Prostate Cancer Working Group report.

The incidence of prostate cancer, while still lower than in Western nations, is increasing rapidly in Asian countries due to a more westernized lifestyle. Prostate cancer mortality is declining in the USA, where most prostate cancers are diagnosed in the early stage. In contrast, the mortality rates of prostate cancer in Asian countries are expected to continue to increase, because the percentage of advanced-stage prostate cancers remains high. Therefore, early detection by prostate-specific antigen screening and a comprehensive strategy for cancer prevention are essential for Asian people. The exposure rate of prostate-specific antigen screening is very low in Asian countries. Increased prostate-specific antigen screening may reduce the mortality rate. The stances regarding population screening differ among countries. Urological associations should promote population screening. Reliable data from Asian countries are needed. The prostate cancer incidence is low in Asian countries, perhaps due to high soy consumption. Isoflavones may prevent prostate cancer in Asian countries, but that is not yet clear. A large, multinational study in Asia is needed to clarify whether or not isoflavone consumption shows efficacy in preventing prostate cancer. Clinical data suggest that hormonal therapy is more effective in Asians than in Westerners. Clinical guidelines should consider including hormonal therapy as one of the options for the treatment of localized prostate cancer. At the same time, effort should be made to decrease the adverse effects of each treatment. Collaborative studies on the treatment of prostate cancer should be carried out among Asian countries.

Efficacy of bladder-preserving therapy for patients with t3b, t4a, and t4b transitional cell carcinoma of the bladder.

PURPOSE: Radical cystectomy has been the most widely used method in the treatment of bladder cancer, but it is limited by major problems. Therefore, we investigated the results of bladder-preserving treatment in patients with T3b, T4a, and T4b transitional carcinoma of the bladder who underwent transurethral resection of bladder cancer and subsequent administration of chemotherapy. MATERIALS AND METHODS: Of all patients who were diagnosed with bladder cancer and underwent bladder-preserving treatment between January 2001 and August 2008, 78 patients with at least 12 months of follow-up data were enrolled in this study. All patients received gemcitabine (1,000 mg/m(2)) and cisplatin (70 mg/m(2)) once per month postoperatively for a total of 6 months and completed a follow-up visit every 3 months. The patient survival rate and prognostic factors (age, tumor size, differentiation, number of lesions, stage, and presence of hydronephrosis) were assessed. The Kaplan-Meier method was used to analyze survival rate, and Cox multiple regression analysis was used for prognostic factors. RESULTS: The mean patient age was 68.32+/-8.6 years, the mean duration of follow-up was 54.70+/-32.8 months, and the median duration of follow-up was 49.0 months. The 5-year survival rate was 66.2%. Single lesions were found in 28 cases (35.9%), and multiple lesions were found in 50 cases (64.1%). Stage T3b lesions were identified in 56 cases (71.8%), stage T4a lesions were identified in 16 cases (20.5%), and stage T4b lesions were identified in 6 cases (7.7%). Tumor size was less than 4 cm in 4 cases (59.0%) and greater than 4 cm in 32 (41.0%). Hydronephrosis was present in 21 cases (26.9%). In the 5-year survival analysis, prognostic factors significantly influencing survival rate were T-stage of the tumor and absence of hydronephrosis and complete regression after treatment (p<0.05). Multivariate analysis revealed that tumor stage and the absence of hydronephrosis were statistically significant prognostic indicators. CONCLUSIONS: In patients with T3b, T4a, and T4b transitional carcinoma of the bladder, bladder preservation may prevent a decrease in quality of life. Also, our findings suggest that this approach could be considered a primary treatment option for patients with T3b stage tumors without evidence of hydronephrosis.

The association between Toll-like receptor 4 (TLR4) polymorphisms and the risk of prostate cancer in Korean men.

The Toll-like receptor 4 (TLR4) has a wide spectrum of bacteria recognition receptors that may be involved in the signaling of the immune responses in the prostate. A few association studies have assessed the relationship between the risk of prostate cancer (PC) and the polymorphism in the TLR4 gene in European-ancestry populations. To evaluate the association of TLR4 polymorphisms and the risk for PC in Korean men, we genotyped five single-nucleotide polymorphisms (SNPs) of the TRL4 gene (rs11536858, rs1927914, 1927911, rs11536891, and rs11536897) by PCR-restriction fragment length polymorphism from unrelated 157 PC patients and 143 age-matched controls. The rs1927911 SNP increased the risk of PC (adjusted odds ratio ORadj=2.73, 95% CI=1.54-4.87 for the TC genotype; ORadj=6.68, 95% CI=3.27-13.66 for the CC genotype). The GG genotype of the rs11536858 SNP also carried increased risk (ORadj=2.296, 95% CI=1.07-4.93). There was no statistically significant correlation between any of the SNPs of TRL4 and such PC prognostic factors as Gleason grade, initial prostate-specific antigen level, or tumor stage. In conclusion, inherited differences in the TLR4 gene influence the risk of PC in Korean men.

Translation and validation of the Korean version of MUDI and MUSIQ with urinary incontinent older men.

PURPOSE: The purpose of this study was to evaluate the psychometric properties of the Korean version of the Male Urinary Distress Inventory (MUDI) and Male Urinary Symptom Impact Questionnaire (MUSIQ). PATIENTS AND METHODS: A convenient sample of community-dwelling older men with urinary incontinence participated. A cross-sectional survey design was used for this study. A panel of experts completed the initial translation into Korean and back-translated the MUDI and MUSIQ. Upon establishment of the content and translation equivalence between English and Korean versions of the MUDI and MUSIQ, psychometric properties were evaluated for reliability, concurrent, and construct validity with a sample of 143 older men. RESULTS: The internal consistencies of both instruments were found to be acceptable, and Cronbach's coefficients were 0.88 for the MUDI-K and 0.92 for the MUSIQ-K. A significant moderate correlation between MUDI-K and MUSIQ-K was found in this study, indicating modest concurrent validity between these 2 instruments (r = 0.56, p < 0.001). For construct validity, the mean scores of the MUDI-K were significantly different for age, marital status, prostate surgery, erectile dysfunction, and depression (p < 0.05). The means scores of MUSIQ-K were significantly different for depression (p < 0.05) only. For both the MUDI-K and MUSIQ-K, 7 factors were extracted, accounting for 68.1% and 72.1% of the variance. CONCLUSION: Results of this study suggest that the MUDI-K and MUSIQ-K can be used as a reliable and valid measure of health-related quality of life in community-dwelling Korean older men with urinary incontinence.

The 5th Conference on Asian Trends in Prostate Cancer Hormone Therapy.

The Conference on Asian Trends in Prostate Cancer Hormone Therapy is an annual forum for Asian urologists now in its 5th year. The 2006 conference, held in Bali, Indonesia, was attended by 27 leading urologic oncologists from China, Indonesia, Japan, Korea, Singapore, and Taiwan and featured a packed program of presentations and discussions on a wide range of topics such as relationships among clinicians and the newly opened Asia Regional Office for Cancer Control of the International Union Against Cancer (UICC), detection rates of prostate cancer by biopsy in each of the 6 Asian countries, and favored treatment modalities for hormone-refractory prostate cancer (HRPC) in each country. The first session of the conference kicked off with a keynote lecture entitled "Activities of the UICC ARO". UICC's new office will be the nerve center for its activities in the Asia region. Along with the Asian Pacific Organization for Cancer Prevention (APOCP), UICC aims to shift the focus of attention to cancer control. As such APOCP's long-running publication the APJCP is to be re-launched as the Asian Pacific Journal of Cancer Control. Although UICC is primarily concerned with cancer, several risk factors for cancer are common also to other non-communicable diseases such as diabetes and heart disease, and an important strategy is to implement measures to control these various pathologic conditions as a whole. Apart from contributing to an Asian prostate cancer registry the UICC-ARO will provide training courses, working groups, and assistance in collecting and processing data. The keynote lecture was followed by a roundtable discussion on possible ways in which clinicians from each Asian country can work with UICC. A number of suggestions were put forth including better registration, epidemiology research, possible implementation of UICC prostate cancer guidelines, early detection and screening, and roles of diet and phytotherapy. The underlying reasons for the large but dwindling difference in incidence rates of prostate cancer in various regions of Asia should be studied while the opportunity lasts. Session 2 was devoted to 6 presentations on detection rates by biopsy in each country. Although biopsy is the gold standard for detecting prostate cancer in most areas, indications for conducting biopsy are different in each country. For example, in Indonesia doctors may use PSAD 0.15 as the cutoff level. TRUS-guided biopsy is most widely used in Asian countries. Traditional sextant biopsy is often performed, although multiple-core biopsy is commonly available and associated with better detection rates, especially in men with large prostate volume. Positive DRE, high PSA, and older age were identified as factors associated with high biopsy detection rate, although elevated PSA has limited specificity. First biopsy in men with elevated PSA had a positive detection rate of approximately 30% in all countries. Community-based screening in some countries has an overall detection rate of approximately 1%. The favorable treatment modality for HRPC was the subject of the final session. First priority for doctors in all 6 countries is to maintain serum testosterone at castration level. Many therapeutic options are available, from cytotoxic drugs to traditional herbal medicines Chemotherapeutic agents such as estramustine, docetaxel, cyclophosphamide, and mitoxantrone are often given to patients with HRPC although not all are available in every country. Prednisone and dexamethasone are used for secondary hormonal therapy. External beam radiotherapy, radioisotopic drugs such as strontium 89, and bisphosphonates are common choices to control bone pain.

Detrusor and blood pressure responses to dorsal penile nerve stimulation during hyperreflexic contraction of the bladder in patients with cervical cord injury.

OBJECTIVE: To investigate the immediate effect of dorsal penile nerve (DPN) stimulation on detrusor pressure (P(det)) and blood pressure during hyperreflexic contractions of the bladder in patients with cervical spinal cord injury (SCI). DESIGN: Blood pressure and P(det) monitoring during cystometry with and without DPN stimulation. SETTING: Urodynamic laboratory in a university hospital in Korea. PARTICIPANTS: Eight men (age range, 20-55y) with cervical SCI that was incurred from 4 months to 10 years before this study. INTERVENTION: During water cystometry, blood pressure was monitored with an intra-arterial catheter introduced percutaneously into the radial artery and was recorded simultaneously with the P(det). Blood pressure was also measured manually with an electronic blood pressure cuff. Electric stimulation was applied to the DPN by using surface electrodes each time a bladder contraction was detected. Stimulation intensity was twice the threshold of the pudendal-anal reflex. MAIN OUTCOME MEASURES: P(det), systolic blood pressure, and diastolic blood pressure. RESULTS: As P(det) increased, the blood pressure increased in all cases. All the reflex contractions of the bladder were effectively suppressed by DPN stimulation, and as the P(det) decreased during stimulation, radial arterial pressure also decreased immediately and significantly. CONCLUSIONS: DPN stimulation can decrease P(det) and the increased blood pressure associated with it.