확대 전립선 생검을 통해 저위험성으로 확인된 국소전립선암의 근치적 전립선적출술 후 병리학적 결과

정재승,한병규,정성진,홍성규,변석수,최기영,이상은 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.10

Purpose: To investigate clinicopathologic characteristics of unilateral, low risk prostate cancers detected via multi(≥12)-core prostate biopsy. Materials and Methods: One hundred four patients who underwent radical retropubic prostatectomy(RRP) for unilateral, low risk prostate cancer (clinical stage ≤T2a, biopsy Gleason sum ≤6, PSA ≤10ng/ml, and ipsilateral positive cores ≤2) detected via multi (≥12)-core prostate biopsy were enrolled. In this retrospective study, we reviewed the patients’ preoperative and pathologic data to assess potential predictors of pT2c or greater disease at the time of RRP, as well as characteristics of such disease. Results: Of the 104 subjects, only 34(32.7%) were pathologically-proven to have unilateral disease, while the others showed pathologically-bilateral or worse disease from analysis of the RRP specimens. Subjects pathologically found to have uni- and bi-lateral disease showed no significant differences regarding age, prostate-specific antigen(PSA), free-to-total PSA ratio, prostate volume, clinical stage, number of positive cores, biopsy Gleason score, number of total biopsy sites, and highest percentage of tumor at any biopsy site. Multivariate logistic regression analysis revealed no significant preoperative predictors of pT2c or greater disease at RRP. Conclusions: Most patients with unilateral, low risk prostate cancer detected on multi(≥12)-core prostate biopsy actually had pathologically- worse disease. For clinically-localized prostate cancer, a more accurate method to identify appropriate candidates for unilateral or focal ablative therapy should be developed. Purpose: To investigate clinicopathologic characteristics of unilateral, low risk prostate cancers detected via multi(≥12)-core prostate biopsy. Materials and Methods: One hundred four patients who underwent radical retropubic prostatectomy(RRP) for unilateral, low risk prostate cancer (clinical stage ≤T2a, biopsy Gleason sum ≤6, PSA ≤10ng/ml, and ipsilateral positive cores ≤2) detected via multi (≥12)-core prostate biopsy were enrolled. In this retrospective study, we reviewed the patients’ preoperative and pathologic data to assess potential predictors of pT2c or greater disease at the time of RRP, as well as characteristics of such disease. Results: Of the 104 subjects, only 34(32.7%) were pathologically-proven to have unilateral disease, while the others showed pathologically-bilateral or worse disease from analysis of the RRP specimens. Subjects pathologically found to have uni- and bi-lateral disease showed no significant differences regarding age, prostate-specific antigen(PSA), free-to-total PSA ratio, prostate volume, clinical stage, number of positive cores, biopsy Gleason score, number of total biopsy sites, and highest percentage of tumor at any biopsy site. Multivariate logistic regression analysis revealed no significant preoperative predictors of pT2c or greater disease at RRP. Conclusions: Most patients with unilateral, low risk prostate cancer detected on multi(≥12)-core prostate biopsy actually had pathologically- worse disease. For clinically-localized prostate cancer, a more accurate method to identify appropriate candidates for unilateral or focal ablative therapy should be developed.

Expression of human β‐defensin‐2 in the prostate

Kim, Hae Jong,Jung, Ja Rang,Kim, Hea Jin,Lee, Shin Young,Chang, In Ho,Lee, Tae Jin,Kim, Wonyong,Myung, Soon Chul Blackwell Publishing Ltd 2011 BJU INTERNATIONAL Vol.107 No.1

<P>We found the expression of human beta-defensin-2 (HBD-2) in the prostate for the first time and LPS, a gram negative bacterial component, upregulated HBD-2 in prostate epithelial cells. We are looking for other antimicrobial peptides expressed in the prostate besides human beta-defensin-2. Also, we are studying the relationship between antimicrobial peptides and the development or progression of prostate diseases. OBJECTIVE To investigate the expression and regulation of human beta-defensin-2 (HBD-2) in the prostate. PATIENTS AND METHODS Normal human prostate epithelial cell line (RWPE-1), human prostate cancer cell lines (DU-145, PC-3), and paraffin-embedded prostate tissue from patients with benign prostatic hyperplasia (BPH) were analysed by RT-PCR and immunohistochemical staining. HBD-2 expression was also analysed by RT-PCR and ELISA in RWPE-1 cells treated with lipopolysaccharide (LPS). Nuclear factor-kappa B (NF-kappa B) activation was assessed by I kappa B alpha immunoblotting and electrophoretic mobility shift assay (EMSA). RESULTS BPH tissue and all of the tested prostate cell lines other than PC-3 constitutively express HBD-2 mRNA. HBD-2 protein was strongly detected in prostate gland tissue surrounded by inflammatory cells including macrophages. Exposure to LPS induced HBD-2 upregulation and NF-kappa B activation, as assessed by I kappa B alpha phosphorylation and degradation in RWPE-1 cells. Bay11-7082, an NF-kappa B inhibitor prevented LPS-induced HBD-2 production in RWPE-1 cells. CONCLUSIONS Prostate epithelial cells may constitutively express HBD-2, and its expression was upregulated by LPS. Our data indicate that HBD-2 may be an important immunomodulatory factor in prostate function. Expression of HBD-2 in normal prostates and the potential role of HBD-2 in prostatitis and BPH should be addressed in the future.</P>

Interval from Prostate Biopsy to Robot-Assisted Laparoscopic Radical Prostatectomy (RALP): Effects on Surgical Difficulties

김인성,나웅,남정수,오종진,정창욱,홍성규,변석수,이상은 대한비뇨의학회 2011 Investigative and Clinical Urology Vol.52 No.10

Purpose: Traditionally, an interval of 4 to 6 weeks has been recommended after prostate biopsy before open radical prostatectomy. However, such an interval is not explicitly specified in robot-assisted laparoscopic radical prostatectomy (RALP). This study was designed to determine whether the interval from prostate biopsy to RALP affects surgical difficulties. Materials and Methods: Between January 2008 and May 2009, a total of 237 men underwent RALP in our institution. The interval from biopsy to RALP was categorized as follows: ≤ 2 weeks, >2 to ≤ 4 weeks, >4 to ≤ 6 weeks, >6 to ≤ 8 weeks, and >8 weeks. Multivariate analysis was used to identify whether the interval from prostate biopsy to RALP was an independent predictor of operative time, estimated blood loss (EBL), margin positivity, continence, and potency. Results: Among the 5 groups, there were no significant differences in age, body mass index (BMI), preoperative serum prostate-specific antigen (PSA), prostate volume, or preoperative International Index of Erectile Dysfunction-5 score (all p>0.05). In the multivariate analysis, operative time was significantly associated with prostate volume. EBL was associated with prostate volume and BMI. Margin positivity was associated with preoperative serum PSA, prostate volume, and biopsy Gleason score. Postoperative continence and potency were significantly associated with age. However, in univariate and multivariate analyses, the interval from biopsy to RALP was not significantly associated with operative time, EBL, margin positivity, postoperative continence, or potency (all p>0.05). Conclusions: Our data suggest that the interval from prostate biopsy to RALP is not related to surgical difficulties.

전립선특이항원 선별검사 도입에 따른 전립선암의 임상병리학적 특성의 변화

권종규,장인호,김태형,명순철 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.5

PURPOSE: The aim of this study was to investigate the changes in the clinical and prognostic parameters of prostate cancer in Korean men in the eras before and after prostate-specific antigen (PSA) testing. MATERIALS AND METHODS: The medical records of 303 patients treated for prostate cancer between 1982 and 2005 were reviewed with respect to age, chief complaints, clinical stage, tumor grade, treatment options, and prognosis. We classified the patients as follows: those treated in the pre- PSA era (1982-1995, n=81), and those treated in the PSA era (1996-2000, PSA era phase 1, n=92; and 2001-2005, PSA era phase 2, n=130). RESULTS: There was no significant difference in age or clinical stage between patients treated before and those treated during the PSA era, although there was a downward migration of grade. The cancer-specific survival rates were also not different in all cases and in metastatic prostate cancer cases between the pre-PSA era and the PSA era, although the overall survival rates were significantly greater in all cases in phase 2 of the PSA era than in the pre-PSA era or in phase 1 of the PSA era (p<0.05). However, the cancer-specific survival rates for localized or locally advanced prostate cancer were significantly greater in phase 2 of the PSA era than in the pre-PSA era or in phase 1 of the PSA era (p<0.05). CONCLUSIONS: We observed a downward migration of tumor grade, but there were no migrations in the age of patients or clinical stage, and these findings have not contributed to changes in the cancer survival of Korean men with prostate cancer after the advent of PSA testing. PURPOSE: The aim of this study was to investigate the changes in the clinical and prognostic parameters of prostate cancer in Korean men in the eras before and after prostate-specific antigen (PSA) testing. MATERIALS AND METHODS: The medical records of 303 patients treated for prostate cancer between 1982 and 2005 were reviewed with respect to age, chief complaints, clinical stage, tumor grade, treatment options, and prognosis. We classified the patients as follows: those treated in the pre- PSA era (1982-1995, n=81), and those treated in the PSA era (1996-2000, PSA era phase 1, n=92; and 2001-2005, PSA era phase 2, n=130). RESULTS: There was no significant difference in age or clinical stage between patients treated before and those treated during the PSA era, although there was a downward migration of grade. The cancer-specific survival rates were also not different in all cases and in metastatic prostate cancer cases between the pre-PSA era and the PSA era, although the overall survival rates were significantly greater in all cases in phase 2 of the PSA era than in the pre-PSA era or in phase 1 of the PSA era (p<0.05). However, the cancer-specific survival rates for localized or locally advanced prostate cancer were significantly greater in phase 2 of the PSA era than in the pre-PSA era or in phase 1 of the PSA era (p<0.05). CONCLUSIONS: We observed a downward migration of tumor grade, but there were no migrations in the age of patients or clinical stage, and these findings have not contributed to changes in the cancer survival of Korean men with prostate cancer after the advent of PSA testing.

Prostate-Specific Antigen Mass and Free Prostate-Specific Antigen Mass for Predicting the Prostate Volume of Korean Men With Biopsy-Proven Benign Prostatic Hyperplasia

박태용,채지윤,김종욱,김진욱,오미미,윤철용,문두건 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.9

Purpose: It has been reported that prostate-specific antigen (PSA) correlates with prostate volume. Recently, some studies have reported that PSA mass (PSA adjusted for plasma volume) is more accurate than PSA at predicting prostate volume. In this study, we analyzed the accuracy of PSA and the related parameters of PSA mass, free PSA (fPSA), and fPSA mass in predicting prostate volume. Materials and Methods: We retrospectively investigated 658 patients who underwent prostate biopsy from 2006 to 2012 and had a confirmed negative biopsy result. International Prostate Symptom Score (IPSS) questionnaire, PSA, fPSA, and prostate volume were investigated. PSA mass and fPSA mass were calculated by use of established formulas. The association between PSA-related parameters and IPSS and prostate volume was assessed by using Pearson correlation coefficient and receiver operating characteristic curves. Results: There was no significant difference between PSA and PSA mass, fPSA, or fPSA mass in predicting prostate volume except in obese patients (p-value of PSA–PSA mass for 40 cm3, 0.54; p-value of fPSA–fPSA mass for 40 cm3, 0.34). fPSA performed significantly better than PSA at predicting prostate volume (p-value for 40 cm3, <0.001). IPSS and the aforementioned PSA-related parameters were not significantly correlated. Conclusions: PSA mass was not a better predictive value than PSA for estimating the prostate volume in Korean men except in obese men. This finding was also applicable to the relationship of fPSA and fPSA mass, which appeared to be more accurate predictors of prostate volume than either PSA or PSA mass.

경직장 초음파를 이용한 전립선 부피 측정의 신뢰도

김미현,김정곤,최영준,조경식 대한초음파의학회 2008 ULTRASONOGRAPHY Vol.27 No.1

PURPOSE : The purpose of study was to evaluate the reliability of transrectal ultrasonography (TRUS) in the prostate volume measurement. MATERIALS and METHODS : Forty-one patients underwent two TRUS examinations during two independent sessions to measure the three-dimensional diameters and volume of the prostate. The difference between the two TRUS examinations was evaluated, and the reliability of TRUS was assessed using the intraclass correlation coefficient (ICC), coefficient of variation(CV), and Bland and Altman plot. RESULTS : The patients were divided into two subgroups by two observers those with the mean prostate volume same or greater than 30 ml (group A) and those with the mean prostate volume less than 30 ml (group B). A prostate volume difference greater than 5 ml and 10 ml between the two TRUS examinations was more frequently included in the group A than in the group B (43% and 33%, 5% and 0%, respectively) (p <0.05). ICC and CV showed poor reliability for measuring the prostate height, length and volume in the group A (ICC for width,height, length and volume < 0.75, CV for volume =12.97%). CONCLUSION : Prostate volume measurement by TRUS may be unreliable in large prostates with unreliable measurement of the height and length being the primary limiting cause. PURPOSE : The purpose of study was to evaluate the reliability of transrectal ultrasonography (TRUS) in the prostate volume measurement. MATERIALS and METHODS : Forty-one patients underwent two TRUS examinations during two independent sessions to measure the three-dimensional diameters and volume of the prostate. The difference between the two TRUS examinations was evaluated, and the reliability of TRUS was assessed using the intraclass correlation coefficient (ICC), coefficient of variation(CV), and Bland and Altman plot. RESULTS : The patients were divided into two subgroups by two observers those with the mean prostate volume same or greater than 30 ml (group A) and those with the mean prostate volume less than 30 ml (group B). A prostate volume difference greater than 5 ml and 10 ml between the two TRUS examinations was more frequently included in the group A than in the group B (43% and 33%, 5% and 0%, respectively) (p <0.05). ICC and CV showed poor reliability for measuring the prostate height, length and volume in the group A (ICC for width,height, length and volume < 0.75, CV for volume =12.97%). CONCLUSION : Prostate volume measurement by TRUS may be unreliable in large prostates with unreliable measurement of the height and length being the primary limiting cause.

Emerging Roles of Human Prostatic Acid Phosphatase

( Hoon Young Kong ),( Jong Hoe Byun ) 한국응용약물학회 2013 Biomolecules & Therapeutics(구 응용약물학회지) Vol.21 No.1

Prostate cancer is one of the most prevalent non-skin related cancers. It is the second leading cause of cancer deaths among males in most Western countries. If prostate cancer is diagnosed in its early stages, there is a higher probability that it will be completely cured. Prostatic acid phosphatase (PAP) is a non-specific phosphomonoesterase synthesized in prostate epithelial cells and its level proportionally increases with prostate cancer progression. PAP was the biochemical diagnostic mainstay for prostate cancer until the introduction of prostate-specific antigen (PSA) which improved the detection of early-stage prostate cancer and largely displaced PAP. Recently, however, there is a renewed interest in PAP because of its usefulness in prognosticating intermediate to high-risk prostate cancers and its success in the immunotherapy of prostate cancer. Although PAP is believed to be a key regulator of prostate cell growth, its exact role in normal prostate as well as detailed molecular mechanism of PAP regulation is still unclear. Here, many different aspects of PAP in prostate cancer are revisited and its emerging roles in other environment are discussed.

경직장 초음파 유도 41부위 전립선 생검법

전상봉,조신,정영범,박영경,박종관 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.2

Purpose: We evaluated the rate of prostate cancer detection using the transrectal ultrasound(TRUS) guided, 41-core prostate needle biopsy protocol. Materials and Methods: Between May 2006 and May 2007, 110 patients received a 12-core prostate needle biopsy(Group I) and 62 patients underwent a 41-core prostate needle biopsy(Group II) under local anesthesia. In addition to sextant biopsy, 41-core prostate needle biopsies were obtained from the each lateral peripheral zone(base, mid, and apex glands), midline peripheral zone(base, mid, and apex glands) and each transition zone. Results: There were no significant differences between the two groups for age, prostate-specific antigen(PSA), or prostate volume. The cancer detection rate in the Group I and Group II was 19.1% and 24.2%, respectively. We found a significantly higher detection rate in the 41-core biopsy with prostate volumes of more than 40cc(28.1% vs 11.3%). The intraoperative pain score was lower in Group II than Group I(1.57±1.45 vs 3.17±1.73, p<0.01). Conclusions: The 41-core prostate needle biopsy protocol is safe and intraoperative pain is low. The cancer detection rate of the 41-core prostate needle biopsy was higher than the 12-core prostate needle biopsy in patients with a prostate volume of more than 40cc. (Korean J Urol 2008; 49:122-126) Purpose: We evaluated the rate of prostate cancer detection using the transrectal ultrasound(TRUS) guided, 41-core prostate needle biopsy protocol. Materials and Methods: Between May 2006 and May 2007, 110 patients received a 12-core prostate needle biopsy(Group I) and 62 patients underwent a 41-core prostate needle biopsy(Group II) under local anesthesia. In addition to sextant biopsy, 41-core prostate needle biopsies were obtained from the each lateral peripheral zone(base, mid, and apex glands), midline peripheral zone(base, mid, and apex glands) and each transition zone. Results: There were no significant differences between the two groups for age, prostate-specific antigen(PSA), or prostate volume. The cancer detection rate in the Group I and Group II was 19.1% and 24.2%, respectively. We found a significantly higher detection rate in the 41-core biopsy with prostate volumes of more than 40cc(28.1% vs 11.3%). The intraoperative pain score was lower in Group II than Group I(1.57±1.45 vs 3.17±1.73, p<0.01). Conclusions: The 41-core prostate needle biopsy protocol is safe and intraoperative pain is low. The cancer detection rate of the 41-core prostate needle biopsy was higher than the 12-core prostate needle biopsy in patients with a prostate volume of more than 40cc. (Korean J Urol 2008; 49:122-126)

전립선특이항원치 4.0ng/ml 이상인 환자에서 전립선용적과 나이에 따른 전립선암의 발견율

윤병일,김수진,조혁진,홍성후,손동완,이지열,황태곤,김세웅 대한남성과학회 2010 The World Journal of Men's Health Vol.28 No.1

Purpose: We retrospectively investigated the changes of prostate cancer detection rate according to patients prostate volume, age with prostate-specific antigen (PSA) levels of above 4.0ng/ml. Material and Methods: Data were collected from 663 patients who underwent 10 core prostate biopsy for elevated PSA above 4.0ng/ml. The biopsy-proven cancer patient group was compared to the non-cancer patient group according to age, PSA, prostate volume and PSAD. Prostate cancer detection rate was calculated according to prostate volume (less than 40 vs 40 or more 40ml) and age (less than 60, 60-69, 70-79, 80 or more years old). Also we compared prostate cancer detection rate according to PSA levels (4-10 vs 10-20ng/ml). Results: Among the 663 patients who underwent prostate biopsy, prostate cancer was detected in 134 patients (20.2%). There were no stastically difference in mean age, mean prostate volume, and mean PSAD except mean PSA (13.9 vs 11.9ng/ml) between cancer and non-cancer groups. The cancer detection rate in small prostate was significantly higher than large prostate (23.5% vs 16.0%). The cancer detection rate was significantly increased with age: from 14.5% for below 60 year-old patients to 30.3% for the 80 or more year-old patients. There was no significant difference in cancer detection rate between the two PSA groups (19.0 vs 20.5%). Conclusion: Prostate cancer detection rate was higher in old patients and patients with small prostate volume. The older age group and the patients with small prostate volume was considered as the important factors to decide whether biopsy of prostate is needed.

전립선암의 진단에서 경직장 초음파검사의 유용성 : 수지직장검사, 혈청 전립선 특이항원 및 전립선 특이항원밀도와의 비교

윤정환,김보현,최상희,김승훈,최한용,채수응,윤혜경,이순진,주인욱 대한영상의학회 1998 대한영상의학회지 Vol.39 No.5

Purpose : To determine the usefulness of transrectal ultrasonography (TRUS) in diagnosing prostate cancer by comparing the sensitivity, specificity, accuracy, and positive and negative predictive values of TRUS with those of serum prostate-specific antigen (PSA), prostate-specific antigen density (PSAD) and digital rectal examination(DRE). Materials and Methods : Two hundred and ten consecutive patients underwent TRUS-guided prostate biopsy due to elevated PSA and/or abnormal findings on TRUS or DRE. The TRUS findings were analyzed and correlated with pathological diagnosis. PSAD was calculated by dividing the serum PSA level by the prostate volume calculated on TRUS. The sensitivity, specificity, accuracy, and positive and negative predictive values of TRUS were compared with those of PSA, PSAD and DRE. Using ROC curve analysis, the combinations of these diagnostic methods were also evaluated for the determination of efficacy in diagnosing prostate cancer. Results : The sensitivity and specificity of serum PSA (cut-off level, 4ng/ml/), PSAD (cut-off level, 0.15ng/ml/cm3), DRE, and TRUS were 96%/17%,96%/37%, 72%/62%, and 89%/68%, respectively. On TRUS, the sensitivity and specificity of low echoic lesions and those of irregular outer margin were 89%/69%, and 60%/90%, respectively. TRUS was statistically more accurate than other diagnostic methods. Of the combinations of diagnostic methods, TRUS and PSAD were most accurate.Conclusion: TRUS demonstrated lower sensitivity but higher specificity than PSA or PSAD. Although it is an accurate modality for the diagnosis of prostate cancer, it cannot be used as a confirmative test due to its relatively low positive predictive value. A combination of diagnostic methods and random biopsy is needed in patients in whom prostate cancer is suspected.