Erdafitinib in BCG-treated high-risk non-muscle-invasive bladder cancer

BACKGROUND

Treatment options are limited for patients with high-risk non-muscle-invasive bladder cancer (NMIBC) with disease recurrence after bacillus Calmette-Guérin (BCG) treatment and who are ineligible for/refuse radical cystectomy. FGFR alterations are commonly detected in NMIBC. We evaluated the activity of oral erdafitinib, a selective pan-fibroblast growth factor receptor (FGFR) tyrosine kinase inhibitor, versus intravesical chemotherapy in patients with high-risk NMIBC and select FGFR3/2 alterations following recurrence after BCG treatment.

PATIENTS AND METHODS

Patients aged ≥18 years with recurrent, BCG-treated, papillary-only high-risk NMIBC (high-grade Ta/T1) and select FGFR alterations refusing or ineligible for radical cystectomy were randomized to 6 mg daily oral erdafitinib or investigator's choice of intravesical chemotherapy (mitomycin C or gemcitabine). The primary endpoint was recurrence-free survival (RFS). The key secondary endpoint was safety.

RESULTS

Study enrollment was discontinued due to slow accrual. Seventy-three patients were randomized 2 : 1 to erdafitinib (n = 49) and chemotherapy (n = 24). Median follow-up for RFS was 13.4 months for both groups. Median RFS was not reached for erdafitinib [95% confidence interval (CI) 16.9 months-not estimable] and was 11.6 months (95% CI 6.4-20.1 months) for chemotherapy, with an estimated hazard ratio of 0.28 (95% CI 0.1-0.6; nominal P value = 0.0008). In this population, safety results were generally consistent with known profiles for erdafitinib and chemotherapy.

CONCLUSIONS

Erdafitinib prolonged RFS compared with intravesical chemotherapy in patients with papillary-only, high-risk NMIBC harboring FGFR alterations who had disease recurrence after BCG therapy and refused or were ineligible for radical cystectomy.

Influence of environmental factors on chronic prostatitis-like symptoms in young men: results of a community-based survey

OBJECTIVES

To investigate the influence of environmental factors on chronic prostatitis-like symptoms among young men in a community.

METHODS

Of 28,841 men aged 20 years dwelling in the community, a total of 16,321 men (response rate 56.6%) were included in this study. The National Institutes of Health Chronic Prostatitis Symptom Index was used to identify men with chronic prostatitis-like symptoms. The questionnaire also queried sociodemographic characteristics. The Korean Meteorological Administration provided information on the weather of the community. We determined the risk factors of chronic prostatitis-like symptoms among these environmental factors using univariate and multivariate analyses.

RESULTS

Six percent of the men were identified as having significant prostatitis-like symptoms (perineal and/or ejaculatory pain and a total pain score of 4 or greater). The univariate logistic regression analysis indicated that education level, average duration of sunlight, and average temperature were risk factors for chronic prostatitis-like symptoms. As these variables increased, the scores of chronic prostatitis-like symptoms decreased. In the multivariate model used, the likelihood of chronic prostatitis-like symptoms varied by the final educational level, with middle school and high school graduates having 1.8 and 1.4-fold higher odds, respectively, than men attending college. In the same model, the average duration of sunlight was also an independent risk factor of chronic prostatitis-like symptoms (odds ratio 0.85; 95% confidence interval 0.77 to 0.95; P = 0.003), but the average temperature lost statistical significance.

CONCLUSIONS

Our findings suggest that the community-based prevalence of chronic prostatitis-like symptoms may be high in young men. Higher education and a longer time in sunlight were associated with a decreased likelihood of chronic prostatitis-like symptoms.

Initial tumor stage and grade as a predictive factor for recurrence in patients with stage T1 grade 3 bladder cancer

PURPOSE

We evaluated whether the risk of progression and the recurrence rate were different in patients with primary and nonprimary stage T1 grade 3 transitional cell carcinoma of the bladder.

MATERIALS AND METHODS

Between 1983 and 1997, 75 patients were treated for stage T1 grade 3 transitional cell carcinoma of the bladder. Of these patients 68 (primary and nonprimary tumor in 58 and 14, respectively) without carcinoma in situ who had not undergone complete cystectomy immediately after diagnosis were included in the study. No maintenance regimen was used. Median followup was 100 months (range 9 to 217).

RESULTS

The incidence of multiple tumors in patients with nonprimary tumors was significantly higher than in patients with primary disease (p = 0.035). However, the recurrence-free survival rate in patients with primary T1 GIII bladder tumor was significantly lower than that of patients with nonprimary T1 GIII bladder tumor (p = 0.0016). Multivariate analysis using Cox's proportional hazard regression model revealed that only initial tumor status had statistically significant effects on tumor recurrence (p = 0.007) and no other factors had a significant influence on recurrence-free survival. Progression-free and cancer specific survival rates were also significantly different between the 2 groups (p = 0.036 and 0.0307, respectively).

CONCLUSIONS

Our study indicates that patients with primary stage T1 grade 3 bladder cancers have higher recurrence and progression potential than those with nonprimary disease despite the higher incidence of multiple tumors in patients with nonprimary tumors.

Factors influencing the outcome of mid urethral sling procedures for female urinary incontinence

PURPOSE

We evaluated the outcome at least 6 months after the tension-free vaginal tape or transobturator tape procedure in women with urinary incontinence, and identified factors predicting persistent stress urinary incontinence.

MATERIALS AND METHODS

A total of 464 women 28 to 80 years old (mean age 56) were included in the study. Tension-free vaginal tape (252) and transobturator tape (212) procedures were performed by the same surgeon. Mean followup was 10.8 months (range 6 to 52).

RESULTS

Bladder perforations were noted in 12 patients (4.8%) in the tension-free vaginal tape group but there was no bladder perforation after the transobturator tape procedure (p = 0.001). The rate of urinary retention in the tension-free vaginal tape group was significantly higher than that in the transobturator tape group (15.1% vs 6.6%, p = 0.004). The overall cure rate was significantly higher in the tension-free vaginal tape group than in the transobturator tape group (92.1% vs 84.9%, p = 0.015). On multivariate analysis 4 variables were independent risk factors for persistent stress urinary incontinence, that is comorbid disease (OR 2.37, 95% CI 1.26-4.47, p = 0.008), urge urinary incontinence (OR 1.95, 95% CI 1.02-3.74, p = 0.044), severe grade of cystocele (OR 2.73, 95% CI 1.43-5.20, p = 0.002) and transobturator tape procedure (OR 2.87, 95% CI 1.50-5.47, p = 0.001).

CONCLUSIONS

The cure rates in women with urinary incontinence are not similar after tension-free vaginal tape and transobturator tape procedures. Our findings suggest that characteristics including the type of procedure, comorbid diseases, mixed urinary incontinence and severe grade cystocele should be considered high risk factors for persistent stress urinary incontinence in these patients.

Diagnostic Value of 18F-fluorodeoxyglucose Positron Emission Tomography with Computed Tomography for Lymph Node Staging in Patients with Upper Tract Urothelial Carcinoma

BACKGROUND

Presence of lymph node metastases (LNM) is an important prognostic factor for cancer-specific survival (CSS) in patients with upper tract urothelial carcinoma (UTUC). In various neoplasms, 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) is an established modality for preoperative lymph node (LN) staging. In UTUC, the diagnostic value of FDG-PET/CT for LN staging is unknown.

OBJECTIVE

To determine the diagnostic value of FDG-PET/CT for LN staging in patients with UTUC.

DESIGN, SETTING, AND PARTICIPANTS

Data of 152 patients with UTUC who underwent FDG-PET/CT followed by surgical treatment in eight centers between 2007 and 2017 were retrospectively collected. Patients receiving neoadjuvant chemotherapy were excluded.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

FDG-PET/CT results were compared with histopathology after lymph node dissection (LND). Recurrence-free survival (RFS), CSS, and overall survival (OS) were analyzed using Kaplan-Meier estimates, and compared for patients with and without suspicious LNs on FDG-PET/CT.

RESULTS AND LIMITATIONS

We included 117 patients, of whom 62 underwent LND. Seventeen patients had LNM at histopathological evaluation. Sensitivity and specificity of FDG-PET/CT for diagnosis of LNM were 82% (95% confidence interval [CI]: 57-96) and 84% (95% CI: 71-94), respectively. RFS was significantly worse in patients with LN-positive FDG-PET/CT than in those with LN-negative FDG-PET/CT (p=0.03). CSS (p=0.11) and OS (p=0.5) were similar between groups. This study is limited by its retrospective design and by its sample size. Our results warrant further validation.

CONCLUSIONS

FDG-PET/CT has 82% sensitivity and 84% specificity for the detection of LNM in patients with UTUC. Presence of suspicious LNs on FDG-PET/CT is associated with worse RFS.

PATIENT SUMMARY

In patients with upper tract urothelial cancer, positron emission tomography with computed tomography (PET/CT) scans can detect lymph node metastases with noteworthy accuracy. Presence of suspicious lymph nodes on 18F-fluorodeoxyglucose PET/CT is associated with worse recurrence-free survival.

Young age is independent prognostic factor for cancer-specific survival of low-stage clear cell renal cell carcinoma

OBJECTIVES

To clarify the clinicopathologic features and prognosis of renal cell carcinoma (RCC) in young adults. The features of RCC in young adults have been reported, but the results have been conflicting.

METHODS

The data from 619 patients with RCC were analyzed. The patients were divided into 2 groups according to age at diagnosis, 55 years of age. The clinicopathologic parameters were compared, and a survival analysis was performed.

RESULTS

Younger patients were more likely to have a lower disease stage (P < .001), lower nuclear grade (P = .018), and smaller tumor size (P = .005) and a greater 5-year cancer-specific survival rate (P < .001) than older patients. Young age was a favorable prognostic factor for cancer-specific survival of clear cell RCC (P < .001). On multivariate analysis, young age was independently associated with a longer cancer-specific survival rate of clear cell RCC (P = .003). In addition, the prognostic implication of age differed between low (I or II) and high (III or IV) stage tumors. In low-stage clear cell RCC, young age was significantly associated with prolonged cancer-specific survival on univariate (P < .001) and multivariate (P = .007) analyses, but not in high-stage clear cell RCC (P = .906).

CONCLUSIONS

RCC in patients <55 years presented with a lower stage, lower nuclear grade, and smaller size than did the older patients. Young age was an independent prognostic factor for cancer-specific survival of low-stage clear cell RCC.

Bladder cancer after nephroureterectomy in patients with urothelial carcinoma of the upper urinary tract

OBJECTIVES

To determine the independent risk factors of bladder recurrence in patients with upper urinary tract (UUT) urothelial carcinoma (UC).

MATERIALS AND METHODS

A total of 181 patients with UUT-UC were enrolled in this study. Their median age was 63 years (range 36-90), and median follow-up after total nephroureterectomy was 37.5 months (range 1.0-174.0). The end-point of this study was defined as the initial intravesical recurrence of UC.

RESULTS

Of the 181 patients, 64 (35.4%) developed subsequent bladder tumors at a median interval of 6.3 months (range 1.7-50.1) after initial treatment. By univariate analysis, a previous bladder tumor history (P = 0.046) and tumor necrosis (P < 0.001) were found to have a significant prognostic impact on bladder tumor-free survival in patients with superficial UUT-UC, whereas surgical margin status (P = 0.045) and the use of adjuvant chemotherapy (P = 0.003) were found to be prognostic factors for bladder tumor-free survival in those with invasive UUT-UC. However, by multivariate analysis, only tumor necrosis (P = 0.012, relative risk = 6.512) was found to have a significant impact on intravesical recurrence in patients with superficial UUT-UC. However, surgical margin status (P = 0.007, relative risk = 5.846) and the use of adjuvant chemotherapy (P = 0.001, relative risk = 0.223) were retained as independent predictors of bladder tumor survival in those with invasive UUT-UC.

CONCLUSIONS

Our findings may be useful in patients with UUT-UC who may require more stringent follow-up by cystoscopy to detect bladder tumors.

Laparoscopic radical nephroureterectomy is associated with worse survival outcomes than open radical nephroureterectomy in patients with locally advanced upper tract urothelial carcinoma

PURPOSE

To compare survival outcomes between laparoscopic radical nephroureterectomy (LRNU) and open radical nephroureterectomy (ORNU) in upper urinary tract urothelial carcinoma (UTUC) patients.

METHODS

We retrospectively analyzed the data of 371 UTUC patients who underwent ORNU (n = 271) or LRNU (n = 100) between 1992 and 2012. The survival outcomes included intravesical recurrence (IVR)-free survival, overall survival (OS), and cancer-specific survival (CSS). The Kaplan-Meier method and log-rank test were used to estimate and compare survival curves between groups. Factors associated with survival outcomes were evaluated using univariable and multivariable Cox proportional hazard models.

RESULTS

The three-year IVR-free survival rates were similar between the ORNU and LRNU groups (59.9 and 61.7 %, p = 0.267). However, the LRNU group showed worse five-year OS (59.1 vs. 75.2 %, p = 0.027) and CSS (66.1 vs. 80.2 %, p = 0.015) rates than the ORNU group. In particular, on stratifying the study cohort by pathological stages, significant differences in OS (p = 0.007) and CSS (p = 0.005) between the surgical approaches were observed only in locally advanced disease (pT3/T4). In multivariable analysis, LRNU was an independent predictor of worse OS (p = 0.001) and CSS (p = 0.006) than ORNU. Likewise, in multivariable analysis in patients with pT3/T4 stage, LRNU was significantly associated with worse OS (hazard ratio [HR] 2.59, p = 0.001) and CSS (HR 2.50, p = 0.005).

CONCLUSIONS

Our data suggest that in UTUC patients, LRNU, compared to ORNU, is generally associated with unfavorable OS and CSS results. In particular, LRNU should be performed in locally advanced UTUC patients after careful consideration of its impact on patient survival.

Variant histology as a significant predictor of survival after radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma

OBJECTIVES

To investigate the effect of variant histology (VH) on survival after radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma (UTUC) and the effect of adjuvant chemotherapy on the survival of patients with UTUC with VH.

MATERIALS AND METHODS

A total of 452 patients who underwent radical nephroureterectomy for UTUC without neoadjuvant chemotherapy in our institution between 1991 and 2012 were retrospectively analyzed. We performed a comparative analysis between pure UTUC and UTUC with VH groups. The Kaplan-Meier method was used to calculate survival estimates for cancer-specific survival (CSS) and overall survival (OS), and log-rank test was used to conduct comparisons between the groups. Univariate and multivariate Cox-proportional hazard regression analyses were performed to evaluate significant variables associated with CSS and OS.

RESULTS

UTUC with VH was present in 41 (9.1%) patients. UTUC with VH showed aggressive clinicopathological features in comparison with pure UTUC. The Kaplan-Meier curves showed significantly decreased 5-year CSS and OS (both, P<0.001) in UTUC with VH group. Multivariate analysis revealed that VH was an independent predictor of CSS (P<0.001) and OS (P<0.002). The Kaplan-Meier curves also showed significantly decreased 5-year CSS and OS in UTUC with the VH group compared to the pure UTUC group in patients who received adjuvant chemotherapy.

CONCLUSIONS

We found that UTUC with VH harbored aggressive biologic features, and VH was an independent prognostic factor for CSS and OS on both univariate and multivariate analyses. In addition, UTUC with VH group had poorer survival outcomes than pure UTUC group in patients who received adjuvant chemotherapy. Consequently, adjuvant treatment modalities other than adjuvant chemotherapy should be considered in this group.

Lymphovascular invasion as a prognostic factor in the upper urinary tract urothelial carcinoma: a systematic review and meta-analysis

BACKGROUND

The objective of the present study was to conduct a systematic review and meta-analysis of the published literature investigating lymphovascular invasion (LVI) and its effects on upper urinary tract urothelial carcinoma (UTUC) prognosis.

METHODS

To identify relevant studies, PubMed, Cochrane Library, OVID and SCOPUS database were searched from the inception until June 2012.

RESULTS

A total of 17 trials met the eligibility criteria for the meta-analysis. The total number of patients included was 4896, ranging from 60 to 2492 per study. None of the 17 included studies was based on the data of prospective analysis of survival. In 13 of 17 studies, patients had received adjuvant chemotherapy. Despite our attempts to limit the between-study heterogeneity through a strict inclusion criteria, there was a between-study heterogeneity in the effect of LVI on all of the meta-analyses, with a p value of <0.05 and I(2) generally greater than 50%. Thus, the hazard ratio (HR) was calculated using the random-effect model. The pooled HRs were statistically significant for disease-free survival (pooled HR, 1.91; 95% confidence interval [CI], 1.40-2.41), cancer-specific survival (CSS) (pooled HR, 1.72; 95% CI, 1.28-2.71) and overall survival (pooled HR, 4.05; 95% CI, -0.44-8.53). There was no clear evidence of funnel plot asymmetry, and thus, no evidence of publication bias was found.

CONCLUSIONS

Our meta-analysis showed that LVI is predictive of mortality in UTUC. However, these findings should be interpreted with caution due to the heterogeneity in the series. These results need to be further confirmed by an adequately designed prospective study to provide a better conclusion on the relationship between LVI and the outcome of patients with UTUC.

Prevalence of urinary incontinence in Korean women:an epidemiologic survey

The purpose of this study was to evaluate the prevalence of urinary incontinence (UI) in a Korean national community sample of female adults aged 30-79 years. During April 2003, a national Korea telephone survey using quota sampling methods was conducted. The clinically validated computer-assisted telephone interview approach was used in the survey. Of the 1,500 subjects contacted, 1,303 were successfully interviewed (response rate 86.9%). Overall, UI was reported by 40.8%, and 22.9, 3.1, and 14.9% reported pure stress, urge, and mixed UI, respectively. The prevalence of stress, urge, and mixed UI generally did not increase with age. Urge and mixed UI had a greater impact than stress UI on daily tasks (P < 0.001), social life (P < 0.001), depression or anxiety due to UI (P < 0.001), worry about UI (P < 0.001), sex life (P < 0.001), wear protection due to UI (P = 0.011), and quality of life (P < 0.001). In subjects with pure stress UI, 28.3% reported impaired quality of life compared with 43.9% and 43.8% of subjects with urge and mixed UI. Of those individuals with stress, urge, and mixed UI, 19.1, 20.0, and 25.8% had the willingness to seek medical consultation. This study is the first to examine the prevalence of UI in Korean women. The present study revealed that there was a high prevalence of UI in this population. Our descriptive research provides a valuable insight into the need for tailored education to this population about UI.

Percutaneous posterior tibial nerve stimulation in patients with chronic pelvic pain: a preliminary study

BACKGROUND

We evaluated the clinical effect of intermittent percutaneous posterior tibial nerve stimulation (PTNS) in patients with chronic pelvic pain (CPP).

METHODS

A total of 15 patients (10 women and 5 men, mean age 60.0 years, range 41-78) with CPP were enrolled in an open prospective clinical trial. The patients had 12 weekly outpatient treatment sessions, each lasting 30 min. All patients were evaluated by history, physical as well as urological examination, the Visual Analogue Scale (VAS) for pain and urgency, the International Prostate Symptom Score, and a 3-day frequency-volume chart.

RESULTS

After 12 weeks of PTNS, 9 (60%) and 3 patients (30%) had an improvement of >50% and 25-50% in the VAS score for pain, respectively. Six patients (40%) ended up with a mean VAS <3. Mean VAS for pain changed from 8.1 +/- 0.2 at baseline to 4.1 +/- 0.6 after 12 weeks of treatment (p < 0.01). Mean VAS for urgency changed from 4.5 +/- 1.0 at baseline to 2.7 +/- 0.7 after 12 weeks of treatment (p < 0.05). However, there was no statistically significant improvement in the International Prostate Symptom Score. There was no statistically significant difference in the number of voids and bladder volumes either.

CONCLUSIONS

Our findings suggest that PTNS may improve pain symptoms for over half of the patients with CPP. Long-term follow-up studies are needed to verify these preliminary results.

External validation of an online nomogram in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma

BACKGROUND

The objective was to validate an online nomogram developed based on the French collaborative national database on upper urinary tract urothelial carcinoma (UUT-UC) using a different cohort.

METHODS

The study comprised 328 patients with UUT-UC who underwent radical nephroureterectomy. The discrimination of models was quantified using Harrell's concordance index. The relationship between the model-derived and actuarial cancer-specific mortality was graphically explored within calibration plots. Calibration was also assessed using the quartiles of the predicted survival at 3 and 5 years and calculation of the corresponding observed Kaplan-Meier estimates. Clinical net benefit was evaluated constructing decision curve analysis.

RESULTS

The discrimination accuracy of the nomograms at 3 and 5 years was 71.6% and 71.8%, respectively. Although nomograms discriminated well by Kaplan-Meier curves, and log-rank tests were all highly significant, the calibration plots tended to exaggerate the overestimation of mortality between predicted and observed probabilities at 3 and 5 years for survival. When compared with the AJCC/UICC staging system, the nomograms performed well across a wide range of threshold probabilities using decision curve analysis.

CONCLUSION

The online nomogram is a highly accurate prognostic tool for patients with UUT-UC treated with radical nephroureterectomy. The model can provide an accurate estimate of the individual risk of cancer-specific mortality. Further improvement and implementation of novel molecular marker is needed.

Prognostic role of survivin in bladder cancer: a systematic review and meta-analysis

PURPOSE

The objective of the present study was to conduct a systematic review and meta-analysis of published literature investigating the survivin expression and its effects on bladder cancer prognosis.

MATERIALS AND METHODS

We carefully searched online Pubmed, Cochrane Library and SCOPUS database from August 1997 to May 2013.

RESULTS

A total of 14 articles met the eligibility criteria for this systematic review. The eligible studies included a total of 2,165 patients with a median number of 155 patients per study (range: 17-726). Of the 14 studies, nine evaluated immunohistochemistry in formalin-fixed paraffin-embedded tissue blocks. In non-muscle invasive bladder tumor, the pooled hazard ratio (HR) was statistically significant for recurrence-free survival (pooled HR, 1.81; 95% confidence interval [CI], 1.30-2.52), progression-free survival (pooled HR, 2.12; 95% CI, 1.60-2.82), cancer-specific survival (pooled HR, 2.01; 95% CI, 1.32-3.06), and overall survival (pooled HR, 1.53; 95% CI, 1.02-2.29). The overall HRs by survivin status were robust across advanced stages. When only adjusted survival data were included, statistically significant differences were identified for all survival subgroup analyses. There was no between-study heterogeneity in the effect of survivin status on the majority of meta-analyses. There was no clear evidence of publication bias in this meta-analysis.

CONCLUSIONS

Survivin expression indicates worse prognosis in patients with bladder cancer but the results should be interpreted with caution. It is necessary that better-designed studies with standardized assays need to provide a better conclusion about the relationship between survivin expression and the outcome of patients with bladder cancer.

Effect of subclinical prostatic inflammation on serum PSA levels in men with clinically undetectable prostate cancer

OBJECTIVES

To examine whether subclinical prostatic inflammation might influence serum prostate-specific antigen (PSA) levels in men with clinically undetectable prostate cancer.

METHODS

A total of 461 patients who underwent prostate biopsy at our hospital were studied between January 1996 and December 1999. Of these patients, a total of 125 patients without detectable prostate cancer or a history or symptoms of prostatitis, with serum PSA levels of less than 20.0 ng/mL and other specified exclusion criteria, were included in the study. Inflammation observed at biopsy was scored for inflammation extent and inflammatory aggressiveness, and the effects of these morphologic aspects of inflammation on serum PSA levels were examined.

RESULTS

The extent of inflammation tended to increase as the prostate volume increased (P = 0.006). Patients with a PSA greater than 2.5 ng/mL had a greater extent and aggressiveness of inflammation than those with PSA levels of 2.5 ng/mL or less (P = 0.004 and P = 0.050, respectively). However, no statistically significant differences were found in terms of the extent of inflammation or inflammatory aggressiveness between patients with PSA levels greater than 4.0 ng/mL and those with PSA levels of 4.0 ng/mL or less. Furthermore, the extent of inflammation did not account for PSA levels greater than 2.5 or 4.0 ng/mL by multivariate analysis.

CONCLUSIONS

Our results indicate that subclinical prostatic inflammation is not the etiology of a serum PSA greater than 4.0 ng/mL in men without clinically detectable prostate cancer.

Psychological problems in young men with chronic prostatitis-like symptoms

OBJECTIVE

To take a different perspective in assessing young men with chronic prostatitis-like symptoms, this study was designed since few prospective studies are available to survey a population of young men.

MATERIAL AND METHODS

One hundred and fifty men aged 20 years dwelling in the community were randomly selected. Chronic prostatitis-like symptoms were measured by the National Institutes of Health-Chronic Prostatitis Symptom Index and the selfreported scores for pain and urinary symptoms were used to identify chronic prostatitis-like symptoms. The psychological methods used were the Beck Depression Inventory, the State-Trait Anxiety Inventory, and the Bem Sex Role Inventory. A total of 87 men (a response rate 58%) completed self-administered questionnaires.

RESULTS

As the scores for pain and urinary symptoms increased, those for depression increased (p < 0.001 and p = 0.01, respectively). However, the mean scores for state and trait anxiety were not different according to the scores for pain and urinary symptoms. The mean masculinity scores were not different according to the scores for pain but those were significantly different according to the scores of urinary symptoms (p = 0.042). The mean femininity scores were not different according to the scores of pain and urinary symptoms.

CONCLUSIONS

Our findings suggest that psychological factors, especially depression and weak masculine identity may be associated with an early stage of chronic prostatitis-like symptoms. Young men with chronic prostatitis-like symptoms also have psychological problems.

Extended versus Standard Pelvic Lymph Node Dissection in Radical Prostatectomy on Oncological and Functional Outcomes: A Systematic Review and Meta-Analysis

BACKGROUND

We evaluated the effect of the extent of pelvic lymph node dissection (PLND) on oncological and functional outcomes in patients with intermediate- to high-risk prostate cancer (PCa) by conducting a systematic review and meta-analysis.

METHODS

Two independent researchers performed a systematic review of radical prostatectomy (RP) with extended PLND (ePLND), and RP with standard (sPLND) or limited PLND (lPLND) in patients with PCa using the PubMed, EMBASE, and Cochrane Library databases and using the terms 'prostatectomy', 'lymph node excision', and 'prostatic neoplasm'. The primary outcome was biochemical-free survival, which was analyzed by extracting survival data from the published Kaplan-Meier (KM) curves. In addition, we obtained summarized survival curves by reconstructing the KM data. Secondary outcomes of the recovery of erection and continence were also analyzed.

RESULTS

Nine studies involving over 1554 patients were included, one of which was a randomized controlled trial. The pooled analysis showed a significant difference in biochemical recurrence between ePLND and sPLND (hazard ratio 0.71, 95% confidence interval 0.56-0.90, p = 0.005), with no significant between-study heterogeneity (I 2 = 37%). From the summary survival curves, it can be observed that the curves for the two groups diverged more and more as a function of time. From the analyses of functional outcomes including only three studies, no statistically significant differences in the recovery of erectile function and continence were observed. No evidence of significant publication bias was found.

CONCLUSIONS

In patients with PCa, ePLND could be an oncological benefit; however, a functional compromise cannot be determined.

Concurrent Autophagy Inhibition Overcomes the Resistance of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors in Human Bladder Cancer Cells

Despite the potential therapeutic efficacy of epithelial growth factor receptor (EGFR) inhibitors in the treatment of advanced stage bladder cancer, there currently is no clear evidence to support this hypothesis. In this study, we investigate whether the concurrent treatment of autophagy-blocking agents with EGFR inhibitors exerts synergistic anti-cancer effects in T24 and J82 human bladder cancer cells. Lapatinib and gefitinib were used as EGFR inhibitors, and bafilomycin A1 (BFA1), chloroquine (CQ) and 3-methyladenine (3-MA) were used as the pharmacologic inhibitors of autophagy activities. To assess the proliferative and self-renewal capabilities, the Cell Counting Kit-8 (CCK-8) assay and a clonogenic assay were performed, respectively. To examine apoptotic cell death, flow cytometry using annexin-V/propidium iodide (PI) was used. To measure the autophagy activities, the expression levels of LC3I and II was determined by Western blot analysis. To validate the synergistic effects of autophagy inhibition with EGFR inhibitors, we specifically blocked key autophagy regulatory gene ATG12 by transfection of small interference RNA and examined the phenotypic changes. Of note, lapatinib and gefitinib triggered autophagy activities in T24 and J82 human bladder cancer cells, as indicated by upregulation of LC3II. More importantly, inhibiting autophagy activities with pharmacologic inhibitors (BFA1, CQ or 3-MA) remarkably reduced the cell viabilities and clonal proliferation of T24 and J82 cells, compared to those treated with either of the agents alone. We also obtained similar results of the enhanced anti-cancer effects of EGFR inhibitors by suppressing the expression of ATG12. Notably, the apoptotic assay showed that synergistic anti-cancer effects were induced via the increase of apoptotic cell death. In summary, concomitant inhibition of autophagy activities potentiated the anti-cancer effects of EGFR inhibitors in human bladder cancer cells, indicating a novel therapeutic strategy to treat advanced bladder cancer.

Hand assisted laparoscopic radical nephrectomy: comparison with open radical nephrectomy

PURPOSE

We compared the results of hand assisted laparoscopic and conventional open radical nephrectomy.

MATERIALS AND METHODS

Clinical data on 54 hand assisted and 50 open radical nephrectomies performed at our hospital from September 1999 to October 2002 were reviewed.

RESULTS

Mean operative time in the laparoscopic and open groups was similar (194.9 and 180.7 minutes, respectively, p = 0.087). However, estimated mean blood loss (182.8 vs 262.8 ml, p <0.001), mean days to oral intake (2.6 vs 3.7 days, p <0.001) mean duration of an indwelling drain (2.6 vs 3.2 days, p <0.001) and mean hospital stay (6.8 vs 8.9 days, p <0.001) were significantly less in the laparoscopic group. In the laparoscopic group no conversions or re-explorations were required and no major complications occurred.

CONCLUSIONS

Our findings suggest that hand assisted laparoscopic radical nephrectomy represents an effective, minimally invasive treatment option in patients with suspected renal cell carcinoma.

Concurrent treatment with simvastatin and NF-κB inhibitor in human castration-resistant prostate cancer cells exerts synergistic anti-cancer effects via control of the NF-κB/LIN28/let-7 miRNA signaling pathway

We examined the anti-cancer effects and molecular mechanism of simvastatin in human castration-resistant prostate cancer (CRPC) cells, particularly focused on LIN28B and its target molecule, let-7 microRNA (miRNA) among the various target genes of NF-κB. A human CRPC cell line (PC3) was used in the current study. Gene expression patterns were evaluated using real time-PCR and western blot analysis. CCK-8 assay was used for assessing cell viability and proliferation, and a clonogenic assay was adopted to evaluate clonal proliferative capabilities. Induction of apoptotic cell death was analyzed via flow cytometry. Small interfering RNA (siRNA) and short-hairpin RNA (shRNA) were used for manipulating the expression of genes of interest. PC3 showed relatively higher expression levels of LIN28B and lower expression levels of let-7 miRNAs. Simvastatin treatment significantly inhibited cell viability and clonal proliferation in a dose-dependent manner. Importantly, the downregulated let-7 miRNA family was restored after simvastatin treatment. We further observed that human CRPC cells transfected with LIN28B-siRNA or shRNA also showed upregulated let-7 miRNAs. Finally, dual treatment with simvastatin and an NF-κB inhibitor (CAPE) synergistically induced apoptotic cell death, along with reduction of LIN28B expression, and restoration of let-7 miRNAs levels. Our data illustrate that simvastatin remarkably inhibits the growth of human CRPC cells by suppressing NF-κB and LIN28B and subsequently upregulating let-7 miRNAs. Moreover, concurrent treatment with simvastatin and an NF-κB inhibitor synergistically suppressed the growth of human CRPC cells, suggesting a novel therapeutic approach for human CRPC treatment.

Accuracy of post-void residual urine volume measurement using a portable ultrasound bladder scanner with real-time pre-scan imaging

AIMS

To evaluate whether the bladder scanner with real-time pre-scan imaging (RPI) is superior to the conventional bladder scanner in measuring post-void residual urine (PVR) volume.

METHODS

Sixty-seven patients with voiding dysfunction were subjected to PVR volume measurements. The PVR volume was measured three times by two experienced examiners using bladder scanners with (BioCon-500, Mcube Technology, Seoul, Korea) or without (BVI-3000 BladderScan, Verathon, WA) RPI. Immediately after the procedure, urethral catheterization was performed to obtain true volume. The accuracy and variability of measurements were compared between the two devices and correlation coefficients were obtained.

RESULTS

The Pearson correlation coefficients between the PVR volume measured by each device and the true volume were 0.932 for the bladder scanner without RPI and 0.950 for the bladder scanner with RPI. The bladder scanner without RPI tended to overestimate the true volume in moderate volume ranges (>100 ml) by a mean percentage of differences of volume (PDV) of 16.3%, while the bladder scanner with RPI underestimated the true volume in the whole volume range by a mean PDV of -14.1% (P<0.001). Repeated measures ANOVA showed no significant interobserver variability (P=0.977 for the bladder scanner without RPI and P=0.853 for the bladder scanner with RPI) or intraobserver variability (P=0.660 for the bladder scanner without RPI and P=0.271 for the bladder scanner with RPI).

CONCLUSIONS

Our results showed that exact pointing to the bladder prior to actual measurement of bladder volume with RPI seems to reduce the variability of the measured values.

Partial nephrectomy versus radical nephrectomy for non-metastatic pathological T3a renal cell carcinoma: a multi-institutional comparative analysis

OBJECTIVES

To compare the recurrence-free survival of partial nephrectomy and radical nephrectomy in patients with non-metastatic pathological T3a renal cell carcinoma.

METHODS

We reviewed the records of 3567 patients who had undergone a nephrectomy for renal cell carcinoma at five institutions in Korea from January 2000 to December 2010. The clinical data of 45 patients with pathological T3a renal cell carcinoma in the partial nephrectomy group were compared with 298 patients with pathological T3a renal cell carcinoma in the radical nephrectomy group. The effects of surgical methods on recurrence-free survival were assessed by a multivariate Cox proportional hazard analysis. All comparisons were repeated in subgroup analysis on 63 clinical T1a patients with tumors ≤4 cm.

RESULTS

During a median 43-month follow-up period, disease recurrence occurred in two patients (4.4%) in the partial nephrectomy group, and 94 patients (31.5%) in the radical nephrectomy group. The results from a multivariate model showed that radical nephrectomy was a significant predictor of recurrence. However, in subgroup analysis that included 63 clinical T1a pathological T3a patients, the recurrence-free survival rates were not significantly different between the two cohorts. The renal function was significantly better preserved in the partial nephrectomy cohort than in the radical nephrectomy cohort.

CONCLUSIONS

Partial nephrectomy provides similar recurrence-free survival outcomes compared with radical nephrectomy in patients with clinical T1a pathological T3a renal cell carcinoma. However, there seems to be a higher risk of recurrence for large pathological T3a tumors treated by radical nephrectomy compared with small tumors treated by partial nephrectomy. Thus, large tumors with the same pathological T3a renal cell carcinoma grade could have hidden aggressive features.

Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate

AIMS

To investigate the incidence of de novo urinary incontinence (UI) after holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia and to determine predictors of postoperative de novo UI.

METHODS

A total of 204 men who underwent HoLEP and in whom 12-month follow-up data on UI were available were included in this study. The efficacy of HoLEP was assessed at 1-, 3-, 6-, and 12-month postoperatively using the International Prostate Symptom Score (IPSS) and with uroflowmetry. The presence or absence of UI was recorded at each follow-up visit. All definitions of UI corresponded to recommendations of the International Continence Society.

RESULTS

The mean preoperative total prostate and transition zone volumes were 53.3 (range 20-162) g and 27.2 (range 4-107) g, respectively. The mean enucleated weight was 23.0 (range 3.0-82.3) g. The IPSS and uroflowmetry showed that all micturition parameters improved significantly starting at 1-month postoperatively. After HoLEP, 29 patients (16.2%) had de novo UI, most of which resolved within 1-6 months; 11 had stress UI, 12 had urgency UI, and the remaining 6 had mixed UI. On logistic regression analysis, bladder mucosal injury during morcellation and maximum urethral closure pressure on baseline urodynamics were the independent predictors of de novo UI after surgery.

CONCLUSIONS

Our data suggest that HoLEP is effective in improving micturition, but de novo postoperative UI occurred in some patients although usually transient. Surgeons should be careful to not injure the bladder mucosa during morcellation.

Cross-cultural differences for adapting overactive bladder symptoms: results of an epidemiologic survey in Korea

The purpose of this study was to evaluate the prevalence of overactive bladder (OAB) in a Korean national community sample of adults aged 40-89 years. A national Korean telephone survey using quota sampling methods was conducted. A clinically validated computer-assisted telephone interview approach was used in the survey. In 2,005 subjects (1,005 women and 1,000 men) interviewed, the prevalence of OAB(wet) increased with age in both men and women but OAB(dry) did not. OAB(dry) of men and women was not different in each age decade but OAB(wet) was more common among women than men aged <70 years. Multivariate analysis indicated that sex, age and body mass index (BMI) were associated with OAB(dry). For OAB(wet), sex and age were independent risk factors but BMI was not. In multivariate analysis, urgency was not associated with an increased likelihood of the impact on sexual life in men. The likelihood of the impact on sexual life, quality of life (QOL) and willingness to seek medical consultation was not related to nocturia. In female subjects, odds ratios for the impact of daily living, sexual life, QOL, and willingness to seek help from a health professional were not increased for nocuria. The likelihood of the impact on sexual life and willingness to seek medical help was not related to urge incontinence. Our study provides a valuable insight into the need for tailored education to this population about OAB. These findings suggest that there are cross-cultural differences for adapting OAB symptoms.