Prostate Cancer In Korea Research Articles

Epidemiological evidences on overdiagnosis of prostate and kidney cancers in Korean.

OBJECTIVES:The prostate specific antigen test is widely used as the main method of screening prostate cancer in Korea. Additionally, the use of ultrasound sonography may lead to overdiagnosis of kidney cancer as well as thyroid cancer. This study aimed to highlight epidemiological evidences regarding overdiagnosis of prostate and kidney cancers in Korean.METHODS:The annual trends of national incidence and mortality of prostate and kidney cancers provided by the Korean Statistical Information Service were evaluated.RESULTS:The rate of increase in the incidence of prostate and kidney cancer was 6 and 5 times higher than that of mortality between 2000 and 2011, respectively. Additionally, the age group showing the highest incidence in prostate cancer shifted from 85 years and older to 75-79 years.CONCLUSIONS:This evidence suggests that prostate and kidney cancers are overdiagnosed in Korea. Further research in this area, using national cancer registry databases, should be encouraged to prevent overdiagnosis.

Treatment outcome of docetaxel plus prednisolone for metastatic castration-resistant prostate cancer in Korea.

We retrospectively reviewed the treatment outcomes of docetaxel plus prednisolone chemotherapy in Korean men with metastatic castration-resistant prostate cancer (mCRPC). This Study included 106 consecutive Korean patients with mCRPC who were treated with a 3-weekly regimen of docetaxel plus prednisolone chemotherapy between 2005 and 2011. The oncologic results and treatment-related adverse events were analyzed. The mean patient age was 66 years. Of the 106 patients, 70 (66.0%) received docetaxel as the first-line chemotherapy. A 50% reduction in prostate-specific antigen and objective response in measurable lesion were observed in 45 (48.9%) and 14 (17.9%) patients respectively. Fifteen (14.4%) patients experienced grade 3 or higher neutropenic fever. One patient had a treatment-related death. median follow-up time was 26.5 months. The median progression-free survival and overall survival (OS) were 6.0 and 16.0 months respectively. Of several factors examined, multivariate analysis Identified good performance status and first-line setting predict longer OS. The median OS of the patients in the first- and second-line setting was 23.0 versus 11.0 months (Hazard ratio 2.485, 95% confidence interval 1.558-3.966, P < 0.001). The survival rates in the first-line at 12 and 24 months were 73.8% and 47.2% respectively. Korean castration-resistant prostate cancer patients that receive docetaxel chemotherapy have a relatively longer survival outcome compared with western countries in the first-line setting. In addition, good performance status and first-line setting predicts longer survival. A prospective study including genetic background associated with the prognosis of mCRPC patients might be required.

Effect of Rubus coreanus Miquel on prostate tumour growth

The rapidly increasing incidence of prostate cancer in Korea has increased awareness of preventive measures, such as dietary supplementation. Unripe Rubus coreanus Miquel (RCM) has been used to improve prostate health. Using nude mice transplanted with a prostate cancer cell line, we investigated whether RCM supplementation was beneficial for inhibiting the formation or growth of prostate tumour, and its mechanisms. RCM effectively restricted tumour growth compared to the control but had no effect on tumour initiation. Ripe and unripe RCM exerted significant reduction in tumour growth compared to the control. The reduction in tumour mass shown in the RCM groups was associated with increased active form of caspase-3, indicating an enhanced caspase-3-mediated apoptotic process. In addition, RCM demonstrated a strong antioxidant capacity through a decrease in lipid peroxidation products. In addition, RCM modulated the activity of endogenous antioxidant enzymes through modest changes. Collectively, our data indicate that RCM is a promising alternative supplementation for limiting the growth of prostate cancer, and its effect is likely to be achieved through the initiation of caspase-3-mediated apoptosis. The antioxidant properties of RCM appear to play an essential role in its anti-proliferative effect on prostate tumours.

The Establishment of K-CaP (the Multicenter Korean Prostate Cancer Database)

PurposeThe purpose of this article was to announce the establishment of the multicenter Korean Prostate Cancer Database (K-CaP) and to provide urologists with details about K-CaP's methodology.Materials and MethodsThe initial participating K-CaP institutions include five medical centers in Korea. First, we registered prostate cancer patients who underwent radical prostatectomy as the basic background data. K-CaP is poised to combine these initial observational longitudinal studies with those of other eligible institutions as the database grows. All current prostate cancer patients in Korea are able to be registered into the Web-based database system and thereby have a role in several observational studies. The structure of the database for K-CaP was developed by matching it with the respective data from different studies. The operability of the K-CaP database system was verified by using the existing databases from three participating institutions.ResultsThe analysis of clinicopathologic characteristics of patients with the use of the Web-based database was successfully conducted. We confirmed the accurate operation of the Web-based database system without any difficulties.ConclusionsWe are announcing the establishment of K-CaP the first database of comprehensive observational longitudinal studies about prostate cancer in Korea. The database will be successfully maintained by sufficiently and continuously updating all patient data covering several treatments. Complete statistical results for registered prostate cancer patients are forthcoming for the basic background data to establish the database. Even though much trial and error are expected during the development process, we expect that K-CaP will eventually become one of the most powerful longitudinal observation databases.

Clinical Experience with Limited Lymph Node Dissection for Prostate Cancer in Korea: Single Center Comparison of 247 Open and 354 Robot-Assisted Laparoscopic Radical Prostatectomy Series

PurposeThere are limited data on the role of limited pelvic lymph node dissection (PLND) in patients with prostate cancer in Korea. The objective of this study was to demonstrate our clinical experience with limited PLND and the difference in its yield between open retropubic radical prostatectomy (RRP) and robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer patients in Korea.Materials and MethodsWe retrospectively analyzed 601 consecutive patients undergoing radical prostatectomy and bilateral limited PLND by either RRP (n=247) or RALP (n=354) in Asan Medical Center. All patients were divided into three groups according to the D'Amico's risk stratification method. Clinicopathologic data, including the yield of lymph nodes, were thoroughly reviewed and compared among the three risk groups or between the RRP and RALP subjects.ResultsThe mean patient age was 64.9 years and the mean preoperative prostate-specific antigen was 9.8 ng/ml. The median number of removed lymph nodes per patient was 5 (range, 0 to 20). The numbers of patients of each risk group were 167, 199, and 238, and the numbers of patients with tumor-positive lymph nodes were 1 (0.6%), 4 (2.0%), and 17 (7.1%) in the low-, intermediate-, and high-risk groups, respectively. In the high-risk group, the lymph node-positive ratio was higher in RRP (14.9%) than in RALP subjects (2.4%).ConclusionsWe speculate that limited PLND may help in prostate cancer staging in intermediate- and high-risk prostate cancer groups. RRP is a more effective surgical modality for PLND than is RALP, especially in high-risk prostate cancer groups.

Recent Changes in the Clinicopathologic Features of Korean Men with Prostate Cancer: A Comparison with Western Populations

PurposeThe aim of this study was to evaluate the recent changes in the clinicopathologic features of prostate cancer in Korea and to compare these features with those of Western populations.Materials and MethodsWe retrospectively reviewed the data of 1582 men undergoing radical prostatectomy for clinically localized prostate cancer between 1995 and 2007 at 10 institutions in Korea for comparison with Western studies. The patients were divided into two groups in order to evaluate the recent clinicopathological changes in prostate cancer: Group 1 had surgery between 1995 and 2003 (n=280) and Group 2 had surgery between 2004 and 2007 (n=1302). The mean follow-up period was 24 months.ResultsGroup 1 had a higher prostate-specific antigen level than Group 2 (10.0 ng/mL vs. 7.5 ng/mL, respectively; p<0.001) and a lower proportion of biopsy Gleason scores ≤6 (35.0% vs. 48.1%, respectively; p<0.001). The proportion of patients with clinical T1 stage was higher in Group 2 than in Group 1. Group 1 had a lower proportion of organ-confined disease (59.6% vs. 68.6%; p<0.001) and a lower proportion of Gleason scores ≤6 (21.3% vs. 33.0%; p<0.001), compared to Group 2. However, the relatively higher proportion of pathologic Gleason scores ≤6 in Group 2 was still lower than those of Western men, even though the proportion of organ-confined disease reached to that of Western series.ConclusionKorean men with prostate cancer currently present better clinicopathologic parameters. However, in comparison, Korean men still show relatively worse pathologic Gleason scores than Western men.

Prostate Cancer: Recent Trends in Korea

Introduction: We investigated the yearly changes in the baseline prostate-specific antigen (PSA) levels and the incidence of prostate cancer in men screened at our health promotion center from 1995 to 2008 to determine the trends in prostate cancer in Korea. Subjects and Methods: The participants were 6,007 men, who had PSA screening for the first time at the health promotion center. Changes in the baseline PSA levels, age, body mass index (BMI), and cholesterol levels were investigated. We evaluated the percentage of participants with a PSA level ≧2.0 and 4.0 ng/ml; the men were stratified by a 5-year age range, over two calendar years. In addition, we reviewed the results of their prostate biopsies. Results: The median baseline PSA level and the percentage of participants with a PSA level ≧2.0 and 4.0 ng/ml was not increased. The univariate and multivariate analyses, controlled for age and BMI, showed that two calendar years was not an independent predictive factor of the PSA level. The biopsy compliance rate increased from 36% during 1997–1998 to 70% during 2005–2006. Conclusions: The data from this study suggest that the increase in the incidence of prostate cancer might have been inaccurate in Korea.

Familial Prostate Cancer in Three Brothers

Familial Prostate Cancer in Three Brothers Sung Han Kim, Kang Su Cho, Kyung Seok Han, Jae Young Joung, Ho Kyung Seo, Jinsoo Chung, Hee Ok Pak, Weon Seo Park, Kang Hyun Lee From the Urologic Oncology Clinic, National Cancer Center, Goyang, Department of Urology, Seoul National University College of Medicine, Seoul, Gachon University of Medicine and Science, Department of Pathology, National Cancer Center, Goyang, Korea We treated a family of 3 brothers with prostate cancer, which is the first report of familial prostate cancer in Korea. Prostate cancer was diagnosed in the first brother with a prostate-specific antigen (PSA) level of 12.70 ng/ml of at the age of 68 years. He underwent a radical retropubic prostatectomy (RRP); the cancer was pathologically staged to T2cN1Mo. He received adjuvant hormonal therapy postoperatively. Three years later, prostate cancer was diagnosed in the third brother at the age of 61 years with a high PSA level of 4.45 ng/ml. He underwent RRP, which revealed the pathological stage to be T2cN0M0. Three months later, the second brother, who had visited our hospital for lower urinary tract symptoms and for a PSA screening test was diagnosed with prostate cancer at the age of 60 years (PSA level of 3.96 ng/ml). He also underwent RRP, and his cancer was staged pathologically as T2cN0M0. (Korean J Urol 2009; 50:195-198) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Mass Screening for Prostate Cancer in Korea: A Population Based Study

We investigated the detection rate of prostate cancer in Korean men through a population based mass screening test. In June 2007 serum prostate specific antigen was examined in 3,943 residents in the Gangneung (1,429), Daegu (1,396) and Jeonju (1,118) areas who were 55 years or older with prostate specific antigen 3.0 ng/ml or greater considered the criterion for 12-site transrectal biopsy recommendation. The serum prostate specific antigen distribution and the cancer detection rate were analyzed according to participant regions and age groups. Mean +/- SD serum prostate specific antigen in the entire cohort was 2.4 +/- 8.6 ng/ml. It significantly increased with increasing age, that is 1.2, 2.2, 3.4 and 4.7 ng/ml in the groups 55 to 64, 65 to 74, 75 to 84 and 85 years or older, respectively (p <0.0001). However, no regional differences were noted among Gangneung, Daegu and Jeonju (2.2, 2.7 and 2.3 ng/ml, respectively, p = 0.290). Biopsy candidates represented 7.3% (48 men), 17.7% (395), 25.5% (240) and 32.7% (36) of the 55 to 64, 65 to 74, 75 to 84 and 85 years or older groups, respectively, or 18.2% of the entire cohort of 719. Of biopsy candidates 268 (37.3%) had undergone biopsy, of whom cancer was detected in 76 (28.4%) for a cancer detection rate and estimated cancer detection rate of 1.93% and 5.17%, respectively. The age adjusted estimated cancer detection rate (55 years or older) was 3.36%. Cancer detection increased significantly with increasing prostate specific antigen, that is 12.3% at 3.0 to 4.0 ng/ml, 27.3% at 4.1 to 10.0 and 64.1% at greater than 10.0. The Gleason score was 2-6 in 41 men (53.9%), 7 in 14 (18.4%) and 8-10 in 21 (27.6%). The estimated cancer detection rate in Korean men 55 years or older was 3.36%. The significance of the high rate in this population should be determined through repeat screening and further surveillance in the future.

Prostate Biopsy Patterns in the CaPSURE Database: Evolution With Time and Impact on Outcome After Prostatectomy

Significant variability exists in the urological community regarding the number of cores that should be taken during prostate biopsy. Using CaPSURE we determined trends in prostate biopsy patterns during the last decade and assessed whether changes in biopsy number have had an impact on outcomes after radical prostatectomy. In CaPSURE between 1995 and 2004 we identified 6,450 men with newly diagnosed prostate cancer who underwent biopsy with 6 cores or greater. The number of cores removed, number of cores positive for cancer and percent of cores containing cancer were analyzed by year of diagnosis. For 1,757 men who underwent radical prostatectomy these variables were entered into Cox proportional hazards models controlling for preoperative prostate specific antigen, biopsy Gleason sum and clinical stage to predict recurrence-free survival. The mean number of removed cores increased from 6.9 in 1995 to 10.2 in 2004 (p <0.0001). The mean number of positive cores remained unchanged from 2.9 in 1995 to 3.2 in 2004 (p = 0.40). The percent of positive cores decreased from 42.6% in 1995 to 32.1% in 2004 (p <0.0001). The number and percent of positive cores were associated with recurrence-free survival after radical prostatectomy throughout the study period (each p <0.001). The percent of positive cores is an independent predictor of disease recurrence after radical prostatectomy. The total number of tissue cores sampled increased during the last decade, thereby driving down the mean percent of positive cores from 42.6% to 32.1%. The trend toward an increasing number of removed cores may have contributed indirectly to improved outcomes after radical prostatectomy in the last decade.

Continuing Trends of the Clinical Parameter Migration in Patients with Prostate Cancer in Korea

Purpose: With the widespread use of screening for prostate-specific antigen (PSA), T1c prostate cancer has shown a marked increase in Western countries. We reviewed the trends in clinical stage migration and the changes in the clinical characteristics for patients with prostate cancer in Korea, and we compared these values with those of Western men. Materials and Methods: Between 1997 and 2006, 758 men (mean age: 68.6 years) were diagnosed with prostate cancer at our institution. According to the diagnostic period, the patients were divided into 3 groups (the 1997-2000, 2001-2003 and 2004-2006 groups) for comparative analysis of the clinical stage, the serum PSA level and the biopsy Gleason score. Results: The proportion of clinically localized prostate cancer significantly increased by the period (56.8%, 62.5% and 75.4%, respectively; p＜0.001) with that of metastatic disease showing a decreasing according to groups (40.0%, 27.5% and 17.6%, respectively; p＜0.001). For localized disease, T1c cancers also increased from 26.4% to 19.2% to 31.6% (p=0.002), respectively. The median serum PSA level at diagnosis decreased from 34.5 ng/ml to 16.6ng/ml to 10.8ng/ml (p＜0.001), respectively, with the proportion of patients with a PSA level≤10ng/ml increasing significantly (19.2%, 33.3% and 47.7%, respectively; p＜0.001). Although the proportion of biopsy Gleason scores that were 8-10 decreased from 71.2% to 50.2% to 38.3%, respectively, it still comprised 20.8% of the T1c cancers and 22.8% of the cancers with a PSA≤10ng/ml in the last period, and these values were significantly higher than those in the Western reports. Conclusions: Downward migration of the clinical stage along with decreases for the serum PSA level and biopsy Gleason score were evident in Korean men. However, the proportion of T1c cancer was still lower than that in the Western series and the fraction of Gleason score 8-10 cancer was distinctively high. We believe this mandates establishing PSA screening programs and administering vigorous management. (Korean J

A Continuous Increase in Prevalence of Prostate Cancer in Korea and Its Causes

한국인의 유병률 증가추세와 원인 394 전립선암은 서양인에서 가장 흔히 진단되는 남성의 암이며, 암으로 사망하는 남성의 두번째 흔한 암 이므로 공중보건의 중요한 문제가 되어 왔으나 우리나라 를 비롯한 동양인에서는 발생률이 낮아 일반인은 물론 의 사들에게도 큰 관심의 대상이 되지 못하였다. 구미에 비 해 우리나라에서 전립선암에 대한 최신치료법의 도입이 비교적 늦었던 것도 전립선암 환자의 발생빈도가 적은 것 이 중요한 요인이다. 그러나 최근 우리나라에서도 전립선 암으로 진단받는 남성의 수가 다른 암에 비해 급격히 증 가하여 보건복지부 중앙암등록 사업통계에 의하면 2002 년 암 발생등록 6위를 차지하였으며, 1995년 이후 표준 화 발생비에서 가장 높은 증가를 보였고, 통계청 보고에 의하면 2002년 전립선암 사망률이 10만명당 3.1명으로 암 사망례의 7위로 부상함으로써 노인인구의 증가와 함 께 의사는 물론 일반인에서도 전립선암에 대한 관심이 크 게 증가하고 있다. 전립선암 발생의 중요 위험인자로 연령, 종족, 가족력, 유전인자, 음식물, 호르몬, 감염 등이 지적되고 있다. 이 들 전립선암의 가능한 위험인자들에 대한 역학적 조사는 전립선암의 방지와 전립선암 발생의 위험이 높은 대상을 조기에 진단할 수 있게 할 것이다. 본 특집은 최근 우리나 라를 비롯하여 전 세계적으로 전립선암 발생빈도의 증가 추세와 위험인자에 대해 기술하였다. A Continuous Increase in Prevalence of Prostate Cancer in Korea and Its Causes