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Objectives We investigated the relationships of serum sex hormone-binding globulin (SHBG) level with known prognostic factors for prostate cancer in men who received radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. Methods Preoperative serum levels of SHBG were analyzed in 288 consecutive patients who were scheduled to undergo RRP for clinically localized prostate cancer. We investigated the potential associations of preoperative serum SHBG level with various clinical and pathological factors. Accuracy of variables in predicting adverse pathological features was assessed via receiver operator characteristics (ROC) curves. Results In univariate analysis, preoperative serum SHBG level was observed to be significantly associated with extraprostatic extension of a tumor ( p =0.019) and with pathological Gleason score ( p =0.001). In multivariate analysis, serum SHBG level ( p =0.039) along with serum PSA ( p p p =0.004) was observed to be an independent predictor of the extraprostatic extension of prostate cancer. The area under ROC curve that demonstrated the performance of a multivariate logistic regression model (MLRM), which included serum SHBG level and other preoperative variables, in predicting extraprostatic extension of tumor was larger than that of MLRM without SHBG (0.797 vs. 0.758, p =0.121). Meanwhile, serum SHBG level was not observed to be significantly associated with pathological Gleason score in multivariate analysis ( p =0.303). Conclusions Our data showed that serum SHBG level is an independent predictive factor for extraprostatic extension of tumor in patients with clinically localized prostate cancer.

Aim: To investigate the relationships of serum testosterone, insulin-like growth factor (IGF)-1 and IGF-binding protein (IGFBP)-3 levels with prostate cancer risk and also with known prognostic parameters of prostate cancer in Korean men who received radical retropubic prostatectomy (RRP) for clinically-localized prostate cancer. Methods: Serum levels of total testosterone, free testosterone, IGP-1 and IGFBP-3 were determined in 592 patients who subsequently received prostate biopsy. Results were compared between patients who eventually received RRP for prostate cancer (n = 159) and those who were not diagnosed with prostate cancer from biopsy (control group, n = 433). Among the prostate cancer only patients, serum hormonal levels obtained were analyzed in relation to serum prostate specific antigen (PSA), pathological T stage and pathological Gleason score. Results: Prostate cancer patients and the control group demonstrated no significant differences regarding serum levels of total testosterone, free testosterone, IGF-1 and IGFBP-3 across the different age groups. Among the cancer only patients, no significant associations were observed for serum levels of total testosterone, free testosterone, IGF-1 and IGFBP-3 levels with pathological T stage, pathological Gleason score and preoperative PSA. Conclusion: Our data indicate that simple quantifications of serum testosterone and IGF-1 along with IGFBP-3 levels might not provide useful clinical information in the diagnosis of clinically localized prostate cancer in Korean men. Also, our results suggest that serum levels of testosterone, IGF-1 and IGFBP-3 might not be significantly associated with known prognostic factors of clinically localized prostate cancer in Korean men.

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

Objective: We investigated the prognostic significance of tumor necrosis in primary transitional cell carcinoma (TCC) of upper urinary tract. Methods: We retrospectively analyzed the records of 119 patients who received surgical management for primary TCC of upper urinary tract. The presence or absence of tumor necrosis was evaluated based on the macroscopic description of the tumor. Along with pathologic features of tumor necrosis, we assessed the impacts of various prognostic factors previously reported for TCC of upper urinary tract. Results: Tumor necrosis was identified in 19 (16.0%) patients. Patients with tumor necrosis were more likely to have higher local stage, nodal involvement, higher tumor grade, lymphovascular invasion (LVI), and recurrence of disease. Among all subjects, disease-specific survival rates at 5 years after surgery for patients with and without macroscopic tumor necrosis were 36.7 and 83.2%, respectively (P ¼ 0.0001). In multivariate analysis, only pathologic T stage, LVI and tumor necrosis were shown to be independent predictors for disease-specific survival. For solely the invasive tumors, variables including age, surgical margin and tumor necrosis were observed to be independent prognostic factors for disease-specific survival in multivariate analysis, with tumor necrosis showing the highest rank order of statistical significance. Conclusions: Our results suggest that macroscopic tumor necrosis may be a useful prognostic indicator for primary TCC of upper urinary, especially for invasive tumors. Further investigation would be warranted for the prognostic implications of tumor necrosis in TCCs of upper urinary tract and on actual pathogenesis of tumor necrosis in upper tract TCC.

A paucity of data exists on actual pathology of the contemporary patients strictly categorized as having low-risk prostate cancer. We tried to identify useful preoperative predictors of Gleason score upgrading in patients who underwent radical retropubic prostatectomy (RRP) for low-risk prostate cancer diagnosed via multi-core prostate biopsy.A total of 203 patients who underwent radical RRP for low-risk prostate cancer, as defined by D'Amico et al.'s classification (clinical stageor = T2a, biopsy Gleason sumor = 6, and PSAor = 10 ng/ml), detected via multi (or = 12)-core prostate biopsy were enrolled. We reviewed patients preoperative and pathological data.Among all subjects, 81 (39.9%) were upgraded to Gleason scoreor = 7 after RRP, whereas no downgrading was observed. In multivariate analysis, only preoperative PSA level (P = 0.024) and number of positive cores (P = 0.027) were observed to be independent predictors of Gleason score upgrading following RRP. Also, Gleason core upgrading was observed to be significantly associated with extraprostatic extension of tumor (P0.001) and positive surgical margin (P = 0.002).A significant proportion of patients with low-risk prostate cancer as defined by D'Amico et al.'s classification diagnosed via multi-core prostate biopsy in contemporary period may have Gleason score upgrading following RRP. For patients with low-risk prostate cancer, preoperative PSA level and number of positive cores may be useful predictors of Gleason score upgrading, which was observed to significantly associated with other adverse pathologic features.

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.

We prospectively investigated whether postoperative statin use would contribute to earlier recovery of erectile function in men who underwent bilateral nerve sparing radical retropubic prostatectomy for clinically localized prostate cancer.A total of 50 potent men without hypercholesterolemia undergoing bilateral nerve sparing radical retropubic prostatectomy for clinically localized prostate cancer were prospectively randomized into 2 equal groups. Group 1 patients were instructed to ingest only 50 mg sildenafil per day if needed following hospital discharge after radical retropubic prostatectomy. Group 2 patients were prescribed atorvastatin at a dose of 10 mg daily from postoperative days 1 to 90 and they were also instructed to ingest sildenafil, as in group 1. Patient status regarding potency and adverse events were assessed 6 months after surgery.The 2 groups demonstrated no significant differences regarding various baseline factors, including International Index of Erectile Function-5 scores. Group 2 had a significantly higher postoperative International Index of Erectile Function-5 score than group 1 at 6 months postoperatively (p = 0.003). Meanwhile, as judged by a preset definition, the incidence of potent patients 6 months after prostatectomy was 26.1% in group 1 and 55% in group 2 (p = 0.068). Also, 17.4% and 40% of the men reported achieving intercourse by vaginal penetration without a phosphodiesterase 5 inhibitor in groups 1 and 2, respectively (p = 0.172). No serious adverse events associated with medication were reported.Postoperative treatment with atorvastatin in men who report normal erectile function preoperatively may contribute to earlier recovery of erectile function after nerve sparing radical retropubic prostatectomy.

OBJECTIVE To investigate the prognostic significance of common preoperative laboratory variables evaluated before surgery for clear cell renal cell carcinoma (RCC). PATIENTS AND METHODS We retrospectively analysed the records of 355 patients who had surgery for clear cell RCC, assessing: clinical factors, including preoperative laboratory measurements, i.e. haemoglobin level, leukocyte count, platelet count, erythrocyte sedimentation rate (ESR), serum calcium, alkaline phosphatase (ALP), albumin, bilirubin, alanine aminotransferase, aspartate aminotransferase, and red blood cells in urine; and pathological factors, with the survival rates after surgery. RESULTS The presence of metastasis, tumour stage and tumour size, with the ESR and ALP before surgery, were identified as significant prognostic factors for progression-free survival in a multivariate analysis. The same factors were significant independent factors for disease-specific survival, except for ESR and ALP, which were nearly statistically significant. When limited to non-metastatic tumours only, the multivariate analysis showed that ESR and ALP, with tumour stage, grade, size and necrosis, were independent prognostic factors for disease-specific survival. CONCLUSIONS Along with traditionally accepted prognostic factors, these results suggest that common laboratory variables assessed before surgery, e.g. ESR and ALP, might also be useful in assessing the prognosis for patients with non-metastatic clear cell RCC. Including various laboratory variables in prognostic algorithms for RCC should be considered after further validation in RCCs of various histological subtypes and stages.

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.

INTRODUCTION AND OBJECTIVES: While mid-urethral sling (MUS) operation has expanded its application to more complicated cases such as the patients with mixed urinary incontinence (MUI), the success rates in the patients with MUI have been reported lower than the patients with pure stress urinary incontinence (SUI). If the failure of operation is predicted in the patients with MUI, one could change the therapeutic modalities to obtain the best results regarding continence and the risk factors for failure could help the physicians to counsel the patients ahead of operation. We evaluated and compared the risk factors for failure after MUS operation between pure SUI and MUI. METHODS: Two hundred and twenty-eight women were categorized into pure SUI (Group A, 163 patients) and MUI (Group B, 65 patients). Preoperative evaluations including symptom questionnaire, physical examination and urodynamic study were performed. Patients received the retropubic (17.5%) or trans-obturator (82.5%) MUS operations. RESULTS: Follow-up for Group A and B were 18.8 months (3-52) and 19.2 months (3-54), respectively. The demographic characteristics different between both group were body mass index, presence of cystocele, and severity of incontinence. The MUCP, VLPP, Q-tip and weight of 1-hour pad test were not significantly different in both groups. The success rate in Group A (95.7%) was higher than in Group B (84.6%) (p=0.015, Chi-Square test). In Group A, VLPP, PdetQmax and weight of 1-hour pad test were identified risk factors for failure of operation in univariate analysis, but, only weight of 1-hour pad test was independent risk factor in multivariate analysis (adjusted OR 3.5, 95% CI 1.204-8.895, p=0.045). In Group B, menopause without hormone replacement, AUA Symptom Index-QoL score, maximal cystometric capacity (MCC) and involuntary detrusor contraction (IDC) were the risk factors in univariate analysis, but MCC (adjusted OR 0.9, 95% CI 0.645-0.984, p=0.032) and IDC (adjusted OR 2.3, 95% CI 1.014-3.309, p=0.044) were independent risk factors in multivariate analysis. CONCLUSIONS: The risk factors for failure after MUS operation were different between pure SUI and MUI. Unlike pure SUI, weight of 1-hour pad test was not significant to predict the failure of operation in MUI. Meanwhile, MCC and IDC, indicating the pathophysiological status of the detrusor muscle itself, were important to predict the failure of operation in MUI.

Purpose: Although application of the mid-urethral sling (MUS) operation has expanded to more complicated cases such as patients with mixed urinary incontinence (MUI), the success rates in patients with MUI have been reported to be lower than those in patients with pure stress urinary incontinence (SUI). We evaluated and compared the risk factors for failure after MUS surgery in patients with pure SUI and in those with MUI. Materials and Methods: Two hundred twenty-eight women were categorized as having pure SUI (Group A, 163 patients) or MUI (Group B, 65 patients). Preoperative evaluations including a symptom questionnaire, physical examination, and urodynamic study were performed. Patients underwent retropubic (17.5%) or trans-obturator (82.5%) MUS surgery. Results: The demographic characteristics that differed between the 2 groups were body mass index, presence of cystocele, and severity of incontinence. The success rate in Group A (95.7%) was higher than that in Group B (84.6%) (p=0.015, chi-square test). In Group A, VLPP, PdetQmax, and weight of the 1-hour pad test were identified as risk factors for failure of the operation in the univariate analysis, but only weight of the 1-hour pad test was an independent risk factor in the multivariate analysis (adjusted odds ratio [OR]=3.5; 95% confidence interval [CI]=1.204-8.895, p=0.045). In Group B, menopause without hormone replacement, AUA Symptom Index-QoL score, maximal cystometric capacity (MCC), and involuntary detrusor contraction (IDC) were the risk factors in the univariate analysis, but only MCC (adjusted OR=0.9; 95% CI=0.645-0.984, p=0.032) and IDC (adjusted OR=2.3; 95% CI=1.014-3.309, p=0.044) were independent risk factors in the multivariate analysis. Conclusions: Unlike in pure SUI, weight of the 1-hour pad test was not a significant predictor of failure of surgery in MUI. Meanwhile, MCC and IDC, which indicate the pathophysiologic status of the detrusor muscle itself, were important predictors of failure of surgery in MUI. (Korean J Urol 2009;50:573-580) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: To evaluate the incidence and identify the predicting factors of extraprostatic extension (EPE) in T1c prostate cancers. Materials and Methods: Of 267 consecutive men who underwent radical retropubic prostatectomy (RRP) as initial treatment for prostate cancers, 131 (49.1%) presented with a clinical stage T1c disease. Clinicopathological data were collected, and factors related to biopsy collected; i.e. the number of positive cores (No. (+) core); the percentage of positive cores (% (+) core); the maximal tumor length (Max. mm cancer); the sum of tumor length (Total mm cancer); the maximal ratio of tumor/core length (Max. % mm cancer) and the mean ratio of tumor/core length (Mean % mm cancer). A logistical regression analysis was performed after dividing the cases into organ-confined (OC) and EPE. Results: Of the T1c tumors, 107 (81.7%) and 24 (18.3%) were found to be OC and to have EPE after RRP, respectively. The preoperative factors that showed a significant difference between the two groups (OC vs. EPE) were %free prostate-specific antigen (17.7 vs. 11.1%), prostate volume (43.5 vs. 34.6ml), Gleason score (6.4 vs. 6.8), % (+) core (17.9 vs. 27%), Max. mm cancer (3.5 vs. 6.7mm) and Max. % mm cancer (24.0 vs. 41.6%). Of these factors, those significantly predicting EPE in the receiver operator characteristics curve were: the Gleason score, % (+) core, Max. mm cancer and Max. % mm cancer. Of these, only the % (+) core and Max. mm cancer were significant in predicting EPE in the multivariate logistical regression. When the cutoff of % (+) core was 19%, the risk of EPE increased 2.3 times, and when the cutoff of Max. mm cancer was 5mm the risk increased 3.6 times. Conclusions: Max. mm cancer and % (+) core during a biopsy are preoperative factors that predict the EPE of a clinical stage T1c disease, and should be considered for modifying the surgical technique and in establishing treatment plans. (Korean J Urol 2007;48:797-803) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: There have been reports that clinical stages do not reflect patients' postoperative prognosis well. On the contrary, the clinical application of the percentage of positive core (% (+) core), which predicts tumor volume has been increasing. We developed nomogram for predicting pathologic outcome using prostate-specific antigen (PSA), Gleason score and % (+) core based on data of radical prostatectomy and compared it with nomogram using clinical stage instead of % (+) core. Materials and Methods: Two hundred and fifty nine patients with clinically confined prostate cancers were included in the study. Nomogram for predicting pathologic outcome was developed through multinominal logistic regression analysis, and pathologic outcomes were extracapsular invasion (ECE), seminal vesicle invasion (SVI) and bladder neck invasion (BNI). The accuracy of each nomogram for predicting each pathologic outcome was compared on the basis of receiver operating characteristic (ROC) curve analysis. Results: The mean % (+) core was 24.6% and clinical stages T1c, T2a,b and T2c were 58.7%, 32.0% and 9.3%, respectively. ECE was observed in 45 (17.4%), SVI in 9 (3.5%), and BNI in 12 (4.6%). With an increase in PSA, Gleason score, clinical stage, or % (+) core, the incidence of extraprostatic involvement increased gradually. Two nomograms for predicting pathologic outcome were developed. In quantifying expected predictive improvement, area under ROC curve for predicting ECE was greater in the nomogram using % (+) core than clinical stage (0.815 vs. 0.778). These values for predicting SVI were 0.886 and 0.760, respectively, and for predicting BNI, 0.743 and 0.764, respectively. Conclusions: We developed nomogram for predicting pathologic outcomes using % (+) core instead of clinical stage. Nomogram using % (+) core predicted ECE and SVI with greater accuracy than nomogram using clinical stage. (Korean J Urol 2007;48:789-796) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

To examine the pathologic characteristics of prostate cancers missed by application of the age-specific prostate-specific antigen(PSA) reference in Korean men over sixties in clinical practice based on PSA cutoff 3.0ng/ml. Materials and Methods: We made retrospective analysis of 1,063 patients aged between 60-79 who had had transrectal ultrasonography(TRUS)- guided biopsy due to the rise of PSA over 3.0ng/ml or abnormal findings in digital rectal examination(DRE) or TRUS. Age-specific PSA reference was set at 3.9ng/ml for 60s and 5.4ng/ml for 70s. Results: Prostate cancer was detected in 34.3%(365/1,063) as a whole, and 31.5% in 60s, and 39.5% in 70s according to the age. When age-specific reference 3.9ng/ml was applied to 60s, 20(9.6%) cancers were missed compared with clinical cutoff value(3.0ng/ml). When age-specific reference 5.4ng/ml was applied to 70s, 23(16.0%) cancers were missed. On the average, 43(12.2%) of cancers were missed in 60s and 70s. Of 43 missed cancers, 39(90.7%) were with normal DRE and TRUS. Of these cancers, 16(41.0%) were clinically insignificant on biopsy, but only 7(22.6%) were insignificant in the pathologic examination of 31 radical prostatectomy specimens. Conclusions: In our clinical practice based on PSA cutoff 3.0ng/ml, most cancers missed by application of age-specific reference are clinically significant. But, considering the positive effect of age-specific reference on avoidance of unnecessary biopsies, large prospective study is needed to evaluate the efficacy of age-specific reference in Korean men over sixties.

Purpose: To investigate the significance of various preoperative factors with regard to postoperative erectile function in Korean men undergoing a bilateral nerve sparing radical retropubic prostatectomy (BNSRRP), using the validated Korean version of the International Index of Erectile Function (IIEF-5). Materials and Methods: Between March 2004 and March 2005, 83 consecutive patients, who underwent a BNSRRP, with preoperative IIEF-5 scores greater than 13, were retrospectively analyzed. All patients were asked to answer the IIEF-5 questionnaire during the preoperative period and 1 year postoperatively. The responses were stratified on the basis of the clinical characteristics and the preoperative predictive factors for regaining a normal erectile function (NEF: IIEF-5 score≥18) investigated. Results: At the baseline, 56 patients (67.5%) had NEF. At the 1 year follow-up after the BNSRRP, 58 (70.5%) patients reported a return of a sufficient erection for sexual intercourse, with or without oral phosphodiesterase type 5 (PDE5) inhibitors, but 37 (44.6%) patients regained a NEF. Of these 37 patients, 15 (40.5%) were able to spontaneously regain a NEF, but 22 (59.5%) needed the help of oral PDE5 inhibitors. When the patients were divided according to postoperative NEF and erectile dysfunction (ED: 14≤IIEF-5 score