Prognostic Value of Focal Positive Surgical Margins After Radical Prostatectomy.

BACKGROUND: The significance of focal positive margins (FPMs) after radical prostatectomy (RP) is unclear. Our objective was to investigate the prognostic value of FPMs in patients undergoing RP. MATERIALS AND METHODS: The data were analyzed retrospectively for 1733 patients with clinically localized prostate cancer who had undergone RP at our institution from December 2003 to March 2014 without neoadjuvant or adjuvant therapy. Positive surgical margins were characterized as FPMs (≤ 3 mm long) or non-FPMs (> 3 mm long). Multivariate analysis of the clinicopathologic factors, including FPMs, was performed with respect to biochemical recurrence (BCR)-free survival. RESULTS: Of the 1733 patients, 1260 (72.7%) had negative margins, 114 (6.6%) had a FPM, 218 (12.6%) had a nonfocal single positive margin (NFSPM), and 141 (8.1%) had nonfocal multiple positive margins (NFMPMs). Of the patients with pathologic T2 prostate cancer, 1065 (84.3%) had negative margins, 62 (4.9%) had 1 FPM, 104 (8.2%) had 1 NFSPM, and 33 (2.6%) had NFMPMs. The 5-year BCR-free survival for patients with negative margins and FPMs was 90% and 83.4%, respectively. On multivariate analysis, the presence of a FPM was not a significant prognostic factor for BCR-free survival in all the patients or in the patients with pathologic T2 disease (P = .458 and P = .512, respectively). CONCLUSIONS: FPMs after RP do not significantly affect BCR-free survival in patients with prostate cancer.

Correlation Between the Timing of Diagnostic Ureteroscopy and Intravesical Recurrence in Upper Tract Urothelial Cancer.

UNLABELLED: To identify the effects of diagnostic ureteroscopy on intravesical recurrence, 104 patients who had undergone radical nephroureterectomy were analyzed. The number of patients with intravesical recurrence was 34 (32.6%) at a mean of 37 months. Multivariate Cox model analysis revealed that delayed nephroureterectomy after diagnostic ureteroscopy were independent predictive factors for intravesical recurrence. BACKGROUND: The purpose of this study was to evaluate the effects of the timing of diagnostic ureteroscopy (URS) relative to radical nephroureterectomy (RNU) on intravesical recurrence (IVR). PATIENTS AND METHODS: We retrospectively evaluated 104 patients who had undergone RNU for upper tract urothelial cancer (UTUC) at a single tertiary referral center between March 2003 and December 2012. All patients were divided depending on the timing of diagnostic URS: the no URS group (30 patients, no URS), 1-session group (33 patients, diagnostic URS immediately followed by RNU), and 2-session group (41 patients, RNU after diagnostic URS at a median time of 5 days). We analyzed for IVR-free survival using the Kaplan-Meier and Cox proportional regression methods. RESULTS: Of the 104 patients, 34 (32.6%) developed subsequent IVR at a mean interval of 7.2 months. The Kaplan-Meier curve showed that the IVR rate was significantly greater in the 2-session group than in the other groups (P = .004). Univariate analysis indicated no effect on IVR in the 1-session group compared with the no URS group (hazard ratio [HR], 95% confidence interval [CI] 1.58; 0.517-4.833). However, the 2-session group had a significantly greater number of patients with IVR than the no URS group (HR, 3.82; 95% CI 1.438-10.131). Multivariate Cox proportional analysis revealed that the 2-session group was an independent predictor of IVR in UTUC patients (HR, 3.61; 95% CI 1.039-12.557). CONCLUSION: Delay of RNU after diagnostic URS significantly increased the risk of IVR in UTUC patients.

Urodynamic assessment of bladder and urethral function among men with lower urinary tract symptoms after radical prostatectomy: A comparison between men with and without urinary incontinence.

PURPOSE: We compared bladder and urethral functions following radical prostatectomy (RP) between men with and without urinary incontinence (UI), using a large-scale database from SNU-experts-of-urodynamics-leading (SEOUL) Study Group. MATERIALS AND METHODS: Since July 2004, we have prospectively collected data on urodynamics from 303 patients with lower urinary tract symptoms (LUTS) following RP at three affiliated hospitals of SEOUL Study Group. After excluding 35 patients with neurogenic abnormality, pelvic irradiation after surgery, or a history of surgery on the lower urinary tract, 268 men were evaluated. We compared the urodynamic findings between men who had LUTS with UI (postprostatectomy incontinence [PPI] group) and those who had LUTS without UI (non-PPI group). RESULTS: The mean age at an urodynamic study was 68.2 years. Overall, a reduced bladder compliance (≤20 mL/cmH2O) was shown in 27.2% of patients; and 31.3% patients had idiopathic detrusor overactivity. The patients in the PPI group were older (p=0.001) at an urodynamic study and had a lower maximum urethral closure pressure (MUCP) (p<0.001), as compared with those in the non-PPI group. Bladder capacity and detrusor pressure during voiding were also significantly lower in the PPI group. In the logistic regression, only MUCP and maximum cystometric capacity were identified as the related factor with the presence of PPI. CONCLUSIONS: In our study, significant number of patients with LUTS following RP showed a reduced bladder compliance and detrusor overactivity. PPI is associated with both impairment of the urethral closuring mechanism and bladder storage dysfunction.

Clinical effect of abiraterone acetate in Korean patients with metastatic castration-resistant prostate cancer according to duration of androgen deprivation therapy.

PURPOSE: Few data are available concerning the clinical outcome of abiraterone acetate treatment in patients with metastatic castration-resistant prostate cancer (mCRPC) in terms of the duration of androgen deprivation therapy (ADT) before diagnosis of CRPC. We investigated the clinical efficacy of abiraterone acetate according to the duration of ADT. MATERIALS AND METHODS: We reviewed the medical records of 20 patients with mCRPC who received abiraterone acetate after failure of docetaxel chemotherapy from May 2012 to March 2014 at Seoul National University Bundang Hospital. Clinical factors including prostate-specific antigen (PSA) nadir level, time to PSA nadir, PSA doubling time, PSA response, and modes of progression (PSA, radiologic, clinical) were analyzed. Disease progression was classified according to the Prostate Cancer Working Group 2 criteria. RESULTS: The mean age and PSA value of the entire cohort were 76.0±7.2 years and 158.8±237.9 ng/mL, respectively. The median follow-up duration was 13.4±6.7 months. There were no statistically significant differences in clinical characteristics between patients who received abiraterone acetate with ADT duration<35 months and those who received abiraterone acetate with ADT duration≥35 months. There were also no significant differences in terms of PSA progression-free survival, radiologic progression-free survival, and clinical progression-free survival between patients with ADT duration<35 months and those with ADT duration ≥35 months. CONCLUSIONS: Although this was a retrospective study with a small sample size, we did not observe any statistically significant differences in the clinical response to abiraterone acetate between mCRPC patients with long ADT duration and those with short ADT duration in terms of disease progression-free survival.

Salvage radiotherapy after radical prostatectomy: prediction of biochemical outcomes.

INTRODUCTION: A significant proportion of patients undergoing salvage radiotherapy (RT) for biochemical recurrence (BCR) following radical prostatectomy (RP) may again experience BCR after salvage RT. Thus, we evaluated the clinical significances of different parameters on the biochemical outcome of RT in salvage setting. METHODS: We reviewed the records of 212 patients who underwent salvage RT between November 2003 and December 2012 for BCR following primary RP. BCR-free survivals after salvage RT were estimated using the Kaplan-Meier method. Cox proportional hazard regression models were used to evaluate the impacts of clinicopathologic parameters on BCR following salvage RT. RESULTS: The overall median follow-up duration was 63.5 months. The BCR-free survival rate after salvage RT was 58.2% at 5 years. Multivariate analysis showed that a pre-RT prostate-specific antigen (PSA) level of ≤0.5 ng/mL, a pre-RT PSA doubling time (PSADT) of >4.5 months, concomitant androgen deprivation therapy (ADT) with salvage RT, and a positive surgical margin were independent predictors of favorable biochemical outcomes after salvage RT (hazard ratios [HR] = 3.012, 1.132, 2.000, and 1.805, respectively, p = less than 0.001, 0.013, 0.005, and 0.036, respectively). In the early (pre-RT PSA ≤0.5 ng/mL) salvage RT setting, concomitant ADT administration was also shown to be significantly associated with higher risk of BCR-free survival following salvage RT (HR = 2.611, p = 0.038). CONCLUSION: Lower pre-RT PSA value, longer PSADT before salvage RT, concomitant ADT administration, and a positive surgical margin were significant predictors of favorable biochemical outcomes following salvage RT performed for BCR after primary RP.