Benign prostatic hyperplasia (BPH) is one of the most common diseases in older men and it may be accompanied with significant problems in the quality of life. Histological changes of BPH is starting at the age of 35, and there is induced in 60% of 60-year-old men, 80% of 80-year-old men, in 50% of the patient group may lead to lower urinary tract symptoms (LUTS). A 74-year-old man with huge BPH visited outpatient clinic with severe LUTS of an year duration. He was diagnosed with BPH 11 years ago and underwent transurethral resection of prostate twice. However, the prostate grew up to remarkable size again, which lead to the bladder outlet obstruction (BOO) and renal failure. There is no report for huge BPH (above 300 g) in Korea, we report a case with huge prostate size that is measured 330 g and treated with suprapubic open prostatectomy.
Aged ; Aged, 80 and over ; Ambulatory Care Facilities ; Humans ; Korea ; Lower Urinary Tract Symptoms ; Male ; Middle Aged ; Prostate ; Prostatectomy ; Prostatic Hyperplasia* ; Quality of Life ; Renal Insufficiency ; Transurethral Resection of Prostate ; Urinary Bladder Neck Obstruction

PURPOSE: We compared the effects of alpha-adrenergic receptor blocker (alpha-blocker) monotherapy with those of combination therapy with alpha-blocker and 5-alpha-reductase inhibitor (5-ARI) on benign prostatic hyperplasia (BPH) progression for over 10 years. MATERIALS AND METHODS: A total of 620 patients with BPH who received alpha-blocker monotherapy (alpha-blocker group, n=368) or combination therapy (combination group, n=252) as their initial treatment were enrolled from January 1989 to June 2000. The incidences of acute urinary retention (AUR) and BPH-related surgery were compared between the two groups. Incidences stratified by follow-up period, prostate-specific antigen (PSA), and prostate volume (PV) were compared between the two groups. RESULTS: The incidence of AUR was 13.6% (50/368) in the alpha-blocker group and 2.8% (7/252) in the combination group (p<0.001). A total of 8.4% (31/368) and 3.2% (8/252) of patients underwent BPH-related surgery in the alpha-blocker and combination groups, respectively (p=0.008). According to the follow-up period, the incidence of AUR was significantly decreased in combination group. However, the incidence of BPH-related surgery was significantly reduced after 7 years of combination therapy. Cutoff levels of PSA and PV for reducing the incidences of AUR and BPH-related surgery were 2.0 ng/ml and 35 g, respectively (p<0.001). CONCLUSIONS: Long-term combination therapy with alpha-blocker and 5-ARI can suppress the progression of BPH more efficiently than alpha-blocker monotherapy. For patients with BPH with PSA >2.0 ng/ml or PV >35 ml, combination therapy promises a better effect for reducing the risk of BPH progression.
5-alpha Reductase Inhibitors ; Adrenergic alpha-1 Receptor Antagonists ; Follow-Up Studies ; Humans ; Incidence ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Urinary Retention

Purpose: There have been few reports on comparison between sunitinib and pazopanib as first-line targeted therapy in Korean metastatic clear cell renal cell carcinoma (ccRCC). We sought to analyze the treatment trends of metastatic ccRCC by comparing the effects and adverse events of sunitinib and pazopanib. Materials and Methods: Data of 357 metastatic RCC patients who received the sunitinib or pazopanib as the first-line targeted therapy from the Daegyeong Oncology Study Group database was obtained and analyzed. Among these patients, patients who only clear cell type was confirmed after needle biopsy or nephrectomy were included, and patients who underwent target therapy for less than 3 months were excluded. Results: Of 251 patients who met the inclusion criteria, sunitinib and pazopanib group were identified in 156 (62%) and 95 patients (38%), respectively. Pazopanib group was older (66 years vs. 61 years, p=0.001) and more symptomatic (65% vs. 52%, p=0.037) and had more patients with Karnofsky performance status <80 (20% vs. 11%, p=0.048) and fewer number of organ metastases (p=0.004) compared to sunitinib group. There was no significant difference in disease control rate (88.5% vs. 87.3%, p=0.744), the median progression-free survival (19 months vs. 15 months, p=0.444) and overall survival (25 months vs. 19 months, p=0.721) between sunitinib and pazopanib. The most common grade 3/4 adverse events with sunitinib and pazopanib were anemia (5%) and hand-foot syndrome (3%), respectively. There was no significant difference between sunitinib and pazopanib in number of patients who experienced grade 3/4 adverse events (15% vs. 11%, p=0.275). However, there were more patients who discontinued treatment due to only adverse events in sunitinib group compared to pazopanib group (12% vs. 3%, p=0.020). Conclusions In Korean metastatic ccRCC, pazopanib tended to be used in patients with poorer health status compared to sunitinib. Sunitinib and pazopanib had no significant difference in treatment effect and survival, but pazopanib had more tolerable adverse events.

Purpose: The aim of this study was to analyze the perioperative complications and oncological outcomes of radical prostatectomy (RP) in patients who underwent multiple prostate biopsies.
Materials and Methods: A total of 1,112 patients who underwent RP between January 2009 and April 2016 at 4 different centers were included in this study. We divided these patients into 2 groups: patients who underwent only 1st biopsy, and those who underwent 2nd or more repeated biopsies. The association between the number of prior biopsies and perioperative complications and biochemical recurrence (BCR) was analyzed.
Results: Of 1,112 patients, 1,046 patients (94.1%) underwent only 1st biopsy, and 66 (5.9%) underwent 2nd or more repeated biopsies. There were no significant differences in preoperative prostate-specific antigen levels, operation times, blood loss volumes, or hospital stay durations (all p＞0.05). Patients who underwent multiple prostate biopsies presented with a localized tumor significantly more often (p＜0.05). The Gleason score and rate of positive surgical margins were significantly lower in patients with multiple biopsies (all p＜0.05). The Cox proportional hazards model analysis indicated that there was no association between the number of prior prostate biopsies and BCR (p＞0.05). Kaplan-Meier curve analysis indicated that BCR-free survival rates between the 2 groups were similar (p＞0.05).
Conclusions Multiple prostate biopsies are not associated with an increased risk of perioperative complications, adverse pathological outcomes, or higher rates of BCR in patients who have undergone RP. (Korean J Urol Oncol 2020;18:24-31)