Prostate cancer management in Southeast Asian countries: a survey of clinical practice patterns.

Background: Prostate cancer (PC) has a serious public health impact, and its incidence is rising due to the aging population. There is limited evidence and consensus to guide the management of PC in Southeast Asia (SEA). We present real-world data on clinical practice patterns in SEA for advanced PC care. Method: A paper-based survey was used to identify clinical practice patterns and obtain consensus among the panelists. The survey included the demographics of the panelists, the use of clinical guidelines, and clinical practice patterns in the management of advanced PC in SEA. Results: Most panelists (81%) voted prostate-specific antigen (PSA) as the most effective test for early PC diagnosis and risk stratification. Nearly 44% of panelists agreed that prostate-specific membrane antigen positron emission tomography-computed tomography imaging for PC diagnostic and staging information aids local and systemic therapy decisions. The majority of the panel preferred abiraterone acetate (67%) or docetaxel (44%) as first-line therapy for symptomatic mCRPC patients. Abiraterone acetate (50%) is preferred over docetaxel as a first-line treatment in metastatic castration-sensitive prostate cancer patients with high-volume disease. However, the panel did not support the use of abiraterone acetate in non-metastatic castration-resistant prostate cancer (nmCRPC) patients. Apalutamide (75%) is the preferred treatment option for patients with nmCRPC. The cost and availability of modern treatments and technologies are important factors influencing therapeutic decisions. All panelists supported the use of generic versions of approved therapies. Conclusion: The survey results reflect real-world management of advanced PC in a SEA country. These findings could be used to guide local clinical practices and highlight the financial challenges of modern healthcare.

A primary Ewing's sarcoma of the kidney: A case report and review of literature.

Primary Ewing's kidney sarcoma is a rare and aggressive cancer with poor treatment outcomes. Furthermore, clinical presentations are nonspecific, such as abdominal pain, abdominal mass, cachexia, or hematuria. Currently, there is no consensus guideline for the treatment of this condition. We report on a 22-year-old man who presented with gross hematuria for 3 weeks. Computed tomography demonstrated a huge right renal mass with a thrombus in the inferior vena cava (IVC) without visceral metastasis. A percutaneous tissue biopsy revealed Ewing's sarcoma (ES) and the patient received neoadjuvant chemotherapy (doxorubicin and ifosfamide) for four cycles. This reduced the tumor's size significantly and made it eligible for surgical intervention. Radical nephrectomy and tumor thrombus removal with wedge IVC wall were performed. The final diagnosis of ES was confirmed by the immunohistochemistry of the kidney specimen. After a 5-year follow-up of the patient, clinical and imaging evidence demonstrated that there was no disease recurrence.

Bilateral renal fungal bezoars in a preterm infant: case report and literature review.

Renal fungal bezoars or fungal balls is a rare condition in neonates and infants, usually occurring in immunocompromised patients. Renal bezoars result from accumulations of fungal cells and renal epithelial cells. The most common manifestation is candiduria, which can cause urinary tract obstruction. The treatment of choice is prompt medical or surgical intervention, as indicated to eliminate the infection and preserve renal function. Herein we report the case of a 34-week preterm male infant who presented with feeding intolerance, fever, acute kidney injury and alteration of consciousness. His initial creatinine was 3.4 mg/dL and urine analysis showed pyuria and yeast cells. A renal ultrasound demonstrated a dilated bilateral renal pelvis and calyx with bilateral fungal bezoars. The management was intravenous fluconazole with bilateral nephrostomy tubes and later surgical removal of bilateral fungal balls.

Significance of preoperative hematologic scoring in predicting death among patients with non-metastatic renal cell carcinoma undergoing nephrectomy.

PURPOSE: Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are hematologic scoring and indicators of the systemic inflammatory response. The increasing use of NLR and PLR have been associated with poor outcome in various types of malignancy. We evaluated the effect of NLR and PLR on survival outcomes of nonmetastatic renal cell carcinoma (RCC). MATERIALS AND METHODS: We retrospectively review 150 patients who had undergone nephrectomy for nonmetastatic RCC between 2006 and 2016. Cancer specific survival (CSS) was assessed using Kaplan-Meier method and compared using log-rank test. We applied univariate and multivariate Cox regression model to analyze the association of NLP and PLR with clinical outcome. RESULTS: At median follow up of 33 months, 45 patients had died. High PLR (>100) was an independent prognostic hematologic marker for CSS (hazard ratio [HR] 2.61, 95% confidence interval [CI],1.08-6.31; P = 0.034). Univariate analysis identified elevated NLR (p = 0.005), and anemia (p = 0.023) were significantly associated with CSS. CONCLUSION: Elevated PLR is a strong hematologic prognosis factor in term of survival for patients with nonmetastatic RCC undergoing nephrectomy with curative intent. The PLR is an easily obtained biomarker which is useful for preoperative risk stratification.

Prostate cancer in Asia: design of a patient registry to inform real-world treatments, outcomes, and quality of life.

BACKGROUND: The incidence of prostate cancer (PC) in Asian countries is increasing for reasons that are not clear. Data describing how PC is diagnosed and treated are fragmented across Asia, with marked intercountry and intracountry differences in outcome and knowledge gaps in clinical diagnostic and treatment practices. To address these knowledge gaps, we have established a PC disease registry with the aim of providing a comprehensive picture of PC diagnosis, prognosis, treatment and outcome, population characteristics, and comorbidities in real-world clinical practice in Asia. METHODS: This is a multinational, multicenter, longitudinal, and observational registry of PC patients presenting to participating tertiary-care hospitals in eight Asian countries (www.clinicaltrials.gov NCT02546908. Registry Identifier: NOPRODPCR4001). Approximately 3500-4000 eligible patients with existing or newly diagnosed high-risk localized PC (cohort 1), nonmetastatic biochemically recurrent PC (cohort 2), or metastatic PC (cohort 3) will be consecutively enrolled and followed-up for 5 years. An enrollment cap of 600 patients each will be applied to cohorts 1 and 2. Disease status is collected at enrollment, and outcome variables captured at 3-monthly intervals include diagnostic/staging, treatments including reason for change, laboratory results, comorbidities, and concomitant medications. Treatments and survival outcomes will be captured real time until study end. Patient-reported quality-of-life will be measured every 6 months, and medical resource utilization summarized at study end. Data analysis will include exploratory analyses of potential associations between multiple risk factors and socioeconomic variables with disease progression and evaluation of various treatments for PC including novel therapies on clinical outcome and health-related quality-of-life outcomes. RESULTS: 3636 men with PC were enrolled until July 2018; 416 in cohort 1, 399 in cohort 2 and 2821 in cohort 3. DISCUSSION: A total of 3636 patients were enrolled until July 2018. The prospective disease registry will provide comprehensive and wide-ranging real-world information on how PC is diagnosed and treated in Asia. Such information can be used to inform policy development for best practice and direct clinical study design evaluating new treatments.

Metastatic Castration-Resistant Prostate Cancer Previously Treated With Docetaxel-Based Chemotherapy: Treatment Patterns From the PROXIMA Prospective Registry.

PURPOSE: There is a major clinical need to devise an optimal treatment sequence for the multiple therapy options available for patients with metastatic castration-resistant prostate cancer (mCRPC). In the absence of prospective clinical trials, sequencing information can be derived from large, real-world registry studies. PATIENTS AND METHODS: PROXIMA (Treatment Patterns in Patients With Metastatic Castration-Resistant Prostate Cancer Previously Treated With Docetaxel-Based Chemotherapy) is a large, global, prospective registry study evaluating real-world treatment patterns of patients with mCRPC who experience disease progression during or after docetaxel therapy. Patients were enrolled worldwide between 2011 and 2014. Treatments were determined by the treating physicians and recorded in categories of chemotherapy, hormonal therapy, targeted therapy, immunotherapy, and palliative therapy. Treatment sequencing patterns, response to treatment, and types of progression were recorded and analyzed. Progression-free survival and overall survival with different treatment modalities were analyzed using Kaplan-Meier method. RESULTS: Treatment patterns were evaluated in 903 patients. Therapy selection was influenced by region. Hormonal therapy (57.5%) and taxane chemotherapy (26.4%) were the most frequently administered first subsequent treatments after docetaxel. Tumor responses to first subsequent treatment were observed in 22.6% of evaluable patients. Overall survival and progression-free survival did not differ significantly across different treatment modalities. CONCLUSION: Identifying an optimal treatment sequence is vital for improving the care of patients with mCRPC. The PROXIMA registry provided a representative sample of global data on real-world treatment patterns for patients with mCRPC previously treated with docetaxel. These data can be used to devise optimal therapy sequences and inform treatment decisions.

The Prognostic Factors of Biochemical Recurrence-Free Survival Following Radical Prostatectomy

Objective: To evaluate outcomes, biochemical recurrence-free survival (BCRFS) and to identify parameters influencing BCRFS of radical prostatectomy (RP) and bilateral pelvic lymph node dissection in a single-institution. Methods: A retrospective review of prostate cancer (PC) patients received RP was identified from the medical records. Data was collected from 2007 to 2016. 178 patients received RP were enrolled in a study. These patients were evaluated on efficacy of RP by using prostate-specific antigen (PSA) to analyze BCRFS and compared with Gleason score, pathologic staging, margin status and lymph node status with BCRFS. Results: The median follow up was 32.5 months (n = 178). Sixty-nine patients had extracapsular extension on pathologic results whereas 93 patients were classified as a high risk group. The median time for biochemical recurrence (BCR) was 22.3 months. The 3-year BCRFS in patients with a Gleason score 6, 3+4, 4+3, 8 and 9-10 were 85.8%, 84.6%, 78.7%, 53.3% and 35.8% . Multivariate analysis showed that extracapsular extension was independently associated with BCRFS. Conclusions: New group grading system indicates impact on BCRFS on univariate analysis but show negative impact on a multivariate Cox regression, only pathologic staging was independently associated with the cancer control outcome.

Management of metastatic castration-resistant prostate cancer: Insights from urology experts in Thailand.

Treatment options for castration-resistant prostate cancer (CRPC) are available, but clear instructions for the selection of appropriate treatment are lacking. A meeting of urology experts based in Thailand was convened with the following objectives: (1) to reach a consensus and share real-life experiences about how to identify CRPC; (2) to choose the appropriate treatment for CRPC patients; (3) to evaluate disease progression using novel inhibitors of the androgen receptor pathway; (4) to identify the frequency of monitoring disease; and (5) to promote rational use of corticosteroids in CRPC patients. This consensus document can provide guidance to other urologists in Thailand to provide appropriate treatment to metastatic CRPC patients in a timely manner.

Predictive factor of androgen deprivation therapy for patients with advanced stage prostate cancer.

BACKGROUND: The purpose of this study was to identify the predictive factors for the efficacy of androgen deprivation therapy (ADT) in men with hormone-sensitive prostate cancer (PC) with or without distant metastasis. METHODS: A retrospective review of PC patients was conducted of the medical records. We enrolled 246 patients who received primary ADT. PC patients treated with ADT for presumed nonlocalized PC were evaluated on the efficacy of ADT using prostate-specific antigen (PSA) time to progression (TTP) and compared factors associated with TTP in patients with distant metastasis and patients without distant metastasis. RESULTS: A total of 246 patients were treated primarily with ADT. The median follow-up period was 20.2 months. One hundred and ninety-one patients had metastatic disease. The median TTP on ADT for the distant metastasis group was 14.8 months versus 60.1 months in the without distant metastasis group (P < 0.0001). In the univariate analysis only, PSA nadir after ADT was associated with longer TTP (hazard ratio, 10.69; 95% confidence interval, 5.56-20.57). In the multivariate analysis, high grade tumor and PSA nadir were independent factors associated with a shorter TTP. CONCLUSION: In this study of hormone-sensitive PC patients treated with ADT for nonlocalized PC, high grade tumor and PSA nadir were predicting factors of this treatment.

Oncological Outcomes of Radical Cystectomy for Transitional Cell Carcinoma of Bladder.

Objective: To investigate the oncological outcome of radical cystectomy for muscle invasive bladder (MIBC) on cancerspecific survival. Material and Method: A consecutive series of patients undergoing radical cystectomy from 2004 to 2012 were recorded. The prognostic significance of several clinicopathologic factors in these patients were analyzed. The endpoint of oncological outcome was cancer-specific survival (CSS). The effect of clinical variables on CSS were statistically analysed by a log-rank test or Cox regression with hazard ratios. All analyses were performed using a 0.05 level of significance. Results: One hundred eleven patients were analyzed. The average patient age when cystectomy was carried out was 65 (35 - 84) years. The 5-year cancer-specific survival rate was 36% for all 111 patients. The 5-year cancers-specific survival rates for patients with clinical T1, T2, T3 and T4 were 89%, 32%, 30% and 11.6%, respectively. Positive lymph nodes were found in 26 patients (23.4%) who had a 5-year cancer-specific survival 12.9%. Of several factors examined, univariate analysis identified tumor stage, nodal status, metastasis, margin positive and lymphovascular invasion (LVI) as significant predictors of OS, of which tumor stage and nodal status appeared to be independently related to overall survival on multivariate analysis. Conclusion: Radical cystectomy is a standard treatment for muscle invasive bladder cancer. Oncologic outcomes of radical cystectomy is generally favorable, however, surgery alone had no more potential to prolong survival of patients with invasive cancer, multimodal treatment approaches might need.

Oncological Outcome of Docetaxel-Based Chemotherapy for Men with Metastatic Castration-Resistant Prostate Cancer.

Objective: To retrospectively review the oncological outcome of docetaxel-based chemotherapy in men with metastatic castration-resistant prostate cancer (mCRPC). Material and Method: The present study included 68 patients with mCRPC who were treated with 3-weekly docetaxel (75 mg/m2) plus prednisone between 2010 and 2014. The prognostic significance of several clinicopathologic factors in these patients were analyzed. The endpoints of oncological outcome were overall survival (OS). The effect of clinical variables on OS was statistically analyzed by a log-rank test or Cox regression with hazard ratios. All analyses were performed using a 0.05 level of significance. Results: In these 68 patients, the median age and serum value of prostate-specific antigen (PSA) prior to docetaxel-based chemotherapy were 69 years and 173 ng/ml, respectively. Of these patients, PSA decline ≥50% was observed in 46 patients (67.6%). The OS and progression-free survival were 25.4 and 11.7 months, respectively. Of several factors examined, univariate analysis identified PSA at diagnosis mCRPC, PSA at diagnosis of mCRPC, PSA at first cycle of CMT ≥150 ng/mL, number of CMT response ≤2 cycle as significant predictors of OS, of which only PSA at first cycle of CMT ≥150 ng/mL appeared to be independently related to poor OS on multivariate analysis. Conclusion: Oncologic outcomes in mCRPC patients receiving docetaxel-based chemotherapy is generally favorable and only PSA at first cycle of CMT more than 150 ng/mL appeared to be independently related to poor OS on multivariate analysis.

Mutations of fibroblast growth factor receptor 3 gene (FGFR3) in transitional cell carcinoma of urinary bladder in Thai patients [Revision-2a].

OBJECTIVE: Determine the incidence of FGFR3 mutations in Thai patients with bladder transitional cell carcinoma (TCC), and evaluate their correlation with pathological characteristics. MATERIAL AND METHOD: One hundred twenty two frozen tissue samples from TCC patients were analyzed for mutations in exons 7, 10, and 15 of FGFR3 by polymerase chain reaction and direct DNA sequencing. RESULTS: FGFR3 mutations were detected in 22 of 122 cases (18%) studied, all of which were found within previously identified hotspots, including S249C (13 cases; 59%) and R248C (4 cases; 18%) in exon 7, and Y375C (5 cases; 23%) in exon 10, but no mutations in exon 15. Sixty-five patients (53%) were categorized as non-muscle-invasive TCC (pTa-pT1). The incidence of mutations is significantly higher in non-muscle-invasive tumors (28%) compared to the muscle-invading group (7%) (p < 0.01). Patients with grade (G) 1 TCC have significantly higher mutation frequency (40%) compared to other grades (4%) (p < 0.01). When T stage and grade were considered together, mutations were most commonly found in Ta-T1/G1 TCC (18/45 cases, 40%). Mean follow-up period was 45.1 months. Two-year and four-year overall survival (OS) was 70% and 56% respectively. Three-year OS in non-muscle-invasive TCC (80%) is significantly higher than that of muscle invading TCC (41%) (p < 0.01). However three-year OS in cases with an FGFR3 mutation (73%) is not significantly different from cases without a mutation (61%). In 16 cases with an FGFR3 mutation and recurrent disease, no mutations were detected in metachronous disease. CONCLUSION: The overall incidence of FGFR3 mutations in Thai patients with TCC was lower than similar reports from other ethnic groups. In the presented cases, although FGFR3 mutations were frequently detected in low-grade, non-muscle-invasive TCC, identical mutation was not conserved in metachronous disease, thereby precluding the use of this marker in detection of tumor recurrence.

Laparoscopic radical prostatectomy in Songklanagarind Hospital: first series from Southern Thailand.

OBJECTIVE: To describe our technique of laparoscopic radical prostatectomy (LRP) and evaluated outcome during the first year experience in Songklanagarind Hospital. MATERIAL AND METHOD: Between August 2011 and October 2012, sixteen patients of localized prostate cancer underwent LRP in Songklanagarind Hospital and were evaluated. The authors used five ports and conducted with an extraperitoneal approach. Patient characteristics, operative outcome, and pathological outcomes were analyzed RESULTS: The average age of patients was 66.8 years and average prostate-specific antigen (PSA) value was 14.9 ng/ml. The average operative time was 437 minutes and average blood loss was 1,696 ml. One unit of transfusion was required in most patients. Hospital stay on average was 11 days and average catheter time was 27 days. Maximal weight of prostate was 93 grams. Pathological report demonstrated pT2, pT3 in eleven (69%) and five (31%) patients, respectively. Gleason score of seven was presented in the most of the cases. None of the patients had lymph node metastasis. At average follow-up time of 8.4 months, serum PSA was less than 0.02 ng/ml in 75% and complete continence in nine patients. CONCLUSION: Laparoscopic radical prostatectomy is safe and feasible in initial experience surgeon.

Renal pelvic villous adenoma presented with mucusuria: report of a case and literature review.

Villous adenomas of the urinary tract are an uncommon condition, and appear mostly in patients where the disease occurred in the lower urinary tract. In contrast, upper urinary tract villous adenomas are a rare condition. Currently, just three cases of villous adenoma in the renal pelvis have been published. Herein, we present the fourth case of a renal pelvic villous adenoma, along with muconephrosis and mucusuria. A 73-year-old man presented with abdominal discomfort and a palpable abdominal mass. He had a history of bilateral anatrophic nephrolithotomy, 8 years and 6 years earlier. The preoperative radiographic investigation showed severe right hydronephrosis. A right nephrectomy was carried out and the intraoperative finding showed severe perinephric adhesion and a great deal of mucus in the renal pelvis. The pathological examination showed a villous adenoma and urothelial metaplasia in the kidney.

Tuberculosis of the urinary tract in southern Thailand.

BACKGROUND: The urinary system is one of the common sites of involvement of extrapulmonary tuberculosis (TB). The accurate diagnosis and treatment of extrapulmonary TB is complex and difficult. OBJECTIVE: To address the epidemiology and drug susceptibility of urinary tract TB in southern Thailand. MATERIAL AND METHOD: A retrospective analysis of data collected at the time of diagnosis of urinary tract TB cases, during a 10-year period from 1998 to 2007. Data collection included demography, presenting symptoms, laboratory investigations, and imaging studies of the urinary system. RESULTS: During a 10-year period of the present study, 35 new cases of urinary tract TB were diagnosed, with a male/female ratio of 1.3:1 and a common age group of 31-40 years. 34.3% of the patients were farmers. The most presenting symptoms were polyuria, dysuria and acidic urinary pH with pyuria. 80% ofthe patients had abnormal imaging studies ofthe urinary system, with hydronephrosis being the most frequently found condition. Fifty seven point one percent had positive urine cultures for Mycobacterium and 0.05% of them had streptomycin resistance, while none ofthem had an HIV coinfection. CONCLUSION: The urinary tract TB was more common in male with a common age group of 31-40 years. The common presenting symptoms were long-standing urinary symptoms as frequency in urination, dysuria, hematuria and acidic urinary pH associated with pyuria. In the present study, there was only 0.05% of streptomycin resistance, however, no patients with HIV infection.

An Asian multinational prospective observational registry of patients with benign prostatic hyperplasia, with a focus on comorbidities, lower urinary tract symptoms and sexual function.

OBJECTIVE: To examine the characteristics, management practices and outcomes of patients presenting with symptoms of benign prostatic hyperplasia (BPH) in Asia, with a focus on comorbidities and sexuality. PATIENTS AND METHODS: In this multinational prospective observational registry, eligible patients with BPH attending a urology clinic for the first time were enrolled. Details of comorbidities, sexuality and symptoms of BPH were collected through the International Prostate Symptom Score (IPSS), International Index of Erectile Dysfunction-5 (IIEF-5) and the Danish Prostate Symptom Score (DAN-PSS-1) questionnaires. The follow-up was scheduled at 1-3 or 3-6 months, depending on the treatment. RESULTS: In 994 men aged 40-88 years the most common comorbidities were hypertension (38%) and obesity (36%). Nocturia was the most common symptom for consultation. A previous episode of acute urinary retention (AUR) was recorded in 12%. About 90% of the men had moderate-to-severe lower urinary tract symptoms (LUTS), and the severity increased with age. Sexual dysfunction was reported by 82%, and it correlated with the severity of LUTS. Of 918 sexually active men, only 20% had normal erectile function; 36%, 19% and 25% reported severe, moderate and mild erectile dysfunction (ED), respectively. BPH medication was started in 78%, 9% had surgery, and in 13% an approach of watchful waiting was adopted. In all, 89% of patients completed the follow-up. The symptoms of BPH resolved in 93% after surgery, in 83% on BPH medication and in 34% of those on 'watchful waiting'. Surgery, which led to a mean reduction of 17.0 IPSS points, was the most effective in improving LUTS. Improvement on the DAN-PSS-1 items of reduced erection and reduced ejaculation was higher with medication, while surgery led to better outcomes on the DAN-PSS-1 item of pain/discomfort on ejaculation. For ED, from baseline to after treatment, the mean IIEF-5 scores changed from 19.1 to 18, from 14.2 to 14.8, and from 4.5 to 5.5 for those with mild, moderate and severe ED at baseline, respectively. Only 2.3% of patients had an episode of AUR while on treatment. About 5.5% of patients on BPH medication and 6% of surgical patients reported adverse events. CONCLUSION: Asian patients with BPH usually present with LUTS; sexual dysfunction is also very common. BPH medication is the most frequent treatment approach, followed by watchful waiting and surgery. Medication and surgery resulted in a greater reduction of LUTS and improvement in sexual dysfunction than watchful waiting. As Asian men remain sexually active even at advanced ages, sexual function should be assessed and discussed with the patient before deciding the management strategy for LUTS associated with BPH.

Urinary tract calculi in southern Thailand.

OBJECTIVE: To study the epidemiology of urolithiasis in Southern Thailand. DESIGN: Descriptive study. MATERIAL AND METHOD: An overview of urolithiasis in the South of Thailand was derived from 10,344 urolithiasis patients seeking treatment in 14 hospitals in southern Thailand, from January to December 2000. An epidemiological study focused on 1,452 urolithiasis patients treated at Songklanagarind Hospital during the same period. Composition of calculi was analysed with infrared spectroscopy. RESULTS: The ratio of male to female was 1.6 : 1 and the most common age group was 41 - 50 years. Ureteric calculi were more frequently found than renal calculi. ESWL was the most common treatment for upper urinary tract (UUT) calculi, while surgery was the most common treatment for lower urinary tract (LUT) calculi. The body mass index (BMI) of 48.1% was between 18.5 - 24.9. The study of the calculi composition showed that oxalate was found in most UUT, and uric acid was found in most LUT CONCLUSION: Ureteric calculi were most common in the South of Thailand. The BMI of urolithiasis patients was higher than the population average.