Initial experience of magnetic resonance imaging/ultrasonography fusion transperineal biopsy: Biopsy techniques and results for 75 patients

태종현,심지성,진현정,윤성구,노태일,김재윤,강석호,천준,강성구 대한비뇨의학회 2018 Investigative and Clinical Urology Vol.59 No.6

Purpose: The aim of this study is to describe the technique and to report early results of transperineal magnetic resonance imaging and ultrasonography (MRI-US) fusion biopsy. Materials and Methods: A total of 75 patients underwent MRI-US fusion transperineal biopsy. Targeted biopsy via MRI-US fusion imaging was carried out for cancer-suspicious lesions with additional systematic biopsy. Detection rates for overall and clinically significant prostate cancer (csPCa) were evaluated and compared between systematic and targeted biopsy. In addition, further investigation into the detection rate according to prostate imaging reporting and data system (PI-RADS) score was done. Results of repeat biopsies were also evaluated. Results: Overall cancer detection rate was 61.3% (46 patients) and the detection rate for csPCa was 42.7% (32 patients). Overall detection rates for systematic and targeted biopsy were 41.3% and 57.3% (p<0.05), respectively. Detection rates for csPCa were 26.7% and 41.3%, respectively (p<0.05). The cancer detection rates via MRI fusion target biopsy were 30.8% in PI-RADS 3, 62.1% in PI-RADS 4 and 89.4% in PI-RADS 5. Rates of csPCa missed by targeted biopsy and systematic biopsy were 0.0% and 25.0%, respectively. The cancer detection rate in repeat biopsies was 61.1% (11 among 18 patients) in which 55.5% of cancer suspected lesions were located in the anterior portion. Conclusions: Transperineal MRI-US fusion biopsy is useful for improving overall cancer detection rate and especially detection of csPCa. Transperineal MRI-US targeted biopsy show potential benefits to improve cancer detection rate in patients with high PI-RADS score, tumor located at the anterior portion and in repeat biopsies.

Oncological and functional outcomes of robot-assisted radical cystectomy in bladder cancer patients in a single tertiary center: Can these be preserved throughout the learning curve?

태종현,편종현,심지성,조석,강성구,고영휘,천준,이정구,강석호 대한비뇨의학회 2019 Investigative and Clinical Urology Vol.60 No.6

Purpose: To evaluate the overall and segmental oncological and functional outcome of robot-assisted radical cystectomy (RARC) during the learning curve. Materials and Methods: From August 2007 to November 2017, a total of 120 bladder cancer patients were treated with RARC in a single-tertiary hospital. These were divided into three groups of 40 consecutive cases. Overall and subgroup analysis of each group was used to evaluate oncological and functional outcomes throughout the learning curve. Results: Among the 120 RARC cases, 42, 73, and 5 patients received extracorporeal urinary diversion (ECUD), intracorporeal urinary diversion (ICUD), and ureterocutaneostomy, respectively. There was a transition from ECUD to ICUD during the learning curve. The positive surgical margin rate was 0.8%. The mean lymph node yield for the standard and extended pelvic lymph node dissection was 12.5 and 30.1, respectively, and increased to 19.8 and 31.2 and further to 20.0 and 37.9, respectively, with each additional series of 40 cases. The 5-year overall survival and 3-year recurrence-free survival rates were 86.6% and 81.4%, respectively. The 1-year daytime continence rate was 75.7%, while the nighttime continence rate was 51.4%. The potency preservation rate was 66.7% (n=8) with or without phosphodiesterase-5 inhibitors (PDE5-I) at 1 year and 33.3% without PDE5-I (n=4). Conclusions: RARC results in comparable oncological and functional outcomes to open radical cystectomy. In addition, the oncological and functional outcomes were well maintained throughout the learning curve. ECUD transition to ICUD was safe and did not compromise oncological or functional outcome.

Animal models of bone metastatic prostate cancer

태종현,장인호 대한비뇨의학회 2023 Investigative and Clinical Urology Vol.64 No.3

Metastatic disease is a main cause of mortality in prostate cancer and remains to be incurable despite emerging new treatment agents. Development of novel treatment agents are confined within the boundaries of our knowledge of bone metastatic prostate cancer. Exploration into the underlying mechanism of metastatic tumorigenesis and treatment resistance will further expose novel targets for novel treatment agents. Up to date, many of these researches have been conducted with animal models which have served as classical tools that play a pivotal role in understanding the fundamental nature of cancer. The ability to reproduce the natural course of prostate cancer would be of profound value. However, currently available models do not reproduce the entire process of tumorigenesis to bone metastasis and are limited to reproducing small portions of the entire process. Therefore, knowledge of available models and understanding the strengths and weaknesses for each model is key to achieve research objectives. In this article, we take an overview of cell line injection animal models and patient derived xenograft models that have been applied to the research of human prostate cancer bone metastasis.

Diagnostic Accuracy and Value of Magnetic Resonance Imaging–Ultrasound Fusion Transperineal Targeted and Template Systematic Prostate Biopsy Based on Bi-parametric Magnetic Resonance Imaging

노태일,태종현,김형근,심지성,강성구,성득제,천준,이정구,강석호 대한암학회 2020 Cancer Research and Treatment Vol.52 No.3

Purpose The purpose of this study was to investigate the diagnostic value of magnetic resonance imaging (MRI)–ultrasound (US) fusion transperineal targeted biopsy (FTB) and fusion template systematic biopsy (FSB) for prostate cancer (PCa) and clinically significant prostate cancer (csPCa) (intermediate/high grade [Gleason score ! 3+4]) based on bi-parametric MRI (bpMRI). Materials and Methods Retrospectively, we analyzed 300 patients with elevated prostate-specific antigen (! 4.0 ng/mL) and/or abnormal findings in a digital rectal examination at the Korea University Hospital. All 300 men underwent bpMRI-US fusion transperineal FTB and FSB in the period from April 2017 to March 2019. Results PCas were detected in 158 of 300 men (52.7%), and the prevalence of csPCa was 34.0%. CsPCas were detected in 12 of 102 (11.8%) with Prostate Imaging-Reporting and Data System (PI-RADS) 3, 42 of 92 (45.7%) with PI-RADS 4, respectively; and 45 of 62 (72.6%) men with PI-RADS 5, respectively. BpMRI showed a sensitivity of 95.1% and negative predictive value of 89.6% for csPCa. FTB detected additional csPCa in 33 men (12.9%) compared to FSB. Compared to FTB, FSB detected additional csPCa in 10 men (3.9%). Conclusion BpMRI-US FTB and FSB improved detection of PCa and csPCa. The accuracy of bi-parametric MRI is comparable with that of multi-parametric MRI. Further, it is rapid, simpler, cheaper, and no side effects of contrast media. Therefore, it is expected that bpMRI-US transperineal FTB and FSB could be a good alternative to conventional US-guided transrectal biopsy, which is the current gold standard.

Detection and recurrence rate of transurethral resection of bladder tumors by narrow-band imaging: Prospective, randomized comparison with white light cystoscopy

김승빈,윤성구,태종현,김재윤,심지성,강성구,천준,이정구,김제종,강석호 대한비뇨의학회 2018 Investigative and Clinical Urology Vol.59 No.3

Purpose: The purpose of this study was to evaluate the efficacy of narrow-band imaging (NBI) as a diagnostic tool for detecting bladder tumors during cystoscopy compared with white light cystoscopy (WLC). Materials and Methods: From December 2013 to June 2017, a randomized prospective study was conducted on 198 patients underwent transurethral resection of bladder tumor by a single surgeon. The patients were divided into two groups according to diagnostic method. In Group I, WLC only was performed. In Group II, NBI was additionally performed after WLC. We analyzed the rate of detection of bladder tumors as a primary endpoint. In addition, we evaluated rates of recurrence in each group. Results: There were no significant differences between the two groups in characteristics except hypertension. In the analysis of rates of detection, the probability of diagnosing cancer was 80.9% (114/141) in the WLC group, and the probability of diagnosing cancer using WLC in the NBI group was 85.5% (159/186). After switching from WLC to NBI for second-look cystoscopy in the NBI group, NBI was shown to detect additional tumors with a detection rate of 35.1% (13/37) from the perspective of the patients and 42.2% (27/64) from the perspective of the tumors. The 1-year recurrence-free rate was 72.2% in the WLC group and 85.2% in the NBI group (p=0.3). Conclusions: NBI had benefits for detecting tumors overlooked by WLC. Although the difference in the 1-year recurrence-free rate was not statistically significant, our results showed a trend for higher recurrence in the NBI group.

Initial Experience of Transperineal Biopsy After Multiparametric Magnetic Resonance Imaging in Korea; Comparison With Transrectal Biopsy

윤성구,진현중,태종현,노태일,김재윤,편종현,심지성,강성구,천준,이정구,김제종,성득제,이관희,강석호 대한비뇨기종양학회 2018 대한비뇨기종양학회지 Vol.16 No.3

Purpose: The aim of this study is to confirm the detection rate of transperineal biopsy after multiparametric magnetic resonance imaging (mpMRI) and compared it to that of transrectal biopsy. We also examined the role of mpMRI and the rate of complications for each method. Materials and Methods: In a retrospective study, we analyzed 147 patients who underwent mpMRI before prostate biopsy because of elevated serum prostate-specific antigen and/or abnormal digital rectal examination findings at Korea University Hospital, Seoul, Korea from March 2017 to April 2018. Regions on the mpMRI that were suggestive of prostate cancer were categorized according to the Prostate Imaging–Reporting and Data System (PI-RADS v2). For transperineal biopsy, a 20-core saturation biopsy was performed by MRI-TRUS cognitive or fusion techniques and a 12-core biopsy was performed in transrectal biopsy. Results: Sixty-three and 84 patients were enrolled in transperineal group and transrectal group, respectively. The overall detection rate of prostate cancer in transperineal group was 27% higher than that in transrectal group. Classification according to PI-RADS score revealed a significant increase in detection rate in all patients, as the PI-RADS score increased. Frequency of complications using the Clavien-Dindo classifications revealed no significant differences in the total complications rate, but two patients in transrectal group received intensive care unit care due to urosepsis. Conclusions: Our results confirmed that transperineal biopsy is superior to transrectal biopsy for the detection of prostate cancer. From the complication point of view, this study confirmed that there were fewer severe complications in transperineal biopsy.

Toggling Technique Allows Retrograde Early Release to Facilitate Neurovascular Bundle Sparing During Robot-Assisted Radical Prostatectomy: A Propensity Score-Matching Study

Shim Ji Sung,태종현,Noh Tae Il,Kang Seok Ho,Cheon Jun,Lee Jeong Gu,Patel Vipul R.,Kang Sung Gu 대한의학회 2022 Journal of Korean medical science Vol.37 No.1

Background: This study aimed to present the surgical facilitation of neurovascular bundle (NVB) sparing using the toggling technique (30° lens down/up switching) and to evaluate erectile dysfunction (ED) recovery after robot-assisted radical prostatectomy (RARP). Methods: We assessed 144 patients (group with toggling, n = 72; group without toggling, n = 72) who underwent RARP with bilateral NVB sparing using propensity score matching. Inclusion criteria were ≥ 1 year follow-up and preoperative potency as per the Sexual Health Inventory for Men (SHIM) questionnaire (≥ 17 points). Recovery of ED after RARP was defined as return to baseline sexual function or self-assessment regarding successful intercourse. The subjective surgeon’s nerve sparing (SNS) score and tunneling success rates were used to evaluate surgical facilitation. The recovery rate of ED between the groups was analyzed using Kaplan-Meier analysis. Results: A better ED recovery trend was confirmed according to the SNS score (R2 = 0.142, P = 0.004). In the analysis of NVB sparing ease, the toggling group showed higher SNS scores (on right/left side: P = 0.011 and < 0.001, respectively) and overall tunneling success rates (87% vs. 74%, P = 0.001) than the group without toggling. Overall, ED recovery rates were 82% (59/72) and 75% (54/72) in the groups with and without toggling, respectively, at the 1-year follow-up (P = 0.047), and the toggling group showed a faster ED recovery rate at 3 months (47% vs. 35%, P = 0.013). In a specific analysis of the potent cohort (< 60 years, bilateral full NVB spared, SHIM score ≥ 22), the ED recovery rate reached 87% (14/16) in the toggling group. Conclusion: The retrograde early release with the toggling technique improves the facilitation of NVB sparing, leading to improved ED recovery.

The clinical significance of a second transurethral resection for T1 high-grade bladder cancer: Results of a prospective study

심지성,최훈,노태일,태종현,윤성구,강석호,배재현,박홍석,박재영 대한비뇨의학회 2015 Investigative and Clinical Urology Vol.56 No.6

Purpose: This study was designed to estimate the value of a second transurethral resection of bladder tumor (TURBT) procedure inpatients with initially diagnosed T1 high-grade bladder cancer. Materials and Methods: Between August 2009 and January 2013, a total of 29 patients with T1 high-grade bladder cancer prospectivelyunderwent a second TURBT procedure. Evaluation included the presence of previously undetected residual tumor,changes to histopathological staging or grading, and tumor location. Recurrence-free and progression-free survival curves weregenerated to compare the prognosis between the groups with and without residual lesions by use of the Kaplan-Meier method. Results: Of 29 patients, 22 patients (75.9%) had residual disease after the second TURBT. Staging was as follows: no tumor, 7 (24.1%);Ta, 5 (17.2%); T1, 6 (20.7%); Tis, 6 (20.7%); Ta+Tis, 1 (3.4%); T1+Tis, 1 (3.4%); and ≥T2, 3 (10.3%). The muscle layer was included inthe surgical specimen after the initial TURBT in 24 patients (82.7%). In three patients whose cancer was upstaged to pT2 after thesecond TURBT, the initial surgical specimen contained the muscle layer. In the group with residual lesions, the 3-year recurrencefreesurvival and 3-year progression-free survival rates were 50% and 66.9%, respectively, whereas these rates were 68.6% and68.6%, respectively, in the group without residual lesions. This difference was not statistically significant. Conclusions: Initial TURBT does not seem to be enough to control T1 high-grade bladder cancer. Therefore, a routine secondTURBT procedure should be recommended in patients with T1 high-grade bladder cancer to accomplish adequate tumor resectionand to identify patients who may need to undergo prompt cystectomy.

A Predictive Model Based on Bi-parametric Magnetic Resonance Imaging and Clinical Parameters for Clinically Significant Prostate Cancer in the Korean Population

노태일,현창완,강하은,진현정,태종현,심지성,강성구,성득제,천준,이정구,강석호 대한암학회 2021 Cancer Research and Treatment Vol.53 No.4

Purpose This study aimed to develop and validate a predictive model for the assessment of clinically significant prostate cancer (csPCa) in men, prior to prostate biopsies, based on bi-parametric magnetic resonance imaging (bpMRI) and clinical parameters. Materials and Methods We retrospectively analyzed 300 men with clinical suspicion of prostate cancer (prostate-specific antigen [PSA] ≥ 4.0 ng/mL and/or abnormal findings in a digital rectal examination), who underwent bpMRI-ultrasound fusion transperineal targeted and systematic biopsies in the same session, at a Korean university hospital. Predictive models, based on Prostate Imaging Reporting and Data Systems scores of bpMRI and clinical parameters, were developed to detect csPCa (intermediate/high grade [Gleason score ≥ 3+4]) and compared by analyzing the areas under the curves and decision curves. Results A predictive model defined by the combination of bpMRI and clinical parameters (age, PSA density) showed high discriminatory power (area under the curve, 0.861) and resulted in a significant net benefit on decision curve analysis. Applying a probability threshold of 7.5%, 21.6% of men could avoid unnecessary prostate biopsy, while only 1.0% of significant prostate cancers were missed. Conclusion This predictive model provided a reliable and measurable means of risk stratification of csPCa, with high discriminatory power and great net benefit. It could be a useful tool for clinical decision-making prior to prostate biopsies.

Modified apical dissection improves early continence in robot-assisted laparoscopic radical prostatectomy: Comparative study between modified apical dissection and anterior suspension stitch

강하은,김승빈,노태일,심지성,강석호,천준,태종현,Vipul R. Patel,강성구 대한비뇨의학회 2022 Investigative and Clinical Urology Vol.63 No.6

Purpose: Recently, the modified apical dissection (MAD) technique in robot-assisted laparoscopic radical prostatectomy (RARP) has shown excellent functional outcomes but has never been rigorously validated at various institutions. This study aimed to evaluate the effect of MAD on early continence and potency compared with the anterior suspension stitch (SS) technique. Materials and Methods: A total of 100 patients who underwent RARP with SS and 100 who underwent RARP with MAD by a single surgeon were propensity score matched and retrospectively compared for continence and potency recovery at 1 week and 1, 3, 6, 9, and 12 months. Results: Continence was reached in 20.6%, 33.3%, 67.2%, 74.1%, 81.1%, and 83.0% of patients in the SS group, compared with 49.2%, 73.3%, 86.8%, 96.6%, 100.0%, and 100.0% in the MAD group at postoperative 1 week and 1, 3, 6, 9, and 12 months, respectively. In the SS group, potency rates were 0.0%, 20.0%, 50.0%, 66.7%, 75.0%, and 83.3%; in the MAD group, the rates were 50.0%, 90.0%, 88.9%, 100.0%, 100.0%, and 100.0%. Recovery of continence was higher in the MAD group within the first 6 months (p=0.005, <0.010, 0.041, 0.016 at 1 week, 1, 3, and 6 months). There were no significant differences in potency recovery rates between the two groups (all p≥0.05). Conclusions: The MAD technique results in earlier recovery of continence compared with the SS technique.