Comparative study of extraperitoneal singe-port robot-assisted radical prostatectomy and transperitoneal multiport robot-assisted radical prostatectomy using propensity score matching.

Background: With the introduction of the da Vinci single-port (SP) robot platform, surgery in a narrow space has become easier, and using this, extraperitoneal radical prostatectomy has been frequently performed recently. However, studies comparing it with existing methods are still lacking. Therefore, in this study, we compared the initial extraperitoneal single-port robot-assisted radical prostatectomy (spRARP) with intraperitoneal multiport robot-assisted radical prostatectomy (mpRARP) and tried to investigate the feasibility of extraperitoneal spRARP. Methods: We retrospectively analyzed patients who underwent RARP performed between January 2019 and April 2023. A total of 184 consecutive patients were enrolled in this study: 64 underwent spRARP and 120 underwent mpRARP. Patient characteristics before and after surgery were investigated, and period of passing gas, foley maintenance period, length of hospital stay, and pain changes were compared and analyzed to estimate post-surgery recovery. To address inherent biases stemming from differing patient characteristics at baseline, we performed an additional analysis after propensity score matching (PSM) (ratio, 1:1). Results: After PSM, both the spRARP and mpRARP groups consisted of 64 patients each. On preoperative examination, there were no significant differences in prostate-specific antigen level, Gleason score (GS), prostate volume, magnetic resonance imaging T stage, or Prostate Imaging-Reporting and Data System score between the two groups. Following surgery, there were no significant differences in operative and console time between the two groups. Notably, the estimated blood loss was considerably lesser in the spRARP group than in the mpRARP group (P=0.049). When comparing pathologic outcomes, the GS, T stage, positive surgical margin, extracapsular extension, and seminal vesicle invasion rates showed no significant differences between the two groups. Four patients who underwent spRARP and six who underwent mpRARP suffered Clavien-Dindo classification grade 3 and 4 complications. After 3 months, there were no significant differences in incontinence or potency between the two groups. However, even after PSM, the period of passing gas was earlier in the spRARP group than in the mpRARP group. Conclusions: In this study, both the extraperitoneal spRARP and transperitoneal mpRARP groups exhibited similar complication rates and surgical outcomes. Furthermore, the spRARP group had a short surgical time and demonstrated early recovery. Therefore, extraperitoneal spRARP is a feasible procedure that is expected to become increasingly popular in the future.

Analysis of trend in the role of national and regional hubs in prostatectomy after prostate cancer diagnosis in the past 5 years: A nationwide population-based study.

PURPOSE: The regions where patients diagnosed with prostate cancer by biopsy receive prostatectomy are divided into national hub and regional hubs, and to confirm the change in the role of regional hubs compared to national hub. MATERIALS AND METHODS: Data from July 2013 to June 2017 encompassing 218,155 patients aged ≥18 years diagnosed with prostate cancer were analyzed using the Health Insurance Review & Assessment Service database. The degree of patient outflow was assessed by dividing the regional diagnosis-to-surgery ratio with the national ratio for each year. Based on this ratio, national and regional hubs were determined. RESULTS: Seoul consistently maintained a patient influx with a ratio above 1.6. Busan and Gyeonggi consistently exceeded 0.9, while Ulsan and Daegu steadily increased, exceeding 1.0 between 2015 and 2016. Jeonnam province also consistently maintained the ratio above 0.7. Jeju, Daejeon, Gangwon, and Incheon remained below 0.5, indicative of substantial patient outflows, whereas Gwangju and Gyeongbuk had the highest patient outflows with ratios below 0.15. Therefore, Seoul was designated as a national hub, whereas Busan, Gyeonggi, Ulsan, Daegu, and Jeonnam were classified as regional hubs. Jeju, Daejeon, Gangwon, and Incheon were the dominant outflow areas, while Gwangju and Gyeongbuk were the highest outflow areas. CONCLUSIONS: Seoul, as the national hub for prostate cancer surgery, operated on 1.76 times more patients than any other region during 2013-2017. Busan, Gyeonggi, Ulsan, Daegu, and Jeonnam functioned as regional hubs, but approximately 10%-20% of patients sought treatment at national hubs.

Docetaxel Enhances Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand-Mediated Apoptosis in Prostate Cancer Cells via Epigenetic Gene Regulation by Enhancer of Zeste Homolog 2.

PURPOSE: Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is a promising cancer therapeutic agent because of its tumor selectivity and its ability to induce apoptosis in cancer cells while sparing most normal cells. We evaluated whether docetaxel enhances TRAIL-mediated apoptosis in prostate cancer (PCa) cells and its mechanism. MATERIALS AND METHODS: LNCap-LN3, PC3, and DU 145 PCa cell lines were used to investigate the effects of TRAIL with docetaxel treatment (dosages, 1, 3, 5, and 10 nmol). To evaluate the mechanism, death receptor 4 (DR4), DR5, enhancer of zeste homolog 2 (EZH2) and E2F1 levels were assessed in PCa cells. RESULTS: Hormone-sensitive LNCap-LN3 showed apoptosis in proportion to the concentration of docetaxel. Castration-resistant PC3 and DU 145 showed no change irrespective of the docetaxel concentration. However, combinations of docetaxel (2 nM) and TRAIL (100 ng/mL) had a significant effect on apoptosis of DU 145 cells. In DU 145 cells, docetaxel reduced EZH2 and elevated expression of DR4. The decrease of EZH2 by docetaxel was correlated with the E2F1 level, which was considered as the promoter of EZH2. DZNep reduced EZH2 and elevated DR4 in all PCa cells. Additionally, DZNep-enhanced TRAIL mediated reduction of PCa cell viability. CONCLUSIONS: Docetaxel and the EZH2 inhibitor reduced EZH2 and elevated expression of DR4 in all PCa cell lines. Docetaxel-enhanced TRAIL mediated apoptosis in PCa via elevation of DR4 through epigenetic regulation by EZH2. To improve the efficacy of TRAIL for PCa treatment, adding docetaxel or EZH2 inhibitors to TRAIL may be promising.

Mass size is a major predictor of hypertensive attack during surgery in patients with paraganglioma of retroperitoneum.

Background: Surgical manipulation of paraganglioma can induce a massive release of catecholamines leading to hypertensive attack. But it has been not known about risk factors to cause hypertensive attack because paragangliomas of urinary bladder and retroperitoneum are notably rare tumors and have been recorded as case report or series. We investigated the relationship between mass size and hypertensive attack during surgery in patients with paraganglioma. Methods: Our retrospective chart review included 32 patients who had a pathological diagnosis of paraganglioma between March 2006 and May 2021, in single center. We analyzed the risk factors such as age, sex, height, weight, blood pressure before surgery, history of hypertension, pre-operative symptoms, mass location, and mass in 24 patients with retroperitoneal paragangliomas including urinary bladder. Hypertensive attack was defined as systolic blood pressure >180 mmHg during excision of the mass from the electric medical chart. The predictive power was assessed by the area under the curve of the receiver operating characteristic curve. Results: There were 19 retroperitoneal, 5 urinary bladder, 2 middle-ear cavity, 2 mediastinal, 2 neck, 1 spinal cord and 1 duodenal paraganglioma. Seven (29.2%) of the 24 patients had preoperative symptoms such as pain, fluctuation of blood pressure, and palpable mass. Hypertensive attack during surgery occurred in 11 patients (45.8%). There was a significant difference in mass size between groups with (n=11) and without (n=13) fluctuation of blood pressure (P=0.007). The area under curve for predicting surgical complications according to mass size was 0.808 (cutoff size 4.25 cm, sensitivity 72.7%, specificity 76.9%, 95% CI: 0.635-0.981). Conclusions: Mass size impacted occurrence of hypertensive attack during surgery in patients with retroperitoneal paraganglioma. Surgeons have to be watchful regarding of intraoperative hypertension during resection of retroperitoneal masses exceeding 4.25 cm, which are suspected as paraganglioma.

Varying Outcomes among Patients with Large Angiomyolipomas according to the Treatment Method.

PURPOSE: This study aimed to evaluate the outcomes of large angiomyolipoma (AML) treatment by selective arterial embolization (SAE) versus nephron-sparing surgery (NSS) using a robotic surgical system. MATERIALS AND METHODS: Between January 2011 and June 2018, we retrospectively reviewed 25 patients who underwent robot-assisted partial nephrectomy (RAPN) or SAE for large AMLs. Ten patients underwent RAPN, and 15 underwent SAE. Patient demographics, AML characteristics, and operative and postoperative clinical outcomes were recorded and analyzed. Outcomes were compared between patients who underwent RAPN and patients who underwent SAE. Specifically, changes in renal function and size were evaluated after the treatment. RESULTS: The mean age of the patients was 52.9 years, and 22 of 25 patients were female. The mean maximum AML diameter on computed tomography was 8.9 cm, and 8 patients had multiple masses. Twenty-two of 25 patients had moderate to high RENAL complexity. Patients who underwent SAE had more symptoms (p = 0.018) and higher RENAL complexity scores (p = 0.013) on average. On average, tumor size decreased by 99% among RAPN patients and by 58% among SAE patients (p = 0.001). Although the mean pretreatment estimated glomerular filtration rate (eGFR) was higher among RAPN patients (99.8 vs. 80.0 mL/min/1.73 m2, p = 0.043), there were no significant changes in eGFR in either group after the treatment. One patient in the RAPN group experienced complications, but the postoperative ileus resolved without intervention. CONCLUSIONS: Both RAPN and SAE were effective and feasible treatment options for large AMLs. The AML characteristics and the condition of the patient might be important in determining the appropriate treatment method.

Diagnosis of urine leakage after bladder repair: a prospective comparative study of ultra-low-dose CT cystography and conventional retrograde cystography.

PURPOSE: We performed this prospective cohort study to compare the accuracy and technical characteristics of ultra-low-dose CT cystography with those of conventional retrograde cystography. MATERIALS AND METHODS: A cohort of 31 patients referred for cystography after bladder repair were enrolled. To detect urine leakage, we initially performed conventional cystography after retrograde distention of the bladder with dilute iodinated contrast material, followed by ultra-low-dose CT cystography. The diagnostic accuracy of these two modalities was compared, and the technical characteristics of ultra-low-dose CT cystography were examined. RESULTS: All 31 referred patients were included in this study. Of the 31 patients, 27 (87.1%) underwent bladder repair after radical prostatectomy, 3 (9.7%) after radical cystectomy, and 1 (3.2%) after bladder diverticulectomy. Four of the 31 patients were diagnosed with urine leakage by conventional cystography. These four patients were confirmed to have urine leakage by ultra-low-dose CT cystography. Another five patients who did not have urine leakage according to conventional cystography were diagnosed with urine leakage by ultra-low-dose CT cystography. Moreover, performing ultra-low-dose CT cystography enabled us to identify the precise location and amount of urine leakage in all nine patients. Based on these findings, we were able to establish a proper treatment plan. CONCLUSIONS: Ultra-low-dose CT cystography is an accurate method for evaluating urine leakage after bladder repair, and this technique may help determine the most appropriate treatment strategy for patients with urine leakage after bladder repair.

Renal function is associated with prognosis in stent-change therapy for malignant ureteral obstruction.

Purpose: The authors performed this study to investigate the risk factors for predicting stent failure and to evaluate its impact on prognosis. Materials and Methods: Between January 2002 and March 2017, we retrospectively reviewed 117 consecutive patients who underwent retrograde ureteral stenting and exchanging at least once every 3 months for malignant ureteral obstruction. The patients were classified according to their pre-stenting chronic kidney disease (CKD) stage. The factors affecting stent failure were analyzed using a logistic regression model. Overall survival (OS) was estimated, and the prognostic significance of each variable was estimated using Cox proportional-hazards regression modeling. Results: Before stenting, 91 patients were CKD stages 1-3 and 26 patients were CKD stages 4-5. These two groups differed significantly only in pre-stenting estimated glomerular filtration rate (eGFR), bilateral obstruction, and pre-stenting pyuria. Among the 117 patients, stent failure occurred in 30 patients (25.6%), and there were no differences between the groups. Pre-stenting pyuria and post-stenting complications were significant predictors of stent failure. There were 79 deaths in total, including 56 in the CKD stages 1-3 group and 23 in the CKD stages 4-5 group. In the multivariate analysis predicting patient OS, pre-stenting eGFR and post-stenting disease progression were significant factors. Conclusions: Internal ureteral stenting was effective for maintaining renal function in malignant ureteral obstruction. However, it did not restore renal function, which is related to the prognosis of the patients. Therefore, to improve patients' renal function and prognosis, patients who require stenting must be quickly recognized and treated.

The influence of marital intimacy on urinary and sexual symptom experience among patients with prostate cancer: a cross-sectional study.

BACKGROUND: Little is known about the influence of how patients with prostate cancer perceive emotional support from their spouses on their treatment-related symptoms. AIMS: To explore the influence of marital intimacy on urinary and sexual symptoms. METHODS: The research participants were 42 men diagnosed with prostate cancer recruited from a convenience sample from a university hospital in South Korea. The Expanded Prostate Cancer Index Composite, the Korean Marital Intimacy Scale, and the Hospital Anxiety and Depression Scale were used to measure variables of interest. RESULTS: In the hierarchical multiple regression analysis, higher marital intimacy was associated with more favorable symptom in the urinary domain. In the sexual domain, none of the models were significant, and no influence was found for marital intimacy. CONCLUSIONS: Marital intimacy, measured as perceived emotional support from spouses, was found to positively influence only the experience of urinary symptoms among South Korean men with prostate cancer.

Hypercholesterolemia Is Associated with a Shorter Time to Castration-Resistant Prostate Cancer in Patients Who Have Undergone Androgen Deprivation Therapy.

PURPOSE: The goal of this study was to investigate the association between hypercholesterolemia and the time required for progression to castration-resistant prostate cancer (CRPC) in patients who have undergone androgen deprivation therapy (ADT). MATERIALS AND METHODS: Data from 154 patients with prostate cancer between 2005 and 2012 were reviewed retrospectively. ADT was employed as a treatment modality for these patients either due to multiple bone metastases at the time of diagnosis or due to old age in combination with other morbidities. Serum cholesterol levels and statin use were reviewed. We analyzed the factors associated with the development of CRPC after ADT treatment. The mean follow-up period was 34.8 months. RESULTS: The mean age of the patients was 71.3 years old and their mean prostate-specific antigen level was 141.8±212.6 ng/mL. Their mean cholesterol level was 175.9±37.7 mg/dL, and 14 patients (9.1%) were statin users. CRPC developed in 44 patients (28.6%), and the mean duration from ADT treatment to CRPC was 24.1 months. In a multivariate analysis, hypercholesterolemia was associated with the development of CRPC (hazard ratio [HR]=1.017, p<0.001), depending on clinical T stage (p=0.005) and the presence of bone metastasis (p<0.001). A subanalysis showed that hypercholesterolemia was associated with the development of CRPC in patients with bone metastasis (HR=1.032, p<0.001), but not in patients without bone metastasis. CONCLUSIONS: Hypercholesterolemia may be associated with the development of CRPC after ADT in patients with bone metastasis. Further studies with longer follow-up periods and larger samples are needed to validate this finding.

The effects of different noise types on heart rate variability in men.

PURPOSE: To determine the impact of noise on heart rate variability (HRV) in men, with a focus on the noise type rather than on noise intensity. MATERIALS AND METHODS: Forty college-going male volunteers were enrolled in this study and were randomly divided into four groups according to the type of noise they were exposed to: background, traffic, speech, or mixed (traffic and speech) noise. All groups except the background group (35 dB) were exposed to 45 dB sound pressure levels. We collected data on age, smoking status, alcohol consumption, and disease status from responses to self-reported questionnaires and medical examinations. We also measured HRV parameters and blood pressure levels before and after exposure to noise. The HRV parameters were evaluated while patients remained seated for 5 minutes, and frequency and time domain analyses were then performed. RESULTS: After noise exposure, only the speech noise group showed a reduced low frequency (LF) value, reflecting the activity of both the sympathetic and parasympathetic nervous systems. The low-to-high frequency (LF/HF) ratio, which reflected the activity of the autonomic nervous system (ANS), became more stable, decreasing from 5.21 to 1.37; however, this change was not statistically significant. CONCLUSION: These results indicate that 45 dB(A) of noise, 10 dB(A) higher than background noise, affects the ANS. Additionally, the impact on HRV activity might differ according to the noise quality. Further studies will be required to ascertain the role of noise type.

Role of prostate volume in the early detection of prostate cancer in a cohort with slowly increasing prostate specific antigen.

PURPOSE: To investigate the relationship between prostate volume and the increased risk for being diagnosed with prostate cancer (PCa) in men with slowly increasing prostate specific antigen (PSA). MATERIALS AND METHODS: A cohort of 1035 men who visited our hospital's health promotion center and were checked for serum PSA levels more than two times between January 2001 and November 2011 were included. Among them, 116 patients had a change in PSA levels from less than 4 ng/mL to more than 4 ng/mL and underwent transrectal ultrasound guided prostate biopsy. Median age was 55.9 years and 26 (22.4%) had PCa. We compared the initial PSA level, the last PSA level, age, prostate volume, PSA density (PSAD), PSA velocity, and follow-up period between men with and without PCa. The mean follow- up period was 83.7 months. RESULTS: Significant predictive factors for the detection of prostate cancer identified by univariate analysis were prostate volume, follow-up period and PSAD. In the multivariate analysis, prostate volume (p<0.001, odds ratio: 0.890) was the most significant factor for the detection of prostate cancer. In the receiver operator characteristic curve of prostate volume, area under curve was 0.724. At the cut-off value of 28.8 mL for prostate volume, the sensitivity and specificity were 61.1% and 73.1% respectively. CONCLUSION: In men with PSA values more than 4 ng/mL during the follow-up period, a small prostate volume was the most important factor in early detection of prostate cancer.

Preoperative clinical factors for diagnosis of incidental prostate cancer in the era of tissue-ablative surgery for benign prostatic hyperplasia: a korean multi-center review.

PURPOSE: To identify potential predictive factors of incidental prostate cancer (IPca) in patients considering tissue-ablation treatment for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: From the 11 centers, 1,613 men who underwent transurethral resection of the prostate (TURP) or open prostatectomy were included. Before surgery, prostate biopsy was performed in all patients with prostate-specific antigen (PSA) ≥4.0 ng/ml or with abnormal digital rectal examination (DRE) findings. The patients with prostate cancer preoperatively or with PSA >20 ng/ml were excluded. As predictive factors of IPca, age, body mass index, PSA, DRE, and transrectal ultrasonography (TRUS) findings, including total prostate volume (TPV), transition zone volume (TZV), and the presence of hypoechoic lesions, were reviewed. PSA density (PSAD) and PSAD in the transition zone (PSAD-TZV) were calculated. RESULTS: IPca was diagnosed in 78 patients (4.8%). DRE findings, PSA, and TZV were independent predictive factors in the multivariate analysis. In the receiver operating characteristic curve analysis of PSA, PSAD, and PSAD-TZV, the area under the curve (AUC) was the largest for PSAD-TZV (AUC, 0.685). CONCLUSIONS: IPca was detected in 4.8% of the population studied. In addition to DRE findings, the combination of TZV and PSA can be useful predictive factors of IPca in patients considering tissue-ablation treatment as well as TURP.

Giant ureteral polyps causing proximal ureter obstruction: emphasis on the surgical method and ureteroscopy.

We describe here the case of a 13-year-old boy who had right flank pain for 3 months. An intravenous pyelogram showed filling defects in the right upper part of the ureter as well as hydronephrosis. Because the diseased part of the ureter was about 5 cm in length and we wished to avoid short ureter after surgery, we performed a minimal segmental resection of the ureter including the entire stalk. Perioperative ureteroscopic examination showed another polyp 3 cm below the primary polyp, which was also removed. End-to-end ureteral anastomosis was performed without mobilization of the kidney. Frozen and formal microscopic examination showed that these polyps were fibroepithelial.

Clinical characteristics and surgical outcomes in adolescents and adults with varicocele.

PURPOSE: To compare clinical characteristics and surgical results in adolescents and adults with varicocele. MATERIALS AND METHODS: We retrospectively analyzed the characteristics of 93 patients, 34 adolescents (mean age, 14.4±2.1 years) and 59 adults (mean age, 30.4±12.4 years), who underwent surgical repair of varicocele between 2006 and 2009. Median follow-up time in all patients was 18.7 months. The most bothersome symptoms, bilaterality, grades, surgical methods, artery-sparing rates, operation times, semen analysis, success rates, and recurrence-free period were compared between the two groups. RESULTS: The overall success rate of surgical repair was 92.5%. The most bothersome symptoms were scrotal mass, pain, and hypotrophy in adolescents and pain, scrotal mass, infertility, and hypotrophy in adults (p=0.008). There were no significant between-group differences in bilaterality, grades, surgical methods, operation times, pre- or postoperative semen analyses, success rates, or recurrence-free periods. Patients who underwent artery-sparing surgery had higher recurrence rates than did those who underwent surgery that did not spare arteries. In adults, semen density increased significantly after surgery, from 35.6 million/ml to 49.6 million/ml (p=0.046). CONCLUSIONS: There were no significant differences in clinical characteristics or surgical results between adolescents and adults with varicocele, except for the most bothersome symptoms. Semen density increased after surgery in both groups.

Solitary penile neurofibroma with erectile dysfunction.

Neurofibromas of the penis, although very rare, are often associated with neurofibromatosis type 1. Primary solitary neurofibromas of the penis are extremely rare. We describe a 37-year-old man with a solitary neurofibroma in the dorsum of the penis. The patient reported difficulty with sexual intercourse owing to a penile mass and erectile dysfunction. After surgical excision of the neurofibroma, he had no pain and a normal sensation of the penile glans, and his erectile dysfunction improved. At the present time, 26 months after surgery, there has been no evidence of tumor recurrence.

Short rare hTERT-VNTR2-2nd alleles are associated with prostate cancer susceptibility and influence gene expression.

BACKGROUND: The hTERT (human telomerase reverse transcriptase) gene contains five variable number tandem repeats (VNTR) and previous studies have described polymorphisms for hTERT-VNTR2-2nd. We investigated how allelic variation in hTERT-VNTR2-2nd may affect susceptibility to prostate cancer. METHODS: A case-control study was performed using DNA from 421 cancer-free male controls and 329 patients with prostate cancer. In addition, to determine whether the VNTR polymorphisms have a functional consequence, we examined the transcriptional levels of a reporter gene linked to these VNTRs and driven by the hTERT promoter in cell lines. RESULTS: Three new rare alleles were detected from this study, two of which were identified only in cancer subjects. A statistically significant association between rare hTERT-VNTR2-2nd alleles and risk of prostate cancer was observed [OR, 5.17; 95% confidence interval (CI), 1.09-24.43; P = 0.021]. Furthermore, the results indicated that these VNTRs inserted in the enhancer region could influence the expression of hTERT in prostate cancer cell lines. CONCLUSIONS: This is the first study to report that rare hTERT VNTRs are associated with prostate cancer predisposition and that the VNTRs can induce enhanced levels of hTERT promoter activity in prostate cancer cell lines. Thus, the hTERT-VNTR2-2nd locus may function as a modifier of prostate cancer risk by affecting gene expression.

Relationship between prostate-specific antigen and body mass index according to age: lower prostate-specific antigen in middle-aged overweight and obese Korean men.

OBJECTIVE: To analyze the relationship between serum prostate-specific antigen (PSA) and body mass index (BMI) according to age in a population of ostensibly healthy Korean men. PATIENTS AND METHODS: Between 2002 and 2006, data from 13,025 men who visited health promotion centers were evaluated. All men underwent anthropometric measurements and serum PSA determination. The relationship between serum PSA and BMI according to age was analyzed. RESULTS: The median age was 50.0 years and the median serum PSA level was 0.69 ng/ml. There was no relationship between serum PSA and BMI in the group whose BMI was <23 kg/m(2). The serum PSA showed a significant inverse relationship in those with BMI of ≥23 kg/m(2). However, this finding was only true among 40- to 59-year-old middle aged men and no such relationship between serum PSA and BMI was seen in the older groups (60-79 years of age). CONCLUSION: Our study revealed serum PSA had a significant inverse relationship with BMI in overweight and obese men aged between 40 and 59 years; however, there was no relationship between serum PSA and BMI in men whose age was older than 60 years.

A multi-institutional study on histopathological characteristics of surgically treated renal tumors: the importance of tumor size.

PURPOSE: The incidence of accidentally detected small renal tumors is increasing throughout the world. In this multi-institutional study performed in Korea, histopathological characteristics of contemporarily surgically removed renal tumors were reviewed with emphasis on tumor size. MATERIALS AND METHODS: Between January 1995 and May 2005, 1,702 patients with a mean age of 55 years underwent surgical treatment at 14 training hospitals in Korea for radiologically suspected malignant renal tumors. Clinicopathological factors and patient survival were analyzed. RESULTS: Of the 1,702 tumors, 91.7% were malignant and 8.3% were benign. The percentage of benign tumors was significantly greater among those < or = 4 cm (13.2%) than those > 4 cm (4.5%) (p < 0.001). Among renal cell carcinoma patients, the percentage of tumors classed as stage > or = T3 was significantly less among tumors < or = 4 cm (5.2%) than those > 4 cm (26.8%) (p < 0.001). The percentage of tumors classed as Fuhrman's nuclear grades > or = 3 was also significantly less among tumors < or = 4 cm (27.3%) than tumors > 4 cm (50.9%) (p < 0.001). The 5-year cancer-specific survival rate was 82.7%, and T stage (p < 0.001), N stage (p < 0.001), M stage (p = 0.025), and Fuhrman's nuclear (p < 0.001) grade were the only independent predictors of cancer-specific survival. CONCLUSION: In renal tumors, small tumor size is prognostic for favorable postsurgical histopathologies such as benign tumors, low T stages, and low Fuhrman's nuclear grades. Our observations are expected to facilitate urologists to adopt function-preserving approach in the planning of surgery for small renal tumors with favorable predicted outcomes.

Prostate-specific antigen velocity in healthy Korean men with initial PSA levels of 4.0 ng/mL or less.

OBJECTIVES: To assess the longitudinal changes in serial prostate-specific antigen (PSA) levels in healthy Korean men with initial PSA levels of 4.0 ng/mL. METHODS: The rate of PSA change or PSA velocity (PSAV) in 24 869 healthy men with an initial PSA level of 4.0 ng/mL or less who were clinically free of genitourinary disease was analyzed at intervals of at least 12 months. The influence of age, initial PSA level, and the interval between measurements was assessed. RESULTS: The mean age, initial PSA level, interval between measurements, and change in PSA and PSAV was 46.2 years, 0.86 ng/mL, 21.9 months, and 0.03 ng/mL and 0.02 ng/mL/y, respectively. A cumulative frequency plot of PSAV demonstrated that 50%, 95%, and 97% of subjects had a PSAV of 0.01, 0.40, and 0.52 ng/mL/y or less, respectively. The PSAV correlated with age, initial PSA level, and interval between measurements. The percentage of men with a PSAV greater than 0.75 ng/mL/y was 0.61% (151 of 24 869) and was 0.51% (92 of 17 985) for those with an initial PSA level of less than 1.0 ng/mL, 0.86% (50 of 5807) for those with a PSA level of 1.1-2.0 ng/mL, and 0.84% (9 of 1077) for those with an initial PSA level of 2.1-4.0 ng/mL. CONCLUSIONS: In healthy Korean men with an initial PSA level of 4.0 ng/mL or less, most will have a PSAV of less than 0.75 ng/mL/y. Thus, traditional PSAV cutoff values are not applicable in this population. We propose that a lower PSAV cutoff value should be used to indicate biopsy. Additional large-scale prospective studies, including biopsy data, are required to assess the cutoff value of PSAV for healthy Korean men with a PSA level of 4.0 ng/mL or less.

Eradication of established renal cell carcinoma by a combination of 5-fluorouracil and anti-4-1BB monoclonal antibody in mice.

Renal cell carcinoma (RCC), one of the most incurable malignancies, is highly resistant to chemotherapy and radiotherapy. Cytokine immunotherapy has been the standard approach, but the overall response rate is still very low. Administration of agonistic anti-4-1BB monoclonal antibody (mAb) has been shown to induce regression of several animal tumors but its effect on RCC is unknown. We show here that monotherapy with either anti-4-1BB mAb or the cytotoxic drug, 5-fluorouracil (5-FU), has little effect on established RCC, Renca tumors, but combination therapy with anti-4-1BB mAb and 5-FU eradicates the tumors in more than 70 % of mice. The regressing tumor tissues from mice receiving the combination therapy contained more apoptotic tumor cells and tumor infiltrating lymphocytes than tumor tissues from mice receiving 5-FU or anti-4-1BB mAb monotherapy. The number of lymphocytes in the spleens and tumor- draining lymph nodes (TDLNs) of the combination therapy mice was greatly increased compared to that of control or 5-FU monotherapy mice. Mice that had recovered due to the combination therapy rapidly rejected rechallenge with the tumor, pointing to the establishment of long-lasting tumor-specific memory. Our results indicate that targeting tumors with 5-FU, and immune cells with 4-1BB stimulation, could be a useful strategy for treating incurable RCC.