PURPOSE: To determine whether neoadjuvant androgen deprivation therapy (NADT) improves clinical outcomes in patients with prostate cancer treated with definitive radiotherapy. MATERIALS AND METHODS: We retrospectively reviewed medical records of 201 patients with prostate cancer treated with radiotherapy between January 1991 and December 2008. Of these, 156 patients with more than 3 years of follow-up were the subjects of this study. The median duration of follow-up was 91.2 months. NADT was given in 103 patients (66%) with median duration of 3.3 months (range, 1.0 to 7.7 months). Radiation dose was escalated gradually from 64 Gy to 81 Gy using intensity-modulated radiotherapy technique. RESULTS: Biochemical relapse-free survival (BCRFS) and overall survival (OS) of all patients were 72.6% and 90.7% at 5 years, respectively. BCRFS and OS of NADT group were 79.5% and 89.8% at 5 years and those of radiotherapy alone group were 58.8% and 92.3% at 5 years, respectively. Risk group (p = 0.010) and radiation dose > or =70 Gy (p = 0.017) affected BCRFS independently. NADT was a significant prognostic factor in univariate analysis, but not in multivariate analysis (p = 0.073). Radiation dose > or =70 Gy was only an independent factor for OS (p = 0.007; hazard ratio, 0.261; 95% confidence interval, 0.071-0.963). CONCLUSION: NADT prior to definitive radiotherapy did not result in significant benefit in terms of BCRFS and OS. NADT should not be performed routinely in the era of dose-escalated radiotherapy.
Follow-Up Studies ; Humans ; Medical Records ; Multivariate Analysis ; Prostatic Neoplasms* ; Radiotherapy* ; Radiotherapy, Intensity-Modulated ; Retrospective Studies

PURPOSE: The critical pathway (CP) for radical retropubic prostatectomy (RRP), which is the efficient standardized guideline of clinical practice, was established for all the medical staff, nurses, patients and hospital managers for managing patients with RRP. The aim of this study was to evaluate the usefulness of this CP for RRP. MATERIALS AND METHODS: Our series consisted of 256 consecutive patients who had undergone RRP at a single institution from March 1, 2002 till May 31, 2005. The CP of RRP was implemented January 1, 2004. The patients were subdivided into two groups: (1) the non critical pathway (NCP) group that was made of 91 patients who were treated other than by the CP (from March, 2002 through December, 2003) and (2) the CP group of 134 patients who were placed on CP (from January, 2004 through May, 2005). The factors compared in this study included the average length of stay (LOS), the average hospital charges, the postoperative complications and the patient satisfaction between the two groups. RESULTS: There were no significant differences in the parameters between the two groups including age, the prostate-specific antigen (PSA) level, the Gleason score and the stage. The average LOS decreased significantly after implementation of CP without increasing the incidence of postoperative complications. The average hospital charges were significantly lower for the CP group than for the group without CP. The patients in the CP group were more satisfied than the other patients. CONCLUSIONS: The CP for RRP seems to be effective practical guidelines for managing radical retropubic prostatectomy patients.
Critical Pathways* ; Hospital Charges ; Humans ; Incidence ; Length of Stay ; Medical Staff ; Neoplasm Grading ; Patient Satisfaction ; Postoperative Complications ; Prostate-Specific Antigen ; Prostatectomy* ; Prostatic Neoplasms

PURPOSE: The relationship between pathological parameters, such as blood vessel, lymphatic and perineural invasions, and prognosis, are controversial. We retrospectively analyzed the charts of patients with bladder cancer to identify the prognostic significance of these parameters. MATERIALS AND METHODS: A retrospective review of 125 of 181 patients with bladder cancer treated with radical cystectomy was conducted. Patients treated with neoadjuvant or adjuvant chemotherapy and those who were found to have lymph node metastasis after cystectomy were excluded from the study. RESULTS: The mean patient age was 62.5 years(range 39-84) and the overall median follow-up was 40.1months(range 1 to 146). Blood vessel, lymphatic, and perineural invasions were present in 8.8%, 20.8%, 8.8% of the specimens, respectively, and 28% of the patients had at least one of three factors. Univariate analysis revealed that blood vessel lymphatic, and perineural invasions were prognostic predictors of survival. However, only tumor stage and blood vessel invasion were calculated to be independent factors of survival on multivariate analysis. CONCLUSIONS: In this series, the pathological stage and blood vessel invasion are significant parameters of tumor-free survival in patients who have undergone cystectomy for bladder cancer. Our findings suggest that blood vessel, lymphatic, and perineural invasions should be examined more carefully.
Blood Vessels* ; Carcinoma, Transitional Cell* ; Chemotherapy, Adjuvant ; Cystectomy* ; Follow-Up Studies ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis* ; Retrospective Studies ; Urinary Bladder Neoplasms ; Urinary Bladder*

PURPOSE: Radical cystectomy with urinary tract reconstruction currently remains the standard treatment for invasive bladder cancer, and adjuvant chemotherapy is usually considered for patients with a clinical stage >T2 or nodal metastasis. The aim of this study was to assess the safety of adjuvant chemotherapy in patients with orthotopic bladder substitution in comparison to ileal conduit. MATERIALS AND METHODS: We retrospectively analyzed the patients who underwent radical cystectomy and urinary diversion between 1990 and 2005. The patients who underwent adjuvant chemotherapy were stratified into two groups: those who had orthotopic bladder substitution and those who had ileal conduit. The chemotherapy regimen, renal function change, complications from adjuvant chemotherapy and other relevant data were analyzed. RESULTS: Overall, 341 patients had radical cystectomy, 89 had adjuvant chemotherapy, 28 had orthotopic bladder substitution and 61 had ileal conduit. The patient characteristics, including age, stage and follow-up, were similar in both groups. In all, 42% of patients had grade 1 toxicity, 16% had grade 2, 14% had grade 3 and 0% had grade 4. No patients had serious organ toxicity and none died. There were no significant differences in the chemotherapy toxicity and renal function change among the two groups. CONCLUSIONS: Adjuvant chemotherapy is safe and well tolerated by patients with either orthotopic bladder substitution or ileal conduit. There was no increased morbidity or mortality due to adjuvant chemotherapy in the patients who had orthotopic bladder substitution. Hence, orthotopic bladder substitution should not be denied to those patients with bladder cancer and who might require adjuvant chemotherapy.
Chemotherapy, Adjuvant* ; Cystectomy ; Drug Therapy ; Follow-Up Studies ; Humans ; Mortality ; Neoplasm Metastasis ; Retrospective Studies ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Diversion* ; Urinary Tract

PURPOSE: We analyzed the impact of transurethral resection of the bladder (TUR-B) in patients with bladder cancer, in whom a subsequent cystectomy was performed. MATERIALS AND METHODS: We reviewed the records of 93 patients, with clinical stage T2 or less transitional cell carcinomas of the bladder that underwent a radical cystectomy at our institute. Before the radical cystectomy, TUR-B was performed for diagnostic and therapeutic purposes in all patients. We used the term "complete TUR" for the following procedures. No residual tumors were found after the TUR endoscopically, also, muscle layer should be present in the TUR specimens and no gross residual tumors were found in the cystectomy specimens by the pathologist. RESULTS: Eleven (26.8%) of the 41 patients with superficial bladder cancer had no evidence of residual tumors. Of the 19 patients with superficial bladder cancer that underwent complete TUR-B, 10 (52.6%) had no residual tumors. For the invasive tumors, 10 (19.2%) of the 52 patients that had a T2 stage disease had no residual tumors, and 10 (29.4%) of the 34 patients with a T2 stage disease, who underwent complete TUR-B, had no residual tumors. In the 38 patients with superficial bladder cancer, 17 (44.7%) changed to a higher stage. Of the 17 patients who underwent complete TUR-B, 3 (17.7%) changed to a higher stage. Among the patients with a T2 stage disease, those with the pT0 stage had a better survival than those with the pT2 stage with residual tumors (p=0.04). CONCLUSIONS: The completeness of TUR-B is important in evaluating residual tumors after a previous TUR-B in those patients with both superficial and invasive bladder cancers.
Carcinoma, Transitional Cell ; Cystectomy* ; Humans ; Neoplasm, Residual* ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Purpose: We evaluated the variables that may predict the final Gleason score of a radical prostatectomy in the patients showing more than two different Gleason scores in their positive core biopsy specimens. Materials and Methods: We reviewed the pathological data of patients diagnosed with prostate cancer using extended (12 site or more) needle biopsies who underwent a radical retropubic prostatectomy. A total of 73 patients showed more than two different Gleason scores in their biopsy specimen. The following parameters were assessed: highest Gleason score in the biopsy specimen, the Gleason score of the highest tumor percentage in the core and the highest tumor ratio score (Gleason score of highest total tumor length of same Gleason score/total core length of same Gleason score). Concordance of the Gleason scores between the biopsy specimen and prostatectomy was also examined. Results: The highest tumor ratio score showed the highest (64.4%) concordance rate. The concordance rates of the Gleason scores of the highest tumor percentage in the core and the largest linear cancer length were 59 and 58%, respectively. The concordance rate of the highest Gleason score in the biopsy specimens was only 47%. When stratified by grade: well differentiated (Gleason score=6), moderate (7) and poorly differentiated (8-10), the grade concordance rate of the highest tumor ratio score was 73%. The grade concordance rates of the highest and largest linear cancer length Gleason scores were 64.4 and 64.3%, respectively. Conclusions: If a biopsy specimen shows more than two different Gleason scores in positive cores, the highest tumor ratio score may be the most useful variable for predicting the final Gleason score from radical prostatectomy specimens.
Biopsy* ; Biopsy, Needle ; Humans ; Neoplasm Grading* ; Prostatectomy* ; Prostatic Neoplasms

PURPOSE: To develope the bacillus Calmette-Guerin(BCG) antitumor component therapy which could reduce the adverse effect of intravesical BCG therapy, we investigated the effect of the fractions of BCG on the immune responses of mouse and compared with whole BCG. MATERIALS AND METHODS: Seven fractions, 4(fraction 1, 2, 3, 4) from BCG cell wall and 1 (fraction 7) front BCG cytoplasm and 2(fraction 5, 6) mixed, were collected by multiple ultrasonification and centrifugation of BCG solution and the difference of each fraction was confirmed by spectrophotometric absorbance. Change of lymphokine killer(LAK), natural killer(NK) and tumor cell dependent cytotoxic(TCDC) activities of mouse spleen cells were investigated by 51Cr releasing assay and proportion of T cell subset in mouse spleen and peritoneal lymhocytes were investigated by flow cytometric analyses using monoclonal antibodies to mouse CD4, CD8 and CD2S cells. RESULTS: In LAK and NK activities, fraction 1, 2 and 3 showed similar results with whole BCG. In TCDC activity, the all 7 fraction showed lower activities compared with BCG. In T cell subset analyses, similar results were found in fraction 1, 2 and 3 compared with whole BCG. CONCLUSIONS: We could suggest that the antitumor activity of BCG seems to be mediated by some component in cell wall. Further investigations which could elucidate these findings should be necessary.
Animals ; Antibodies, Monoclonal ; Bacillus* ; Cell Wall ; Centrifugation ; Cytoplasm ; Immunity, Cellular* ; Mice* ; Mycobacterium bovis ; Spleen ; Urinary Bladder Neoplasms

PURPOSE: We assessed the impact of pelvic lymphadenectomy on the survival of patients who had undergone radical cystectomy. MATERIALS AND METHODS: We retrospectively reviewed 107 patients who underwent radical cystectomy for transitional cell carcinoma of the bladder between January 1991 and December 2000. We preoperatively excluded patients with evidence of pelvic lymphadenopathy and distant metastases from the study. Among 107 patients, 61 patients (Group A) underwent pelvic lymphadenectomy while 46 patients (Group B) did not. The clinicopathological parameters were not significantly different in the two groups. RESULTS: In group A, 12 patients (19.6%) were found to have pelvic node metastases. Five-year overall survival and recurrence-free survival rates were 68% and 75% for Group A, respectively. In group B, 5-year overall survival and recurrence-free survival rates were 36% and 56%, respectively. Multivariate analysis revealed that T stage (p=0.004) and lymphadenectomy (p=0.044) were significant prognostic factors for survival. CONCLUSIONS: The overall survival rates between the two groups were significantly different. Our findings suggested that lymphadenectomy may improve the prognosis of patients who underwent radical cystectomy for transitional cell carcinoma of the bladder.
Carcinoma, Transitional Cell* ; Cystectomy* ; Humans ; Lymph Node Excision* ; Lymphatic Diseases ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Survival Rate ; Urinary Bladder Neoplasms ; Urinary Bladder*

PURPOSE: Bax promotes apoptosis and is up-regulated by p53, which is not required for androgen ablation-induced apoptosis of the prostatic cells. We investigated the change of lax during the involution of the rat prostate following castration. MATERIALS AND METHOD: Adult male rats were castrated and the ventral prostatic glands were removed daily for a week following castration. Western blot and immunohistochemical analysis of lax protein were performed using anti-bax rabbit polyclonal IgG. RESULTS: The prostatic weight decreased and the apoptotic cells began to appear 2 days following castration. Western blot analysis showed that lax was absent in the control prostate but began to increase 4 days following castration. Immunohistochemical analysis showed that bars was confined to the cells which had morphological characteristics of the late stage of programmed cell death. CONCLUSIONS: Present results suggest that bars might be involved in the late stage of castration-induced apoptosis of the rat prostatic cells.
Adult ; Animals ; Apoptosis ; Blotting, Western ; Castration* ; Cell Death ; Humans ; Immunoglobulin G ; Male ; Prostate* ; Rats*

PURPOSE: We investigated the in vitro effects of local anesthetics on the contractility of the human bladder. MATERIALS AND METHODS: Using human bladder strips obtained from 20 patients undergoing cystectomy, we investigated the effects of tetracaine, bupivacaine, lidocaine, and ropivacaine on the basal spontaneous contractions and contractions induced by various stimuli: KCl, carbachol (CCh), and electrical field stimulation (EFS). The effect of local anesthetic agents on the Ca2+ -independent sustained tonic contraction (SuTC) was also investigated. RESULTS: Spontaneous contraction was not observed in 181 out of 187 bladder strips. Local anesthetics inhibited nerve-mediated contractions (EFS, 0.8msec) in a concentration-dependent manner and also inhibited non-nerve mediated contractions induced by KCl, long pulse EFS (direct muscle stimulation, 100msec), and CCh. The rank order of inhibitory potency on nerve-mediated contractions and CCh-induced contractions was ropivacaine, tetracaine, bupivacaine, and lidocaine, while the rank order on KCl-induced contractions was ropivacaine, tetracaine, lidocaine, and bupivacaine, both in decreasing order. Higher concentrations of local anesthetics were needed to inhibit the non-nerve-mediated bladder contraction than the nerve-mediated contraction. SuTC was also suppressed by all local anesthetics in a concentration dependent manner. CONCLUSIONS: Our study demonstrates that local anesthetics have inhibitory effects on the contraction of human bladder that is induced by various stimuli. These effects suggest that local anesthetics may be useful as diagnostic and therapeutic agents for bladder dysfunction.
Anesthetics ; Anesthetics, Local* ; Baths* ; Bupivacaine ; Carbachol ; Cystectomy ; Humans* ; Lidocaine ; Muscle Contraction ; Muscle, Smooth ; Tetracaine ; Urinary Bladder*