A Simple and Nonenzymatic Method to Isolate Human Corpus Cavernosum Endothelial Cells and Pericytes for the Study of Erectile Dysfunction

Silencing Histone Deacetylase 7 Alleviates Transforming Growth Factor-β1-Induced Profibrotic Responses in Fibroblasts Derived from Peyronie's Plaque

PURPOSE: Epigenetic modifications, such as histone acetylation/deacetylation and DNA methylation, play a crucial role in the pathogenesis of inflammatory disorders and fibrotic diseases. The aim of this study was to study the differential gene expression of histone deacetylases (HDACs) in fibroblasts isolated from plaque tissue of Peyronie's disease (PD) or normal tunica albuginea (TA) and to examine the anti-fibrotic effect of small interfering RNA (siRNA)-mediated silencing of HDAC7 in fibroblasts derived from human PD plaque. MATERIALS AND METHODS: For differential gene expression study, we performed reverse-transcriptase polymerase chain reaction for HDAC isoforms (1–11) in fibroblasts isolated from PD plaque or normal TA. Fibroblasts isolated from PD plaque were pretreated with HDAC7 siRNA (100 pmol) and then stimulated with transforming growth factor-β1 (TGF-β1, 10 ng/mL). Protein was extracted from treated fibroblasts for Western blotting. We also performed immunocytochemistry to detect the expression of extracellular matrix proteins and to examine the effect of HDAC2 siRNA on the TGF-β1-induced nuclear translocation of Smad2/3 and myofibroblastic differentiation. RESULTS: The mRNA expression of HDAC2, 3, 4, 5, 7, 8, 10, and 11 was higher in fibroblasts isolated from PD plaque than in fibroblasts isolated from normal TA tissue. Knockdown of HDAC7 in PD fibroblasts inhibited TGF-β1-induced nuclear shuttle of Smad2 and Smad3, transdifferentiation of fibroblasts into myofibroblasts, and abrogated TGF-β1-induced production of extracellular matrix protein. CONCLUSIONS: These findings suggest that specific inhibition of HDAC7 with RNA interference may represent a promising epigenetic therapy for PD.

Prognostic Factors for Recurrence and Progression in Korean Non-Muscle-Invasive Bladder Cancer Patients: A Retrospective, Multi-Institutional Study

PURPOSE: To identify the prognostic factors related to tumor recurrence and progression in Korean patients with non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS: Data were collected and analyzed for 2412 NMIBC patients from 15 centers who were initially diagnosed after transurethral resection of bladder tumor (TURBT) from January 2006 to December 2010. Using univariable and multivariable Cox proportional hazards models, the prognostic value of each variable was evaluated for the time to first recurrence and progression. RESULTS: With a median follow-up duration of 37 months, 866 patients (35.9%) experienced recurrence, and 137 (5.7%) experienced progression. Patients with recurrence had a median time to the first recurrence of 10 months. Multivariable analysis conducted in all patients revealed that preoperative positive urine cytology (PUC) was independently associated with worse recurrence-free survival [RFS; hazard ratio (HR) 1.56; p<0.001], and progression-free survival (PFS; HR 1.56; p=0.037). In particular, on multivariable analysis conducted for the high-risk group (T1 tumor/high-grade Ta tumor/carcinoma in situ), preoperative PUC was an independent predictor of worse RFS (HR 1.73; p<0.001) and PFS (HR 1.96; p=0.006). On multivariable analysis in patients with T1 high-grade (T1HG) cancer (n=684), better RFS (HR 0.75; p=0.033) and PFS (HR 0.33; p<0.001) were observed in association with the administration of intravesical Bacillus Calmette-Guérin (BCG) induction therapy. CONCLUSION: A preoperative PUC result may adversely affect RFS and PFS, particularly in high-risk NMIBC patients. Of particular note, intravesical BCG induction therapy should be administered as an adjunct to TURBT in order to improve RFS and PFS in patients with T1HG cancer.

Alpha-Blocker Treatment Response in Men With Lower Urinary Tract Symptoms Based on Sympathetic Activity: Prospective, Multicenter, Open-Labeled, Observational Study / 대한배뇨장애요실금학회지

PURPOSE: In this study, we compared the treatment outcomes for an alpha-blocker between 2 groups of men, one with high sympathetic activity (HSA) and another with low sympathetic activity (LSA) or normal sympathetic activity. METHODS: A total of 159 men (> or =50 years of age) with lower urinary tract symptoms resulting from benign prostatic hyperplasia were analyzed. We assigned patients to groups according to their sympathetic activity, which was evaluated by heart ratevariability measurements. HSA was defined as a low frequency/high frequency ratio greater than 1.6. All patients received 10mg of alfuzosin once a day for 12 weeks. The primary end point was a change in the total International Prostate SymptomScore (IPSS) at 12 weeks from baseline. RESULTS: Sixty-seven men were assigned to the HSA group and 92 men were assigned to the LSA group. The baseline characteristics were not significantly different between the 2 groups, and the response to alfuzosin was good in both groups. Themean total IPSS change was not different between the groups. Both groups were not significantly different with respect to the changes in maximal flow rate, IPSS voiding or storage symptom subscores, quality of life, and rates of adverse drug events. TheHSA group showed a similar willingness to continue treatment compared to the LSA group, although their treatment satisfaction rating was lower. CONCLUSIONS: The therapeutic effects of alfuzosin did not differ in regards to the differences in sympathetic activity, but treatment satisfaction ratings were lower in the HSA group.

A Case Report of Testicular Sparganosis Misdiagnosed as Testicular Tumor

Sparganosis is a parasitic infestation of human by plerocercoid larvae. Sparganum is usually reported to be found in the subcutaneous tissues as well as other organs, including scrotum. However, testicular sparganosis is extremely rare, because of strong capsule of tunica albuginea. An urban-living 54-yr-old Korean man presented with left scrotal pain for 6 yr. Both testes look normal physically. Ultrasonography revealed poorly defined, heterogeneous mass with increased echogenicity in the left testis. This case was misdiagnosed as testicular tumor and underwent orchiectomy, but was diagnosed as testicular sparganosis by histopathology. Sparganosis should be included for differential diagnosis of testis tumor in countries where sparganosis is prevalent.

Preoperative Clinical Factors for Diagnosis of Incidental Prostate Cancer in the Era of Tissue-Ablative Surgery for Benign Prostatic Hyperplasia: A Korean Multi-Center Review

PURPOSE: To identify potential predictive factors of incidental prostate cancer (IPca) in patients considering tissue-ablation treatment for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: From the 11 centers, 1,613 men who underwent transurethral resection of the prostate (TURP) or open prostatectomy were included. Before surgery, prostate biopsy was performed in all patients with prostate-specific antigen (PSA) > or =4.0 ng/ml or with abnormal digital rectal examination (DRE) findings. The patients with prostate cancer preoperatively or with PSA >20 ng/ml were excluded. As predictive factors of IPca, age, body mass index, PSA, DRE, and transrectal ultrasonography (TRUS) findings, including total prostate volume (TPV), transition zone volume (TZV), and the presence of hypoechoic lesions, were reviewed. PSA density (PSAD) and PSAD in the transition zone (PSAD-TZV) were calculated. RESULTS: IPca was diagnosed in 78 patients (4.8%). DRE findings, PSA, and TZV were independent predictive factors in the multivariate analysis. In the receiver operating characteristic curve analysis of PSA, PSAD, and PSAD-TZV, the area under the curve (AUC) was the largest for PSAD-TZV (AUC, 0.685). CONCLUSIONS: IPca was detected in 4.8% of the population studied. In addition to DRE findings, the combination of TZV and PSA can be useful predictive factors of IPca in patients considering tissue-ablation treatment as well as TURP.

Time-Related Changes in Detrusor Overactivity in Awake Rats with Spinal Cord Injury Observed by Simultaneous Registrations of Intravesical and Intraabdominal Pressures / 대한배뇨장애요실금학회지

PURPOSE: To compare the physical characteristics of detrusor overactivity (DO) induced by intravesical infusion of saline in awake, sham rats and rats with chronic spinal cord injury (SCI), by simultaneous registrations of intravesical and intraabdominal pressures. METHODS: Male Sprague-Dawley rats, normal or with a spinal vascular clip at the level of Th9, were investigated cystometrically 1 and 4 weeks after SCI. Intra-vesical pressure (IVP) and intra-abdominal pressure (IAP) were recorded simultaneously to evaluate true DO. During the filling phase, the event of IVP rises, defined as increments that exceeded 2 cmH2O from baseline, were determined as DO according to the absence of simultaneous changes in IAP. RESULTS: All SCI rats exhibited DO during the filling phase, which was not shown in sham rats. The frequency and pressure of DO had a tendency to decrease with time. The DO frequency of SCI rats after 4 weeks (0.9+/-0.2 min(-1)) was decreased compared with that after 1 week (2.1+/-0.4 min(-1); P0.05). CONCLUSIONS: Cystometric studies in awake male SCI rats showed some significant changes in bladder function after SCI. All SCI rats exhibited DO during the filling phase, and showed different physical characteristics of DO over the course of time. The neurological basis of these time-related changes remains poorly understood, but may provide important prognostic information about long-term urological management in SCI patients.

Current Status of Transurethral Prostatectomy: A Korean Multicenter Study

PURPOSE: We aimed to verify the current status of transurethral resection of the prostate (TURP) in Korea. MATERIALS AND METHODS: The medical records of 1,341 men who underwent TURP in 9 Korean medical centers between 2004 and 2008 were reviewed. The patients were divided into two groups according to time periods: 2004-2005 (group 1) and 2006-2008 (group 2). To verify differences in the two patient groups, age, prostate volume, indications for TURP, preoperative International Prostate Symptom Score (IPSS), and resected tissue weight were evaluated. RESULTS: The mean age of the patients was 71.2 years and the mean IPSS was 22.7. The patients' characteristics were not significantly different between the two groups. The annual cases of TURP increased over the study period. The proportion of lower urinary tract symptoms (LUTS) as an indication for TURP increased up to 58.3% in group 2 compared with 51.6% in group 1 (p=0.019). However, the proportion of patients who presented with acute urinary retention decreased from 35.5% to 30.3% with marginal statistical significance (p=0.051). Other indications such as hematuria, bladder stone, recurrent urinary tract infection, and hydronephrosis were not significantly different between the groups. The mean resected weights of the prostate were similar (17.5 g in group 1 and 18.3 g in group 2, respectively; p>0.05). CONCLUSIONS: TURP has been steadily performed in patients with benign prostatic hyperplasia and it is expected to remain constant. LUTS was the most common indication for TURP in recent years.

Accuracy of Methods for Urinary Detection in Women with Stress Urinary Incontinence

PURPOSE: We assessed the accuracy of urinary detection by visualization compared with a method using the urethral channel of a transurethral, three-channel urodynamic catheter. MATERIALS AND METHODS: This was a case series of 52 patients presenting with stress urinary incontinence over 2 years. Patients underwent video-urodynamic studies in both the supine and the erect positions by use of two techniques for measuring leak point pressure (LPP) by one examiner. LPP was determined as the intravesical pressure simultaneous to the starting point of urethral pressure changes through the urethral channel of a urodynamic catheter (LPP-ure) and then by visualization (LPP-vis) during different events. We also measured the time related to the provocations and the time to mark the leakage on the urodynamic machine by the examiner. RESULTS: The LPP-ure values (cough supine: 42.1+/-18.7, cough erect: 42.1+/-21.8, Valsalva supine: 42.2+/-23.3, Valsalva erect: 41.0+/-22.6 cmH2O) were significantly lower than the LPP-vis values (89.9+/-29.4, 97.4+/-30.4, 70.6+/-25.2, and 74.4+/-32.6 cmH2O, respectively, all p<0.001). Whereas the actual leakages happened during the pressure increases, urodynamic recording by visualization was done after those increases had finished. CONCLUSIONS: The use of visualization as a urinary detection method entails potential errors that cannot be adjusted for on that time scale. Our results emphasize the need to standardize the methodologies used for urinary leakage detection, because this measurement is closely related to the accuracy of measurement of leak point pressure.

Prostate-Specific Antigen Test Interval according to Baseline Prostate-Specific Antigen and Age

PURPOSE: The optimal interval at which to repeat prostate-specific antigen (PSA) measurement is controversial. We evaluated the probability of the serum PSA value increasing above specific cutoff values (4.0 ng/ml, 3.0 ng/ml, and 2.5 ng/ml) on annual follow-up visits in men with a lower baseline PSA than each cutoff value. MATERIALS AND METHODS: Between 2002 and 2006, a total of 14,459 men aged 40 to 79 years who underwent serum PSA determinations at least twice during health examinations at 11 medical centers were enrolled in this study. To reduce probable bias, we excluded men with pyuria, those with a baseline or follow-up PSA level of 10.0 ng/ml or more, and those with a history of medication with 5 alpha-reductase inhibitors. Serum PSA underwent logarithmic conversion to work out the normal distribution. The cumulative rate of freedom from increase in PSA above 4.0 ng/ml, 3.0 ng/ml, and 2.5 ng/ml was estimated with the Kaplan-Meier method according to baseline PSA range and age. The significance level was 1%. RESULTS: The rate of increase in PSA was lower in men who had a baseline PSA value in the low range and whose age was in the 40s or 50s. However, the cumulative rate of freedom from increase in PSA decreased as the PSA cutoff value was lowered. The optimal screening interval for men in their 40s and 50s whose baseline serum PSA level was 1.0 ng/ml or lower was 3 years when the significance level for PSA rising above 4.0 ng/ml was 1%. It was 2 years and 1 year, respectively, when the cutoff value was lowered to 3.0 ng/ml or 2.5 ng/ml. An annual PSA screening interval was recommended in men older than their 60s. CONCLUSIONS: The PSA test interval should be individualized according to baseline PSA, age, and PSA cutoff value.

Change in Patients' Perspectives after Education on the Management of Benign Prostatic Hyperplasia

PURPOSE: We assessed patients' understanding of benign prostatic hyperplasia (BPH) and their perspectives on the management of BPH through a questionnaire and evaluated changes in perspective after patient education. MATERIALS AND METHODS: From December 2007 to February 2008, 5 university hospitals participated in the study. A self-administered questionnaire was developed and was completed by patients before and after the patients read the patient's guide. The questionnaire was composed of 22 questions, which were grouped into 4 different categories. The patient's guide was written in everyday words and was based on the American Urological Association patient's guide. RESULTS: A total of 141 patients who visited the urology department for treatment of symptoms suggestive of BPH participated in the survey. Understanding about the statement, "BPH does not progress to become prostate cancer" was increased after reading the patient's guide (35.57%--> 73.87%, p56.7%). Among the desirable effects of drug therapy, the patients' preferences were amelioration of symptoms within a few weeks (51.1%--> 48.9%), reduction in prostate size (18.4%-->24.1%), prevention of acute urinary retention (14.2%-->13.5%), and prevention of prostate surgery (7.8% -->8.5%). The potential side effect of drug therapy that patients were most concerned about was generalized weakness. Patients' reluctance to undergo surgery was increased after reading the patient guide (9.9%-->23.4%, p=0.002). CONCLUSIONS: Patients have considerable misunderstanding about BPH. More efforts should be exercised in patient education and in the development of public education programs. Because patients expect not only rapid symptom improvement but also a reduction in prostate size, physicians should consider these points when treating patients with BPH.

A Multi-institutional Study on Histopathological Characteristics of Surgically Treated Renal Tumors: the Importance of Tumor Size

PURPOSE: The incidence of accidentally detected small renal tumors is increasing throughout the world. In this multi-institutional study performed in Korea, histopathological characteristics of contemporarily surgically removed renal tumors were reviewed with emphasis on tumor size. MATERIALS and METHODS: Between January 1995 and May 2005, 1,702 patients with a mean age of 55 years underwent surgical treatment at 14 training hospitals in Korea for radiologically suspected malignant renal tumors. Clinicopathological factors and patient survival were analyzed. RESULTS: Of the 1,702 tumors, 91.7% were malignant and 8.3% were benign. The percentage of benign tumors was significantly greater among those 4cm (4.5%) (p or = T3 was significantly less among tumors 4cm (26.8%) (p or = 3 was also significantly less among tumors 4cm (50.9%) (p < 0.001). The 5-year cancer-specific survival rate was 82.7%, and T stage (p < 0.001), N stage (p < 0.001), M stage (p = 0.025), and Fuhrman's nuclear (p < 0.001) grade were the only independent predictors of cancer-specific survival. CONCLUSION: In renal tumors, small tumor size is prognostic for favorable postsurgical histopathologies such as benign tumors, low T stages, and low Fuhrman's nuclear grades. Our observations are expected to facilitate urologists to adopt function-preserving approach in the planning of surgery for small renal tumors with favorable predicted outcomes.

Lowering Prostate-specific Antigen Threshold for Prostate Biopsy in Korean Men: Impact on the Number Needing Biopsy / 대한비뇨기과학회지

PURPOSE: We examined the effect of lowering prostate-specific antigen (PSA) threshold on the number of Korean men requiring a prostate biopsy. MATERIALS AND METHODS: We evaluated men who had serum PSA levels tested at routine physical check-ups between 1999 and 2005 at 11 domestic hospitals. Men with PSA> or =10ng/ml or patients with prostate cancer were excluded. A total of 45,074 men(aged 50 to 79 years) were enrolled and split into three age groups: 50-59 years, 60-69 years, and 70-79 years. For each age group, we calculated the number and proportion of men whose PSA level exceeded potential biopsy thresholds: 2.5ng/ml, 3.0ng/ml, and 4.0ng/ml. Results were extrapolated to the 4.992 million men older than 50 years old, or 21.3% of the Korean male population in 2005. RESULTS: The number of biopsy candidates at the threshold of 4.0ng/ml, 3.0ng/ml, and 2.5ng/ml were 1,321(2.9%), 2,248(5.4%), and 3,577(7.9%), respectively. Extrapolating to the male population in Korea, lowering the PSA threshold from 4.0ng/ml to 3.0 or 2.5ng/ml would increase the number of men needing biopsy by 1.75 and 2.49 times, respectively. CONCLUSIONS: Lowering the PSA threshold would increase the number of men receiving prostate biopsy despite the low reference age for PSA in Korea. Considering the low incidence of prostate cancer, physicians should be careful in altering the PSA threshold.

A Comprehensive Prognostic Stratification for Patients with Metastatic Renal Clear Cell Carcinoma

PURPOSE: To develop a reliable prognostic model for patients with metastatic renal cell carcinoma (RCC) based on features readily available in common clinical settings. PATIENTS AND METHODS: A total of 197 patients with RCC who underwent nephrectomy and immunotherapy from 1995 to 2004 were retrospectively reviewed. Their mean age was 55.1+/-11.8 yrs (24-83yrs) and mean survival time from metastasis was 22.6+/-20.2mos (3-120mos). The impact of 24 clinicopathological features on disease specific survival was investigated. RESULTS: On univariate analysis, constitutional symptoms, sarcomatoid differentiation, tumor necrosis, multiple primary lesions, liver metastasis, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), thrombocytosis, alkaline phosphatase, hematocrit, T stage, N stage, and nuclear grade had significant influence on survival (p or =3). CONCLUSION: A comprehensive prognostic stratification model was developed to predict survival and stratify patients for prospective clinical trials.

Leiomyosarcoma Arising from the Blind End of a Bifid Renal Pelvis

Sarcoma of the kidney is a rare condition. Leiomyosarcoma is the most common of the kidney sarcomas. Renal leiomyosarcoma usually originates from the smooth muscle layers of the kidney, for example, the renal capsule and renal vessels. Renal pelvis neoplasms, however, are primarily transitional cell carcinomas, and renal pelvis leiomyosarcomas are extremely uncommon. Renal pelvis leiomyosarcoma has never been reported in Korea. Moreover, no more than 10 cases have been reported internationally. However, none of these were associated with kidney abnormalities. Here we describe a case of leiomyosarcoma that originated from the blind end of a bifid renal pelvis.

The Relationship between Inflammation or Bacterial Infection according to the Traditional 4-glass Tests or Tc-99m Ciprofloxacin Imaging and the Scores of the National Institute of Health-Chronic Prostatitis Symptom Index in Men with Chronic Prostatitis / 대한비뇨기과학회지

PURPOSE: We wanted to determine whether inflammation and bacterial infection, as tested for by the traditional 4-glass test or Tc-99m ciprofloxacin imaging, correlate with the symptom severity in men with chronic prostatitis. MATERIALS AND METHODS: The study included 256 patients with symptoms of prostatitis. The Korean version of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was used to measure the symptoms of each patient. To diagnose bacterial infection, four-glass tests were performed that included culture for general bacteria, Mycoplasma hominis and Ureaplasma urealyticum, and polymerase chain reaction was performed for Chlamydia trachomatis. The patients with established uropathogens localized to the expressed prostatic secretion or the voided urine 3 were classified as having chronic bacterial prostatitis (CBP). To further localize the infection, the single photon emission computerized tomography images were obtained 3 hours after intravenous injection of Tc-99m ciprofloxacin. Associations between the symptoms and the inflammation and infection were evaluated. RESULTS: Based on the 4-glass tests, the patients were classified as CBP (n=16) or as chronic pelvis pain syndrome (CCPS) (the inflammatory type, n=94; non-inflammatory type, n=146). The CBP patients had a higher pain score than did the CPPS patients and there were no significant differences in the subscores for voiding symptoms and the quality of life between the groups. No significant differences were found in the total score or the subscores of the NIH-CPSI based on the presence or location of infection on the Tc-99m ciprofloxacin imaging. CONCLUSIONS: These findings suggest that bacterial infection, not inflammation, as determined by traditional laboratory tests contribute to the symptoms, especially pain, in men with chronic prostatitis.

The Efficacy of Transurethral Resection of Prostate in Patients with Large Prostate (over 100 g): Comparison with Open Prostatectomy

PURPOSE: We performed transurethral resection of prostate(TURP) in benign prostatic hyperplasia(BPH) patients with large prostate greater than 100 g and evaluated the efficacy of TURP compared with open prostatectomy. MATERIALS AND METHODS: From June 1998 to January 2006, all 26 patients with symptomatic BPH patients with large prostate greater than 100 g were entered into the study. 7 patients underwent open prostatectomy (open group) and the other 19 patients underwent TURP(TURP group). The pre-operative evaluation included International Prostate Symptom Score(IPSS), quality of life(QoL), peak urinary flow rate(Qmax), satisfaction index and transrectal ultrasonography, operation time, weight of resected tissue, postoperative hospital stay and complications were noted. RESULTS: Between two groups there were no statistically significant differences in pre-operative data. In open group resected tissue was larger than TURP group, however, hospital stay and operation time were longer, and operation-related complications happened more frequently than TURP group. There were no statistically significant differences in postoperative IPSS, QoL, Qmax and satisfaction index between the two groups. CONCLUSION: Compared with open prostatectomy, TURP can be safely performed for treating symptomatic BPH greater than 100 g in size.

Extramedullary Plasmacytoma of the Retroperitoneum / 대한비뇨기과학회지

Extramedullary plasmacytoma is an uncommon neoplasm and it occurs most frequently in the upper respiratory tract. Among the extramedullary plasmacytomas, retroperitoneal plasmacytoma is an extremely rare tumor with only about 10 cases having been reported in the world. Herein, we reported on a extramedullary plasmacytoma in the retroperitoneum. A 68-year-old man presented with left flank pain. The initial clinical diagnosis was retroperitoneal tumor. Retroperitoneal tumor mass excision along with left nephrectomy was performed and the histopathology showed plasmacytoma. There was no evidence of multiple myeloma. After the operation, he was treated with radiotherapy and the out-patient department follow-up is going on.

The Influence of Age and Prostate Volume on the Cancer Detection Rate in Korean Men with PSA Levels of 4.0 to 10.0ng/ml: a Multicenter, Retrospective Study / 대한비뇨기과학회지

PURPOSE: We retrospectively investigated how patients age and prostate volume influence on the cancer detection rate in Korean men with prostate-specific antigen (PSA) levels of 4.0 to 10.0ng/ml. MATERIALS AND METHODS: 791 Korean men who underwent transrectal ultrasound guided prostate biopsies (TRBx) at 12 medical centers were analyzed retrospectively during the previous 10 years. TRBx were performed in cases with PSA levels of 4.0 to 10.0ng/ml. The biopsy-proven cancer patient group was compared to the non-cancer patient group according to age, PSA, prostate volume and PSAD. RESULTS: Among the 791 patients who underwent TRBx, prostate cancer was detected in 123 patients (15.5%). The mean age (cancer group vs non-cancer group=69.1 vs 63.8 year-old), prostate volume (38.0 vs 42.5ml, respectively) and PSAD (0.21 vs 0.18ng/ml/ml, respectively) were found in statistically significant between the two groups. The cancer detection rate (20.1%) in the small prostate (less than 40ml) was significantly higher than that (10.3%) of the large prostate. The cancer detection rate was significantly increased with age: from 14.4% for the 50 to 59 year-old patients to 31.6% for the 80 or more year-old patients. CONCLUSIONS: The cancer detection rate in Korean men with a gray zone PSA level is lower than that of Caucasians. However, regarding the detection of prostate cancer in Korean men, the older age group and the patients with less than 40ml of prostate volume among the patients with gray zone PSA levels are considered as the important factors to decide whether biopsy of prostate is needed.

Age-Specific Reference Ranges for Serum Prostate-Specific Antigen in Korean Men / 대한비뇨기과학회지

PURPOSE: The level of serum prostate-specific antigen (PSA) varies according to both age and race. It is known that the level of PSA increases with age, and that Asians have a lower incidence of prostate cancer and levels of PSA than Caucasians. In this study, the variation in the serum PSA level in samples collected from general populations were used to find an actual standard age-specific PSA reference range for Koreans. MATERIALS AND METHODS: Patients who received serum PSA level check-ups, between November 1998 and July 2005, at 8 domestic hospitals, were selected for the investigation. The PSA levels of 120,439 adult males, aged between 30 and 80 years, were measured, and those lower than 10ng/ml were analyzed. To estimate the increase in the level of serum PSA according to age, a simple linear regression analysis was carried out. RESULTS: The mean PSA level reference ranges according to age were 1.88, 1.92, 2.37, 3.56 and 5.19ng/ml for those in their thirties, forties, fifties, sixties and seventies, respectively. The rates of PSA change were 0.0023, 0.0175 and 0.0499 for those in their forties, fifties and sixties, respectively, indicating the rates of PSA level change increase steady with age, but these increases are greater for those in their fifties and most severe after their sixties. The level of age-specific PSA reference in Korean men was lower than that of men from Western countries. CONCLUSIONS: The age-specific PSA reference levels, as found in pre-existing literature, showed differences between races, with the overall reference levels being low for domestic data. The standard reference level of age-specific PSA for the screening of prostate cancer may be lower in Korean men than those from Western countries.