Wk Ma

Partial nephrectomy for T1 renal cancer can achieve an equivalent oncological outcome to radical nephrectomy with better renal preservation: the way to go.

INTRODUCTION Patients who undergo partial nephrectomy have been shown to be at decreased risk of renal impairment compared with radical nephrectomy. We examined the oncological outcome of patients in our centre who underwent partial or radical nephrectomy for T1 renal cancer (7 cm or smaller), and compared the likelihood of developing chronic kidney disease. METHODS This historical cohort study with internal comparison was conducted in a tertiary hospital in Hong Kong. A cohort of 86 patients with solitary T1 renal cancer and a normal contralateral kidney who underwent radical (38 patients) or partial (48 patients) nephrectomy between January 2005 and December 2010 was included. The overall and cancer-free survival, change in glomerular filtration rate, and new onset of chronic kidney disease were compared between the radical and partial nephrectomy groups. RESULTS A total of 32 (84%) radical nephrectomy patients and 43 (90%) partial nephrectomy patients were alive by 31 December 2012. The mean follow-up was 43.5 (standard deviation, 22.4) months. There was no significant difference in overall survival (P=0.29) or cancer-free survival (P=0.29) between the two groups. Both groups enjoyed good oncological outcome with no recurrence in the partial nephrectomy group. Overall, 18 (21%) patients had pre-existing chronic kidney disease. The partial nephrectomy group had a significantly smaller median reduction in glomerular filtration rate (12.6% vs 35.4%; P<0.001), and radical nephrectomy carried a significantly higher risk of developing chronic kidney disease (hazard ratio=5.44; 95% confidence interval, 1.26-23.55; P=0.02). CONCLUSIONS Compared with radical nephrectomy, partial nephrectomy can prevent chronic kidney disease and still achieve an excellent oncological outcome for T1 renal tumours, in particular T1a tumours and tumours with a low R.E.N.A.L. score.

Prostate cancer detection upon transrectal ultrasound-guided biopsy in relation to digital rectal examination and prostate-specific antigen level: what to expect in the Chinese population?

We investigated the prostate cancer detection rates upon transrectal ultrasound (TRUS)-guided biopsy in relation to digital rectal examination (DRE) and prostate-specific antigen (PSA), and risk factors of prostate cancer detection in the Chinese population. Data from all consecutive Chinese men who underwent first TRUS-guided prostate biopsy from year 2000 to 2013 was retrieved from our database. The prostate cancer detection rates with reference to DRE finding and PSA level of < 4, 4-10, 10.1-20, 20.1-50 and > 50 ng ml−1 were investigated. Multivariate logistic regression analyses were performed to investigate for potential risk factors of prostate cancer detection. A total of 2606 Chinese men were included. In patients with normal DRE, the cancer detection rates were 8.6%, 13.4%, 21.8%, 41.7% and 85.2% in patients with PSA < 4, 4-10, 10.1-20, 20.1-50 and > 50 ng ml−1 respectively. In patients with abnormal DRE, the cancer detection rates were 12.4%, 30.2%, 52.7%, 80.6% and 96.4% in patients with PSA < 4, 4-10, 10.1-20, 20.1-50 and > 50 ng ml−1 respectively. Older age, smaller prostate volume, larger number of biopsy cores, presence of abnormal DRE finding and higher PSA level were associated with increased risk of prostate cancer detection upon multivariate logistic regression analyses (P < 0.001). Chinese men appeared to have lower prostate cancer detection rates when compared to the Western population. Taking the different risk factors into account, an individualized approach to the decision of TRUS-guided biopsy can be adopted.

Impact of skeletal-related events on survival in patients with metastatic prostate cancer prescribed androgen deprivation therapy.

OBJECTIVE To investigate the impact of skeletal-related events on survival in patients with metastatic prostate cancer prescribed long-term androgen deprivation therapy. METHODS This historical cohort study was conducted in two hospitals in Hong Kong. Patients who were diagnosed with metastatic prostate cancer and prescribed androgen deprivation therapy between January 2006 and December 2011 were included. Details of skeletal-related events and mortality were examined. RESULTS The median follow-up was 28 (range, 1-97) months. Of 119 patients, 52 (43.7%) developed skeletal-related events throughout the study, and the majority received bone irradiation for pain control. The median actuarial overall survival and cancer-specific survival for patients with skeletal-related events were significantly shorter than those without skeletal-related events (23 vs 48 months, P=0.003 and 26 vs 97 months, P<0.001, respectively). Multivariate analysis revealed that the adjusted hazard ratio of presence of skeletal-related events on overall and cancer-specific survival was 2.73 (95% confidence interval, 1.46-5.10; P=0.002) and 3.92 (95% confidence interval, 1.87-8.23; P<0.001), respectively. A prostate-specific antigen nadir of >4 ng/mL was an independent poor prognostic factor for overall and cancer-specific survival after development of skeletal-related events (hazard ratio=10.42; 95% confidence interval, 2.10-51.66 and hazard ratio=10.54; 95% confidence interval, 1.94-57.28, respectively). CONCLUSIONS Skeletal-related events were common in men with metastatic prostate cancer. This is the first reported study to show that a skeletal-related event is an independent prognostic factor in overall and cancer-specific survival in patients with metastatic prostate cancer prescribed androgen deprivation therapy. A prostate-specific antigen nadir of >4 ng/mL is an independent poor prognostic factor for overall and cancer-specific survival following development of skeletal-related events.

The performance characteristics of prostate-specific antigen and prostate-specific antigen density in Chinese men.

We investigated the performance characteristics of prostate-specific antigen (PSA) and PSA density (PSAD) in Chinese men. All Chinese men who underwent transrectal ultrasound-guided prostate biopsy (TRUS-PB) from year 2000 to 2013 were included. The receiver operating characteristic (ROC) curves for both PSA and PSAD were analyzed. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at different cut-off levels were calculated. A total of 2606 Chinese men were included. For the ROC, the area under curve was 0.770 for PSA (P < 0.001) and 0.823 for PSAD (P < 0.001). PSA of 4.5 ng ml−1 had sensitivity of 94.4%, specificity of 14.1%, PPV of 29.5%, and NPV of 86.9%; PSAD of 0.12 ng ml−1 cc−1 had sensitivity of 94.5%, specificity of 26.6%, PPV of 32.8%, and NPV of 92.7%. On multivariate logistic regression analyses, PSA cut-off at 4.5 ng ml−1 (OR 1.61, 95% CI 1.05-2.45, P= 0.029) and PSAD cut-off at 0.12 ng ml−1 cc−1 (OR 6.22, 95% CI 4.20-9.22, P< 0.001) were significant predictors for prostate cancer detection on TRUS-PB. In conclusion, the performances of PSA and PSAD at different cut-off levels in Chinese men were very different from those in Caucasians. PSA of 4.5 ng ml−1 and PSAD of 0.12 ng ml−1 cc−1 had near 95% sensitivity and were significant predictors of prostate cancer detection in Chinese men.

Pathological outcome for Chinese patients with low-risk prostate cancer eligible for active surveillance and undergoing radical prostatectomy: comparison of six different active surveillance protocols

INTRODUCTION Active surveillance is one of the therapeutic options for the management of patients with low-risk prostate cancer. This study compared the performance of six different active surveillance protocols for prostate cancer in the Chinese population. METHODS Patients who underwent radical prostatectomy for prostate cancer from January 1998 to December 2012 at a university teaching hospital in Hong Kong were reviewed. Six active surveillance protocols were applied to the cohort. Statistical analyses were performed to compare the probabilities of missing unfavourable pathological outcome. The sensitivity and specificity of each protocol in identifying low-risk disease were compared. RESULTS During the study period, 287 patients were included in the cohort. Depending on different active surveillance protocols used, extracapsular extension, seminal vesicle invasion, pathological T3 disease, and upgrading of Gleason score were present on final pathology in 3.3%-17.1%, 0%-3.3%, 3.3%-19.1%, and 20.6%-34.5% of the patients, respectively. The University of Toronto protocol had a higher rate of extracapsular extension at 17.1% and pathological T3 disease at 19.1% on final pathology than the more stringent protocols from John Hopkins (3.3% extracapsular extension, P=0.05 and 3.3% pathological T3 disease, P=0.03) and Prostate Cancer Research International: Active Surveillance (PRIAS; 8.0% pathological T3 disease, P=0.04). The Royal Marsden protocol had a higher rate of upgrading of Gleason score at 34.5% compared with the more stringent protocol of PRIAS at 20.6% (P=0.04). The specificities in identifying localised disease and low-risk histology among different active surveillance protocols were 59%-98% and 58%-94%, respectively. The John Hopkins active surveillance protocol had the highest specificity in both selecting localised disease (98%) and low-risk histology (94%). CONCLUSIONS Active surveillance protocols based on prostate-specific antigen and Gleason score alone or including Gleason score of 3+4 may miss high-risk disease and should be used cautiously. The John Hopkins and PRIAS protocols are highly specific in identifying localised disease and low-risk histology.

Destruction of the urinary tract by ketamine abuse: Hong Kong local experience

Aim:  To report and analyze the disastrous effects of ketamine abuse on the urinary system seen in young Hong Kong patients.

Is prostate specific antigen (PSA) density necessary in selecting prostate cancer patients for active surveillance and what should be the cutoff in the Asian population

Background To investigate the role of Prostate Specific Antigen density (PSAD) in selecting prostate cancer patients for active surveillance (AS) and to determine a cutoff PSAD in identifying adverse pathological outcomes. Methods Data from 287 patients who underwent radical prostatectomy for prostate cancer were retrospectively reviewed. Six different AS protocols, the University of Toronto; Royal Marsden; John Hopkins; University of California San Francisco (UCSF); Memorial Sloan Kettering Cancer Center (MSKCC) and Prostate Cancer Research International: Active Surveillance (PRIAS), were applied to the cohort. Pre-operative demographics and pathological outcomes were analysed. Statistical analyses on the predictive factors of adverse pathological outcomes and significance of PSAD were performed. A cutoff PSAD with best balance between sensitivity and specificity in identifying adverse pathological outcome was determined. Results PSAD predicted adverse pathological outcomes better than Prostate Specific Antigen (PSA) level alone. The PSAD was significantly lower (0.12–0.13 ng/dl/ml) in protocols including PSAD (the John Hopkins and PRIAS) compared with the other four protocols not including PSAD as a selection criteria (0.21–0.25 ng/dl/dl, P = 0.00). PSAD predicted adverse pathological outcomes in all protocols not incorporating PSAD as an inclusion criteria (P = 0.00–0.02). By the receiver operator characteristics curve analysis, it was found that a PSAD level of 0.19 ng/ml/ml had the best balance between sensitivity and specificity in predicting pathological adverse disease (Area under curve = 0.63, P = 0.004). Conclusion PSAD is necessary in selecting prostate cancer patients for active surveillance. It predicts adverse pathological outcomes in patients eligible for active surveillance better than PSA level alone. A PSAD cutoff at 0.19 ng/ml/ml has the best balance between sensitivity and specificity in predicting pathological adverse disease. We recommend using AS protocol incorporating PSAD as a selection criteria (in particular the PRIAS protocol with a cutoff PSAD at 0.2 ng/ml/ml) when recruiting prostate cancer patients for AS.

Elective nephron-sparing surgery for renal cell carcinoma: Trifecta outcomes in a university teaching hospital

Correlations among penile length, prostate size, testicular volume and PSA in Chinese men VHW YEUNG, ATO YU, TCT PUN, CH CHENG, MTY CHAN, PSK CHU and CW MAN Division of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong Objective: There are numerous studies on the correlation of penile length with different body parameters published worldwide, but none of these studies are based on Chinese men. In this study, we analyzed the correlations among penile length, prostate size, testicular volume and PSA in Chinese men. Patients and Methods: From April 1 to July 31, 2016, 120 patients were recruited into the study. Their flaccid and stretched penile lengths were measured from tip to base of penis. Ultrasound was used to calculate the testicular volume and prostate size. PSA would be also taken on the same day. Results: Two patients with suspected prostate cancer were excluded from the analysis. The average patient’s age was 66.9 years (Range: 47–88 years) with a mean PSA of 3.7 ng/mL (Range: 0.2– 12.7 ng/mL). The average flaccid penile length was 8.4 cm (SD: 2.1 cm) whereas the mean stretched penile length was 10.3 cm (SD: 2.3 cm). The mean testicular volume was 8.9 cm (SD: 3.4 cm). There were some positive correlations identified: prostate size and flaccid penile length (R = 0.376), prostate size and stretched penile length (R = 0.323), prostate size and PSA (R = 0.286). Conclusion: There were positive correlations between prostate size and penile length or PSA. Retrospective review of roboticassisted Vs laparoscopic radical nephroureterectomy – sharing of a simplified approach requiring No patient repositioning or robot redocking CY NG, CH IP, CF LI, Y CHIU, TY CHU and FK

Diagnostic value of prostate imaging - reporting and data system (PI-RADS) version 2 in the Chinese population: a correlation study with magnetic resonance imaging (MRI)/ultrasound (US) fusion targeted biopsy

Correlations among penile length, prostate size, testicular volume and PSA in Chinese men VHW YEUNG, ATO YU, TCT PUN, CH CHENG, MTY CHAN, PSK CHU and CW MAN Division of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong Objective: There are numerous studies on the correlation of penile length with different body parameters published worldwide, but none of these studies are based on Chinese men. In this study, we analyzed the correlations among penile length, prostate size, testicular volume and PSA in Chinese men. Patients and Methods: From April 1 to July 31, 2016, 120 patients were recruited into the study. Their flaccid and stretched penile lengths were measured from tip to base of penis. Ultrasound was used to calculate the testicular volume and prostate size. PSA would be also taken on the same day. Results: Two patients with suspected prostate cancer were excluded from the analysis. The average patient’s age was 66.9 years (Range: 47–88 years) with a mean PSA of 3.7 ng/mL (Range: 0.2– 12.7 ng/mL). The average flaccid penile length was 8.4 cm (SD: 2.1 cm) whereas the mean stretched penile length was 10.3 cm (SD: 2.3 cm). The mean testicular volume was 8.9 cm (SD: 3.4 cm). There were some positive correlations identified: prostate size and flaccid penile length (R = 0.376), prostate size and stretched penile length (R = 0.323), prostate size and PSA (R = 0.286). Conclusion: There were positive correlations between prostate size and penile length or PSA. Retrospective review of roboticassisted Vs laparoscopic radical nephroureterectomy – sharing of a simplified approach requiring No patient repositioning or robot redocking CY NG, CH IP, CF LI, Y CHIU, TY CHU and FK

Epithelioid angiomyolipoma of the kidney: a case series with literature review

Correlations among penile length, prostate size, testicular volume and PSA in Chinese men VHW YEUNG, ATO YU, TCT PUN, CH CHENG, MTY CHAN, PSK CHU and CW MAN Division of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong Objective: There are numerous studies on the correlation of penile length with different body parameters published worldwide, but none of these studies are based on Chinese men. In this study, we analyzed the correlations among penile length, prostate size, testicular volume and PSA in Chinese men. Patients and Methods: From April 1 to July 31, 2016, 120 patients were recruited into the study. Their flaccid and stretched penile lengths were measured from tip to base of penis. Ultrasound was used to calculate the testicular volume and prostate size. PSA would be also taken on the same day. Results: Two patients with suspected prostate cancer were excluded from the analysis. The average patient’s age was 66.9 years (Range: 47–88 years) with a mean PSA of 3.7 ng/mL (Range: 0.2– 12.7 ng/mL). The average flaccid penile length was 8.4 cm (SD: 2.1 cm) whereas the mean stretched penile length was 10.3 cm (SD: 2.3 cm). The mean testicular volume was 8.9 cm (SD: 3.4 cm). There were some positive correlations identified: prostate size and flaccid penile length (R = 0.376), prostate size and stretched penile length (R = 0.323), prostate size and PSA (R = 0.286). Conclusion: There were positive correlations between prostate size and penile length or PSA. Retrospective review of roboticassisted Vs laparoscopic radical nephroureterectomy – sharing of a simplified approach requiring No patient repositioning or robot redocking CY NG, CH IP, CF LI, Y CHIU, TY CHU and FK