significantly higher for Group 2 (132.4+/-17.7 vs. 151.4+/-21.4 minutes, p=0.031). Estimated blood loss was slightly higher for Group 2, with marginal statistical significance (173.7+/-11.5 vs. 211.2+/-43.8 ml, p=0.06). Histologic examination revealed that over 80% of the tumors in both groups were renal cell carcinomas. For all patients, the pathology results of specimens were negative. Serum creatinine, checked at 1, 3, and 7 days after the operation, was significantly increased in both groups to a similar degree. However, 30 days after surgery, the patterns of serial serum creatinine levels demonstrated statistically significant differences by repeated-measures ANOVA (p<0.001), with a trend of more elevated in Group 2 than in Group 1, although values were within the normal range. No major complications occurred in either group. CONCLUSIONS: OPN using the parenchymal compression method had acceptable outcomes in terms of complete tumor control, avoiding warm ischemic time, and minimizing blooding, with good preservation of renal function and minimal complications.

Does robot-assisted laparoscopic radical prostatectomy enable to obtain adequate oncological and functional outcomes during the learning curve? From the Korean experience / 亚洲男科学杂志(英文版)

To estimate the short-term results of robot-assisted laparoscopic radical prostatectomy (RALRP) during the learning curve, in terms of surgical, oncological and functional outcomes, we conducted a prospective survey on RALRP. From July 2007, a single surgeon performed 63 robotic prostatectomies using the same operative technique. Perioperative data, including pathological and early functional results of the patient, were collected prospectively and analyzed. Along with the accumulation of the cases, the total operative time, setup time, console time and blood loss were significantly decreased. No major complication was present in any patient. Transfusion was needed in six patients; all of them were within the initial 15 cases. The positive surgical margin rate was 9.8% (5/51) in pT2 disease. The most frequent location of positive margin in this stage was the lateral aspect (60%), but in pT3 disease multiple margins were the most frequent (41.7%). Overall, 53 (84.1%) patients had totally continent status and the median time to continence was 6.56 weeks. Among 17 patients who maintained preoperative sexual activity (Sexual Health Inventory for Men > or = 17), stage below pT2, followed up for > 6 months with minimally one side of neurovascular bundle preservation procedure, 12 (70.6%) were capable of intercourse postoperatively, and the mean time for sexual intercourse after operation was 5.7 months. In this series, robotic prostatectomy was a feasible and reproducible technique, with a short learning curve and low perioperative complication rate. Even during the initial phase of the learning curve, satisfactory results were obtained with regard to functional and oncological outcome.

A Comparison of Outcomes between Transurethral Resection of the Prostate and High Power Potassium-titanyl-phosphate Laser Vaporization of the Prostate / 대한남성과학회지

PURPOSE: Transurethral resection of the prostate (TURP) is the gold standard for the surgical treatment for benign prostatic hyperplasia (BPH), but the procedure's limitations are its invasiveness and the high prevalence of complications. Photoselective vaporization of the prostate (PVP) using an 80w high power potassium-titanyl-phosphate (KTP) laser has recently been developed as a less invasive treatment. We assessed the efficacy of PVP as an alternative to TURP for the treatment of BPH. MATERIALS AND METHODS: The medical records of 324 patients who were surgically treated for BPH from July 2005 to December 2007 were retrospectively reviewed. Among the 324 patients, 190 patients of Group I were treated by TURP and 134 patients of Group II were treated by PVP. Before treatment, assessing the serum PSA level transrectal ultrasound and urodynamic study were done. The primary efficacy parameters were the postoperative international prostatic symptom score and the uroflow parametersat 6 months after the operation. The secondary efficacy parameters were perioperative factors such as the duration of the hospital stay, the operative time and the catheter-indwelling period. Any adverse reactions were monitored. RESULTS: There was no significant difference in the basal characteristics of the study subjects between both the groups. The primary efficacy parameters, the IPSS, the Qmax and thepostvoid residual urine volume were significantly improved in both groups, but there were no significant differences between both the groups. In group II, the perioperative parameters such as the operation time, the hospitalization day and the catheter-indwelling periodwere significantly shorter than those of group I (p<0.05). But the urethral complications such as urethral stricture, dysuria and bladder neck contracture were more common in group II. CONCLUSIONS: These results suggest that PVP using an 80w high power KTP could be an alternative for TURP in terms of efficacy. For the general, safe use of PVP, PVP should be carefully done until the causes of the urethral complications of PVP are determined.

Antitumor Effect of in Situ Cryoablation with Systemic Immunotherapy on Murine Renal Cell Tumor / 대한비뇨기과학회지

PURPOSE: To investigate synergistic effect of local cryoablation with systemic immunotherapy, the tumor control ability and immunologic responses of combining these two modalities was compared with that of cryoablation, surgical excision, and immunotherapy only group in a tumor re-challenge model. MATERIALS AND METHODS: Preliminary experiments were performed in two stages. The first stage consisted of 36 Balb/c mice with Renca bearing tumors imbedded in the right thigh, and was treated with interleukin-2 (IL-2) and interferon-alpha(IFN-alpha) to evaluate the efficacy of immunotherapy and to determine the adequate dosage. The second stage was performed on 10 mice, to evaluate histological changes and efficacy after cryoablation. The main experiment was performed on 48 mice, divided into 6 groups of control with tumor implantation, excision of tumor, excision combined with immunotherapy, cryoablation of tumor, cryoablation with immunotherapy and control without tumor. After treatment, tumor re-challenge was performed with Renca cell, then the growth pattern was evaluated with physical measurements, and immune response was investigated with fluorescent activated cell sorter and cytotoxicity assay. RESULTS: Preliminary studies on immunologic efficacy revealed that IL-2 and IFN-alpha have a dose dependent inhibition of tumor growth. The main experiment evaluating the efficacy of combination treatment revealed that cryoablation with immunotherapy proved to be most effective in terms of tumor recurrence and tumor growth inhibition, yet the difference was not statistically significant from monotherapy with cryoablation. However, cytotoxicity was significantly increased cryoablation with immunotherapy compared with other groups. CONCLUSIONS: Cryoablation on tumor re-challenge mice model showed advantages with immunotherapy most prominently in cytotoxicity.

Initial Experiences of Intravesical Gemcitabine Instillation Followed by Bacillus Calmette-Guerin(BCG) Therapy for Treating Intermediate or High Risk Patients with Superficial Bladder Cancer / 대한비뇨기과학회지

PURPOSE: To investigate the safety and the efficacy of intravesical gemcitabine therapy, we prospectively studied intravesical gemcitabine instillation followed by Bacillus Calmette-Guerin(BCG) instillation for treating the patients who suffer from superficial bladder cancer, and the above method was then compared with conventional BCG instillation. MATERIALS AND METHODS: Between May 2005 and April 2007, a total of 84 patients were divided into Group I: the patients were treated with a 2-week course of gemcitabine(1,000mg/50ml, 2,000mg/50ml) followed by a conventional 6-week course of BCG, and Group II: the patients were treated by BCG instillation only. Gemcitabine was instilled immediately within 6 hours after complete trans-urethral resection of the bladder tumor (TURBT) and then this was repeated one week later. BCG instillation was started 2 weeks after TURBT. The complications, recurrence rates, progression rates and recurrence-free period(RFP) were analyzed in both groups. RESULTS: The treatment was well tolerated in all the patients. Most of the complications were self-limiting, and there was no significant difference between the two groups(p=0.379). The recurrence rates of the two groups were 25.6% and 26.7%, respectively(p=0.899). Yet the recurrence-free period(RFP) was significantly longer in Group I(p=0.021). The progression rates of the two groups were 2.6% and 6.7%, respectively(p=0.620). CONCLUSIONS: Intravesical gemcitabine instillation showed the effect to prolong the recurrence-free period for patients with superficial bladder cancer. Further long-term study will be needed.

Risk Factors of the Infectious Complications and Causative Microorganisms after Transrectal Ultrasound-guided Prostate Needle Biopsy / 대한남성과학회지

PURPOSE: Transrectal ultrasound-guided prostate needle biopsy (TRUS-PBx) is the standard procedure to diagnose prostate cancer. We evaluated the incidence and risk factors of infectious complications, the species cultured and rates of resistance for antibiotics of microorganism in infectious complications after TRUS-PBx. MATERIALS AND METHODS: We retrospectively evaluated the medical records of 742 patients who underwent TRUS-PBx from January 2004 to May 2007. All patients were treated with intravenous ciprofloxacin and oral ciprofloxacin for 1 week after discharge. Patients who presented infectious complications were performed chest x-ray, blood analysis, urine analysis and culture studies. RESULTS: Among 742 patients, 15 patients (2.0%) developed infectious complications. There were no significant differences between the complication and non-complications groups in age, PSA, prostate volume, nodule, hypoechoic lesion on transrectal sonography and underlying medical diseases. Twelve cases were performed in outpatient department and 3 cases were in operation room and that suggests high frequency of infectious complication when transrectal prostate biopsy is performed in outpatient department (p=0.007). Six kinds of microorganisms were cultivated in 12 patients (1.9%). E. coli (7/12) was most common. Extended-spectrum beta-lactamase suggesting nosocomial infection was positive in 3 cases of outpatient department. On logistic regression analysis, urethral catheter indwelling was a significant risk factor increasing infectious complications. CONCLUSIONS: After TRUS-PBx, the rate of severe infectious complications and nosocomial infections were more frequent in outpatient department. And urethral catheter indwelling significantly increased infectious complication rate. So we should sublate the urethral catheter and keep in mind the aseptic technique at outpatient department.

Metachronous Bilateral Renal Lymphangiomatosis Mimicking as a Simple Renal Cyst / 대한비뇨기과학회지

Renal lymphangiomatosis is a rare developmental malformation of the perirenal lymphatic system, and this can result in the development of cystic masses in the peri-pelvic or peri-renal areas. This is difficult to differentiate from other cystic renal disease on imaging studies. We present here a case of metachronous bilateral renal lymphangiomatosis that was falsely diagnosed as a simple renal cyst. A 47 year-old man was referred for a large amount of drainage after right renal cyst marsupialization. The abdominal computed tomography(CT) findings and fluid analysis were compatible with a lymphangiomatosis. After 6 month, he presented with flank pain on his left side and CT showed intracystic hemorrhage on the left renal lymphangiomatosis. Percutaneus drainage and conservative management were done.

Metachronous Bilateral Renal Lymphangiomatosis Mimicking as a Simple Renal Cyst / 대한비뇨기과학회지

Renal lymphangiomatosis is a rare developmental malformation of the perirenal lymphatic system, and this can result in the development of cystic masses in the peri-pelvic or peri-renal areas. This is difficult to differentiate from other cystic renal disease on imaging studies. We present here a case of metachronous bilateral renal lymphangiomatosis that was falsely diagnosed as a simple renal cyst. A 47 year-old man was referred for a large amount of drainage after right renal cyst marsupialization. The abdominal computed tomography(CT) findings and fluid analysis were compatible with a lymphangiomatosis. After 6 month, he presented with flank pain on his left side and CT showed intracystic hemorrhage on the left renal lymphangiomatosis. Percutaneus drainage and conservative management were done.

A Matched-cohort Comparison of Laparoscopic Renal Cryoablation using Ultra-thin Cryoprobes with Open Partial Nephrectomy for the Treatment of Small Renal Cell Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To evaluate the feasibility and efficacy of performing laparoscopic renal cryoablation (LRC) for the treatment of RCC, as compared with open partial nephrectomy (OPN), which is the established NSS. MATERIALS AND METHODS: From April 2004, among the patients who underwent LRC with a 1.47 mm cryoprobe, we enrolled 20 patients who were pathologically confirmed as having RCC with a tumor size smaller than 4 cm. These patients were matched with a group of 20 patients, who were selected based on the pre-operative characteristics of the tumor and those of the patients, from a pre-existing database of the patients who underwent OPN during the same period. RESULTS: The mean age and tumor size were 56.3+/-11.5 years and 2.4+/-1.7 cm in the LRC group, and 57.6+/-10.9 years and 2.2+/-1.1 cm in the OPN group. The two groups were similar for their age, gender, BMI, ASA, the tumor characteristics and the indications for operation. While the pathologic results and the operation time showed similarity, the EBL (98+/-87 ml vs 351+/-147 ml, respectively, p=0.001), the transfusion rate (10% vs 40%, respectively, p=0.03) and the hospital stay (4.2+/-1.5 days vs 8.2+/-2.4 days, respectively, p=0.005) were significantly less in the LRC group. Major complications did not occur in the LRC group, but in the OPN group, one patient experienced urine leakage and one patient had a perirenal hematoma. During the mean follow up of 27.3+/-10.8 months and 28.7+/-14.9 months for each group, respectively, all the patients remained disease- free with no evidence of local recurrence or metastases. CONCLUSIONS: LRC using ultra-thin cryoprobes for the treatment of small RCC showed similar effective oncologic results with the merits of minimal invasiveness, as compared with OPN, during the intermediate term follow up.

Metastatic Tumor of Tunica Vaginalis Testis with Hydrocele in a Patient with Gastric Cancer / 대한비뇨기과학회지

Metastatic tumors of the tunica vaginalis testis from gastric cancer are extremely rare. We report here on a case of a 48-year-old man who had undergone total gastrectomy due to advanced gastric cancer 23 months previously, and he presented with right painless scrotal swelling. A hard mass was palpated along the right spermatic cord and there was an associated hydrocele around the mass. Ultrasonography showed homegenous hypoechoic lesions in the spermatic cord and anechoic lesion superior to the right testis, which was suggestive of hydrocele of the testis. Exploration was performed via inguinal incision. Multiple hemorrhagic small nodules were noted on the surface of the tunica vaginalis. Also, a tumor in the spermatic cord was present beyond the inner inguinal ring. On microscopic examination, adenocarcinoma cell nests, which were consistent with primary gastric cancer, were found in the tunica vaginalis testis, spermatic cord and peritesticular soft tissue, but not within the parenchyme of the testis or epididymis.

The Use of Complementary and Alternative Medicine in Patients with a Urological Malignancy / 대한비뇨기과학회지

PURPOSE: The use of complementary and alternative medicine (CAM) is very common among patients with a urological malignancy. We assessed the prevalence and patterns of use of complementary therapies among patients with bladder, prostate and renal cancers. MATERIALS AND METHODS: Between May and July 2004, we conducted a survey to assess the use of CAM at 13 outpatient clinics in Korea. Seven hundred and eleven patients with bladder (269), prostate (300) or renal cancers (142) were selected to answer a self-administered questionnaire on CAM, which were then analyzed. RESULTS: Among 711 patients with urological malignancies, 279 (39.2%) had been treated with at least one type of CAM, in addition to conventional Western treatment. The cancer patients treated with radiation therapy or immunotherapy were more likely to employ CAM than those using other therapies. Age, gender, cancer type, occupations, religions, level of education and disease status (stable or progressive) were not associated with the prevalence of CAM. 44.3% of CAM users wanted to discuss CAM techniques with their doctors, but only 24.8% received an explanation of there use. CONCLUSIONS: CAM is used by a large number of patients with urological malignancies, particularly in those undergoing radiation therapy or immunotherapy. Urologists need to have an accurate knowledge and apprehension of CAM. The possible effects and side effects should be defined, with appropriate guidelines recommended for patients with a urological malignancy.

Targeted-cryosurgical ablation of the prostate with androgen deprivation therapy: quality of life in high-risk prostate cancer patients / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To present preliminary results on health-related quality of life (QoL), prostate-associated symptoms and therapeutic effects of targeted-cryosurgical ablation of the prostate (TCSAP) with androgen deprivation therapy (ADT) in high-risk prostate cancer (PCa) patients.</p><p><b>METHODS</b>Thirty-four men with high-risk PCa features underwent TCSAP, and ADT was added to improve the treatment outcomes. High-risk parameters were defined as either prostate-specific antigen (PSA) = or > 100ng/mL, or Gleason score = or > 8, or both. The Genito-Urinary Group of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) with prostate-cancer-specific module (QLQ-PR25) was used for evaluating morbidities and PSA levels were recorded every 3 months. PSA failure was defined as the inability to reach a nadir of 0.4 ng/mL or less.</p><p><b>RESULTS</b>Although it was not statistically significant, the global health status scores increased after TCSAP with ADT. The scores for five functional scales also became higher after treatment. The most prominent symptom after treatment was sexual dysfunction, followed by treatment-related and irritative voiding symptoms.</p><p><b>CONCLUSION</b>TCSAP with ADT appears to be minimally invasive with high QoL except for sexual dysfunction. Long-term follow-up of PSA data and survival is necessary before any conclusions can be made on the efficacy of this promising new therapeutic modality in the treatment of PCa.</p>

Expression of Osteopontin and Clusterin in Transitional Cell Carcinoma of the Bladder: Comparison to the Pathologic Stage / 대한비뇨기과학회지

PURPOSE: This study was performed to evaluate the expressions of osteopontin (OPN) and clusterin in a transitional cell carcinoma (TCC) of the urinary bladder, and then compare their expression rates with the tumor invasiveness. MATERIALS AND METHODS: Twenty-five superficial and 25 invasive TCC were used for immunohistochemical staining. RESULTS: All 25 non-invasive TCC showed a strong positive reaction for OPN. Twenty of the invasive TCC showed a strong positive reaction for OPN, but 5 showed only a weak positive reaction. OPN expression was significantly decreased in the invasive TCC (p=0.02). Eighteen superficial TCC showed a weak positive reaction for clusterin, with 7 showing a negative reaction. Nine invasive TCC showed a strong positive reaction for clusterin, and 11 showed only a weak positive reaction. Five invasive TCC showed a negative reaction for clusterin. Clusterin expression was significantly increased in the invasive TCC (p=0.001). CONCLUSIONS: These results may suggest that OPN and clusterin could be used as markers to predict the biological behavior of a TCC.

Stu I Polymorphism of Androgen Receptor in Korean Men with Prostate Cance / 대한비뇨기과학회지

PURPOSE: Single nucleotide polymorphisms (SNPs) are considered very promising genetic markers for a better understanding of the genetic basis for complex diseases. Recently, various mutations have been described in the gene encoding the androgen receptor (AR) in a variety of disease, including male pattern baldness and prostate cancer. Analyzing the SNPs among different population or races shows unpredictable different expression patterns or diseases incidences. Because the incidence and mortality of prostate cancer varies worldwide, the SNPs may explain the differences among races. It has been reported that a synonymous A/G variant in exon I of the AR (NM_000044) at position 1754 showed different expression patterns in male pattern baldness. These observations raise important questions regarding the functional and clinical significances of the AR polymorphism. First, does the A/G variation of the AR have significance in prostate cancer? Second, if not, is the variation ethnogeographically specific in Koreans? To date, no studies have given answers to the above questions. MATERIALS AND METHODS: A total 120 unrelated subjects were enrolled between May and July 2004. Of the 120 patients, 80 had pathologically confirmed prostate cancer, 20 benign prostate hyperplasia (BPH) and 20 were non-bald men. Genomic DNAs were procured from the blood of the patients. A 416bp fragment in exon I of the AR was amplified, and the polymerase chain reaction (PCR) products digested with Stu I enzyme. RESULTS: All the prostate cancer and BPH patients, and even the controls, showed the Stu I restriction enzyme site at position 1754 in the AR. CONCLUSIONS: The Stu I polymorphism in the AR is not related to the occurrence of prostate cancer in Koreans. This suggests that the high incidence of the Stu I polymorphism may be from racial differences in the AR gene. (Korean J Urol 2005;46:561-564)

Obesity is an Independent Predictor of Biochemical Failure following Radical Prostatectomy and Androgen Deprivation Therapy (ADT) for Prostate Cancer / 대한비뇨기과학회지

PURPOSE: We explored the prognostic significance of obesity for the surgical and hormonal treatment of prostate cancer in correlation with the other prognostic factors such as Gleason's sum, the clinicopathologic stage, and the pre- and post treatment prostate specific antigen (PSA) changes. MATERIALS AND METHODS: A retrospective review was performed on 132 consecutive patients who had received androgen deprivation therapy (ADT) (108 patients) or radical prostatectomy (24 patients) under the diagnosis of prostate cancer via transrectal prostatic biopsy from July 1993 to May 2003 in our hospital. Obesity was evaluated in terms of the body mass index (BMI), and the patients were categorized into four groups according to the National Institute of Health (NIH) classification. The relationship between the BMI and the other prognostic factors were statistically analyzed by One-way ANOVA test and the Spearman correlation coefficient. RESULTS: There were no significant associations between the BMI and any of the measured clinical and pathological parameters except for the time to hormone failure and biochemical recurrence. In the ADI group, the mean time to hormone failure was significantly longer in case of the low BMI group compared to the normal and overweight groups (p<0.006). Sperman's correlation analysis showed a significant inverse correlation between the BMI and the PSA free survival after radical prostatectomy. CONCLUSIONS: These findings showed that the BMI is closely related to the failure to hormone treatment after ADI and the BMI was also related to the biological failures after radical prostatectomy.