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

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

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

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

Primary Classic Kaposi's Sarcoma of the Penis in an HIV-Negative Patient

Kaposi's sarcoma (KS) is a multifocal hemorrhagic sarcoma that occurs primarily on the extremities. KS limited to the penis is rare and a well-recognized manifestation of acquired immune deficiency syndrome (AIDS). However, KS confined to the penis is extraordinary in human immunodeficiency virus (HIV)-negative patients. We present the case of a 68-year-old man with a dark reddish ulcerated nodule on the penile skin, which was reported as a nodular stage of KS. We detected no evidence of immunosuppression or AIDS or systemic involvements in further evaluations. In his past medical history, the patient had undergone three transurethral resections of bladder tumors due to urothelial cell carcinoma since 2000 and total gastrectomy, splenectomy, and adjuvant fluorouracil/cisplatin chemotherapy for 7 months due to advanced gastric carcinoma in 2005. The patient was circumcised and has had no recurrence for 2 years.

Predictive Factors of Prostate Cancer at Repeat Biopsy in Patients with an Initial Diagnosis of Atypical Small Acinar Proliferation of the Prostate

PURPOSE: The factors that predict prostate cancer detection on repeat biopsy were evaluated in patients with atypical small acinar proliferation (ASAP) on the initial biopsy. MATERIALS AND METHODS: From 2003 to 2008, 3,130 men with suspected prostate cancer underwent a prostate needle biopsy, and 244 (7.8%) were diagnosed as having ASAP. One hundred seventy of 244 patients were rebiopsied at least once more. They were classified into a prostate cancer group and a noncancer group according to the final pathological diagnosis. The database of rebiopsied patients included age, initial prostate-specific antigen (PSA), PSA density (PSAD), PSA velocity (PSAV), total prostate volume (TPV), and transitional zone volume of the prostate (TZV). We compared differences in the aforementioned parameters between the 2 groups. RESULTS: A total of 57 patients (33.5%) with ASAP were ultimately shown to have prostate cancer. Univariate analysis showed that PSAD (p=0.002), PSAV (p=0.001), TPV (p=0.035), and TZV (p=0.005) differed significantly between the cancer and noncancer groups. The results of the multivariate analysis showed that PSAD (p=0.022), PSAV (p<0.001), and TPV (p=0.037) had a statistically significant correlation with cancer detection. CONCLUSIONS: PSAD, PSAV, and TPV are predictive factors of prostate cancer in patients with an initial diagnosis of ASAP of the prostate. Although repeat biopsy is mandatory irrespective of PSA values, the follow-up of PSA may help to estimate the probability of cancer in these men.

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

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

Validity of the Prediction Equation of the Maximal OxygenConsumption in Submaximal Exercise Test

OBJECTIVE: To explore accuracy and validity of a VO2max prediction equation of the multistage model using by modified Bruce protocol submaximal exercise test in healthy subjects. METHOD: Thirty three healthy subjects (age: 44.0+/-12.9) were recruited. VO2max was measured during treadmill by direct gas analysis from a maximal incremental test. VO2max was then predicted from multistage model equation with age, measured oxygen consumption and heart rate during a maximal incremental treadmill test. And the predicted VO2max values from equation were compared with the measured VO2max values. RESULTS: The predicted VO2max values and the measured VO2max values were highly correlated (r=0.9, p<0.001). The predicted VO2max values (2,285.3+/-536.0 ml/min) were not significantly different from the measured VO2max values (2,285.5+/-598.5 ml/min). CONCLUSION: In healthy subjects, the multistage model equation offers a fairly accurate VO2max prediction. Therefore the equation can be used in the estimation of VO2max at modified Bruce protocol in an aerobic exercise program.

High-Dose Terazosin Therapy (5mg) in Korean Patients with Lower Urinary Tract Symptoms with or without Concomitant Hypertension: A Prospective, Open-Label Study

PURPOSE: We determined the efficacy and safety of a relatively high dose of terazosin (5mg) in Korean patients with lower urinary tract symptoms (LUTS), with or without concomitant hypertension. MATERIALS AND METHODS: From July to December 2006, 200 men who consecutively presented with LUTS were prospectively studied. Eight weeks after treatment, blood pressure (BP), uroflowmetry, and International Prostate Symptom Score (I-PSS) were assessed. For analysis purposes, patients were stratified according to concomitant hypertension. Of the 200 patients, 173 completed the scheduled eight-week treatment period. RESULTS: At baseline, no differences were evident in the two groups in terms of I-PSS, Qmax, PVR and BP. After eight weeks of treatment-although I-PSS and uroflowmetry parameters were not significantly different in the two groups-systolic and diastolic BP in the non-hypertensive control group were higher than in the hypertensive group (p= 0.001 and p=0.0100, respectively). Changes in I-PSS, uroflowmetry parameters, and BPs measured at week eight post- treatment commencement did not significantly differ between the two groups. Moreover, the addition of 5mg of terazosin to antihypertensives did not cause a significant reduction in either systolic or diastolic BP in either group. CONCLUSION: Adding terazosin to existing antihypertensive regimens did not seem to increase the incidence of adverse events. Our findings suggest that 5mg terazosin is effective and that it has an acceptable safety profile as an add-on therapy for patients with LUTS and concomitant hypertension.

Effect-site Target-Controlled Infusion of Propofol and Alfentanil for Laryngeal Mask Airway (LMA) Insertion in Ambulatory Breast Surgery without Neuromuscular Blockade / 대한마취과학회지

BACKGROUND: We performed this study to evaluate the appropriate effect-site concentrations of propofol and alfentanil for LMA insertion in ambulatory breast surgery without neuromuscular blockade. METHODS: Seventy-three ASA physical status 1 patients were enrolled. The administration of propofol and alfentanil was titrated versus bispectral index (BIS or = 80 mmHg) and heart rate (HR > or = 50/min), respectively. The condition of LMA insertion was assessed as grade 1 (excellent), 2 (acceptable), and 3 (poor) according to gag, cough, movement, and laryngospasm. We recorded SBP, HR and BIS before and after LMA insertion, the effect-site concentrations of propofol and alfentanil at the time of LMA insertion, and the LMA removal time at recovery. RESULTS: The condition of LMA insertion at first attempt was grade 1 in 71.6% of patients, grade 2 in 20.3%, and grade 3 in 8.1%. After the first attempt at LMA insertion, movement occurred in 25.7% and the BIS increased above 60 in 31.5%. The range of the effect-site concentrations of propofol and alfentanil at the first attempt were 2.0 6.0 (3.7 +/- 0.7)microgram/ml and 30.0 150.0 (71.6 +/- 24.4) ng/ml, which reflected a large inter-individual variability. The incidences of hypertension, tachycardia, hypotension, and bradycardia were 6.8%, 1.4%, 11.0% and 5.5%, respectively. The mean LMA removal time was 4.7 min. CONCLUSIONS: LMA was inserted successfully in 91.7% at first attempt and removed promptly at recovery. Movement and increase of BIS above 60 occurred frequently after the first attempt of LMA insertion with the effect-site target-controlled infusion of propofol and alfentanil without neuromuscular blockade.

Complete Remission of Renal Cell Carcinoma with Metastases to Lung and Bone Following Initial Interferon-alpha Immunotherapy and Adjuvant Nephrectomy / 대한비뇨기과학회지

Patients with metastatic renal cell carcinomas have a median survival of less than 1 year and a 0-20% 5-year survial. The immunotherapy agent interferon-alpha has consistently produced objective responses rarely exceeding 20% of treated patients. Moreover, in patients with metastases to brain, liver or bone, the prognosis is extremely poor. A 66-year-old man, with a right renal cell carcinoma, with metastases to lung and bone who had entered a remarkable complete radiological remission of the metastases to lung and bone by 82 months following interferon-alpha immunotherapy, underwent a nephrectomy. The patient has remained recurrence free for 16 months after the nephrectomy.

A Case of Primary Choriocarcinoma of the Fallopian Tube / 대한산부인과학회잡지

Primary choriocarcinoma of the fallopian tube has been known for 4% of choriocarcinoma also 1.7% of gestational trophoblastic disease. Its symptom and sign in presentation are similar to the ectopic pregnancy or adnexal mass, thus it is confirmed through histopathological descriptions after explolaparotomy or laparoscopy. Mostly it is common in younger women who are reproductive, we have done conservative surgery followed by chemotherapy. After that, the prognosis was good. We have experienced a case of primary choriocarcinoma of the fallopian tube and reported with a brief review.

A case of Neuroblastoma Diagnosed by Prenatal Ultrasonography / 대한산부인과학회잡지

We report a case that a neuroblastoma in a fetus was recognized before birth and its growth could be observed. The diagnosis was made by ultrasonography. The suprarenal mass initially showed pure cystic features on ultrasound. Surgical exploration revealed an adrenal cystic tumor and histology showed a neuroblastoma in situ. Forty-five infants with prenatally detected neuroblastoma were found in the English literature; about one-half of them were cystic neuroblastomas and most had a favorable outcome.