Results of Definitive Radiotherapy in the Treatment of Prostate Cancer / 대한비뇨기과학회지

PURPOSE: To evaluate the results of radiotherapy for the treatment of prostate cancer, we retrospectively analyzed the biochemical recurrence and morbidity after radiotherapy. MATERIALS AND METHODS: Between August 1994 and July 2002, 59 patients with prostate cancer received definitive radiotherapy. Their median age was 69 years. Of the treated patients 64.4% had T1-2 tumor, 66.1% had a Gleason score of 7 or greater, 50.9% had presenting initial prostate-specific antigen (PSA) values of 20ng/ml or greater. Conventional external radiotherapy was administered to 40 patients (67.8%), using the four-field box technique and 3-dimensional conformal radiotherapy (3D-CRT) to 19 patients (32.2%). The pelvic lymph nodes were irradiated in 23 patients (39.0%). The median radiation dose to the prostate was 66Gy (range: 64.0-70.4Gy). A PSA relapse was defined according to the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus criteria. Rectal and bladder morbidities were graded using the criteria of the Radiation Therapy Oncology Group. RESULTS: The 5-year estimates of overall survival and the freedom from PSA recurrence were 87.6 and 58.3%, respectively. A PSA recurrence developed in 22 patients (37.3%). A PSA recurrence was significantly associated with the primary tumor stage and post-radiotherapy PSA nadir value. Prognostic groups and the post-radiotherapy PSA nadir value emerged as independent indicators of a PSA recurrence-free survival. The rates of grades 1-2 rectum and bladder late morbidity were 18.6 and 8.5%, respectively. Most of the complicated patients experienced grade 1-2 morbidities. CONCLUSIONS: Prognostic groups and the post-radiotherapy PSA nadir value were useful prognostic factors for predicting the prognosis after radiotherapy. Further prospective studies are needed to spare more normal tissues, yield lower PSA recurrence and result in less treatment morbidity with 3D-CRT and intensity modulated radiotherapy.

Predictive Factor for the Early Progression of Androgen Independent Prostate Cancer in Intermittent Androgen Deprivation Therapy / 대한비뇨기과학회지

PURPOSE: The purpose of this study was to define the predictive factors for the early progression of androgen independent prostate cancer in patients receiving intermittent androgen deprivation (IAD) therapy. MATERIALS AND METHODS: A total of 101 patients (stages A to C in 29 and stage D in 72), who had completed at least 1 cycle of IAD, were included. A variety of possible prognostic factors, such as age, initial prostate-specific antigen (PSA) and testosterone, Gleason score, lymph node or bone metastasis, nadir PSA and testosterone, duration to nadir PSA, duration of off treatment, and ECOG performance index were analyzed using uni- and multivariate tests. RESULTS: Patients had completed at least one, and up to six, treatment cycles with a median follow-up of 43 (13-100) months. The median nadir PSA levels were 0.28, 0.41, 0.71, 0.88, 1.85 and 0.79ng/ml for cycles 1 to 6 (median 4.6 months), respectively. The median one cycle duration (on off treatment) was 14 months, 44% of that time spent off treatment, but the off treatment duration decreased with increasing number of treatment cycles. A total of 42 patients progressed to androgen independent prostate cancer, and the progression free rates at 36 and 60 months were 72 and 52%, respectively, according to the Kaplan-Meier method. Using multivariate analysis, the nadir PSA (p=0.044), ECOG performance index (p= 0.039) and lymph node or bone metastasis (p=0.03) were the strongest predictors for the progression of androgen independent prostate cancer. CONCLUSIONS: On receiving IAD, prostate cancer patients with lymph node or bone metastasis, a poor performance status and comparatively higher serum PSA nadir value after the first treatment phase, there is a high possibility for the early progression of androgen independent prostate cancer.

Long-Term Health-Related Quality of Life in Patients with Prostate Cancer after Treatment / 대한비뇨기과학회지

PURPOSE: The study of quality of life issues has been gaining importance because treatment significantly impacts on the ability of a patient to continue social and occupational activities. The impact of treatment modalities for localized or locally advanced prostate cancer on the quality of life of patients was compared. MATERIALS AND METHODS: 186 eligible patients with localized or locally advanced prostate cancer were enrolled from four treatment groups: radical prostatectomy (RP), external beam radiotherapy (EBRT), hormonal therapy (HT) and watchful waiting (WW). To compare changes in the Health Related Quality of Life (HRQoL) after treatment by these modalities, the patients were given questionnaires, with self-addressed, stamped envelopes, for completion and return both before and after treatment. The questionnaire was mailed to the patients that were followed up for more than 12 months after treatment. Finally, 98 patients (RP 36, EBRT 31, HT 13, and WW 18) remained on the study. The sexual, urinary and bowel functions, and certain aspects of the HRQoL of these treatment groups were examined. The general HRQoL was evaluated with the EORTC QLQ-C30 (version 3.0), and the prostate cancer-specific QoL measured using EORTC QLQ-PR25. RESULTS: On global health status and functional scales, the RP group showed the worst progression in their mean scores between baseline and treatment, and had the worst urinary incontinence, erection and ejaculation problems of the groups. EBRT was associated with adverse bowel function, HT tended to produce more sexual functioning symptoms and WW had the least erection and ejaculation problems. CONCLUSIONS: The assignment of patients to several treatment modalities entails different risks of erectile dysfunction, urinary leakage, and bowel dysfunction. These findings will help facilitate patient counseling with regard to the HRQoL expectations of patients.

Predictors of Biochemical Failure after Radical Perineal Prostatectomy for Localized Prostate Cancer / 대한비뇨기과학회지

PURPOSE: We analyzed the radical prostatectomy cases retrospectively to stratify the risk of biochemical failure in order to appropriately select patients who potentially may benefit from adjuvant therapy. MATERIALS AND METHODS: A Cox multiple regression test was used to identify the variables associated with biochemical failure in 82 patients that underwent a radical perineal prostatectomy for prostate cancer, between 1995 and 2001, at the Samsung Medical Center. Numerous clinicopathological variables, including preoperative PSA, clinical stage, prostatectomy Gleason score, perineural invasion, seminal vesicle invasion, margin status, and pathological stage were evaluated. The Kaplan-Meier method was used to calculate the biochemical failure rates(BFR). RESULTS: Of the 82 patients, a biochemical failure developed in 17(20.7%) after a mean follow-up of 30.5 months. The overall BFR's calculated by the Kaplan-Meier method at 3 and 5 years were 24.9 and 29.3%, respectively. A biochemical failure was associated with the preoperative PSA, perineural invasion, seminal vesicle invasion, margin status and pathological stage(all log rank test p<0.05) in a univariate analysis. However, all the predictors, with the exception of the preoperative PSA, failed to remain significant with the multivariate model. CONCLUSIONS: The preoperative PSA is a strong independent predictor of biochemical failure in patients that underwent a radical perineal prostatectomy as a definitive local therapy for prostate cancer.

Predictive Factors of Prostatic Cancer Detection on Repeat Prostate Biopsy / 대한비뇨기과학회지

PURPOSE: To determine the demographic and tumor related predictors of repeat biopsy cancer detection in men diagnosed with benign prostatic tissue following an initial prostate biopsy. We evaluated the clinical parameters of prostate cancers detected on repeat biopsy. MATERIALS AND METHODS: Between May 1994 and 2001, 1,016 patients with suspected prostatic cancer underwent a transrectal ultrasound guided prostate biopsy. Of the 721 patients whose biopsy specimens were negative for prostate cancer, 53 had a repeat prostate biopsy for persistently, or abruptly elevated, prostate specific antigen (PSA) values. We examined their serum PSA, PSA density, free to total PSA value, annualized interbiopsy PSA change and biopsy core numbers, as well as their age, prostate size and the histological results of their initial, and repeated, biopsies, to determine if any predictor of the need for a repeat biopsy could be identified. RESULTS: From the repeat biopsies, 15 patients (28.3%) had prostate cancer. There were significant differences between the benign and malignant repeat biopsies, in relation to PSA density (p=0.001), free to total PSA value (p=0.002) and annualized interbiopsy PSA change (p=0.001). No patient with high-grade prostatic intraepithelial neoplasia was subsequently found to have cancer. CONCLUSIONS: The PSA density, free to total PSA value and annualized interbiopsy PSA change appear to aid in the prediction of cancer on a repeat biopsy.

Predictive Factors of Prostatic Cancer Detection on Repeat Prostate Biopsy / 대한비뇨기과학회지

PURPOSE: To determine the demographic and tumor related predictors of repeat biopsy cancer detection in men diagnosed with benign prostatic tissue following an initial prostate biopsy. We evaluated the clinical parameters of prostate cancers detected on repeat biopsy. MATERIALS AND METHODS: Between May 1994 and 2001, 1,016 patients with suspected prostatic cancer underwent a transrectal ultrasound guided prostate biopsy. Of the 721 patients whose biopsy specimens were negative for prostate cancer, 53 had a repeat prostate biopsy for persistently, or abruptly elevated, prostate specific antigen (PSA) values. We examined their serum PSA, PSA density, free to total PSA value, annualized interbiopsy PSA change and biopsy core numbers, as well as their age, prostate size and the histological results of their initial, and repeated, biopsies, to determine if any predictor of the need for a repeat biopsy could be identified. RESULTS: From the repeat biopsies, 15 patients (28.3%) had prostate cancer. There were significant differences between the benign and malignant repeat biopsies, in relation to PSA density (p=0.001), free to total PSA value (p=0.002) and annualized interbiopsy PSA change (p=0.001). No patient with high-grade prostatic intraepithelial neoplasia was subsequently found to have cancer. CONCLUSIONS: The PSA density, free to total PSA value and annualized interbiopsy PSA change appear to aid in the prediction of cancer on a repeat biopsy.

Does Transurethral Resection Affect the Results of Computed Tomography in the Clinical Staging of Invasive Bladder Cancer? / 대한비뇨기과학회지

Purpose: Computed tomography (CT) is commonly used for the clinical staging of bladder cancer. However, a previous transurethral resection (TUR) often results in an overestimation of a proper muscle and perivesical fat invasion in the CT. The purpose of this study was to evaluate the effects of a TUR on CT staging in patients with bladder cancer. MATERIALS AND METHODS: A total of 67 patients who underwent a radical cystectomy for primary bladder cancer were included in this study. CT was performed before a TUR in 38 patients (group 1) and after a TUR in 29 (group 2). In each patient, CT evaluated the presence or absence of a proper muscle and perivesical fat invasion and the findings were then compared with the histopathologic findings following the radical cystectomy. RESULTS: CT had an overall staging accuracy of 79.1% for a proper muscle invasion and 67.2% for a perivesical fat invasion. For a proper muscle invasion, there was a significant difference between both groups in the CT specificity (76.9% vs. 30.0%, p=0.024) while no difference in the sensitivity (92.0% vs. 89.5%) was noted. For a perivesical fat invasion, there was also a significant difference between the two groups in terms of the CT specificity (75.0% vs. 35.7%, p=0.022) while there was no difference in the sensitivity (72.2% vs. 80.0%). CONCLUSIONS: A TUR before a CT may cause a false positive result in the clinical staging of bladder cancer using CT. Therefore, to minimize the confounding effect of a TUR on CT staging, it is strongly recommended that a CT be performed before a TUR in the case of a highly suspicious invasive bladder cancer.

Changes in Serum Immunosuppressive Acidic Protein Following Radical Nephrectomy in Patients with Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: The serum immunosuppressive acidic protein (IAP) has been reported to be a useful tumor marker for renal cell carcinoma. In a previous study, the serum levels of IAP were shown to be related to the TNM stages and the nuclear grades in patients with renal cell carcinoma. The effectiveness of the IAP as a follow-up marker for renal cell carcinoma was evaluated. MATERIALS AND METHODS: In 135 patients who underwent a radical or partial nephrectomy for renal cell carcinoma, the serum concentrations of the IAP were measured by radial immunodiffusion preoperatively and postoperatively every 3 months. The changes in the serum IAP levels in the follow-up were recorded, and the change in the recurrence group was compared with that of the non-recurrence group. RESULTS: The mean age of 135 patients (male 87, female 48) was 52.2 12.3 (18-86) years. At follow-up, metastatic recurrences were observed in 8 patients an average of 18.4 months after surgery. The metastatic lesions were found in the bone in 3 patients, the liver in 2, the lung in 2 and the spleen in 1. In patients with an increased serum IAP preoperatively, the IAP levels were significantly lower 7-9 months postoperatively (p<0.05) (from 752.4 296.8microgram/ml to 465.9 88.9microgram/ml). With the metastatic recurrence, the serum IAP level was continuously higher. CONCLUSIONS: The serum IAP might be a valuable tool in following up a renal cell carcinoma for a postoperative recurrence.

Comparision of Unenhanced Helical Computerized Tomography and Intravenous Urography in the Radiologic Evaluation of Acute Flank Pain / 대한비뇨기과학회지

PURPOSE: This study was conducted to compared unenhanced helical computerized tomography (CT) with intravenous urography (IVU) in the evaluation of acute flank pain. MATERIALS AND MTHODS: Between April 2000 and April 2001, 59 patients with acute flank pain suspected of having urolithiasis underwent an unenhanced helical CT followed by an IVU. Two independent consultation urologic radiologists randomly assessed these patients for the presence, size and location of the calculus, ureteral dilatation and secondary sign of a ureteral obstruction. Of the 59 patients, 45 had a calculus confirmed on removal or a documented passage of a stone. The absence of a calculus was based on a clinical and radiological follow up with clinical resolution. RESULTS: CT revealed all 62 calculi from 45 patients and no calculus in 14 of the patients with a 98.4% sensitivity and a 100% specificity. IVU demonstrated 36 calculi from 35 patients and no calculus in 14 of the patients with a 57.1% sensitivity and a 100% specificity. Both CT and IVU demonstrated the secondary signs of a ureteral obstruction in 34 and 31 patients, respectively. The cost of the helical CT was 4-5 times higher than that of the IVU. CONCLUSIONS: Unenhanced helical CT is an accurate, safe, and a rapid technique for assessing acute flank pain and evaluate the choice for patients who would otherwise require a IVU for diagnosis but with a lower cost.

Comparision of Unenhanced Helical Computerized Tomography and Intravenous Urography in the Radiologic Evaluation of Acute Flank Pain / 대한비뇨기과학회지

PURPOSE: This study was conducted to compared unenhanced helical computerized tomography (CT) with intravenous urography (IVU) in the evaluation of acute flank pain. MATERIALS AND MTHODS: Between April 2000 and April 2001, 59 patients with acute flank pain suspected of having urolithiasis underwent an unenhanced helical CT followed by an IVU. Two independent consultation urologic radiologists randomly assessed these patients for the presence, size and location of the calculus, ureteral dilatation and secondary sign of a ureteral obstruction. Of the 59 patients, 45 had a calculus confirmed on removal or a documented passage of a stone. The absence of a calculus was based on a clinical and radiological follow up with clinical resolution. RESULTS: CT revealed all 62 calculi from 45 patients and no calculus in 14 of the patients with a 98.4% sensitivity and a 100% specificity. IVU demonstrated 36 calculi from 35 patients and no calculus in 14 of the patients with a 57.1% sensitivity and a 100% specificity. Both CT and IVU demonstrated the secondary signs of a ureteral obstruction in 34 and 31 patients, respectively. The cost of the helical CT was 4-5 times higher than that of the IVU. CONCLUSIONS: Unenhanced helical CT is an accurate, safe, and a rapid technique for assessing acute flank pain and evaluate the choice for patients who would otherwise require a IVU for diagnosis but with a lower cost.

The Pre-operative Clinical Predictors for Renal Insufficiency Developing after Radical Nephrectomy in the Patients with Contralateral Normal Kidney / 대한비뇨기과학회지

PURPOSE: In order to help selecting candidates for nephron-sparing surgery, the pre-operative clinical parameters that can predict a renal insufficiency developing after a radical nephrectomy even in patients with contralateral normal kidney were identified. MATERIALS AND METHODS: Of 551 patients who underwent a radical nephrectomy to treat a renal cell carcinoma, 213 patients with a pre-operative serum creatinine >2.0mg/dl or with synchronous bilateral or metastatic tumors were excluded. In 338 patients (male 227, female 111), the incidence of post-operative renal insufficiency was evaluated. Using Kaplan-Meier's method, the clinical parameters including age, sex, pre-operative serum creatinine level, hypertension and diabetes mellitus were evaluated to determine if they could be used to predict a post-nephrectomy creatinine failure, which was defined as a serum creatinine >2.0mg/dl. RESULTS: Of the 338 patients, creatinine failure had developed in 25 (6.1%) at post-operative 8 months (1-72 months). The mean pre-operative serum creatinine level of these patients was 1.35mg/dl. Six patients were older than 60, 16 patients had hypertensive and 8 patients were diabetic. In 2 patients, hemodialysis was required due to a progressive post-operative deterioration in the renal function. Multivariate analysis revealed that all the pre-operative clinical parameters such as old age (>60 years), male sexuality, hypertension, diabetes mellitus and an elevated serum creatinine level (>1.4mg/dl) were significant independent predictors of a post-nephrectomy renal insufficiency (p< 0.05). CONCLUSIONS: Patients with clinical factors including old age, male sexuality, hypertension, diabetes mellitus and an elevated creatinine value have an increased risk of a renal insufficiency after a radical nephrectomy even though the contralateral kidney is normal. Therefore, in these patients nephron-sparing surgery is strongly recommended.

The Pre-operative Clinical Predictors for Renal Insufficiency Developing after Radical Nephrectomy in the Patients with Contralateral Normal Kidney / 대한비뇨기과학회지

PURPOSE: In order to help selecting candidates for nephron-sparing surgery, the pre-operative clinical parameters that can predict a renal insufficiency developing after a radical nephrectomy even in patients with contralateral normal kidney were identified. MATERIALS AND METHODS: Of 551 patients who underwent a radical nephrectomy to treat a renal cell carcinoma, 213 patients with a pre-operative serum creatinine >2.0mg/dl or with synchronous bilateral or metastatic tumors were excluded. In 338 patients (male 227, female 111), the incidence of post-operative renal insufficiency was evaluated. Using Kaplan-Meier's method, the clinical parameters including age, sex, pre-operative serum creatinine level, hypertension and diabetes mellitus were evaluated to determine if they could be used to predict a post-nephrectomy creatinine failure, which was defined as a serum creatinine >2.0mg/dl. RESULTS: Of the 338 patients, creatinine failure had developed in 25 (6.1%) at post-operative 8 months (1-72 months). The mean pre-operative serum creatinine level of these patients was 1.35mg/dl. Six patients were older than 60, 16 patients had hypertensive and 8 patients were diabetic. In 2 patients, hemodialysis was required due to a progressive post-operative deterioration in the renal function. Multivariate analysis revealed that all the pre-operative clinical parameters such as old age (>60 years), male sexuality, hypertension, diabetes mellitus and an elevated serum creatinine level (>1.4mg/dl) were significant independent predictors of a post-nephrectomy renal insufficiency (p< 0.05). CONCLUSIONS: Patients with clinical factors including old age, male sexuality, hypertension, diabetes mellitus and an elevated creatinine value have an increased risk of a renal insufficiency after a radical nephrectomy even though the contralateral kidney is normal. Therefore, in these patients nephron-sparing surgery is strongly recommended.

A Follow-up Guideline after Radical Nephrectomy for Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: To establish the stage specific follow-up guideline for renal cell carcinoma (RCC), we evaluated the pattern of metastases and the clinical course of patients who had underwent radical nephrectomy. MATERIALS AND METHODS: We reviewed retrospectively the records of 165 patients who underwent radical nephrectomy with a final pathologic diagnosis of RCC. We compared the time of the first recurrence, the site of metastasis and detection modality according to the pathologic stages. RESULTS: Metastases were found in 18 patients in an average of 12.9 9.5 months after nephrectomy. None of the 77 patients with pT1 ( or = 5cm), 4 of the 47 patients with pT2 disease and 10 of the 20 patients with pT3 disease. CONCLUSIONS: The risk of recurrence and metastasis in RCC is stage-dependent. Therefore, a different follow-up guideline should be applied for each stage of RCC after surgical treatment. There is no need for follow-up in patients with pT1 tumors smaller than 5cm. For patients with pT1 tumor larger than 5cm, pT2, pT3 diseases, follow-up studies including history of symptoms, laboratory studies, chest x-ray, and computerized tomography are indicated at defined intervals.

The Usefulness of Endo-rectal Coil MRI in the Staging of Clinically Localized Prostate Cancer / 대한비뇨기과학회지

PURPOSE: We evaluated the ability of endo-rectal coil MRI (ER-MRI) to predict the local pathological stage of prostate cancer prior to radical prostatectomy and compared the results with those of transrectal ultrasonography (TRUS). MATERIALS AND METHODS: ER-MRI using high field magnets (1.5 Tesla) were performed in 22 patients (mean age 62.8 years, range 51-73) with clinically localized prostate cancer before radical prostatectomy. Of the 22 patients, 17 patients were also assessed by TRUS. The results of the imaging techniques were compared with the post-operative histopathological findings. As one patient with pelvic lymph node metastasis, which was detected on frozen-section examination during surgery, was spared radical prostatectomy, the final evaluation included 21 patients. RESULTS: DSeven of the 21 patients (33%) were found to have extraprostatic extension (EPE), and 5 had seminal vesicle invasion (SVI). The sensitivity and specificity for diagnosing EPE using ER-MRI were 62.5% and 84.6%, respectively, and 16.7% and 100% with TRUS. The sensitivity and specificity for diagnosing SVI were 80.0% and 93.8%, respectively with ER-MRI, and 0% and 92.3% with TRUS. The accuracy of predicting SVI was 90.5% with ER-MRI compared to 70.6% with TRUS. CONCLUSIONS: ER-MRI was significantly better than TRUS for determining the local extent of prostatic cancer and for prediction of SVI in the preoperative staging of clinically localized prostate cancer.

Comparision of Extracoporeal Shock Wave Lithotripsy (ESWL) and Ureteroscopic Lithotripsy (URS) for Treatment of Upper Ureteral Calculi / 대한비뇨기과학회지

PURPOSE: The aim of this study is to compare extracoporeal shock wave lithotripsy (ESWL) with ureteroscopic lithotripsy (URS) to establish the efficacy in treating upper ureteral calculi. MATERIALS AND METHODS: We retrospectively reviewed our experience with 279 patients treated with ESWL and URS for a upper ureteral calculi. Two hundred and four patients were treated with ESWL using MPL-9000 while 75 patients were treated with URS using 8/9.8Fr rigid ureteroscopes. Upper ureteral calculi were classified as those above L3 and below L4. We determined the comparative efficacies of ESWL with URS in the treatment of upper ureteral calculi according to location and size of stones. RESULTS: In the ESWL treatment, the overall stone free rate was 90.2%. The stone free rates were significantly affected by the location of the calculi with 92% above L3, and 84% below L4. The stone free rates according to the size were 91.9% for stones OR =21mm. Regardless of the size of the calculi, complete removal of all stone fragments was achieved in 86.7% of the patients treated with URS. The stone free rates according to the location of calculi were 79.2% in those above L3, and 90.1% in those below L4 with URS. ESWL has been found with a statistically significant higher success rate than URS in the treatment of above L3 ureteral calculi (p<0.05). On the other hand, URS showed a statistically significant higher success rate in the treatment of calculi larger than 21mm in size. The cost of URS was cheaper than ESWL but the complication rate was higher than ESWL. CONCLUSIONS: Our study demonstrates that the highly successful stone free rates can be achieved with either ESWL or URS. ESWL is useful as the first-line therapy for treatment of the upper ureteral calculi whereas URS should be considered as a treatment modality when the calculi are below L4 of the upper ureter and sizes of the calculi are larger than 21mm (URS).

The Role of Renal Ultrasonography in Asymptomatic Microscopic Hematuria / 대한비뇨기과학회지

PURPOSE: Serious urologic lesions have been reported in 4.8% to 16.5% of patients referred for asymptomatic microscopic hematuria. This study aimed to demonstrate the cause of microscopic hematuria and to evaluate the diagnostic efficacy of urologic workup methods. MATERIALS AND METHODS: Between February 1995 and July 1999, 970 patients with asymptomatic microscopic hematuria were examined by urinalysis, urine culture, intravenous pyelography and renal ultrasonography. Patients with proterinuria of 2+ or more and RBC casts were excluded from the study. Average patient age was 53 years (20-82 years). The male-to-female ratio was approximately 1:1 (473:497). RESULTS: Among 970 patients with asymptomatic microscopic hematuria, the cause was detected in 96 patients, including 2 renal cell carcinoma and 2 bladder tumor. In patients over the age of 50 years, the incidence of malignancy was 6.6% (4/610) and higher incidence of significant lesions was found (11.0%) compared to patients under the age of 50 (8.1%). Malignancy was not found in any of the 360 patients under the age of 50 years. Neither the degree of hematuria nor sexual difference correlates with clinically significant lesions. In 96 patients with significant lesions, the detection rate of abnormalities by renal ultrasonography and IVP was 26% (25/96) and 12.5% (12/96), respectively (p=0.004). CONCLUSIONS: Our report has shown that 9.9% of the patients had significant urologic lesions including 4 malignancies. We demonstrate that renal ultrasonography was more beneficial than IVP for the evaluation of the upper tract in patients with asymptomatic microscopic hematuria. It may be more appropriate to consider renal ultrasonography in addition to IVP as an initial examination in the evaluation of microscopic hematuria.

Microscopic Vascular Invasion as Prognostic Factor for Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: It has been reported that renal cell carcinoma patients with microscopic vascular invasion showed poor treatment outcome. We analysed the association between microscopic vascular invasion and other variable pathologic and clinical parameters, which are known as poor prognostic factors, to evaluate the significance of microscopic vascular invasion as a prognostic factor. MATERIALS AND METHODS: 157 patients (108 men and 49 women, mean age 53 years) who had received radical nephrectomy (153 patients) or partial nephrectomy (4 patients) for the treatment of renal cell carcinoma were evaluated. Microscopic vascular invasion was compared with Fuhrman's nuclear grade, TNM stage, tumor diameter, lymph node involvement, p53 point mutation, result of flow cytometry, and recurrence. RESULTS: Microscopic vascular invasion was found in 51 of 157 patients (32.5%). Microscopic vascular invasion showed significant relationship with Fuhrman's nuclear grade, T stage, and tumor diameter (p<0.05). Microscopic vascular invasion was observed more frequently in patients with lymph node involvement, DNA aneupolid tumor, and recurrence (p<0.05). CONCLUSIONS: Microscopic vascular invasion was related to higher T stage, higher grade, larger tumor diameter, lymph node involvement, DNA aneuploid tumor, and recurrence. Microscopic vascular invasion might be another important finding to predict prognosis not to be overlooked. And since there is a higher possibility of lymph node metastasis and tumor recurrence in cases with microscopic vascular invasion, localized renal cell carcinoma patients with microscopic vascular invasion should be followed closely for metastatic disease.

Can PSA Density and Parameters Derived from Biopsy Specimens Predict Bone Scan Evidence of Metastases in Newly Diagnosed Prostate Cancer? / 대한비뇨기과학회지

No abstract available.

Induction of Prostate Apoptosis by Low Dose Terazosin in Benign Prostatic Hyperplasia / 대한비뇨기과학회지

No abstract available.

The Use of Standardized Patients in Medical Education / 한국의학교육

Standardized patients(SPs) are either persons who are trained to simulate a patient's illness in a standardized way or actual patients. Newly established Sungkyunkwan University School of Medicine started problem based learning(PBL) curriculum and SP program has been developed for teaching and evaluating clinical skills in medical education. Standardized patients were recruited from the community. Small-group SP training sessions were operated by two SP trainers and supervised by a clinical faculty. Standardized patients were used in teaching and practicing interviewing and physical examination skills for students. We report the experiences of initial stage of SP program and views of students and SPs. We surveyed 35 first-year medical students after SP encounters. The questionnaire was about effectiveness and realism of SP and general views of students. Another simple survey was conducted on 12 SPs who had participated in SP program for more than 4 months. Most students answered that SP encounters were interesting and more helpful in learning history-taking and clinical skills. The attitude of SPs was enthusiastic and their simulations were rated as appropriate and acceptable. The evaluations of the SP program by students, SPs, and faculty were very favorable. As an alternative to real patients, the SP can offer advantages such as availability, adaptability and controllability. If trained well, they also can provide objective feedback to the students. The SP offers a readily available tool for teaching and evaluating the clinical performance and interpersonal skills of medical students. It is suggested that the use of SP is stimulating and challenging way of teaching and evaluating in medical education.