Brain metastases are not rare in patients with renal cell carcinoma. However, there have been few reports of isolated brain metastases. In patients with localized renal masses, urologists tend to evaluate only the chest and abdomen region. We report the case of a 65-year-old patient who presented with sudden left-sided weakness. He underwent brain surgery after a mass was found on brain imaging. Histopathology analysis revealed a single brain metastasis that occurred 15 months after robot-assisted laparoscopic radical nephrectomy for renal cell carcinoma. Although the patient had been evaluated for localized kidney cancer in preoperative staging, he had not complained of any neurological symptoms before or after radical nephrectomy. Therefore, we had not perceived a need for brain evaluation at that time. This report is intended to draw attention to the need for further evaluation in patients with large renal masses, as well as patients with moderate to high recurrence risk scores.

Inflammatory myofibroblastic tumor (IMT) of the urinary bladder is an uncommon disease in young patients that presents with gross hematuria. However, IMT should be cautiously diagnosed because of its similarities with malignant spindle cell sarcoma. In this case, the tumor was successfully removed by transurethral resection of the bladder tumor and a final diagnosis of IMT was established conclusively.

Purpose: The aims of this study were to investigate the clinical value of Rab27a as a urinary biomarker, and its efficiency in the prediction of bladder cancer grade. Materials and Methods: The expression of Rab27a in urine samples of patients with bladder cancer, cell line (T-24), and tissue samples of patients with bladder cancer was estimated via quantitative reverse transcription polymerase chain reaction (qRT-PCR). The Rab27a expression level was investigated according to sex, age, and histological grade via qRT-PCR and Western blotting. Results: Rab27a was also expressed at high levels in urine compared to cell lines and tissues from bladder cancer patients. In addition, Rab27a expression varied significantly according to tumor grade (p<0.001). Rab27a was expressed at high levels in male and elderly patients, however, there was not statistically significant. Conclusions Our results indicated that Rab27a is valuable as a urinary diagnostic biomarker for bladder cancer. In addition, it may serve as a predictive factor for determining bladder cancer grade.

Purpose: To trace the incidence of serum prostate-specific antigen (PSA) tests by the residential areas of Korea, where social awareness on prostate cancer (PCa) is limited due to the absence of a public screening. Materials and Methods: From Korean national health insurance data, the number of men older than 40 years who performed PSA testing without PCa or before the enrollment on the national registry during 2006–2016 was identified, then its association with the incidence of PCa were analyzed by a residential area categorized into metropolitan, urban, and rural area. Results: PSA testing was performed more in the metropolitan area in 2006–2008, but performed the most prevalently in the rural area since 2010. Among the 17 administrative districts, the most PSA-tested district was Jeollabuk-do (9.36%) in 2016, which was Seoul (2.85%) in 2006. The mean repetition number of PSA tests during 11 years of the study period was highest among the inhabitant of Seoul (3.25 times, p<0.0001), followed by Gwangju (2.98 times), another metropolitan city. The mean repetition number of PSA tests during the study decade was in the order of metropolitan area (2.97 times), rural area (2.83 times), and urban area (2.75 times, p<0.0001). In every year, however, the incidence of PCa was the highest in a rural area, where had the oldest mean age. Conclusions Despite a recent increase of PSA screening and diagnosis of PCa especially in the rural area, the opportunity of repeated testing was presented more to the inhabitant of a metropolitan area.

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 determine the prognostic roles of several immune-related laboratory parameters in patients with metastatic kidney and bladder cancer treated with immune checkpoint inhibitors (ICIs). Materials and Methods: Overall, 36 patients with either metastatic bladder (N=18) or kidney cancer (N=18) were enrolled retrospectively. Progression-free survival (PFS) and overall survival according to the pretherapeutic serum De Ritis ratio (DRR), neutrophil-to-lymphocyte ratio (NLR), and albumin level after ICI treatment, were analyzed. Treatment duration was adjusted using Contal and O’Quigley’s method to explore the cutoff and maximize the log-rank test statistic. Cox proportional hazards model was used to analyze the laboratory parameters. Results: A total of 9 patients received a combination therapy of multiple ICIs (N=9) and targeted agents (N=7). The median NLR, DRR, and albumin level at baseline were 1.7, 1.2, and 4.2 mg/dL, respectively. In the univariable analysis, combination of immunotherapies, total ICI cycles, baseline DRR, and albumin level were significant for PFS. Sex ratio, total ICI cycles, and baseline NLR and DRR were significant for cancer-specific survival (CSS). DRR and albumin levels, which were measured for up to 10 cycles, were significant in PFS and CSS. NLR was additionally significant in CSS. After adjusting total ICI cycles, DRR was significant in PFS and CSS, albumin level was significant only in PFS, and NLR was significant only in CSS in the multivariable analysis. Conclusions NLR, DRR, and albumin level are significant factors associated with the survival of patients with metastatic kidney and bladder cancer treated with ICI.

For intermediate- and high-risk nonmuscle invasive bladder cancer (NMIBC), intravesical Bacillus Calmette-Guérin (BCG) therapy is the standard adjuvant treatment following transurethral resection of bladder tumor. Although intravesical BCG therapy improves disease progression and bladder preservation in most patients, there are still a considerable number of BCG-unresponsive cases, for whom radical cystectomy (RC) is the recommended salvage treatment option. However, RC is associated with high morbidity and mortality rates, and alternative treatment options are needed. New approaches, such as intravesical chemotherapy, device-assisted treatments, immune checkpoint inhibitors, viral gene therapy, antibody-drug conjugates, fibroblast growth factor receptor inhibitors, and other novel agents are being investigated. This review aims to provide an overview of the recent trials for BCG-unresponsive NMIBC.

Poly (ADP-ribose) polymerase inhibitors (PARP inhibitor) is a new targeted drug for metastatic prostate cancer in which the patient has a mutation on homologous repair gene including BRCA1/2 gene. This drug was the first gene-based targeted agent in prostate cancer and there were more than 5 available drugs for PARP inhibitors. Only 4 were approved for clinical use for patients with cancer from the U.S. Food and Drug Administration. This review article deals with the overview of the PARP inhibitors and their use in future research and clinical fields.

Peripheral T-cell lymphoma (PTCL) of the urinary bladder is rare. PTCL can either be primary or secondary and is difficult to differentiate from other inflammatory bladder lesions. We report a case of PTCL involving the bladder in a 63-year-old man who complained of dysuria without gross hematuria. In this report, we focus on the cystoscopic and histologic findings of urinary bladder lymphoma and its differential diagnosis.