Comparison of Clinical Outcomes of Radical Prostatectomy versus IMRT with Long-Term Hormone Therapy for Relatively Young Patients with High- to Very High-Risk Localized Prostate Cancer.

That intensity-modulated radiotherapy (IMRT) plus antiandrogen therapy (IMRT-ADT) and radical prostatectomy (RP) are the definitive optimal treatments for relatively young patients (aged ≤ 65 years) with high- or very high-risk localized prostate cancer (HR/VHR-LPC), but remains controversial. We conducted a national population-based cohort study by using propensity score matching (PSM) to evaluate the clinical outcomes of RP and IMRT-ADT in relatively young patients with HR/VHR-LPC. Methods: We used the Taiwan Cancer Registry database to evaluate clinical outcomes in relatively young (aged ≤ 65 years) patients with HR/VHR-LPC, as defined by the National Comprehensive Cancer Network risk strata. The patients had received RP or IMRT-ADT (high-dose, ≥72 Gy plus long-term, 1.5-3 years, ADT). Head-to-head PSM was used to balance potential confounders. A Cox proportional hazards regression model was used to analyze oncologic outcomes. Results: High-dose IMRT-ADT had a higher risk of biochemical failure (adjusted hazard ratio [aHR] = 2.03, 95% confidence interval [CI] 1.56-2.65, p < 0.0001) compared with RP; IMRT-ADT did not have an increased risk of all-cause death (aHR = 1.2, 95% CI 0.65-2.24, p = 0.564), locoregional recurrence (aHR = 0.88, 95% CI 0.67-1.06, p = 0.3524), or distant metastasis (aHR = 1.03, 95% CI 0.56-1.9, p = 0.9176) compared with RP. Conclusion: In relatively young patients with HR/VHR-LPC, RP and IMRT-ADT yielded similar oncologic outcomes and RP reduced the risk of biochemical failure compared with IMRT-ADT.

Survival Impact of Current-Smoking-Related COPD or COPD with Acute Exacerbation on Bladder Preservation through Concurrent Chemoradiotherapy for Muscle-Invasive Bladder Urothelial Carcinoma.

PURPOSE: The survival effect of smoking-related chronic obstructive pulmonary disease (COPD) and COPD with acute exacerbation (COPDAE) on patients with muscle-invasive bladder urothelial carcinoma (MIBUC) receiving concurrent chemoradiotherapy (CCRT) for bladder preservation is unclear. METHODS: We recruited patients with MIBUC, clinical stages IIA-IVB, who had received maximal transurethral resection of bladder tumor (TURBT) followed by CCRT from the Taiwan Cancer Registry Database. The Cox proportional hazards model was used to analyze all-cause mortality. We categorized the patients into two groups by using propensity score matching based on the preexisting COPD status (within 1 year before CCRT) to compare overall survival outcomes: Group 1 (never smokers without COPD) and Group 2 (current smokers with COPD). RESULTS: In multivariate Cox regression analyses, the adjusted hazard ratio (aHR; 95% confidence interval (CI)) of all-cause mortality in Group 2 compared with Group 1 was 1.89 (1.12-3.18), p = 0.017. The aHRs (95% CIs) of all-cause mortality for ≥1 and ≥2 hospitalizations for COPDAE within 1 year before CCRT for bladder preservation were 3.26 (1.95-5.46) and 6.33 (3.55-11.281) compared with non-COPDAE patients with MIBUC undergoing CCRT for bladder preservation. CONCLUSIONS: Among patients with MIBUC undergoing TURBT followed by CCRT for bladder preservation, current smokers with smoking-related COPD had worse survival outcomes than did nonsmokers without COPD. CONDENSED ABSTRACT: This was the first study to estimate the survival impact of smoking-related chronic obstructive pulmonary disease (COPD) on patients with muscle-invasive bladder urothelial carcinoma (MIBUC) receiving maximal transurethral resection of bladder tumor (TURBT) followed by concurrent chemoradiotherapy (CCRT) for bladder preservation. Smoking-related COPD was a significant independent risk factor for all-cause mortality in patients with clinical stages IIA-IVB receiving TURBT followed by CCRT. Hospitalization frequency for COPD with at least one acute exacerbation within 1 year before CCRT was highly associated with high mortality for patients with MIBUC receiving CCRT for bladder preservation. Not only all-cause death but also bladder cancer death and COPD death were significantly higher in the current-smoking COPD group than in the never-smoking non-COPD group.

Latest Comprehensive Medical Resource Consumption in Robot-Assisted versus Laparoscopic and Traditional Open Radical Prostatectomy: A Nationwide Population-Based Cohort Study.

BACKGROUND: Few studies have evaluated long-term medical monetary cost in patients with prostate cancer (PC) receiving open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP). To the best of our knowledge, this is the largest and longest follow-up study to examine medical monetary cost in patients with PC undergoing ORP, LRP, or RARP. After adjustment for confounders, the medical monetary cost in the RARP group was the least compared with that in the ORP and LRP groups. PURPOSE: To estimate long-term medical resource consumption among patients with prostate cancer (PC) receiving open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), or robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS: Participants were men enrolled in the Taiwan Cancer Registry with localized PC diagnosis who received radical prostatectomy. After adjustment for confounders, a generalized linear mixed model was used to determine significant differences in the number of urology outpatient clinic visits required, proportion of patients being hospitalized for urinary diseases or surgical complications, and medical reimbursement for urinary diseases or surgical complications following ORP, LRP, or RARP in the first, second, and third years. Results: No differences were observed in the median number of urology outpatient clinic visits between the three types of surgical modalities up to the second year after ORP, LRP, and RARP (median: 15, 10, and seven visits, respectively; p < 0.001), but significant differences were observed in the third year. Similarly, with RARP (10.9% versus 18.7% in ORP and 9.8% in LRP; p = 0.0014), the rate of hospitalization for urinary diseases or surgical complications decreased in the third year. Medical reimbursement for urinary diseases or surgical complications reduced after RARP compared with that for ORP and LRP, with approximately 22% reduction in the first year (p = 0.0052) and 20-40% reduction in the third year (p value = 0.0024). CONCLUSIONS: Medical resource consumption in the RARP group was less compared with those in the ORP and LRP groups.

Oncologic Outcomes of Radical Prostatectomy and High-Dose Intensity-Modulated Radiotherapy with Androgen-Deprivation Therapy for Relatively Young Patients with Unfavorable Intermediate-Risk Prostate Adenocarcinoma.

PURPOSE: To estimate the oncologic outcomes of radical prostatectomy (RP) and high-dose intensity-modulated radiotherapy (IMRT) with short-term androgen-deprivation therapy (ADT) in relatively young men with unfavorable intermediate-risk prostate cancer, as defined by the National Comprehensive Cancer Network (NCCN-UIR-PC). PATIENTS AND METHODS: We enrolled relatively young men (≤65 years) from the Taiwan Cancer Registry who had been diagnosed as having NCCN-UIR-PC and who had received RP or high-dose IMRT (at least ≥72 Gy) with short-term ADT (4-6 months). After propensity score matching of the confounders, Cox proportional regression was used to model the time from the index date (i.e., date of diagnosis) to all-cause death, biochemical failure (BF), locoregional recurrence (LRR), and distant metastasis (DM). RESULTS: The corresponding adjusted hazard ratios (95% confidence intervals) of the risk of all-cause death, BF, LRR, and DM were 2.76 (1.36-5.60, p = 0.0050), 2.74 (1.72-4.84, p < 0.0001), 1.28 (1.09-1.90, p = 0.0324), and 2.11 (1.40-4.88, p = 0.0052), respectively. CONCLUSIONS: RP is superior to high-dose IMRT with short-term ADT in terms of oncologic outcomes for relatively young men with UIR-PC.

Effects of 1-Year Hospital Volume on Surgical Margin and Biochemical-Failure-Free Survival in Patients Undergoing Robotic versus Nonrobotic Radical Prostatectomy: A Nationwide Cohort Study from the National Taiwan Cancer Database.

PURPOSE: To examine the effect of hospital volume on positive surgical margin (PSM) and biochemical-failure-free survival (BFS) rates in patients with prostate cancer (PC) undergoing robotic-assisted or nonrobotic-assisted radical prostatectomy (RP). PATIENTS AND METHODS: The patients were men collected in the National Taiwan Cancer Registry diagnosed as having PC without distant metastasis who received RP from 44 multi-institutes in Taiwan. The logistic regression method was used to analyze the risk from RP to PSM in included patients with hospital volume (i.e., number of patients with PC receiving robotic RP per year), and the Cox proportional hazards method was used to analyze the time from the index date to biochemical recurrence. RESULTS: After propensity score adjustment, compared with hospitals with >100 patients/year, the adjusted odds ratios (aORs; 95% confidence intervals) of PSM in the robotic RP group in hospitals with 1-25, 26-50, and 51-100 patients/year were 2.25 (2.10-3.11), 1.42 (1.25-2.23), and 1.33 (1.13-2.04), respectively (type III p < 0.0001). Sensitivity analysis indicated that the aORs of PSM were 1.29 (1.07-1.81), 1.07 (0.70-1.19), and 0.61 (0.56-0.83), respectively, for patients receiving robotic RP compared with nonrobotic RP within hospitals with 1-25, 26-50, and 51-100 patients/year, respectively. Compared with hospitals with >100 patients/year, the adjusted hazard ratios (aHRs) of biochemical failure in the robotic RP group were 1.40 (1.04-1.67), 1.34 (1.06-1.96), and 1.31 (1.05-2.15) in hospitals with 1-25, 26-50, and 51-100 patients/year, respectively. CONCLUSIONS: Hospital volume significantly affected PSM and BFS in robotic RP, but not in nonrobotic RP. When patients with PC want to receive robotic RP, it should be performed in a relatively high-volume hospital (>100 patients/year).

There Are No Differences in Positive Surgical Margin Rates or Biochemical Failure-Free Survival among Patients Receiving Open, Laparoscopic, or Robotic Radical Prostatectomy: A Nationwide Cohort Study from the National Cancer Database.

Purpose: To estimate the rates of positive surgical margin (PSM) and biochemical failure-free survival (BFS) among patients with prostate cancer (PC) receiving open, laparoscopic, or robotic radical prostatectomy (RP). Patients and Methods: The patients were men enrolled in the Taiwan Cancer Registry diagnosed as having PC without distant metastasis who received RP. After adjustment for confounders, logistic regression was used to model the risk of PSM following RP. After adjustment for confounders, Cox proportional regression was used to model the time from the index (i.e., surgical) date to biochemical recurrence. Results: The adjusted odds ratios (95% CIs) of PSM risk after propensity score adjustment for laparoscopic versus open, robotic versus open, and robotic versus laparoscopic RP 95% CIs were 1.25 (0.88 to 1.77; p = 0.2064), 1.16 (0.88 to 1.53; p = 0.2847), and 0.93 (0.70 to 1.24; p = 0.6185), respectively. The corresponding adjusted hazard ratios (95% CIs) of risk of biochemical failure after propensity score adjustment were 1.16 (0.93 to 1.47; p = 0.1940), 1.10 (0.83 to 1.47; p = 0.5085), and 0.95 (0.74 to 1.21; p = 0.6582). Conclusions: No significant differences in PSM or BFS were observed among patients receiving open, laparoscopic, or robotic RP.

The effect of nocturia on sleep quality and daytime function in patients with lower urinary tract symptoms: a cross-sectional study.

BACKGROUND: Nocturia has been proven to have a negative impact on the quality of life and sleep quality in general elderly population. However, there are limited studies on the quantitative effect of nocturia on sleep quality and daytime dysfunction, specifically in patients with lower urinary tract symptoms. PATIENTS AND METHODS: During March 1, 2015 to December 31, 2015, a total of 728 patients who visited our urology department due to voiding dysfunction and experienced nocturia at least once per night were enrolled. Three questionnaires were administered to them after obtaining their written consents. Pittsburgh Sleep Quality Index (PSQI) questionnaire, Epworth Sleepiness Scale (ESS) questionnaire, and International Prostate Symptom Score (IPSS) questionnaire were applied to evaluate their sleep quality, daytime dysfunction, and voiding problems, respectively. Statistical analysis of the impact of nocturia on sleep quality and daytime dysfunction was performed. RESULTS: The mean age of patients was 61 years, with a male-to-female ratio of 2.7. The mean nocturia number was 3.03. The IPSS, PSQI, and ESS scores were 17.56, 8.35, and 8.22, respectively. The nocturia number increased with age and was significantly correlated to ESS score (daytime dysfunction) and PSQI total score (sleep quality) in overall group. Among subgroups divided by age and sex, there was a significant correlation between nocturia number and daytime dysfunction in male patients or patients younger than 65 years. CONCLUSION: In patients with lower urinary tract symptoms, nocturia number increased with age and was significantly correlated with poor sleep quality. Nocturia plays an important role in patients younger than 65 years in daytime dysfunction.

Successful use of modified suprapubic catheter to rescue prostatorectal fistula.

Prostatorectal fistula is a complication following radiotherapy. It remains a clinical challenge to treat because most patients experience a poor quality of life. This case report discusses a modified suprapubic catheter for use in a patient with a prostatorectal fistula that developed after radiotherapy for localized prostate cancer. It is an inexpensive, easily available, and more patient-tolerable catheter that improves quality of life. Herein, we describe the development of this catheter.

Complications of pure transperitoneal laparoscopic surgery in urology: the Taipei Veterans General Hospital experience.

BACKGROUND: We present our experience of complications of pure transperitoneal laparoscopic surgery in urology at Taipei Veterans General Hospital. METHODS: Between September 2003 and March 2006, 185 laparoscopic urologic operations were performed, consisting of 70 nephrectomies (36 radical, 17 partial, 11 simple, 6 donor), 28 adrenalectomies, 28 nephroureterectomies, 22 radical prostatectomies, 17 ureterolithotomies, 6 radical cystectomies, 5 pyeloplasties, 2 renal cyst unroofings, 2 nephropexies and 5 other operations. We reviewed the database of the patients to evaluate the complications and analyze factors related to laparoscopic surgeries. RESULTS: A total of 25 patients had 26 complications (14.1%, major in 4, minor in 22). The complications were categorized into intraoperative and postoperative complications in 10 and 16 patients, respectively. The mortality rate was 0%. The conversion rate was 0.54% (1 patient). The re-operation rate was 1.08% (2 patients). The most common intraoperative complication was vascular injury (5 patients). The incidence of complication was related to the difficulty level of operation. No statistically significant differences were found between complication rate and patient age, patient body mass index or the American Society of Anesthesiologist score. CONCLUSION: The complications of laparoscopic urologic surgeries are strongly correlated with the operative difficulties. In spite of elevated complication rates in difficult surgeries, the major complication rate in this study was very low. As the laparoscopic surgeries in urology involve more and more technique-dependent difficult fields, documentation and analysis of experience of complications is important for the development of this surgical modality.

Correlation between serum prostate specific antigen and prostate volume in Taiwanese men with biopsy proven benign prostatic hyperplasia.

PURPOSE: We studied the correlation between serum prostate specific antigen and the volume of different zones of the prostate in Taiwanese men with biopsy proven benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 233 patients with a mean age of 71.4 years (range 42 to 89), serum prostate specific antigen less than 10 ng/ml and pathologically confirmed benign prostatic hyperplasia were enrolled in this study. Total prostate and transitional zone volumes were measured with transrectal ultrasonography. Peripheral zone volume was determined by subtracting transitional zone volume from total prostate volume. Correlations between patient age, total serum prostate specific antigen and the volume of each prostate zone were analyzed with the Pearson correlation coefficient. A linear regression model was used to determine the relationship between prostate specific antigen and prostate volume. The prostate specific antigen-prostate volume relationship in our patients was compared with published data on white and Japanese men. RESULTS: Age did not significantly correlate with serum prostate specific antigen and prostate volume. Serum prostate specific antigen significantly correlated with the volume of each prostate zone. After log transformation the Pearson correlation coefficient between total prostate specific antigen and the volume of the whole prostate gland, the transitional zone and the peripheral zone were 0.369, 0.377 and 0.272, respectively (p <0.001). Taiwanese men had lower prostate volume per unit prostate specific antigen comparing with white men, while the prostate specific antigen-total prostate volume relationship between Taiwanese and Japanese men was similar. CONCLUSIONS: In Taiwanese men with biopsy proven benign prostatic hyperplasia the volume of each prostate zone has significantly correlates with serum prostate specific antigen. The prostate specific antigen-total prostate volume relationship in Taiwanese men is different from that in white men. However, the prostate specific antigen-total prostate volume relationship between Taiwanese and Japanese men is similar.

Multifactorial nature of male nocturia.

OBJECTIVES: To conduct a prospective study to determine the causes of nocturia in men. METHODS: The study included 41 male patients (mean age 72.5 years) bothered by nocturia (two or more micturitions per night). Eleven asymptomatic young men (mean age 28.4 years) were enrolled as a control group. All completed a 3-day voiding diary. Daytime and nighttime urine samples were collected to determine osmolality and sodium and potassium levels. Urodynamic studies were performed for all patients with nocturia to evaluate for bladder outlet obstruction using the International Continence Society definition. Polysomnography was performed on selected patients to detect sleep apnea. RESULTS: The average nighttime voiding frequency was 3.9 in the patients with nocturia. Nocturnal polyuria (NP) was found in 34 (82.9%) of 41 patients. In these patients, the nighttime urinary sodium excretion was significantly greater than the daytime excretion, with lower nighttime urine osmolality. In contrast, nighttime and daytime sodium excretion was not significantly different in patients without NP, and greater nighttime urine osmolality was noted in the patients without NP and the control group. Of the 41 patients, 24 (58.5%) had a small nocturnal bladder capacity, with detrusor overactivity in 14 of 24 patients. Eighteen patients (43.9%) had both NP and a small nocturnal bladder capacity. Another 18 patients had bladder outlet obstruction and NP. Two patients had sleep apnea. CONCLUSIONS: Our observations have shown that a significant contributor to male nocturia is NP, which results from a disordered diurnal rhythm of sodium excretion and other unknown factors causing nocturnal urinary dilution. However, male nocturia can also be secondary to a combination of factors. Detailed workup is necessary to elucidate all causes.

Fine (PM2.5), coarse (PM2.5-10), and metallic elements of suspended particulates for incense burning at Tzu Yun Yen temple in central Taiwan.

Ambient suspended particulate concentrations were measured at Tzu Yun Yen temple (120 degrees, 34('), 10(") E; 24 degrees, 16('), 12(") N) in this study. This is representative of incense burning and semi-open sampling sites. The Universal-sampler collected fine and coarse particle material was used to measure suspended particulate concentrations, and sampling periods were from 16/08/2001 to 2/1/2002 at Tzu Yun Yen temple. In addition, metallic element concentrations, compositions of PM(2.5) and PM(2.5-10) for incense burning at Tzu Yun Yen temple were also analyzed in this study. The PM(2.5)/PM(10) ratios ranged between 31% and 87% and averaged 70+/-11% during incense the burning period, respectively. The median metallic element concentration order for these elements is Fe>Zn>Cr>Cd>Pb>Mn>Ni>Cu in fine particles (PM(2.5)) at the Tzu Yun Yen temple sampling site. The median metallic element concentration order for these elements is Fe>Zn>Cr>Pb>Cd>Ni>Mn>Cu in coarse particle (PM(2.5-10)) at the Tzu Yun Yen temple sampling site. Fine particulates (PM(2.5)) are the main portion of PM(10) at Tzu Yun Yen temple in this study. From the point of view of PM(10), these data reflect that the elements Fe, Zn, and Cr were the major elements distributed at Tzu Yun Yen temple in this study.

Suspended particulate variations and mass size distributions of incense burning at Tzu Yun Yen temple in Taiwan, Taichung.

Ambient suspended particulate concentrations were measured at Tzu Yun Yen temple in this study. This is characteristic place of incense burning and indoor air pollution sampling site. A universal sampler, micro-orifice uniform deposited impactor (MOUDI) sampler and dry deposition plate were used to measure particulate concentrations. Tzu Yun Yen temple is a typical famous Buddhist-Taoist combined temple, where many pilgrims come from different areas and various belief systems indicating the eclecticism of the temple. The average number of people visiting this temple is above 5000 per day. The PM2.5/PM10 ratios ranged between 31.2 and 87.4% and averaged 69.6+/-12.3% during the incense-burning period, respectively. The results also demonstrated that the fine particulates concentrations (PM2.5) constituted the majority of indoor-suspended particulates at Tzu Yun Yen temple. PM10 concentration was 110.1 microg m(-3) for Zhong Yuan Jie (A festival on the seventh full moon in a lunar year, otherwise known as a summer lantern festival and (or) the commemoration of the dead. Almost all temples have maximum pilgrims for the commemoration of the dead on this day.) and the 1st or 15th of nong li (Nong li is a Chinese lunar calendar system in which 1 year is divided into fixed periods, and the beginning and end of a year is determined. The new moon and full moon are the 1st and 15th, respectively of each month in the Chinese lunar calendar. Many pilgrims appeared at each temple for blessing and good luck for themselves on the 1st and 15th of each Chinese lunar month.) with numbers higher than non-Zhong Yuan Jie and non-1st or -15th day of nong li (average = 85.5 microg m(-3)). In general, the average dry deposition flux (49.4 mg m(-2) day(-1)) in the indoor environment is lower than those measured in the outdoor environment (184.0 mg m(-2) day(-1)) in this study. The mean dry deposition flux of indoor/outdoor ratio was 46.2%. The average mass size distributions were bimodal with the major peaks within 0.56-1 microm and 5.6-10 microm, respectively during non-Zhong Yuan Jie and non-1st or -15th days of each month (Chinese lunar calendar). The average mass size distributions were bimodal with the major peaks within 0.18-0.32 microm and 5.6-10 microm, respectively during Zhong Yuan Jie and the 1st or 15th of nong li of each month (Chinese lunar calendar) at Tzu Yun Yen temple.

Concentration of atmospheric particulates during a dust storm period in central Taiwan, Taichung.

In this study we monitored concentrations of particles in central Taiwan using PS-1 (GPS1 PUF Sampler) and Model 310 Universal Air Sampler (UAS) from 02/23/2001 to 03/12/2001 at two sampling sites. During this period, an Asian dust storm moved across central Taiwan from 3/3 to 3/6. The total ambient air particle concentrations during the dust storm period were than compared with previous data from this region. In general, the average total suspended particulate (TSP) concentration order was during dust storm period > after dust storm period > non-dust storm period at both HKITT (traffic) and THUC (rural) sampling sites. The ratio of PM2.5/PM10 was 60% before and after the dust storm period. However, this ratio was decreased to less than 50% during the dust storm. This demonstrates that the coarse particulate concentrations (PM2.5-10) increased during the dust storm period. In contrast the increase of ambient air particles concentrations after the Taiwan Chi-Chi Earthquake were mainly due to fine particles (PM2.5). And, the increased of ambient air particles concentrations after dust storm period were mainly coarse particle (PM2.5-10) concentrations in central Taiwan.