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Hyun CL, Park KK. The feasibility of distance to the tumor of biopsy cores to estimate the extracapsular extension. Prostate Int 2023; 11:233-238. [PMID: 38196557 PMCID: PMC10772149 DOI: 10.1016/j.prnil.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 01/11/2024] Open
Abstract
Background To investigate the predictive capability of a new parameter, the distance between the fibromuscular capsule and the tumor as measured using a prostate biopsy core (referred to as "distance to the tumor" [DTT]), for the presence of extracapsular extension (ECE). Materials and methods We analyzed specimens obtained from 246 patients diagnosed with prostate cancer. All patients underwent prebiopsy, prostate magnetic resonance imaging (MRI), and subsequent prostatectomy. DTT measurements were obtained for each prostate biopsy core, and the minimum (min) DTT was extracted. We assessed the relationship between min DTT, MRI-estimated ECE, and pathological ECE, considering factors such as the PI-RADS score and tumor location. Results In this study of 246 patients, the mean age was 65.8 years, and the mean prostate-specific antigen (PSA) level was 18.9 ng/ml. Patients with suspicious lesions in the peripheral zone and pathological ECE displayed higher rates of positive digital rectal examination (DRE), elevated PSA levels, and shorter DTT values in the biopsy cores. DTT demonstrated an accurate estimation of the presence of ECE, similar to MRI findings. Min DTT exhibited higher accuracy for peripheral zone masses, with a cutoff value of 1.0 mm for min DTT predicting ECE (AUC: 0.84, sensitivity: 72.23%, specificity: 77.78%, P < 0.01). Of the 246 patients, 66 had no ECE on MRI; however, 18 of these patients displayed pathological ECE, with 14 having DTT values <1.0 mm. Conclusions Min DTT, positive DRE results, and a higher Gleason grade were significantly associated with ECE. DTT measurements of <1 mm can provide a more accurate prediction of ECE in the peripheral zone of the prostate than MRI-based assessments.
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Affiliation(s)
- Chang Lim Hyun
- Department of Pathology, School of Medicine, Jeju National University, Jeju, Korea
| | - Kyung Kgi Park
- Department of Urology, School of Medicine, Jeju National University, Jeju, Korea
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2
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Song SH, Byun SS. Polygenic risk score for genetic evaluation of prostate cancer risk in Asian populations: A narrative review. Investig Clin Urol 2021; 62:256-266. [PMID: 33943048 PMCID: PMC8100017 DOI: 10.4111/icu.20210124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 12/16/2022] Open
Abstract
Decreasing costs of genetic testing and interest in disease inheritance has changed the landscape of cancer prediction in prostate cancer (PCa), and guidelines now include genetic testing for high-risk groups. Familial and hereditary PCa comprises approximately 20% and 5% of all PCa, respectively. Multifaceted disorders like PCa are caused by a combinatory effect of rare genes of high penetrance and smaller genetic variants of relatively lower effect size. Polygenic risk score (PRS) is a novel tool utilizing PCa-associated single nucleotide polymorphisms (SNPs) identified from genome-wide association study (GWAS) to generate an additive estimate of an individual's lifetime genetic risk for cancer. However, most PRS are developed based on GWAS collected from mainly European populations and do not address ethnic differences in PCa genetics. This review highlights the attempts to generate a PRS tailored to Asian males including data from Korea, China, and Japan, and discuss the clinical implications for prediction of early onset and aggressive PCa.
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Affiliation(s)
- Sang Hun Song
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seok Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Korea.
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3
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Song SH, Kim JK, Lee H, Lee S, Hong SK, Byun SS. A single-center long-term experience of active surveillance for prostate cancer: 15 years of follow-up. Investig Clin Urol 2020; 62:32-38. [PMID: 33258324 PMCID: PMC7801164 DOI: 10.4111/icu.20200206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/29/2020] [Accepted: 07/17/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose To describe a single-center 15-year experience of active surveillance (AS) for prostate cancer (PCa). Materials and Methods We retrospectively reviewed patients who underwent AS between 2003 and 2018. One hundred fifty-three patients were selected according to the following criteria: (1) biopsy Gleason pattern ≤3+4 with (2) ≤two positive core(s) and (3) ≤50% core involvement, clinical-stage ≤T2a, and prostate-specific antigen (PSA) ≤20 ng/mL. Follow-up included PSA measurement every six months, prostate biopsies at one year and then every 2–3 years, and MRI every year. Intervention was triggered by (1) Gleason score (GS) upgrading, (2) >two positive cores, or (3) PSA doubling-time in <3 years. Results Mean (±standard deviation) follow-up was 36.4 (±31.9) months. Ninety-three (60.8%) and 20 (13.1%) patients received second and third biopsies, respectively. Seventy-two patients (47.1%) discontinued AS for various reasons (59, intervention; 13, follow-up loss). Reasons for intervention consisted of GS upgrading (42.4%), >two positive cores (8.5%), abnormal PSA kinetics (11.9%), and patient preference (37.3%). Notably, 12 (25.5%) patients had pathologic GS ≥4+3 (unfavorable disease) and 3 (6.4%) patients had pathologic stage ≥T3a at radical prostatectomy. Median time to treatment-free survival was 19.5 months. Of the 59 patients who switched to intervention, biochemical recurrence was reported in only one (0.7%) patient. Conclusions AS is an available option for low-risk PCa in carefully selected patients. Further larger prospective studies are needed to determine the optimal criteria for AS, especially in Korean PCa patients.
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Affiliation(s)
- Sang Hun Song
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Kwon Kim
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hakmin Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
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Singh S, Patil S, Tamhankar AS, Ahluwalia P, Gautam G. Low-risk prostate cancer in India: Is active surveillance a valid treatment option? Indian J Urol 2020; 36:184-190. [PMID: 33082633 PMCID: PMC7531380 DOI: 10.4103/iju.iju_37_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/08/2020] [Accepted: 05/03/2020] [Indexed: 01/24/2023] Open
Abstract
Introduction and Objective: Carcinoma prostate is considered highly aggressive in Asian countries such as India. This raises an argument whether active surveillance (AS) gives a false sense of security as opposed to upfront radical prostatectomy (RP) in Indian males with low-risk prostate cancer (PCa). We analyzed our prospectively maintained robot-assisted RP (RARP) database to address this question. Materials and Methods: Five hundred and sixty-seven men underwent RARP by a single surgical team from September 2013 to September 2019. Of these, 46 (8.1%) were low risk considering the National Comprehensive Cancer Network criteria. Gleason grade group and stage were compared before and after surgery to ascertain the incidence of upgrading and upstaging. Preoperative clinical and pathological characteristics were analyzed for association with the probability of upstaging and upgrading. Results: The mean age was 60.8 ± 6.8 years. Average prostate-specific antigen level was 6.7 ± 2.0 ng/mL. 40 (86.9%) patients had a T1 stage disease and 6 (13%) patients were clinically in T2a stage. A total of 25 (54.3%) cases were either upstaged or upgraded, 19 (41.3%) showed no change, and the remaining 2 (4.3%) had no malignancy on the final RP specimen. Upstaging occurred in 8 (17.4%) cases: 5 (10.9%) to pT3a and 3 (6.5%) to pT3b. Upgrading occurred in 23 (50%) cases: 19 (41.3%) to Grade 2; 3 (6.5%) to Grade 3; and 1 (2.2%) to Grade 4. Conclusions: There is a 50% likelihood of upstaging or upgrading in Indian males with low-risk PCa eligible for AS. Decision to proceed with AS should be taken carefully.
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Affiliation(s)
- Shanky Singh
- Department of Urology, AIIMS, Rishikesh, Uttarakhand, India
| | - Saurabh Patil
- Department of Urooncology, Max Institute of Cancer Care, New Delhi, India
| | | | - Puneet Ahluwalia
- Department of Urooncology, Max Institute of Cancer Care, New Delhi, India
| | - Gagan Gautam
- Department of Urooncology, Max Institute of Cancer Care, New Delhi, India
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5
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Song G, Ruan M, Wang H, Lin Z, Wang X, Li X, Li P, Wang Y, Zhou B, Hu X, Liu H, Wang H, Guo Y. Predictive model using prostate MRI findings can predict candidates for nerve sparing radical prostatectomy among low-intermediate risk prostate cancer patients. Transl Androl Urol 2020; 9:437-444. [PMID: 32420149 PMCID: PMC7215049 DOI: 10.21037/tau.2020.01.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background In order to improve postoperative functional outcome, including urinary continence and erectile function, nerve sparing surgery is recommended for patients with clinically localized prostate cancer (PCa). However, due to poor diagnosis accuracy at the preoperative stage, upstaging occurs in a considerable proportion of patients. Multiparametric magnetic resonance imaging (mpMRI) and the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) have recently shown excellent performance in diagnosis and staging of PCa. The aim of this study was to develop a predictive model based on PI-RADS v2 for postoperative upstaging in patients with low-intermediate risk PCa. Methods The medical records of 314 patients with low-intermediate risk PCa [prostate-specific antigen (PSA) level ≤20 ng/mL, Gleason score (GS) <8, and clinical stage < T3] who underwent preoperative mpMRI and radical prostatectomy in the Department of Urology, Peking University First Hospital between January 2012 and July 2019 were reviewed retrospectively. Clinicopathological characteristics were collected. All MRI reports were done at our institution as part of routine clinical practice before prostate biopsy and there was no re-reporting occurred. Using PI-RADS v2, the mpMRI results were assigned to three groups: “negative”, “suspicious”, and “positive”. Multivariate logistic regression analysis was used to assess factors associated with postoperative pathological upstaging, defined as the presence of pT3 at final pathology. A regression coefficient based model for predicting postoperative upstaging was constructed and internally validated using 1,000 bootstrap resamples. The performance of the model was assessed using the area under the receiver operating characteristic curve (AUC). With the optimal cutoff point the performance of the model was assessed through analysis of sensitivity, specificity, positive predictive value, and negative predictive value. Results Upstaging was observed in 119 (37.9%) patients. The univariate and multivariate analyses revealed that PSA density, biopsy Gleason grade group (GGG), and mpMRI findings were significantly independent predictors for postoperative upstaging (all P<0.05). A predictive model showing very favorable calibration characteristics and higher accuracy than the single variables was constructed (AUC =0.74; P<0.001). At the optimal cutoff point, the model demonstrated a sensitivity and negative predictive value of 87.4% and 87.0%, respectively. Conclusions PI-RADS v2 assessment proved to be one of the most valuable predictors for postoperative upstaging in patients with low-intermediate risk PCa. The predictive model, based on PI-RADS v2 assessment, PSA density, and biopsy GGG, may help to select suitable candidates for nerve sparing radical prostatectomy among patients with low-intermediate risk PCa.
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Affiliation(s)
- Gang Song
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Urological Cancer Center of China, Beijing 100034, China
| | - Mingjian Ruan
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Urological Cancer Center of China, Beijing 100034, China
| | - He Wang
- Department of Radiology, Peking University First Hospital, Beijing 100034, China
| | - Zhiyong Lin
- Department of Radiology, Peking University First Hospital, Beijing 100034, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, Beijing 100034, China
| | - Xueying Li
- Department of Statistics, Peking University First Hospital, Beijing 100034, China
| | - Peng Li
- Department of Ultrasound, Peking University First Hospital, Beijing 100034, China
| | - Yandong Wang
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Urological Cancer Center of China, Beijing 100034, China.,Department of Urology, the People's Hospital of Guizhou Province, Guiyang 550002, China
| | - Binyi Zhou
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Urological Cancer Center of China, Beijing 100034, China
| | - Xuege Hu
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Urological Cancer Center of China, Beijing 100034, China
| | - Hua Liu
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Urological Cancer Center of China, Beijing 100034, China
| | - Hao Wang
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Urological Cancer Center of China, Beijing 100034, China
| | - Yinglu Guo
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, Beijing 100034, China.,National Urological Cancer Center of China, Beijing 100034, China
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6
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Morrison BF, Aiken WD, Reid G, Mayhew R, Hanchard B. Pathological upgrading and upstaging at radical prostatectomy in Jamaican men with low-risk prostate cancer. Ecancermedicalscience 2019; 13:971. [PMID: 31921342 PMCID: PMC6834384 DOI: 10.3332/ecancer.2019.971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Indexed: 01/05/2023] Open
Abstract
Several studies suggest race-based health disparities in men with low-risk prostate cancer (PCa), with African American males having poorer oncological outcomes. We sought to determine the prevalence and predictors of pathological upgrading and upstaging in Jamaican men with low-risk PCa treated with radical prostatectomy (RP). Data on 141 men who met the National Comprehensive Cancer Network criteria for low-risk PCa and underwent RP at a single institution were reviewed. All men had a transrectal ultrasound-guided biopsy. Pre-operative clinical and final pathological data were obtained. Data were summarised as means and standard deviations or percentages as appropriate. Bivariate analyses such as independent samples t-tests and chi-square tables were conducted and logistic regression models were estimated to predict upgrading (>Gleason 6) and upstaging (p ≥ T3). The mean age was 59.5 ± 7.8 years with mean prostate specific antigen (PSA) of 6.6 ± 2 ng/mL. A total of 48.3% of men were upgraded and 11.4% were upstaged. Bivariate analyses indicated that PSA (p = 0.008) and percentage positive cores (p = 0.002) were associated with upgrading. PSA (p = 0.042) and percentage positive cores (p = 0.003) were significantly associated with upstaging. The odds of upgrading increased with increased PSA levels (OR 1.40, 95% CI 1.05-1.87, p = 0.021) or increased percentage positive cores (OR 8.27, 95% CI 2.19-31.16, p = 0.002). The odds of upstaging increased with increased PSA levels (OR 1.4, 95% CI 1.01-1.96, p = 0.046) and with increased percentages positive cores (OR 11.4; 95% CI 2.06-63.09, p = 0.005). Jamaican men with low-risk PCa are at high risk of pathological upgrading and upstaging at RP. These findings should be taken into consideration when discussing treatment options with these patients.
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Affiliation(s)
| | | | - Gareth Reid
- University of the West Indies, Mona PO, Kingston 7, Jamaica
| | - Richard Mayhew
- University of the West Indies, Mona PO, Kingston 7, Jamaica
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7
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Huang QX, Xiao CT, Chen Z, Lu MH, Pang J, Di JM, Luo ZH, Gao X. Combined analysis of CRMP4 methylation levels and CAPRA-S score predicts metastasis and outcomes in prostate cancer patients. Asian J Androl 2019; 20:56-61. [PMID: 28382925 PMCID: PMC5753555 DOI: 10.4103/aja.aja_3_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The present study analyzed the predictive value of combined analysis of collapsin response mediator protein 4 (CRMP4) methylation levels and the Cancer of the Prostate Risk Assessment (CAPRA-S) Postsurgical score of patients who required adjuvant hormone therapy (AHT) after radical prostatectomy (RP). We retrospectively analyzed 305 patients with prostate cancer (PCa) who received RP and subsequent androgen deprivation therapy (ADT). Two hundred and thirty patients with clinically high-risk PCa underwent immediate ADT, and 75 patients with intermediate risk PCa underwent deferred ADT. CRMP4 methylation levels in biopsies were determined, and CAPRA-S scores were calculated. In the deferred ADT group, the values of the hazard ratios for tumor progression and cancer-specific mortality (CSM) in patients with ≥15% CRMP4 methylation were 6.81 (95% CI: 2.34–19.80) and 12.83 (95% CI: 2.16–26.10), respectively. Receiver-operating characteristic curve analysis indicated that CRMP4 methylation levels ≥15% served as a significant prognostic marker of tumor progression and CSM. In the immediate ADT group, CAPRA-S scores ≥6 and CRMP4 methylation levels ≥15% were independent predictors of these outcomes (uni- and multi-variable Cox regression analyses). The differences in the 5-year progression-free survival between each combination were statistically significant. Combining CAPRA-S score and CRMP4 methylation levels improved the area under the curve compared with the CRMP4 or CAPRA-S model. Therefore, CRMP4 methylation levels ≥15% were significantly associated with a poor prognosis and their combination with CAPRA-S score accurately predicted tumor progression and metastasis for patients requiring AHT after RP.
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Affiliation(s)
- Qun-Xiong Huang
- Department of Urology, The Third Affiliated Hospital of Sun-Yat sen University, Guangzhou 510630, China
| | - Chu-Tian Xiao
- Department of Urology, The Third Affiliated Hospital of Sun-Yat sen University, Guangzhou 510630, China
| | - Zheng Chen
- Department of Urology, The Third Affiliated Hospital of Sun-Yat sen University, Guangzhou 510630, China
| | - Min-Hua Lu
- Department of Urology, The Third Affiliated Hospital of Sun-Yat sen University, Guangzhou 510630, China
| | - Jun Pang
- Department of Urology, The Third Affiliated Hospital of Sun-Yat sen University, Guangzhou 510630, China
| | - Jin-Ming Di
- Department of Urology, The Third Affiliated Hospital of Sun-Yat sen University, Guangzhou 510630, China
| | - Zi-Huan Luo
- Department of Urology, The Third Affiliated Hospital of Sun-Yat sen University, Guangzhou 510630, China
| | - Xin Gao
- Department of Urology, The Third Affiliated Hospital of Sun-Yat sen University, Guangzhou 510630, China
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8
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Lee HY, Park S, Doo SW, Yang WJ, Song YS, Kim JH. Trends in Prostate Cancer Prevalence and Radical Prostatectomy Rate according to Age Structural Changes in South Korea between 2005 and 2015. Yonsei Med J 2019; 60:257-266. [PMID: 30799588 PMCID: PMC6391527 DOI: 10.3349/ymj.2019.60.3.257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Radical prostatectomy (RP) is one of main treatments for prostate cancer (Pca). The prevalence of Pca has been decreasing in recent reports. However, no study has reported trends in Pca prevalence or RP rate according to age structural changes. The objective of this study was to investigate trends in Pca prevalence and frequency of RP according to age structural change. MATERIALS AND METHODS We evaluated trends in Pca prevalence and RP rate using National Health Insurance Data from 2005 to 2015. Relationships for Pca prevalence and RP rate with age structural change were also determined. Primary outcomes included trends in Pca prevalence and RP rates according to age groups, comparing those before and after 2011. RESULTS Pca prevalence tended to increase before 2011 and decreased after 2011 in persons in the 60-years age group. RP rate increased pattern before 2011 and decreased after 2011 in age groups of 50s, 60s, and over 70s. Pca prevalence and age structural change showed a significantly positive relationship in all age groups, except for the age group under 40 years. RP rate and age structural change also showed a significantly positive relationship in all age groups. CONCLUSION Age structural change can affect the decreasing trend in Pca prevalence and RP rate in South Korea. Future studies are needed to validate this result.
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Affiliation(s)
- Hyun Young Lee
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Seung Whan Doo
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, Korea
| | - Won Jae Yang
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, Korea
| | - Yun Seob Song
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, Korea.
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Ha JY, Shin TJ, Jung W, Kim BH, Park CH, Kim CI. Updated clinical results of active surveillance of very-low-risk prostate cancer in Korean men: 8 years of follow-up. Investig Clin Urol 2017; 58:164-170. [PMID: 28480341 PMCID: PMC5419108 DOI: 10.4111/icu.2017.58.3.164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/20/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose Update and reanalysis of our experience of active surveillance (AS) for prostate cancer (PCa) in Korea. Materials and Methods A prospective, single-arm, cohort study was initiated in January 2008. Patients were selected according to the following criteria: Gleason sum ≤6 with single positive core with ≤30% core involvement, clinical stage≤T1c, prostate-specific antigen (PSA)≤10 ng/mL, and negative magnetic resonance imaging (MRI) results. Follow-up was by PSA measurement every 6 months, prostate biopsies at 1 year and then every 2–3 years, and MRI every year. Results A total of 80 patients were treated with AS. Median follow-up was 52 months (range, 6–96 months). Of them, 39 patients (48.8%) discontinued AS for various reasons (17, disease progression; 9, patient preference; 10, watchful waiting due to old age; 3, follow-up loss; 2, death). The probability of progression was 14.0% and 42.9% at 1 and 3 years, respectively. Overall survival was 97.5%. PCa-specific survival was 100%. Progression occurred in 5 of 7 patients (71.4%) with a prostate volume less than 30 mL, 7 of 40 patients (17.5%) with a prostate volume of 30 to 50 mL, and 5 of 33 patients (15.2%) with a prostate volume of 50 mL or larger. There were 8 detectable positive lesions on follow-up MRI. Of them, 6 patients (75%) had actual progressed disease. Conclusions Small prostate volume was associated with a tendency for cancer progression. MRI was helpful and promising for managing AS. Nevertheless, regular biopsies should be performed. AS is a safe and feasible treatment option for very-low-risk PCa in Korea. However, AS should continue to be used in carefully selected patients.
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Affiliation(s)
- Ji Yong Ha
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
| | - Teak Jun Shin
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
| | - Wonho Jung
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
| | - Byung Hoon Kim
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
| | - Choal Hee Park
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
| | - Chun Il Kim
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
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10
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Santok GDR, Abdel Raheem A, Kim LHC, Chang K, Lum TGH, Chung BH, Choi YD, Rha KH. Prostate-specific antigen 10-20 ng/mL: A predictor of degree of upgrading to ≥8 among patients with biopsy Gleason score 6. Investig Clin Urol 2017; 58:90-97. [PMID: 28261677 PMCID: PMC5330379 DOI: 10.4111/icu.2017.58.2.90] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/22/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study aimed to identify the predictors of upgrading and degree of upgrading among patients who have initial Gleason score (GS) 6 treated with robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS A retrospective review of the data of 359 men with an initial biopsy GS 6, localized prostate cancer who underwent RARP between July 2005 to June 2010 was performed. They were grouped into group 1 (nonupgrade) and group 2 (upgraded) based on their prostatectomy specimen GS. Logistic regression analysis of studied cases identified significant predictors of upgrading and the degree of upgrading after RARP. RESULTS The mean age and prostate-specific antigen (PSA) was 63±7.5 years, 8.9±8.77 ng/mL, respectively. Median follow-up was 59 months (interquartile range, 47-70 months). On multivariable analysis, age, PSA, PSA density and ≥2 cores positive were predictors of upgrading with (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.06; p=0.003; OR, 1.006; 95% CI, 1.01-1.11; p=0.018; OR, 0.65; 95% CI, 0.43-0.98, p=0.04), respectively. On subanalysis, only PSA level of 10-20 ng/mL is associated with upgrading into GS ≥8. They also had lower biochemical recurrence free survival, cancer specific survival, and overall survival (p≤0.001, p=0.003, and p=0.01, respectively). CONCLUSIONS Gleason score 6 patients with PSA (10-20 ng/mL) have an increased risk of upgrading to pathologic GS (≥8), subsequently poorer oncological outcome thus require a stricter follow-up. These patients should be carefully counseled in making an optimal treatment decision.
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Affiliation(s)
- Glen Denmer R. Santok
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ali Abdel Raheem
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Urology, Tanta University Medical School, Tanta, Egypt
| | - Lawrence HC Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kidon Chang
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Trenton GH Lum
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ha Chung
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Xu M, Zhang L, Liang C. Is it appropriate to conduct conventional active surveillance for Asian men with low-risk prostate cancer? Int Urol Nephrol 2016; 48:1287-1289. [PMID: 27118567 DOI: 10.1007/s11255-016-1287-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/07/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Ming Xu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Li Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China. .,Institute of Urology, Anhui Medical University, Hefei, China.
| | - Chaozhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China. .,Institute of Urology, Anhui Medical University, Hefei, China.
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De Cobelli O, Buonerba C, Terracciano D, Bottero D, Lucarelli G, Bove P, Altieri V, Coman I, Perdonà S, Facchini G, Berretta M, Di Lorenzo G, Grieco P, Novellino E, Franco R, Caraglia M, Manini C, Mirone V, De Placido S, Sonpavde G, Ferro M. Urotensin II receptor on preoperative biopsy is associated with upstaging and upgrading in prostate cancer. Future Oncol 2015; 11:3091-8. [PMID: 26381851 DOI: 10.2217/fon.15.249] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
AIM A higher Gleason score was associated with a lower tumor urotensin II receptor (UTII-R) expression in prostate cancer patients. METHODS A retrospective review of formalin-fixed paraffin-embedded tumor tissue derived from those who had prostatectomy and matching biopsy specimens was conducted at six Institutions. UTII-R expression was evaluated on biopsy by immunohistochemistry. RESULTS A total of 58 subjects undergoing radical prostatectomy were included. At multivariate analysis, low UTII-R expression was a significant predictor of Gleason upgrading, with an odds ratio of 10.3 (95% CI: 1.55-68.4), and of pathology upstaging, with an odds ratio of 11.1 (95% CI: 1.23-100.48). CONCLUSIONS UTII-R expression on biopsy was associated with Gleason upgrading and pathology upstaging in prostate cancer patients.
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Affiliation(s)
- Ottavio De Cobelli
- Division of Urology, European Institute of Oncology, Milan, Italy.,Department of Urology, 'Iuliu Hatieganu' University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - Carlo Buonerba
- Oncologia Urologica, Dipartimento di Medicina Clinica e Chirurgia, Azienda Ospedaliera Universitaria 'Federico II', Napoli, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University 'Federico II', Naples, Italy
| | - Danilo Bottero
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Giuseppe Lucarelli
- Department of Emergency & Organ Transplantation - Urology, Andrology & Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Pierluigi Bove
- Department of Urology, Tor Vergata University of Rome, V.le Oxford 81, Rome, 00133, Italy
| | - Vincenzo Altieri
- Department of Urology of San Giovanni di Dio & Ruggi d'Aragona Hospital, University of Salerno, Salerno, SA, Italy
| | - Ioman Coman
- Department of Urology, 'Iuliu Hatieganu' University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - Sisto Perdonà
- Department of Urology, National Cancer Institute of Naples, Naples, Italy
| | - Gaetano Facchini
- Gineco-urological Department, National Cancer Institute of Naples 'Fondazione G Pascale', Naples, Italy
| | | | - Giuseppe Di Lorenzo
- Oncologia Urologica, Dipartimento di Medicina Clinica e Chirurgia, Azienda Ospedaliera Universitaria 'Federico II', Napoli, Italy
| | - Paolo Grieco
- Department of Pharmacy, University of Naples, Federico II, Naples 80131, Italy
| | - Ettore Novellino
- Department of Pharmacy, University of Naples, Federico II, Naples 80131, Italy
| | - Renato Franco
- Pathology Unit, National Cancer Institute 'Fondazione G. Pascale', Naples, Italy
| | - Michele Caraglia
- Department of Biochemistry, Biophysics & General Pathology, Second University of Naples, Naples, Italy
| | - Claudia Manini
- Division of Pathology, Giovanni Bosco Hospital, Turin, Italy
| | - Vincenzo Mirone
- Urology Division, University Federico II of Naples, Napoli, Italy
| | - Sabino De Placido
- Oncologia Urologica, Dipartimento di Medicina Clinica e Chirurgia, Azienda Ospedaliera Universitaria 'Federico II', Napoli, Italy
| | - Guru Sonpavde
- UAB (University of Alabama at Birmingham) Cancer Center, Birmingham, AL 35233, USA
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
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