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)

The Characteristics of Prostate Cancer with Metabolic Syndrome in Korean Men / 대한비뇨기과학회지

PURPOSE: Metabolic syndrome, a concurrence of disturbed glucose and insulin metabolism, overweight, abdominal fat distribution, dyslipidemia, and hypertension, has been reported to have some association with prostate cancer. Here, we assessed the relationship between metabolic syndrome and prostate cancer. MATERIALS AND METHODS: We assessed a total of 261 men who underwent radical retropubic prostatectomy between January 2004 and May 2005. The patients were stratified into two groups, with metabolic syndrome (n=75) or without (n=186). Metabolic syndrome was defined by the criteria of National Cholesterol Education Program Adult Treatment Panel III. We compared the clinical and pathologic features of specimens between the groups. RESULTS: There was no significant difference between the two groups in terms of mean age, serum prostate specific antigen level, prostate size, Gleason score, and pathologic stage. The tumor volume of prostate cancer was significantly higher in the metabolic syndrome group (6.6+/-5.5cc vs 5.0+/-4.5cc, p=0.010). No significant differences were observed in extracapsular extension, seminal vesicle invasion, bladder neck invasion, angiolymphatic invasion, perineural invasion, and multicentricity of cancer between the two groups. As the component of metabolic syndrome increased, the tumor volume was also found to increase (p-value=0.025). CONCLUSIONS: The data from our study support that metabolic syndrome is closely associated with the development and progression of prostate cancer.

Development of Nomogram for Predicting Pathologic Outcome using Prostate-specific Antigen, Gleason Score, and the Percentage of Positive Core in the Clinically Confined Prostate Cancers, and Comparison with Nomogram using Existing Factors / 대한비뇨기과학회지

PURPOSE: There have been reports that clinical stages do not reflect patients' postoperative prognosis well. On the contrary, the clinical application of the percentage of positive core(%(+) core), which predicts tumor volume has been increasing. We developed nomogram for predicting pathologic outcome using prostate-specific antigen(PSA), Gleason score and %(+) core based on data of radical prostatectomy and compared it with nomogram using clinical stage instead of %(+) core. MATERIALS AND METHODS: Two hundred and fifty nine patients with clinically confined prostate cancers were included in the study. Nomogram for predicting pathologic outcome was developed through multinominal logistic regression analysis, and pathologic outcomes were extracapsular invasion(ECE), seminal vesicle invasion(SVI) and bladder neck invasion(BNI). The accuracy of each nomogram for predicting each pathologic outcome was compared on the basis of receiver operating characteristic(ROC) curve analysis. RESULTS: The mean %(+) core was 24.6% and clinical stages T1c, T2a,b and T2c were 58.7%, 32.0% and 9.3%, respectively. ECE was observed in 45(17.4%), SVI in 9(3.5%), and BNI in 12(4.6%). With an increase in PSA, Gleason score, clinical stage, or %(+) core, the incidence of extraprostatic involvement increased gradually. Two nomograms for predicting pathologic outcome were developed. In quantifying expected predictive improvement, area under ROC curve for predicting ECE was greater in the nomogram using %(+) core than clinical stage(0.815 vs. 0.778). These values for predicting SVI were 0.886 and 0.760, respectively, and for predicting BNI, 0.743 and 0.764, respectively. CONCLUSIONS: We developed nomogram for predicting pathologic outcomes using %(+) core instead of clinical stage. Nomogram using %(+) core predicted ECE and SVI with greater accuracy than nomogram using clinical stage.

A Study on the Incidence and Preoperative Predicting Factors of Extraprostatic Extension in T1c Prostate Cancers / 대한비뇨기과학회지

PURPOSE: To evaluate the incidence and identify the predicting factors of extraprostatic extension(EPE) in T1c prostate cancers. MATERIALS AND METHODS: Of 267 consecutive men who underwent radical retropubic prostatectomy(RRP) as initial treatment for prostate cancers, 131(49.1%) presented with a clinical stage T1c disease. Clinicopathological data were collected, and factors related to biopsy collected; i.e. the number of positive cores(No.(+) core); the percentage of positive cores(%(+) core); the maximal tumor length(Max. mm cancer); the sum of tumor length (Total mm cancer); the maximal ratio of tumor/core length(Max. % mm cancer) and the mean ratio of tumor/core length(Mean % mm cancer). A logistical regression analysis was performed after dividing the cases into organ-confined(OC) and EPE. RESULTS: Of the T1c tumors, 107(81.7%) and 24(18.3%) were found to be OC and to have EPE after RRP, respectively. The preoperative factors that showed a significant difference between the two groups(OC vs. EPE) were %free prostate-specific antigen(17.7 vs. 11.1%), prostate volume(43.5 vs. 34.6ml), Gleason score(6.4 vs. 6.8), %(+) core(17.9 vs. 27%), Max. mm cancer(3.5 vs. 6.7mm) and Max. % mm cancer(24.0 vs. 41.6%). Of these factors, those significantly predicting EPE in the receiver operator characteristics curve were: the Gleason score, %(+) core, Max. mm cancer and Max. % mm cancer. Of these, only the %(+) core and Max. mm cancer were significant in predicting EPE in the multivariate logistical regression. When the cutoff of %(+) core was 19%, the risk of EPE increased 2.3 times, and when the cutoff of Max. mm cancer was 5mm the risk increased 3.6 times. CONCLUSIONS: Max. mm cancer and %(+) core during a biopsy are preoperative factors that predict the EPE of a clinical stage T1c disease, and should be considered for modifying the surgical technique and in establishing treatment plans.

Pathologic Characteristics of Prostate Cancers Missed by Application of the Age-specific Prostate-specific Antigen Reference in Men over Sixties / 대한비뇨기과학회지

PURPOSE: To examine the pathologic characteristics of prostate cancers missed by application of the age-specific prostate-specific antigen(PSA) reference in Korean men over sixties in clinical practice based on PSA cutoff 3.0ng/ml. MATERIALS AND METHODS: We made retrospective analysis of 1,063 patients aged between 60-79 who had had transrectal ultrasonography(TRUS)- guided biopsy due to the rise of PSA over 3.0ng/ml or abnormal findings in digital rectal examination(DRE) or TRUS. Age-specific PSA reference was set at 3.9ng/ml for 60s and 5.4ng/ml for 70s. RESULTS: Prostate cancer was detected in 34.3%(365/1,063) as a whole, and 31.5% in 60s, and 39.5% in 70s according to the age. When age-specific reference 3.9ng/ml was applied to 60s, 20(9.6%) cancers were missed compared with clinical cutoff value(3.0ng/ml). When age-specific reference 5.4ng/ml was applied to 70s, 23(16.0%) cancers were missed. On the average, 43(12.2%) of cancers were missed in 60s and 70s. Of 43 missed cancers, 39(90.7%) were with normal DRE and TRUS. Of these cancers, 16(41.0%) were clinically insignificant on biopsy, but only 7(22.6%) were insignificant in the pathologic examination of 31 radical prostatectomy specimens. CONCLUSIONS: In our clinical practice based on PSA cutoff 3.0ng/ml, most cancers missed by application of age-specific reference are clinically significant. But, considering the positive effect of age-specific reference on avoidance of unnecessary biopsies, large prospective study is needed to evaluate the efficacy of age-specific reference in Korean men over sixties.