Impacts of leuprolide acetate on quality of life in patients with prostate cancer: A prospective multicenter study

You, Dalsan,Jeong, In Gab,Kim, Sae Woong,Chung, Byung Ha,Cho, Jin Seon,Lee, Hyun Moo,Yun, Sung-Cheol,Kim, Choung-Soo Informa Healthcare 2010 Scandinavian journal of urology and nephrology Vol.44 No.6

<P><I>Objective.</I> To investigate the impacts of leuprolide acetate on the quality of life (QoL) of patients with prostate cancer. <I>Material and methods.</I> A total of 104 patients was enrolled in this prospective multicenter study. All patients received subcutaneous injections of 3.75 mg leuprolide acetate at 4 week intervals for a total of 12 weeks. QoL was assessed before treatment and at 12 weeks using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and an accompanying prostate cancer-specific module (QLQ-PR25). <I>Results.</I> Eighty-nine of 104 patients (85.6%) completed the 12 week study. Eighty-six of 89 patients (96.6%) achieved and maintained medical castration. The results of the EORTC QLQ-C30 indicated that patients experienced an improvement in global health status/QoL (<I>p</I> < 0.001), despite a deterioration in physical and role functioning (<I>p</I> == 0.012 and <I>p</I> == 0.007, respectively). The symptom scales indicated a statistically significant improvement in appetite (<I>p</I> == 0.003). The results of the QLQ-PR25 revealed that patients experienced an increase in hot flushes (<I>p</I> < 0.001) and erection problems and uncomfortable sexual intimacy among the sexual functioning items (<I>p</I> == 0.030 and <I>p</I> == 0.023, respectively), but day-time urinary frequency was improved (<I>p</I> == 0.004). <I>Conclusion.</I> The results of this prospective study indicate that leuprolide acetate treatment was accompanied by improvements in global health status/QoL, despite a deterioration in physical, role and sexual function.</P>

Urothelial carcinoma of the bladder with seminal vesicle invasion: prognostic significance

You, Dalsan,Kim, Seong Choel,Jeong, In Gab,Hong, Jun Hyuk,Ro, Jae Y.,Ahn, Hanjong,Kim, Choung-Soo Blackwell Publishing Ltd 2010 BJU INTERNATIONAL Vol.106 No.11

<P>Study Type – Prognosis (case series)Level of Evidence 4</P><P>OBJECTIVE</P><P>To evaluate the prognostic impact of seminal vesicle invasion in men who underwent radical cystectomy for bladder cancer.</P><P>PATIENTS AND METHODS</P><P>Of the 610 patients who underwent radical cystectomy for urothelial carcinoma of the bladder at our institution from 1989 to 2008, 60 male patients who had pathological stage T4 disease were divided into three groups: prostatic stromal invasion only (Group A, <I>n</I>= 35), seminal vesicle invasion regardless of prostatic stromal invasion (Group B, <I>n</I>= 19), and rectum or pelvic wall invasion (Group C, <I>n</I>= 6). We assessed the effect of several variables on recurrence-free survival (RFS) and cancer-specific survival (CSS).</P><P>RESULTS</P><P>The 2- and 5-year RFS rates for the entire cohort were 33.5% and 22.5%, respectively, and the 2- and 5-year CSS rates were 48.0% and 23.6%, respectively. Median RFS (6.6 months vs 26.3 months, <I>P</I> < 0.001) and CSS (14.5 months vs 35.9 months, <I>P</I>= 0.005) were significantly shorter for Group B than for Group A, but were similar in Groups B and C (6.6 months vs 8.8 months, <I>P</I>= 0.859 and 14.5 months vs 11.8 months, <I>P</I>= 0.613, respectively). On multivariate analysis, seminal vesicle invasion was an independent predictor of RFS (hazard ratio 2.94, 95% CI 1.40–6.17, <I>P</I>= 0.004) and CSS (2.63, 1.21–5.70, <I>P</I>= 0.014), along with pathological nodal status (3.90, 1.64–9.28, <I>P</I>= 0.002 and 4.39, 1.79–10.76, <I>P</I>= 0.001) and adjuvant therapy (2.76, 1.31–5.82, <I>P</I>= 0.008 and 4.14, 1.86–9.23, <I>P</I>= 0.001).</P><P>CONCLUSION</P><P>Seminal vesicle invasion by urothelial carcinoma of the bladder is a poor prognostic indicator for RFS and CSS. The prognosis of patients with seminal vesicle invasion mimics that of patients with pT4b bladder cancer.</P>

Role of Radical Prostatectomy for High-Risk Prostate Cancer

You, Dalsan,Jeong, In Gab,Kim, Choung-Soo The Korean Urological Association 2010 Korean Journal of Urology Vol.51 No.9

<P>High-risk localized prostate cancer traditionally includes patients with clinical T3 disease but also includes those with apparently localized disease but with adverse prognostic factors such as a Gleason score of 8 to 10, prostate-specific antigen of more than 20 ng/ml, or extensive disease on biopsy. In the past, these patients were treated primarily with radiation therapy due to concerns that surgery was not likely to be curative and was associated with a high incidence of side-effects. In addition, the lack of randomized trials comparing curative treatments for high-risk prostate cancer makes treatment decisions in this patient population difficult. Several retrospective series have reported the long-term efficacy of radical prostatectomy monotherapy in a high-risk population, showing that the 5-year cancer-specific survival rate was more than 80% and the 5-year biochemical recurrence-free survival rate was about 50%. In addition, comparisons of different treatment options by means of nonrandomized trials have shown improved outcomes with surgery compared with radiation therapy or observation. Thus, there is renewed interest in radical prostatectomy as the primary treatment for patients with high-risk prostate cancer. Here, we reviewed the outcomes of radical prostatectomy, with or without neoadjuvant or adjuvant therapies, in high-risk patients and what is known about the choice and timing of adjuvant therapies.</P>

Therapeutic Effect of Human Mesenchymal Stem Cell-Conditioned Medium on Erectile Dysfunction

Kim Seul Gi,You Dalsan,Kim Kyung,Aum Joomin,Kim Yu Seon,Jang Myoung Jin,Moon Kyung Hyun,Kang Hyun-Wook 대한남성과학회 2022 The World Journal of Men's Health Vol.40 No.4

Purpose: Owing to the safety and cost effectiveness of conditioned medium (CM), its therapeutic effects have attracted significant attention from many researchers. To date, numerous studies have been conducted on CM; however, little has been done with regard to erectile dysfunction (ED). In this research, the potential of human mesenchymal stem cell-derived CM (MSC-CM) for the treatment of ED was investigated. Materials and Methods: A high concentration of MSC-CM was prepared through 3D spheroid culturing with bone marrowderived MSCs and cut-off filtering. The composition of CM was analyzed using biochemical assays, and the effect of the preparation process on the quality of CM was investigated. The therapeutic effects of MSC-CM were evaluated through animal studies using a cavernous nerve (CN) injury rat model. Results: 3D spheroid culturing afforded a 278-fold increase in the total protein content of CM, as compared to that from 2D cultures; the protein concentration increased by 19 times on increasing the centrifugation time for cut-off filtering. Biochemical assays indicated that the CM contains various types of angiogenic, neurotrophic, and anti-inflammatory factors. Histological assay results showed that MSC-CM has angio- and neuro-trophic effect in a CN injury rat model in vivo, and these therapeutic effects appear in a dose-dependent manner. Conclusions: The experimental results confirmed the therapeutic effect of MSC-CM in healing damaged cavernosal tissue and restoring erectile function. These results successfully demonstrated that MSC-CM has significant potential for the treatment of ED.

Hypoxic Preconditioned Mesenchymal Stromal Cell Therapy in a Rat Model of Renal Ischemia-reperfusion Injury: Development of Optimal Protocol to Potentiate Therapeutic Efficacy

Jang, Myoung Jin,You, Dalsan,Park, Jin Young,Kim, Kyung,Aum, Joomin,Lee, Chunwoo,Song, Geehyun,Shin, Ha Chul,Suh, Nayoung,Kim, Yong Man,Kim, Choung-Soo Korean Society for Stem Cell Research 2018 International journal of stem cells Vol.11 No.2

<P>Although previous and ongoing clinical studies have used stromal cells during renal ischemia-reperfusion injury (IRI), there is little consensus regarding the optimal protocol. We aimed to optimize the protocol for hypoxic preconditioned human bone marrow-derived mesenchymal stromal cell (HP-hBMSC) therapy in a rat model of renal IRI. We determined the optimal injection route (renal arterial, renal parenchymal, and tail venous injection), dose (low-dose: 1×10<SUP>6</SUP>, moderate-dose: 2×10<SUP>6</SUP>, and high-dose: 4×10<SUP>6</SUP>), and injection period (pre-, concurrent-, and post-IRI). During optimal injection route study, renal arterial injections significantly reduced the decreasing glomerular filtration rate (GFR), as compared to GFRs for the IRI control group, 2 and 4 days after IRI. Therapeutic effects and histological recoveries were the greatest in the group receiving renal arterial injections. During the dose finding study, high-dose injections significantly reduced the decreasing GFR, as compared to GFRs for the IRI control group, 3 days after IRI. Therapeutic effects and histological recoveries were the greatest in the high-dose injection group. While determining the optimal injection timing study, concurrent-IRI injection reduced elevated serum creatinine levels, as compared to those of the IRI control group, 1 day after IRI. Pre-IRI injection significantly reduced the decreasing GFR, as compared with GFRs for the IRI control group, 1 day after IRI. Therapeutic effects and histological recoveries were the greatest in the concurrent-IRI group. In conclusion, the concurrent-IRI administration of a high dose of HP-hBMSC via the renal artery leads to an optimal recovery of renal function after renal IRI.</P>

A Study on the Efficacy and Safety of Rivaroxaban in Urologic Cancer-Associated Venous Thromboembolism

Jang Ho Lee(이장호),Dalsan You(유달산),Sang-Do Lee(이상도),Yeon-Mok Oh(오연목),Jae Seung Lee(이재승) 대한비뇨기종양학회 2019 대한비뇨기종양학회지 Vol.17 No.3

Purpose: Although direct oral anticoagulants (DOACs) are recommended as an alternative to low-molecular weighted heparin for cancer-associated venous thromboembolism (VTE), there is no firm evidence on the efficacy and safety of DOACs in patients with urologic cancer. Therefore, we compared the efficacy and safety of rivaroxaban and dalteparin for treating cancer-associated VTE in urologic cancer. Materials and Methods: We reviewed the medical records of 124 eligible VTE patients with urologic cancers who were treated with dalteparin or rivaroxaban. The primary outcome was the composite event of clinically relevant bleeding or VTE recurrence. The secondary outcomes were VTE recurrence, clinically relevant bleeding events, and all-cause mortality. Results: During anticoagulation period, there was no significant difference in primary and secondary outcomes between the groups. In Cox proportional hazards model for composite events, although there was no statistical significance, rivaroxaban presented lower hazard ratio (HR) than dalteparin (HR, 0.472; 95% confidence interval [CI], 0.210-1.060; p=0.069 in univariate analysis; HR, 0.505; 95% CI, 0.206-1.234; p=0.134 in multivariate analysis). In clinically relevant bleeding events, there was no significance difference between rivaroxaban and dalteparin (HR, 0.568; 95% CI, 0.238-1.358; p=0.203 in univariate analysis; HR, 0.617; 95% CI, 0.232-1.636; p=0.331 in multivariate analysis). Conclusions: Rivaroxaban can be regarded as a valuable option for VTE in urologic cancer. Further prospective studies are warranted to prove the safety or efficacy of rivaroxaban for treating VTE in patients with urologic cancer.

Risk Factors Leading to Radical Cystectomy in Patients Who Had Undergone Nephroureterectomy

Janghui Lee(이장희),Bumjin Lim(임범진),Dalsan You(유달산),In Gab Jeong(정인갑),Cheryn Song(송채린),Jun Hyuk Hong(홍준혁),Choung-Soo Kim(김청수),Hanjong Ahn(안한종),Bumsik Hong(홍범식) 대한비뇨기종양학회 2021 대한비뇨기종양학회지 Vol.19 No.4

Purpose: To identify the risk factors leading to radical cystectomy in patients who had undergone nephroureterectomy (NUx). Materials and Methods: We retrospectively reviewed the medical records of patients with upper tract urothelial carcinoma who underwent NUx during 2011–2019 and excluded patients with metastatic cancer. In total 646 patients were included in this study; of these, 532 had no previous bladder cancer history. Follow-up was performed every 3 months for 2 years after NUx was administered, and recurrence was confirmed using cystoscopy, urine cytology, computed tomography, and chest radiography. Bladder recurrence was confirmed through biopsy, urine cytology, or radiologic examination. Univariate and multivariate Cox regression analyzes were performed for statistical analysis of risk factors leading to radical cystectomy in patients undergoing NUx. Results: Lymphovascular invasion (LVI) (hazard ratio [HR], 4.728; 95% confidence interval [CI], 1.463–15.570; p=0.011), previous transurethral resection of bladder tumor history (HR, 3.825; 95% CI, 1.164–12.571; p=0.027), and intravesical recurrence (IVR) within 6 months (HR, 3.733; 95% CI, 1.091–12.778; p=0.036) in patients undergoing NUx are predictors of radical cystectomy implementation. In a multivariate analysis of patients without bladder cancer history, bladder recurrence was identified as a predictor of radical cystectomy implementation, if it occurred within 6 months of NUx (HR, 8.608; 95% CI, 1.545–47.976; p=0.014). Conclusions: LVI and IVR within 6 months and previous bladder cancer history are factors that can predict the need for radical cystectomy after NUx. Even in patients without bladder cancer history, early bladder recurrence within 6 months is a major predictor of radical cystectomy.

Utility of Urinalysis as a Follow-up Surveillance Tool in Nonmuscle Invasive Bladder Cancer

Minuk Park(박민욱),Bumjin Lim(임범진),Dalsan You(유달산),In Gab Jeong(정인갑),Cheryn Song(송채린),Bumsik Hong(홍범식),Choung-Soo Kim(김청수),Hanjong Ahn(안한종),Jun Hyuk Hong(홍준혁) 대한비뇨기종양학회 2021 대한비뇨기종양학회지 Vol.19 No.4

Purpose: To evaluate the association between microscopic hematuria (MH) detected by surveillance urinalysis and cancer recurrence in nonmuscle invasive bladder cancer (NMIBC) patients. Materials and Methods: A total of 1,082 NMIBC patients who underwent transurethral resection of bladder tumor (TURB) procedures at Asan Medical Center between January 2017 and December 2019 were included. We retrospectively reviewed the follow-up data for these cases including cystoscopy, urinalysis, and urine cytology. The association between urine testing and cancer recurrence was assessed by both univariable and multivariable logistic regression analysis. Results: The study patients had a median age of 68 years (interquartile range, 60–75 years) and comprised 898 men and 184 women. Among the 1,428 TURB procedures conducted in this series, 548 of the lesions (38.4%) were diagnosed as low-grade and 880 (61.6%) as high-grade cancers. A total of 3,309 follow-up cystoscopies were conducted during the study period and were divided into high-grade (HG) (2,011 cases) and low-grade (LG) (1,298 cases) groups according to the latest TURB pathology. MH was found to have a statistically significant association with NMIBC recurrence in both the LG (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.107–2.223; p=0.011) and HG (OR, 1.90; 95% CI, 1.434–2.517; p<0.001) groups. Conclusions: Urinalysis during follow-up may provide important information on cancer recurrence in NMIBC patients.

Oncological effect of palliative transurethral resection of the prostate in patients with advanced prostate cancer: a propensity score matching study

Choi, Se Young,Ryu, Jeman,You, Dalsan,Jeong, In Gab,Hong, Jun Hyuk,Ahn, Hanjong,Kim, Choung-Soo Springer-Verlag 2018 Journal of cancer research and clinical oncology Vol.144 No.4

<P>The oncologic effect of pTURP as cytoreductive operation seems to be limited. Patients who had to receive pTURP due to cancer-related symptoms, especially early necessity of pTURP (within 3 months after biopsy), showed worse clinical courses; therefore, they should be treated more carefully and actively.</P>

Prognostic factors of oncologic outcomes in metastatic chemotherapy-naïve castration-resistant prostate cancer treated with enzalutamide in actual clinical practice in East Asia

Choi, Se Young,Ryu, Jeman,You, Dalsan,Jeong, In Gab,Hong, Jun Hyuk,Ahn, Hanjong,Kim, Choung-Soo Elsevier 2018 Urologic oncology Vol.36 No.9

<P><B>Abstract</B></P> <P><B>Objectives</B></P> <P>We aimed to evaluate the prognostic factors for chemotherapy-naïve castration-resistant prostate cancer (CRPC) treated with enzalutamide in actual clinical practice using easily accessible clinical variables.</P> <P><B>Methods and materials</B></P> <P>We retrospectively reviewed the following data from 113 patients with chemotherapy-naïve CRPC treated with enzalutamide: serum levels of prostate-specific antigen (PSA), testosterone, hemoglobin, total protein, albumin, and alkaline phosphatase (ALP); platelet, neutrophil, and lymphocyte counts; neutrophil-to-lymphocyte ratios (NLRs); and liver profiles. PSA progression-free survival (PFS), radiological PFS, and overall survival were estimated by Cox regression analysis.</P> <P><B>Results</B></P> <P>Compared with baseline levels, laboratory values at 2 months showed significantly lower PSA (160.2 ± 351.5 ng/ml vs. 47.4 ± 117.1 ng/ml) and ALP levels (201.86 ± 223.77 IU/l vs. 148.25 ± 146.81 IU/l) and a significantly higher percentage of lymphocytes (28.1% ± 10.6% vs. 31.2% ± 9.7%); those at 1 month showed a significantly lower percentage of neutrophils (61.0% ± 11.0% vs. 57.1% ± 12.5%). In the multivariate analysis, poor prognostic factors for PSA PFS were Gleason score ≥ 9 (hazard ratio [HR] 2.022; <I>P</I> = 0.0250); visceral metastasis (HR 3.143; <I>P</I> = 0.0002); high NLR (HR 1.205; <I>P</I> = 0.0126); and high ALP (HR 1.002; <I>P</I> = 0.0015). For radiological PFS, high NLR (HR 1.249; <I>P</I> = 0.0002) and high ALP (HR 1.002; <I>P</I> = 0.0001) were associated with poor outcomes. The predictors of poor overall survival were visceral metastasis (HR 3.155; <I>P</I> < 0.0001); high NLR (HR 1.341; <I>P</I> < 0.0001); and high ALP (HR 1.001; <I>P</I> = 0.0017).</P> <P><B>Conclusion</B></P> <P>Enzalutamide is less effective in patients with metastatic chemotherapy-naïve CRPC with Gleason scores ≥ 9, visceral metastasis, high NLR, and high ALP.</P> <P><B>Highlights</B></P> <P> <UL> <LI> PSA levels in metastatic CRPC patients had limitations in predicting PSA and radiological progression-free survivals and OS. </LI> <LI> Visceral metastasis, GS ≧ 9, high NLR, and high ALP level were risk factors. </LI> <LI> Enzalutamide was less effective in metastatic chemotherapy-naïve CRPC patients with these factors. </LI> </UL> </P>