Association between the symptoms of benign prostatic hyperplasia and social disparities: Does social capital promote prostate health?

This cross-sectional study investigated the relationships between socioeconomic factors and social capital and benign prostatic hyperplasia symptoms. The participants were 100,000 adult men who participated in the Korea Community Health Survey. The surveyors used the International Prostate Symptom Score. As regards occupation, the prevalence of benign prostatic hyperplasia was higher in men with blue-collar occupations or those who were unemployed than in those with white-collar jobs. In terms of marital status, the prevalence of benign prostatic hyperplasia was 1.319 times higher among divorced men than married men. As regards social capital, the prevalence of benign prostatic hyperplasia in men with positive attitudes towards one's community scores that reflected good, poor and very poor community scores was 1.228, 1.246 and 1.447 times higher than that of men who had very good scores respectively. The groups with good, poor, and very poor community participation scores had 1.115, 1.202 and 1.364 times higher prevalence of benign prostatic hyperplasia than the group with very good scores. Social disparities and social capital of a community were associated with the prevalence of benign prostatic hyperplasia. Thus, the use of social capital in the community setting will be effective in the management of the condition.

Significance of perineural invasion, lymphovascular invasion, and high-grade prostatic intraepithelial neoplasia in robot-assisted laparoscopic radical prostatectomy.

BACKGROUND: Recently, more detailed histopathological variables such as perineural invasion (PNI), lymphovascular invasion (LVI), and high-grade prostatic intraepithelial neoplasia (HGPIN) have been investigated as prognostic factors for adverse pathologic findings on the radical prostatectomy specimen. We aim to determine whether these pathological factors are associated with adverse pathologic features after robot-assisted laparoscopic radical prostatectomy (RALP). METHODS: All 407 patients who underwent RALP with pelvic lymphadenectomy between July 2005 and December 2009 were analyzed, retrospectively. We investigated the association of these three pathological parameters with adverse pathological findings in RALP specimen and biochemical recurrence using Kaplan-Meier analysis with log-rank test and a multivariate Cox proportional hazard model. RESULTS: The PNI and LVI were significantly associated with a higher pathological stage, a higher pathological Gleason score, a higher tumor volume in RALP specimen, a higher frequency of positive surgical margins, and a higher frequency of seminal vesicle invasion. In addition, PNI correlated with preoperative PSA, clinical stage, and Gleason score on needle biopsy. However, the HGPIN was not significantly associated with the clinicopathological characteristics studied. Using log-rank test, presence of PNI (P < 0.001) increases the probability of biochemical recurrence. On multivariate analysis, all three pathological parameters were not significantly correlated with biochemical recurrence. CONCLUSION: Although presence of PNI and LVI in RALP specimen correlated with multiple adverse clinicopathological factors, it did not predict biochemical recurrence, thus limiting its clinical usefulness. HGPIN was not significantly associated with the clinicopathological characteristics studied.

Prostate Cancer Working Group report.

The incidence of prostate cancer, while still lower than in Western nations, is increasing rapidly in Asian countries due to a more westernized lifestyle. Prostate cancer mortality is declining in the USA, where most prostate cancers are diagnosed in the early stage. In contrast, the mortality rates of prostate cancer in Asian countries are expected to continue to increase, because the percentage of advanced-stage prostate cancers remains high. Therefore, early detection by prostate-specific antigen screening and a comprehensive strategy for cancer prevention are essential for Asian people. The exposure rate of prostate-specific antigen screening is very low in Asian countries. Increased prostate-specific antigen screening may reduce the mortality rate. The stances regarding population screening differ among countries. Urological associations should promote population screening. Reliable data from Asian countries are needed. The prostate cancer incidence is low in Asian countries, perhaps due to high soy consumption. Isoflavones may prevent prostate cancer in Asian countries, but that is not yet clear. A large, multinational study in Asia is needed to clarify whether or not isoflavone consumption shows efficacy in preventing prostate cancer. Clinical data suggest that hormonal therapy is more effective in Asians than in Westerners. Clinical guidelines should consider including hormonal therapy as one of the options for the treatment of localized prostate cancer. At the same time, effort should be made to decrease the adverse effects of each treatment. Collaborative studies on the treatment of prostate cancer should be carried out among Asian countries.

Failing to achieve a nadir prostate-specific antigen after combined androgen blockade: predictive factors.

OBJECTIVES: To determine the optimal cut-off of a nadir prostate-specific antigen (PSA) for prediction of progression within 24 months after combined androgen blockade (CAB) and to analyze predictive factors of failing to achieve the nadir PSA. METHODS: We retrospectively reviewed the medical records of 343 patients with prostate cancer treated with CAB from 2000 to 2005. We determined the nadir PSA level that predicts progression to hormone refractory prostate cancer (HRPC) at 24 months after CAB. Predictive factors for failing to achieve a determined nadir PSA were analyzed. RESULTS: Mean age was 74.0 years. Mean follow up was 42.1 month. Seventy-seven patients experienced progression to HRPC. A nadir PSA of 1.0 ng/mL predicts progression to HRPC at 24 months. Predictive factors for failing to achieve a nadir PSA of 1.0 ng/mL or less include pretreatment PSA, percentage positive biopsy core, Gleason score, serum hemoglobin, stage, and extent of bone metastasis in univariate analysis. Pretreatment PSA (>50 ng/mL) and serum hemoglobin (<12 g/dL) were significant factors to predict failing to achieve a nadir PSA of 1.0 ng/mL or less in logistic regression analysis. CONCLUSIONS: A nadir PSA of 1.0 ng/mL can predict progression to HRPC after CAB. Pretreatment PSA and serum hemoglobin are significant predictors of failing to achieve a nadir PSA of 1.0 ng/mL or less.

The 5th Conference on Asian Trends in Prostate Cancer Hormone Therapy.

The Conference on Asian Trends in Prostate Cancer Hormone Therapy is an annual forum for Asian urologists now in its 5th year. The 2006 conference, held in Bali, Indonesia, was attended by 27 leading urologic oncologists from China, Indonesia, Japan, Korea, Singapore, and Taiwan and featured a packed program of presentations and discussions on a wide range of topics such as relationships among clinicians and the newly opened Asia Regional Office for Cancer Control of the International Union Against Cancer (UICC), detection rates of prostate cancer by biopsy in each of the 6 Asian countries, and favored treatment modalities for hormone-refractory prostate cancer (HRPC) in each country. The first session of the conference kicked off with a keynote lecture entitled "Activities of the UICC ARO". UICC's new office will be the nerve center for its activities in the Asia region. Along with the Asian Pacific Organization for Cancer Prevention (APOCP), UICC aims to shift the focus of attention to cancer control. As such APOCP's long-running publication the APJCP is to be re-launched as the Asian Pacific Journal of Cancer Control. Although UICC is primarily concerned with cancer, several risk factors for cancer are common also to other non-communicable diseases such as diabetes and heart disease, and an important strategy is to implement measures to control these various pathologic conditions as a whole. Apart from contributing to an Asian prostate cancer registry the UICC-ARO will provide training courses, working groups, and assistance in collecting and processing data. The keynote lecture was followed by a roundtable discussion on possible ways in which clinicians from each Asian country can work with UICC. A number of suggestions were put forth including better registration, epidemiology research, possible implementation of UICC prostate cancer guidelines, early detection and screening, and roles of diet and phytotherapy. The underlying reasons for the large but dwindling difference in incidence rates of prostate cancer in various regions of Asia should be studied while the opportunity lasts. Session 2 was devoted to 6 presentations on detection rates by biopsy in each country. Although biopsy is the gold standard for detecting prostate cancer in most areas, indications for conducting biopsy are different in each country. For example, in Indonesia doctors may use PSAD 0.15 as the cutoff level. TRUS-guided biopsy is most widely used in Asian countries. Traditional sextant biopsy is often performed, although multiple-core biopsy is commonly available and associated with better detection rates, especially in men with large prostate volume. Positive DRE, high PSA, and older age were identified as factors associated with high biopsy detection rate, although elevated PSA has limited specificity. First biopsy in men with elevated PSA had a positive detection rate of approximately 30% in all countries. Community-based screening in some countries has an overall detection rate of approximately 1%. The favorable treatment modality for HRPC was the subject of the final session. First priority for doctors in all 6 countries is to maintain serum testosterone at castration level. Many therapeutic options are available, from cytotoxic drugs to traditional herbal medicines Chemotherapeutic agents such as estramustine, docetaxel, cyclophosphamide, and mitoxantrone are often given to patients with HRPC although not all are available in every country. Prednisone and dexamethasone are used for secondary hormonal therapy. External beam radiotherapy, radioisotopic drugs such as strontium 89, and bisphosphonates are common choices to control bone pain.

The Correlation between Body Mass Index and Routine Parameters in Men Over Fifty.

PURPOSE: This study aimed to investigate the relationships between body mass index (BMI) and prostate-specific antigen (PSA) levels, international prostate symptom score (IPSS), quality of life (QoL), and prostate volume (PV). MATERIALS AND METHODS: Height, weight, PSA levels, PV, and IPSS were analyzed in 15,435 patients who underwent a prostate examination between 2001 and 2014. Patients aged <50 years or with a PSA level ≥10 ng/mL were excluded. The relationships between BMI and PSA, IPSS, QoL, and PV were analyzed by a scatter plot, one-way analysis of variance, and the Pearson correlation coefficient. RESULTS: The mean age was 71.95±7.63 years, the mean BMI was 23.59±3.08 kg/m², the mean PSA level was 1.45±1.45 ng/mL, the mean IPSS was 15.53±8.31, the mean QoL score was 3.48±1.25, and the mean PV was 29.72±14.02 mL. PSA, IPSS, and QoL showed a tendency to decrease with increasing BMI, and there were statistically significant differences for each parameter (p≤0.001). PV showed a significant tendency to increase with BMI (p<0.001). In the correlation analysis, BMI showed a statistically significant correlation (p<0.001) with PSA, IPSS, and QoL, although the correlations were very weak. In contrast, BMI showed a significant correlation with PV (p<0.001), with a meaningful Pearson correlation coefficient of 0.124. CONCLUSIONS: Higher BMI was associated with lower PSA levels and higher IPSS and QoL scores. Meanwhile, PV increased with BMI. Although obese individuals had a greater PV, obesity did not aggravate lower urinary tract symptoms.

Prostate cancer control--aims of the UICC Asia Regional Office Consortium.

Cancer of the prostate remains at relatively low incidence in Asia but rates are increasing rapidly in some countries and specific populations so that measures for control need our attention. Little is known about risk factors, although vegetables and phytoestrogens may be protective and fat, meat and dairy products may increase the risk. Physical exercise may have preventive effects, while tobacco and alcohol appear to have no consistent relationship. The lack of clear lifestyle targets means that emphasis needs to be placed on screening for various prostate specific antigen parameters and clinical treatment, whether hormonal, radio or surgical, alone or in combination. While there is a massive literature for the Western world, the limited literature available for Asia means that cooperation to obtain a standardized data base is a high priority if the most effective measures for the specific populations of Asian countries are to be identified and put into practice.

Obesity as a Risk Factor for Prostatic Enlargement: A Retrospective Cohort Study in Korea.

PURPOSE: We aimed to evaluate obesity, a risk factor of metabolic syndrome, and its association with prostatic enlargement in a retrospective cohort in Korea. METHODS: Baseline data were obtained from the Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population (KoGES-ARIRANG). Between March 2015 and November 2015, 2,127 male participants of KoGES-ARIRANG were invited to the Korean Prostate Health Council Screening Program, and 602 participants underwent urological examination, including serum prostate specific antigen measurement and transrectal ultrasonography, and completed the International Prostate Symptom Score questionnaire. The data for 571 participants were analyzed, after excluding 31 men who had a history of prostatic disease or testosterone replacement, or had undergone a prior prostatic surgery or procedure. RESULTS: Among components of metabolic syndrome, waist circumference had a statistically significant linear correlation with incremental increases in prostate volume (B=0.181, P=0.004). Abdominal obesity as determined by anthropometric measures including body mass index (odds ratio [OR], 1.205; 95% confidence interval [CI], 1.088-1.336), waist circumference (OR, 1.073; 95% CI, 1.032-1.115), body fat (OR, 1.126; 95% CI, 1.056-1.202), and visceral fat composition (OR, 1.667; 95% CI, 1.246-2.232) was significantly associated with the presence of high-volume benign prostatic hyperplasia (BPH) (prostate volume≥ 40 mL). Furthermore, the highest quartile of serum leptin (OR, 3.541; 95% CI, 1.103-11.365) and adiponectin levels (OR, 0.315; 95% CI, 0.102-0.971) were significantly correlated with high-volume BPH compared to the lowest quartile of levels. CONCLUSIONS: Abdominal obesity and serum leptin level are positively associated with prostate growth, whereas serum adiponectin level is inversely associated with the presence of prostatic enlargement.

Prostate-specific antigen, digital rectal examination and transrectal ultrasonography: a meta-analysis for this diagnostic triad of prostate cancer in symptomatic korean men.

We conducted a meta-analysis using results from the Korean literature to determine whether prostate-specific antigen (PSA) or digital rectal examination (DRE) or transrectal ultrasonography (TRUS) provides a better diagnostic outcome for possible prostate cancer patients. An extensive literature search of MedRIC database et al. (1980 to 2003) was performed using the medical subject headings "PSA", "DRE", "TRUS" and "prostate cancer". Of the 108 articles that we retrieved, 13 studies (2,029 subjects) were selected for this meta-analysis. The criteria for quality evaluation were as follows: the study subjects must have been compared clinically for suspected prostate cancer, and the articles must have included individual data about sensitivity and specificity for this diagnostic triad based on the biopsy results as a reference standard. For the quantitative meta-analysis process the Hasselblad method was utilized. The pooled sensitivity and specificity for a PSA level greater than 4ng/mL were 91.3 % and 35.9 %, respectively; and those for a PSA level greater than 10ng/mL were 77.3 % and 67.5 %, respectively; and those for DRE were 68.4 % and 71.5 %, respectively; and those for TRUS were 73.6 % and 61.3 %, respectively. According to the results in a fixed effect model for PSA criteria, the estimates of d for PSA4 and PSA10 were 0.8517 [95 % confidence interval (CI): 0.6694, 1.0340] and 1.0996 (95 % CI: 0.9459, 1.2534), respectively. Also, according to the results using a random effect model for both DRE and TRUS criteria, the estimates of d for DRE and TRUS were 0.8398 (95 % CI: 0.7169, 0.9627) and 0.8002 (95 % CI: 0.6714, 0.9289), respectively. The detection rate for combination testing of PSA, DRE and TRUS for the diagnosis of prostate cancer jumped further to 68.3 % or to 76.8 %. In conclusion, this study suggests that this diagnostic triad for prostate cancer was noneffective when they were used separately. Therefore, we recommend that the urologists should use PSA together with DRE and TRUS for the primary diagnosis of prostate cancer in men with lower urological symptoms.

The incidence and histological characteristics of intratubular germ cell neoplasia in postpubertal cryptorchid testis.

PURPOSE: It is well known that testicular germ cell tumors arise with increased frequency in patients with cryptorchidism. In addition, intratubular germ cell neoplasia (ITGCN) is a precursor lesion to testicular germ cell tumor. Approximately 50% of patients with ITGCN will develop an invasive of testicular germ cell tumors within 5 years. Therefore, we evaluated that the incidence of ITGCN in postpubertal cryptorchidism. MATERIALS AND METHODS: Between January 2002 and August 2012, orchiectomy specimens from 31 postpubertal patients (aged 12 or over) with cryptorchid testis were reviewed. The specimens were evaluated for ITGCN using immunohistochemical stains of placental-like alkaline phosphatase and Oct 3/4 with routine hematoxylin-eosin stain. Additionally, the degree of spermatogenesis was assessed using the Johnsen score. RESULTS: Mean age was 34 years (range, 17 to 74 years) at surgery. All patients were diagnosed as unilateral cryptorchidism. One patient (3.2%) of 20-year-old had ITGCN in surgical specimen with all positive markers. Histological assessment of spermatogenesis showed that mean Johnsen score was 3.42 (range, 1 to 9). Majority of patients (27 of 31) presented impaired spermatogenesis with low Johnsen score lesser than 5. CONCLUSIONS: Considering the risk of malignancy and low spermatogenesis, we should perform immunohistochemical stains and discuss preventative orchiectomy for the postpubertal cryptorchidism.

Asian trends in prostate cancer hormone therapy.

The first Conference on Asian Trends in Prostate Cancer Hormone Therapy was held in September 2001 to serve as a forum for Asian urologists to compare data on prostate cancer and discuss issues regarding the use of hormone therapy. The conference revealed that due to various cultural and philosophical factors, differences exist in prostate cancer management among the Asian countries. In addition, a lack of databases on hormone therapy was exposed in some countries. It was noted that many decisions in the treatment of prostate cancer are influenced by the strategies adopted in Western countries, and that attempts to formulate uniform guidelines for the Asian region have hitherto been unsuccessful. The main findings of the conference are reported in this review.

The 3rd Conference on Asian Trends in Prostate Cancer Hormone Therapy.

From its inception in 2001, the Conference on Asian Trends in Prostate Cancer Hormone Therapy has served as an annual forum for Asian urologists to compare data on prostate cancer and to discuss issues regarding the use of hormone therapy. The 3rd conference, held in Tokyo in December 2003, began with participants from China, Indonesia, Japan, Korea, Singapore, and Taiwan presenting QOL data deriving from a survey of patients with prostate cancer. For this purpose, each country translated the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire into its own language. Although the surveys conducted in each country included a heterogeneous cohort of patients and gave very mixed results, the trial of FACT-P in Asian countries seemed propitious and in future may provide insights that could prove beneficial to patients. Day 2 of the conference included 2 discussions, focusing on the most appropriate number of biopsy cores and the implementation of prospective trials involving the collaboration of Asian countries, respectively. In the latter discussion, although a varied assortment of proposals were put forth, the participants generally agreed that any collaborative study must be a prospective outcome study conducted in a relatively short time not exceeding 2-3 years, and that patient registration should be done using the Internet.

Clinical effects of discontinuing 5-alpha reductase inhibitor in patients with benign prostatic hyperplasia.

PURPOSE: To assess changes in lower urinary tract symptoms (LUTS), prostate volume, and serum prostate-specific antigen (PSA) after discontinuation of 5-alpha reductase inhibitor (5ARI) combination therapy in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: From December 2003 to December 2012, data were collected retrospectively from 81 men more than 40 years of age with moderate to severe BPH symptoms (International Prostate Symptom Score [IPSS]≥8). The men were classified into group 1 (n=42) and group 2 (n=39) according to the use of 5ARI therapy. A combination of dutasteride 0.5 mg with tamsulosin 0.2 mg was given daily to all patients for 1 year. For the next 1 year, group 1 (n=42) received the combination therapy and group 2 (n=39) received tamsulosin 0.2 mg monotherapy only. The IPSS, prostate volume, and PSA level were measured at baseline and at 12 and 24 months according to the use of dutasteride. RESULTS: Discontinuation of dutasteride led to significant deterioration of LUTS, increased prostate volume, and increased PSA level. The repeated-measures analysis of variance showed that the changes in IPSS, prostate volume, and PSA level over time also differed significantly between groups 1 and 2 (p<0.001). CONCLUSIONS: Withdrawal of 5ARI during combination therapy resulted in prostate regrowth and deterioration of LUTS. The PSA level is also affected by the use of 5ARI. Therefore, regular check-up of the IPSS and PSA level may be helpful for all patients who either continue or discontinue the use of 5ARI.

Simultaneous robot-assisted laparoendoscopic single-site partial nephrectomy and standard radical prostatectomy.

Recently, patients with urologic malignancies are treated with robot-assisted surgery and the expanded role of robot-assisted surgery includes even those patients with two concomitant primary urologic malignancies. In an effort to further reduce port site-related morbidity, robot-assisted laparoendoscopic single-site surgery (RLESS) has been developed. Therefore, we present herein our early experience and feasibility of simultaneous RLESS partial nephrectomy and standard robotrobot- assisted laparoendoscopic radical prostatectomy (RALP) on 3 patients with synchronous renal masses and prostate cancer.

Clinical application of computed tomography on prostate volume estimation in patients with lower urinary tract symptoms.

PURPOSE: To compare estimated prostate volume (PV) based on computed tomography (CT) scan and transrectal ultrasonography (TRUS) in patients with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: Between January 2010 and October 2012, 107 consecutive patients with LUTS were analyzed, retrospectively. PV measures were performed by the means of ellipsoid formula (PV = π/6 [width (cm) thick­ness (cm) length (cm)]) from TRUS (PVTRUS) and CT (PVCT ellipsoid). In addition, PV was calculated as the sum of the area of each slice and the CT slice interval using commercial software program (PVCT 3D reconstruction). RESULTS: Mean PVCT ellipsoid was 40.63 & plusmn; 31.06 cm3 (range, 8.34-217.46). Mean PVTRUS and PVCT 3D reconstruction were 39.20 & plusmn; 33.04 (range, 4.00-223.81) and 45.30 & plusmn; 32.98 (range, 8.90-248.30), respectively. PVCT ellipsoid was highly correlated with PVTRUS and PVCT 3D reconstruction (r = 0.935, P < .001; r = .970, P < .001, respectively). Moreover, there was very strong agreement for PV measurements with all three methods (intraclass correlation coefficient = 0.934, P < .001). CONCLUSION: PVCT ellipsoid is adequate method for quick volume assessment with reasonable accuracy. Therefore, we can easily predict PV by CT scan using ellipsoid formula without performing additional TRUS in patients with LUTS.& nbsp;

Clinical significance of free-to-total prostate-specific antigen (PSA) ratio in advanced prostate cancer patients with PSA less than 0.1 ng/ml after hormone treatment.

PURPOSE: We analyzed the pattern of change in the free-to-total prostate-specific antigen (f/t PSA) ratio and the progression to castration-resistant prostate cancer (CRPC) in patients with advanced prostate cancer who received hormone treatment and whose PSA nadir was below 0.1 ng/ml. MATERIALS AND METHODS: We retrospectively analyzed the medical records of 52 patients with advanced prostate cancer. All patients were treated with maximum androgen blockade (gonadotrophin-releasing hormone agonist and anti-androgen agents). The patients were divided into two groups: those with a nadir f/t PSA ratio above 60% and those with a nadir f/t PSA ratio of 60% or below. Age, initial PSA, clinical stage, lymph node metastasis, bone metastasis, and follow-up data, including PSA, free PSA, and f/t PSA ratio, were collected. The Mann-Whitney U-test, Fisher exact test, chi-square test, Kaplan-Meier survival analysis, and log rank test were used. RESULTS: There were 24 patients in the group with a nadir f/t PSA ratio above 60% and 28 patients in the group with a nadir f/t PSA ratio of 60% or below. After hormone therapy, the median f/t PSA ratio in each group increased from 37% and 34% at 3 months to 75% and 60% at 6 months, respectively. At 9 months, however, the f/t PSA ratio increased to 80% in the group with a nadir f/t PSA ratio above 60%, whereas it decreased to 31% in the group with a nadir f/t PSA ratio of 60% or below. From 9 to 15 months, the f/t PSA ratio showed a tendency to decrease (75 to 37% and 27 to 20%, respectively). The progression to CRPC was significantly different between the two groups (10 vs. 24). CONCLUSIONS: Progression to CRPC was significantly higher in the group with a lower f/t PSA ratio. Additionally, the pattern of change in the f/t PSA ratio was significantly different after 9 months. Collectively, the f/t PSA ratio can be used as an additional marker for prognosis of hormone treatment.

Relationships between Prostate-Specific Antigen, Prostate Volume, and Components of Metabolic Syndrome in Healthy Korean Men.

PURPOSE: Metabolic syndrome (MS) plays a potential role in the etiology of benign prostatic hyperplasia (BPH). Recent studies have reported on an association between MS and BPH. However, there has been no consensus on recent results. This study was conducted to evaluate the associations among prostate-specific antigen (PSA), prostate volume (PV), and metabolic components in men who visited our health promotion center. MATERIALS AND METHODS: During the period from January 2005 to December 2010, 521 consecutive men (age range, 40 to 70 years) who underwent transrectal ultrasonography were enrolled in this retrospective study. The health screening program includes blood pressure, body measurements (height, weight, waist circumference, body mass index), biochemical analysis (serum glucose, total cholesterol, triglycerides, high-density and low-density lipoprotein cholesterol, fasting plasma glucose, tumor markers), stool and urine analysis, and a detailed clinical examination. RESULTS: The serum PSA level and PV were significantly higher in patients with MS than in patients without MS, retrospectively (p<0.001, p<0.001). Patients with more than one metabolic component were significantly more likely to have a larger PV and higher serum PSA level. The serum PSA level and PV were increased in a similar manner with the increasing sum of MS components (p<0.0001, p<0.0001). CONCLUSIONS: The MS components were associated with larger PV and higher serum PSA level. Therefore, each MS component could be an important factor in BPH development and management.

Extended pelvic lymph node dissection including internal iliac packet should be performed during robot-assisted laparoscopic radical prostatectomy for high-risk prostate cancer.

INTRODUCTION: The indication and anatomic limits of pelvic lymph node dissection (PLND) have not been clearly defined. Therefore, we assessed whether the extent of PLND at robot-assisted laparoscopic radical prostatectomy (RALP) had any benefit on lymph node yield, staging accuracy, and biochemical recurrence (BCR) in patients with high-risk prostate cancer. PATIENTS AND METHODS: Between July 2005 and July 2010, a retrospective analysis was performed on 200 patients with high-risk prostate cancer stratified by D'Amico classification. The study population was divided into different groups: patients in Group 1 had standard PLND, and Group 2 had extended PLND (ePLND). The clinicopathologic findings of patients and surgical outcomes of PLND with each procedure were measured. Kaplan-Meier and log rank tests were used to estimate BCR-free survival rates. Univariate and multivariate survival analyses were done with the Cox proportional hazard regression model. RESULTS: Medians of 15 (interquartile range, 11-19) and 24 (interquartile range, 18-28) lymph nodes were dissected in Groups 1 and 2, respectively (P<.001). The incidences of lymph node metastasis were 5.2% (8/155) in Group 1 and 22.2% (10/45) in Group 2. Regardless of the extent of PLND, the patients with positive lymph nodes had a significantly lower BCR-free survival than those with negative lymph nodes. Twenty-five percent (7/27) of positive lymph nodes were in the internal iliac packet and common iliac packet. In particular, of the positive internal iliac nodes, 75% (3/4) of nodes were found in that location, exclusively. CONCLUSIONS: An ePLND that identifies patients with lymph node metastasis including the internal iliac packet during RALP provides an accurate pathologic staging and may have survival benefits in high-risk prostate cancer.

Immediate robot-assisted ureteral reimplantation during robotic prostatectomy in locally advanced prostate cancer.

We report the technique and outcomes of immediate robot-assisted ureteral reimplantation due to unexpected ureteral injury during robot-assisted laparoscopic prostatectomy (RALP). A 61-year-old male was diagnosed with locally advanced prostate adenocarcinoma (T3bN0M0). Multiple positive margins at the bladder neck were noted on frozen section during RALP, and re-excision of the bladder neck was done. Unfortunately, the distal third of right ureter was transected. We immediately performed robot-assisted ureteroneocystostomy with double J stent insertion. No complications developed during the follow-up period.

Analysis of the factors causing bladder irritation after transurethral resection of the prostate.

PURPOSE: Approximately 20% to 30% of patients with benign prostatic hyperplasia (BPH) require medication or supplementary treatment for their continuous irritative bladder symptoms after transurethral resection of the prostate (TURP). The purpose of this study was to identify any factors related to continuous bladder irritation in patients after TURP. MATERIALS AND METHODS: Of all patients who underwent TURP from January 2000 to December 2007, 160 who underwent long-term follow-up were selected for this study. The International Prostate Symptom Score (IPSS) was assessed 12 months after TURP, and the patients were divided into two groups: one group with an irritative bladder symptom score on the IPSS of 7 or less (non-irritative group) and another group with an irritative bladder symptom score on the IPSS of 8 or greater (irritative group). Preoperative urodynamic study variables, preoperative and postoperative IPSS, and the shape of the prostate upon transrectal ultrasonography (TRUS) were analyzed. RESULTS: Of the 160 patients, 93 patients were assigned to the non-irritative group, and 67 were assigned to the irritative group. Initial irritative bladder symptoms were significantly different between the two groups (p<0.05). Also, a retrourethral enlarged prostate was more frequently observed upon TRUS in the irritative group. Symptoms of urinary frequency, incontinence, and urgency were significantly greater in the irritative group. Although there was no significant difference in the preoperative quality of life between the two groups, postoperative quality of life was significantly worse in the irritative group. CONCLUSIONS: The shape of the prostate and the preoperative irritation score correlated significantly with the postoperative severity of irritative bladder symptoms. Therefore, physicians should be cautious when performing TURP in patients with a retrourethral enlarged prostate and severe irritative symptoms.