PURPOSE: To evaluate the results of radiotherapy for the treatment of prostate cancer, we retrospectively analyzed the biochemical recurrence and morbidity after radiotherapy. MATERIALS AND METHODS: Between August 1994 and July 2002, 59 patients with prostate cancer received definitive radiotherapy. Their median age was 69 years. Of the treated patients 64.4% had T1-2 tumor, 66.1% had a Gleason score of 7 or greater, 50.9% had presenting initial prostate-specific antigen (PSA) values of 20ng/ml or greater. Conventional external radiotherapy was administered to 40 patients (67.8%), using the four-field box technique and 3-dimensional conformal radiotherapy (3D-CRT) to 19 patients (32.2%). The pelvic lymph nodes were irradiated in 23 patients (39.0%). The median radiation dose to the prostate was 66Gy (range: 64.0-70.4Gy). A PSA relapse was defined according to the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus criteria. Rectal and bladder morbidities were graded using the criteria of the Radiation Therapy Oncology Group. RESULTS: The 5-year estimates of overall survival and the freedom from PSA recurrence were 87.6 and 58.3%, respectively. A PSA recurrence developed in 22 patients (37.3%). A PSA recurrence was significantly associated with the primary tumor stage and post-radiotherapy PSA nadir value. Prognostic groups and the post-radiotherapy PSA nadir value emerged as independent indicators of a PSA recurrence-free survival. The rates of grades 1-2 rectum and bladder late morbidity were 18.6 and 8.5%, respectively. Most of the complicated patients experienced grade 1-2 morbidities. CONCLUSIONS: Prognostic groups and the post-radiotherapy PSA nadir value were useful prognostic factors for predicting the prognosis after radiotherapy. Further prospective studies are needed to spare more normal tissues, yield lower PSA recurrence and result in less treatment morbidity with 3D-CRT and intensity modulated radiotherapy.
Consensus ; Freedom ; Humans ; Lymph Nodes ; Neoplasm Grading ; Prognosis ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Radiation Oncology ; Radiotherapy* ; Radiotherapy, Conformal ; Rectum ; Recurrence ; Retrospective Studies ; Urinary Bladder

PURPOSE: The study of quality of life issues has been gaining importance because treatment significantly impacts on the ability of a patient to continue social and occupational activities. The impact of treatment modalities for localized or locally advanced prostate cancer on the quality of life of patients was compared. MATERIALS AND METHODS: 186 eligible patients with localized or locally advanced prostate cancer were enrolled from four treatment groups: radical prostatectomy (RP), external beam radiotherapy (EBRT), hormonal therapy (HT) and watchful waiting (WW). To compare changes in the Health Related Quality of Life (HRQoL) after treatment by these modalities, the patients were given questionnaires, with self-addressed, stamped envelopes, for completion and return both before and after treatment. The questionnaire was mailed to the patients that were followed up for more than 12 months after treatment. Finally, 98 patients (RP 36, EBRT 31, HT 13, and WW 18) remained on the study. The sexual, urinary and bowel functions, and certain aspects of the HRQoL of these treatment groups were examined. The general HRQoL was evaluated with the EORTC QLQ-C30 (version 3.0), and the prostate cancer-specific QoL measured using EORTC QLQ-PR25. RESULTS: On global health status and functional scales, the RP group showed the worst progression in their mean scores between baseline and treatment, and had the worst urinary incontinence, erection and ejaculation problems of the groups. EBRT was associated with adverse bowel function, HT tended to produce more sexual functioning symptoms and WW had the least erection and ejaculation problems. CONCLUSIONS: The assignment of patients to several treatment modalities entails different risks of erectile dysfunction, urinary leakage, and bowel dysfunction. These findings will help facilitate patient counseling with regard to the HRQoL expectations of patients.
Counseling ; Ejaculation ; Erectile Dysfunction ; Humans ; Male ; Postal Service ; Prostate* ; Prostatectomy ; Prostatic Neoplasms* ; Quality of Life* ; Surveys and Questionnaires ; Radiotherapy ; Urinary Incontinence ; Watchful Waiting ; Weights and Measures

PURPOSE: The purpose of this study was to define the predictive factors for the early progression of androgen independent prostate cancer in patients receiving intermittent androgen deprivation (IAD) therapy. MATERIALS AND METHODS: A total of 101 patients (stages A to C in 29 and stage D in 72), who had completed at least 1 cycle of IAD, were included. A variety of possible prognostic factors, such as age, initial prostate-specific antigen (PSA) and testosterone, Gleason score, lymph node or bone metastasis, nadir PSA and testosterone, duration to nadir PSA, duration of off treatment, and ECOG performance index were analyzed using uni- and multivariate tests. RESULTS: Patients had completed at least one, and up to six, treatment cycles with a median follow-up of 43 (13-100) months. The median nadir PSA levels were 0.28, 0.41, 0.71, 0.88, 1.85 and 0.79ng/ml for cycles 1 to 6 (median 4.6 months), respectively. The median one cycle duration (on off treatment) was 14 months, 44% of that time spent off treatment, but the off treatment duration decreased with increasing number of treatment cycles. A total of 42 patients progressed to androgen independent prostate cancer, and the progression free rates at 36 and 60 months were 72 and 52%, respectively, according to the Kaplan-Meier method. Using multivariate analysis, the nadir PSA (p=0.044), ECOG performance index (p= 0.039) and lymph node or bone metastasis (p=0.03) were the strongest predictors for the progression of androgen independent prostate cancer. CONCLUSIONS: On receiving IAD, prostate cancer patients with lymph node or bone metastasis, a poor performance status and comparatively higher serum PSA nadir value after the first treatment phase, there is a high possibility for the early progression of androgen independent prostate cancer.
Follow-Up Studies ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Grading ; Neoplasm Metastasis ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Testosterone

PURPOSE: We analyzed the radical prostatectomy cases retrospectively to stratify the risk of biochemical failure in order to appropriately select patients who potentially may benefit from adjuvant therapy. MATERIALS AND METHODS: A Cox multiple regression test was used to identify the variables associated with biochemical failure in 82 patients that underwent a radical perineal prostatectomy for prostate cancer, between 1995 and 2001, at the Samsung Medical Center. Numerous clinicopathological variables, including preoperative PSA, clinical stage, prostatectomy Gleason score, perineural invasion, seminal vesicle invasion, margin status, and pathological stage were evaluated. The Kaplan-Meier method was used to calculate the biochemical failure rates(BFR). RESULTS: Of the 82 patients, a biochemical failure developed in 17(20.7%) after a mean follow-up of 30.5 months. The overall BFR's calculated by the Kaplan-Meier method at 3 and 5 years were 24.9 and 29.3%, respectively. A biochemical failure was associated with the preoperative PSA, perineural invasion, seminal vesicle invasion, margin status and pathological stage(all log rank test p<0.05) in a univariate analysis. However, all the predictors, with the exception of the preoperative PSA, failed to remain significant with the multivariate model. CONCLUSIONS: The preoperative PSA is a strong independent predictor of biochemical failure in patients that underwent a radical perineal prostatectomy as a definitive local therapy for prostate cancer.
Follow-Up Studies ; Humans ; Neoplasm Grading ; Prostate* ; Prostate-Specific Antigen ; Prostatectomy* ; Prostatic Neoplasms* ; Retrospective Studies ; Seminal Vesicles

PURPOSE: To determine the demographic and tumor related predictors of repeat biopsy cancer detection in men diagnosed with benign prostatic tissue following an initial prostate biopsy. We evaluated the clinical parameters of prostate cancers detected on repeat biopsy. MATERIALS AND METHODS: Between May 1994 and 2001, 1,016 patients with suspected prostatic cancer underwent a transrectal ultrasound guided prostate biopsy. Of the 721 patients whose biopsy specimens were negative for prostate cancer, 53 had a repeat prostate biopsy for persistently, or abruptly elevated, prostate specific antigen (PSA) values. We examined their serum PSA, PSA density, free to total PSA value, annualized interbiopsy PSA change and biopsy core numbers, as well as their age, prostate size and the histological results of their initial, and repeated, biopsies, to determine if any predictor of the need for a repeat biopsy could be identified. RESULTS: From the repeat biopsies, 15 patients (28.3%) had prostate cancer. There were significant differences between the benign and malignant repeat biopsies, in relation to PSA density (p=0.001), free to total PSA value (p=0.002) and annualized interbiopsy PSA change (p=0.001). No patient with high-grade prostatic intraepithelial neoplasia was subsequently found to have cancer. CONCLUSIONS: The PSA density, free to total PSA value and annualized interbiopsy PSA change appear to aid in the prediction of cancer on a repeat biopsy.
Biopsy* ; Humans ; Male ; Prostate* ; Prostate-Specific Antigen ; Prostatic Intraepithelial Neoplasia ; Prostatic Neoplasms* ; Ultrasonography

PURPOSE: To determine the demographic and tumor related predictors of repeat biopsy cancer detection in men diagnosed with benign prostatic tissue following an initial prostate biopsy. We evaluated the clinical parameters of prostate cancers detected on repeat biopsy. MATERIALS AND METHODS: Between May 1994 and 2001, 1,016 patients with suspected prostatic cancer underwent a transrectal ultrasound guided prostate biopsy. Of the 721 patients whose biopsy specimens were negative for prostate cancer, 53 had a repeat prostate biopsy for persistently, or abruptly elevated, prostate specific antigen (PSA) values. We examined their serum PSA, PSA density, free to total PSA value, annualized interbiopsy PSA change and biopsy core numbers, as well as their age, prostate size and the histological results of their initial, and repeated, biopsies, to determine if any predictor of the need for a repeat biopsy could be identified. RESULTS: From the repeat biopsies, 15 patients (28.3%) had prostate cancer. There were significant differences between the benign and malignant repeat biopsies, in relation to PSA density (p=0.001), free to total PSA value (p=0.002) and annualized interbiopsy PSA change (p=0.001). No patient with high-grade prostatic intraepithelial neoplasia was subsequently found to have cancer. CONCLUSIONS: The PSA density, free to total PSA value and annualized interbiopsy PSA change appear to aid in the prediction of cancer on a repeat biopsy.
Biopsy* ; Humans ; Male ; Prostate* ; Prostate-Specific Antigen ; Prostatic Intraepithelial Neoplasia ; Prostatic Neoplasms* ; Ultrasonography

Purpose: Computed tomography (CT) is commonly used for the clinical staging of bladder cancer. However, a previous transurethral resection (TUR) often results in an overestimation of a proper muscle and perivesical fat invasion in the CT. The purpose of this study was to evaluate the effects of a TUR on CT staging in patients with bladder cancer. MATERIALS AND METHODS: A total of 67 patients who underwent a radical cystectomy for primary bladder cancer were included in this study. CT was performed before a TUR in 38 patients (group 1) and after a TUR in 29 (group 2). In each patient, CT evaluated the presence or absence of a proper muscle and perivesical fat invasion and the findings were then compared with the histopathologic findings following the radical cystectomy. RESULTS: CT had an overall staging accuracy of 79.1% for a proper muscle invasion and 67.2% for a perivesical fat invasion. For a proper muscle invasion, there was a significant difference between both groups in the CT specificity (76.9% vs. 30.0%, p=0.024) while no difference in the sensitivity (92.0% vs. 89.5%) was noted. For a perivesical fat invasion, there was also a significant difference between the two groups in terms of the CT specificity (75.0% vs. 35.7%, p=0.022) while there was no difference in the sensitivity (72.2% vs. 80.0%). CONCLUSIONS: A TUR before a CT may cause a false positive result in the clinical staging of bladder cancer using CT. Therefore, to minimize the confounding effect of a TUR on CT staging, it is strongly recommended that a CT be performed before a TUR in the case of a highly suspicious invasive bladder cancer.
Cystectomy ; Humans ; Neoplasm Staging ; Sensitivity and Specificity ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: This study was conducted to compared unenhanced helical computerized tomography (CT) with intravenous urography (IVU) in the evaluation of acute flank pain. MATERIALS AND MTHODS: Between April 2000 and April 2001, 59 patients with acute flank pain suspected of having urolithiasis underwent an unenhanced helical CT followed by an IVU. Two independent consultation urologic radiologists randomly assessed these patients for the presence, size and location of the calculus, ureteral dilatation and secondary sign of a ureteral obstruction. Of the 59 patients, 45 had a calculus confirmed on removal or a documented passage of a stone. The absence of a calculus was based on a clinical and radiological follow up with clinical resolution. RESULTS: CT revealed all 62 calculi from 45 patients and no calculus in 14 of the patients with a 98.4% sensitivity and a 100% specificity. IVU demonstrated 36 calculi from 35 patients and no calculus in 14 of the patients with a 57.1% sensitivity and a 100% specificity. Both CT and IVU demonstrated the secondary signs of a ureteral obstruction in 34 and 31 patients, respectively. The cost of the helical CT was 4-5 times higher than that of the IVU. CONCLUSIONS: Unenhanced helical CT is an accurate, safe, and a rapid technique for assessing acute flank pain and evaluate the choice for patients who would otherwise require a IVU for diagnosis but with a lower cost.
Calculi ; Diagnosis ; Dilatation ; Flank Pain* ; Follow-Up Studies ; Humans ; Sensitivity and Specificity ; Tomography, Spiral Computed ; Ureteral Calculi ; Ureteral Obstruction ; Urography* ; Urolithiasis

PURPOSE: This study was conducted to compared unenhanced helical computerized tomography (CT) with intravenous urography (IVU) in the evaluation of acute flank pain. MATERIALS AND MTHODS: Between April 2000 and April 2001, 59 patients with acute flank pain suspected of having urolithiasis underwent an unenhanced helical CT followed by an IVU. Two independent consultation urologic radiologists randomly assessed these patients for the presence, size and location of the calculus, ureteral dilatation and secondary sign of a ureteral obstruction. Of the 59 patients, 45 had a calculus confirmed on removal or a documented passage of a stone. The absence of a calculus was based on a clinical and radiological follow up with clinical resolution. RESULTS: CT revealed all 62 calculi from 45 patients and no calculus in 14 of the patients with a 98.4% sensitivity and a 100% specificity. IVU demonstrated 36 calculi from 35 patients and no calculus in 14 of the patients with a 57.1% sensitivity and a 100% specificity. Both CT and IVU demonstrated the secondary signs of a ureteral obstruction in 34 and 31 patients, respectively. The cost of the helical CT was 4-5 times higher than that of the IVU. CONCLUSIONS: Unenhanced helical CT is an accurate, safe, and a rapid technique for assessing acute flank pain and evaluate the choice for patients who would otherwise require a IVU for diagnosis but with a lower cost.
Calculi ; Diagnosis ; Dilatation ; Flank Pain* ; Follow-Up Studies ; Humans ; Sensitivity and Specificity ; Tomography, Spiral Computed ; Ureteral Calculi ; Ureteral Obstruction ; Urography* ; Urolithiasis

PURPOSE: In order to help selecting candidates for nephron-sparing surgery, the pre-operative clinical parameters that can predict a renal insufficiency developing after a radical nephrectomy even in patients with contralateral normal kidney were identified. MATERIALS AND METHODS: Of 551 patients who underwent a radical nephrectomy to treat a renal cell carcinoma, 213 patients with a pre-operative serum creatinine >2.0mg/dl or with synchronous bilateral or metastatic tumors were excluded. In 338 patients (male 227, female 111), the incidence of post-operative renal insufficiency was evaluated. Using Kaplan-Meier's method, the clinical parameters including age, sex, pre-operative serum creatinine level, hypertension and diabetes mellitus were evaluated to determine if they could be used to predict a post-nephrectomy creatinine failure, which was defined as a serum creatinine >2.0mg/dl. RESULTS: Of the 338 patients, creatinine failure had developed in 25 (6.1%) at post-operative 8 months (1-72 months). The mean pre-operative serum creatinine level of these patients was 1.35mg/dl. Six patients were older than 60, 16 patients had hypertensive and 8 patients were diabetic. In 2 patients, hemodialysis was required due to a progressive post-operative deterioration in the renal function. Multivariate analysis revealed that all the pre-operative clinical parameters such as old age (>60 years), male sexuality, hypertension, diabetes mellitus and an elevated serum creatinine level (>1.4mg/dl) were significant independent predictors of a post-nephrectomy renal insufficiency (p< 0.05). CONCLUSIONS: Patients with clinical factors including old age, male sexuality, hypertension, diabetes mellitus and an elevated creatinine value have an increased risk of a renal insufficiency after a radical nephrectomy even though the contralateral kidney is normal. Therefore, in these patients nephron-sparing surgery is strongly recommended.
Carcinoma, Renal Cell ; Creatinine ; Diabetes Mellitus ; Female ; Humans ; Hypertension ; Incidence ; Kidney* ; Male ; Multivariate Analysis ; Nephrectomy* ; Renal Dialysis ; Renal Insufficiency* ; Sexuality