Purpose: Radical cystectomy (RC), which is the standard of care for muscle-invasive and high-grade noninvasive bladder cancer, is accompanied by postoperative renal function deterioration. We aimed to evaluate the effect of serum albumin level on postoperative renal function decline after RC. Materials and Methods: A total of 272 patients with estimated glomerular filtration rate (eGFR) ≥60 mL/minute/1.73 m 2 who underwent RC between October 2003 and December 2020 were included. Acute kidney injury (AKI) was defined according to the KDIGO (Kidney Disease Improving Global Outcomes) criteria, while postoperative chronic kidney disease (CKD) progression was defined as an eGFR <60 mL/minute/1.73 m 2 at ≥3 months after RC. Results: In our cohort, 20 (7.4%) and 99 (36.4%) patients experienced postoperative AKI and CKD progression, respectively, with a median follow-up period of 51.5 months. The median preoperative serum albumin level and eGFR were 4.1 g/dL and 82.0 mL/minute/1.73 m 2 , respectively. Preoperative serum albumin less than the median (4.1 g/dL) was associated with postoperative AKI (odds ratio [OR] 3.76, p=0.027) and CKD progression (OR 2.87, p<0.001) after adjusting for other factors. Conclusions Serum albumin level <4.1 g/dL was associated with short- and long-term renal function decline after RC, suggesting that close monitoring of renal function after RC might be considered in these patients.

Purpose: This postmarketing surveillance (PMS) study aimed to evaluate real-world data on the effectiveness and safety of abiraterone acetate plus prednisone (AAP) in patients with metastatic hormone-sensitive prostate cancer (mHSPC). Materials and Methods: This prospective, multicenter observational study was conducted at 27 centers in South Korea between June 2018 and April 2021. Among 117 enrolled patients, 108 were included in the final analysis. Median follow-up period was 40.4 weeks (interquartile range, 22.8–49.2 weeks). Patients aged ≥18 years with mHSPC treated with AAP were included. Effectiveness endpoints included radiographic progression-free survival (rPFS), time to prostate-specific antigen (PSA) progression (TTPP), and PSA response (≥50%, ≥90% reduction). Adverse events (AEs) were assessed and graded based on severity. Results: A total of 108 patients were included in the analysis. Radiographic and PSA progression were observed in 13 (12.0%) and 26 patients (24.1 %), respectively. In the Kaplan-Meier analysis, the median rPFS and TTPP were not reached. The PSA response rates were 85.2% (≥50% reduction) and 75.9% (≥90% reduction) during the study period. AEs were reported in 31 patients (28.7%), with grade 3 or 4 AEs reported in 6 patients (5.6%). The most frequently observed AE was elevated aspartate aminotransferase level (5.6%). Conclusion This PMS study found that AAP is effective and well-tolerated in the real-world management of mHSPC.

Purpose: This study aimed to assess the rate of germline variant detection following targeted cascade genetic testing among family members of prostate cancer (PCa) probands. Materials and Methods: Records of PCa patients with confirmed germline mutations and their family members recommended for cascade testing were retrospectively reviewed. Cascade testing for germline mutations identified in PCa probands was conducted among first-degree relatives (FDRs) and second-degree relatives. The rate of counseled family members who proceeded to actual testing, the proportion of mutation carriers detected, and the reasons for test refusal were analyzed. Clinical variables, including family history of malignancy and variant type, were also collected. Results: A total of 15 PCa patients and 44 eligible relatives were included in the final analysis. Eleven probands (73.3%) had a positive family history of cancer across 22 family members (18 FDRs). Among FDRs, breast/ovarian cancer (27.8%) and gastric cancer (22.2%) were the most common, followed by lymphoma, prostate, esophageal, and lung cancer (each 11.1%). Among probands, BRCA2 variants were predominant (80%, 12 of 15), followed by BRCA1 (n=2) and MLH1 (n=1) mutations. Of 41 eligible FDRs, 21 (51.2%) underwent genetic testing, and 61.9% (13 of 21) were found to carry identical germline mutations. Approximately half of the counseled family members declined testing due to concerns regarding privacy and disclosure, travel distance to the clinic, or loss to follow-up. Conclusion Over half of the FDRs who underwent cascade testing were confirmed to carry pathogenic germline variants. As the first study to evaluate cascade testing in family members of PCa probands in Korea, these findings underscore the strong heritable component of PCa and highlight the need to enhance participation in familial genetic screening.

Purpose: Germline mutations in DNA damage repair (DDR) genes such as BRCA2 have been associated with prostate cancer (PC) risk but has not been thoroughly evaluated for metastatic prostate cancer (mPC) in Asian men. This study attempts to evaluate frequency of DDR mutations in the largest cohort of Koreans. Materials and Methods: We recruited 340 patients with mPC unselected for family history of cancer and compared to 495 controls. Whole genome sequencing was applied to assess germline pathogenic/likely pathogenic variants (PV/LPVs) in 26 DDR genes and HOXB13, including 7 genes (ATM, BRCA1/2, CHEK2, BRIP1, PALB2, and NBN) associated with hereditary PC. Comparisons to published Caucasian and Japanese cohorts were performed. Results: Total of 28 PV/LPVs were identified in 30 (8.8%) patients; mutations were found in 13 genes, including BRCA2 (15 men [4.41%]), ATM (2 men [0.59%]), NBN (2 men [0.59%], and BRIP1 (2 men [0.59%]). Only one patient had HOXB13 mutation (0.29%). A lower rate of overall germline variant frequency was observed in Korean mPC compared to Caucasians (8.8% vs. 11.8%), but individual variants notably differed from Caucasian and geographically similar Japanese cohorts. PV/LPVs in DDR genes tended to increase gradually with higher Gleason scores (GS 7, 7.1%; GS 8, 7.5%; GS 9–10, 9.9%). Conclusions BRCA2 was the most frequently mutated gene common to different cohorts supporting its importance, but differences in variant distribution in Korean mPC underscore the need for ethnic-specific genetic models. Future ethnic-specific analyses are warranted to verify our findings.

Focused ultrasound (FUS) has been utilized for the treatment of localized prostate cancer. Initially, FUS was performed as a whole-gland treatment comparable to radical prostatectomy or radiation therapy. However, after overall downward stage migration due to health screening programs involving prostate-specific antigen testing, as well as advances in conservative or observative strategies such as active surveillance, FUS has evolved from a whole-gland treatment to a focal treatment. This new treatment technique aims to ablate tumors while preserving the normal prostate tissue, thereby ensuring better preservation of urinary and erectile function. In this article, we review the mechanism and clinical outcomes of the FUS procedure.

Previous studies investigating prostate cancer (PCa) features in younger men have reported conflicting findings. This study aimed to investigate pathologic outcomes and biochemical recurrence (BCR) status in younger men who underwent radical prostatectomy (RP) for PCa. Records of 2057 patients who underwent RP at Seoul National University Bundang Hospital (Seongnam, Korea) between 2006 and 2015 were reviewed; patients were divided according to age into the younger and older groups (men aged ≤50 and >50 years, respectively). Postoperative BCR status and functional outcomes and clinicopathologic features were compared between both groups. All analyses were repeated after propensity score matching. Younger men were more likely to have low-risk disease (P < 0.001), lower pathologic Gleason score (P < 0.001) and pathologic stages (P < 0.001) than older men. The pathologic Gleason score (P = 0.002) and rates of extracapsular extension (P = 0.004) were lower in younger men after propensity score matching. In multivariate analysis, age at RP was not an independent predictor of BCR-free survival after RP (P = 0.669). Moreover, at 1 year after RP, younger men with preoperative 5-item International Index of Erectile Function score ≥22 (n = 228) showed more favorable results for urinary continence (defined as nonuse of pads daily) (99.4% vs 95%, P = 0.009) and erections sufficient for vaginal intercourse (81.8% vs 55.5%, P = 0.001). Younger men had more favorable clinicopathologic features at RP than their older counterparts. Although age was not an independent predictor of BCR status outcome, younger men had better functional outcomes following RP.
Age Factors ; Disease-Free Survival ; Humans ; Male ; Middle Aged ; Neoplasm Grading ; Prognosis ; Propensity Score ; Prostatectomy/methods* ; Prostatic Neoplasms/surgery* ; Retrospective Studies ; Treatment Outcome

PURPOSE: The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) and the Memorial Sloan Kettering Cancer Center (MSKCC) risk models were developed predominantly with clear cell renal cell carcinoma (RCC). Accordingly, whether these two models could be applied to metastatic non-clear cell RCC (mNCCRCC) as well has not been well-known and was investigated herein. MATERIALS AND METHODS: From the Korean metastatic RCC registry, a total of 156 patients (8.1%) with mNCCRCC among the entire cohort of 1,922 patients were analyzed. Both models were applied to predict first-line progression-free survival (PFS), total PFS, and cancer-specific survival (CSS). RESULTS: The median first-line PFS, total PFS, and CSS were 5, 6, and 24 months, respectively. The IMDC risk model reliably discriminated three risk groups to predict survival: the median first-line PFS, total PFS, and CSS for the favorable, intermediate, and poor risk groups were 9, 5, and, 2 months (p=0.001); 14, 7, and 2 months (p < 0.001); and 41, 21, and 8 months (p < 0.001), all respectively. The MSKCC risk model also reliably differentiated three risk groups: 9, 5, and, 2 months (p=0.005); 10, 7, and 3 months (p=0.002); and 50, 21, and 8 months (p < 0.001), also all respectively. The concordance indices were 0.632 with the IMDC model and 0.643 with the MSKCC model for first-line PFS: 0.748 and 0.655 for CSS. CONCLUSION: The current IMDC and MSKCC risk models reliably predict first-line PFS, total PFS, and CSS in mNCCRCC.
Carcinoma, Renal Cell ; Cohort Studies ; Disease-Free Survival ; Humans ; Prognosis ; Retrospective Studies

PURPOSE: We tried to investigate the clinical impact of Ki-67 (MIB-1) expression on the oncological and survival outcomes in patients with bladder cancer (BCa) after the radical cystectomy. MATERIALS AND METHODS: We retrospectively analyzed the data of 230 patients who were treated by radical cystectomy for BCa. Multivariate Cox-proportional hazards models and logistic regression tests were performed to evaluate the prognostic value of each variable. RESULTS: The patients with positive Ki-67 expression showed significant worse clinical characteristics and pathologic outcomes than negative Ki-67 group. Furthermore, the patients with Ki-67 expression showed significant worse recurrence (p=0.018) and cancer-specific mortality free survival (p=0.019) than negative Ki-67 group. The overall survival was also revealed to be inferior in Ki-67 positive group than Ki-67 negative group but the statistical significance was marginal (p=0.062). Subsequent multivariate Cox analyses showed that Ki-67 was independent predictor for disease recurrence after surgery (hazard ratio, 3.142; 95% CI, 1.287–7.671; p=0.012). CONCLUSIONS: In our study, high Ki-67 expression was significantly related with worse clinical outcomes after radical cystectomy in the patients with BCa. Further prospective and basic researches are needed to validate the true prognostic value of Ki-67.
Cystectomy* ; Humans ; Logistic Models ; Mortality ; Prognosis* ; Proportional Hazards Models ; Prospective Studies ; Recurrence ; Retrospective Studies ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: We compared the staging ability and early complications of standard and extended pelvic lymph node dissection (sPLND and ePLND, respectively) in patients with localized bladder cancer during radical cystectomy. MATERIALS AND METHODS: We prospectively collected and analyzed the data of 261 patients who underwent radical cystectomy for localized bladder cancer. The resected lymph nodes were categorized according to anatomic locations and were carefully inspected by an experienced pathologist. The perioperative complications were classified using the Clavien-Dindo classification system. RESULTS: The 2 groups showed no significant differences in preoperative characteristics except for preoperative clinical stage (p=0.015). There were no significant differences in pathologic outcomes including pathologic stage, positive surgical margin, and lymphovascular invasion (all p>0.05), but the sPLND group showed a significantly higher cellular grade (p<0.001). The ePLND group showed a higher number of removed lymph nodes than the sPLND group (p=0.015) and a higher rate of positive lymph node invasion (35.8% vs. 28.9%). There were no significant differences in complication rates according to the extent of lymph dissection and urinary diversion type, respectively (p=0.063 and p=0.486). CONCLUSIONS: The ePLND showed more accurate nodal staging ability with comparable complication rates when compared to sPLND in patients who underwent radical cystectomy for localized bladder cancer. A further, larger prospective study is needed to confirm the result of the present study.
Classification ; Cystectomy* ; Humans ; Lymph Node Excision* ; Lymph Nodes* ; Prospective Studies ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urinary Diversion

PURPOSE: The purpose of the present study was to evaluate the perioperative changes in bladder wall thickness and detrusor wall thickness after transurethral prostatectomy. MATERIALS AND METHODS: Fifty-one men who were treated for benign prostatic hyperplasia/lower urinary tract symptoms with transurethral prostatectomy were prospectively analyzed from May 2012 to July 2013. Prostate size, detrusor wall thickness, and bladder wall thickness were assessed by transrectal and transabdominal ultrasonography perioperatively. All postoperative evaluations were performed 1 month after the surgery. RESULTS: The patients' mean age was 69.0 years, the mean prostate-specific antigen concentration was 8.1 ng/mL, and the mean prostate volume was 63.2 mL. The mean bladder wall thickness was 5.1 mm (standard deviation [SD], +/-1.6), 5.1 mm (SD, +/-1.6), and 5.0 mm (SD, +/-1.4) preoperatively and 4.5 mm (SD, +/-1.5), 4.5 mm (SD, +/-1.3), and 4.6 mm (SD, +/-1.2) postoperatively in the anterior wall, dome, and trigone, respectively (p=0.178, p=0.086, and p=0.339, respectively). The mean detrusor wall thickness was 0.9 mm (SD, +/-0.4) preoperatively and 0.7 mm (SD, +/-0.3) postoperatively (p=0.001). A subgroup analysis stratifying patients into a large prostate group (weight, > or =45 g) and a high Abrams-Griffiths number group (>30) showed a significant decrease in detrusor wall thickness (p=0.002, p=0.018). CONCLUSIONS: There was a decrease in detrusor wall thickness after transurethral prostatectomy. The large prostate group and the high Abrams-Griffiths number group showed a significant decrease in detrusor wall thickness after surgery.
Humans ; Lower Urinary Tract Symptoms* ; Male ; Prospective Studies ; Prostate ; Prostate-Specific Antigen ; Transurethral Resection of Prostate ; Ultrasonography ; Urinary Bladder* ; Urinary Tract