ABSTRACT
Prostate cancer has long been considered a disease with a heterogeneous phenotype. The intratumor heterogeneity (ITH) may affect diverse phenotypes such as treatment response, drug resistance, and overall clinical outcomes. Despite technical advances over the past decade, we have an incomplete understanding of the extent and effects of ITH in prostate cancer progression. We present here a comprehensive review of the various studies dealing with ITH in prostate cancer. We discuss the advanced next-generation sequencing analyses including single cell sequencing and circulating cell-free DNA sequencing that have the impact of heterogeneity on clinical decision making.
ABSTRACT
Prostate cancer has long been considered a disease with a heterogeneous phenotype. The intratumor heterogeneity (ITH) may affect diverse phenotypes such as treatment response, drug resistance, and overall clinical outcomes. Despite technical advances over the past decade, we have an incomplete understanding of the extent and effects of ITH in prostate cancer progression. We present here a comprehensive review of the various studies dealing with ITH in prostate cancer. We discuss the advanced next-generation sequencing analyses including single cell sequencing and circulating cell-free DNA sequencing that have the impact of heterogeneity on clinical decision making.
ABSTRACT
PURPOSE: To evaluate the efficacy of holmium laser enucleation of the prostate (HoLEP) in relation to prostate size and urodynamic parameters, including bladder outlet obstruction index (BOOI), presence of detrusor overactivity, and detrusor contractility, and to investigate factors predictive of HoLEP success. METHODS: This retrospective analysis of prospective data included 174 consecutive patients treated with HoLEP at Samsung Medical Center from 2009 to 2013. Prostate-specific antigen, prostate size, urodynamic parameters, and International Prostate Symptom Score (IPSS)/quality of life (QoL) were evaluated preoperatively, while prostate-specific antigen, uroflowmetry/postvoid residual (PVR) urine, and IPSS were measured six months after HoLEP. Two definitions of treatment success were established based on the following three variables: IPSS, maximum flow rate (Qmax), and QoL index. Factors predictive of HoLEP success were identified using multiple logistic regression analysis. RESULTS: IPSS/QoL, Qmax, and PVR improved significantly following HoLEP. Improvements in IPSS and PVR were more significant in the BOOI> or =40 group compared to the BOOI or =40 group had a significantly higher success rate, and BOOI> or =40 was a significant predictor of HoLEP success based on the multivariate analyses. CONCLUSIONS: We found good surgical outcomes after HoLEP, and specifically patients with a higher BOOI had a greater chance of surgical success.
Subject(s)
Humans , Holmium , Lasers, Solid-State , Logistic Models , Multivariate Analysis , Prospective Studies , Prostate , Prostate-Specific Antigen , Prostatic Hyperplasia , Retrospective Studies , Urinary Bladder Neck Obstruction , Urinary Bladder, Overactive , UrodynamicsABSTRACT
PURPOSE: Nationwide database regarding stress urinary incontinence (SUI) is important for evaluating treatment patterns for SUI and for establishing appropriate national policies regarding SUI management. The purpose of this present study was to investigate surgical treatment patterns for women with SUI and analyze the current status of SUI management in Korea by using a nationwide database. METHODS: Data used for investigating the surgical trends and changes in Korea were retrieved from the Health Insurance Review & Assessment Service from 2008 to 2011. RESULTS: The number of surgical cases of SUI decreased continuously from 2008 to 2011. The proportion of transvaginal surgery using a midurethral sling increased continuously. Sling procedures were most commonly performed for women in their 40s followed by women in their 50s. Transvaginal surgery using a single sling or a readjustable sling was performed from 5.6% to 6.1%, which showed no significant change in the number of surgical cases. CONCLUSIONS: There is a growing need for an appropriate national welfare policy and budget to care for aged and super-aged women in Korea. The early detection and intervention of silent SUI should be actively considered as an important preventive strategy to improve the quality of life in younger women.
Subject(s)
Female , Humans , Budgets , Insurance, Health , Korea , Quality of Life , Suburethral Slings , Urinary IncontinenceABSTRACT
The bone morphogenetic proteins (BMPs), as members of the transforming growth factor-beta (TGF-beta) superfamily, not only control bone formation, but also regulate multiple key steps during embryonic development and differentiation. Furthermore, BMPs play critical roles in maintaining the homeostasis of the cardiovascular, pulmonary, reproductive, urogenital, and nervous systems in adult life. Like all members of the TGF-beta superfamily, BMP signaling is mediated through a heteromeric complex of type I and type II transmembrane serine/threonine kinase receptors. The subsequent signal transduction cascade includes either the canonical Smad-dependent or non-canonical Smad-independent pathways. Reflecting the critical function of BMPs, BMP signaling is tightly regulated at multiple steps by various mechanisms including extracellular endogenous antagonists, neutralizing antibodies/extracellular soluble receptor domains, small molecule inhibitors, cytoplasmic inhibitory Smads, and transcriptional co-repressors. Recently, dorsomorphin, the first small molecule inhibitor of BMP signaling, was identified and suggested as a useful tool for dissecting the mechanisms of signaling pathways and for developing novel therapeutics for diverse human diseases that are related to the BMP signaling pathways. In this article, we discuss various mechanisms involved in regulating BMP signaling pathways and their implications for urology.