During last many decades, androgen deprivation therapy (ADT) was the main treatment of choice for metastatic castration-naïve prostate cancer (mCNPC). However, there are now more possible treatment options for mCNPC. In CHAARTED, GETUG-AFU 15, and STAMPEDE trial, docetaxel added to ADT improved overall survival compared to ADT alone in mCNPC. Also, STAMPEDE and LATITUDE trial revealed that abiraterone added to ADT improved overall survival compared to ADT alone for mCNPC patient. Furthermore, ARCHES and ENZAMET trial showed that enzalutamide added to ADT also can be a treatment option for mCNPC. Apalutamide added to ADT also improved survival compared to ADT alone in castration resistant prostate cancer patient. The usefulness of radiation therapy to primary tumor in mCNPC has also been studied in HORRAD and STAMPEDE trial. There are many ongoing trials for mCNPC setting. The aim of this paper is to review the current status of mCNPC management options. (Korean J Urol Oncol 2020;18:11-17)

Symptomatic neuroepithelial cysts of the lateral ventricles are rare. The CT and MRI findings of the intraventricular neuroepithelial cysts in the surgically proven three cases are reported. On CT, the cysts had density similar to CSF, and the cyst walls were generally not seen. The cyst contents were slightly higher signal than CSF signal in Tl-weighted and proton density MR images. The delicate cyst walls were easily seen in spin echo MR images. MRI was better than CT in the demonstration of the cyst wall and the evaluation of the cyst content in patients with neuroepithelial cysts in the lateral ventricles.
Humans ; Lateral Ventricles* ; Magnetic Resonance Imaging ; Protons

PURPOSE: The diagnosis and treatment of prenatally-diagnosed hydronephrosis remain controversial. We have conducted a retrospective study to examine the clinical characteristics and course of prenatally-diagnosed hydronephrosis, especially when in the presence of ureteropelvic junction obstruction(UPJO). MATERIALS AND METHODS: Among all pediatric patients diagnosed with hydronephrosis by prenatal ultrasonography between September 2002 and June 2008, the study was performed on 103 patients(126 renal units), and the mean follow-up period was 19.2 months(range, 6-24 months). Ultrasonography was performed 2-3 days after birth, and after 1, 3, 6, and 12 months, and annually thereafter. Hydronephrosis was graded according to the Society for Fetal Urology(SFU) classification guidelines. RESULTS: On ultrasonography performed 2-3 days after birth hydronephrosis was graded as follows: grade 1, 45(35.7%); grade 2, 49(38.9%); grade 3, 23(18.3%); and grade 4, 9(7.1%) renal units. In cases with UPJO complete improvement of hydronephrosis was detected in 16 renal units(40%); the renal units and rate of complete improvement in grades 1, 2, 3, and 4 were 12(75%), 3(17.6%), 1(16.7%), and 0(0%), respectively. The anticipated times of complete improvement of hydronephrosis in UPJO grades 1, 2, and 3 were 22.0, 31.3, and 50.4 months, respectively. CONCLUSIONS: In UPJO, the possibility of improvement of hydronephrosis lower than grade 2 was high, and thus follow-up for approximately 30 months may be needed. In patients with hydronephrosis >grade 3, the rate of improvement was low, thus compulsive follow-up is required.
Follow-Up Studies ; Humans ; Hydronephrosis ; Parturition ; Retrospective Studies ; Ultrasonography, Prenatal

The therapeutic effects and side effects of androgen deprivation therapy (ADT), which is a main treatment method for metastatic prostate cancer, are well known, but the metabolic effects have only recently been studied. This review describes the effects of ADT on body habitus, insulin resistance, lipid profiles, diabetes, metabolic syndrome, and cardiovascular morbidity and mortality. The review was done by using KoreaMed and PubMed to search the medical literature related to prostate cancer, ADT, body habitus, lipid profile, diabetes, insulin resistance, metabolic syndrome, and cardiovascular disease. ADT increases fat mass and decreases lean body mass. Fat mostly accumulates in the subcutaneous area. ADT increases total cholesterol, triglycerides, and high-density lipoprotein, as well as the risk for insulin resistance and diabetes. ADT also increases the risk for cardiovascular events, but insufficient evidence is available for a correlation with mortality. ADT changes body habitus and lipid profiles and has different characteristics than those of classic metabolic syndrome, but it is related to insulin resistance and diabetes. ADT increases the risk for cardiovascular events. No consistent guidelines have been proposed for treating the metabolic effects of ADT, but the generally recommended treatment methods for lowering the risk of diabetes and cardiovascular disease should be fully understood. Additional studies are necessary.
Androgen Antagonists/*adverse effects/therapeutic use ; Body Composition/drug effects ; Cardiovascular Diseases/metabolism/mortality ; Cholesterol/chemistry ; Diabetes Mellitus/epidemiology/metabolism ; Gonadotropin-Releasing Hormone/*agonists ; Humans ; Insulin Resistance ; Lipids/blood ; Lipoproteins, HDL/blood ; Male ; Metabolic Syndrome X/epidemiology/metabolism ; Prostatic Neoplasms/*drug therapy ; Risk Factors ; Triglycerides/chemistry

PURPOSE: We experimentally induced hepatic infarction in rabbits to evaluate MR findings of liver parenchyma and capsule and its changes with time and to confirm the capsular structure correlating with its histologic findings. MATERIALS AND METHODS: After ligation of hepatic artery, vein and duct of right inferior posterior lobe of liver, T1, T2 weighted and enahnced T1 weighted image were obtained at several time intervals. Histologic samples were taken of two rabbits or more at each time intervals. RESULTS: During the first several days, the signal intensity of the ischemic necrosis showed strong high signal intensity relative to normal liver on both T1 and T2 weighted images. After 2 weeks however, the necrotic areas gradually changed to isointensity or low signal intensity. Capsular structure was observed as slightly high signal intensity compare to ischemic areas on both enhanced T1 and T2 weighted images in six cases, and five cases of 12, respectively. From the first day, homogeneous coagulation necrosis without hemorrhage or liquefaction was observed. Fibrous thickening with rich vascularity was observed along the surface of the necrotic area after two weeks. CONCLUSION: During the first several days, the signal intensity of the ischemic necrosis showed strong high signal intensity on both T1 and T2 weighted images and gradually changed to isointensity or low signal intensity. Liver capsule was shown and slightly high signal intensity along the surface of the necrotic area and could be explained by fibrous thickening of the liver capsule end the rich vascularity within in it.
Hemorrhage ; Hepatic Artery ; Infarction* ; Ligation ; Liver* ; Magnetic Resonance Imaging* ; Necrosis ; Rabbits ; Veins

PURPOSE: To identify sexual function improvement associated with alfuzosin (10 mg daily for 2 years). MATERIALS AND METHODS: We enrolled 30 men with lower urinary tract symptom (LUTS) who visited Gyeongsang National University Hospital between 2010 and 2012. At first visit, urinalysis, prostate specific antigen, transrectal ultrasound, and uroflowmetry were performed. The nternational Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF), and Male Sexual Health Questionnaire Ejaculation Function Domain (MSHQ-EjFD) questionnaires were administered, and the subjects answered the same questionnaires at 1 month, 6 months, 1 year, and 2 years of follow-up. RESULTS: Twelve men completed of the entire study. After administration of alfuzosin, the median IPSS at first visit, 1 month, 6 months, 1 year, and 2 years was 18.00 (interquatile range [IQR]: 14.00~29.75), 20.00 (IQR: 11.50~30.00), 15.50 (IQR: 8.50~25.25), 14.50 (IQR: 9.25~19.50), and 11.50 (IQR: 5.00~17.75), respectively, which showed an improvement. The median QoL at the same times was 4.50 (IQR: 4.00~5.00), 4.50 (IQR: 4.00~5.00), 3.00 (IQR: 2.00~4.00), 3.50 (IQR: 2.25~4.00), and 3.00 (IQR: 1.00~3.00), respectively, and also showed improvement. Likewise, the median IIEF was 36.50 (IQR: 24.50~46.75), 37.50 (IQR: 26.75~47.25), 45.50 (IQR: 35.00~59.75), 48.50 (IQR: 34.75~62.75), and 47.50 (IQR: 43.25~61.00), while the median MSHQ-EjFD was 19.00 (IQR: 12.0~24.75), 19.50 (IQR: 13.50~27.75), 23.00 (IQR: 19.25~32.25), 26.50 (IQR: 18.25~34.50), 27.00 (IQR: 21.50~32.50), respectively, with both showing improvement. CONCLUSIONS: After administration of alfuzosin (10 mg daily for 2 years), the IPSS, QoL, IIEF, and MSHQ-EjFD all improved significantly. This means long-term administration of 10 mg of alfuzosin daily would be effective not only for LUTS but also erectile function and ejaculation.
Ejaculation ; Follow-Up Studies ; Humans ; Male ; Observational Study* ; Penile Erection ; Prospective Studies* ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia* ; Quality of Life ; Surveys and Questionnaires ; Reproductive Health ; Ultrasonography ; Urinalysis ; Urinary Tract

The aim of the present study was to evaluate the efficacy and toxicity of stereotactic body radiation therapy (SBRT) for low- to intermediate-risk prostate adenocarcinoma. Thirty-nine patients were retrospectively reviewed. The SBRT was delivered using the CyberKnife with the fiducial tracking method combined with In-tempo imaging. The gross target volume, which included the prostate only, was delineated on the fused CT/MRI scans. The prescription dose was delivered every other day as 5 fractions of 7.5 Gy. Venous blood was obtained before and after SBRT to assess the prostate-specific antigen (PSA) level. Toxicity was evaluated using the CTCAE, v4.03. The median follow-up time was 30.0 months. The median initial PSA level was 7.7 ng/mL. PSA levels decreased in all patients treated with SBRT, and after 5 months, the median PSA was less than 2 ng/mL. The rate of overall 3-yr actuarial biochemical failure free survival was 93.9%. Acute side effects were generally comparable with those of previous studies. The PSA change and toxicity after SBRT for low- to intermediate-risk prostate adenocarcinoma indicates favorable biochemical responses and tolerable levels of toxicity. Additionally short course treatment may produce cost benefit and convenience to patients.
Adenocarcinoma/*diagnosis/*surgery ; Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Prostatic Neoplasms/*diagnosis/*surgery ; Radiosurgery/*methods ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Image-Guided/*methods ; Risk Assessment ; Treatment Outcome

PURPOSE: Transrectal ultrasound (TRUS)-guided biopsy of the prostate is usually safe. However, some patients are hospitalized owing to complications from TRUS biopsy. We identified the risk factors for complications and effective preventive measures for treating complications after TRUS biopsy. MATERIALS AND METHODS: Medical records and radiological images of 1,083 patients who underwent TRUS biopsy of the prostate over 10 years in Gyeongsang National University Hospital were examined retrospectively to investigate the correlation between complications after TRUS biopsy and preventive antibiotics, prebiopsy enema, number of biopsy cores, and pathological findings. RESULTS: Complications occurred in 69 patients (6.4%). The complication rates of the 1,008 patients who received antibiotics and the 75 patients who did not were 6.3% and 8.0%, respectively (p=0.469). Complication rates of the pre-biopsy enema group (n=658) and the group without prebiopsy enema (n=425) were 4.7% and 8.9%, respectively (p=0.007). Complication rates of the 6-core biopsy group (n=41) and the 12-core biopsy group (n=955) were 7.3% and 6.3%, respectively (p=0.891). Complication rates of the prostate cancer group (n=306) and the no prostate cancer group (n=713) were 6.2% and 6.6%, respectively (p=0.740). CONCLUSIONS: A prebiopsy enema was associated with a reduced risk of complications after TRUS biopsy. Preventive antibiotics, number of biopsy cores, and pathological findings did not significantly influence the complication rate.
Aged ; *Endosonography ; Enema/*methods ; Humans ; Image-Guided Biopsy/*adverse effects/methods ; Incidence ; Male ; Prostatic Neoplasms/*pathology ; Prostatitis/epidemiology/etiology/*prevention & control ; Rectum ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Syncope, Vasovagal/epidemiology/etiology/*prevention & control ; Urinary Retention/epidemiology/etiology/*prevention & control

PURPOSE: I-131 labeled (2'-deoxy-2-iodo-p-D-arabinofuranosyl) adenine (IAD) may be involved in DNA synthesis during active proliferation of tumor cells. We conducted this study to find out the biodistribution of IAD and its feasibility for scintigraphic tumor imaging. MATERIALS AND METHODS: Tosyl acetyl-adenosine was dissolved in acetonitrile, and I-131-NaI was added and heated to synthesize IAD. Female Fisher 344 rats innoculated with breast tumor cells were injected witb 0.27 MBq of IAD. Rats were sacrificed at 0.5, 1, 2, 4, 24h and the % of injected dose per gram of tissue (%ID/g) was determined. For scintigraphy, rats bearing breast cancer were administered with 1.11 MBq of IAD and imaging was perforrned after 2 and 24h. Then, rat body was fixed and rnicrotomized slice was placed on radiographic film for autoradiography, RESULTS: %ID/g of tumor wa.' 0.74 (0.5h), 0.73 (1h), 0.55 (2h), 0.38 (4h), and 0.05 (24h), respectively. At 1h after injection, %ID/g of tumor was higher than that of heart (0.34), liver (0.42), spleen (0.47), kidney (0,69), muscle (0.14), bone (0.33) and intestine (0.51). However, %1D/g of tumor was lower than blood (1.06), lung (0.77), and thyroid (177.71). At 4h, %ID/g of tumor in comparison with other tissue did not change. Tumor contrast expressed by tumor to blood ratio was 0.69 and tumor to muscle ratio was 5.11 at 1h. However, these ratios did not improve through 24h. On autoradiogram and scintigraphy at 2 and 24 hour, the tumor was well visualized. CONCLUSION: This results suggest that Ial) may have a potential for tumor scintigraphy. However, further work is needed to improve localization in tumor tissue.
Adenine ; Animals ; Autoradiography ; Breast Neoplasms* ; Breast* ; DNA ; Female ; Heart ; Hot Temperature ; Humans ; Intestines ; Kidney ; Liver ; Lung ; Radionuclide Imaging* ; Rats* ; Spleen ; Thyroid Gland ; X-Ray Film

PURPOSE: Numerous studies of the effect of tadalafil on sexual function have been performed. However, its effects on lower urinary tract symptoms (LUTS) are unclear. Therefore, the long-term effects of tadalafil on the improvement of LUTS as well as erectile dysfunction were examined. MATERIALS AND METHODS: 69 patients who visited our hospital reporting LUTS and erectile dysfunction as chief complaints were divided into 3 groups. Group 1 received 10 mg/day alfuzosin (39 patients, age: 61.36+/-8.69), group 2 received 10 mg/day alfuzosin and 5 mg/2 day tadalafil (15 patients, age: 58.00+/-7.91), and group 3 received 5 mg/2day tadalafil (15 patients, age: 54.70+/-10.01). Drugs were administered for 24 weeks. At before and 12 weeks and 24 weeks after drug administration, maximum flow rate, IPSS, quality of life, IIEF-5, and self satisfaction were measured and analyzed. The SPSS 14.0 was used as statistical software, and the data were validated using ANOVA. RESULTS: Between pre- and post-administration, the maximum flow rate significantly increased in all groups (p<0.05). The IPSS of groups 1 and 2 were significantly reduced (p<0.05). Quality of life significantly decreased in group 3 (p<0.05). IIEF-5 for groups 2 and 3 significantly increased (p<0.05). Self satisfaction significantly decreased in groups 2 and 3 (p<0.05). CONCLUSIONS: When alfuzosin and tadalafil were administered together for 24 weeks, both LUTS and erectile dysfunction improved significantly. In the group administered tadalafil alone, LUTS improved. Thus, administration of tadalafil for 24 weeks is able to improve not only erectile dysfunction but also LUTS.
Erectile Dysfunction* ; Humans ; Lower Urinary Tract Symptoms* ; Male ; Quality of Life ; Tadalafil