Publications by authors named "Seong Soo Jeon"

170 Publications

Comparison of Efficacy of Different Surgical Techniques for Benign Prostatic Obstruction.

Int Neurourol J 2021 May 5. Epub 2021 May 5.

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: We compared success rates of three surgical techniques [holmium laser enucleation of the prostate (HoLEP), transurethral resection of the prostate (TURP), and photoselective laser vaporization prostatectomy (PVP)] for treatment of benign prostatic obstruction (BPO). We aimed to identify preoperative clinical variables and urodynamic parameters that predict surgical success.

Methods: A total of 483 patients who underwent surgical treatment for BPO at Samsung Medical Center between 2006 and 2017 were retrospectively analyzed; of these 361, 81, and 41 patients underwent HoLEP, TURP, and PVP, respectively. Prostate-specific antigen, prostate volume, urodynamic parameters, and International Prostate Symptom Score (I-PSS)/quality of life (QoL) index were evaluated preoperatively; uroflowmetry, post-void residual urine, and I-PSS/QoL index were measured six months postoperatively. Surgical success was defined based on I-PSS, maximum flow rate (Qmax), and QoL index and predictive factors were identified using multiple logistic regression analyses.

Results: Success rates of HoLEP, TURP, and PVP were 67.6%, 65.4%, and 34.1%, respectively, and the HoLEP and TURP groups were not significantly different. Regression analysis revealed prostate volume ≥ 50 cc and bladder outlet obstruction index (BOOI) ≥ 40 to be independent factors predicting HoLEP success. Only high preoperative QoL could predict the success of TURP, whereas other urodynamic parameters remained unrelated.

Conclusions: Patients treated with HoLEP and TURP displayed equivalent efficacies, but PVP was relatively less efficient than both. Preoperative variables of prostate volume ≥ 50 cc and BOOI ≥ 40 were independent predictive factors for the success of HoLEP but not of TURP.
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http://dx.doi.org/10.5213/inj.2040314.157DOI Listing
May 2021

Biochemical recurrence after radical prostatectomy according to nadir prostate specific antigen value.

PLoS One 2021 3;16(5):e0249709. Epub 2021 May 3.

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

The hypersensitive prostate specific antigen (PSA) test can measure in 0.01 ng/mL units, and its efficacy for screening after radical prostatectomy (RP) has been reported. In this study, we assessed patients who underwent RP to evaluate whether the nadir value affects biochemical recurrence (BCR). From 1995 to 2014, patients classified as N0 who had negative resection margins and a nadir PSA of less than 0.2 ng/mL were evaluated. The characteristics, pathological outcomes, PSA after RP, and BCR were assessed. A total of 1483 patients were enrolled. Among them, 323 (21.78%) patients showed BCR after RP. The mean age of the BCR group was 63.86±7.31 years, and while that of the no-recurrence group was 64.06±6.82 years (P = 0.645). The mean preoperative PSA of the BCR group was 9.75±6.92 ng/mL and that of the no-recurrence group was 6.71±5.19 ng/mL (P < 0.001). The mean time to nadir (TTN) in the BCR group was 4.64±7.65 months, while that in the no-recurrence group was 7.43±12.46 months (P < 0.001). The mean PSA nadir value was 0.035±0.034 ng/mL in the BCR group and 0.014±0.009 ng/mL in the no-recurrence group (P < 0.001). In multivariable Cox regression analyses, Gleason score, positive biopsy core percentages, minimal invasive surgery, nadir PSA value, and TTN were independently associated with BCR. The mean BCR occurred at 48.23±2.01 months after RP, and there was a significant difference in BCR occurrence according to the nadir PSA value (P < 0.001). A high PSA nadir value and short TTN may predict the risk of BCR after successful RP, aiding the identification of candidates for adjuvant or salvage therapies after RP.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249709PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092790PMC
May 2021

Assessment of Agreement between Two Difference Prostate-Specific Antigen Assay Modalities.

Biology (Basel) 2021 Apr 5;10(4). Epub 2021 Apr 5.

Samsung Medical Center, Department of Urology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.

There is controversy over the usefulness of prostate-specific antigen (PSA) as a prostate cancer (PCa) biomarker. This controversy arises when there are differences in the results of PSA assay modalities. In this study, which aimed to evaluate a proper validation between the two PSA assay modalities, the agreement between the results of the two modalities was analyzed. PSA examinations were conducted using two PSA assay modalities in 4810 patients. The intra-class correlation coefficient (ICC) and weighted kappa analysis were used to evaluate the agreement between the two assay modalities. A linear regression was performed to evaluate the association between the two assay modalities. According to ICC values (ICC: 0.999, < 0.001) and weighted kappa analysis values (kappa: 0.951, alpha's standard error (ASE): 0.001, < 0.0001), the agreement between the assay modalities was rated as excellent. However, the strength of agreement was poor in the following PSA sub-groups: 0.05-0.1 ng/mL (ICC: 0.281, = 0.0860); 0.15-0.2 ng/mL (ICC: 0.288, = 0.0036); 1.5-2.0 ng/mL (ICC: 0.360, = 0.0860); and 2.0-2.5 ng/mL (ICC: 0.303, = 0.0868). In linear regression analysis, when modality B PSA yielded a value of 0.2 ng/mL, the expected value for modality A was 0.258 ng/mL (95% CI: 0.255-0.260), and when modality B PSA yielded a value of 4 ng/mL, the expected value for modality A was 3.192 ng/mL (95% CI: 3.150-3.235). The difference in the PSA values between the two PSA assay modalities is confirmed, and this difference may be clinically meaningful.
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http://dx.doi.org/10.3390/biology10040297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065834PMC
April 2021

Prostate cancer trajectory-map: clinical decision support system for prognosis management of radical prostatectomy.

Prostate Int 2021 Mar 30;9(1):25-30. Epub 2020 Jul 30.

Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Purpose: Prostate cancer has a low mortality rate and requires persistent treatment; however, treatment decisions are challenging. Because prostate cancer is complex, the outcomes warrant thorough follow-up evaluation for appropriate treatment. Electronic health records (EHRs) do not present intuitive information. This study aimed to develop a Clinical Decision Support System (CDSS) for prognosis management of radical prostatectomy.

Methods: We used data from 5,199 prostate cancer patients from three hospitals' EHRs in South Korea, comprising laboratory results, surgery, medication, and radiation therapy. We used open source R for data preprocessing and development of web-based visualization system. We also used R for automatic calculation functionalities of two factors to visualize the data, e.g., Prostate-Specific Antigen Doubling Time (PSADT), and four Biochemical Recurrence (BCR) definitions: American Society of Therapeutic Radiology and Oncology (ASTRO), Phoenix, consecutive PSA > 0.2 ng/mL, and PSA > 0.2 ng/mL.

Results: We developed the Prostate Cancer Trajectory Map (PCT-Map) as a CDSS for intuitive visualization of serial data of PSA, testosterone, surgery, medication, radiation therapy, BCR, and PSADT.

Conclusions: The PCT-Map comprises functionalities for BCR and PSADT and calculates and visualizes the newly added patient data automatically in a PCT-Map data format, thus optimizing the visualization of patient data and allowing clinicians to promptly access patient data to decide the appropriate treatment.
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http://dx.doi.org/10.1016/j.prnil.2020.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053691PMC
March 2021

Risk Factors and Patterns of Locoregional Recurrence After Radical Nephrectomy for Locally Advanced Renal Cell Carcinoma.

Cancer Res Treat 2021 Apr 15. Epub 2021 Apr 15.

Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: We aimed to investigate the risk factors and patterns of locoregional recurrence (LRR) after radical nephrectomy (RN) in patients with locally advanced renal cell carcinoma (RCC).

Materials And Methods: We retrospectively analyzed 245 patients who underwent RN for non-metastatic pathologic T3-4 RCC from January 2006 to January 2016. We analyzed the risk factors associated with poor locoregional control using Cox regression. Anatomical mapping was performed on reference computed tomography scans showing intact kidneys.

Results: The median follow-up duration was 56 months (1-128 months). Tumor extension to renal vessels or the inferior vena cava (IVC) and Fuhrman's nuclear grade IV were identified as independent risk factors of LRR. The 5-year actuarial LRR rates in groups with no risk factor, one risk factor, and two risk factors were 2.3%, 19.8%, and 30.8%, respectively (p<0.0001). The locations of LRR were distributed as follows: aortocaval area (n=2), retrocaval area (n=5), and tumor bed (n=11). No LRR was observed above the celiac axis (CA) or under the inferior mesenteric artery (IMA).

Conclusions: Tumor extension to renal vessels or the IVC and Fuhrman's nuclear grade IV are the independent risk factors associated with LRR after RN for pT3-4 RCC. The locations of LRR after RN for RCC were distributed in the tumor bed and regional lymphatic area from the bifurcation of the CA to that of the IMA.
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http://dx.doi.org/10.4143/crt.2020.1373DOI Listing
April 2021

Comparison of oncologic and functional outcomes between radical nephroureterectomy and segmental ureterectomy for upper urinary tract urothelial carcinoma.

Sci Rep 2021 Apr 9;11(1):7828. Epub 2021 Apr 9.

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.

This study aims to compare oncologic and functional outcomes after radical nephroureterectomy (RNU) and segmental ureterectomy (SU) in patients with upper urinary tract urothelial carcinoma (UTUC). We retrospectively collected data on patients who underwent either RNU or SU of UTUC. Propensity score matching was performed among 394 cases to yield a final cohort of 40 RNU and 40 SU cases. Kaplan-Meier analysis and the log-rank test were used to compare overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), and intravesical recurrence-free survival (IVRFS) between the groups. We also compared the change in postoperative estimated glomerular filtration rate (eGFR). There was no significant difference in terms of CSS, PFS, and IVRFS between the RNU and SU groups, but the RNU group had a better OS than the SU group (p = 0.032). Postoperative eGFR was better preserved in the SU group than in the RNU group (p < 0.001). SU provides comparable CSS, PFS, and IVRFS for patients with UTUC compared to RNU, even in patients with advanced-stage and/or high-grade cancer. Further, SU achieves better preservation of renal function.
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http://dx.doi.org/10.1038/s41598-021-87573-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035162PMC
April 2021

Potential of circulating tumor DNA as a predictor of therapeutic responses to immune checkpoint blockades in metastatic renal cell carcinoma.

Sci Rep 2021 Mar 10;11(1):5600. Epub 2021 Mar 10.

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.

We evaluated the predictive role of circulating tumor DNA (ctDNA) detection by targeted deep sequencing in patients with metastatic renal cell carcinoma (mRCC) treated with immune checkpoint blockades (ICB). To determine the feasibility of ctDNA detection in our panel encompassing 40 genes, we collected 10 ml of blood from 20 patients at the time of radical nephrectomy. We analyzed somatic mutations in primary tumors and ctDNA samples from these patients. We finally collected 10 ml of blood before and after 1 month of treatment, respectively, from four patients with mRCC who received first-line ICB treatment. Variants were detected in primary tumors of 15 patients (75%) and ctDNA was detected in the plasma of 9 patients (45%). We examined the predictive role of ctDNA in four patients who received first-line ICB therapy. In two patients showing partial response, ctDNA levels decreased after 1 month of ICB treatment. However, in one patient who showed disease progression, ctDNA levels increased after 1 month of ICB treatment. Taken together, ctDNA detection in plasma by targeted deep sequencing was feasible in patients with RCC. Moreover, the levels of ctDNA could be an early predictor of treatment response in patients with mRCC who receive ICB therapy.
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http://dx.doi.org/10.1038/s41598-021-85099-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970914PMC
March 2021

Genomic mutation profiling using liquid biopsy in Korean patients with prostate cancer: Circulating tumor DNA mutation predicts the development of castration resistance.

Investig Clin Urol 2021 Mar;62(2):224-232

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: To investigate germline and somatic mutation profiles in Korean patients with prostate cancer using liquid biopsy and solid tissue testing and to evaluate the prognostic value of circulating tumor DNA (ctDNA) in predicting castration resistance in patients with metastatic hormone-sensitive prostate cancer (mHSPC).

Materials And Methods: Plasma samples from 56 prostate cancer patients were subjected to next-generation sequencing (NGS) to identify germline mutations and ctDNA analysis using liquid biopsy to detect somatic mutations. Additionally, paired solid cancer tissues from 18 patients were subject to NGS to detect somatic mutations. The clinical parameters and ctDNA profiles of patients with mHSPC were analyzed to evaluate the prognostic value of ctDNA mutations with respect to predicting castration resistance using Cox proportional hazards regression analysis.

Results: Germline mutations occurred in 3.6% of the patients in this cohort, with mutations identified in (1.8%) and (1.8%). Somatic mutations detected by liquid biopsy and solid tissue testing were common in (12.5%), (3.6%), and (3.6%). Of the 18 patients with paired tissue testing, two patients had at least one identical somatic mutation in both the liquid biopsy and solid tissue testing. In patients with mHSPC, the presence of ctDNA mutations could independently predict the castration resistance development (hazard ratio, 13.048; 95% confidential interval, 1.109-153.505; p=0.041).

Conclusions: Korean patients with prostate cancer showed a relatively low germline mutation rate compared to other ethnicities. The ctDNA mutations detected by liquid biopsy can predict the development of castration resistance in patients with mHSPC.
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http://dx.doi.org/10.4111/icu.20200406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940855PMC
March 2021

Effects of Complete Bladder Cuff Removal on Oncological Outcomes Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma.

Cancer Res Treat 2020 Dec 28. Epub 2020 Dec 28.

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: This study aimed to evaluate the effects of bladder cuff method on oncological outcomes in patients who underwent radical nephroureterectomy (RNU) for upper tract urothelial carcinoma.

Materials And Methods: The records of 1,095 patients treated with RNU performed at our hospital between 1994 and 2018 were retrospectively reviewed; 856 patients with no bladder tumor history were enrolled in the present study. The management of bladder cuff was divided into two categories: extravesical ligation (EL) or transvesical resection (TR). Survival was analyzed using the Kaplan-Meier method and Cox regression analyses were performed to determine which factors were associated with intravesical recurrence-free survival (IVRFS), cancer-specific survival (CSS), and overall survival (OS).

Results: The mean patient age was 64.8 years and the median follow-up was 37.7 months. Among the 865 patients, 477 (55.7%) underwent the TR and 379 (44.3%) the EL. Significantly higher IVRFS (p=0.001) and OS (p=0.013) were observed in the TR group. In multivariable analysis, IVR, CSS, and OS were independently associated with the EL. Among 379 patients treated with the EL, 8 underwent remnant ureterectomy. Based on radical cystectomy-free survival, significant difference was not observed between the two groups. However, significantly higher IVRFS was observed in the TR group when the tumor was located in the renal pelvis.

Conclusion: Intramural complete excision of the distal ureter during RNU should be the gold standard approach compared with EL for the management of distal ureter in terms of oncological outcomes.
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http://dx.doi.org/10.4143/crt.2020.919DOI Listing
December 2020

Risk of dementia and Parkinson's disease in patients treated with androgen deprivation therapy using gonadotropin-releasing hormone agonist for prostate cancer: A nationwide population-based cohort study.

PLoS One 2020 30;15(12):e0244660. Epub 2020 Dec 30.

Department of Urology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, GyeongGi-Do, Korea.

Recent studies reported conflicting results on the association of androgen deprivation therapy (ADT) with dementia and Parkinson's disease in patients with prostate cancer (Pca). Therefore, this study aimed to investigate whether use of gonadotropin-releasing hormone agonist (GnRHa) increases the risk of both diseases. A nationwide population cohort study was conducted involving newly diagnosed patients with Pca %who started ADT with GnRHa (GnRHa users, n = 3,201) and control (nonusers, n = 4,123) between January 1, 2012, and December 31, 2016, using data from the National Health Insurance Service. To validate the result, a hospital cohort of patients with Pca consisting of GnRHa users (n = 205) and nonusers (n = 479) in a tertiary referral center from January 1, 2006 to December 31, 2016, were also analyzed. Traditional and propensity score-matched Cox proportional hazards models were used to estimate the effects of ADT on the risk of dementia and Parkinson's disease. In univariable analysis, risk of dementia was associated with GnRHa use in both nationwide and hospital validation cohort (hazard ratio [HR], 1.696; 95% CI, 1.425-2.019, and HR, 1.352; 95% CI, 1.089-1.987, respectively). In a nationwide cohort, ADT was not associated with dementia in both traditional and propensity score-matched multivariable analysis, whereas in a hospital validation cohort, ADT was associated with dementia only in unmatched analysis (HR, 1.203; 95% CI, 1.021-1.859) but not in propensity score-matched analysis. ADT was not associated with Parkinson's disease in either nationwide and validation cohorts. This population-based study suggests that the association between GnRHa use as ADT and increased risk of dementia or Parkinson's disease is not clear, which was also verified in a hospital validation cohort.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244660PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773184PMC
March 2021

Prognostic Impact of Bone Metastasis on Survival Outcomes in Patients with Metastatic Renal Cell Carcinoma Treated by First Line Tyrosine Kinase Inhibitors: A Propensity-Score Matching Analysis.

J Cancer 2020 18;11(24):7202-7208. Epub 2020 Oct 18.

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

To investigate the effect of bone metastasis (BM) on survival outcomes in patients with metastatic renal cell carcinoma (mRCC) treated with first-line tyrosine kinase inhibitors (TKI) by performing propensity-score matching (PSM) analysis. We retrospectively reviewed 1,151 patients with mRCC who were treated with first-line TKI from December 2006 to September 2016. After excluding 135 patients, 1,016 patients with mRCC were finally analyzed. The primary and secondary end points were overall survival (OS) and progression-free survival (PFS), respectively. After 1:1 PSM analysis, survival outcomes were compared between patients with BM (n237) and without BM (n237). Multivariate Cox regression analysis was used to determine predictors of survival. Among 1,016 total patients, 27.5% (n279) had BM. Before PSM, patients with BM had worse OS outcomes than those without BM. Even after PSM, OS was significantly poorer in patients with BM compared to those without BM. Of note, the presence of BM was identified as an independent predictor of OS (HR=1.36), in addition to prior nephrectomy, sarcomatoid differentiation, and IMDC risk group. However, there were no differences in PFS according to the presence of BM after PSM. In the subgroup analysis, only intermediate IMDC risk group showed significant differences in OS according to the presence of BM. Based on PSM analysis, the presence of BM negatively affected OS outcomes in patients with mRCC treated with first-line TKI, particularly in the IMDC intermediate risk group.
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http://dx.doi.org/10.7150/jca.48062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646162PMC
October 2020

Correlation between Gleason score distribution and Prostate Health Index in patients with prostate-specific antigen values of 2.5-10 ng/mL.

Investig Clin Urol 2020 11;61(6):582-587

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: To determine the clinical significance and correlation between the Prostate Health Index (PHI) and Gleason score in patients with a prostate-specific antigen (PSA) value of 2.5-10 ng/mL.

Materials And Methods: This retrospective analysis included 114 patients who underwent biopsy after completion of the PHI from November 2018 to July 2019. Various parameters such as PSA, PHI, PSA density, free PSA, p2PSA, and %free PSA were collected, and correlations with biopsy Gleason score and cancer detection rates were investigated.

Results: Baseline characteristics were comparable between PHI groups (0-26.9 [n=11], 27.0-35.9 [n=17], 36.0-54.9 [n=50], and ≥55.0 [n=36]). A total of 37 patients (32.5%) were diagnosed with prostate cancer, and 28 (24.6%) were diagnosed with clinically significant prostate cancer (CSPC, Gleason score ≥7) after prostate biopsy. The cancer detection rate gradually increased with a corresponding increase in the PHI (18%, 24%, 30%, and 44%, respectively). The same pattern was observed with detecting CSPC (0%, 18%, 26%, and 33%, respectively). There was no CSPC in the groups with PHI <27.0, and Gleason score 7 began to appear in groups with PHI ≥27.0. In particular, patients with Gleason score 8 and 9 were distributed only in the groups with PHI ≥36.0.

Conclusions: The diagnostic accuracy of detection of CSPC could be increased when prostate biopsy is performed in patients with a PHI ≥36.0. In this study, there was a clear Gleason score difference when the PHI cutoff value was set to 27.0 or 36.0.
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http://dx.doi.org/10.4111/icu.20200084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606122PMC
November 2020

Programmed Cell Death-Ligand 1 Expression Status in Urothelial Carcinoma According to Clinical and Pathological Factors: A Multi-Institutional Retrospective Study.

Front Oncol 2020 2;10:568809. Epub 2020 Oct 2.

Department of Urology, Center for Urologic Cancer, Hospital and Division of Tumor Immunology, Research Institute, National Cancer Center, Goyang, South Korea.

To investigate programmed cell death-ligand 1 (PD-L1) expression status and the clinical and pathological factors related to its expression in urothelial carcinoma (UC) patients. Data from 761 UC patients who underwent testing for PD-L1 expression using the VENTANA (SP-142 immunohistochemistry assay) for measuring PD-L1 expression according to the manufacturer's protocol between February 2016 and July 2019 were retrospectively reviewed. Patients were categorized into three groups based on the percentage of tumor area covered by PD-L1-expressing tumor-infiltrating immune cells (ICs) as follows: IC0 (<1%), IC1 (≥1% and <5%), and IC2/3 (≥5%). Positive PD-L1 expression was defined as IC2/3 (≥5%). The factors related to positive PD-L1 expression were assessed by using unadjusted and adjusted logistic regression analyses. In the entire cohort, 213 (28%) patients showed positive PD-L1 expression. Final adjusted regression analyses for positive PD-L1 expression revealed that several factors, including intravesical BCG prior to PD-L1 testing (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.37-0.96), advanced tumor stage (stage III/IV) (OR 2.04, 95% CI 1.41-2.93), and high tumor grade (OR 5.31, 95% CI 2.38-11.83) were significantly associated with positive PD-L1 expression. This study showed that the PD-L1 expression is associated with several clinical and pathological factors for the first time in a real-world setting. Further follow-up clinical trials should consider adjusting these factors, including intravesical BCG treatment, tumor stage and grade to clarify the utility of PD-L1 as a biomarker.
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http://dx.doi.org/10.3389/fonc.2020.568809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7562813PMC
October 2020

Strategy for Prostate Cancer Patients with Low Prostate Specific Antigen Level (2.5 to 4.0 ng/mL).

J Korean Med Sci 2020 Oct 26;35(41):e342. Epub 2020 Oct 26.

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: To evaluate the strategy for detection of prostate cancer (PCa) with low prostate specific antigen (PSA) level (2.5-4.0 ng/mL), prostate biopsy patients with low PSA were assessed. We evaluated the risk of low PSA PCa and the strategy for screening low-PSA patients.

Methods: We retrospectively analyzed the patients who underwent prostate biopsy with low PSA level. Baseline characteristics, PSA level before prostate biopsy, prostate volume, prostate specific antigen density (PSAD), and pathological data were assessed.

Results: Among the 1986 patients, 24.97% were diagnosed with PCa. The PSAD was 0.12 ± 0.04 ng/mL² in the PCa-diagnosed group and 0.10 ± 0.04 ng/mL² in non-cancer-diagnosed group ( < 0.001). Of the 496 patients diagnosed with PCa, 302 (60.89%) were in the intermediate- or high-risk group. PSAD was 0.13 ± 0.04 ng/mL² in the intermediate- or high-risk group and 0.11 ± 0.03 ng/mL² in the very low- and low-risk group ( < 0.001). Of 330 patients who underwent radical prostatectomy, 85.15% were diagnosed as having significant cancer. There was significant correlation between PSAD and PCa ( = 0.294, < 0.001). PSAD with a specificity of 80.00% of a clinically significant cancer diagnosis was assessed at 0.1226 ng/mL².

Conclusion: The PCa detection rate in the low-PSA group was not lower than that of previous studies of patients with PSA from 4.0 to 10.0 ng/mL. Further, it may be helpful to define a strategy for PCa detection using PSAD in the low-PSA group.
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http://dx.doi.org/10.3346/jkms.2020.35.e342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590649PMC
October 2020

Detection of prostate cancer using prostate imaging reporting and data system score and prostate-specific antigen density in biopsy-naive and prior biopsy-negative patients.

Prostate Int 2020 Sep 1;8(3):125-129. Epub 2020 Apr 1.

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: Few studies report on indications for prostate biopsy using Prostate Imaging-Reporting and Data System (PI-RADS) score and prostate-specific antigen density (PSAD). No study to date has included biopsy-naïve and prior biopsy-negative patients. Therefore, we evaluated the predictive values of the PI-RADS, version 2 (v2) score combined with PSAD to decrease unnecessary biopsies in biopsy-naïve and prior biopsy-negative patients.

Materials And Methods: A total of 1,098 patients who underwent multiparametric magnetic resonance imaging at our hospital before a prostate biopsy and who underwent their second prostate biopsy with an initial benign negative prostatic biopsy were included. We found factors associated with clinically significant prostate cancer (csPca). We assessed negative predictive values by stratifying biopsy outcomes by prior biopsy history and PI-RADS score combined with PSAD.

Results: The median age was 65 years (interquartile range: 59-70), and the median PSA was 5.1 ng/mL (interquartile range: 3.8-7.1). Multivariate logistic regression analysis revealed that age, prostate volume, PSAD, and PI-RADS score were independent predictors of csPca. In a biopsy-naïve group, 4% with PI-RADS score 1 or 2 had csPca; in a prior biopsy-negative group, 3% with PI-RADS score 1 or 2 had csPca. The csPca detection rate was 2.0% for PSA density <0.15 ng/mL/mL and 4.0% for PSA density 0.15-0.3 ng/mL/mL among patients with PI-RADS score 3 in a biopsy-naïve group. The csPca detection rate was 1.8% for PSA density <0.15 ng/mL/mL and 0.15-0.3 ng/mL/mL among patients with PI-RADS score 3 in a prior biopsy-negative group.

Conclusion: Patients with PI-RADS v2 score ≤2, regardless of PSA density, may avoid unnecessary biopsy. Patients with PI-RADS score 3 may avoid unnecessary biopsy through PSA density results.
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http://dx.doi.org/10.1016/j.prnil.2020.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557180PMC
September 2020

Docetaxel rechallenge in metastatic castration-resistant prostate cancer: A retrospective, single-center study.

Investig Clin Urol 2020 11 8;61(6):588-593. Epub 2020 Sep 8.

Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: To assess the efficacy and safety of docetaxel rechallenge in the salvage setting in metastatic castration-resistant prostate cancer (mCRPC) patients.

Materials And Methods: Clinicopathologic data from patients treated with docetaxel rechallenge were collected from a single-center cancer registry. Among 227 patients who received first-line docetaxel for mCRPC between January 2011 and June 2019, 23 undergo rechallenge docetaxel after failure to androgen receptor targeting agents and/or cabazitaxel treatment. Endpoints included radiologic progression-free survival (PFS), treatment duration, and prostate-specific antigen (PSA) response and safety.

Results: Overall, 30%, 44%, 13%, and 13% of patients received docetaxel rechallenge as either the third, fourth, fifth, or sixth-line therapy, respectively, at a median of 23.6 months after stopping first-line docetaxel. With first-line docetaxel and rechallenge, median treatment duration was 6.4 and 3.3 months, respectively. With docetaxel rechallenge, PSA response was 35% (95% confidence interval [CI], 15% to 54%) and median PFS was 4.5 months (95% CI, 1.9 to 7.1 months). The median OS was 24.3 months (95% CI, 4.6 to 44.0 months). There were 7 severe adverse events (grade 3 or more) including anemia (8.7%), neutropenia, thrombocytopenia, leukopenia, diarrhea, and nausea (4.3% each).

Conclusions: Docetaxel rechallenge showed meaningful anti-tumor activity with acceptable toxicity in heavily pretreated patients with mCRPC.
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http://dx.doi.org/10.4111/icu.20200214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606124PMC
November 2020

Dr. Answer AI for prostate cancer: Clinical outcome prediction model and service.

PLoS One 2020 5;15(8):e0236553. Epub 2020 Aug 5.

Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Objectives: The importance of clinical outcome prediction models using artificial intelligence (AI) is being emphasized owing to the increasing necessity of developing a clinical decision support system (CDSS) employing AI. Therefore, in this study, we proposed a "Dr. Answer" AI software based on the clinical outcome prediction model for prostate cancer treated with radical prostatectomy.

Methods: The Dr. Answer AI was developed based on a clinical outcome prediction model, with a user-friendly interface. We used 7,128 clinical data of prostate cancer treated with radical prostatectomy from three hospitals. An outcome prediction model was developed to calculate the probability of occurrence of 1) tumor, node, and metastasis (TNM) staging, 2) extracapsular extension, 3) seminal vesicle invasion, and 4) lymph node metastasis. Random forest and k-nearest neighbors algorithms were used, and the proposed system was compared with previous algorithms.

Results: Random forest exhibited good performance for TNM staging (recall value: 76.98%), while k-nearest neighbors exhibited good performance for extracapsular extension, seminal vesicle invasion, and lymph node metastasis (80.24%, 98.67%, and 95.45%, respectively). The Dr. Answer AI software consisted of three primary service structures: 1) patient information, 2) clinical outcome prediction, and outcomes according to the National Comprehensive Cancer Network guideline.

Conclusion: The proposed clinical outcome prediction model could function as an effective CDSS, supporting the decisions of the physicians, while enabling the patients to understand their treatment outcomes. The Dr. Answer AI software for prostate cancer helps the doctors to explain the treatment outcomes to the patients, allowing the patients to be more confident about their treatment plans.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236553PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406030PMC
October 2020

Relationship between robotic-assisted radical prostatectomy and retropubic radical prostatectomy in the learning curve of a single surgeon as a novice in radical prostatectomy: A retrospective cohort study.

Int J Surg 2020 Sep 29;81:74-79. Epub 2020 Jul 29.

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address:

Objective: We compared the learning curve and pathologic and functional outcomes of retropubic radical prostatectomy (RRP) and robotic-assisted radical prostatectomy (RARP) performed during the same time period by a novice to identify how the two surgical types affect each other.

Methods: We retrospectively reviewed 480 men who underwent RRP or RARP for prostate cancer between January 2008 and December 2012. Operation time, estimated blood loss (EBL), positive surgical margin (PSM) rate, urinary continence and potency recovery, and complications were compared. Scatter-graphs were drawn using locally weighted scatterplot smoothing (LOWESS).

Results: Operation time reached the lowest point in the 90th case in RRP and the 200th case in RARP. EBL showed a similar pattern, reaching the lowest point in the 95th case in RRP and the 230th case in RARP. The lowest points for both operation time and EBL took about 3 years to reach for both surgical types. PSM rate was not significantly different (P = 0.807). No pads were required at 6 and 12 months in 55.6% and 66.9% of patients in RRP, respectively, but in 79.6% and 88.4% of patients in RARP. The potency recovery rates were 59.1% in RRP and 70.9% in RARP at 12 months.

Conclusions: When RRP and RARP were begun contemporaneously by a novice, they showed similar learning curve patterns. The direct tactile feedback in RRP and the magnified field of view and detailed techniques in RARP help improve surgical skills complementarily to attain proficiency in both surgical types.
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http://dx.doi.org/10.1016/j.ijsu.2020.07.006DOI Listing
September 2020

Clinical Significance of Pre-to-Postoperative Dynamics of Aspartate Transaminase/Alanine Transaminase Ratio in Predicting the Prognosis of Renal Cell Carcinoma after Surgical Treatment.

Dis Markers 2020 4;2020:8887605. Epub 2020 Jul 4.

Department of Urology, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea.

Background: This study is aimed at examining the prognostic role of pre-to-postoperative dynamics of De Ritis ratio (aspartate aminotransaminase (AST)/alanine aminotransaminase (ALT)) in patients with nonmetastatic renal cell carcinoma (RCC) following radical nephrectomy.

Methods: We retrospectively reviewed the records of 670 patients who underwent radical nephrectomy for nonmetastatic RCC between 1996 and 2012 at our institution. The cutoff points for preoperative (=1.0) and postoperative AST/ALT ratios (=1.12) were assigned based on the median values. We categorized patients into four groups according to the dynamics of AST/ALT ratios: group 1 (lower (≤1.0) ⟶ lower (≤1.12)), group 2 (lower (≤1.0) ⟶ higher (>1.12)), group 3 (higher (>1.0) ⟶ lower (≤1.12)), and group 4 (higher (>1.0) → higher (>1.12)).

Results: When grouped by a preoperative AST/ALT ratio alone, the groups were not statistically different in cancer-specific survival (CSS) or overall survival (OS). In contrast, in Kaplan-Meier analysis, CSS ( = 0.0296) and OS ( = 0.0324) were both significantly shorter with an increased postoperative AST/ALT ratio. According to the pre-to-postoperative dynamics of the AST/ALT ratio, group 2 (lower (≤1.0) ⟶ higher (>1.12)) had a significantly lower CSS ( = 0.0028) and OS ( = 0.0194) than the other groups. On multivariate Cox regression analysis, the pre-to-postoperative dynamics of the AST/ALT ratio were a significant prognostic factor for CSS (hazard ratio, HR = 3.45) and OS (HR = 2.18).

Conclusion: This study is the first to suggest that the dynamics of the pre-to-postoperative De Ritis ratio represent an independent prognostic factor for RCC patients following nephrectomy.
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http://dx.doi.org/10.1155/2020/8887605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364199PMC
May 2021

Integrative Radiogenomics Approach for Risk Assessment of Post-Operative Metastasis in Pathological T1 Renal Cell Carcinoma: A Pilot Retrospective Cohort Study.

Cancers (Basel) 2020 Apr 2;12(4). Epub 2020 Apr 2.

Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon 16149, Korea.

Despite the increasing incidence of pathological stage T1 renal cell carcinoma (pT1 RCC), postoperative distant metastases develop in many surgically treated patients, causing death in certain cases. Therefore, this study aimed to create a radiomics model using imaging features from multiphase computed tomography (CT) to more accurately predict the postoperative metastasis of pT1 RCC and further investigate the possible link between radiomics parameters and gene expression profiles generated by whole transcriptome sequencing (WTS). Four radiomic features, including the minimum value of a histogram feature from inner regions of interest (ROIs) (INNER_Min_hist), the histogram of the energy feature from outer ROIs (OUTER_Energy_Hist), the maximum probability of gray-level co-occurrence matrix (GLCM) feature from inner ROIs (INNER_MaxProb_GLCM), and the ratio of voxels under 80 Hounsfield units (Hus) in the nephrographic phase of postcontrast CT (Under80HURatio), were detected to predict the postsurgical metastasis of patients with pathological stage T1 RCC, and the clinical outcomes of patients could be successfully stratified based on their radiomic risk scores. Furthermore, we identified heterogenous-trait-associated gene signatures correlated with these four radiomic features, which captured clinically relevant molecular pathways, tumor immune microenvironment, and potential treatment strategies. Our results of accurate surrogates using radiogenomics could lead to additional benefit from adjuvant therapy or postsurgical metastases in pT1 RCC.
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http://dx.doi.org/10.3390/cancers12040866DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7226068PMC
April 2020

The Use of Gonadotropin-Releasing Hormone Agonist Does Not Affect the Development of Cardiovascular Disease in Prostate Cancer Patients: a Nationwide Population-Based Cohort Study.

J Korean Med Sci 2020 Feb 3;35(4):e47. Epub 2020 Feb 3.

Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.

Background: The objective of this study was to investigate whether androgen deprivation therapy (ADT) with gonadotropin-releasing hormone agonist (GnRHa) in prostate cancer (Pca) patients is associated with cardiovascular disease in the cohort based from the entire Korean population.

Methods: Using the Korean National Health Insurance database, we conducted an observational study of 579,377 men who sought treatment for Pca between January 1, 2012 and December 31, 2016. After excluding patients with previously diagnosed cardiovascular disease or who had undergone chemotherapy, we extracted the data from 2,053 patients who started GnRHa (GnRHa users) and 2,654 men who were newly diagnosed with Pca (GnRHa nonusers) between July 1, 2012, and December 31, 2012, with follow-up through December 31, 2016. The primary outcomes were cerebrovascular attack (CVA) and ischemic heart disease (IHD).

Results: GnRHa users were older, were more likely to reside in rural areas, had lower socioeconomic status, and had more comorbidities than nonusers (all < 0.050). Although GnRHa users had an increased incidence of CVA and IHD ( = 0.013 and 0.048, respectively) in univariate analysis, GnRHa use was not associated with the outcomes in multivariate analysis. Furthermore, the cumulative duration of ADT was not associated with the outcomes whereas the associations between age at diagnosis with all diseases were significant.

Conclusion: Our complete enumeration of the Korean Pca population shows that ADT is not associated with increased risks of cardiovascular disease.
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http://dx.doi.org/10.3346/jkms.2020.35.e47DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995814PMC
February 2020

Enzalutamide in chemotherapy-naive patients with metastatic castration-resistant prostate cancer: A retrospective Korean multicenter study in a real-world setting.

Investig Clin Urol 2020 01 10;61(1):19-27. Epub 2019 Dec 10.

Department of Urology, Chonnam National University Medical School, Gwangju, Korea.

Purpose: This study aimed to evaluate the clinical efficacy of enzalutamide in chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) patients using real-world data from Korean patients.

Materials And Methods: We retrospectively reviewed the medical records of 199 chemotherapy-naïve patients with mCRPC at 13 tertiary centers in Korea between 2014 and 2017. All patients received enzalutamide daily and 89 patients received concurrent androgen deprivation therapy (ADT).

Results: The median age of the patients was 74 years. Initial results showed that 81.5% of the patients had Gleason score ≥8 and 33.3% of the patients had European Cooperative Oncology Group Performance Status 0. The overall mortality rate was 12%. The median OS was not archieved and 76.7% of patients were alive at 30 months. Median time until PSA progression was 6 months. The overall survival rate at 2 years was significantly higher (84.6% vs. 71.7%, p=0.015) and the duration of PSA progression-free survival was significantly longer (8.0 vs. 4.6 months, p=0.008) in patients receiving concurrent ADT than in those receiving enzalutamide alone. The incidence of adverse events of grade 3 or higher was 1.7%. Multivariate Cox proportional hazard analysis indicated that ADT administered concurrently with enzalutamide significantly improved the overall survival (hazard ratio, 0.346; 95% confidence interval, 0.125-0.958).

Conclusions: Enzalutamide is effective and safe for chemotherapy-naïve patients with mCRPC. Furthermore, the overall survival was significantly higher in patients receiving enzalutamide and concurrent ADT than in patients receiving enzalutamide alone.
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http://dx.doi.org/10.4111/icu.2020.61.1.19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946821PMC
January 2020

Role of Adjuvant Chemotherapy in Advanced Stage Upper Urinary Tract Urothelial Carcinoma after Radical Nephroureterectomy: Competing Risk Analysis after Propensity Score-Matching.

J Cancer 2019 17;10(27):6896-6902. Epub 2019 Nov 17.

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine.

: To determine whether adjuvant chemotherapy (ACH) influences cancer-specific mortality, bladder cancer-specific mortality, and other-cause mortality in patients with locally advanced upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU) through the use of competing risk analysis. : Among 785 patients with UTUC who underwent RNU from 1994 through 2015, we analyzed 338 individuals with locally advanced UTUC (pathologic T3-T4 and/or positive lymph nodes) without distant metastases. Patients were classified into two groups according to receipt of ACH. We performed a 1:1 propensity score-matching analysis between the ACH and no ACH group. The study endpoints were UTUC- and other cause-specific survivals. The association of potential risk factors with outcome was tested with the Fine and Gray regression model. : During a median follow-up duration of 31.5 months, rates of UTUC- and other cause-mortalities were 32.9% (n = 79) and 8.7% (n = 21), respectively. Of note, there were no significant differences in overall survival between the observation and ACH groups according to the competing risks of death (UTUC and other causes of death). Multivariate analysis showed that only older age at surgery (≥ 65 years; hazard ratio [HR] = 1.73), multifocality (HR = 1.74), and tumor size (HR = 1.92) remained as poor predictors of UTUC-specific survival. Additionally, positive surgical margin was only identified as independent predictor of other causes of death (HR = 4.23). : In summary, postoperative chemotherapy failed to improve UTUC- and other cause-specific survival rates, based on competing risk analysis after propensity score-matching.
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http://dx.doi.org/10.7150/jca.34103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909941PMC
November 2019

Relationship between occupational sunlight exposure and the incidence of renal cancer.

Ann Occup Environ Med 2019 7;31:e32. Epub 2019 Nov 7.

Department of Occupational and Environmental Medicine, Inha University Hospital, Incheon, Korea.

Background: The risk factors for renal cancer include smoking, obesity, hypertension, and exposure to trichloroethylene. Recent studies have shown that low sunlight exposure increases the risk of developing a range of cancers, including renal cancer. Given that most of the daytime is spent at work, a lack of occupational sunlight exposure can be a risk factor for renal cancer. Therefore, this study examined the relationship between occupational sunlight exposure and the incidence of renal cancer.

Methods: This was a university hospital-based case-control study on renal cancer. Of the 706 newly diagnosed patients with renal cell carcinoma (RCC), 633 cases were selected; 73 who had no occupational history were excluded. In addition, 633 controls were selected from the general population after 1:1 matching with respect to sex, age (within 5 years), and residential area (constituency-level). Information on sunlight exposure by the occupational group was referred to data from France. To estimate the association between occupational sunlight exposure and the RCC risk, the odds ratios (ORs) were calculated using conditional logistic regression analysis.

Results: Sunlight exposure was divided into quartiles and the risk of RCC was analyzed. The adjusted OR of RCC (OR: 0.664, 95% confidence interval: 0.449-0.983) was significantly lower for the Q4 group than Q1 group but the Q2 and Q3 groups did not show significant results. The risk of RCC tended to decrease with increasing exposure to sunlight ( for trend < 0.028).

Conclusions: Higher occupational sunlight exposure reduces the risk of RCC.
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http://dx.doi.org/10.35371/aoem.2019.31.e32DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850789PMC
November 2019

The clinical utility of transperineal template-guided saturation prostate biopsy for risk stratification after transrectal ultrasound-guided biopsy.

Investig Clin Urol 2019 11 11;60(6):454-462. Epub 2019 Sep 11.

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: To investigate the clinical utility of transperineal template-guided saturation prostate biopsy (TPB) for risk stratification after transrectal ultrasound (TRUS)-guided biopsy.

Materials And Methods: We retrospectively reviewed 155 patients who underwent TPB after previously negative results on TRUS-guided biopsy (n=58) or who were candidates for active surveillance (n=97) fulfilling the PRIAS criteria between May 2017 and November 2018. The patients' clinicopathologic data were reviewed, and the detection of clinically significant cancer (CSC) and upgrading of Gleason grade were identified.

Results: The patients' median age and pre-TPB prostate-specific antigen (PSA) value were 65.0 years and 5.74 ng/mL, respectively. A median of 36 biopsy cores was obtained in each patient, with a median TPB core density of 0.88 cores/cm. Of the 58 males with a previous negative result on TRUS-guided biopsy, prostate cancer (PCa) was detected in 17 males (29.3%), including 8 with CSC. Of the 97 patient candidates for active surveillance, upgrading of the Gleason grade was identified in 31 males (32.0%), 20 with a Gleason grade of 7 (3+4), 6 with a Gleason grade of 7 (4+3), and 5 with a Gleason grade of 8 (4+4). The overall complication rate was 14.8% (23/155), and there were no Clavien-Dindo grade 3 to 5 complications.

Conclusions: TPB helps to stratify the risk of PCa that was previously missed or underdiagnosed by TRUS-guided biopsy. TPB might be used as a diagnostic tool to determine risk classification and to help counsel patients with regard to treatment decisions.
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http://dx.doi.org/10.4111/icu.2019.60.6.454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6821983PMC
November 2019

Comparison by Pentafecta Criteria of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Large Renal Tumors.

J Endourol 2020 02 20;34(2):175-183. Epub 2019 Nov 20.

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

To compare and analyze surgical and functional outcomes of transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN) in localized renal tumors, including ≥4 cm renal masses. Of 566 consecutive patients who underwent robotic partial nephrectomy by a single surgeon from December 2008 through July 2017, records for 523 patients who were preoperatively and 1 year postoperatively evaluated were analyzed for estimated glomerular filtration rate (eGFR). Primary endpoint was a comparison of Pentafecta criteria (negative surgical margin, no 30-day complications, warm ischemic time [WIT] ≤25 minutes, return of eGFR to >90% from baseline, and no upstaging of chronic kidney disease) between TRPN and RRPN. Secondary endpoint was finding predictors for Pentafecta achievement. In all 523 patients, these Pentafecta criteria were lower for RRPN than TRPN: operation time ( < 0.001), WIT ( = 0.008), and estimated blood loss ( = 0.003). In patients with ≥4 cm renal tumors, only operation time was faster in RRPN than TRPN ( = 0.032). RRPN demonstrated more eGFR decrease in all patients ( = 0.006) and patients with ≥4 cm renal tumors ( = 0.008). Pentafecta achievements, complications, and recurrences were not significantly different between TRPN and RRPN in all patients and patients with ≥4 cm renal tumors. Multivariable analysis revealed baseline hemoglobin ( = 0.013) and tumor size ( < 0.001) were predictive for Pentafecta achievement. Pentafecta achievement was similar for TRPN and RRPN. Baseline hemoglobin and tumor size were predictors of Pentafecta achievement. RRPN was properly performed for anterolateral renal tumor.
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http://dx.doi.org/10.1089/end.2019.0410DOI Listing
February 2020

Novel Predictive Models of Early Death Less Than 1 Year in Patients With Metastatic Renal Cell Carcinoma After Treatment With First-line Tyrosine Kinase Inhibitors.

Clin Genitourin Cancer 2019 12 6;17(6):e1137-e1146. Epub 2019 Aug 6.

Department of Urology, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, South Korea. Electronic address:

Background: We aimed to develop a modified International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model that can predict early death less than 1 year in patients with metastatic renal cell carcinoma (mRCC) after receiving first-line tyrosine kinase inhibitors (TKIs).

Patients And Methods: We retrospectively reviewed records of patients with mRCC treated with first-line TKIs at our institution between 2007 and 2012. The primary endpoint was the rate of early death within 1 year after first-line TKI administration. We determined statistically significant factors predicting early death by performing multiple logistic regression. The modified IMDC model 1 was developed using new variables in addition to the risk criteria of the IMDC model, and model 2 was developed using new variables irrespective of the risk classification of IMDC model.

Results: Early mortality within 1 year of first-line TKI treatment was 19.7% (n = 98) in 462 patients. Although the C-index of the IMDC model for early death was 0.655, the C-index of model 1, which includes 5 variables (previous nephrectomy, body mass index, multiple metastases, previous metastasectomy, and serum albumin level) in addition to the Heng criteria, was 0.823. The C-index of model 2, which includes 7 variables (hemoglobin, neutrophil level, and the 5 variables of model 1) was 0.822. Of note, there was no significant difference in net reclassification index between the 2 models.

Conclusion: This is the first study suggesting novel prediction models for early death less than 1 year in patients with mRCC treated with first-line TKI.
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http://dx.doi.org/10.1016/j.clgc.2019.07.014DOI Listing
December 2019

Genomic analysis of Korean patients with advanced prostate cancer by use of a comprehensive next-generation sequencing panel and low-coverage, whole-genome sequencing.

Investig Clin Urol 2019 07 20;60(4):227-234. Epub 2019 Jun 20.

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: To analyze the characteristics of somatic mutations and copy number alterations (CNAs) in Korean patients with advanced prostate cancer (PCa) by use of the Oncomine Comprehensive Panel (ThermoFisher Scientific) and low-coverage, whole-genome sequencing (LC-WGS).

Materials And Methods: We retrospectively analyzed PCa tissues obtained from 14 patients with advanced PCa (metastatic tumor, 12 [85.7%]; nonmetastatic castration-resistant PCa, 1 [7.1%]; pT3b, 1 [7.1%]) from 2009 to 2017. The Oncomine Comprehensive Panel included a total of 143 genes. Moreover, LC-WGS was performed to detect CNAs of the entire genome. Two plasma samples matched with tumor tissues were analyzed using LC-WGS to compare the chromosomal aberration patterns between circulating tumor DNA and tumor tissue.

Results: Genetic alterations were most frequently observed in the androgen receptor () (42.9%, n=6/14), (14.3%, n=2/14), and (14.3%, n=2/14) genes in the Oncomine panel. AR amplification was the most common CNA (35.7%, n=5/14). As a result of LC-WGS, CNAs were confirmed in about 92.9% (n=13/14) of the samples in regions Xq12, 8q24.21, and 11q13.3 (gains) and in regions 6q16.1, 8p23.1, 10q25.1, 16q24.2, 18q12.3, Xq25, and Xq26.3 (losses). All CNAs identified in the Oncomine panel matched the results of LC-WGS. Additionally, LC-WGS of two plasma samples that matched tumor tissues revealed that CNA patterns of plasma samples (circulating tumor DNA) were very similar to those detected in tumor samples.

Conclusions: Our data showed that the characteristics of mutations and CNAs in Korean patients with advanced PCa were similar to those observed in previous studies.
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http://dx.doi.org/10.4111/icu.2019.60.4.227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6607069PMC
July 2019

Cancer Location in Upgrading and Detection after Transperineal Template-Guided Mapping Biopsy for Patients in Active Surveillance and Negative Transrectal Ultrasonography-Guided Prostate Biopsy.

Urol Int 2019 3;103(3):262-269. Epub 2019 Jul 3.

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea,

Objectives: We investigated the efficacy of transperineal template-guided mapping biopsy (TTMB) for patients on active surveillance (AS) or those with previous negative transrectal ultrasound-guided biopsy (TRUS-Bx).

Methods: We retrospectively analyzed 99 patients on AS and 60 patients with previous negative TRUS-Bx, which is a total of 159 patients who underwent TTMB from May 2017 to January 2019. Cancer location was analyzed with focus on the anterior and apex lesions of the prostate after TTMB. Multiparametric magnetic resonance imaging was performed before TTMB. Cancer location after TTMB in 138 patients, excluding 21 patients who were not eligible for analysis (4 patients on AS and 17 patients with previous negative TRUS-Bx) was compared with Prostate Imaging-Reporting and Data System version 2 (PI-RADSTM v2) score. Factors that may affect detecting cancer after TTMB with previous negative TRUS-Bx was analyzed using a logistic regression model.

Results: In AS patients, 29 patients (29.3%) exhibited an upgrade in Gleason score (GS) after TTMB. Among them, 22 patients (75.9%) showed at the anterior or apex lesions. In patients with previous negative TRUS-Bx, 18 patients (30.0%) were diagnosed with prostate cancer. Among them, 13 patients (72.2%) exhibited cancer at the anterior or apex lesion. Among the 25 AS patients with PI-RADSTM score 1-2, 5 patients (20.0%) showed an upgrade in GS. Among the 26 patients with previous negative TRUS-Bx and PI-RADSTM score 1-2, 6 patients (23.1%) had cancer. In multivariate regression model, prostate volume (OR 0.951) was identified as the predictor for a positive biopsy result after TTMB with previous negative TRUS-Bx.

Conclusions: TTMB is efficient for patients on AS in the detection of upgraded cancer located in anterior or apex or those with previous negative TRUS-Bx in the detection of anterior or apex cancer. In PI-RADSTM score 1-2, a substantial proportion of patients after experienced upgrade in GS on AS patients or cancer detection on previous negative TRUS-Bx. Moreover, we identified prostate volume is the independent predictor for a positive biopsy result after TTMB with previous negative TRUS-Bx.
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http://dx.doi.org/10.1159/000501527DOI Listing
February 2020

Predictors of postoperative complications after robot-assisted radical cystectomy with extracorporeal urinary diversion.

Cancer Manag Res 2019 31;11:5055-5063. Epub 2019 May 31.

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Robot-assisted radical cystectomy (RARC) is known to have less postoperative morbidity and complications than open radical cystectomy. However, various complications not yet have been reported after RARC. In this study, we aimed to identify the predictors of complications following RARC. From August 2008 to November 2017, we retrospectively reviewed 126 patients who underwent RARC with extracorporeal urinary diversion. Overall perioperative complications were examined, and factors that may affect complications were analyzed using a logistic regression model. Complications were classified according to the Clavien-Dindo system. Overall postoperative complications occurred in 78 (61.9%) of 126 patients. Whereas the rate of minor complications was 58.0% (grade I=15.9% (n=20), grade II=42.1% (n=53)), the rate of major complications was very low (grade IIIa=1.6% (n=2), grade IIIb =2.4% (n=3)). No fatal complications more than grade IV were developed. Notably, transfusions (27.0%), urinary tract infection (15.9%), anastomosis site leakage (14.3%), and ileus (10.3%) were the most common complications after RARC. In the multivariate regression model, previous intravesical instillation (odds ration [OR]=3.374), preoperative hemoglobin (OR=0.751), and estimated blood loss (EBL) (OR=3.949) were identified as the predictors of postoperative complications. In sum, our data showed the rates of major complications were comparable after RARC with extracorporeal urinary diversion compared as reported in previous studies and lower major than minor complications following RARC. Moreover, we identified the independent predictors of postoperative complications, such as preoperative hemoglobin, intravesical instillation, and EBL.
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http://dx.doi.org/10.2147/CMAR.S199432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549423PMC
May 2019