The serum prostate specific antigen (PSA) screening test plays a pivotal role in the diagnosis of prostate cancer (PCa), especially for early detection, before symptoms of systemic spread. Even though clinical trials for the PSA screening test have demonstrated limited benefits with regard to patient survival, recent trends have shown a continuous decrease in the PCa mortality rate in Western countries. In many Asian countries where PSA screening has not yet been widely adopted, the screening strategy reduces the metastatic spread. While PCa became the 10th most common malignant disease in the Korean male population in 2000, recent national reports indicate that its increase in the last two decades have now made it the third most popular malignant condition. Due to the different epidemiologic background and limited social awareness of PCa compared to Western countries, the PSA screening test was not routinely performed in Korea, in contrast with other prevalent malignant diseases such as stomach, colon, and lung cancers. Therefore, only about a quarter of the patients newly diagnosed with PCa in Korea were found to have undergone repeated PSA screening. However, the screened population showed a higher probability of local rather than systemic treatment, which reflects an earlier disease stage at the time of diagnosis in comparison with their non-screened counterparts. Given the relatively high survival rate of PCa and the increasing lifespan of Korean males, the increase of PCa will accelerate, suggesting the clinical relevance of PSA screening as part of regular checkups for Korean males.

PURPOSE: This study was performed to identify the effects of bethanechol, pyridostigmine and levosulpiride, on the contraction of rabbit bladder strip tissue in a single agent administration, and to investigate the synergistic effects in a mixed administration. MATERIALS AND METHODS: Smooth muscle strips of bladder were prepared using female, New Zealand white, rabbits. After an equilibration period, dose response curves to each agent, with cumulative administration, were performed in the basal tension state of the strips. Each strip was then pretreated with the agent at the maximal concentration that would not induce a bladder contraction, and second dose-response curves for the other agents were obtained. Following this, the maximal stimulation with bethanechol was performed, and during the tonic response, pyridostigmine or levosulpiride was administrated to observe any synergistic effects of the agents. Similar experiments were repeated for the pyridostigmine and levosulpiride. RESULTS: Each agent elicited a dose-dependent contractile response, in the order; bethanechol (0-4.49g/100mg tissue), pyridostigmine (0-1.58g/100mg tissue) and levosulpiride (0-0.44g/100mg tissue). In the presence of pyridostigmine (3x10(-6)M) or levosulpiride (10(-4)M), no additive effects were noted after the cumulative stimulation with bethanechol (10(-10)-10(-4)M). During the tonic response of bethanechol (10(-4)M) or pyridostigmine (10(-2)M), the addition of levosulpiride (10(-2)M) induced a significant increase in the bladder strip contractions, but the addition of pyridostigmine (10(-2)M) or bethanechol (10(-4)M) decreased the maximal response (p<0.05). CONCLUSIONS: These results imply that pyridostigmine may be useful for impaired detrusor contractility management. Synergistic effects can also be expected when administrating levosulpiride, in addition to bethanechol, in improving bladder contractility.
Bethanechol ; Female ; Humans ; Muscle, Smooth ; New Zealand ; Pyridostigmine Bromide* ; Rabbits ; Urinary Bladder*

With the enthusiasm regarding robotic application in radical prostatectomy in accordance with the widespread use of serum prostate-specific antigen as a screening test, the number of surgeries performed for complete removal of the gland is increasing continuously. However, owing to the adjacent anatomical location of the prostate to the nerve and urethral sphincter complex, functional recovery, namely improvement from post-prostatectomy incontinence (PPI) and post-prostatectomy erectile dysfunction, still remains a main problem for patients who are reluctant to undergo surgery and tend to choose alternative ways instead. Since the late 1980s, the introduction of radical prostatectomy by open surgical modalities, the depth of the anatomical understanding of the structure surrounding the prostate is getting tremendous, which leads to the development of new surgical modalities and techniques that are consequently aimed at reducing the incidences of PPI and erectile dysfunction. Briefly, recent data from robotic radical prostatectomy, particularly on PPI, are quite acceptable, but by contrast, the reported potency regain rate still remains < 20%, which indicates the need for advanced surgical modification to overcome it. In this review, the authors summarized the recent findings on the anatomy and surgical techniques reported up to now.
Erectile Dysfunction ; Humans ; Incidence ; Male ; Mass Screening ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Urethra

Background: To determine the benefit of pelvic floor muscle exercise with visual biofeedback on promoting patient recovery from incontinence, we investigated variables associated with the early restoration of continence for patients who underwent robot-assisted radical prostatectomy. Methods: Of the 83 patients enrolled, 41 consecutive patients completed pelvic floor muscle exercise (the exercise group), and the other 42 consecutive patients just before the pelvic floor muscle exercise program commenced (the control group). The primary outcome was whether pelvic floor muscle exercise engagement was associated with zero pad continence restoration within 3 months of surgery. Results: Continence restoration percentages (defined as zero pads used per day) at 1, 3, and 6 months after surgery were 49.4%, 77.1%, and 94.0%, respectively. The exercise group achieved significantly higher recovery rates at 1 month (p=0.037), 3 months (p<0.001), and 6 months (p=0.023). Cox regression analysis demonstrated that a lower Gleason score (<8; hazard ratio, 2.167), lower prostate specific antigen (<20 ng/dL; hazard ratio, 2.909), and engagement in pelvic floor muscle exercise (hazard ratio, 3.731) were independent predictors of early recovery from postprostatectomy incontinence. Stratification by age showed that those younger than 65 years did not benefit significantly from exercise (log-rank test, p=0.08), but that their elderly counterparts, aged 65–70 years (p=0.007) and >70 years old (p=0.002) benefited significantly. Conclusion This study suggests that postoperative engagement in pelvic floor muscle exercise with biofeedback speeds up the recovery of continence in elderly patients (≥65 years old) that undergo robot-assisted radical prostatectomy.

With the enthusiasm regarding robotic application in radical prostatectomy in accordance with the widespread use of serum prostate-specific antigen as a screening test, the number of surgeries performed for complete removal of the gland is increasing continuously. However, owing to the adjacent anatomical location of the prostate to the nerve and urethral sphincter complex, functional recovery, namely improvement from post-prostatectomy incontinence (PPI) and post-prostatectomy erectile dysfunction, still remains a main problem for patients who are reluctant to undergo surgery and tend to choose alternative ways instead. Since the late 1980s, the introduction of radical prostatectomy by open surgical modalities, the depth of the anatomical understanding of the structure surrounding the prostate is getting tremendous, which leads to the development of new surgical modalities and techniques that are consequently aimed at reducing the incidences of PPI and erectile dysfunction. Briefly, recent data from robotic radical prostatectomy, particularly on PPI, are quite acceptable, but by contrast, the reported potency regain rate still remains < 20%, which indicates the need for advanced surgical modification to overcome it. In this review, the authors summarized the recent findings on the anatomy and surgical techniques reported up to now.

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: This study evaluated the prognostic differences in invasive cancer that progressed from a superficial transitional cell carcinoma (TCC) compared to an already invasive TCC at the time of the initial presentation. MATERIALS AND METHODS: Seventy-one patients who had a radical cystectomy performed for an invasive TCC were enrolled in this study. They were divided into two groups. In the first group, the patients were diagnosed as a superficial TCC at initially, which progressed to an invasive tumor. The second group consisted of patients who were diagnosed with invasive TCC at the time of the initial diagnosis. Two groups were compared with regard to the TNM stage, Ash grade, presence of accompanying carcinoma in-situ and survival rate. RESULTS: The group with invasive cancer at the time of the initial presentation had a significantly higher grade than the progressed group. The five-year survival rate was lower in the progressed group. Moreover, Kaplan-Meier analysis showed it was statistically significant (p=0.04). CONCLUSIONS: The grade was higher and the five-year survival rate was lower in the group with invasive cancer at the time of the initial presentation. Therefore, the invasive TCC at the initial diagnosis might take a more aggressive nature than the progressed group.
Carcinoma, Transitional Cell ; Cystectomy ; Diagnosis* ; Humans ; Kaplan-Meier Estimate ; Prognosis ; Survival Rate ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: To evaluate the actual impact of testosterone replacement therapy (TRT) on patients with lower urinary tract symptom (LUTS), without benign prostate hyperplasia (BPH) medication. MATERIALS AND METHODS: Two hundreds forty-six patients underwent TRT using intramuscular injection of 3 months bases injection of testosterone 100 mg undecanoate over a year. Among them, 17 patients had moderate LUTS with a maximal flow rate of at least 10 ml/s but did not take any BPH-specific medication during TRT. The changes in prostate specific antigen (PSA), International Prostate Symptom Score (IPSS), and uroflowmetery were measured before and after TRT. RESULTS: After TRT, PSA remained unchanged after a year of treatment (p=0.078). Compared with their counterparts (n=229), the patients without BPH medication had similar baseline prostate characteristics in all variables, including prostate volume, IPSS, maximal flow rate, voiding volume, and PSA, except the median amount of residual urine, which was higher in the patients without BPH medication (21 ml vs. 10 ml). In the no-BPH medication group, the total IPSS score was decreased significantly (p=0.028), both in storage symptoms (questionnaire 2, 4, 7) and voiding symptoms (questionnaire 1, 3, 5, 6), while the maximal flow rate and residual urine amount remained unchanged after a year of TRT. During the median follow up of 15.1 months, no patients experienced urinary retention, BPH-related surgery, or admission for urinary tract infection. CONCLUSIONS: Over a year of TRT for the no-BPH medication patients with moderate LUTS and maintained a relatively high maximal flow rate and improved both storage and voiding symptoms, without the clinical progression of BPH or rising PSA.
Follow-Up Studies ; Humans ; Hyperplasia ; Injections, Intramuscular ; Lower Urinary Tract Symptoms ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Testosterone ; Testosterone Congeners ; Urinary Retention ; Urinary Tract

PURPOSE: The purpose of this study was to calculate the operating characteristics of narrowband imaging (NBI) cystoscopy versus traditional white light cystoscopy (WLC) in common clinical scenarios involving suspicion of bladder urothelial carcinoma (UC). MATERIALS AND METHODS: Sixty-three consecutive patients initially underwent WLC and then NBI in a single session for evaluation of microscopic hematuria (group I, n=20), gross hematuria (group II, n=19), and follow-up for prior UC (group III, n=24), by an experienced urologist. All lesions that were abnormal in contrast with adjacent normal mucosa were diagnosed as positive and biopsied. RESULTS: Sixty-six biopsies from 47 patients were performed. Pathologic examination showed 17 cases of UC from 21 sites. While the overall sensitivity of NBI was similar to that of WLC (100% vs. 94.1%), the specificity of NBI was significantly lower than that of WLC (50% vs. 86.9%, p < 0.001), particularly in group III (38.9% vs. 88.9%, p=0.004). Based on identification by NBI only, 23 additional biopsies from 18 cases were performed for identification of one patient with UC, who belonged to group III. In this group, to identify this specific patient, 15 additional biopsies were performed from 10 patients. All seven cases with positive findings from NBI within 2 months after the last intravesical therapy were histologically proven as negative. CONCLUSION: In evaluation for recurrence early after intravesical instillation, the decision based on NBI increased unnecessary biopsy in the absence of an established standard for judging NBI.
Administration, Intravesical* ; Biopsy* ; Cystoscopy* ; Follow-Up Studies ; Hematuria ; Humans ; Mucous Membrane ; Narrow Band Imaging* ; Recurrence ; Sensitivity and Specificity ; Urinary Bladder Neoplasms ; Urinary Bladder*

PURPOSE: This study was conducted to identify the predictive factors for prostate cancer in patients with prostate-specific antigen (PSA) levels equal to or less than 4 ng/ml. MATERIALS AND METHODS: A retrospective study of medical records was conducted on 292 patients with initial serum PSA < or =4 ng/ml among 2,305 patients who underwent prostate biopsy from January 2003 to December 2008. Prostate biopsy was performed on patients with PSA < or =4 ng/ml in the case of abnormal findings in the digital rectal examination (DRE) or transrectal ultrasonography (TRUS) or in those with a PSA level higher than the age-adjusted PSA levels. The patients were divided into the group diagnosed with prostate cancer and the non-prostate-cancer group. Subsequently, the variables of the two groups were compared. RESULTS: The patients' mean age was significantly higher in the prostate cancer group (n=28) than in the non-prostate-cancer group (n=264; p=0.033). In addition, for the patients with a PSA range of 2.0-2.9 ng/ml, their age (p=0.049) and PSA density (PSAD; p=0.042) were significantly higher and the prostate volume (p=0.028) was significantly smaller in the prostate cancer group than in the non-prostate-cancer group. CONCLUSIONS: Of the patients with PSA < or =4 ng/ml, the age of the patients who showed abnormal findings in the DRE or TRUS or who had a PSA level higher than the age-adjusted PSA level was a significant predictive factor for prostate cancer. In particular, for the PSA range of 2.0-2.9 ng/ml, a thorough screening test for prostate cancer was required if the patients had conditions such as higher age, smaller prostate, and higher PSAD.
Biopsy ; Digital Rectal Examination ; Humans ; Mass Screening ; Medical Records ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Retrospective Studies