The Change of Prostate Cancer Treatment in Korea: 5 Year Analysis of a Single Institution

PURPOSE: We analyzed changes to the trends of prostate cancer management and patient characteristics at a single institute during 5 years due to the significant increase of the prostate cancer incidence and the robotic equipment in Korea. MATERIALS AND METHODS: Prostate cancer patient data from a single institute recorded from 2006 to 2010 were analyzed. Cancer stage, initial treatment modalities, and the pattern of outpatient clinical management were reviewed. RESULTS: Between 2006 and 2010, 386 prostate cancers were newly diagnosed at the institute. The proportion of localized and locally advanced cancer cases increased from 67% in 2006 to 79% in 2010 respectively. Among the treatment choices during follow-up in the out-patients clinic, the proportion of radical prostatectomies increased from 43% in 2006 to 62% in 2010. In contrast, the proportion of hormone therapies decreased from 58% to 37%. For initial treatment choice, radical prostatectomy was chosen for 59% of the patients who were newly diagnosed with cancer during the study period. However, hormone therapy alone was administrated as a primary therapy to 26%. Analysis of the radical prostatectomy subgroup showed that a robot- assisted technique was used in 83% of the patients, and the remaining 17% underwent an open radical prostatectomy. CONCLUSION: As the prostate cancer incidence increased in Korea, the proportion of localized and locally advanced cancer also increased. In addition, the main treatment modality changed from non-surgical treatment to radical prostatectomy.ope

Can Western Based Online Prostate Cancer Risk Calculators Be Used to Predict Prostate Cancer after Prostate Biopsy for the Korean Population?

PURPOSE: To access the predictive value of the European Randomized Screening of Prostate Cancer Risk Calculator (ERSPC-RC) and the Prostate Cancer Prevention Trial Risk Calculator (PCPT-RC) in the Korean population. MATERIALS AND METHODS: We retrospectively analyzed the data of 517 men who underwent transrectal ultrasound guided prostate biopsy between January 2008 and November 2010. Simple and multiple logistic regression analysis were performed to compare the result of prostate biopsy. Area under the receiver operating characteristics curves (AUC-ROC) and calibration plots were prepared for further analysis to compare the risk calculators and other clinical variables. RESULTS: Prostate cancer was diagnosed in 125 (24.1%) men. For prostate cancer prediction, the area under curve (AUC) of the ERSPC-RC was 77.4%. This result was significantly greater than the AUCs of the PCPT-RC and the prostate-specific antigen (PSA) (64.5% and 64.1%, respectively, p<0.01), but not significantly different from the AUC of the PSA density (PSAD) (76.1%, p=0.540). When the results of the calibration plots were compared, the ERSPC-RC plot was more constant than that of PSAD. CONCLUSION: The ERSPC-RC was better than PCPT-RC and PSA in predicting prostate cancer risk in the present study. However, the difference in performance between the ERSPC-RC and PSAD was not significant. Therefore, the Western based prostate cancer risk calculators are not useful for urologists in predicting prostate cancer in the Korean population.ope

Comparison of pathological outcomes of active surveillance candidates who underwent radical prostatectomy using contemporary protocols at a high-volume Korean center

OBJECTIVE: We compared contemporary active surveillance protocols based on pathological outcomes in patients who underwent radical prostatectomy. METHODS: We identified the experimental cohort from prostate cancer patients who underwent radical prostatectomy between 2001 and 2011 ; and who met the inclusion criteria of five published active surveillance protocols ; namely Johns Hopkins Medical Institution ; University of California at San Francisco ; Memorial Sloan-Kettering Cancer Center ; University of Miami and Prostate Cancer Research International: Active Surveillance. To compare each protocol ; we evaluated the pathological outcomes and calculated the sensitivity ; specificity and accuracy for each protocol according to the proportion of organ-confined Gleason≤6 disease. RESULTS: Overall ; 376 patients met the inclusion criteria of the active surveillance protocols with 61 ; 325 ; 222 ; 212 and 206 patients meeting the criteria of the Johns Hopkins Medical Institution ; University of California at San Francisco ; Memorial Sloan-Kettering Cancer Center ; University of Miami and Prostate Cancer Research International: Active Surveillance protocols ; respectively. The sensitivity and specificity values of the five protocols ; respectively ; were 0.199 and 0.882 in Johns Hopkins Medical Institution ; 0.855 and 0.124 in University of California at San Francisco ; 0.638 and 0.468 in Memorial Sloan-Kettering Cancer Center ; 0.599 and 0.479 in University of Miami ; and 0.609 and 0.527 in Prostate Cancer Research International: Active Surveillance. In terms of both the sensitivity and specificity ; Prostate Cancer Research International: Active Surveillance was the most balanced protocol. In addition ; Prostate Cancer Research International: Active Surveillance showed a more accurate performance for favourable pathological outcomes than the others. However ; using the area under the curve to compare the discriminative ability of each protocol ; there were no statistically significant differences. CONCLUSIONS: The contemporary active surveillance protocols showed similar pathological characteristics in patients who had undergone radical prostatectomy. However ; we concluded that the Prostate Cancer Research International: Active Surveillance protocol would be most helpful to Korean populations in choosing candidates for active surveillance considering the balance between sensitivity and specificity and the accuracy of diagnosis.ope

Patent processus vaginalis in adults who underwent robot-assisted laparoscopic radical prostatectomy: Predictive signs of postoperative inguinal hernia in the internal inguinal floor

OBJECTIVE: To evaluate the risk for postoperative inguinal hernia according to the presence of patent processus vaginalis in an adult population. METHODS: Medical records of 205 patients who underwent robot-assisted laparoscopic radical prostatectomy from May 2007 to November 2011 were reviewed. Age, prostate-specific antigen, prostate volume, body mass index, operative time and history of previous abdominal surgery were evaluated. The existence of patent processus vaginalis was also evaluated for the development of postoperative inguinal hernia. RESULTS: Postoperative inguinal hernia occurred in 20 out of 410 (4.9%) groins (17/205 patients; 8.3%), and patent processus vaginalis was observed in 49 out of 410 (11.9%) groins. In the normal groin group, inguinal hernia occurred in seven out of 361 (1.9%) groins. However, in the patent processus vaginalis group, it occurred in 13 out of 49 (26.5%) groins. On univariate analysis using Cox proportional hazards model, age, body mass index, history of previous abdominal surgery and patent processus vaginalis were significant risk factors. Among them, patent processus vaginalis significantly increased the risk of postoperative inguinal hernia in multivariate analysis (hazard ratio 22.37). In the patent processus vaginalis group, inguinal hernia developed at 12.9 ± 9.2 months after robot-assisted laparoscopic radical prostatectomy and 15 ± 7.4 months in the normal groin group. Inguinal hernia-free ratios were significantly lower in the patent processus vaginalis group than the normal groin group (P<0.001). CONCLUSIONS: The existence of patent processus vaginalis represents an important risk factor for postoperative inguinal hernia in adults. Urologists should consider the possibility of postoperative inguinal hernia when patent processus vaginalis is observed during surgery.ope