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) > or =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.

Long-Term Results of Radical Cystectomy in Elderly Patients with Comorbidity

PURPOSE: Radical cystectomy is a standard treatment for muscle-invasive bladder cancer in healthy individuals. However, few data are available on radical cystectomy in elderly patients with comorbidity. We determined the safety of radical cystectomy and the long-term benefit and survival outcomes after radical cystectomy in elderly patients with comorbidity. MATERIALS AND METHODS: We reviewed the records of all patients undergoing radical cystectomy between 1986 and 2005. We identified 31 elderly patients with comorbidity, as defined by age 75 years or greater and American Society of Anesthesiologist (ASA) classification 3. We analyzed patient characteristics, presenting symptoms, surgical outcomes including perioperative complications, pathologic stage, and survival. RESULTS: The patients' median age was 77 years (range, 75-89 years). ASA class was 3 in 31 patients. Complications developed in 8 cases (25.8%). Postoperatively, 6 of the 31 patients (20%) were transferred directly to the general urology floor. No patients died in the perioperative period or were hospitalized within 6 months of discharge home. During the follow-up period of 54 months (range, 11-135 months), 11 (31.4%) patients were alive. Cause of death was known in 20 patients, with majority (7/20) because of bladder cancer. Kaplan-Meier survival curves demonstrated that patients with organ-confined disease had a significantly longer overall survival than did patients with non-organ-confined disease. CONCLUSIONS: Our results support the safety and feasibility of radical cystectomy in elderly patients with comorbidity. Palliation of local symptoms, local cancer control, and long-term survival benefit might be expected after radical cystectomy, especially in patients with organ-confined disease.