Oncological Outcomes in Men with Metastatic Castration-Resistant Prostate Cancer Treated with Enzalutamide with versus without Confirmatory Bone Scan / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#In men with metastatic castration-resistant prostate cancer (mCRPC), new bone lesions are sometimes not properly categorized through a confirmatory bone scan, and clinical significance of the test itself remains unclear. This study aimed to demonstrate the performance rate of confirmatory bone scans in a real-world setting and their prognostic impact in enzalutamide-treated mCRPC. @*Materials and Methods@#Patients who received oral enzalutamide for mCRPC during 2014-2017 at 14 tertiary centers in Korea were included. Patients lacking imaging assessment data or insufficient drug exposure were excluded. The primary outcome was overall survival (OS). Secondary outcomes included performance rate of confirmatory bone scans in a real-world setting. Kaplan-Meier analysis and multivariate Cox regression analysis were performed. @*Results@#Overall, 520 patients with mCRPC were enrolled (240 [26.2%] chemotherapy-naïve and 280 [53.2%] after chemotherapy). Among 352 responders, 92 patients (26.1%) showed new bone lesions in their early bone scan. Confirmatory bone scan was performed in 41 patients (44.6%), and it was associated with prolonged OS in the entire population (median, 30.9 vs. 19.7 months; p < 0.001), as well as in the chemotherapy-naïve (median, 47.2 vs. 20.5 months; p=0.011) and post-chemotherapy sub-groups (median, 25.5 vs. 18.0 months; p=0.006). Multivariate Cox regression showed that confirmatory bone scan performance was an independent prognostic factor for OS (hazard ratio 0.35, 95% confidence interval, 0.18 to 0.69; p=0.002). @*Conclusion@#Confirmatory bone scan performance was associated with prolonged OS. Thus, the premature discontinuation of enzalutamide without confirmatory bone scans should be discouraged.

Differential Immunohistochemical Profiles for Distinguishing Prostate Carcinoma and Urothelial Carcinoma

BACKGROUND: The pathologic distinction between high-grade prostate adenocarcinoma (PAC) involving the urinary bladder and high-grade urothelial carcinoma (UC) infiltrating the prostate can be difficult. However, making this distinction is clinically important because of the different treatment modalities for these two entities. METHODS: A total of 249 patient cases (PAC, 111 cases; UC, 138 cases) collected between June 1995 and July 2009 at Seoul St. Mary's Hospital were studied. An immunohistochemical evaluation of prostatic markers (prostate-specific antigen [PSA], prostate-specific membrane antigen [PSMA], prostate acid phosphatase [PAP], P501s, NKX3.1, and α-methylacyl coenzyme A racemase [AMACR]) and urothelial markers (CK34βE12, p63, thrombomodulin, S100P, and GATA binding protein 3 [GATA3]) was performed using tissue microarrays from each tumor. RESULTS: The sensitivities of prostatic markers in PAC were 100% for PSA, 83.8% for PSMA, 91.9% for PAP, 93.7% for P501s, 88.3% for NKX 3.1, and 66.7% for AMACR. However, the urothelial markers CK34βE12, p63, thrombomodulin, S100P, and GATA3 were also positive in 1.8%, 0%, 0%, 3.6%, and 0% of PAC, respectively. The sensitivities of urothelial markers in UC were 75.4% for CK34βE12, 73.9% for p63, 45.7% for thrombomodulin, 22.5% for S100P, and 84.8% for GATA3. Conversely, the prostatic markers PSA, PSMA, PAP, P501s, NKX3.1, and AMACR were also positive in 9.4%, 0.7%, 18.8%, 0.7%, 0%, and 8.7% of UCs, respectively. CONCLUSIONS: Prostatic and urothelial markers, including PSA, NKX3.1, p63, thrombomodulin, and GATA3 are very useful for differentiating PAC from UC. The optimal combination of prostatic and urothelial markers could improve the ability to differentiate PAC from UC pathologically.

A Comparison between Single Scrotal Incision Orchiopexy and the Inguinal Approach in Patients with Palpable Undescended Testes Distal to the External Inguinal Ring

PURPOSE: Single scrotal incision orchiopexy is emerging as an alternative to the traditional inguinal approach. The purpose of this study was to compare the operative time, success rates, and complications of single scrotal incision orchiopexy with the traditional inguinal approach. MATERIALS AND METHODS: We reviewed the charts of patients with palpable undescended testes treated with a single scrotal incision or inguinal orchiopexy from April 2004 to April 2008. The position of the testis was confirmed under general anesthesia before any incision. Retractile and ectopic testes were excluded. We compared preoperative and postoperative testicular position, operative time, prevalence of patent processus vaginalis, and complications between the two groups. RESULTS: There were 43 patients who had palpable undescended testes below the external inguinal ring. A total of 57 orchiopexies were performed in 43 patients by either the single scrotal approach (group 1; n=25, mean age 3.12+/-1.99 years) or the inguinal approach (group 2; n=32, mean age 2.56+/-1.92 years). The average operative times for groups 1 and 2 were 39.76+/-7.66 and 53.31+/-6.33 minutes, respectively (p<0.05). Only 1 patient required conversion to an inguinal incision because of inappropriate mobilization. The complication rates were similar between the two groups. Testicular atrophy, hernia, or hydrocele formation did not occur during the follow-up period (4-41 months). CONCLUSIONS: Single scrotal incision orchiopexy is an effective procedure in selected patients regardless of patency of the processus vaginalis. It has the advantages of a shorter operative time and a more cosmetically appealing result compared with the inguinal two-incision approach.

Intrascrotal Extratesticular Epidermal Cyst / 대한비뇨기과학회지

An epidermal cyst, presenting as an intrascrotal tumor, with no relation to the testicles or cord structures, is a rare benign tumor. Their etiology is unknown, but the most widely accepted theory on the histogenesis of testicular epidermal cysts is that they are the end result of a monolayer teratoma arising from germ cells; however, an extratesticular epidermoid cyst is believed to be an abnormal closure of the median raphe and urethral groove. An extratesticular epidermal cyst is normally subcutaneous, and can be localized anywhere along the median raphe, from the distal penis to the anus. To our knowledge, there has been no case reported in the Korean literature. A case of an intrascrotal epidermal cyst is reported in a 44-year-old man.