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Purpose: The purpose of this study is to investigate the clinical oncological outcomes and prognostic factors of high-volume disease (HVD) in the Asian population with metastatic hormone-sensitive prostate cancer. Methods: We retrospectively analyzed 503 patients with newly diagnosed metastatic prostate cancer. Patients were classified as HVD if visceral metastases were present and/or ≥4 bone lesions with ≥1 lesion beyond the vertebral bodies and pelvis. Overall survival (OS) and cancer-specific survival were investigated based on the disease burden. The Cox proportional hazards regression model was used to evaluate the prognostic factors. Results: About 50.7% patients were classified as low-volume disease (LVD) and 49.3% were HVD at diagnosis. The medians of OS and cancer-specific survival were 64 and 116 months, respectively, for patients with LVD and 26 and 46 months, respectively, for men with HVD (both P < 0.001). Among patients with HVD, 76.6% had both high-volume bone disease (HBD) (≥4 bone metastases) and appendicular bone involvement. There was no significant difference in both OS and cancer-specific survival between patients with visceral metastases and those with HBD combined with appendicular bone involvement. In the multivariable analysis, presence of Gleason score ≥8, HBD, or HVD may predict poorer OS and cancer-specific survival outcomes (all P < 0.05). Conclusions: Asian patients with high-volume metastatic prostate cancer had a larger proportion of HBD with appendicular bone involvement, who had a comparably poor prognosis to those with visceral metastases. Patients with HBD or HVD had reduced survival outcomes.

Objectives To analyze the clinicopathologic characteristics and oncologic outcomes of radical cystectomy (RC) and trimodality therapy (TMT) for patients with clinical stage II bladder urothelial carcinoma (UC). Methods Between January 2004 and September 2013, the medical records of 93 consecutive patients with clinical stage II bladder cancer (cT2N0M0), diagnosed at National Taiwan University Hospital, were retrospectively reviewed, including 66 with RC and 27 with TMT. Univariate and multivariate Cox regression analyses were performed to determine prognostic factors. Results The median follow-up time was 34.1 months. Significant differences between TMT and RC groups with respect to age, gender, cancer grade and the presence of hydronephrosis were not noted. The 5-year overall survival rate (74%) and the 5-year cancer specific survival rate (76%) showed comparable results between RC and TMT groups. The overall recurrence rate was 38% (RC: 41% vs. TMT: 30%, p = 0.35). The presence of hydronephrosis demonstrated a statistically significant association with tumor recurrence (HR: 2.03, 95% CI 1.03–4.00, p = 0.04). Diabetes mellitus (DM) in patients independently correlated with poorer overall survival (HR: 2.74, 95% CI 1.09–6.83, p = 0.03) and cancer-specific survival (HR: 3.32, 95% CI 1.28–8.69, p = 0.01). Conclusions TMT is an optimal therapeutic option in selected patients with clinical stage II bladder UC. In our study, despite the method of treatment, the presence of hydronephrosis increased the risk of cancer recurrence and DM demonstrated a significantly negative effect on overall survival and cancer-specific survival.

Objective: To compare pathological and oncological outcomes between robotic-assisted laparoscopic radical prostatectomy (RaLRP) and laparoscopic radical prostatectomy (LRP) among high-risk prostate cancer patient in a tertiary center in Taiwan. Materials and methods: From November 2003 to October 2013, 129 high-risk prostate cancer patients receiving minimally-invasive radical prostatectomy were included. The Kaplan–Meier analysis was used for measuring biochemical recurrence-free survival (BFS). Multivariate logistic regression models and Cox proportional hazards regression models were used to determine predictors of positive surgical margin and BFS. Results: Among the 129 high-risk prostate cancer patients included, 80 (62%) patients received LRP and 49 (38%) patients received RaLRP. There was no significant difference of positive surgical margin and biochemical recurrence rate between RaLRP and LRP group (P = 0.802 and 0.292). Higher pathological T stage predicted an increased likelihood of positive margins (OR = 3.44, 95% CI [1.45, 8.18], P = 0.005). Higher initial PSA level (HR = 2.88, 95% CI [1.04, 7.94], P = 0.041) and positive surgical margin (HR = 2.55, 95% CI [1.20, 5.44], P = 0.015) were poor prognostic factors for BFS. Conclusion: RaLRP can be considered among high-risk prostate cancer in Asian people with comparable oncological outcomes to LRP. Higher pathological T stage was associated with increased likelihood of positive margins, patients with higher iPSA level and positive surgical margin had worsen biochemical recurrence-free survival.

Objectives Our objective was to examine the detection rate of routine urine cultures and genital discharge swab cultures for the detection of gonococcal urethritis in male patients. In addition, we evaluated the results of urinalysis for gonococcal infections and investigated the drug sensitivity of Neisseria gonorrhoeae strains isolated from these patients. Materials and methods From August 2009 to October 2015, 202 men diagnosed with gonococcal infection, based on the results of a urine culture or genital discharge swab culture, were enrolled in this study. Initial clinical symptoms and urinalysis results were collected. The susceptibility of N. gonorrhoeae to penicillin, cefmetazole, cefotaxime, ceftazidime, cefuroxime, ceftriaxone, and ofloxacin were determined using agar plate dilution method. Results The mean age of the patients was 29.67 ± 10.39 years, and 157 of the 202 male patients (87.6%) were aged between 15 years and 34 years. We determined that the diagnostic value of genital discharge swab culture was significantly higher than that of the urine culture (90.9% vs. 67.4%, respectively). Genital or urethral discharge is the major symptom in these patients (88.89%). The susceptibility of N. gonorrhoeae to cefuroxime, cefmetazole, cefotaxime, ceftazidime, penicillin, and ciproxin revealed an increasing prevalence of resistant strains in recent years. Conclusion Genital discharge swab culture is a more effective method than urine culture to detect gonorrhea in patients with dysuria and urethral discharge. The increasing numbers of antibiotic-resistant N. gonorrhoeae strains is a major problem in treating gonococcal urethritis.

Purpose: Few studies have reported the value of the diameter-axial-polar (DAP) score in robot-assisted partial nephrectomy (RaPN) for renal cell carcinoma (RCC) and sequentially compare DAP and RENAL nephrometry score to predict long-term surgical, oncological, and functional outcomes of RaPN for renal cancer. This study demonstrated that the DAP score is effective enough to predict long-term trifecta outcomes of RaPN. Materials and Methods: We retrospectively collected clinical data of 108 patients with pathologically confirmed RCC who received RaPN by a single surgeon during 2012–2017. The patients were stratified into low, intermediate, and high complexities according to the RENAL and DAP scoring systems. We analyzed warm ischemia time (WIT), cancer-specific survival, radiographic progression-free survival, positive rate of surgical margin, renal function from the preoperative period to postoperative 1st/6th month, and postoperative complications. Results: The median follow-up period was 36 months. The 3-year cancer-specific survival rate and 3-year radiographic progression-free survival were 98.4% and 95.2%, respectively. Four patients (3.6%) had positive surgical margins. The largest decrease of renal functions from pre- to postoperative 6th month was noted in the intermediate DAP score group. No difference was observed between the DAP and RENAL scores in terms of WIT in 25 min, positive margin, complication, 3-year radiographic local recurrence, and chronic kidney disease (CKD) change, but a significant difference was observed in WIT in 20 min (area under the curve of DAP vs. RENAL = 0.81 vs. 0.54, P = 0.03). Age is an independent factor for progression to CKD after RaPN (odds ratio = 1.054, 95% confidence interval = 1.008–1.102, P = 0.022). Complications occurred in 22 patients (20.4%), and the most common postoperative complications were bleeding (12.2%), postoperative fever (0.5%), and urinary leakage (0.3%). Conclusion: The DAP score is an easy and effective tool for predicting perioperative outcomes of RaPN, especially in WIT in 20 min.

Purpose: The aim of our study was to analyze the outcomes and predictive factors in patients with an initial biopsy grade group 1 (GG1) prostate cancer (PCa) at risk of GG upgrading. Materials and Methods: We performed a retrospective review of patients who had GG1 PCa at biopsy and were managed with robotic-assisted laparoscopic radical prostatectomy (RaLRP) from January 2012 to December 2018 and collected their clinical characteristics and pathological data. The primary outcomes were GG upgrading at RaLRP and biochemical recurrence-free survival (BCRFS) in these patients. The secondary outcome was to analyze the risk factors of pathological upgrades. Results: Among the 159 patients with initial prostate biopsy of GG1, 122 patients (76.7%) had GG upgrading based on the final pathology at RaLRP. Multivariable analysis showed that transrectal ultrasound (TRUS)-measured prostate volume

Objective To compare pathological and oncological outcomes between robotic-assisted laparoscopic radical prostatectomy (RaLRP) and laparoscopic radical prostatectomy (LRP) among high-risk prostate cancer patient in a tertiary center in Taiwan. Materials and methods From November 2003 to October 2013, 129 high-risk prostate cancer patients receiving minimally-invasive radical prostatectomy were included. The Kaplan–Meier analysis was used for measuring biochemical recurrence-free survival (BFS). Multivariate logistic regression models and Cox proportional hazards regression models were used to determine predictors of positive surgical margin and BFS. Results Among the 129 high-risk prostate cancer patients included, 80 (62%) patients received LRP and 49 (38%) patients received RaLRP. There was no significant difference of positive surgical margin and biochemical recurrence rate between RaLRP and LRP group (P = 0.802 and 0.292). Higher pathological T stage predicted an increased likelihood of positive margins (OR = 3.44, 95% CI [1.45, 8.18], P = 0.005). Higher initial PSA level (HR = 2.88, 95% CI [1.04, 7.94], P = 0.041) and positive surgical margin (HR = 2.55, 95% CI [1.20, 5.44], P = 0.015) were poor prognostic factors for BFS. Conclusion RaLRP can be considered among high-risk prostate cancer in Asian people with comparable oncological outcomes to LRP. Higher pathological T stage was associated with increased likelihood of positive margins, patients with higher iPSA level and positive surgical margin had worsen biochemical recurrence-free survival.

Leuprolide acetate is usually used in the treatment of advanced prostate cancer. The adverse events associated with administration of leuprolide acetate include fatigue, hot flashes, loss of libido, impotence, and depression. These side effects can be treated conservatively. Acute manic and psychiatric symptoms following leuprolide acetate injection are very rare. Few case reports have been published documenting these symptoms. Here, we describe the case of a 62-year-old male with metastatic prostate cancer, who developed acute manic and psychiatric symptoms 2 months after subcutaneous leuprolide acetate injection. These symptoms were relieved after administration of neuroleptic drugs, such as risperidone. Administration of leuprolide acetate was eventually stopped. The exact mechanism causing the manic and psychiatric adverse events is unclear. Some experts have theorized that estrogen withdrawal following leuprolide acetate therapy may induce psychiatric symptoms. Manic episodes may arise from a deficit in central serotonergic neurotransmission. Based on these hypotheses, risperidone, lithium, and some anticonvulsants, such as divalproex sodium and carbamazepine, have been used effectively in the treatment and prophylaxis of manic episodes. Although psychiatric adverse events are rare following administration of leuprolide acetate, clinicians should be aware of the possibility.