title: Is bladder tumor location associated with prostate cancer detection after intravesical bacillus Calmette-Guérin instillation?
abstract: OBJECTIVE
  The aim of this study was to evaluate the effect of bladder tumor (BT) location on prostate cancer (PCa) detection in patients with elevated PSA levels after intravesical BCG instillation.
  
  
  METHODS
  Between February 2004 and January 2013 prostate biopsies were performed in 59 non-muscle invasive bladder cancer (NMIBC) patients whose PSA level were elevated (≥3 ng/ml) after a 6 week course of intravesical BCG (Oncotice, 12.5 mg in 50 ml normal saline). Differences in PCa detection according to the BT location [bladder neck and/or trigone (Group 1, n = 22) vs. other locations (Group 2, n = 37)] were evaluated. The Fisher's exact test and the Mann-Whitney U test were used to evaluate the association between categorical and continuous variables, respectively.
  
  
  RESULTS
  A total of 14 patients (23.7%) were diagnosed with PCa. The mean ± standard deviation (SD) PSA before intravesical BCG instillation and prostate biopsy were 1.36±1.04 ng/ml in Group 1 and 1.09±1.12 ng/ml in Group 2 (P = 0.633), and 6.05±3.57 ng/ml in Group 1 and 5.13±3.88 ng/ml in Group 2 (P = 0.378), respectively. Interestingly, whereas PCa was detected upon biopsy in only one patient in Group 1 (4.5%), 13 cases were detected in Group 2 (35.1%) (P = 0.009).
  
  
  CONCLUSIONS
  PCa detection after intravesical BCG was highly associated with BT location. Prostate biopsy should therefore be considered when PSA level is elevated after BCG instillation and his BT is located far from the bladder neck.
authors: Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Urology, Dankook University College of Medicine, Cheonan, Korea.
authors: Sungwoo
authors: S
authors: Hong
authors: Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Urology, Inje University Medical College, Pusan, Korea.
authors: Seong-Cheol
authors: SC
authors: Kim
authors: Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Taekmin
authors: T
authors: Kwon
authors: Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: In Gab
authors: IG
authors: Jeong
authors: Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Choung-Soo
authors: CS
authors: Kim
authors: Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Hanjong
authors: H
authors: Ahn
authors: Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Jun Hyuk
authors: JH
authors: Hong
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000627:therapeutic use*; D000283:Administration, Intravesical; D000368:Aged; D001500:BCG Vaccine / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000097:blood / Q000473:pathology / Q000628:therapy*
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine; D017430:Prostate-Specific Antigen