Tae Young Jung

Usefulness of a malleable penile prosthesis in patients with a spinal cord injury

Objectives:  The usefulness of a malleable penile prosthesis was evaluated in patients with spinal cord injury (SCI) by investigating the complications and the patients’ satisfaction.

Predictive factors of prostate cancer at repeat biopsy in patients with an initial diagnosis of atypical small acinar proliferation of the prostate.

Purpose The factors that predict prostate cancer detection on repeat biopsy were evaluated in patients with atypical small acinar proliferation (ASAP) on the initial biopsy. Materials and Methods From 2003 to 2008, 3,130 men with suspected prostate cancer underwent a prostate needle biopsy, and 244 (7.8%) were diagnosed as having ASAP. One hundred seventy of 244 patients were rebiopsied at least once more. They were classified into a prostate cancer group and a noncancer group according to the final pathological diagnosis. The database of rebiopsied patients included age, initial prostate-specific antigen (PSA), PSA density (PSAD), PSA velocity (PSAV), total prostate volume (TPV), and transitional zone volume of the prostate (TZV). We compared differences in the aforementioned parameters between the 2 groups. Results A total of 57 patients (33.5%) with ASAP were ultimately shown to have prostate cancer. Univariate analysis showed that PSAD (p=0.002), PSAV (p=0.001), TPV (p=0.035), and TZV (p=0.005) differed significantly between the cancer and noncancer groups. The results of the multivariate analysis showed that PSAD (p=0.022), PSAV (p<0.001), and TPV (p=0.037) had a statistically significant correlation with cancer detection. Conclusions PSAD, PSAV, and TPV are predictive factors of prostate cancer in patients with an initial diagnosis of ASAP of the prostate. Although repeat biopsy is mandatory irrespective of PSA values, the follow-up of PSA may help to estimate the probability of cancer in these men.

Results of Urine Culture and Antimicrobial Sensitivity Tests According to the Voiding Method Over 10 Years in Patients with Spinal Cord Injury

Purpose We studied the results of urine cultures and antimicrobial sensitivity tests according to the voiding method used by spinal cord injury (SCI) patients over a recent 10-year period. Materials and Methods We retrospectively analyzed 1,236 urine samples and their antimicrobial sensitivity tests for 112 patients who had used only one voiding method between January 2000 and December 2009. The voiding methods were classified into four groups: clean intermittent catheterization (CIC), suprapubic catheterization, urethral Foley catheter, and spontaneous voiding. Results Of the 1,236 urine samples, 925 (74.8%) were positive and 279 (30.2%) had more than one bacteria. The CIC group showed the lowest rate of bacteriuria, colony counts, and polymicrobial infection (p<0.001). Causative organisms were mostly Gram-negative bacteria (84%), including Pseudomonas aeruginosa (22.9%), Escherichia coli (21.1%), Klebsiella species (6.7%), and Citrobacter species (6.3%). The rate of Gram-positive bacterial infection was 13.6%, and major pathogenic organisms were Streptococcus species (8.6%) and Staphylococcus species (2.6%). Major pathogenic organisms and the results of antimicrobial sensitivity tests differed according to the voiding method. Conclusions Although the patients condition and preferences are important when choosing the method of bladder management, CIC is the best voiding method for reducing urinary tract infections in SCI patients. When immediate use of antibiotics is needed for treatment of urinary tract infections, an appropriate antibiotic can be chosen according to the voiding method on the basis of our study and can be administered before the results of an antimicrobial sensitivity test are available.

Efficacy of Alternative Antiandrogen Therapy for Prostate Cancer That Relapsed after Initial Maximum Androgen Blockade

Purpose We evaluated the effectiveness of second-line maximum androgen blockade (MAB) with an alternative antiandrogen in patients who relapsed after initial MAB. Materials and Methods We retrospectively analyzed 47 patients with prostate cancer who relapsed after initial MAB, including surgical or medical castration combined with antiandrogens, from January 1998 to December 2009. When the serum prostate-specific antigen (PSA) level was increased on three consecutive occasions, we discontinued the antiandrogen and then administered an alternative antiandrogen. Seven patients were assessed for antiandrogen withdrawal syndrome (AWS). The effect of the second-line MAB was evaluated by the serum PSA level, and response was subdivided into ≥50% and <50% PSA reductions from the baseline PSA at the start of second-line MAB. Results PSA reduction was observed in 32 patients (68.1%). Among them, 23 (48.9%) achieved ≥50% PSA reductions with a mean response duration of 13.4±5.4 months. Nine (19.2%) patients reached <50% PSA reductions with a mean response duration of 12.2±6.2 months. The time to nadir PSA level after first-line MAB in the ≥50% PSA reduction group, <50% PSA reduction group, and PSA elevation group was 15.6±12.9 months, 11.8±6.0 months, and 8±6.5 months, respectively. That is to say, it was significantly longer in the responder groups (p=0.038). Conclusions Second-line MAB using an alternative antiandrogen is an effective treatment option before cytotoxic chemotherapy in patients who relapse after initial MAB.

Pathologic results of radical prostatectomies in patients with simultaneous atypical small acinar proliferation and prostate cancer.

Purpose The incidence of adenocarcinoma on a subsequent biopsy following a diagnosis of atypical small acinar proliferation (ASAP) ranges from 34% to 60%. We reexamined radical prostatectomy (RP) specimens of patients diagnosed as having synchronous ASAP with prostate cancer (PCa) to evaluate pathological entities and the clinical significance of ASAP. Materials and Methods From January 2007 to December 2008, a total of 118 patients who had been diagnosed with adenocarcinoma on prostate needle biopsy underwent RP. Forty-six of the 118 patients (39%) were diagnosed as having synchronous ASAP with PCa on the prostate needle biopsy. Using whole-mount sections and prostate mapping, we evaluated the RP specimens that were close sections to the ASAP on prostate needle biopsy. All tissues were examined by immunohistochemistry with high molecular weight cytokeratin (34βE12), p63, and AMACR/P504S added to initial H&E stains by one pathologist. Results Thirty-six of the 46 patients (78%) were diagnosed as having adenocarcinoma at sites of ASAP on the initial prostate needle biopsies. The Gleason score was 5 to 6 in 22 patients (61%), 7 in 3 (8%), and unknown due to multifocal and microfocal lesions in 11 (31%). The tumor volume of 14 of the 36 patients (39%) was 0.5 cc or less and was unknown due to multifocal and microfocal lesions in 8 (22%). Conclusions Most ASAP on initial prostate needle biopsy was a true pathological entity, in other words, prostatic adenocarcinoma. Aggressive approaches including more extended repeat biopsy with additional biopsy of the site of the ASAP are needed to diagnose PCa in patients with ASAP.

Oncologic Outcomes of Patients With Gleason Score 7 and Tertiary Gleason Pattern 5 After Radical Prostatectomy

Purpose We evaluated oncologic outcomes following radical prostatectomy (RP) in patients with a Gleason score (GS) of 7 with tertiary Gleason pattern 5 (TGP5). Materials and Methods We retrospectively reviewed the medical records of 310 patients who underwent RP from 2005 to 2010. Twenty-four patients who received neoadjuvant or adjuvant antiandrogen deprivation or radiation therapy were excluded. Just 239 (GS 6 to 8) of the remaining 286 patients were included in the study. Patients were classified into four groups: GS 6, GS 7 without TGP5, GS 7 with TGP5, and GS 8. We analyzed preoperative clinical factors, postoperative pathological outcomes, and biochemical recurrence (BCR). Results TGP5 in GS 7 was an independent predictor of primary Gleason pattern 4, tumor volume larger than 10%, positive surgical margin, and lymphovascular invasion. The presence of TGP5 in GS 7 was not associated with BCR-free survival. Subgroup analyses revealed that BCR-free survival did not differ significantly between patients with GS 7 with TGP5 and those with GS 8 (p=0.120). In addition, time to BCR in patients with a higher percentage of TGP5 was shorter than that in patients with a lower percentage of TGP5. TGP5 in GS 7 was not a significant predictive factor for BCR, whereas prostate-specific antigen density and a positive surgical margin were shown to be independent predictors of BCR. Conclusions TGP5 in GS 7 was an independent predictor of unfavorable pathologic outcomes. The rate of BCR was similar in GS 7 disease with TGP5 and in GS 8 disease, even though TGP5 was not a significant predictive factor for BCR in Cox proportional hazards models.

Do Positive Surgical Margins Predict Biochemical Recurrence in All Patients Without Adjuvant Therapy After Radical Prostatectomy

Purpose The objective was to study whether positive surgical margins (PSMs) predict biochemical recurrence (BCR) in all patients without adjuvant therapy after radical prostatectomy (RP). Materials and Methods We retrospectively reviewed the medical records of patients who underwent RP for prostate cancer at Veterans Health Service Medical Center from 2005 to 2011. BCR was defined by a prostate-specific antigen (PSA) value ≥0.2 ng/mL. The clinicopathological factors of the PSM group were compared with those of the negative surgical margin (NSM) group, and the predictive impact of a PSM for BCR-free survival were evaluated. In addition, we analyzed the prognostic difference for BCR-free survival between solitary and multiple PSMs. Results A PSM was noted in 167 patients (45.5%). BCR was reported in 101 men in total (27.5%). The BCR-free survival rate of the PSM group was lower than that of the NSM group (p<0.001). In a multivariate analysis for the total patients, PSM was significantly associated with BCR-free survival (p<0.001). After stratification by pathological T stage, Gleason score (GS), and preoperative PSA value, PSM was significantly predictive for BCR-free survival in men with pT2 and/or GS ≤6 or 7 and/or a PSA value <10 or 10-20 ng/mL (all p<0.05). Multiple PSMs were more predictive of BCR-free survival than was a solitary PSM (p=0.001). Conclusions A PSM is a significant predictor of postoperative BCR in patients with pT2 and/or GS ≤7 and/or preoperative PSA <20 ng/mL. Multiple PSMs are considered a stronger prognostic factor for prediction of BCR than is a solitary PSM.

Differences in Postoperative Pathological Outcomes between Prostate Cancers Diagnosed at Initial and Repeat Biopsy

Purpose We evaluated the differences in pathological outcomes between prostate cancers (PCas) diagnosed at initial and repeat biopsy. Materials and Methods We retrospectively reviewed the medical records of 287 patients who underwent radical retropubic prostatectomy from 2005 to 2010. We investigated preoperative factors, such as age, serum prostate-specific antigen (PSA), prostate volume (PV), digital rectal examination (DRE) results, biopsy schema, clinical stage, and number of prior biopsies, and postoperative pathological outcomes, including specimen volume, percent tumor volume, Gleason score (GS), tumor bilaterality, pathological stage, positive surgical margin (PSM), lymphovascular invasion (LVI), and perineural invasion (PNI). Patients were then classified into two groups by the number of prior biopsies (initial biopsy vs. repeat biopsy). We compared preoperative factors and postoperative pathological outcomes between the two groups. Results Of the 287 patients, 246 (85.7%) were diagnosed with cancer at the initial biopsy and 41 (14.3%) at the repeat biopsy. The repeat biopsy group was older (p=0.048), had a larger PV (p=0.009), had a significantly different biopsy schema (p<0.001), and had a lower (<10%) percentage tumor volume (p=0.016). In the multivariate analysis (after adjustment for biopsy schema, age, serum PSA, PV, and DRE), repeat biopsy was not an independent predictor of GS, tumor bilaterality, pathological stage, PSM, LVI, or PNI (p=0.212, 0.456, 0.459, 0.917, 0.991 and 0.827, respectively), but repeat biopsy could predict lower percentage tumor volume (p=0.037). Conclusions The pathological outcomes of PCas detected at repeat biopsy were not significantly different from those of PCas detected at initial biopsy except for a lower (<10%) percentage tumor volume.