Jin Seon Cho

Relationship between serum prostate-specific antigen and prostate volume in Korean men with benign prostatic hyperplasia: A multicentre study

To evaluate the relationship between prostate specific antigen (PSA) and prostate volume (PV) in Korean men, as PV is a key predictor of both disease progression and response to medical therapy in patients with benign prostatic hyperplasia (BPH), and PSA has been suggested as a proxy marker to estimate the total PV, mainly in Caucasians.

Stent Position Is More Important than α-Blockers or Anticholinergics for Stent-Related Lower Urinary Tract Symptoms after Ureteroscopic Ureterolithotomy: A Prospective Randomized Study

Purpose To evaluate the clinical factors that impact ureteral stent-related lower urinary tract symptoms (LUTS) after ureteroscopic ureterolithotomy, including the stent position and medication. Materials and Methods Fifty-three patients who underwent ureteroscopic ureterolithotomy with indwelling a stent were distributed into three groups. On demand analgesics were given to the group 1 (n=18). Daily tamsulosin 0.2 mg was added for group 2 (n=15) and daily tamsulosin 0.2 mg and tolterodine 4 mg was added for group 3 (n=20). The patients were also subclassified into appropriate or inappropriate group according to stent position. All the patients completed a visual analogue scale (VAS) and International Prostate Symptom Score (IPSS) on the 1st and 7th postoperative days. The VAS and IPSS were analyzed according to the medication groups and the stent position. Results In the appropriate stent potion group, only the storage symptom scores of groups 2 and 3 on the 1st postoperative day were significantly lower than those of the group 1 (p=0.001). This medication effect on LUTS was not observed in the inappropriate stent position group. In this group, total IPSS (p=0.015) and storage symptom scores (p=0.002) were higher than in the appropriate stent position group on the 7th postoperative day. Conclusions Correct placement of the stent was more important than medication for lessening stent-related storage symptoms.

Recent Changes in the Clinicopathologic Features of Korean Men with Prostate Cancer: A Comparison with Western Populations

Purpose The aim of this study was to evaluate the recent changes in the clinicopathologic features of prostate cancer in Korea and to compare these features with those of Western populations. Materials and Methods We retrospectively reviewed the data of 1582 men undergoing radical prostatectomy for clinically localized prostate cancer between 1995 and 2007 at 10 institutions in Korea for comparison with Western studies. The patients were divided into two groups in order to evaluate the recent clinicopathological changes in prostate cancer: Group 1 had surgery between 1995 and 2003 (n=280) and Group 2 had surgery between 2004 and 2007 (n=1302). The mean follow-up period was 24 months. Results Group 1 had a higher prostate-specific antigen level than Group 2 (10.0 ng/mL vs. 7.5 ng/mL, respectively; p<0.001) and a lower proportion of biopsy Gleason scores ≤6 (35.0% vs. 48.1%, respectively; p<0.001). The proportion of patients with clinical T1 stage was higher in Group 2 than in Group 1. Group 1 had a lower proportion of organ-confined disease (59.6% vs. 68.6%; p<0.001) and a lower proportion of Gleason scores ≤6 (21.3% vs. 33.0%; p<0.001), compared to Group 2. However, the relatively higher proportion of pathologic Gleason scores ≤6 in Group 2 was still lower than those of Western men, even though the proportion of organ-confined disease reached to that of Western series. Conclusion Korean men with prostate cancer currently present better clinicopathologic parameters. However, in comparison, Korean men still show relatively worse pathologic Gleason scores than Western men.

Preoperative Nomograms for Predicting Extracapsular Extension in Korean Men with Localized Prostate Cancer: A Multi-institutional Clinicopathologic Study

We developed a nomogram to predict the probability of extracapsular extension (ECE) in localized prostate cancer and to determine when the neurovascular bundle (NVB) may be spared. Total 1,471 Korean men who underwent radical prostatectomy for prostate cancer between 1995 and 2008 were included. We drew nonrandom samples of 1,031 for nomogram development, leaving 440 samples for nomogram validation. With multivariate logistic regression analyses, we made a nomogram to predicts the ECE probability at radical prostatectomy. Receiver operating characteristic (ROC) analyses were also performed to assess the predictive value of each variable alone and in combination. The internal validation was performed from 200 bootstrap re-samples and the external validation was also performed from the another cohort. Overall, 314 patients (30.5%) had ECE. Age, Prostate specific antigen (PSA), biopsy Gleason score, positive core ratio, and maximum percentage of biopsy tumor were independent predictors of the presence of ECE (all P values <0.05). The nomogram predicted ECE with good discrimination (an area under the ROC curve of 0.777). Our nomogram allows for the preoperative identification of patients with an ECE and may prove useful in selecting patients to receive nerve sparing radical prostatectomy.

The Long-term Effect of Alfuzosin in Patients With Lower Urinary Tract Symptoms Suggestive of Benign Prostate Hyperplasia: Evaluation of Voiding and Storage Function With Respect to Bladder Outlet Obstruction Grade and Contractility

OBJECTIVES To evaluate the efficacy of alfuzosin treatment on voiding and storage in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) with respect to bladder outlet obstruction and contractility. METHODS A 12-month, multicenter, observational, prospective study was conducted at four university hospitals in Korea. Patients were divided into four groups: group 1 (bladder outlet obstruction index (BOOI) ≥20, bladder contractility index (BCI) ≥100), group 2 (BOOI ≥20, BCI <100), group 3 (BOOI <20, BCI ≥100), and group 4 (BOOI <20, BCI <100), with respect to BOOI and BCI evaluated by pressure-flow study. Treatment efficacy was analyzed by validated symptom scores. RESULTS Two-hundred thirty-two men with LUTS/BPH were enrolled, and 165 (41, 50, 30, and 44 in groups 1-4, respectively) were followed to the end of the study. After 12 months of alfuzosin treatment, all International Prostate Symptom Score (IPSS) parameters improved in all four groups. Mean improvement in IPSS subscore for voiding was 4.0 points in group 1, 5.5 points in group 2, 5.5 points in group 3, and 3.0 points in group 4. Change in IPSS subscore for storage was 2.5 points in group 1, 3.6 points in group 2, 2.9 points in group 3, and 1.8 points in group 4. There was no difference among four groups in improvements seen in storage or voiding IPSS subscore. International Continence Society male questionnaire scores significantly improved in all four groups with no between-group differences. CONCLUSIONS Alfuzosin treatment in men with LUTS indicative of BPH effectively improved voiding and storage symptoms regardless of BOOI or BCI.

Preoperative Clinical Factors for Diagnosis of Incidental Prostate Cancer in the Era of Tissue-Ablative Surgery for Benign Prostatic Hyperplasia: A Korean Multi-Center Review

Purpose To identify potential predictive factors of incidental prostate cancer (IPca) in patients considering tissue-ablation treatment for benign prostatic hyperplasia (BPH). Materials and Methods From the 11 centers, 1,613 men who underwent transurethral resection of the prostate (TURP) or open prostatectomy were included. Before surgery, prostate biopsy was performed in all patients with prostate-specific antigen (PSA) ≥4.0 ng/ml or with abnormal digital rectal examination (DRE) findings. The patients with prostate cancer preoperatively or with PSA >20 ng/ml were excluded. As predictive factors of IPca, age, body mass index, PSA, DRE, and transrectal ultrasonography (TRUS) findings, including total prostate volume (TPV), transition zone volume (TZV), and the presence of hypoechoic lesions, were reviewed. PSA density (PSAD) and PSAD in the transition zone (PSAD-TZV) were calculated. Results IPca was diagnosed in 78 patients (4.8%). DRE findings, PSA, and TZV were independent predictive factors in the multivariate analysis. In the receiver operating characteristic curve analysis of PSA, PSAD, and PSAD-TZV, the area under the curve (AUC) was the largest for PSAD-TZV (AUC, 0.685). Conclusions IPca was detected in 4.8% of the population studied. In addition to DRE findings, the combination of TZV and PSA can be useful predictive factors of IPca in patients considering tissue-ablation treatment as well as TURP.

Impacts of leuprolide acetate on quality of life in patients with prostate cancer: A prospective multicenter study

Abstract Objective. To investigate the impacts of leuprolide acetate on the quality of life (QoL) of patients with prostate cancer. Material and methods. A total of 104 patients was enrolled in this prospective multicenter study. All patients received subcutaneous injections of 3.75 mg leuprolide acetate at 4 week intervals for a total of 12 weeks. QoL was assessed before treatment and at 12 weeks using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and an accompanying prostate cancer-specific module (QLQ-PR25). Results. Eighty-nine of 104 patients (85.6%) completed the 12 week study. Eighty-six of 89 patients (96.6%) achieved and maintained medical castration. The results of the EORTC QLQ-C30 indicated that patients experienced an improvement in global health status/QoL (p < 0.001), despite a deterioration in physical and role functioning (p = 0.012 and p = 0.007, respectively). The symptom scales indicated a statistically significant improvement in appetite (p = 0.003). The results of the QLQ-PR25 revealed that patients experienced an increase in hot flushes (p < 0.001) and erection problems and uncomfortable sexual intimacy among the sexual functioning items (p = 0.030 and p = 0.023, respectively), but day-time urinary frequency was improved (p = 0.004). Conclusion. The results of this prospective study indicate that leuprolide acetate treatment was accompanied by improvements in global health status/QoL, despite a deterioration in physical, role and sexual function.

Comparison of hand-assisted laparoscopic radical nephrectomy with open radical nephrectomy for pT1-2 clear cell renal-cell carcinoma: a multi-institutional study.

PURPOSE This multiinstitutional report assesses the oncologic efficacy of hand-assisted laparoscopic radical nephrectomy (HLRN) compared with open radical nephrectomy (ORN) in patients with localized clear cell renal-cell carcinoma (RCC). PATIENTS AND METHODS We analyzed the data from 2561 patients who underwent radical nephrectomy at 26 institutions in Korea between June 1998 and December 2007 for localized RCC. One hundred ninety-seven patients with clear cell RCC in the HLRN group were compared with 917 patients with clear cell RCC in the ORN group. To evaluate the technical adequacy and oncologic outcome, we compared the operative time, estimated blood loss, and 5-year overall and disease-free survival rates. RESULTS The median follow-up was 36 months for the HLRN group and 27 months for the ORN group. The operative time was significantly longer in the HLRN group than in the ORN group (206.8 +/- 68.7 minutes vs. 179.1 +/- 61.5 minutes, p < 0.001), and blood loss was significantly lower in the HLRN group than in the ORN group (311.6 +/- 238.7 mL vs. 372.4 +/- 367.3 mL, p = 0.003). There was no significant difference in pathologic T stage and Fuhrmans nuclear grade in the two groups. No statistically significant difference was found in the 5-year overall (91.2% vs. 90.3%, p = 0.286) and disease-specific (95.2% vs. 92.1%, p = 0.222) survival rates between the HLRN and ORN groups. CONCLUSIONS Despite the longer operative time, HLRN was an effective and less-invasive treatment option for localized clear cell RCC. HLRN could achieve cancer control similar to that obtained with ORN.

Prostate-specific antigen velocity in healthy Korean men with initial PSA levels of 4.0 ng/mL or less.

OBJECTIVES To assess the longitudinal changes in serial prostate-specific antigen (PSA) levels in healthy Korean men with initial PSA levels of 4.0 ng/mL. METHODS The rate of PSA change or PSA velocity (PSAV) in 24 869 healthy men with an initial PSA level of 4.0 ng/mL or less who were clinically free of genitourinary disease was analyzed at intervals of at least 12 months. The influence of age, initial PSA level, and the interval between measurements was assessed. RESULTS The mean age, initial PSA level, interval between measurements, and change in PSA and PSAV was 46.2 years, 0.86 ng/mL, 21.9 months, and 0.03 ng/mL and 0.02 ng/mL/y, respectively. A cumulative frequency plot of PSAV demonstrated that 50%, 95%, and 97% of subjects had a PSAV of 0.01, 0.40, and 0.52 ng/mL/y or less, respectively. The PSAV correlated with age, initial PSA level, and interval between measurements. The percentage of men with a PSAV greater than 0.75 ng/mL/y was 0.61% (151 of 24 869) and was 0.51% (92 of 17 985) for those with an initial PSA level of less than 1.0 ng/mL, 0.86% (50 of 5807) for those with a PSA level of 1.1-2.0 ng/mL, and 0.84% (9 of 1077) for those with an initial PSA level of 2.1-4.0 ng/mL. CONCLUSIONS In healthy Korean men with an initial PSA level of 4.0 ng/mL or less, most will have a PSAV of less than 0.75 ng/mL/y. Thus, traditional PSAV cutoff values are not applicable in this population. We propose that a lower PSAV cutoff value should be used to indicate biopsy. Additional large-scale prospective studies, including biopsy data, are required to assess the cutoff value of PSAV for healthy Korean men with a PSA level of 4.0 ng/mL or less.

A survey conducted on patients' and urologists' perceptions of benign prostatic hyperplasia.

Objectives: To better understand the discrepancy that may exist between urologists and patients on various aspects of their perception of benign prostatic hyperplasia (BPH). Subjects and Methods: Questionnaires on BPH for patients and urologists and a BPH patient education brochure were developed. 141 patients with symptoms of BPH completed a set of two questionnaires, to be filled out before and after reading the education brochure. 172 urologists practicing in Korea were randomly selected to complete the questionnaire. Results: Nearly 60% of patients misunderstood the risk for BPH to progress to prostate cancer. In addition, the perceived risks of untreated BPH, desirable treatment effects and undesirable side effects were significantly different between the patients and the urologists. Among the discrete attributes of available medical therapy, the 5α-reductase inhibitor monotherapy was the preferred method chosen by patients. Although the patient brochure significantly improved most of the patients’ misconceptions about BPH, the patient preference did not change significantly. Conclusions: Patients with BPH do not have accurate information about their disease and their expectations of treatment may be very different from their urologist.