PURPOSE: To determine whether neoadjuvant androgen deprivation therapy (NADT) improves clinical outcomes in patients with prostate cancer treated with definitive radiotherapy. MATERIALS AND METHODS: We retrospectively reviewed medical records of 201 patients with prostate cancer treated with radiotherapy between January 1991 and December 2008. Of these, 156 patients with more than 3 years of follow-up were the subjects of this study. The median duration of follow-up was 91.2 months. NADT was given in 103 patients (66%) with median duration of 3.3 months (range, 1.0 to 7.7 months). Radiation dose was escalated gradually from 64 Gy to 81 Gy using intensity-modulated radiotherapy technique. RESULTS: Biochemical relapse-free survival (BCRFS) and overall survival (OS) of all patients were 72.6% and 90.7% at 5 years, respectively. BCRFS and OS of NADT group were 79.5% and 89.8% at 5 years and those of radiotherapy alone group were 58.8% and 92.3% at 5 years, respectively. Risk group (p = 0.010) and radiation dose > or =70 Gy (p = 0.017) affected BCRFS independently. NADT was a significant prognostic factor in univariate analysis, but not in multivariate analysis (p = 0.073). Radiation dose > or =70 Gy was only an independent factor for OS (p = 0.007; hazard ratio, 0.261; 95% confidence interval, 0.071-0.963). CONCLUSION: NADT prior to definitive radiotherapy did not result in significant benefit in terms of BCRFS and OS. NADT should not be performed routinely in the era of dose-escalated radiotherapy.
Follow-Up Studies ; Humans ; Medical Records ; Multivariate Analysis ; Prostatic Neoplasms* ; Radiotherapy* ; Radiotherapy, Intensity-Modulated ; Retrospective Studies

PURPOSE: The aim of this study was to evaluate the recent changes in the clinicopathologic features of prostate cancer in Korea and to compare these features with those of Western populations. MATERIALS AND METHODS: We retrospectively reviewed the data of 1582 men undergoing radical prostatectomy for clinically localized prostate cancer between 1995 and 2007 at 10 institutions in Korea for comparison with Western studies. The patients were divided into two groups in order to evaluate the recent clinicopathological changes in prostate cancer: Group 1 had surgery between 1995 and 2003 (n=280) and Group 2 had surgery between 2004 and 2007 (n=1302). The mean follow-up period was 24 months. RESULTS: Group 1 had a higher prostate-specific antigen level than Group 2 (10.0 ng/mL vs. 7.5 ng/mL, respectively; p<0.001) and a lower proportion of biopsy Gleason scores < or =6 (35.0% vs. 48.1%, respectively; p<0.001). The proportion of patients with clinical T1 stage was higher in Group 2 than in Group 1. Group 1 had a lower proportion of organ-confined disease (59.6% vs. 68.6%; p<0.001) and a lower proportion of Gleason scores < or =6 (21.3% vs. 33.0%; p<0.001), compared to Group 2. However, the relatively higher proportion of pathologic Gleason scores < or =6 in Group 2 was still lower than those of Western men, even though the proportion of organ-confined disease reached to that of Western series. CONCLUSION: Korean men with prostate cancer currently present better clinicopathologic parameters. However, in comparison, Korean men still show relatively worse pathologic Gleason scores than Western men.
Adult ; Aged ; Aged, 80 and over ; Humans ; Korea ; Male ; Middle Aged ; Prostate-Specific Antigen/blood ; Prostatectomy ; Prostatic Neoplasms/blood/*pathology/surgery ; Retrospective Studies ; Treatment Outcome

PURPOSE: The aim of this study was to determine the risk factors for developing an inguinal hernia after undergoing radical retropubic prostatectomy(RRP). MATERIALS AND METHODS: We retrospectively investigated the hospital records of 382 patients who underwent RRP and who were followed over 12 month periods at our institute between January 2000 and December 2006. All the operations were performed by a single surgeon. The clinical and pathological parameters were compared between the patients with and without inguinal hernia, and the risk factors were analyzed using the Cox proportional hazards model. RESULTS: The mean age of the patients was 64.6 years(range, 40 to 83). 32(8.3%) of the 382 patients developed an inguinal hernia at a mean time of 14 months. 8(25.8%) of 32 patients developed an inguinal hernia within 6 months, 23(61.8%) within 1 year, 26(83.9%) within 2 years and 28 (90.3%) developed an inguinal hernia within 3 years. 25(78.1%) developed an inguinal hernia in the right side, 3(9.4%) in left and 4(12.5%) developed an inguinal hernia in both sides. The operative time(p<0.001), prostate volume(p=0.001), the presence of transfusion (p=0.001) and pelvic lymph node dissection(p=0.007) were significantly different between the patients with and without inguinal hernia. Multivariate analysis showed that the operative time(p=0.039), pelvic lymph node dissection(p=0.002), the presence of transfusion(p=0.012) and the prostate volume(>50cc, p=0.012) were independent predictors for post-prostatectomy inguinal hernia. CONCLUSIONS: The results of our study show that the duration of surgery, pelvic lymph node dissection, the presence of transfusion and the prostate volume all increase the risk of post-radical retropubic prostatectomy inguinal hernia.
Incidence ; Risk Factors

PURPOSE: In this multi institutional study, the data of 604 men with clinically localized prostate cancer, who underwent radical prostatectomy, with updated nomograms predicting the pathological stage, were analyzed. MATERIALS AND METHODS: Prostate biopsies and prostatectomy specimens from men treated with radical prostatectomy, obtained between 1990 and 2003, were included. The patient distribution with respect to clinical stage, serum prostate-specific antigen (PSA) and biopsy Gleason score, as well as final pathological findings, including organ-confined disease (OCD), extracapsular extension (ECE), seminal vesicle invasion (SVI), and lymph node metastasis (LNM), were analyzed for the construction of nomograms representing the percent probabilities of each respective pathological outcome. RESULTS: The median serum PSA at the time of surgery and biopsy Gleason score were 9.9ng/ml and 7, respectively. The preoperative serum PSA was 4ng/ml or less in 38 (6.3%) patients and the tumor was impalpable in 292 (48.2%) of patients. The biopsy Gleason scores were 7 and 8 or higher in 186 (30.7%) and 169 (27.9%), respectively. Throughout the clinical stages and PSA ranges, the Gleason score was 7 or higher in more than 50% of patients, but 8-10 in 20-30%. The overall OCD, ECE, SVI and LNM rates were 57.1, 27.8, 10.9 and 4.2%, respectively. CONCLISIONS: A significantly high proportion of prostate cancers arising in Korean men exhibited poor differentiation, with Gleason scores of 7 or higher, regardless of the clinical stage or initial serum PSA. Updated nomograms acknowledging such characteristics have been developed, which may aid in the treatment planning of these individuals.
Biopsy ; Humans ; Lymph Nodes ; Male ; Neoplasm Grading ; Neoplasm Metastasis ; Nomograms* ; Prostate* ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms* ; Seminal Vesicles

PURPOSE: Radical cystectomy with urinary tract reconstruction currently remains the standard treatment for invasive bladder cancer, and adjuvant chemotherapy is usually considered for patients with a clinical stage >T2 or nodal metastasis. The aim of this study was to assess the safety of adjuvant chemotherapy in patients with orthotopic bladder substitution in comparison to ileal conduit. MATERIALS AND METHODS: We retrospectively analyzed the patients who underwent radical cystectomy and urinary diversion between 1990 and 2005. The patients who underwent adjuvant chemotherapy were stratified into two groups: those who had orthotopic bladder substitution and those who had ileal conduit. The chemotherapy regimen, renal function change, complications from adjuvant chemotherapy and other relevant data were analyzed. RESULTS: Overall, 341 patients had radical cystectomy, 89 had adjuvant chemotherapy, 28 had orthotopic bladder substitution and 61 had ileal conduit. The patient characteristics, including age, stage and follow-up, were similar in both groups. In all, 42% of patients had grade 1 toxicity, 16% had grade 2, 14% had grade 3 and 0% had grade 4. No patients had serious organ toxicity and none died. There were no significant differences in the chemotherapy toxicity and renal function change among the two groups. CONCLUSIONS: Adjuvant chemotherapy is safe and well tolerated by patients with either orthotopic bladder substitution or ileal conduit. There was no increased morbidity or mortality due to adjuvant chemotherapy in the patients who had orthotopic bladder substitution. Hence, orthotopic bladder substitution should not be denied to those patients with bladder cancer and who might require adjuvant chemotherapy.
Chemotherapy, Adjuvant* ; Cystectomy ; Drug Therapy ; Follow-Up Studies ; Humans ; Mortality ; Neoplasm Metastasis ; Retrospective Studies ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Diversion* ; Urinary Tract

PURPOSE: The critical pathway (CP) for radical retropubic prostatectomy (RRP), which is the efficient standardized guideline of clinical practice, was established for all the medical staff, nurses, patients and hospital managers for managing patients with RRP. The aim of this study was to evaluate the usefulness of this CP for RRP. MATERIALS AND METHODS: Our series consisted of 256 consecutive patients who had undergone RRP at a single institution from March 1, 2002 till May 31, 2005. The CP of RRP was implemented January 1, 2004. The patients were subdivided into two groups: (1) the non critical pathway (NCP) group that was made of 91 patients who were treated other than by the CP (from March, 2002 through December, 2003) and (2) the CP group of 134 patients who were placed on CP (from January, 2004 through May, 2005). The factors compared in this study included the average length of stay (LOS), the average hospital charges, the postoperative complications and the patient satisfaction between the two groups. RESULTS: There were no significant differences in the parameters between the two groups including age, the prostate-specific antigen (PSA) level, the Gleason score and the stage. The average LOS decreased significantly after implementation of CP without increasing the incidence of postoperative complications. The average hospital charges were significantly lower for the CP group than for the group without CP. The patients in the CP group were more satisfied than the other patients. CONCLUSIONS: The CP for RRP seems to be effective practical guidelines for managing radical retropubic prostatectomy patients.
Critical Pathways* ; Hospital Charges ; Humans ; Incidence ; Length of Stay ; Medical Staff ; Neoplasm Grading ; Patient Satisfaction ; Postoperative Complications ; Prostate-Specific Antigen ; Prostatectomy* ; Prostatic Neoplasms

PURPOSE: We evaluated the effect of the serum prostate specific antigen (PSA) levels in the range 4.1 to 10.0ng/ml on the pathologic characteristics after a radical prostatectomy. MATERIALS AND METHODS: Between July 1997 and June 2004, 117 men (64 years: 44-75) with an intermittent PSA level underwent radical retropubic prostatectomy. The patients were divided into 6 groups according to the PSA level (4.1-5.0, 5.0-6.1, 6.1-7.0. 7.1-8.0, 8.1-9.0 and 9.1-10.0ng/ml), and compared the age, prostate volume, Gleason score of biopsy specimen and pathologic stage, grade and margin status of prostatectomy specimen between the 6 groups. RESULTS: The mean age, prostate volume and Gleason score of the biopsy were not significantly different between the 6 groups. The pathologic stage and margin status also were not significantly different between the 6 groups. The mean Gleason score was higher in the high PSA group, but this was not statistically significant. When divided into two groups (group with PSA 4.1-7.0 and 7.1-10.0ng/ml), the pathologic stage and margin status were no different. However, the mean Gleason score and the rate of high grade (Gleason score 8-10) prostate cancer were higher in the high PSA group. The mean high grade prostate cancer rates were 22 and 7% in the PSA 7.1-10.0 and 4.1-7.0ng/ml groups, respectively (p=0.019). CONCLUSIONS: A PSA level above 7.0ng/ml in the intermediate group influenced the pathologic grade of the radical prostatectomy. This result suggests that prostate cancer with a PSA level higher than 7.0ng/ml may have a more aggressive feature.
Biopsy ; Humans ; Male ; Neoplasm Grading ; Prostate ; Prostate-Specific Antigen ; Prostatectomy* ; Prostatic Neoplasms

PURPOSE: To investigate the feasibility of using a poly (epsilon-caprolactone) (PCL) sheet seeded with autologous muscle-derived stem cells as a bladder substitute. MATERIALS AND METHODS: Muscle-derived stem cells were isolated from the gastrocnemius muscle of 9 female Sprague-Dawley rats using a preplate technique, and cultured on a 5x5mm PCL sheet. The sheets were implanted into the mesentery of the rats in an autologous manner. Three rats were sacrificed 2, 4 and 8 weeks after implantation, and the morphological changes were assessed by H&E and immunofluorescence staining including DAPI, myosin heavy chain (MHC) and choline acetyl transferase (CAT). RESULTS: All the rats survived for the scheduled time. A mild inflammatory reaction was observed around the PCL sheet in the postoperative 2-week specimen but this receded with time. Muscle cells on the sheet were observed over the experimental period. The 8-week specimen showed a moderate amount of muscle cells on the sheet, and MHC and CAT immunofluorescence staining showed a positive reaction. The muscle layer was not well organized. Angiogenesis was quite noticable between the sheet and the muscle cells on the 8-week specimen. CONCLUSIONS: A PCL sheet seeded with autologous muscle-derived stem cells showed skeletal muscle differentiation on the sheets 8 weeks after mesenteric implantation in an autologous manner. This suggests the feasibility of using a PCL sheet seeded with autologous muscle-derived stem cell as a bladder substitute.
Animals ; Atrophy ; Cats ; Choline ; Female ; Fluorescent Antibody Technique ; Humans ; Mesentery ; Muscle Cells ; Muscle, Skeletal ; Myosin Heavy Chains ; Rats ; Rats, Sprague-Dawley ; Regeneration* ; Stem Cells* ; Transferases ; Urinary Bladder*

Purpose: We evaluated the variables that may predict the final Gleason score of a radical prostatectomy in the patients showing more than two different Gleason scores in their positive core biopsy specimens. Materials and Methods: We reviewed the pathological data of patients diagnosed with prostate cancer using extended (12 site or more) needle biopsies who underwent a radical retropubic prostatectomy. A total of 73 patients showed more than two different Gleason scores in their biopsy specimen. The following parameters were assessed: highest Gleason score in the biopsy specimen, the Gleason score of the highest tumor percentage in the core and the highest tumor ratio score (Gleason score of highest total tumor length of same Gleason score/total core length of same Gleason score). Concordance of the Gleason scores between the biopsy specimen and prostatectomy was also examined. Results: The highest tumor ratio score showed the highest (64.4%) concordance rate. The concordance rates of the Gleason scores of the highest tumor percentage in the core and the largest linear cancer length were 59 and 58%, respectively. The concordance rate of the highest Gleason score in the biopsy specimens was only 47%. When stratified by grade: well differentiated (Gleason score=6), moderate (7) and poorly differentiated (8-10), the grade concordance rate of the highest tumor ratio score was 73%. The grade concordance rates of the highest and largest linear cancer length Gleason scores were 64.4 and 64.3%, respectively. Conclusions: If a biopsy specimen shows more than two different Gleason scores in positive cores, the highest tumor ratio score may be the most useful variable for predicting the final Gleason score from radical prostatectomy specimens.
Biopsy* ; Biopsy, Needle ; Humans ; Neoplasm Grading* ; Prostatectomy* ; Prostatic Neoplasms

Purpose: We evaluated the improvement in the rate of prostate cancer detection with the use of an extensive 12-site biopsy protocol in patients with only an elevated level of serum prostate-specific antigen (PSA). Materials and Methods: A total of 109 men with elevated PSA levels between 3 and 20ng/ml, but with no abnormal finding on digital rectal and transrectal ultrasound examinations, received transrectal ultrasound- guided prostate biopsies, which were performed at 12 sites, including the routine sextant and 6 far lateral regions (lateral apex, mid-lobe and base). The improvement in the detection rate was assessed according to the PSA level and prostate volume. Results: The mean age and PSA level of the patients were 63.5 8.6 years and 7.0 3.7ng/ml, respectively. Twenty-eight (25.7%) out of 109 men were diagnosed with prostate cancer. A traditional sextant biopsy detected 19 (67.9%) of the 28 prostate cancer patients, while 9 (32.1%) cancers were detected in the lateral region only. Overall, this extensive protocol resulted in a significant improvement, 8.3% (17.4 to 25.7%), in the detection rate (p=0.032). The improvement in men with a PSA of 10 ng/ml or less was 8.1% (14.0% to 22.1%, p=0.007) and in those with a PSA greater than 10 ng/ml the improvement was 8.7% (30.4% to 39.1%, p=0.162). The improvement in men with a prostate volume of 50cc or less was 8.0% (22.3% to 30.3%, p=0.083) and in those with a prostate volume greater than 50cc this was 9.1% (6.1% to 15.2%, p=0.043). Conclusions: The twelve-site biopsy protocol is a more efficient method in men with a PSA and prostate volume of 10ng/ml or less and greater than 50cc, respectively, compared to the sextant protocol.
Biopsy* ; Humans ; Male ; Prostate ; Prostate-Specific Antigen* ; Prostatic Neoplasms ; Ultrasonography