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OBJECTIVES To investigate the association of prostate size with aggressiveness of prostate cancer in Korean men who received radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. METHODS We evaluated the association of RRP specimen weight and prostate volume measured by transrectal ultrasound (TRUS) with pathologic tumor grade, extraprostatic extension of disease, surgical margin status, and seminal vesicle invasion by reviewing data of 346 consecutive patients who underwent RRP for clinically localized prostate cancer at our institution without receiving preoperative radiation or hormonal treatment. RESULTS A strong correlation was observed between RRP specimen weight and TRUS-measured prostate volume (Spearman r = 0.76; P

To investigate the relationship between prostate-specific antigen (PSA) and prostate volume in a histologically defined subset of Korean men confirmed to have benign prostatic hyperplasia (BPH) only from multicore biopsy of prostate.A total of 707 Korean men with a PSA level of 10 ng/mL or lower who were shown to have stromoglandular hyperplasia only from transrectal ultrasound (TRUS)-guided multicore biopsy of prostate were included in the study. We analyzed PSA and total prostate volume (TV) measured through TRUS by stratified age cohorts. We used Pearson correlation coefficient (r) and linear regression model to describe the relationship between variables.Serum PSA level significantly correlated with TV in all stratified age cohorts, with r ranging from 0.29 to 0.47 (all P0.001). Meanwhile, the degree of correlation appeared to increase with age. The slope of linear regression showing an association of PSA and TV was 3.68. The PSA increase per unit prostate volume decreased with the advancing cohort of age when we excluded subjects 70 years or older.Although PSA was significantly correlated with TV, the exact nature of the relationship between PSA and TV in Korean men with biopsy-proven BPH may be different from that in other races. Further basic research on the pathophysiology of BPH is needed to explain such a racial difference.

OBJECTIVES To investigate the impact of variations in bony pelvic dimensions observed from preoperative magnetic resonance imaging on operative time, intraoperative blood loss, and surgical margin status on performing open radical retropubic prostatectomy. METHODS A prospective study was undertaken in which preoperative magnetic resonance imaging was performed in 190 patients who were diagnosed with clinically localized prostate cancer before radical retropubic prostatectomy. Using the magnetic resonance image findings, various bony pelvic dimensions were measured. The associations of the measured pelvic dimensions and various clinicopathologic factors with the operative time, estimated blood loss, and surgical margin status were analyzed on multivariate analyses. RESULTS For operative time, none of the individual pelvic dimensions measured demonstrated significant associations on univariate analysis. In contrast, only the newly developed parameter, the pelvic dimension index, approached significance (P = 0.095). Only body mass index (BMI) proved to be independently associated with the operative time on multivariate analysis (P = 0.030). Also, only the prostate volume (P = 0.015) was independently associated with the estimated blood loss. For the surgical margin status, the preoperative PSA level (P = 0.041), pathologic Gleason score (P = 0.015), and BMI (P = 0.020), along with the pelvic dimension index (P = 0.048), demonstrated significant associations on univariate analyses. However, only the PSA level (P = 0.071) and BMI (P = 0.059) approached significance on multivariate analysis. CONCLUSIONS Our results have demonstrated that variations in the bony pelvic dimensions might have some impact, but not significantly so, on open radical retropubic prostatectomy compared with other patient-related baseline factors such as the BMI or prostate volume.

OBJECTIVES To investigate the significance of variations in neurovascular bundle (NVB) formation observed on preoperative magnetic resonance imaging (MRI) regarding postoperative potency after nerve-sparing radical retropubic prostatectomy (RRP). METHODS Preoperative MRI was performed in 93 patients who underwent bilateral nerve-sparing RRP for clinically localized prostate cancer and were followed up for at least 12 months after surgery. Judging from the MRI scans, patients were categorized into three groups: group 1, patients with no definite NVB observed on MRI, group 2, those with probable NVB formation observed on MRI but not definite, and group 3, those with NVB more definitely observed on MRI. Patients' erectile function status was assessed preoperatively and postoperatively using the International Index Erectile Function 5-item (IIEF-5) questionnaire. RESULTS Of the 93 patients, 40.9% were in group 1, 21.5% in group 2, and 37.6% in group 3 according to the MRI findings. The patient characteristics, including age, serum prostate-specific antigen, pathologic Gleason score, and preoperative IIEF-5 scores, were not significantly different among the three groups. However, the changes in the IIEF-5 scores after bilateral nerve-sparing RRP demonstrated a significantly larger decrease for group 1 compared with groups 2 and 3. Similar trends were observed when patients 60 years old or younger and those older than 60 years were analyzed separately. CONCLUSIONS In patients with no definite NVB formation observed on MRI, the nerves associated with erectile function may run along both sides of the prostate and spread more anteriorly than those with the NVB more definitely observed. Thus, to preserve the NVBs completely at all times, it would be important to widely dissect the lateral aspects of the prostate during nerve-sparing RRPs.