Purpose: Limited treatment options exist for patients with metastatic castration-resistant prostate cancer (mCRPC) after the failure of taxane-based chemotherapy and novel hormonal therapy. Here, we report the safety and efficacy of ifosfamide and mesna in patients with mCRPC after the failure of taxane-based chemotherapy and novel hormonal therapy (NCT06236789). Materials and Methods: Patients with histologically confirmed prostate cancer who had failed taxane-based chemotherapy and novel hormonal therapy received ifosfamide 2,500 mg/m2 and mesna 1,500 mg/m2 on days 1–3, repeated every 21 days. Safety, objective response rate, disease control rate, reduction in serum prostate-specific antigen (PSA) concentration by >50% (PSA50) or >90% (PSA90), radiographic progression-free survival (rPFS), and overall survival (OS) were analyzed. Results: A total of 47 patients with mCRPC were included in the study. The median number of lines of treatment was 5 (range, 3 to 7). All patients were previously administered docetaxel and novel hormonal therapies including abiraterone (51.1%) and/or enzalutamide (61.7%). Thirty-eight patients (80.9%) were administered cabazitaxel. The objective response and disease control rates were 21.3% and 80.9%, respectively. PSA50 and PSA90 were achieved in 31.9% and 10.6%, respectively. During a median follow-up duration of 54.3 months, rPFS and OS were 5.0 and 9.0 months, respectively. All the patients experienced treatment-related adverse events of any grades; however, no new safety signs were detected. Genomic biomarker analysis revealed that alterations in the TP53 pathway were associated with inferior rPFS and OS. Conclusion Ifosfamide and mesna showed appreciable efficacy and manageable safety profiles in heavily treated patients with mCRPC.

Purpose: To evaluate patient‐reported experiences of 3 primary treatments for localized or locally advanced prostate cancer—radical prostatectomy (RP), radiation therapy (RT), and active surveillance (AS)—based on cross‐sectional data from a prospective registry, and to explore how these findings can inform a structured shared decision making (SDM) framework. Materials and Methods: Men with clinical stage cT3aN0M0 or lower were enrolled. Those who underwent RP or RT were surveyed 6–24 months posttreatment; men on AS had 6–60 months of follow‐up. All participants completed the EORTC QLQ‐PR25 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Prostate Cancer Module), capturing urinary, bowel, hormonal, and sexual function. The Kruskal‐Wallis test evaluated group differences, with significance set at p<0.05. Results: Among 542 patients, 435 underwent RP, 73 received RT (43% with androgen deprivation therapy), and 34 were on AS. RP patients reported higher rates of urinary incontinence and sexual dysfunction, whereas RT patients had more severe urinary irritative and bowel symptoms. AS generally preserved baseline sexual function but still involved some urinary complaints and anxiety regarding disease progression. These findings underscore the distinct trade‐offs among the 3 management strategies, emphasizing the importance of individualized SDM that accounts for functional priorities and patient values. Conclusion Each treatment modality poses unique impacts on quality of life. Incorporating these patient‐reported data into SDM discussions can improve alignment between clinical recommendations and patient preferences, potentially reducing decisional regret and enhancing long‐term outcomes.

Purpose: To evaluate the placement accuracy and learning curve of SpaceOAR hydrogel and gold fiducial marker insertion in Korean prostate cancer patients undergoing carbon ion radiotherapy (CIRT), performed by a single urologist without prior experience. Materials and Methods: In this retrospective observational study, 104 prostate cancer patients scheduled for CIRT at Severance Hospital between November 2022 and October 2023 underwent simultaneous SpaceOAR hydrogel insertion and 2 gold fiducial markers placement under transrectal ultrasound guidance. Postprocedural magnetic resonance imaging scans assessed spacer placement accuracy using the SpaceOAR Symmetry Score. Complications were documented and graded according to the Common Terminology Criteria for Adverse Events v5.0. Statistical analyses evaluated the impact of age, prostate volume, and operative time on complication rates and procedural efficiency. Results: Spacer placement was successful in all cases, achieving SpaceOAR Symmetry Score of 2.0 or less in 85.58% of the cases. The average operative time for the first 50 cases was 12.70±3.40 minutes, while for the latter 54 cases was 12.50±5.35 minutes, which suggests no significant learnig curve exist. Complications occurred in 25 of patients (24.0%), with constipation (9.6%), weak urinary stream (4.8%) and perianal pain (3.8%) being the most common. Acute urinary retention (grade 2) occurred in 3 patients and was not related to patient age or the presence of benign prostatic hyperplasia. Other complications were rare and mostly mild (grade 1). Conclusions SpaceOAR hydrogel insertion with gold fiducial marker placement is a reliable and efficient procedure that can be effectively performed by urologists without prior experience in patients undergoing CIRT. The procedure demonstrates a significant learning curve, with operative efficiency improving over time, supporting its feasibility and potential for widespread adoption.

Purpose: Acinar adenocarcinoma with mucinous components is a rare histologic variant of prostate cancer (PC) that was previously reported to exhibit more aggressive behavior than typical PC. However, recent studies have suggested that PC with mucinous components may not be more aggressive and could even have a more favorable prognosis. Therefore, this study investigated the clinical outcomes of PC with mucinous components. Materials and Methods: We reviewed 7,983 patients with PC who underwent radical prostatectomy between 2006 and 2019. Propensity score matching and Kaplan-Meier analyses were performed to compare outcomes between patients with typical PC (group 1) and those with PC containing mucinous components (group 2). Matching variables included age, initial prostate-specific antigen level, clinical stage, and pathological Gleason score (GS). Biochemical recurrence-free survival (BCRFS) and cancer-specific survival (CSS) were analyzed using Cox regression analysis to identify survival predictors. Results: Sixty-one patients (0.76%) had PC with mucinous components. No significant differences were observed in matched variables between the 2 groups. Pathological stage, lymph node invasion (LNI), and positive surgical margin rates were also comparable. At a median follow-up of 53 (interquartile range, 24–80) months, biochemical recurrence occurred in 29 patients in group 1 and 24 in group 2 (p=0.361). Two patients in group 1 and 3 in group 2 died from PC (p>0.999). BCRFS and CSS did not differ significantly between the 2 groups (p=0.676 and p=0.458, respectively). High GS (≥8) (p=0.007) and pT3b stage (p=0.035) were independent risk factors for BCRFS, while LNI (p=0.001) predicted CSS. The presence of mucinous components was not a significant predictor of either BCRFS or CSS (p=0.127 and p=0.561, respectively). Conclusion PC with mucinous components demonstrated clinical outcomes comparable to those of typical PC and was not an independent prognostic factor for survival. PC with mucinous components may not be as aggressive as previously believed.

Objective: Internet gaming disorder (IGD) is a growing problem, particularly among adolescents. Although cocaine- and amphetamine- regulated transcript (CART) has been explored as a potential biomarker for addictive disorders, its relationship with IGD remains poorly understood. This study investigated the differences in serum CART levels between adolescents with IGD and healthy controls (HCs) in order to find potential biomarkers as a therapeutic target in IGD. Additionally, we investigated correlations of serum CART levels with personality traits within the IGD group. Methods: A total of 114 adolescents participated in this study (43 in the IGD group and 71 in the HC group). Blood samples (10 mL) were collected and serum CART concentrations were determined using an enzyme-linked immunosorbent assay. Participants also completed the Junior Temperament and Character Inventory. Results: Serum CART levels in the IGD group were significantly lower than those in the HC group (p<0.05). IGD participants had higher novelty-seeking and harm-avoidance traits, accompanied by reduced persistence, self-directedness, and cooperativeness. Notably, a significant correlation emerged between serum CART levels and cooperativeness within the IGD group. Lower cooperativeness trait scores could indicate reduced social interaction. Conclusion The present findings suggest serum CART levels might serve as a neurobiological marker for cooperativeness function in adolescents with IGD.

Purpose: Oxaliplatin, a component of the capecitabine plus oxaliplatin (XELOX) regimen, has a more favorable toxicity profile than cisplatin in patients with advanced gastric cancer (GC). However, oxaliplatin can induce sensory neuropathy and cumulative, dose-related toxicities. Thus, the capecitabine maintenance regimen may achieve the maximum treatment effect while reducing the cumulative neurotoxicity of oxaliplatin. This study aimed to compare the survival of patients with advanced GC between capecitabine maintenance and observation after 1st line XELOX chemotherapy. Materials and Methods: Sixty-three patients treated with six cycles of XELOX for advanced GC in six hospitals of the Catholic University of Korea were randomized 1:1 to receive capecitabine maintenance or observation. The primary endpoint was progression-free survival (PFS), analyzed using a two-sided log-rank test stratified at a 5% significance level. Results: Between 2015 and 2020, 32 and 31 patients were randomized into the maintenance and observation groups, respectively. After randomization, the median number of capecitabine maintenance cycles was 6. The PFS was significantly higher in the maintenance group than the observation group (6.3 vs. 4.1 months, P=0.010). Overall survival was not significantly different between the 2 groups (18.2 vs. 16.5 months, P=0.624). Toxicities, such as hand-foot syndrome, were reported in some maintenance group patients. Maintenance treatment was a significant factor associated with PFS in multivariate analysis (hazard ratio, 0.472; 95% confidence interval, 0.250–0.890; P=0.020). Conclusions After 6 cycles of XELOX chemotherapy, capecitabine maintenance significantly prolonged PFS compared with observation, and toxicity was manageable. Maintenance treatment was a significant prognostic factor associated with PFS.

Purpose: We investigated whether the use of a phosphodiesterase-5 inhibitor (PDE5i) after robot assited radical prostatectomy has a survival benefit over non-use patients because there are controversial results on the association between PDE5i use and survival outcomes for prostate cancer patients in literature. Materials and Methods: We designed a retrospective, matched, large-sample cohort study of 5,545 patients who underwent robot assisted radical prostatectomy (RARP) during 2013–2021 in a single institute. The exclusion criteria was patients who were aged >70 years at surgery, American Society of Anesthesiologists (ASA) physical status classification grade 4 or 5, history of other malignancies, patients who started PDE5i 6 months after survery and patients with follow up period less than 24 months after surgery. Among the 1,843 included patients, 1,298 were PDE5i users, and 545 were PDE5i non-users. We performed propensity score matching (PSM) of PDE5i users (n=529) with non-users (n=529) by adjusting for the variables of age, Gleason grade group, pathological T stage, preoperative ASA physical status grade, and International Index of Erectile Function score. Results: There were no significant difference in patient characteristics according to PSM. Kaplan–Meier curve revealed the difference of overall survival for PDE5i users and non-users (clustered log-rank test p<0.05). In a stratified Cox regression analysis, PDE5i use after RARP was associated with improved overall survival and reduced risk of death (hazard ratio 0.43; confidence interval 0.24–0.79; p=0.007). The limitation of this study was that the indication for the prescription of PDE5i was not given. Conclusions PDE5i administration after RARP were associated with overall survival of patients with prostate cancer. A further randomized control trial may reveal whether routine use of PDE5i after prostatectomy can improve survival of prostate cancer patient.

Background: Residual neuromuscular blockade (RNMB) is a frequent event after general anesthesia, which can lead to serious complications, such as upper airway obstruction. Sugammadex is useful in reversing RNMB. However, its use in infants has not yet been approved by the Food and Drug Administration. Therefore, anesthesiologists can be hesitant use it, even in situations where no other choice is available.Case: A two-month-old baby presented to the hospital for umbilical polypectomy. At the end of the surgery, neostigmine was administered. Even after waiting for 30 min and injecting an additional dose of neostigmine, neuromuscular blockade was not adequately reversed. Eventually, sugammadex was administered, and spontaneous breathing returned. Conclusions If there were no particular causes of delayed return to spontaneous breathing in infants, RNMB should be considered and reversal with sugammadex would be useful.

Purpose: Using a new robotic endoscopic platform system developed for retrograde intrarenal surgery (RIRS) called easyUretero (ROEN Surgical Inc.), we evaluated the feasibility and safety of renal stone retrieval in a porcine model. Materials and Methods: Six female pigs were used for our in vivo study. First, 0.3-cm-sized phantom stones were inserted into the kidneys of each pig via the ureteral access sheath. Next, renal stone retrieval was attempted using manual RIRS in three pigs and robotic RIRS in three pigs. Three surgeons performed extraction of 10 stones in each session. Results: The mean stone retrieval time by manual RIRS was significantly shorter than that by robotic RIRS (399.9±185.4 sec vs. 1127.6±374.5 sec, p=0.001). In contrast, the questionnaire regarding usability showed high satisfaction in the surgeons’ fatigue category for surgeons using robotic RIRS. The radiation exposure dose was also lower in robotic RIRS than in manual RIRS (0.14 μSv vs. 45.5 μSv). Postoperative ureteral injury assessment revealed Grade 0 in manual RIRS cases and Grades 0, 1, and 2 in robotic RIRS cases. Conclusion The easyUretero system is a new robotic RIRS system that was developed in Korea. The results of the present study suggest that using easyUretero for stone retrieval during RIRS is safe and ergonomic.

Autosomal dominant polycystic kidney disease (ADPKD), one of the most common human monogenic diseases, is characterized by the presence of numerous fluid-filled renal cysts and is a leading cause of end-stage renal disease (ESRD). Urinary biomarkers may be useful for predicting the variable course of ADPKD progression from cyst growth to ESRD. Methods: To identify candidate urinary biomarkers of ADPKD progression, we used CRISPR/Cas9 genome editing to generate porcine fibroblasts with mono- and biallelic ADPKD gene knockout (PKD2+/– and PKD2–/–, respectively). We then performed RNA-sequencing analysis on these cells. Results: Levels of osteopontin (OPN), which is expressed by renal epithelial tubular cells and excreted into urine, were reduced in PKD2–/– cells but not in PKD2+/– cells. OPN levels were also reduced in the renal cyst cells of ADPKD patients. Next, we investigated whether OPN excretion was decreased in patients with ADPKD via enzyme-linked immunosorbent assay. OPN levels excreted into renal cyst cell culture media and urine from ADPKD patients were decreased. To investigate whether OPN can predict the rate of ADPKD progression, we compared urinary excretion of OPN in ADPKD patients with slow progression and those with rapid progression. Those with rapid progression had an estimated glomerular filtration rate of >60 mL/min/1.73 m2 . Urinary OPN excretion levels were lower in rapid progressors than in slow progressors. Conclusion: These findings suggest that OPN is a useful urinary biomarker for predicting ADPKD progression.