Are clinically insignificant prostate cancers really insignificant among Korean men?

PURPOSE: We aimed to determine whether 12 core-extended biopsies of the prostate could predict insignificant prostate cancer (IPCa) in Koreans reliably enough to recommend active surveillance. MATERIALS AND METHODS: Two hundred and ninety-seven patients who underwent radical prostatectomy after 12 core-extended prostate biopsies were retrospectively reviewed. 38 cases (12.8%) were shown to be IPCa. RESULTS: The average age was 65.2 years, serum PSA was 5.49 ng/dL, and the PSA density was 0.11. The Gleason scores (GS) were 6 (3+3) in 31, 5 (3+2) in 4, and 4 (2+2) in 3. After radical prostatectomy, higher GS was given in 16 (42.1%), whereas lower GS was given in 1 case (2.6%), as compared with the GS obtained from biopsy. 11 (28.9%) had GS of 7 (3+4) and 5 (13.2%) had GS of 7 (4+3). 6 in GS 7 (4+3) and 1 in GS 7 (3+4) showed prostate capsule invasion and 1 in GS 7 (4+3) had seminal vesicle invasion. Prostate capsule invasion was observed in 1 with GS 6 (3+3). The rate of inaccuracy of the contemporary Epstein criteria was 42.1%. Only PSA density was a reliable indicator of clinically IPCa (odds ratio=1.384, 95% CI, 1.103 to 2.091). CONCLUSION: Diagnosis of IPCa from a prostate biopsy underestimated the true nature of prostate cancer in as many as 42.1% of Koreans.ope

Efficacy and safety of low-dose anticholinergics to treat men with lower urinary tract symptoms with overactive bladder: a retrospective study based on real life practice

PURPOSE: To investigate whether combination treatment using an α-blocker and 2 mg of tolterodine could improve the International Prostate Symptom Score (IPSS) as much as α-blocker and 4 mg of tolterodine without voiding difficulties in real life practice. METHODS: We restrospectively recruited patients who were treated at four urology clinics between January 2006 and May 2008. A total of 1,094 men with lower urinary tract symptoms/overactive bladder (LUTS/OAB) were assigned to one of three groups: an α-blocker only group (group I, n=152), an α-blocker plus tolterodine 2 mg group (group II, n=520), and an α-blocker plus tolterodine 4 mg group (group III, n=574). Eligible patients were 50 years or older men who had a total IPSS of 8 or higher and a IPSS storage subscore of 5 or higher and were followed up for 12 weeks. RESULTS: The total IPSS score and quality of life scores were significantly improved at week 12 in groups II and III. The incidence of acute urinary retention was similar between both combination treatment groups, but the incidence of voiding difficulty was much lower in group II (2.1%) than group III (10.8%) tolterodine. CONCLUSIONS: Our results suggest that treatment of LUTS/OAB patients with an α-blocker plus tolterodine 2 mg is as effective as α-blocker plus tolterodine 4 mg, and the incidence of voiding difficulty was in the low-dose anticholinergic is lower. These results indicate that dose strength should be decided on a case-by-case basis to balance the efficacy and safety.ope

Effect of Photoselective Vaporization Prostatectomy on Lower Urinary Tract Symptoms in Benign Prostatic Hyperplasia With or Without Intravesical Prostatic Protrusion

PURPOSE: Intravesical protrusion of the prostate (IPP) can affect voiding. We evaluated the improvement in lower urinary tract symptoms and patient satisfaction after laser prostate photovaporization in benign prostatic hyperplasia (BPH) patients with or without IPP. MATERIALS AND METHODS: This prospective study included 134 patients who underwent GreenLight HPS laser photoselective vaporization prostatectomy (PVP) between January 2010 and July 2011 patient. Preoperative IPP was evaluated by using the retroflexed view from flexible cystoscopy. evaluation included complete medical history, International Prostate Symptom Scores (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), serum prostate-specific antigen (PSA), and transrectal ultrasonogram. Changes from baseline in Qmax, PVR, total IPSS, and IPSS subscores (voiding and storage) were analyzed at postoperative months 1, 3, and 6. RESULTS: The patients' mean age was 66.6±7.8 years. Mean serum PSA and prostate volume were 1.7±1.5 ng/mL and 42.9±16.7 g, respectively. No significant differences existed between the IPP and no IPP groups in preoperative prostate volume, total IPSS, PSA, or lasing time and energy. The mean follow-up duration was 6.2±1.9 months. IPP patients showed significant improvements in total IPSS and voiding subscores at months 1 and 3. Improvements in the quality of life score and storage subscore were not significantly different between the groups. Qmax was significantly improved at 6 months postoperatively in the IPP group versus the no IPP group. CONCLUSIONS: Among patients who underwent PVP for BPH, the IPP group showed more symptom improvement, especially in voiding symptoms, than did the no IPP group. Preoperative cystoscopy is helpful for evaluating IPP and for anticipating postoperative outcome.ope

Is it suitable to eliminate bone scan for prostate cancer patients with PSA ≤ 20 ng/mL?

PURPOSE: We evaluated the relationship between bone metastasis (BM) and clinical or pathological variables, including the serum prostate-specific antigen (PSA) concentration. METHODS: This retrospective study included 579 consecutive patients with newly diagnosed prostate cancer (Pca) who underwent a bone scan study at our institution between 2002 and 2010. We used receiver operating characteristics curves to evaluate accuracy of bone metastasis between serum PSA 10 and 20 ng/mL. RESULTS: A positive bone scan result was found in 83 men (14.3%) with PCa. However, 27 men (4.6%) with serum PSA between 10 and 20 ng/mL, 29/579 men (5.0%) with GS ≤ 7, and 21/83 (25.3%) with serum PSA ≤ 20 ng/mL and Gleason score (GS) ≤ 7 had positive bone scans. In the logistic regression analyses, clinical T stage (odds ratio [OR] = 3.26; 95% CI, 2.29-4.33; P = 0.021), GS (OR = 3.41; 95% CI, 2.91-4.63; P = 0.019), and serum PSA (OR = 8.37; 95% CI, 3.91-19.21; P < 0.001) were predictive factors of detecting the BM. When the serum PSA concentration ≤20 ng/mL and GS ≤ 7, AUC value of bone scans for the detection of BM was 0.640 (P = 0.020; 95% CI, 0.563-0.717). With serum PSA at 10 ng/mL and GS ≤ 7, the AUC values of bone scans were 0.828 (P < 0.001; 95% CI, 0.773-0.883). CONCLUSIONS: Bone scans might be necessary in men with serum PSA between 10 and 20 ng/mL. New guidelines for eliminating bone scans in patients with newly diagnosed Pca are needed, especially in Asians.ope

Optimal baseline prostate-specific antigen level to distinguish risk of prostate cancer in healthy men between 40 and 69 years of age

The present study evaluated optimal baseline prostate-specific antigen (PSA) level at different ages in order to determine the risk of developing prostate cancer (CaP). We analyzed 6,651 Korean men, aged 40-69 yr. The serum PSA levels for these men were measured at one institute from 2000 to 2004 and were determined to be between 0-4 ng/mL. Patients were divided into 4 groups of 25th-percentile intervals, based on initial PSA level. Of these, the group with an increased risk was selected, and the optimal value was determined by the maximal area under a receiver-operating characteristic curve within the selected group. The risk of CaP diagnosis was evaluated by Cox regression. The mean follow-up period was 8.3 yr. CaP was detected in 27 of the 6,651 subjects. CaP detection rate was increased according to age. The optimal PSA value to distinguish the risk of CaP was 2.0 ng/mL for 50- to 69-yr-olds. Patients with a baseline PSA level greater than the optimal value had a 27.78 fold increase in the prostate cancer risk. Baseline PSA values are useful for determining the risk of developing CaP in Korean men for 50- and 69-yr-old. We suggest that PSA testing intervals be modified based on their baseline PSA levels.ope

Effects of α-blocker 'add on' treatment on blood pressure in symptomatic BPH with or without concomitant hypertension

We investigated the effects of 'add on' treatment of α-blocker (AB) on blood pressure (BP) and the safety of ABs in men with symptomatic BPH with or without hypertension. We retrospectively reviewed 2,924 BPH outpatients who took ABs at our institution between 2005 and 2009. BPH symptom severity, prostate volume and BP were determined for 953 patients with their baseline data. BP level and International Prostate Symptom Score were measured within 2 months after AB treatment. Patients were assigned to four groups: group 1 had 272 normotensive patients on concomitant hypertensive medication; group 2 had 293 normotensive patients not on the medication; group 3 had 216 hypertensive patients on concomitant medication; and group 4 had 172 hypertensive patients not on the medication. The addition of AB lowered the mean systolic BP by 16.6 mm Hg for group 3 and by 8.6 mm Hg for group 4, and diastolic BP by 18.0 mm Hg for group 3 (P<0.05). However, normotensive groups on entry, irrespective of antihypertensive medication, showed no significant BP changes from baseline after AB medication. In the hypertensive groups on entry, the doxazosin gastrointestinal therapeutic system (GITS) resulted in significant reductions in systolic BP from 142.2 to 134.9 mm Hg and in diastolic BP from 97.6 to 84.6 mm Hg. When analyzed by AB regimen, the incidence of BP-related adverse events was comparable. AB therapy for BPH can have an appropriate and beneficial effect on BP, especially in baseline hypertensive patients. Doxazosin GITS treatment resulted in optimal management of BP within the normal range, especially in pharmacologically or physiologically hypertensive patients.ope

Effects of Post Biopsy Digital Rectal Compression on Improving Prostate Cancer Staging Using Magnetic Resonance Imaging in Localized Prostate Cancer

PURPOSE: To evaluate the effectiveness of digital rectal-compression immediately after transrectal prostate biopsy (P-bx) for improving the accuracy of prostate cancer (PCa) staging. MATERIALS AND METHODS: Between July 2008 and June 2010, 94 consecutive patients who had a radical prostatectomy were included in our retrospective analysis. The exclusion criteria included a history of previous P-bx and surgery, a biopsy performed in another hospital, a number of biopsy cores different from 12, or a condition interfering with bleeding assessment. The subjects were divided into two groups, compression and non-compression. All enrolled patients took magnetic resonance imaging (MRI) for PCa staging. RESULTS: The compression and non-compression groups were comparable with respect to several baseline characteristics. However, the total hemorrhage score of intraprostatic bleeding was significantly different between the groups, even with adjustment for the time from biopsy to MRI (compression:15.4 ± 2.32, non-compression: 24.9 ± 2.43, p<0.001). The intra-prostatic cancer location matching rate was higher in the compression group (78.0%) than in the non-compression group (70.2%) (p = 0.011). Overall accuracy of staging in compression and non-compression groups was 84.7% and 77.3%, respectively. CONCLUSION: Our results demonstrate that digital rectal compression performed immediately after prostate biopsy to reduce intraprostatic hemorrhage improves the accuracy for detection of PCa using MRI.ope

경영위원회 및 경영위원회 특성이 기업성과에 미치는 영향

학위논문(석사) -- 서울대학교대학원 : 경영대학 경영학과, 2024. 2. 이준만.This study examines the effect of executive (management) committee within the board of directors and the potential theoretical mechanism by which such presence affects the performance of Korean listed firms. I address this through agency theory and the perspective of information segregation on corporate governance structure. Furthermore, I explore the effect of executive committee characteristics on firm performance. Using 480 firm-year observations of 96 KOSPI 100-listed firms from 2015 to 2019, I found an adverse relationship between executive committee presence and firm operating performance, proxied by Return on Assets (ROA). However, for firms with an executive committee, performance improves with high independence and frequent meetings. The proportion of committees with executive committee multi-committee directors shows a positive yet insignificant relationship with firm performance. These findings contribute to our understanding of agency problems tied to executive committee while highlighting that effective operations can enhance firm performance. This study offers practical implications for firm's decision-makers seeking to enhance firm performance through corporate governance structure.본 연구는 이사회 내 경영위원회가 한국 상장기업의 기업성과에 미치는 영향과 경영위원회 설치에 따른 잠재적인 이론적 구조를 살펴본다. 대리인 이론과 정보 분리 관점을 고려한 본 연구는 더 나아가 경영위원회 특성이 기업성과에 미치는 영향을 탐구한다. 2015년부터 2019년까지 96개 KOSPI 100 상장기업의 480개 기업-연도 관측치를 통해, 경영위원회 유무와 총자산이익률(ROA)로 측정된 기업 운영성과 간에 음(-)의 연관성이 있음을 확인하였다. 반면 경영위원회가 설치된 기업들의 기업성과는 경영위원회 독립성 및 회의빈도 사이에 양(+)의 연관성이 있음이 확인되었다. 경영위원회 소속 이사들이 복수로 참여하는 위원회 수의 비율은 기업성과와 양(+)의 관계가 있으나 유의하지 않은 것으로 나타났다. 이러한 실증적 결과는 경영위원회 설치에 따른 대리인 문제에 대한 이해를 돕고 경영위원회의 효과적인 운영이 기업성과를 제고할 수 있음을 시사한다. 본 연구는 기업지배구조를 고려하여 기업성과를 높이고자 하는 기업의 의사결정권자에게 실질적인 시사점을 제공한다.1. INTRODUCTION 1 2. THEORY AND HYPOTHESES 5 2.1. Board and Board Committees 5 2.2. The Effect of Executive Committee 8 2.3. Executive Committee and Firm Performances 11 2.4. Executive Committee Meeting Cadences 13 2.5. Executive Committee Multi-Committee Directors 14 2.6. Executive Committee Independence 16 3. METHODS 18 3.1. Sample and Data 18 3.2. The Unit of Analysis and Variables 20 3.3. Model Analysis 24 4. RESULTS 26 5. DISCUSSION AND CONCLUSION 29 REFERENCES 35 TABLES AND FIGURES 42 국문 초록 46석

70세 이하의 한국 남성의 전립선 암 발생 예측에 쓰이는 기초 전립선 특이항원(baselinePSA)의 효용성 및 적정 절단치

Dept. of Medicine/석사Objectives: To evaluated the optimal baseline PSA level at different ages to determine the risk of CaP.Patients and Methods: We analyzed a large cohort of 6,651 Korean men in age 40-69, The serum PSA levels for the men were measured at one institute from 2000 to 2004 and were determined to be between 0-4 ng/ml. Patients were divided into 4 groups of 25th-percentile intervals, based on initial PSA level. Of these, the group which has a increased risk were selected, and the optimal value was determined by the maximal AUC from the receiver-operating characteristic curve (ROC) within the selected group. The risk of CaP diagnosis was evaluated by Cox regression.Results: The mean follow-up period was 8.3 years. The optimal PSA values to distinguish the risk of CaP were 2.0ng/ml for 50- to 59-year-olds and 1.5ng/ml for 60- to 69-year-olds. Patients with a baseline PSA level greater than the optimal value had a 33.15 and 24.41-fold increase in the age-adjusted prostate cancer risk, respectively.Conclusions: Baseline measurements of PSA should begin at the age of 50. Furthermore, the optimal cutoff values depend on the age.Impact: Optimal PSA cutoff value to distinguish the risk of prostate cancer was different depending on the incidence of prostate cancer of ages.ope

거세 남성 쥐에 시행한 남성 호르몬 보충이 성기의 구조와 발기력에 미치는 영향

Dept. of Medicine/박사Objectives: To evaluate the effects of testosterone on penile structure and erectile function in adult male rats. Patients and Methods: Whole subjects were divided into two groups by observation period (group I (n=30), 12 weeks; group II (n=30), 20 weeks). Each group had three difference subgroups (10 rats each). Sham-operated control, surgical castration group and testosterone replacement for 4 week after 8 weeks of castration period. Group II also had a same kind of subgroup. Control, castration, and last subgroup had more longer castration period (16wks) and testosterone replacement at 4weeks before sacrifice. Erectile function was assessed by measuring intracavernosal pressure in response to cavernous nerve stimulation, and the expression of nNOS protein was determined by Western blot analysis. Serum testosterone values were measured in each animal by radioimmunoassay Results: Serum testosterone levels and cavernousal smooth muscle contents and nNOS activity decreased significantly in castrated animals, whereas Testosterone undecanoate injection normalized the serum levels of testosterone and others. Total Intracavernosal pressure / mean arterial pressure was significantly decreased in untreated castrated rats. compared with intact controls (28.3 +- 3.5 and 78.9+-8.2, respectively). Erectile function was normalized in 4 weeks of androgen-replaced rats. The expression of nNOS was decreased in the corpus cavernosum of castrated animals compared with controls, whereas androgen replacement normalized the expression of nNOS. These results were consistently observed despite the period of androgen deprivation. Conclusions: These data suggest that androgen regulates the expression of nNOS in rat penile corpus cavernosum and confirms the importance of androgens in the maintenance of erectile function. Howerver, irreversible structural and erectile functional changes are not found during study period.ope