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Comparison of Synchronous and Metachronous Primary Carcinomas of the Bladder and Prostate.

Ho Seok CHUNG ; Young Ho SEO ; Seung Il JUNG ; Eu Chang HWANG ; Taek Won KANG ; Dong Deuk KWON

Korean Journal of Urological Oncology.2017;15(1):44-50. doi:10.22465/kjuo.2017.15.1.44

PURPOSE: The incidence of multiple primary malignant neoplasms increases with age. An unforeseen finding is the high number of prostate and bladder cancers pairs. Of prostate and bladder cancers pair as first primary and second primary cancers and vice versa, we investigated the differences in clinicopathological features between synchronous and metachronous primary carcinomas of the bladder and prostate. MATERIALS AND METHODS: Fifty-three patients diagnosed with dual prostate and bladder cancer in a 12-year period (2004–2015) excluding cases with incidental prostate cancer after radical cystectomy were reviewed. Enrolled patients were divided into 3 groups according to cancer development (group I, synchronous cancer; group II, prostate cancer with metachronous bladder cancer; group III, bladder cancer with metachronous prostate cancer). Each group was compared according to clinicopathological features. RESULTS: Median age was 72 years (range, 54–83 years). Groups I, II, and III comprised 29 (54.7%), 8 (15.1%), and 16 patients (30.2%), respectively. Age, prostate-specific antigen, tumor stage, grade, multifocality of bladder tumor, and treatment modality did not show statistical differences between groups. However, group III showed a lower prostate cancer stage (National Comprehensive Cancer Network anatomic stage; p=0.009) and had low-risk of prostate cancers (p=0.025). CONCLUSIONS: Bladder tumor showed no differences in the clinicopathological features between synchronous and metachronous primary carcinomas. However, metachronous prostate cancer showed better clinicopathological features of prostate cancer. It is important for clinicians to counselling and decision making in clinical situations
Cystectomy ; Decision Making ; Humans ; Incidence ; Neoplasms, Second Primary ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Urinary Bladder Neoplasms ; Urinary Bladder*

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Visible Angle on Magnetic Resonance Imaging Can Be Considered Indicator of Postoperative Outcome in Retropubic Radical Prostatectomy.

Se Yun KWON ; Jun Nyung LEE ; Yun Sok HA ; Seock Hwan CHOI ; Hyun Tae KIM ; Tae Hwan KIM ; Tae Gyun KWON

Korean Journal of Urological Oncology.2017;15(1):38-43. doi:10.22465/kjuo.2017.15.1.38

PURPOSE: We aimed to measure the visible angle (VA) outside the surgical field of view using preoperative magnetic resonance imaging (MRI), and to relate structural data to clinical outcome. MATERIALS AND METHODS: We retrospectively analyzed data obtained from 322 consecutive patients who underwent robot-assisted laparoscopic radical prostatectomy (RALP) or radical retropubic prostatectomy (RRP) for prostate cancer from January 2011 to June 2013, with at least 1 year of follow-up. Patients were divided into 4 groups, according to median VA values and surgical approach. VA was defined as the angle between the horizontal line on view, rotated to 90∘ from the midsagittal T2-weighted sequence image, and the tangent line of the highest protruding surface of the symphysis pubis. RESULTS: The larger VA was, the shorter mean operative time (213.2 minutes vs. 174.2 minutes, p=0.002) was significantly and the smaller VA was, the higher complication rate (10.8% vs. 1.6%, p=0.043) was in RRP patients. There were no significant differences in operative outcomes in RALP patients. CONCLUSIONS: VA in midsagittal T2-weighted sequence predict operative time and complication rates in retropubic radical prostatectomy, and thus, the value may be used as surgical indications for retropubic radical prostatectomy.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Operative Time ; Prostatectomy* ; Prostatic Neoplasms ; Pubic Bone ; Retrospective Studies

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NBR1 and KIF14 Downstream of the Mammarian Target of Rapamycin Pathway Predict Recurrence in Nonmuscle Invasive Low Grade Urothelial Carcinoma of the Bladder.

Dong Gi LEE ; Ha Jeong KIM ; Subin JIN ; Jin Wook KIM ; Young Mi WHANG ; Tae Jin LEE ; In Ho CHANG

Korean Journal of Urological Oncology.2017;15(1):28-37. doi:10.22465/kjuo.2017.15.1.28

PURPOSE: The lack of identified mammalian target of rapamycin (mTOR) pathway downstream genes that overcome cross-talk in nonmuscle invasive low grade (LG)-urothelial carcinoma (UC) of the bladder is a clinical limitation in the use of mTOR inhibitor for the treatment of UC. MATERIALS AND METHODS: Presently, gene expression patterns, gene ontology, and gene clustering by dual (p70S6K and S6K) siRNAs or rapamycin in 253J and TR4 cell lines were investigated by microarray analysis. mTOR/S6K pathway downstream genes suppressed to siRNAs, and rapamycin up-regulated or rapamycin down-regulated genes were identified. The mTOR downstream genes examined using a tissue microarray of 90 nonmuscle invasive LG-UC patients to assess whether any of these genes predicted clinical outcomes. A knockout study evaluated the synergistic effect with rapamycin. RESULTS: In the microarray analysis, mTOR pathway downstream genes selected consisted of 4 rapamycin down-regulated (FOXM1, KIF14, MYBL2, and UHRF1), and 4 rapamycin up-regulated (GPR87, NBR1, VASH1, and PRIMA1). In the tissue microarray, FOXM1, KIF14, and NBR1 were more expressed at T1, and MYBL2, and PRIMA1 were more expressed in tumors exceeding 3 cm. In a multivariate Cox regression model, KIF14 and NBR1 were significant predictors of recurrence in nonmuscle invasive LG-UC of the bladder. In a NBR1 knock out model, rapamycin treatment synergistically inhibited cell viability and colony forming ability compared to rapamycin only. CONCLUSIONS: The results implicate KIF14 and NBR1 as mTOR/S6K pathway downstream genes that predict recurrence in nonmuscle invasive LG-UC of the bladder and demonstrate that NBR1 knockout overcomes rapamycin cross-talk.
Biomarkers ; Cell Line ; Cell Survival ; Gene Expression ; Gene Ontology ; Humans ; Microarray Analysis ; Recurrence* ; RNA, Small Interfering ; Sirolimus* ; Urinary Bladder Neoplasms ; Urinary Bladder*

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Long-term Functional Outcomes of Ileal Neobladder Reconstruction Following Radical Cystectomy.

Jong Kil NAM ; Dong Hoon LEE ; Sung Woo PARK ; Moon Kee CHUNG

Korean Journal of Urological Oncology.2017;15(1):21-27. doi:10.22465/kjuo.2017.15.1.21

PURPOSE: The aim of this study is to compare clinical and urodynamic parameters among patients undergoing orthotopic neobladder substitution with ileal segment. MATERIALS AND METHODS: Between 1991 and 2015 orthotopic bladder replacement with an ileal segment was performed 158 patients. All data were recorded retrospectively from medical records. For neobladder function, at 1-year follow-up we checked abdominal computed tomography, voiding cystourethrography, and voiding diary. Twenty-eight patients underwent urodynamic evaluation. Urodynamic data were divided into 4 groups based on follow-up duration. Preoperative (17 patients), 6 months (24 patients), 1–5 years (20 patients) and above 5 years (15 patients) after surgery evaluations were performed by urodynamic study. RESULTS: All patients were men. Mean age is 61.7 years (range, 40–72 years). Mean follow-up period is 86.7 months (range, 7–182 months). Maximum bladder capacity, maximum detrusor pressure (Pdet), and maximum urethral closure pressure improve over the time. Maximum flow rate (Qmax) is constant during the follow-up. There was vesico-ureteric reflux during voiding in 5 renal units. At day time, 23 of 28 substitution patients were completely continent. Thirteen of 28 substitutions have night time continence. Of neobladder-related complications, the most common was acute pyelonephritis. CONCLUSIONS: Long-term functional outcomes with the ileal neobladder have acceptable. The urodynamic parameters without Qmax tended to improve with the lapse of time. However, the number of patients in each group was relatively small in comparison to the numbers of orthotopic diversion. Our results support the good functional outcomes of radical cystectomy with Studer ileal neobladder.
Cystectomy* ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Pyelonephritis ; Retrospective Studies ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urodynamics

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The Overview of Hospice Care as Urologist.

Jung Sik HUH

Korean Journal of Urological Oncology.2017;15(1):16-20. doi:10.22465/kjuo.2017.15.1.16

The average life expectancy in Korea is increasing with new medical technology and complete understanding of pathophysiology of diseases in human. Physician should provide good and appropriate treatment to patients and also are responsible for offering medical services. Also, needs to improve the quality of life and death for patients with end-of-life have been increased. Urologists are interested in the prevention, diagnosis and treatment of the urogenital system disease but are not interested in the end of terminal cancer patients. Cancer is the most common cause of mortality rate in Korea. Cancer affects individuals, families, and society. Hospice and palliative care is a kind of portion of medicine to take care patients with far-advanced diseases and short-life expectancy, especially less than 6 months, for whom the focus of care is relief of suffering physical problems, social problems, and mental problems, and improvement of the quality of life. It takes a lot of efforts to finish the end-of life in patient. Physician alone can hardly provide all parts of end-of-life cares and cares can be provided through hospice care team including physician, social worker, volunteer, and priest. Hospice and palliative care still take a care for only a small group for dying patients. There have been few data for hospice and palliative care in urology. This review is to summary the concept of hospice for end-of life care and to help understanding hospice and the laws related to hospice to urologists who take care of patient with urogenital tract cancer.
Clergy ; Diagnosis ; Hospice Care* ; Hospices* ; Humans ; Jurisprudence ; Korea ; Life Expectancy ; Mortality ; Palliative Care ; Quality of Life ; Social Problems ; Social Work ; Social Workers ; Urogenital System ; Urology ; Volunteers

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Chemotherapy With Androgen Deprivation for Hormone-Naïve Prostate Cancer.

Byeong Jo JEON ; Bum Sik TAE ; Jae Young PARK

Korean Journal of Urological Oncology.2017;15(1):11-15. doi:10.22465/kjuo.2017.15.1.11

Research regarding the treatment of metastatic prostate cancer has been undergoing dramatic progress. Treatment of hormone-naïve metastatic prostate cancer includes surgical castration and medical castration that lowers androgen level in the blood using drugs. Although these androgen deprivation therapies are very effective, hormone-naïve metastatic prostate cancer finally leads to castration-resistant prostate cancer because resistance to surgical or medical castration occurs. The treatment at this stage includes not only docetaxel, but also new androgen synthesis inhibitor or androgen receptor inhibitors such as abiraterone or enzalutamide, new cytotoxic anticancer agents such as carbazitaxel, and radioisotope treatment such as radium-223. Recently, studies on the effect of chemotherapy on hormone-naïve metastatic prostate cancer before the development of castration-resistant prostate cancer have been actively published. As a result, various guidelines have recommended docetaxel as the first-line therapy for hormone-naïve metastatic prostate cancer. In this manuscript, we will summarize the basic concepts of androgen deprivation therapy for hormone-naïve metastatic prostate cancer and the main results of research on chemotherapy for hormone-naïve metastatic prostate cancer.
Antineoplastic Agents ; Castration ; Drug Therapy* ; Prostate* ; Prostatic Neoplasms* ; Receptors, Androgen

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Manipulating the Angiogenesis by Inflammation.

Myeong Joo KIM ; Subin JIN ; Young Mi WHANG ; In Ho CHANG

Korean Journal of Urological Oncology.2017;15(1):1-10. doi:10.22465/kjuo.2017.15.1.1

There exists a need to develop strategies that promote neovascularization in virtually all tissue engineering and regenerative medicine efforts. While research typically focuses on understanding and exploiting the role of angiogenic factors and vascular cells on new blood vessel formation, the activity of the immune system is being recognized to impact vascular formation and adaptation. This review will provide both an overview of the relationship of angiogenesis and the immune system, and how biomaterials may be designed to promote favorable angiogenesis by interaction between these 2 systems to promote effective vascularization.
Angiogenesis Inducing Agents ; Biocompatible Materials ; Blood Vessels ; Immune System ; Inflammation* ; Regenerative Medicine ; Tissue Engineering

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Idiopathic Calcinosis Cutis of the Scrotum: A Case Report.

In Chang CHO ; Soon Ki KIM ; Kwi Bok CHOI ; Seung Ki MIN ; Ji Yoon BAE ; Jin Soo KO

Korean Journal of Urological Oncology.2017;15(2):88-91. doi:10.22465/kjuo.2017.15.2.88

Calcinosis cutis-calcification in soft tissue-is a rare benign disease that is separated into the following subtypes: dystrophic, iatrogenic, metastatic, calciphylaxis, and idiopathic. One of common site of calcinosis cutis is the scrotum. The nodules slowly grow for years or decades. The characteristic of calcinosis cutis of the scrotum is generally asymptomatic, yellowish marble-like, hard, polypoidal, solitary, or multiple. However, the pathogenesis of this nodule remains ambiguous and controversial. Thus, we reviewed possible causes and therapeutic consideration of calcinosis cutis of the scrotum.
Calcinosis* ; Calciphylaxis ; Scrotum* ; Skin

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Treatment Case of Asymptomatic Prostate Tuberculosis That Developed After Bacillus Calmette-Guerin Intravesical Therapy in a Patient With Nonmuscle Invasive Bladder Cancer.

Jong Won KIM ; Suk Young LEE ; Yee Jeong KIM ; Sang Hee CHOI

Korean Journal of Urological Oncology.2017;15(2):85-87. doi:10.22465/kjuo.2017.15.2.85

Intravesical Bacillus Calmette-Guerin (BCG) therapy after transurethral resection of bladder tumor is considered the most effective treatment for prophylaxis against the recurrence of high risk nonmuscle invasive bladder cancer, and generally well tolerated and infectious complication are rare. We reported a case of granulomatous prostatitis is a patient who had undergone intravesical BCG therapy due to nonmuscle invasive bladder cancer. This patient was diagnosed by prostate biopsy because of prostate-specific antigen elevation without any other voiding symptoms and abnormal abscess pocket in transrectal ultrasonography.
Abscess ; Bacillus* ; Biopsy ; Humans ; Mycobacterium bovis ; Prostate* ; Prostate-Specific Antigen ; Prostatitis ; Recurrence ; Tuberculosis* ; Ultrasonography ; Urinary Bladder Neoplasms* ; Urinary Bladder*

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Incidence of Pathological Downgrading and Treatment Outcome After Radical Prostatectomy in Patients With Biopsy Confirmed High Gleason Score Prostate Cancer.

Jun Phil NA ; Jae Ho YOO ; Tae Heon KIM ; Min Yong KANG ; Hyun Hwan SUNG ; Hwang Gyun JEON ; Byong Chang JEONG ; Seong Il SEO ; Hyun Moo LEE ; Han Yong CHOI ; Seong Soo JEON

Korean Journal of Urological Oncology.2017;15(2):79-84. doi:10.22465/kjuo.2017.15.2.79

PURPOSE: High Gleason score (8 to 10) is a poor prognostic factor regardless of treatment. Pathological downgrading sometimes occurs in high grade prostate cancer. The aim of this study is to evaluate treatment outcomes in patients with high grade prostate cancer on biopsy who were pathological downgrading after radical prostatectomy (RP). The impact on outcomes according to changes in the Gleason score after RP was evaluated. MATERIALS AND METHODS: Of 3,236 men who underwent RP between September 1995 and December 2014, 541 patients with biopsy Gleason score 8 to 10 were retrospectively reviewed. We analyzed incidence and biochemical recurrence (BCR) free probability in this downgraded group according to the Gleason grade of cancer in the RP specimen. RESULTS: Of 541 patients had a prostate biopsy Gleason score of 8 to 10. Two hundred ten patients showed pathological downgrading after RP (38.8%). Five-year BCR-free probability of patients who had Gleason score of 7 or less after RP was 46.8%. However, 5-year BCR-free probability of patients who remained Gleason scores 8 to 10 after RP was 28.5%. There was a significantly higher BCR-free probability in pathological downgrading group (p<0.001). On multivariate analysis, biopsy Gleason 8, lower PSA, clinical T2 stage was a significant predictor of downgrading. CONCLUSIONS: In this study, 38.8% of patients with high grade prostate cancer had a Gleason score of 7 or less in the RP specimen. Downgraded prostate cancer had more favorable treatment outcome. Serum PSA, clinical stage and biopsy Gleason score were the predictive factors for pathological downgrading.
Biopsy* ; Humans ; Incidence* ; Male ; Multivariate Analysis ; Neoplasm Grading* ; Prostate* ; Prostatectomy* ; Prostatic Neoplasms* ; Recurrence ; Retrospective Studies ; Treatment Outcome*

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