Purpose: The use of gallium-68 prostate-specific membrane antigen-11 positron emission tomography/computed tomography (Ga-68 PSMA-11 PET/CT) is becoming increasingly common among men with prostate cancer (PCa). However, it remains uncertain which patients will derive the most benefit, and there is a scarcity of real-world data regarding its impact on altering treatment plans. This study investigated which patients would most benefit from Ga-68 PSMA-11 PET/CT, focusing on detection rates and changes in treatment strategies, drawing from a single-center experience. Materials and Methods: In total, 230 men with PCa who underwent Ga-68 PSMA-11 PET/CT between November 2021 and August 2022 were included in this retrospective study. The patients were classified into 5 groups based on their disease status: group 1, further work-up for high-risk localized PCa; group 2, de novo metastatic PCa; group 3, biochemical recurrence after definitive treatment; group 4, castration-resistant PCa; group 5, others. The positivity rate, positive lesions, predictive value of lymph node metastases, comparison with conventional images, and treatment changes after Ga-68 PSMA-11 PET/CT were analyzed in each group. Results: Of the 230 patients, 40 (17.4%), 20 (8.7%), 77 (33.5%), 76 (33.0%), and 17 (7.4%) were classified into groups 1–5, respectively. Ga-68 PSMA-11 PET/CT showed lesions in 74.8% of patients, and the optimal cutoff value for PSA was 1.99 ng/mL. Lesions not observed on conventional imaging were found in 62 patients (33.2%). In 38 patients (13.5%), treatment was changed due to Ga-68 PSMA-11 PET/CT. Conclusions These real-world data suggest that Ga-68 PSMA-11 PET/CT may be clinically useful for various disease conditions, as substantial stage migration and subsequent treatment changes occur in men with PCa. However, the prognostic impact of this modality remains unclear; thus, a well-designed prospective study is needed to address this issue.

Purpose: To investigate the correlation between preoperative De Ritis ratio (aspartate transaminase [AST]/alanine transaminase [ALT]) and postoperative clinical outcome in patients with upper urinary tract carcinoma (UTUC) who underwent radical nephroureterectomy (RNU) and adjuvant chemotherapy (ACH). Materials and Methods: We respectively analyzed the clinical and pathological data of 102 patients who underwent RNU and ACH for UTUC. Patients were divided into 2 groups, according to the optimal value of AST/ALT ratio. The effect of the AST/ALT ratio was analyzed by the Kaplan-Meier method and Cox regression hazard models for patients’ cancer-specific survival (CSS) and overall survival (OS). Results: Mean survival time was 50.5±41.2 months. Mean age was 61.4±9.7years. Forty-one of the patients (46.5%) were in the high AST/ALT group. According to receiver operating characteristic analysis, the optimal AST/ALT ratio was 1.2. In Kaplan-Meier analyses, the high AST/ALT group showed worse outcomes in OS (p=0.007) and CSS (p=0.011). Using Cox regression models of clinical and pathological parameters to predict OS, high AST/ALT ratio (hazard ratio [HR], 5.428; 95% confidence interval [CI]; 1.803–16.334; p=0.002), pathological T3 (pT3) or higher (HR, 1.464; 95% CI; 1.156-1.857; p=0.002), and to predict CSS, high AST/ALT ratio (HR, 4.417; 95% CI; 1.545–12.632; p=0.005), and pT3 or higher (HR, 1.475; 95% CI; 1.172–1.904; p=0.002) were determined as independent prognostic factors. Conclusions Pretreatment AST/ALT ratio is a significant independent predictor of CSS and OS in advanced UTUC patients receiving systemic ACH after RNU.

Purpose: This study aimed to develop a model for predicting pathologic extracapsular extension (ECE) and seminal vesicle invasion (SVI) while integrating magnetic resonance imaging-based T-staging (cTMRI, cT1c-cT3b). Materials and Methods: A total of 1,915 who underwent radical prostatectomy between 2006-2016 met the inclusion/exclusion criteria. We performed a multivariate logistic regression analysis as well as Bayesian network (BN) modeling based on possible confounding factors. The BN model was internally validated using 5-fold validation. Results: According to the multivariate logistic regression analysis, initial prostate-specific antigen (iPSA) (β=0.050, p < 0.001), percentage of positive biopsy cores (PPC) (β=0.033, p < 0.001), both lobe involvement on biopsy (β=0.359, p=0.009), Gleason score (β=0.358, p < 0.001), and cTMRI (β=0.259, p < 0.001) were significant factors for ECE. For SVI, iPSA (β=0.037, p < 0.001), PPC (β=0.024, p < 0.001), Gleason score (β=0.753, p < 0.001), and cTMRI (β=0.507, p < 0.001) showed statistical significance. BN models to predict ECE and SVI were also successfully established. The overall area under the receiver operating characteristic curve (AUC)/accuracy of the BN models were 0.76/73.0% and 0.88/89.6% for ECE and SVI, respectively. According to internal comparison between the BN model and Roach formula, BN model had improved AUC values for predicting ECE (0.76 vs. 0.74, p=0.060) and SVI (0.88 vs. 0.84, p < 0.001). Conclusion Two models to predict pathologic ECE and SVI integrating cTMRI were established and installed on a separate website for public access to guide radiation oncologists.

Purpose: Limited data exist on the use of low midline and transverse incisions for specimen extraction or stoma sites in laparoscopic rectal cancer surgery (LRCS). We compared the short-term and medium-term outcomes of these incisions and assessed whether wound complications in specimen extraction sites (SES) are increased by specimen extraction through the stoma site (SESS) in LRCS. Methods: From March 2010 to December 2017, 189 patients who underwent LRCS and specimen extraction through low abdominal incisions were divided into 2 groups: midline (n = 102) and transverse (n = 87), and perioperative outcomes were compared. Results: The midline group showed a higher frequency of temporary stoma formation (P = 0.001) and splenic flexure mobilization (P < 0.001) than the transverse group. The overall incisional hernia and wound infection rates in the SES were 21.6% and 25.5%, respectively, in the midline group and 26.4% and 17.2%, respectively, in the transverse group (P = 0.494 and P = 0.232, respectively). In patients who underwent SESS, the incisional hernia and wound infection rates of SES after stoma closure were 39.1% and 43.5%, respectively, in the midline group, and 35.5% and 22.6%, respectively, in the transverse group (P = 0.840 and P = 0.035, respectively). Conclusion In terms of incisional hernia and wound infection at the SES, a low midline incision may be used as a low transverse incision in patients without temporary stoma in LRCS. However, considering the high wound complication rates after stoma closure in patients with SESS in this study, SESS should be performed with caution in LRCS.

Purpose: To evaluate the clinical usefulness of the Seoul National University Prostate Cancer Risk Calculator (SNU-PCRC) to reduce unnecessary prostate biopsy and to increase the detection rate of high-risk cancer. Materials and Methods: We retrospectively analyzed 546 patients who underwent prostate biopsy between 2014 and 2016. The subjects were divided into 2 groups based on the type of risk calculator used: conventional and SNU-PCRC group. In the SNU-PCRC group, prostate biopsy was recommended when the probability of SNU-PCRC was more than 30%. Results: The SNU-PCRC group had significantly smaller prostate volume (p=0.010) and significantly more digital rectal examination and transrectal ultrasonography (TRUS) abnormalities (p=0.011 and p=0.010, respectively). Overall detection (71.9% vs. 32.1%) and high-risk cancer detection rates (40.6% vs. 19.3%) were significantly higher in the gray zone (prostate-specific antigen=4-10 ng/mL) (p<0.001 and p=0.006). The group with prostate cancer risk ≥30% on the SNU-PCRC compared to <30% group, overall detection rate of 72.3% versus 30.2% and high-risk detection rate of 60.6% versus 18.3% were significantly different (p<0.001 and p<0.001). Applying the SNU-PCRC to the conventional group could avoid unnecessary prostate biopsy in 50.6%. Conclusions SNU-PCRC is clinically useful to reduce unnecessary prostate biopsy and increase overall detection rate and high-risk cancer detection rate.

Purpose: To evaluate the clinical usefulness of the Seoul National University Prostate Cancer Risk Calculator (SNU-PCRC) to reduce unnecessary prostate biopsy and to increase the detection rate of high-risk cancer. Materials and Methods: We retrospectively analyzed 546 patients who underwent prostate biopsy between 2014 and 2016. The subjects were divided into 2 groups based on the type of risk calculator used: conventional and SNU-PCRC group. In the SNU-PCRC group, prostate biopsy was recommended when the probability of SNU-PCRC was more than 30%. Results: The SNU-PCRC group had significantly smaller prostate volume (p=0.010) and significantly more digital rectal examination and transrectal ultrasonography (TRUS) abnormalities (p=0.011 and p=0.010, respectively). Overall detection (71.9% vs. 32.1%) and high-risk cancer detection rates (40.6% vs. 19.3%) were significantly higher in the gray zone (prostate-specific antigen=4-10 ng/mL) (p<0.001 and p=0.006). The group with prostate cancer risk ≥30% on the SNU-PCRC compared to <30% group, overall detection rate of 72.3% versus 30.2% and high-risk detection rate of 60.6% versus 18.3% were significantly different (p<0.001 and p<0.001). Applying the SNU-PCRC to the conventional group could avoid unnecessary prostate biopsy in 50.6%. Conclusions SNU-PCRC is clinically useful to reduce unnecessary prostate biopsy and increase overall detection rate and high-risk cancer detection rate.

PURPOSE: We evaluated the prognostic value of the 5-tiered grade group in Korean patients who underwent radical prostatectomy. MATERIALS AND METHODS: Between 1996 and 2016, a number of 2,883 consecutive patients who underwent radical prostatectomy were included for the analysis. The impacts of biopsy and pathologic grade group on predicting biochemical recurrence (BCR) were assessed using multivariate analysis. Median follow-up duration was 49.0 months. RESULTS: Mean age was 66.5 years and prostate-specific antigen (PSA) was 11.8 ng/mL. Prostate cancer was locally advanced on magnetic resonance imaging in 13.4%. Biopsy grade group was as follows: 1 (46.8%), 2 (19.8%), 3 (14.2%), 4 (14.1%), and 5 (5.1%). Pathology stage was ≤T2 in 63.6%, T3a in 26.0%, and T3b/T4 in 10.4% patients. Pathologic grade was as follows: 1 (31.3%), 2 (37.9%), 3 (20.2%), 4 (4.7%), and 5 (5.1%). In multivariate analysis using biopsy-related variables, biopsy grade group (1, reference; 2, hazard ratio [HR], 1.771; p=0.001; 3, HR, 2.736; p < 0.001; 4, HR, 2.966; p < 0.001; 5, HR, 3.707; p < 0.001) was associated with BCR-free survival, PSA level and % positive core. In multivariate analysis using pathologic outcomes, pathologic grade group (1, reference; 2, HR, 1.882; p < 0.001; 3, HR, 3.352; p < 0.001; 4, HR, 3.890; p < 0.001; 5, HR: 3.118, p < 0.001) was associated with BCR-free survival in addition to pathologic stage and positive surgical margin. CONCLUSIONS: New 5-tiered grading system could be useful for predicting oncological outcomes in Korean patients although its role for distinguishing outcomes between patients with grade groups 3–5 need to be validated before wide application of this grade system in Korea.
Biopsy ; Follow-Up Studies ; Humans ; Korea ; Magnetic Resonance Imaging ; Multivariate Analysis ; Neoplasm Grading ; Pathology ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Recurrence

PURPOSE: The purpose of this study was to determine the impact of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), statin, and cyclooxygenase 2 (COX-2) inhibitor on the development of kidney, prostate, and urothelial cancers by analyzing the Korean National Health Insurance Service–National Sample Cohort (NHIS-NSC) database. MATERIALS AND METHODS: Among a representative sample cohort of 1,025,340 participants in NHIS-NSC database in 2002, we extracted data of 799,850 individuals who visited the hospital more than once, and finally included 321,122 individuals aged 40 and older. Following a 1-year washout period between 2002 and 2003, we analyzed 143,870 (male), 320,861 and 320,613 individuals for evaluating the risk of prostate cancer, kidney cancer and urothelial cancer developments, respectively, during 10-year follow-up periods between 2004 and 2013. The medication group consisted of patients prescribed these drugs more than 60% of the time in 2003. To adjustfor various parameters of the patients, a multivariate Cox regression model was adopted. RESULTS: During 10-year follow-up periods between 2004 and 2013, 9,627 (6.7%), 1,107 (0.4%), and 2,121 (0.7%) patients were diagnosed with prostate cancer, kidney cancer, and urothelial cancer, respectively. Notably, multivariate analyses revealed that NSAIDs significantly increased the risk of prostate cancer (hazard ratio [HR], 1.35). Also, it was found that aspirin (HR, 1.28) and statin (HR, 1.55) elevated the risk of kidney cancer. No drugs were associated with the risk of urothelial cancer. CONCLUSION: In sum, our study provides the valuable information for the impact of aspirin, NSAID, statin, and COX-2 inhibitor on the risk of prostate, kidney, and urothelial cancer development and its survival outcomes.
Anti-Inflammatory Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Aspirin* ; Cohort Studies ; Cyclooxygenase 2 ; Follow-Up Studies* ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Kidney ; Kidney Neoplasms ; Korea* ; Multivariate Analysis ; National Health Programs ; Prostate ; Prostatic Neoplasms

PURPOSE: To evaluate the clinicopathologic and oncological outcomes of advanced metastatic testicular cancer in Korean men who underwent retroperitoneal lymph node dissection (RPLND) following chemotherapy. MATERIALS AND METHODS: Data of 26 patients with testicular cancer who underwent RPLND after chemotherapy at 2 hospitals in Korea between September 2004 and June 2016 were retrospectively analyzed. Clinical and histopathological variables such as stage of the testicular cancer, age of the patients during surgery, size of the retroperitoneal lymph nodes (RPLNs), histopathological results, duration and complications related to the surgery, cancer recurrence, and mortality were analyzed. RESULTS: During testicular surgery, the T stage was pT1, pT2, and pT3 in 50% (n=13), 26.9% (n=7), and 15.3% (n=4) of the patients, respectively. Mixed germ cell tumor was the most common finding, seen in 73.1% (n=19) of patients. The indications for RPLND were residual lymph nodes after chemotherapy, 84.6% (n=22); and disease progression and remission, 7.7% (n=2). Pathological analysis revealed viable tumors in 19.2% of patients (n=5), necrotic/fibrotic tissue in 42.3% (n=11), and teratoma in 34.6% (n=9). Intraoperative and postoperative complications occurred in 23.1% (n=6) and 19.2% of patients (n=5). The median duration of follow-up was 27.5 months (interquartile range, 1.3–108.2 months); 11.5% (n=3) patients had recurrence, and 3.8% (n=1) died of progressive metastatic testicular cancer. CONCLUSIONS: Viable germ cell tumors were present in 19.2% of patients with testicular cancer who underwent RPLND after chemotherapy. This is the first study of its kind in the Korean population.
Disease Progression ; Drug Therapy ; Follow-Up Studies ; Humans ; Korea ; Lymph Node Excision* ; Lymph Nodes* ; Male ; Mortality ; Neoplasms, Germ Cell and Embryonal ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Teratoma ; Testicular Neoplasms*

PURPOSE: The purpose of this study is to evaluate the changes of conditional survival (CS) probabilities and to identify the prognostic parameters that significantly affect CS over time post-surgery in upper tract urothelial carcinoma (UTUC) patients. MATERIALS AND METHODS: A total of 330 patients were examined in the final analysis. Primary end point was conditional cancer-specific survival (CSS), overall survival (OS), and intravesical recurrence-free survival (IVRFS) after surgery. The Kaplan-Meier method was used for calculation of CS. Cox regression hazard ratio model was used to determine the predictors of CS. RESULTS: UTUC patients who had already survived 5 years after radical nephroureterectomy had a more favorable CS probability in all given survivorships compared to those with shorter survival times. Patients with unfavorable pathologic features showed a higher increment of 5-year conditional CSS and OS compared to their counterparts. For 5-year conditional CSS, several factors, including high-grade tumor, lymphovascular invasion, and tumor location showed significant association with risk elevation over time. Only age remained as a predictor of 5-year conditional OS with increased risk in all given survivorships. For 5-year IVRFS, no variables remained as significant predictive factors over time after surgery. CONCLUSION: Our study provides valuable information for practical survival estimation and relevant prognostic factors for patients with UTUC after surgery.
Carcinoma, Transitional Cell ; Effect Modifier, Epidemiologic ; Humans ; Retrospective Studies* ; Survival Rate ; Urinary Tract ; Urologic Surgical Procedures