Can We Predict Real T3 Stage Prostate Cancer in Patients with Clinical T3 (cT3) Disease before Radical Prostatectomy?

이혜원,전성수,이현무,최한용,서성일 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.5

Purpose: Down-staging of clinical T3 (cT3) prostate cancer after radical prostatectomy (RP) is not uncommon due to the inaccuracy of the currently available staging modalities, although selected down-staged cT3 patients can be a candidate for definitive RP. We identified the significant predictors for down-staging of cT3after RP. Materials and Methods: We included 67 patients with cT3 stage prostate cancer treated with radical perineal prostatectomy (RPP) between 1998 and 2006and reviewed their medical records retrospectively. The clinical stage was obtained according to the DRE, the prostate biopsy findings, and the prostate MRI. Results:Fifty three (79%) patients with cT3 prostate cancer were down-staged to pT2 after RP. The percent of positive cores had the strongest association with down-staging of cT3 [p = 0.01, odds ratio (OR) = 6.3], followed by baseline prostate specific antigen (PSA) (p = 0.03, OR = 5.0), the biopsy Gleason sum (GS) (p = 0.03, OR =4.7), and the maximum tumor volume of the positive cores (p = 0.05, OR = 4.0). When the cut-off points of significant parameters which were a PSA < 10 ng/mL,a percent of positive cores ≤ 30%, a maximum tumor volume of the positive cores ≤ 75% and GS ≤ 7 were combined, the sensitivity, specificity, and positive predictive value were 0.25%, 1.00%, and 100%, respectively. Conclusion: The percent of positive cores ≤ 30%, serum PSA < 10 ng/mL, the biopsy GS ≤ 7, and the maximum tumor volume of the positive cores ≤ 75% were the significant predictors of down-staging cT3 disease after RP.

Incidence and Predictive Factors of Benign Renal Lesions in Korean Patients with Preoperative Imaging Diagnoses of Renal Cell Carcinoma

박서용,전성수,이서연,정병창,서성일,이현무,최한용 대한의학회 2011 Journal of Korean medical science Vol.26 No.3

The present study was performed to determine the incidence and predictive factors of benign renal lesions in Korean patients undergoing nephrectomy for presumed renal cell carcinoma on preoperative imaging. We analyzed the pathologic reports and medical records of 1,598 eligible patients with unilateral, nonmetastatic, and nonfamilial renal masses. Of the 1,598 renal masses, 114 (7.1%) were benign lesions, including angiomyolipoma in 47 (2.9%), oncocytoma in 23 (1.4%), and complicated cysts in 18(1.1%) patients. On univariate analysis, the proportion of benign lesions was significantly higher in female patients, and in patients with smaller tumors, cystic renal masses, and without gross hematuria as a presenting symptom. When renal lesions were stratified by tumor size, the proportion of benign as opposed to malignant lesions decreased significantly as tumor size increased. On multivariate analysis, female gender, smaller tumor size, and cystic lesions were significantly associated with benign histological features. The findings in this large cohort of Korean patients show a lower incidence (7.1%) of benign renal lesions than those of previous Western reports. Female gender, cystic renal lesions, and smaller tumor size are independent predictors of benign histological features.

Pure Laparoscopic Radical Cystectomy with Ileal Conduit: A Single Surgeon’s Mid-Term Outcomes

박범수,정병창,전성수,이현무,최한용,서성일 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.4

Purpose: The use of laparoscopic radical cystectomy (LRC) for muscle-invasive bladder cancer is not yet widespread because of the technical difficulties of the procedure and the lengthy operating time. In this study, we report a single surgeon’s experience with LRC. Materials and Methods: Thirty patients (25 men and 5 women) with bladder cancer underwent LRC and ileal conduit by a single surgeon between November 2007 and May 2011. An extracorporeal urinary diversion was performed through 5-6 cm midline incision for specimen extraction. Results:The median operating time and estimated blood loss were 527.5 minutes and 275 mL, respectively. There was no conversion to open surgery. The median time to oral intake and postoperative hospital stay were 5 days and 12 days, respectively. The rates of immediate, early postoperative and late postoperative complication were 3.3%, 20% and 20%, respectively. With 16 months of median follow-up, the overall and recurrence-free survival rates were 70% and 56.7%, respectively. Conclusion: LRC is feasible for the management of invasive bladder cancer and, with appropriate patient selection, can be a good alternative to open or robot-assisted radical cystectomy in the era of robot-assisted surgery.

Influence of Body Mass Index, Smoking, and Blood Pressure on Survival of Patients with Surgically-Treated, Low Stage Renal Cell Carcinoma: A 14-Year Retrospective Cohort Study

박범수,정병창,서성일,전성수,최한영,최한용,이현무 대한의학회 2013 Journal of Korean medical science Vol.28 No.2

The association of body mass index, smoking, and blood pressure, which are related to the three well-established risk factors of renal cell carcinoma, and survival in patients with renal cell carcinoma is not much studied. Our objective was to evaluate this association. A cohort of 1,036 patients with low stage (pT1 and pT2) renal cell carcinoma who underwent radical or partial nephrectomy were enrolled. We retrospectively reviewed medical records and collected survival data. The body mass index, smoking status, and blood pressure at the time of surgery were recorded. Patients were grouped according to their obesity grade,smoking status, and hypertension stage. Survival analysis showed a significant decrease in overall (P = 0.001) and cancer-specific survival (P < 0.001) with being underweight, with no differences of smoking status or perioperative blood pressure. On multivariate analysis,perioperative blood pressure ≥ 160/100 mmHg (HR, 2.642; 95% CI, 1.221-5.720) and being underweight (HR, 4.320; 95% CI, 1.557-11.984) were independent predictors of overall and cancer-specific mortality, respectively. Therefore, it is concluded that being underweight and perioperative blood pressure ≥ 160/100 mmHg negatively affect cancerspecific and overall survival, respectively, while smoking status does not influence survivals in patients with renal cell carcinoma.

Outcome of Prostate Biopsy in Men Younger than 40 Years of Age with High Prostate-Specific Antigen (PSA) Levels

양진백,정병창,서성일,전성수,최한용,이현무 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.1

Purpose: Prostate cancer is rarely diagnosed in men younger than 40 years of age. At present, the available data show a low rate of cancer detection from prostate-specific antigen (PSA) screening of this group of young men. We analyzed the outcome of prostate biopsy results in patients of this age group with a high PSA. Materials and Methods: Between October 1997 and August 2008, a total of 81 men less than 40 years of age were referred from the Health Care Promotion Center as the result of elevated PSA levels. Six men with prostatitis were excluded. The remaining 75 men were asymptomatic and had normal findings on the digital rectal examination (DRE) and were selected to have a transrectal ultrasound-guided prostate biopsy for suspected prostate cancer. The patients with sustained high PSA levels underwent repeat biopsies. Results: The median age of the 75 men was 33 years (range, 26-40 years) and the mean PSA level was 6.57 ng/ml (range, 4.32-13.45 ng/ml). The results of the primary biopsy was 1 (1.3%) case of prostate cancer, 70 cases (93%) with benign tissue, 2 cases (2.6%) with inflammation, and 1 case each (1.3%) with high grade intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP). Of the 10 men who underwent a second biopsy, all had benign findings. Three of the men who underwent a third biopsy all had benign tissue findings. Conclusions: The prostate cancer detection rate in young men less than 40 years of age with high PSA levels and normal DREs was very low. Repeat biopsy for sustained high PSA levels in young men less than 40 years of age may not be indicated. Purpose: Prostate cancer is rarely diagnosed in men younger than 40 years of age. At present, the available data show a low rate of cancer detection from prostate-specific antigen (PSA) screening of this group of young men. We analyzed the outcome of prostate biopsy results in patients of this age group with a high PSA. Materials and Methods: Between October 1997 and August 2008, a total of 81 men less than 40 years of age were referred from the Health Care Promotion Center as the result of elevated PSA levels. Six men with prostatitis were excluded. The remaining 75 men were asymptomatic and had normal findings on the digital rectal examination (DRE) and were selected to have a transrectal ultrasound-guided prostate biopsy for suspected prostate cancer. The patients with sustained high PSA levels underwent repeat biopsies. Results: The median age of the 75 men was 33 years (range, 26-40 years) and the mean PSA level was 6.57 ng/ml (range, 4.32-13.45 ng/ml). The results of the primary biopsy was 1 (1.3%) case of prostate cancer, 70 cases (93%) with benign tissue, 2 cases (2.6%) with inflammation, and 1 case each (1.3%) with high grade intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP). Of the 10 men who underwent a second biopsy, all had benign findings. Three of the men who underwent a third biopsy all had benign tissue findings. Conclusions: The prostate cancer detection rate in young men less than 40 years of age with high PSA levels and normal DREs was very low. Repeat biopsy for sustained high PSA levels in young men less than 40 years of age may not be indicated.

Efficacy and Safety of Hexaminolevulinate Fluorescence Cystoscopy in the Diagnosis of Bladder Cancer

이재승,이서연,김우중,서성일,전성수,이현무,최한용,정병창,김경문 대한비뇨의학회 2012 Investigative and Clinical Urology Vol.53 No.12

Purpose: The aim of this study was to evaluate the efficacy and safety of hexaminolevulinate fluorescence cystoscopy in the diagnosis of bladder cancer. Materials and Methods: In a prospective design, we included patients who had a bladder lesion suggesting bladder cancer. Patients with massive hematuria, urethral Foley catheter insertion, chronic retention state, or urinary tract infection were excluded. After the bladder was emptied, hexaminolevulinate was gently administered into the bladder. One hour later, cystoscopy under white light and blue light was performed. After marking the lesions confirmed with white light or blue light, transurethral resection of the bladder lesion and pathologic confirmation were done. Transurethral resection of the lesions that were negative in both white and blue light was also performed. Results: From April 2010 to September 2010, 30 patients were enrolled. From the total of 30 patients (25 men and 5 women; mean age, 60.4±9.22 years), 134 specimens were extracted. Among these, 101 specimens showed positive results by blue light cystoscopy (BLC). The sensitivity of BLC and white light cystoscopy (WLC) was 92.3% and 80.8%,respectively (p=0.021). The specificity of BLC and WLC was 48% and 49.1%, respectively (p>0.05). The positive and negative predictive values of BLC were 71.2% and 81.8%, respectively, whereas those of WLC were 72.0% and 68.6%, respectively. With WLC, 48 specimens showed negative findings, but of that group, 15 specimens (31.2%)were revealed to be malignant with BLC. There were no significant side effects in the 24 hours after the instillation of hexaminolevulinate. Conclusions: Photodynamic diagnosis with hexaminolevulinate helps to find tumors that could be missed by use of WLC only. Photodynamic diagnosis might be valuable in complete resection as well as for more accurate diagnosis of bladder tumor.

The clinical utility of transperineal template-guided saturation prostate biopsy for risk stratification after transrectal ultrasound-guided biopsy

송완,강민용,정병창,서성일,전성수,이현무,전황균 대한비뇨의학회 2019 Investigative and Clinical Urology Vol.60 No.6

Purpose: To investigate the clinical utility of transperineal template-guided saturation prostate biopsy (TPB) for risk stratification after transrectal ultrasound (TRUS)-guided biopsy. Materials and Methods: We retrospectively reviewed 155 patients who underwent TPB after previously negative results on TRUS-guided biopsy (n=58) or who were candidates for active surveillance (n=97) fulfilling the PRIAS criteria between May 2017 and November 2018. The patients' clinicopathologic data were reviewed, and the detection of clinically significant cancer (CSC) and upgrading of Gleason grade were identified. Results: The patients' median age and pre-TPB prostate-specific antigen (PSA) value were 65.0 years and 5.74 ng/mL, respectively. A median of 36 biopsy cores was obtained in each patient, with a median TPB core density of 0.88 cores/cm3. Of the 58 males with a previous negative result on TRUS-guided biopsy, prostate cancer (PCa) was detected in 17 males (29.3%), including 8 with CSC. Of the 97 patient candidates for active surveillance, upgrading of the Gleason grade was identified in 31 males (32.0%), 20 with a Gleason grade of 7 (3+4), 6 with a Gleason grade of 7 (4+3), and 5 with a Gleason grade of 8 (4+4). The overall complication rate was 14.8% (23/155), and there were no Clavien–Dindo grade 3 to 5 complications. Conclusions: TPB helps to stratify the risk of PCa that was previously missed or underdiagnosed by TRUS-guided biopsy. TPB might be used as a diagnostic tool to determine risk classification and to help counsel patients with regard to treatment decisions.

Is Radical Perineal Prostatectomy a Viable Therapeutic Option for Intermediate- and High-risk Prostate Cancer?

이혜원,전황균,정병창,서성일,전성수,이현무,최한용 대한의학회 2015 Journal of Korean medical science Vol.30 No.11

The aim of this study was to investigate a single-institution experience with radical perineal prostatectomy (RPP), radical retropubic prostatectomy (RRP) and minimally invasive radical prostatectomy (MIRP) with respect to onco-surgical outcomes in patients with intermediate-risk (IR; PSA 10-20 ng/mL, biopsy Gleason score bGS 7 or cT2b-2c) and highrisk (HR; PSA >20 ng/mL, bGS ≥8, or ≥cT3) prostate cancer (PCa). We retrospectively reviewed data from 2,581 men who underwent radical prostatectomy for IR and HR PCa (RPP, n = 689; RRP, n = 402; MIRP, n = 1,490 [laparoscopic, n = 206; robot-assisted laparoscopic, n = 1,284]). The proportion of HR PCa was 40.3%, 46.8%, and 49.5% in RPP, RRP, and MIRP (P < 0.001), respectively. The positive surgical margin rate was 23.8%, 26.1%, and 18.7% (P = 0.002) overall, 17.5%, 17.8%, and 8.8% (P < 0.001) for pT2 disease and 41.9%, 44.4%, and 40.0% (P = 0.55) for pT3 disease in men undergoing RPP, RRP, and MIRP, respectively. Biochemical recurrence-free survival rates among RPP, RRP, and MIRP were 73.0%, 70.1%, and 76.8%, respectively, at 5 yr (RPP vs. RPP, P = 0.02; RPP vs. MIRP, P = 0.23). Furthermore, comparable 5-yr metastases-free survival rates were demonstrated for specific surgical approaches (RPP vs. RPP, P = 0.26; RPP vs. MIRP, P = 0.06). RPP achieved acceptable oncological control for IR and HR PCa.

Diagnostic and Prognostic Significance of Radiologic Nodepositive Renal Cell Carcinoma in the Absence of Distant Metastases: A Retrospective Analysis of Patients Undergoing Nephrectomy and Lymph Node Dissection

이혜원,전황균,정병창,서성일,전성수,최한용,이현무 대한의학회 2015 Journal of Korean medical science Vol.30 No.9

The aim of this study was to evaluate the diagnostic and prognostic value of clinicalpositive nodes at preoperative imaging (cN1) in patients with non-metastatic renal cell carcinoma (RCC) treated with lymph node dissection (LND). We retrospectively reviewed data for a cohort of 440 consecutive patients (cN0, 76.8%; cN1, 23.2%) with cTanyNanyM0 RCC who underwent nephrectomy and LND from 1994 to 2013. Metastasisfree survival (MFS) and cancer-specific survival (CSS) were estimated using the Kaplan- Meier method. Multivariate Cox regression analysis was performed to determine significant predictors of MFS and CSS. The mean number of lymph nodes (LNs) examined for all patients was 8.3, and pN1 disease was identified in 31 (7.0%). LN staging by preoperative imaging had a sensitivity of 65%, a specificity of 80%, and an accuracy of 77%. During a median follow-up of 69 months, 5-yr MFS and CSS were 83.6% and 91.3% in patients with cN0 and 49.2% and 70.1% in patients with cN1, demonstrating a trend toward worse prognosis with radiologic lymphadenopathy (all P < 0.001). Furthermore, differences in MFS and CSS between the cN0pN0 and cN1pN0 groups were significant (all P < 0.001). Clinical nodal involvement is an important determinant of adverse prognosis in patients with non-metastatic RCC who undergo LND.

Comparison of Pathological and Biochemical Outcomes after Radical Prostatectomy in Korean Patients with Serum PSA Ranges

이혜원,전황균,정병창,서성일,전성수,최한용,이현무 대한의학회 2015 Journal of Korean medical science Vol.30 No.3

The aim of this study was to assess surgical outcome at radical prostatectomy (RP) inKorean men with a serum prostate-specific antigen (PSA) level of 2.5 to 3.0 ng/mL andcompared with those of patients who had a PSA level of 3.0-4.0 and 4.0-10.0 ng/mL. Weretrospectively compared clinico-pathological characteristics and biochemical recurrence(BCR) risk in patients with PSA level of 2.5-3.0 (group 1, n = 92, 5.7%), 3.0-4.0 (group 2,n = 283, 17.5%), or 4.0-10.0 ng/mL (group 3, n = 1,242, 76.8%) who underwent RPbetween 1995 and 2013. The pathologic characteristics including Gleason score, pathologicstage, and percentage of significant cancer in group 1 were similar to those in group 2 andgroup 3. Furthermore, pathological upgrading and upstaging were found in 23 (30.7%)and 10 (14.7%) in group 1, 84 (33.9%) and 19 (8.8%) in group 2, and 321 (32.8%) and113 (12.8%) in group 3, respectively, with no significant differences among the threegroups (all P > 0.05). In multivariate analysis, PSA grouping was not an independentpredictor of BCR. Within the population with PSA lower than 10 ng/mL, substratificationof PSA is not a significant predictor for upgrading, upstaging, or adverse prognosis.