Chanwoo Lee

Effects of statin use on the response duration to androgen deprivation therapy in metastatic prostate cancer

Purpose To determine whether statin use delays the development of castration-resistant prostate cancer (CRPC) in patients with metastatic prostate cancer treated with androgen deprivation therapy (ADT). Materials and Methods A total of 171 patients with metastatic prostate cancer at the time of diagnosis who were treated with ADT between January 1997 and December 2013 were retrospectively analyzed. The patients were classified into two groups: the nonstatin use group (A group) and the statin use group (B group). Multivariate analysis was performed on statin use and other factors considered likely to have an effect on the time to progression to CRPC. Results The mean patient age was 67.1±9.1 years, and the mean follow-up period was 52 months. The mean initial prostate-specific antigen (PSA) level was 537 ng/mL. Of the 171 patients, 125 (73%) were in group A and 46 (27%) were in group B. The time to progression to CRPC was 22.7 months in group A and 30.5 months in group B, and this difference was significant (p=0.032). Blood cholesterol and initial PSA levels did not differ significantly according to the time to progression to CRPC (p=0.288, p=0.198). Multivariate analysis using the Cox regression method showed that not having diabetes (p=0.037) and using a statin (p=0.045) significantly increased the odds ratio of a longer progression to CRPC. Conclusions Statin use in metastatic prostate cancer patients appears to delay the progression to CRPC. Large-scale, long-term follow-up studies are needed to validate this finding.

A comparative study of pediatric open pyeloplasty, laparoscopy-assisted extracorporeal pyeloplasty, and robot-assisted laparoscopic pyeloplasty

Purpose To compare the outcomes of open pyeloplasty (OP), laparoscopy-assisted extracorporeal (LEXP), and robotic-assisted laparoscopic pyeloplasty (RALP) for ureteropelvic junction obstruction in pediatric patients. Methods We retrospectively reviewed the age-matched cohort of 30 children who underwent OP, 30 who underwent LEXP, and 10 who underwent RALP at a single institution, from 1996 to 2014. Pre- and post-operative variables including success rate were compared among surgical groups. Results The mean age of the patients was 120.2 months, the Society for Fetal Urology grade was 3.6, the anteroposterior diameter was 3.1 cm, and the renal relative function was 44.0%. The distribution of laterality, mean body mass index, and preoperative anteroposterior pelvic diameter on ultrasound did not differ among groups. The mean length of hospital stay was significantly shorter in the RALP group (3.2 days) than in the OP (6.6 days) and LEXP (5.8 days) groups (p<0.001). The duration of analgesics use was shorter in the RALP group (1.1 days) than in the other groups (p<0.001). During the mean follow-up period of 49.0, 20.1, and 16.6 months, the success rate was 96.7%, 89.7%, and 100% in the OP, LEXP, and RALP groups, respectively, although this difference was not statistically different (p = 0.499). In multivariate regression analysis, the presence of crossing vessels was the only factor that decreased the success rate (hazard ratio: 46.09, 95% confidence interval: 2.41–879.6, p = 0.011). Conclusions Patients who undergo RALP have a reduced hospital stay and lower use of pain medication; however, there is no difference in the success rates for OP, LP, and RALP surgeries. The presence of crossing vessels is a negative prognostic indicator for surgical outcome regardless of the surgical method.

Neurovascular bundle size measured on 3.0-T magnetic resonance imaging is associated with the recovery of erectile function after robot-assisted radical prostatectomy

BACKGROUND AND OBJECTIVE Erectile dysfunction is one of the complications occurring after radical prostatectomy (RP), and recovery of erectile function is quantitatively related to the preservation of the neurovascular bundles (NVB).We evaluated the significance of NVB area on functional outcomes after RP. MATERIALS AND METHODS Preoperative magnetic resonance imaging was performed on 141 patients who underwent bilateral, nerve-sparing, robot-assisted RP for clinically localized prostate cancer (clinically T2N0M0 on magnetic resonance imaging) and were evaluated at least 12 months after surgery. NVB area was measured as a region of interest that coincided with the outline of the maximum area of the posterolateral region of the prostate on T2-weighted axial imaging. Factors associated with functional outcomes were evaluated using logistic regression analysis. RESULTS Of 141 patients, 36 patients (25.5%) had no preoperative potency (group 1), 66 patients (46.8%) recovered potency (group 2), and 39 patients (27.7%) did not recover potency (group 3). Although the mean age of the entire cohort was 65.4 years, the mean age of group 1 was greater than groups 2 and 3 (P = 0.001). The NVB area of group 2 was larger than those of groups 1 and 3 (P = 0.001). Potency evaluations involved 105 patients (74.5%; groups 2 and 3), and patients with pre-existing erectile dysfunction were excluded. The median time to potency recovery was 3.0 months after surgery. The multivariable analysis revealed that the NVB area was the only significant factor predictive of potency recovery. CONCLUSIONS The NVB area in the posterolateral region of the prostate is an independent factor for predicting potency recovery. The degree of postoperative erectile function can be predicted based on the preoperative NVB area.

Long-term Outcomes of Endoscopic Anti-reflux Surgery in Pediatric Patients with Vesicoureteral Reflux: Urinary Tract Infection, Renal Scarring, and Predictive Factors for Success

Background To report the long-term outcomes of endoscopic surgery (ES) in pediatric patients with vesicoureteral reflux in terms of success rate, urinary tract infection, and renal function. Methods We retrospectively reviewed the records of 73 pediatric patients (110 ureters) who underwent ES for vesicoureteral reflux. Ultrasonography was performed 1, 3, and 12 months postoperatively. Voiding cystourethrography was performed 3 months postoperatively and repeated after 1 year if vesicoureteral reflux persisted. Success was defined as the absence of reflux at the first voiding cystourethrography. Renal scans were performed at least 12 months postoperatively. Renal function deterioration was defined as a new scar or a greater than 5% decrease in function. Results The median follow-up duration was 24 (12–118) months. The overall success was 65.6%, while it was 78.9%, 87.0%, 62.5%, 37.5%, 66.7% for grades I, II, III, IV, and V, respectively. In multivariate analyses, significant predictive factors for success were vesicoureteral reflux grade (odds ratio [OR], 0.28; P < 0.001) and mound detection at the first postoperative ultrasonography (OR, 13.53; P < 0.001). Renal function deterioration was found in 8 (15.3%) ureters and was less common in those with successful surgeries than in those with failures (9.5% vs. 40.0%; P = 0.035). No significant predictive factor for renal function deterioration or urinary tract infection was found. Conclusion Successful short-term outcomes of ES are expected in low-grade vesicoureteral reflux, especially when a mound is detected by postoperative ultrasonography. However, unpredictable long-term renal deterioration warrants continued follow-up.

Discrimination of local recurrence after radical prostatectomy: value of diffusion-weighted magnetic resonance imaging

Background Multiparametric magnetic resonance is the most accurate imaging technique for prostate cancer detection, staging, localization, and aggressiveness evaluation. We assessed accuracy of diffusion-weighted imaging in local recurrence diagnosis after radical prostatectomy. Materials and methods A retrospective study was conducted in 118 patients with findings suggestive of local recurrence in dynamic contrast-enhanced-magnetic resonance imaging. Local recurrence was defined clinically as a rising prostate-specific antigen level (biochemical recurrence) without radiographic evidence of distant metastasis over 6 months after surgery. Eighty-four patients (71.2%) had local recurrence (group 1) and 34 (28.8%) showed no recurrence (group 2). The diagnostic accuracy of diffusion-weighted imaging was assessed, and factors associated with local recurrence were evaluated using multivariate logistic regression analysis. Additional accuracy analysis was carried out according to the size of the nodule. Results In post-operative findings, group 1 patients had significantly higher serum prostate-specific antigen (P = 0.001), larger enhancing nodules (P = 0.005), and more positive findings in diffusion-weighted imaging (P = 0.001) than group 2 patients. The sensitivity of diffusion-weighted imaging was significantly higher for nodules ≥1 cm than for all nodules (96.6 vs. 80.9%, P = 0.001), whereas the specificities were equivalent (100.0 vs. 97.1, P = 0.529). In multivariate analysis, a positive finding in diffusion-weighted imaging was the independent predictor of local recurrence (P = 0.005), along with pathologic T stage (P = 0.018). Conclusions Diffusion-weighted imaging is accurate in distinguishing recurrence from enhancing nodule on dynamic contrast-enhanced-magnetic resonance. Nodules showing decreased diffusion suggest local recurrence, especially if sized ≥1 cm.

S&T-60 THE INFLUENCE OF LENGTH, GRADE, AND LOCATION OF POSITIVE SURGICAL MARGIN (PSM) ON BIOCHEMICAL RECURRENCE IN ORGAN CONFINED PROSTATE CANCER

history. Without doctor’s explanation the CRR was decreased in patients with urologic medical history. CONCLUSIONS: The RR of FVC was increased by doctor’s explanation in patients aged <50 years, without private insurance, with high school graduate or higher and without past medical history. To explain personally the necessity and the completion method of a FVC by doctor was a help to record accurately the FVC in patients aged <50 years and with urologic medical history.

Comparison of Renal Function between Robot-Assisted and Open Partial Nephrectomy as Determined by Tc 99m-DTPA Renal Scintigraphy

We compared postoperative renal function impairment between patients undergoing robot-assisted partial nephrectomy (RAPN) and those undergoing open partial nephrectomy (OPN) by using Tc-99m diethylenetriaminepentaacetic acid (DTPA) renal scintigraphy. Patients who underwent partial nephrectomy by a single surgeon between 2007 and 2013 were eligible and were matched by propensity score, based on age, tumor size, exophytic properties of tumor, and location relative to the polar lines. Of the 403 patients who underwent partial nephrectomy, 114 (28%) underwent RAPN and 289 (72%) underwent OPN. Mean follow-up duration was 35.2 months. Following propensity matching, there were no significant differences between the two groups in tumor exophytic properties (P = 0.818) or nephrometry score (P = 0.527). Renal ischemic time (24.4 minutes vs. 17.8 minutes, P < 0.001) was significantly longer in the RAPN group than in the OPN group, while the other characteristics were similar. Multivariate analysis showed that greater preoperative renal unit function (P = 0.011) and nephrometry score (P = 0.041) were independently correlated with a reduction in glomerular filtration rate. The operative method did not correlate with renal function impairment (P = 0.704). Postoperative renal function impairment was similar between patients who underwent OPN and those who underwent RAPN, despite RAPN having a longer ischemic time.

PD39-10 CHANGES IN BODY MASS INDEX AND METABOLIC SYNDROME ARE ASSOCIATED WITH PROSTATE GROWTH RATE OVER A 5 YEAR PERIOD

INTRODUCTION AND OBJECTIVES: Lower urinary tract symptoms (LUTS) are common in elderly men. We assessed symptom scores and voiding parameters in a group of community-dwelling elderly men over a period of 5 years with emphasis on the natural history of men with elevated postvoid residual urine at baseline. METHODS: Community dwelling men aged 70 years and over were enrolled to participate in the Concord Health and Ageing in Men Project (CHAMP), a population based study of men living in a defined geographical area in metropolitan Sydney, Australia. Men were required to complete a survey including International Prostate Symptom Score (IPSS) and medical, medication and urological history, then attend a clinical assessment where uroflowmetry and post void residual volume were measured. Subjects were re-assessed after two years and five years with repeat survey and clinical assessment. We report results at baseline and five year follow-up. RESULTS: A total of 1705 men aged 70-97 years participated; 1367 presented for follow-up assessment 2 years later and 940 at 5 years (382 (23%) had died). 275 men with prostate cancer were omitted from analyses. Mean IPSS was 7.4 (mild 63%, moderate 29%, severe 8%) at baseline and 7.3 (mild 64%, moderate 30%, severe 6%) at 5 years. Mean peak flow rate at baseline was 12.7 mls/sec and at 5 years was 12.0 mls/sec (P 85 years) compared to younger men (70-80 years) both at baseline (P 200mls at baseline the residual volume did not change significantly over 5 years (P1⁄40.51). Ten men were using a catheter at baseline and 9 at 5 year assessment. CONCLUSIONS: Both urinary symptom scores and voiding parameters of uroflowmetry and post void residual volume remain remarkably stable over a five year period in elderly, community-dwelling men. Men with elevated postvoid residual urine did not deteriorate significantly and the number of men requiring surgical intervention was low.