Howard H.H. Wu

The correlation between pretreatment serum hormone levels and treatment outcome for patients with prostatic cancer and bony metastasis

Objective To evaluate whether pretreatment serum hormone levels are a prognostic factor for prostatic cancer with bony metastasis under hormonal treatment.

Correlation between serum prostate specific antigen and prostate volume in Taiwanese men with biopsy proven benign prostatic hyperplasia.

PURPOSE We studied the correlation between serum prostate specific antigen and the volume of different zones of the prostate in Taiwanese men with biopsy proven benign prostatic hyperplasia. MATERIALS AND METHODS A total of 233 patients with a mean age of 71.4 years (range 42 to 89), serum prostate specific antigen less than 10 ng/ml and pathologically confirmed benign prostatic hyperplasia were enrolled in this study. Total prostate and transitional zone volumes were measured with transrectal ultrasonography. Peripheral zone volume was determined by subtracting transitional zone volume from total prostate volume. Correlations between patient age, total serum prostate specific antigen and the volume of each prostate zone were analyzed with the Pearson correlation coefficient. A linear regression model was used to determine the relationship between prostate specific antigen and prostate volume. The prostate specific antigen-prostate volume relationship in our patients was compared with published data on white and Japanese men. RESULTS Age did not significantly correlate with serum prostate specific antigen and prostate volume. Serum prostate specific antigen significantly correlated with the volume of each prostate zone. After log transformation the Pearson correlation coefficient between total prostate specific antigen and the volume of the whole prostate gland, the transitional zone and the peripheral zone were 0.369, 0.377 and 0.272, respectively (p <0.001). Taiwanese men had lower prostate volume per unit prostate specific antigen comparing with white men, while the prostate specific antigen-total prostate volume relationship between Taiwanese and Japanese men was similar. CONCLUSIONS In Taiwanese men with biopsy proven benign prostatic hyperplasia the volume of each prostate zone has significantly correlates with serum prostate specific antigen. The prostate specific antigen-total prostate volume relationship in Taiwanese men is different from that in white men. However, the prostate specific antigen-total prostate volume relationship between Taiwanese and Japanese men is similar.

Transurethral Prostatic Resection for Acute Urinary Retention in Patients with Prostate Cancer

Background: Few studies have focused on clinical findings in prostate cancer patients receiving transurethral resection of the prostate (TURP) for acute urinary retention (AUR). We compared the clinical findings (preoperative characteristics, operative morbidities, and pathology results) of patients with diagnosed prostate cancer undergoing palliative TURP for AUR with those of patients undergoing TURP for AUR who were diagnosed with prostate cancer postoperatively. Methods: The charts of 25 patients with prostate cancer undergoing TURP for AUR between 1986 and 2003 were retrospectively reviewed. Fourteen patients underwent palliative TURP (group A) and the other 11 patients with newly diagnosed prostate cancer received TURP (group B). The data, including preoperative characteristics, operative morbidities, and pathology results were analyzed. Results: There were no significant differences between the 2 groups in parameters such as age at diagnosis and operation, operative time, hospitalization, and catheter duration. However, the Gleason score was higher in group A (7.6 ± 1.7) than in group B (5.4 ± 1.8) (p < 0.005). The mean resected weight was lower in group A (19.9 g) than in group B (39.5 g). Group A was more likely to receive recatheterization (33.3% vs 0%, p = 0.058) and repeat operation (28.6%), although the difference was not statistically significant. There were no complications such as transurethral resection syndrome or perioperative death in either group. Conclusion: TURP can be performed safely for relief of AUR in patients with prostate cancer, no matter if the cancer was diagnosed before or after surgery. The higher Gleason score and more advanced cancer stage, as found in group A, may correlate to high recatheterization and reoperation rates due to preexisting tumor progression.

Correlation Between Pretreatment Serum Biochemical Markers and Treatment Outcome for Prostatic Cancer with Bony Metastasis

Background: This study was undertaken to evaluate whether or not pretreatment serum biochemical markers are prognostic factors for prostatic cancer with bony metastasis in patients on hormonal treatment. Methods: Between 1983 and 1998, 127 patients with prostatic cancer and bony metastasis were included for evaluation. Serum prostate‐specific antigen, alkaline phosphatase, calcium (Ca), lactic dehydrogenase, inorganic phosphate, γ‐glutamine transpeptidase, uric acid, albumin (Alb), iron, cholesterol (Cho), triglyceride, alanine aminotransferase, aspartate aminotransferase, and hemoglobin (Hb) were checked before treatment. The patients were divided into 2 groups according to their response (group 1, good response; group 2, poor response). Results: There were 54 patients in group 1 and 73 patients in group 2. Pretreatment levels of serum Ca, Alb, Cho and Hb were higher in group 1 than in group 2, while the other parameters were lower in group 1 than in group 2; only pretreatment levels of serum Ca, Alb and Hb were significantly different between groups (p < 0.05). When stratified by tumor grading, patients in group 1 still had significantly higher pretreatment levels of Ca, Alb and Hb than those in group 2. Conclusion: Higher pretreatment serum levels of Ca, Alb and Hb are good prognostic factors for patients with metastatic prostatic cancer on hormonal treatment, irrespective of tumor grading.

Pan-urethral Wart Treated with 5-Fluorouracil Intraurethral Instillation

We evaluated whether or not intraurethral instillation of 5-fluorouracil (5-FU) solution can rapidly, safely, and effectively eradicate intraurethral condyloma acuminata in a human immunodeficiency virus (HIV) carrier. A 43-year-old man presented with the major complaint of difficult micturition and blood dribbling from the urethral meatus for more than 6 months. He was an HIV carrier for more than 10 years and had undergone diathermy for perianal warts. Physical examination showed cauliflower lesions over the orifice of the urethra and frenulum base of the penile prepuce. Urinalysis disclosed pyuria and microscopic hematuria. Cystourethroscopy on the following day showed extensive wart lesions extending from the urethra to the bladder neck. Biopsy of the lesions was compatible with condyloma acuminata. 5-FU solution (500 mg in normal saline 50 mL) urethral instillation with massage at the ventral side of the penile shaft for 20 minutes was given once a week for 7 doses. The urine routine was normal. Management was then prescribed once a month until the lesions became invisible under urethroscopy. After 18 doses of 5-FU solution urethral instillation, no visible wart lesions were noted. He has been asymptomatic with no voiding difficulty for more than 1 year.

Clinical efficacy of transrectal ultrasound-guided prostate biopsy in men younger than 50 years old with an elevated prostate-specific antigen concentration (>4.0 ng/mL)

Background Prostate cancer (PCa) is not commonly found in men younger than 50 years of age. However, serum prostate‐specific antigen (PSA) concentration has been examined more frequently at a younger age in Asia partially due to an increased awareness of prostate cancer. The purpose of our study was to investigate the efficacy and complication of PSA‐triggered transrectal ultrasonography‐guided prostate (TRUSP) biopsies. We retrospectively reviewed TRUSP biopsies in young men with elevated PSA concentration in Taipei Veterans General Hospital. Methods We reviewed the cases of patients younger than 50 years of age with elevated PSA concentration (>4.0 ng/mL), who received 12 cores TRUSP biopsies at TPEVGH from January 2008–December 2013. The age, family history, digital rectal examination (DRE) results, PSA concentration, free/total PSA ratio, total prostate volume, PSA density, lower urinary tract symptoms and complications after the procedure were reviewed. The pathologic findings of TRUSP biopsy and clinical follow‐up were reviewed and analyzed according to the Epstein criteria. Results A total of 77 patients were included and were divided into 2 groups: 1) the younger group consisted of 20 patients <40 years of age; and 2) the elder group had 57 patients who were 40–50 years of age. The overall detection rate of PCa was 11.69% (9/77), and all of the PCa cases were diagnosed in the elder group (group detection rate: 15.8%). There was a significant difference in the severity of lower urinary tract symptoms (LUTS) between these 2 groups. All PCa patients were clinically significant according to the Epstein criteria. Two patients experienced fever (2.60%) after TRUSP biopsy. Conclusion From our patient cohort, it appears that no benefit was apparent for patients younger than 40 years old who received TRUSP biopsy, even with elevated PSA. However, PCa detected in men between 40 and 50 years of age were all clinically significant. Overall, our results supported current major practice guidelines which recommend an initial PSA checkup at 40 years of age.

Prostate cancer in young adults—Seventeen-year clinical experience of a single center

Background In the general population, prostate adenocarcinoma affects predominately older men. If fact, most current guidelines suggest that males over the age of 50 years should undergo prostate cancer screening. However, the clinical behavior and prognosis of prostate cancer in young adults is not well defined. The aim of this study was to evaluate the clinical behavior, pathological characteristics, and prognosis of prostate cancer in young adults. Methods We retrospectively reviewed the records of young patients (age, ≤50 years) in our hospital with prostate adenocarcinoma between 1997 and 2013. We compared data including initial presentation, cancer cell type, Gleason score, disease stage, prostate‐specific antigen (PSA) level, prostate volume, treatment, and survival between patients both younger and older than 50 years. Data were analyzed using the Kaplan–Meier method to assess survival. Results Twenty‐six patients were enrolled in our study, accounting for 0.55% of all patients with a diagnosis of prostate cancer at our facility. All 26 patients had a pathology diagnosis of adenocarcinoma, with a mean age on diagnosis of 46.8 ± 2.8 years (range, 39–50 years). On initial presentation, patients older than 50 years more frequently displayed lower urinary tract symptoms (LUTS) than younger patients (62.3% vs. 30.4%, p = 0.008). There was no statistical difference in histological grade, disease stage, PSA level, overall survival, and biochemical‐free survival between the two groups. Conclusion The result of our investigation indicated that prostate adenocarcinoma patients younger than 50 years had similar histological grade, disease stage, PSA level, overall survival, and biochemical‐free survival as the older population. However, patients younger than 50 years with prostate cancer less frequently showed initial symptoms of LUTS.

Tuberculosis of the Prostate

OBJECTIVE: To evaluate the clinical manifestations and management of tuberculous prostatitis at Taipei Veterans General Hospital. PATIENTS AND METHODS: Nine adult males presented to the urology clinic with an enlarged prostate. Clinically, a malignant tumor was suspected after digital rectal examination (DRE). Core needle biopsy was performed for further diagnosis at Taipei Veterans General Hospital during a period of over 10 years (from January 1989 to October 1999). They were well identified histologically. RESULTS: The histopathological sections depicted chronic inflammation in all cases and caseous necrosis in 7 patients (78%). Acid-fast stain revealed positive acid-fast bacilli (AFB) in 7 patients (78%). These cases were diagnosed as tuberculosis of the prostate and were treated with an antituberculous drug regimen. CONCLUSIONS: Tuberculosis of the prostate is sometimes difficult to differentiate from carcinoma of the prostate. Transrectal ultrasound-guided biopsy of the prostate allows a reliable diagnosis in tuberculous prostatitis. Therefore, it is recommended as the method of choice for diagnosis and follow-up, as has been advocated for the diagnosis of prostate cancer.

Clinical analysis of 48-h emergency department visit post outpatient extracorporeal shock wave lithotripsy for urolithiasis

Background Patients suffering from renal or ureteral stones can undergo significant discomfort, even when timely diagnosed and treated. The aim of this study was to assess the risk factors and safety of outpatient Extracorporeal Shock Wave Lithotripsy (ESWL) in the management of patients with renal or ureteral stones. Methods In this study, our cohort consisted of 844 outpatients who underwent outpatient ESWL treated between February 2012 and November 2014 at Taipei Veterans General Hospital. Patients who visited the emergency room (ER) within 48 h after Outpatient ESWL were included in this article. This article analyzes the stone size, stone shape (long to short axis ratio), stone location, previous medical management, urinalysis data, complications and treatment received in the emergency department. Results Among the 844 initial consecutive patients who underwent outpatient ESWL a total of 1095 times, there were 22 (2%) patients who sought help at our emergency room within 48 h after the outpatient ESWL. Of those 22 patients, the mean age was 54.3 ± 12.6 years, and the BMI was 25.9 ± 3.2. The most common complication complaint was flank pain (55.2%). Other complications included hematuria (13.8%), fever (17.2%), nausea with vomiting (6.9%), acute urinary retention (3.4%) and chest tightness with cold sweating (3.4%). In 22 patients who went back to the ER, 7 patients were admitted to the ward and 1 patient again returned to the ER. All patients received medical treatment without ESWL or surgical management. The meaningful risk factor of ER‐visiting rate following outpatient ESWL within 48 h was stone location, and the renal stones showed statistic significant (p = 0.047) when compared to ureteral stones. Conclusion Our study indicated that renal stone contributed to a significantly higher risk of ER‐visiting rate to patients than did ureteral stone, following outpatient ESWL within 48 h. This study confirmed that Outpatient ESWL is a safe treatment for renal or ureteral stones, while inpatient ESWL is not absolutely necessary.

Clinical Experiences of Primary Urothelial Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) is an unusual cancer in the urinary tract. In order to investigate the clinical status of primary urothelial SCC, we retrospectively reviewed the records of 12 patients treated at Veterans General Hospital-Taipei between January 1979 and April 1998. Mean age at diagnosis was 70 yr (range 48 to 84). Of these patients, SCC in 11 (92%) was found in the urinary bladder, and 1 (8%) in the ureter. The original specimen of I patient was not available. Of the other 11 patients, 4 (36%) had well-differentiated cancer, 4 (36%) moderately differentiated cancer, and 3 (2 7%) poorly differentiated cancer. Four patients (36%) presented with stage T2N0, 2 (18%) with stage T3N0, 3 (2 7%) with stage T4NQ, and 2 (18%) with stage N1. Mean follow-up period was 9.2 mo (range I to 23). Of 12 patients, 10 underwent surgery, I radiotherapy only, and I no treatment. The postoperative adjuvant treatments were added in 10 patients which included radiotherapy in 4 patients (40%), chemoradiotherapy in 2 (20%), and chemotherapy in 2 (20%). Six patients expired during the follow-up period. Their average survival time from diagnosis was only 5.5 mo. The cumulative survival rate at 23 mo was 40.9%. In conclusion, primary urothelial SCC is a rare cancer. Because most patients have advanced disease as well as moderately to poorly differentiated tumors at the time of diagnosis, the prognosis is grim.