Construction of a Retrospective Cohort to Observe 10-Year Urologic Cancer Treatment Trends at the Biggest Medical Center of South Korea

Purpose@#To construct a urologic cancer database using a standardized, reproducible method, and to assess preliminary characteristics of this cohort. @*Materials and Methods@#Patients with prostate, bladder, and kidney cancers who were enrolled with diagnostic codes in the electronic medical record (EMR) at Asan Medical Center from 2007–2016 were included. Research Electronic Data Capture (REDCap) was used to design the Asan Medical Center-Urologic Cancer Database (AMC-UCD). The process included developing a data dictionary, applying branching logic, mapping clinical data warehouse structures, alpha testing, clinical record summary testing, creating “standards of procedure,” importing data, and entering data. Descriptive statistics were used to identify rates of surgeries and numbers of patients. @*Results@#Clinical variables (n=407) were selected to develop a data dictionary from REDCap. In total, 20,198 urologic cancer patients visited our institution from 2007–2016 (bladder cancer, 4,616; kidney cancer, 5,750; prostate cancer, 10,330). The overall numbers of patients and surgeries increased over time, with robotic surgeries rapidly growing over a decade. The most common treatment for urologic cancer was surgery, followed by chemotherapy and radiation therapy. @*Conclusions@#Using a standardized method, the AMC-UCD fosters multidisciplinary research. This constructed database provides access to clinical statistics to effectively assist research. Preliminary data should be refined through EMR chart review. The successful organization of data from 2007–2016 provides a framework for future periods of investigation and prospective models.

Utility of Urinalysis as a Follow-up Surveillance Tool in Nonmuscle Invasive Bladder Cancer

Purpose@#To evaluate the association between microscopic hematuria (MH) detected by surveillance urinalysis and cancer recurrence in nonmuscle invasive bladder cancer (NMIBC) patients. @*Materials and Methods@#A total of 1,082 NMIBC patients who underwent transurethral resection of bladder tumor (TURB) procedures at Asan Medical Center between January 2017 and December 2019 were included. We retrospectively reviewed the follow-up data for these cases including cystoscopy, urinalysis, and urine cytology. The association between urine testing and cancer recurrence was assessed by both univariable and multivariable logistic regression analysis. @*Results@#The study patients had a median age of 68 years (interquartile range, 60–75 years) and comprised 898 men and 184 women. Among the 1,428 TURB procedures conducted in this series, 548 of the lesions (38.4%) were diagnosed as low-grade and 880 (61.6%) as highgrade cancers. A total of 3,309 follow-up cystoscopies were conducted during the study period and were divided into high-grade (HG) (2,011 cases) and low-grade (LG) (1,298 cases) groups according to the latest TURB pathology. MH was found to have a statistically significant association with NMIBC recurrence in both the LG (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.107–2.223; p=0.011) and HG (OR, 1.90; 95% CI, 1.434–2.517; p<0.001) groups. @*Conclusions@#Urinalysis during follow-up may provide important information on cancer recurrence in NMIBC patients.

Risk Factors Leading to Radical Cystectomy in Patients Who Had Undergone Nephroureterectomy

Purpose@#To identify the risk factors leading to radical cystectomy in patients who had undergone nephroureterectomy (NUx). @*Materials and Methods@#We retrospectively reviewed the medical records of patients with upper tract urothelial carcinoma who underwent NUx during 2011–2019 and excluded patients with metastatic cancer. In total 646 patients were included in this study; of these, 532 had no previous bladder cancer history. Follow-up was performed every 3 months for 2 years after NUx was administered, and recurrence was confirmed using cystoscopy, urine cytology, computed tomography, and chest radiography. Bladder recurrence was confirmed through biopsy, urine cytology, or radiologic examination. Univariate and multivariate Cox regression analyzes were performed for statistical analysis of risk factors leading to radical cystectomy in patients undergoing NUx. @*Results@#Lymphovascular invasion (LVI) (hazard ratio [HR], 4.728; 95% confidence interval [CI], 1.463–15.570; p=0.011), previous transurethral resection of bladder tumor history (HR, 3.825; 95% CI, 1.164–12.571; p=0.027), and intravesical recurrence (IVR) within 6 months (HR, 3.733; 95% CI, 1.091–12.778; p=0.036) in patients undergoing NUx are predictors of radical cystectomy implementation. In a multivariate analysis of patients without bladder cancer history, bladder recurrence was identified as a predictor of radical cystectomy implementation, if it occurred within 6 months of NUx (HR, 8.608; 95% CI, 1.545–47.976; p=0.014). @*Conclusions@#LVI and IVR within 6 months and previous bladder cancer history are factors that can predict the need for radical cystectomy after NUx. Even in patients without bladder cancer history, early bladder recurrence within 6 months is a major predictor of radical cystectomy.

Prevalence of Postprostatectomy Incontinence Requiring Anti-incontinence Surgery After Radical Prostatectomy for Prostate Cancer: A Retrospective Population-Based Analysis / 대한배뇨장애요실금학회지

Purpose@#This study aimed to examine the prevalence of surgery for postprostatectomy incontinence (PI) following minimally invasive surgery compared to conventional open surgery for prostate cancer. @*Methods@#This retrospective cohort study used the Florida State Ambulatory Surgery and State Inpatient Databases, 2008 to 2010, radical prostatectomy (RP) patients were identified using International Classification of Diseases (ICD)-9/10 procedure codes and among this cohort, PI was identified also using ICD-9/10 codes. Surgical approaches included minimally invasive (robotic or laparoscopic) versus open (retropubic or perineal) RP. The primary outcome was the overall prevalence of surgery for PI. The secondary outcome was the association of PI requiring anti-incontinence surgery with the surgical approach for RP. @*Results@#Among the 13,535 patients initially included in the study (mean age, 63.3 years), 6,932 (51.2%) underwent open RP and 6,603 (49.8%) underwent minimally invasive RP. The overall prevalence of surgical procedures for PI during the observation period among the all patients who had received RP was 3.3%. The rate of PI surgery for patients receiving minimally invasive surgery was higher than that for patients receiving open surgery (4.8% vs. 3.0%; risk difference, 1.8%; 95% confidence interval, 0.3%–3.4%). The adjusted prevalence of PI surgery for patients who had undergone laparoscopic RP was higher than that for those with retropubic RP (8.6% vs. 3.7%). @*Conclusions@#Among patients undergoing RP for prostate cancer, the prevalence of PI surgery is not negligible. Patients undergoing minimally invasive RP had higher adjusted rates for PI surgery compared to open approaches, which was attributed to high rate of PI surgery following laparoscopic approach and low rate of PI surgery following perineal approach. More studies are needed to establish strategies to reduce the rate of PI surgery after RP.

Prevalence of Postprostatectomy Incontinence Requiring Anti-incontinence Surgery After Radical Prostatectomy for Prostate Cancer: A Retrospective Population-Based Analysis / 대한배뇨장애요실금학회지

Purpose@#This study aimed to examine the prevalence of surgery for postprostatectomy incontinence (PI) following minimally invasive surgery compared to conventional open surgery for prostate cancer. @*Methods@#This retrospective cohort study used the Florida State Ambulatory Surgery and State Inpatient Databases, 2008 to 2010, radical prostatectomy (RP) patients were identified using International Classification of Diseases (ICD)-9/10 procedure codes and among this cohort, PI was identified also using ICD-9/10 codes. Surgical approaches included minimally invasive (robotic or laparoscopic) versus open (retropubic or perineal) RP. The primary outcome was the overall prevalence of surgery for PI. The secondary outcome was the association of PI requiring anti-incontinence surgery with the surgical approach for RP. @*Results@#Among the 13,535 patients initially included in the study (mean age, 63.3 years), 6,932 (51.2%) underwent open RP and 6,603 (49.8%) underwent minimally invasive RP. The overall prevalence of surgical procedures for PI during the observation period among the all patients who had received RP was 3.3%. The rate of PI surgery for patients receiving minimally invasive surgery was higher than that for patients receiving open surgery (4.8% vs. 3.0%; risk difference, 1.8%; 95% confidence interval, 0.3%–3.4%). The adjusted prevalence of PI surgery for patients who had undergone laparoscopic RP was higher than that for those with retropubic RP (8.6% vs. 3.7%). @*Conclusions@#Among patients undergoing RP for prostate cancer, the prevalence of PI surgery is not negligible. Patients undergoing minimally invasive RP had higher adjusted rates for PI surgery compared to open approaches, which was attributed to high rate of PI surgery following laparoscopic approach and low rate of PI surgery following perineal approach. More studies are needed to establish strategies to reduce the rate of PI surgery after RP.

Serum Testosterone Level as Possible Predictive Marker for Prognosis in Metastatic Castration-Resistant Prostate Cancer Patients Treated With Enzalutamide

Purpose@#This study aimed to evaluate the impact of serum testosterone level before enzalutamide treatment in metastatic castration-resistant prostate cancer (mCRPC) for antitumor outcomes. @*Materials and Methods@#Single-center, retrospective study including patients that treated with enzalutamide for mCRPC before and after docetaxel chemotherapy. Clinicopathological parameters including serum testosterone at initial enzalutamide use were examined. Prostate-specific antigen (PSA) response, progression-free survival (PFS), and cancer-specific survival (CSS) were the outcomes of interest. Logistic-regression analysis was done for discovering odds for PSA response. Cox-proportional model was applied for risk stratification for progression and cancer-specific death. @*Results@#A total of 228 patients with mCRPC, treated with enzalutamide, both prechemotherapy and postchemotherapy, between 2011 and 2019 were included. One hundred sixty-two of patients (71.1%) experienced PSA decline over 50%. Median PFS and CSS were 5.4 and 13.2 months, respectively. Serum testosterone at initial enzalutamide use was the noble predictor for progression (hazard ratio [HR], 0.409; p=0.020) and cancer-specific death (HR, 0.454; p=0.033) in postchemotherapy group. No significant effect of serum testosterone in prechemotherapy group was detected. Time to CRPC, high-metastatic burden revealed as risk factors for PSA response, PFS, and CSS, both in prechemotherapy and postchemotherapy group. @*Conclusions@#High testosterone level at commencement of enzalutamide treatment was associated with a good prognosis in postdocetaxel setting, but not related to oncological outcomes in chemotherapy-naïve patients.

Survey Results on the Perception of Prostate-Specific Antigen and Prostate Cancer Screening Among the General Public

Purpose@#To assess awareness of prostate cancer and prostate cancer screening in high risk Korean men 40 years and older. @*Materials and Methods@#The Korean Urological Oncology Society implemented an online survey of 600 men aged 40 years or older from July 30 to August 6, 2019 to ask questions about prostate cancer and screening. @*Results@#Of the 600 respondents, 96.5% (579 of 600) were aware of prostate cancer and 49.8% (299 of 600) thought they were at risk. Men in their 60s, men with a family history and men with urological conditions were more concerned about prostate cancer. Most respondents (83.3%, 500 of 600) had never received prostate cancer screening. When asked why they had not, (multiple choices: first, second and third priority), the most common responses were: “They had no symptoms of prostate cancer”; “They were in good health”; “Cost burden of screening”; and “They thought screening was included in the National Health Examination Program.” Only 9.7% (58 of 600) were aware of prostate-specific antigen (PSA). After being informed about PSA, 97.7% (586 of 600) wanted it to be included in national cancer screening. @*Conclusions@#In this survey, 96.5% of respondents were aware of prostate cancer, and 44.2% recognized the need for early screening. However, only 16.7% had received screening. Awareness of prostate cancer risks tended to be high in elderly people, people with a family history and people with urological conditions. The results also indicate that there is support for national-level management and early screening programs for prostate cancer. (Korean J Urol Oncol 2020;18:40-46)

Cause of Mortality after Radical Prostatectomy and the Impact of Comorbidity in Men with Prostate Cancer: A Multi-institutional Study in Korea / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#This study aimed to examine the causes of death in Korean patients who underwent radical prostatectomy for prostate cancer and investigate the relationship between comorbidity and mortality. @*Materials and Methods@#We conducted a retrospective multicenter cohort study including 4,064 consecutive patients who had prostate cancer and underwent radical prostatectomy between January 1998 and June 2013. The primary endpoint of this study was all-cause mortality, and the secondary endpoints were cancer-specific mortality (CSM) and other-cause mortality (OCM). Charlson comorbidity index (CCI) was calculated to assess the comorbidities of each patient. @*Results@#Of 4,064 patients, 446 (11.0%) died during follow-up. The cause of death was prostate cancer in 132 patients (29.6%), other cancers in 121 patients (27.1%), and vascular disease in 57 patients (12.8%) in our cohort. The overall 10-year CSM rate was lower than the OCM rate (4.6% vs. 10.5%). The 10-year CSM rate was lower than the OCM rate in low- to intermediate-risk group patients (1.2% vs. 10.6%), whereas they were similar in high-risk group patients (11.8% vs. 10.1%). In the multivariable analysis, CCI was independently associated with all-cause mortality after radical prostatectomy, regardless of age and pathologic features. @*Conclusion@#Death from prostate cancer was rare in Korean men who underwent radical prostatectomy. Clinicians should be aware of the possibility of overtreatment of low-risk prostate cancer in men with significant comorbidity. Our findings may help to facilitate counseling and plan management in this patient group.

Clinical features and outcomes in kidney transplant recipients with renal cell carcinoma: a single-center study

BACKGROUND: Previous studies have recommended a 2- to 5-year waiting time prior to kidney transplantation (KT) in patients with end-stage renal disease (ESRD) and symptomatic renal cell carcinoma (RCC) and no delay for incidental early-stage RCC. Data on Asian KT recipients are unavailable.METHODS: This is a Korean single-center retrospective study on 35 KT recipients with ESRD and RCC. Patients were classified into two groups: early KT (KT performed within 1 year after nephrectomy for RCC, including KT with simultaneous nephrectomy) and delayed KT (KT performed over than 1 year after nephrectomy for RCC). Patient survival, graft survival, and cancer recurrence were compared between both groups.RESULTS: There were no statistically significant differences in patient survival (P = 0.388), graft survival (P = 0.317), or graft rejection rate (P = 0.207) between the early and delayed KT groups. Additionally, there were no differences in pathological characteristics or RCC stage other than cancer histology: acquired cystic disease-associated RCC (47.4%) was the most common RCC type in the early KT group, whereas clear cell type (62.5%) was the most common RCC type in the delayed KT group. No RCC recurrence was observed.CONCLUSION: Patients with early-stage and asymptomatic RCC do not require a mandatory observational period prior to KT after curative nephrectomy

Comparison of Prognosis in Types 1 and 2 Papillary Renal Cell Carcinoma and Clear Cell Renal Cell Carcinoma in T1 Stage

PURPOSE: We compared subtypes of papillary renal cell carcinoma (pRCC; types 1 and 2) and clear cell renal cell carcinoma (ccRCC) in patients with T1-stage RCC to analyze the impact of the subtype on oncological outcomes. MATERIALS AND METHODS: This paper reviewed 75 patients with pRCC and 252 patients with ccRCC at T1-stage from 1998–2012. Thus, we assessed the impact of subtype on oncologic outcomes among patients with T1-stage RCC. We used Kaplan-Meier analysis to estimate the overall survival and recurrence-free survival The median follow-up duration was 95 months (interquartile range, 75.4–119.3 months). RESULTS: The 5-year recurrence-free survivals of pRCC and ccRCC were 95.4% and 97.6%, respectively. pRCC is worse than ccRCC in terms of recurrence-free survival (p=0.008) and there was no significant difference in the overall survival between pRCC and ccRCC (p=0.32). In addition, there was no significant statistical difference between type 1 pRCC and type 2 pRCC in terms of either recurrence-free survival (p=0.526) or overall survival (p=0.701). Age (hazard ratio [HR], 1.069; p < 0.001) and recurrence (HR, 4.93; p < 0.001) were predictors of overall survival. Only tumor size (HR, 1.071; p=0.004) was predictors in the case of cancer specific survival in the multivariate analysis. CONCLUSIONS: Among patients with T1-stage RCC, recurrence after surgery was more common in pRCC than ccRCC. The subtype of pRCC (types 1 and 2) had no impact on the recurrence-free survival or overall survival.

Preserving Renal Function through Partial Nephrectomy Depends on Tumor Complexity in T1b Renal Tumors

This study aimed to determine patients with T1b renal cell carcinoma (RCC) who could benefit from partial nephrectomy (PN) and method to identify them preoperatively using nephrometry score (NS). From a total of 483 radical nephrectomy (RN)-treated patients and 40 PN-treated patients who received treatment for T1b RCC between 1995 and 2010, 120 patients identified through 1:2 propensity-score matching were included for analysis. Probability of chronic kidney disease (CKD) until postoperative 5-years was calculated and regressed with respect to the surgical method and NS. Median follow-up was 106 months. CKD-probability at 5-years was 40.7% and 13.5% after radical and PN, respectively (P = 0.005). While PN was associated with lower risk of CKD regardless of age, comorbidity, preoperative estimated renal function, the effect was observed only among patients with NS ≤ 8 (P < 0.001) but not in patients with NS ≥ 9 (P = 0.746). Percent operated-kidney volume reduction and ischemia time were similar between the patients with NS ≥ 9 and ≤ 8. In the stratified Cox regression accounting for the interaction observed between the surgical method and the NS, PN reduced CKD-risk only in patients with NS ≤ 8 (hazard ratio [HR], 0.054; P = 0.005) but not in ≥ 9 (HR, 0.996; P = 0.994). In T1b RCC with NS ≥ 9, the risk of postoperative CKD was not reduced following PN compared to RN. Considering the potential complications of PN, minimally invasive RN could be considered with priority in this subgroup of patients.

Impact of Histologic Variants of Bladder Cancer on Oncology Outcome After Radical Cystectomy

PURPOSE: To evaluate the oncological outcome of histologic variants in bladder cancer patients who underwent radical cystectomy. MATERIALS AND METHODS: We identified 393 bladder cancer patients who underwent radical cystectomy at single center between January 2007 and August 2014. Patients were divided into 4 groups according to histologic types: pure urothelial cell carcinoma (UC) and squamous, micropapillary, and other variants. Kaplan-Meier analysis was performed to assess recurrence-free (RFS) and overall survivals (OS). The patients were divided into those with pathologic stage and nodal status. RESULTS: Among 393 bladder cancer patients, squamous, micropapillary histologic variants were observed in 38 (9.7%), 26 (6.6%), respectively, whereas 39 had other variant types. Stage T3 cancer occurred in more patients with histologic variant compared with those with pure UC. Pathologic positive nodal status was also frequently found in the histologic variant groups. Subgroup analysis according to T stage and nodal status showed no significant difference in RFS and OS. On multivariate analysis, pathologic T stage (stage T2: hazard ratio [HR], 2.75; 95% confidence interval [CI], 1.34–5.63; p=0.005; stage ≥T3: HR, 3.20; 95% CI, 1.62–6.30; p=0.001) and nodal status (HR, 1.85; 95% CI, 1.05–2.56; p=0.028) were prognostic factors for RFS. CONCLUSIONS: In patients who underwent radical cystectomy, histologic variants were detected more often at advanced pathologic stage. Although histologic variants have been identified in the radical cystectomy specimen, treatment should be performed according to the pathologic stage.

Comparison of Renal Function between Robot-Assisted and Open Partial Nephrectomy as Determined by Tc 99m-DTPA Renal Scintigraphy

We compared postoperative renal function impairment between patients undergoing robot-assisted partial nephrectomy (RAPN) and those undergoing open partial nephrectomy (OPN) by using Tc-99m diethylenetriaminepentaacetic acid (DTPA) renal scintigraphy. Patients who underwent partial nephrectomy by a single surgeon between 2007 and 2013 were eligible and were matched by propensity score, based on age, tumor size, exophytic properties of tumor, and location relative to the polar lines. Of the 403 patients who underwent partial nephrectomy, 114 (28%) underwent RAPN and 289 (72%) underwent OPN. Mean follow-up duration was 35.2 months. Following propensity matching, there were no significant differences between the two groups in tumor exophytic properties (P = 0.818) or nephrometry score (P = 0.527). Renal ischemic time (24.4 minutes vs. 17.8 minutes, P < 0.001) was significantly longer in the RAPN group than in the OPN group, while the other characteristics were similar. Multivariate analysis showed that greater preoperative renal unit function (P = 0.011) and nephrometry score (P = 0.041) were independently correlated with a reduction in glomerular filtration rate. The operative method did not correlate with renal function impairment (P = 0.704). Postoperative renal function impairment was similar between patients who underwent OPN and those who underwent RAPN, despite RAPN having a longer ischemic time.

Lymph Node-related Parameters as Prognostic Markers in Lymph Node Positive Bladder Cancer

In spite of multidisciplinary treatment, about 70% of lymph node (LN) positive bladder cancer reported to be recurred within 5-year after radical cystectomy and pelvic lymphadenectomy although considerable number of patients survived for a long period without adjuvant treatment after surgery. Current TNM nodal staging system doesn't account for this survival differences. In this regard, several LN-related parameters were developed to predict prognosis of LN positive bladder cancer. In this article, we will state the controversies on current TNM nodal staging system for bladder cancer. In addition, we will review the accuracy of imaging studies to predict LN metastasis before surgery and impact of several surgical and pathologic LN-related parameters, such as extent of lymphadenectomy, number of removed LNs, number of metastatic LNs, LN density, extracapsular extension of LN, on prognosis of LN positive bladder cancer. Moreover, we will review the value of adjuvant chemotherapy on LN positive bladder cancer.

Clinical features and prognosis of prostate cancer with high-grade prostatic intraepithelial neoplasia

PURPOSE: To evaluate the clinical features and biochemical recurrence (BCR) in prostate cancer (PCa) with high-grade prostatic intraepithelial neoplasia (HGPIN). MATERIALS AND METHODS: We retrospectively analyzed the medical records of 893 patients who underwent a radical prostatectomy for PCa between 2011 and 2012 at Asan Medical Center; 752 of these patients who did not receive neoadjuvant or adjuvant therapy and were followed up for more than 1 year were included. The cohort was divided into two groups-patients with and without HGPIN-and their characteristics were compared. The Cox proportional hazards model was used to analyze factors affecting BCR. RESULTS: In total, 652 study patients (86.7%) had HGPIN. There were no significant differences in preoperative factors between the two groups, including age (p=0.369) and preoperative prostate-specific antigen concentration (p=0.234). Patients with HGPIN had a higher Gleason score (p=0.012), more frequent multiple tumor (p=0.013), and more perineural invasion (p=0.012), but no other postoperative pathologic characteristics were significantly different between the two groups. There were no significant differences in BCR (13.0% vs. 11.5%, p=0.665) and HGPIN was not associated with BCR (p=0.745). In multivariate analysis, only the T stage (p<0.001) was associated with BCR. CONCLUSIONS: PCa patients with HGPIN have a higher Gleason score, more frequent multiple tumors, and more perineural invasion than those without HGPIN. The presence of HGPIN is not an independent predictor of BCR.

Antibiotic prophylaxis with intravenous ceftriaxone and fluoroquinolone reduces infectious complications after transrectal ultrasound-guided prostatic biopsy

PURPOSE: To assess the rates of infectious complications before and after the change of prophylactic antibiotic regimens in prostate needle biopsy. MATERIALS AND METHODS: The records of 5,577 patients who underwent prostate needle biopsy at Asan Medical Center between August 2005 and July 2012 were retrospectively reviewed. Group 1 (n=1,743) included patients treated between 2005 and 2009 with fluoroquinolone for 3 days, group 2 (n=2,723) included those treated between 2009 and 2012 with ceftriaxone once before the biopsy and fluoroquinolone before biopsy and continue therapy for 3 days, and group 3 (n=1,111) received the same treatment for more than 7 days after the biopsy. Univariable and multivariable logistic regression models addressed risk factors associated with infectious complication after prostate needle biopsy. RESULTS: Infectious complication after prostate needle biopsy developed in 18 (group 1), seven (group 2), and two patients (group 3) (p=0.001). In group 1, seven patients with infectious complication had positive blood cultures and harbored fluoroquinolone-resistant Escherichia coli, four had ceftriaxone susceptible isolates, and three had extended spectrum beta-lactamase-positive E. coli. Two patients in group 1 required intensive care because of septic shock. In multivariable analysis, the patients with combination of fluoroquinolone and ceftriaxone had significantly lower infectious complication rate than the fluoroquinolon alone (p=0.003). CONCLUSIONS: Antibiotic prophylaxis with ceftriaxone and fluoroquinolone before prostate needle biopsy decreased the risk of potentially serious infectious complications.

Prevalence and clinical significance of incidental 18F-fluoro-2-deoxyglucose uptake in prostate

PURPOSE: To investigate the prevalence and clinical significance of incidental prostate fluoro-2-deoxyglucose (FDG) uptake and to evaluate its impact on patient management. MATERIALS AND METHODS: Of 47,109 men who underwent FDG positron emission tomography between 2004 and 2014, 1,335 (2.83%) demonstrated incidental FDG uptake in the prostate, with 99 of the latter undergoing prostate biopsy. The primary end point was the histological presence of prostate adenocarcinoma in the biopsy specimen. Outcomes, including treatment methods, survival, and causes of death, were also assessed. Factors associated with the diagnosis of prostate cancer were evaluated by using logistic regression analysis. RESULTS: Patients with prostate cancer were more likely to have higher serum prostate-specific antigen (PSA) (p=0.001) and focal FDG uptake (p=0.036) than were those without. Prostate cancer occurred in 1 of 26 patients (3.8%) with serum PSA or =2.5 ng/mL. Multivariable analysis showed that focal lesions (odds ratio [OR], 5.50; p=0.038), age (OR, 1.06; p=0.031), and serum PSA (OR, 1.28; p=0.001) were independent predictors of prostate cancer diagnosis. Most patients with prostate cancer had organ-confined tumors. Of these, 12 (29.3%) underwent radical prostatectomy and 25 (60.9%) received hormone therapy. Of the 11 patients who died, 9 died of primary cancer progression, with only 1 patient dying from prostate cancer. CONCLUSIONS: The prevalence of incidental FDG uptake in the prostate was not high, although patients with elevated serum PSA had a higher incidence of prostate cancer. Patients with FDG uptake in the prostate should be secondarily evaluated by measuring serum PSA, with those having high serum PSA undergoing prostate biopsy.

Is Intravesical Bacillus Calmette-Guerin Therapy Superior to Chemotherapy for Intermediate-risk Non-muscle-invasive Bladder Cancer?: An Ongoing Debate

The objective of this study was to evaluate the risk of recurrence in patients with intermediate-risk non-muscle-invasive bladder cancer (NMIBC) after intravesical instillation with chemotherapeutic agents or Bacillus Calmette-Guerin (BCG) therapy. A cohort of 746 patients with intermediate-risk NMIBC comprised the study group. The primary outcome was time to first recurrence. The recurrence rates of the transurethral resection (TUR) alone, chemotherapy, and BCG groups were determined using Kaplan-Meier analysis. Risk factors for recurrence were identified using Cox regression analysis. In total, 507 patients (68.1%), 78 patients (10.5%), and 160 (21.4%) underwent TUR, TUR+BCG, or TUR+chemotherapy, respectively. After a median follow-up period of 51.7 months (interquartile range=33.1-77.8 months), 286 patients (38.5%) developed tumor recurrence. The 5-yr recurrence rates for the TUR, chemotherapy, and BCG groups were 53.6%+/-2.7%, 30.8%+/-5.7%, and 33.6%+/-4.7%, respectively (P<0.001). Chemotherapy and BCG treatment were found to be predictors of reduced recurrence. Cox-regression analysis showed that TUR+BCG did not differ from TUR+chemotherapy in terms of recurrence risk. Adjuvant intravesical instillation is an effective prophylactic that prevents tumor recurrence in intermediate-risk NMIBC patients following TUR. In addition, both chemotherapeutic agents and BCG demonstrate comparable efficacies for preventing recurrence.

Multiparametric magnetic resonance imaging for prostate cancer: A review and update for urologists

Recently, imaging of prostate cancer has greatly advanced since the introduction of multiparametric magnetic resonance imaging (mpMRI). mpMRI consists of T2-weighted sequences combined with several functional sequences including diffusion-weighted imaging, dynamic contrast-enhanced imaging, and/or magnetic resonance spectroscopy imaging. Interest has been growing in mpMRI because no single MRI sequence adequately detects and characterizes prostate cancer. During the last decade, the role of mpMRI has been expanded in prostate cancer detection, staging, and targeting or guiding prostate biopsy. Recently, mpMRI has been used to assess prostate cancer aggressiveness and to identify anteriorly located tumors before and during active surveillance. Moreover, recent studies have reported that mpMRI is a reliable imaging modality for detecting local recurrence after radical prostatectomy or external beam radiation therapy. In this regard, some urologic clinical practice guidelines recommended the use of mpMRI in the diagnosis and management of prostate cancer. Because mpMRI is the evolving reference standard imaging modality for prostate cancer, urologists should acquire cutting-edge knowledge about mpMRI. In this article, we review the literature on the use of mpMRI in urologic practice and provide a brief description of techniques. More specifically, we state the role of mpMRI in prostate biopsy, active surveillance, high-risk prostate cancer, and detection of recurrence after radical prostatectomy.

Prognostic impact of preoperative statin use after radical nephroureterectomy for upper urinary tract urothelial carcinoma

PURPOSE: The objective was to investigate the impact of statin use on prognosis after radical nephroureterectomy for upper urinary tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: A retrospective review of medical records identified 277 patients who underwent radical nephroureterectomy for primary UTUC at Asan Medical Center between January 2006 and December 2011. Information on preoperative statin use was obtained from patient charts in an electronic database. We assessed the impact of statin use on recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS: Of these 277 patients, 62 (22.4%) were taking statin medications. Compared to the statin nonusers, the statin users were older, had a higher body mass index, and had higher rates of cardiovascular disease and diabetes. The 5-year RFS rates of statin users and nonusers were 78.5% and 72.5%, respectively (p=0.528); the 5-year CSS rates were 85.6% and 77.7%, respectively (p=0.516); and the 5-year OS rates were 74.5% and 71.4%, respectively (p=0.945). In the multivariate analysis, statin use was not an independent prognostic factor for RFS (hazard ratio, 0.47; p=0.056), CSS (hazard ratio, 0.46; p=0.093), or OS (hazard ratio, 0.59; p=0.144) in patients who underwent radical nephroureterectomy for UTUC. CONCLUSIONS: Statin use was not associated with improved RFS, CSS, or OS in the sample population of patients with UTUC.