Byung Kyu Han

Evaluation of pT2 subdivisions in the TNM staging system for prostate cancer

To evaluate the subclassifications of pT2 diseases in tumour‐nodes‐metastases (TNM) staging system for prostate cancer.

Prognostic significance of common preoperative laboratory variables in clear cell renal cell carcinoma

To investigate the prognostic significance of common preoperative laboratory variables evaluated before surgery for clear cell renal cell carcinoma (RCC).

Relationship of Prostate-Specific Antigen and Prostate Volume in Korean Men with Biopsy-Proven Benign Prostatic Hyperplasia

OBJECTIVES To investigate the relationship between prostate-specific antigen (PSA) and prostate volume in a histologically defined subset of Korean men confirmed to have benign prostatic hyperplasia (BPH) only from multicore biopsy of prostate. METHODS A total of 707 Korean men with a PSA level of 10 ng/mL or lower who were shown to have stromoglandular hyperplasia only from transrectal ultrasound (TRUS)-guided multicore biopsy of prostate were included in the study. We analyzed PSA and total prostate volume (TV) measured through TRUS by stratified age cohorts. We used Pearson correlation coefficient (r) and linear regression model to describe the relationship between variables. RESULTS Serum PSA level significantly correlated with TV in all stratified age cohorts, with r ranging from 0.29 to 0.47 (all P <0.001). Meanwhile, the degree of correlation appeared to increase with age. The slope of linear regression showing an association of PSA and TV was 3.68. The PSA increase per unit prostate volume decreased with the advancing cohort of age when we excluded subjects 70 years or older. CONCLUSIONS Although PSA was significantly correlated with TV, the exact nature of the relationship between PSA and TV in Korean men with biopsy-proven BPH may be different from that in other races. Further basic research on the pathophysiology of BPH is needed to explain such a racial difference.

Preoperative Serum Sex Hormone-Binding Globulin as a Predictive Marker for Extraprostatic Extension of Tumor in Patients with Clinically Localized Prostate Cancer

OBJECTIVES We investigated the relationships of serum sex hormone-binding globulin (SHBG) level with known prognostic factors for prostate cancer in men who received radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. METHODS Preoperative serum levels of SHBG were analyzed in 288 consecutive patients who were scheduled to undergo RRP for clinically localized prostate cancer. We investigated the potential associations of preoperative serum SHBG level with various clinical and pathological factors. Accuracy of variables in predicting adverse pathological features was assessed via receiver operator characteristics (ROC) curves. RESULTS In univariate analysis, preoperative serum SHBG level was observed to be significantly associated with extraprostatic extension of a tumor (p=0.019) and with pathological Gleason score (p=0.001). In multivariate analysis, serum SHBG level (p=0.039) along with serum PSA (p<0.001) level, biopsy Gleason score (p<0.001), and clinical stage (p=0.004) was observed to be an independent predictor of the extraprostatic extension of prostate cancer. The area under ROC curve that demonstrated the performance of a multivariate logistic regression model (MLRM), which included serum SHBG level and other preoperative variables, in predicting extraprostatic extension of tumor was larger than that of MLRM without SHBG (0.797 vs. 0.758, p=0.121). Meanwhile, serum SHBG level was not observed to be significantly associated with pathological Gleason score in multivariate analysis (p=0.303). CONCLUSIONS Our data showed that serum SHBG level is an independent predictive factor for extraprostatic extension of tumor in patients with clinically localized prostate cancer.

Changes in Prostate-specific Antigen Levels and Prostate Volume in Octogenarian Men: Community-based Study

OBJECTIVES To examine the change in prostate-specific antigen (PSA) levels and prostate volume (PV) in octogenarian men compared with those in septuagenarian men and evaluate the possibility of PSA as a surrogate marker for PV in octogenarian men. METHODS A total of 441 men were recruited from whom random and selected oldest-old samples (age >or=85 years) from the Korean Longitudinal Study on Health and Aging, which was a population-based, prospective cohort study on health, aging, and common geriatric diseases of Koreans >or=65 years old. Men in their 70s (n = 136, 70-79 years) and 80s (n = 125, 80-89 years) were included. The PV was measured by transrectal ultrasonography, and the PSA level was determined using immunoradioassay. RESULTS No significant differences were found in the serum PSA levels between the men in their 70s and 80s (P = .128). However, the 95th percentile of the serum PSA level was 5.23 and 6.60 ng/mL in those in their 70s and 80s, respectively. The men in their 80s had a greater total PV and transitional volume than did men in their 70s (P = .026 and P = .009, respectively). The PV and PSA level correlated with age (P = .034), and the increase in PV stratified by PSA was statistically significant (P < .0001). CONCLUSIONS Although the PV had increased steadily in octogenarian men, the serum PSA level of men in their 80s did not show a significant difference compared with men in their 70s. We suggest that PSA is a good surrogate marker for PV, even in octogenarian men.

ARE RISK FACTORS FOR FAILURE AFTER MID-URETHRAL SLING OPERATION DIFFERENT BETWEEN PURE STRESS AND MIXED URINARY INCONTINENCE?

INTRODUCTION AND OBJECTIVES: While mid-urethral sling (MUS) operation has expanded its application to more complicated cases such as the patients with mixed urinary incontinence (MUI), the success rates in the patients with MUI have been reported lower than the patients with pure stress urinary incontinence (SUI). If the failure of operation is predicted in the patients with MUI, one could change the therapeutic modalities to obtain the best results regarding continence and the risk factors for failure could help the physicians to counsel the patients ahead of operation. We evaluated and compared the risk factors for failure after MUS operation between pure SUI and MUI. METHODS: Two hundred and twenty-eight women were categorized into pure SUI (Group A, 163 patients) and MUI (Group B, 65 patients). Preoperative evaluations including symptom questionnaire, physical examination and urodynamic study were performed. Patients received the retropubic (17.5%) or trans-obturator (82.5%) MUS operations. RESULTS: Follow-up for Group A and B were 18.8 months (3-52) and 19.2 months (3-54), respectively. The demographic characteristics different between both group were body mass index, presence of cystocele, and severity of incontinence. The MUCP, VLPP, Q-tip and weight of 1-hour pad test were not significantly different in both groups. The success rate in Group A (95.7%) was higher than in Group B (84.6%) (p=0.015, Chi-Square test). In Group A, VLPP, PdetQmax and weight of 1-hour pad test were identified risk factors for failure of operation in univariate analysis, but, only weight of 1-hour pad test was independent risk factor in multivariate analysis (adjusted OR 3.5, 95% CI 1.204-8.895, p=0.045). In Group B, menopause without hormone replacement, AUA Symptom Index-QoL score, maximal cystometric capacity (MCC) and involuntary detrusor contraction (IDC) were the risk factors in univariate analysis, but MCC (adjusted OR 0.9, 95% CI 0.645-0.984, p=0.032) and IDC (adjusted OR 2.3, 95% CI 1.014-3.309, p=0.044) were independent risk factors in multivariate analysis. CONCLUSIONS: The risk factors for failure after MUS operation were different between pure SUI and MUI. Unlike pure SUI, weight of 1-hour pad test was not significant to predict the failure of operation in MUI. Meanwhile, MCC and IDC, indicating the pathophysiological status of the detrusor muscle itself, were important to predict the failure of operation in MUI.