Publications by authors named "Levent Turkeri"

94 Publications

Sextant Biopsy-Based Criteria for Clinically Insignificant Prostate Cancer Are Also Valid for the 12-Core Prostate Biopsy Scheme: A Multicenter Study of Urooncology Association, Turkey.

Urol Int 2021 May 5:1-9. Epub 2021 May 5.

Department of Urology, Altunizade Hospital, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey.

Background: Epstein criteria based on sextant biopsy are assumed to be valid for 12-core biopsies. However, very scarce information is present in the current literature to support this view.

Objectives: To investigate the validity of Epstein criteria for clinically insignificant prostate cancer (PCa) in a cohort of the currently utilized 12-core prostate biopsy (TRUS-Bx) scheme in patients with low-risk and intermediate-risk PCa.

Method: Pathological findings were separately evaluated in the areas matching the sextant biopsy (6-core paramedian) scheme and in all 12-core schemes. Patients were divided into 2 groups according to the final pathology report of RP as true clinically significant PCa (sPCa) and insignificant PCa (insPCa) groups. Predictive factors (including Epstein criteria) and cutoff values for the presence of insPCa were separately evaluated for 6- and 12-core TRUS-Bx schemes. Then, different predictive models based on Epstein criteria with or without additional biopsy findings were created.

Results: A total of 442 patients were evaluated. PSA density, biopsy GS, percentage of tumor and number of positive cores, PNI, and HG-PIN were independent predictive factors for insPCa in both TRUS-Bx schemes. For the 12-core scheme, the best cutoff values of tumor percentage and number of positive cores were found to be ≤50% (OR: 3.662) and 1.5 cores (OR: 2.194), respectively. The best predictive model was found to be that which added 3 additional factors (PNI and HG-PIN absence and number of positive cores) to Epstein criteria (OR: 6.041).

Conclusions: Using a cutoff value of "1" for the number of positive biopsy cores and absence of biopsy PNI and HG-PIN findings can be more useful for improving the prediction model of the Epstein criteria in the 12-core biopsy scheme.
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http://dx.doi.org/10.1159/000513658DOI Listing
May 2021

The effect of risk factors on surgical and oncological results in high-risk prostate cancer: A multicentre study of the urooncology society, Turkey.

Int J Clin Pract 2021 Apr 29:e14281. Epub 2021 Apr 29.

Department of Urology, Faculty of Medicine, Çukurova University, Adana, Turkey.

Purpose: To evaluate the effect of risk factors and selected surgical methods on operative and oncological results of patients undergoing radical prostatectomy (RP) with high-risk prostate cancer (HRPC).

Methods: Retrospective analysis of patients who underwent RP for HRPC from 13 urology centres between 1990 and 2019 was performed. Groups were created according to the risk factors of D'Amico classification. Patients with one risk factor were included in group 1 where group 2 consisted of patients with two or three risk factors.

Results: A total of 1519 patients were included in this study and 1073 (70.6%) patients were assigned to group 1 and 446 (29.4%) patients to group 2. Overall (biochemical and/or clinical and/or radiological) progression rate was 12.4% in group 1 and 26.5% in group 2 (P = .001). Surgical procedure was open RP in 844 (55.6%) patients and minimally invasive RP in 675 (44.4%) patients (laparoscopic and robot-assisted RP in 230 (15.1%) and 445 (29.3%) patients, respectively). Progression rates were similar in different types of operations (P = .22). Progression rate was not significantly different in patients who either underwent pelvic lymph node dissection (PLND) or not in each respective group.

Conclusion: RP alone is an effective treatment in the majority of patients with HRPC and PLND did not affect the progression rates after RP. According to the number of pre-operative high-risk features, as the number of risk factors increases, there is a need for additional treatment.
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http://dx.doi.org/10.1111/ijcp.14281DOI Listing
April 2021

Factors affecting long-term renal functions after partial vs radical nephrectomy for clinical T1 renal masses: A Multicentre Study of the Urooncology Association, Turkey.

Int J Clin Pract 2021 May 22;75(5):e13960. Epub 2021 Jan 22.

Department of Urology, Faculty of Medicine, Cukurova University, Adana, Turkey.

Purpose: To compare the functional outcomes of patients who underwent partial (PN) or radical nephrectomy (RN) for clinical T1 (cT1) renal tumours using the Kidney Cancer Database of the Urooncology Association, Turkey.

Methods: We retrospectively reviewed 1004 patients who underwent PN and RN for cT1 renal tumours at multiple academic tertiary centres between 2000 and 2018. Patients with preoperative end-stage chronic kidney disease and/or metastatic disease were excluded.

Results: There were 452 patients in the PN group and 552 patients in the RN group. The median follow-ups were 74.9 and 83.7 months in RN and PN cohort. The eGFR was significantly reduced in both groups on postoperative day 1 (PN = 13.7 vs RN = 19.1 mL/min/1.73 m : P < .001). In the PN group, eGFR showed a tendency to recover according to a quadratic pattern and reached preoperative levels in the first and third years (95.6 ± 28.8 mL/min/1.73 m and 96.9 ± 28.9 mL/min/1.73 m , respectively), with no significant difference between the eGFRs in the 1st and 3rd years (P = .710). To define groups at risk, different cut-off values for the GFR were considered. Among patients with a baseline GFR < 90, the RN cohort had significantly lower eGFRs in the first and third years than the PN cohort (P = .02). Logistic regression showed that comorbidities, coronary artery disease, diabetes and hypertension had no adverse impacts on the changes in the eGFR (P = .60, P = .13, and P = .13, respectively).

Conclusion: For the treatment of stage T1 kidney tumours, open or laparoscopic partial nephrectomy has the benefit to preserve renal function.
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http://dx.doi.org/10.1111/ijcp.13960DOI Listing
May 2021

Comparison of TRUS and combined MRI-targeted plus systematic prostate biopsy for the concordance between biopsy and radical prostatectomy pathology.

Int J Clin Pract 2021 Mar 20;75(3):e13797. Epub 2020 Nov 20.

Department of Urology, Acıbadem University, Istanbul, Turkey.

Aim: To evaluate the accuracy in histologic grading of MRI/US image fusion biopsy by comparing conventional 12-core TRUS-Bx at radical prostatectomy specimens (RP).

Methods: Consecutive patients diagnosed prostate cancer (127 with combination of both targeted biopsy (TBx) plus systematic biopsies (SBx) and separate patient cohort of 330 conventional TRUS-Bx without mpMRI) with a PSA level of <20 ng/mL prior to RP were included. The primary end point was the grade group concordance between biopsy and RP pathology according to biopsy technique.

Results: Clinically significant prostate cancer detection was 51.2% for TRUS-Bx, 49.5% for SBx, 67% for TBx and 75.7% for TBx + SBx. Upgrading and downgrading of at least one Gleason Grade Group (GGG) was recorded in 43.3%/ 6.7% patients of the TRUS-Bx and in 20.5%/ 22% of the TBX + SBx group, respectively (all P < .001). Concordance level was detected to be significantly higher for ISUP 1 in combined TBx + SBx method compared to conventional TRUS-Bx (61.3% vs 37.9%, P = .014). In ISUP 1 exclusively, significant upgrading was seen in TRUS-Bx (62.1%) when compared to TBx (41.4%) and TBx + SBx (38.7%).

Conclusions: MRI-targeted biopsies detected more significant PCa than TRUS-Bx but, superiority in significant cancer detection appears as a result of inadvertant selective sampling of small higher grade areas. Within an otherwise low grade cancer and does not reflect accurate GGG final surgical pathology. TBx + SBx has the greatest concordance in ISUP Grade 1 with less upgrading which is utmost important for active surveillance.
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http://dx.doi.org/10.1111/ijcp.13797DOI Listing
March 2021

Omission of Cortical Renorrhaphy During Robotic Partial Nephrectomy: A Vattikuti Collective Quality Initiative Database Analysis.

Urology 2020 Dec 15;146:125-132. Epub 2020 Sep 15.

Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI. Electronic address:

Objectives: To analyze the outcomes of patients in whom cortical (outer) renorrhaphy (CR) was omitted during robotic partial nephrectomy (RPN).

Methods: We analyzed 1453 patients undergoing RPN, from 2006 to 2018, within a large multi-institutional database. Patients having surgery for bilateral tumors (n = 73) were excluded. CR and no-CR groups were compared in terms of operative and ischemia time, estimated blood loss (EBL), complications, surgical margins, hospital stay, change in estimated glomerular filtration rate (eGFR), and need of angioembolization. Inverse probability of treatment weighting with Firth correction for center code was performed to account for selection bias.

Results: CR was omitted in 120 patients (8.7%); 1260 (91.3%) patients underwent both inner layer and CR. There was no difference in intraoperative complications (7.4% CR; 8.9% no-CR group; P = .6), postoperative major complications (1% and 2.8% in CR and no-CR groups, respectively; P = .2), or median drop in eGFR (7.3 vs 10.4 mL/min/m). The no-CR group had a higher incidence of minor complications (26.7% vs 5.5% in CR group; P < .001). EBL was 100 mL (IQR 50-200) in both groups (P = .6). Angioembolization was needed in 0.7% patients in CR vs 1.4% in no-CR group (P = .4). Additionally, there was no difference in median operative time (168 vs 162 min; P = .2) or ischemia time (18 vs 17 min; P = .7).

Conclusion: In selected patients with renal masses, single layer renorrhaphy does not significantly improve operative time, ischemia time, or eGFR after RPN. There is a higher incidence of minor complications, but not major perioperative complications after no-CR technique.
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http://dx.doi.org/10.1016/j.urology.2020.09.003DOI Listing
December 2020

Suboptimal Prediction of Clinically Significant Prostate Cancer in Radical Prostatectomy Specimens by mpMRI-Targeted Biopsy.

Urology 2021 Feb 29;148:217-223. Epub 2020 Aug 29.

Department of Urology, Acibadem M.A. Aydinlar University, Altunizade Hospital, Istanbul, Turkey.

Objective: To investigate the correlation of multiparametric magnetic resonance imaging targeted (TBx) and/or systematic prostate biopsy (SBx) in predicting the presence of clinically significant (cs) prostate cancer (PCa) in radical prostatectomy (RP) specimens. Concordance of mpMRI and RP specimen lesions was also investigated in terms of tumor localization and histopathological features.

Methods: A total of 70 male patients with PCa and treated with robot-assisted RP were included in this study between January 2016 and December 2019. All patients underwent mpMRI-TBx and concomitant SBx. Suspicious lesions on mpMRI were scored according to Prostate Imaging-Reporting and Data System version 2 (PI-RADS) criteria. TBx was performed for all suspicious lesions with a PI-RADS score ≥3.

Results: The median age was 67 (43-77) years. Presence of csPCa in prostatectomy specimens was missed by TBx and SBx specimens in 25.4% and 19.4% of the cases, respectively (P<.001, for each). Combination of both biopsy (CBx) results improved detection by missing only 4.5% of csPCa (P = .250). International Society of Urologic Pathology grade group concordance with RP specimens were 50%, 54.3% and 67.1% for SBx, TBx, and CBx, respectively. There was a statistically significant correlation in terms of tumor localization and histopathological features between prostatectomy specimens and the first 3 lesions, particularly for the index lesions.

Conclusions: CBx improved detection rate of csPCa. We propose TBx of 3 lesions with highest PI-RADS score(s) and a combination with SBx for the highest correlation with prostatectomy histopathology.
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http://dx.doi.org/10.1016/j.urology.2020.08.031DOI Listing
February 2021

Treatment of High-grade Non-muscle-invasive Bladder Carcinoma by Standard Number and Dose of BCG Instillations Versus Reduced Number and Standard Dose of BCG Instillations: Results of the European Association of Urology Research Foundation Randomised Phase III Clinical Trial "NIMBUS".

Eur Urol 2020 11 20;78(5):690-698. Epub 2020 May 20.

EAU Research Foundation, Arnhem, The Netherlands.

Background: Intravesical instillation of bacillus Calmette-Guérin (BCG) is an accepted strategy to prevent recurrence of non-muscle-invasive bladder cancer (NMIBC) but associated with significant toxicity.

Objective: NIMBUS assessed whether a reduced number of standard-dose BCG instillations are noninferior to the standard number and dose in patients with high-grade NMIBC.

Design, Setting, And Participants: A total of 345 patients from 51 sites were randomised between December 2013 and July 2019. We report results after a data review and safety analysis by the Independent Data Monitoring Committee based on the cut-off date of July 1, 2019.

Intervention: The standard BCG schedule was 6 wk of induction followed by 3 wk of maintenance at 3, 6, and 12 mo (15 instillations). The reduced frequency BCG schedule was induction at wks 1, 2, and 6 followed by 2 wk (wks 1 and 3) of maintenance at 3, 6, and 12 mo (nine instillations).

Outcome Measurements And Statistical Analysis: The primary endpoint was time to first recurrence. Secondary endpoints included progression to ≥ T2 and toxicity.

Results And Limitations: In total, 170 patients were randomised to reduced frequency and 175 to standard BCG. Prognostic factors at initial resection were as follows: Ta/T1: 46/54%; primary/recurrent: 92/8%; single/multiple: 57/43%; and concomitant carcinoma in situ: 27%. After 12 mo of median follow-up, the intention-to-treat analysis showed a safety-relevant difference in recurrences between treatment arms: 46/170 (reduced frequency) versus 21/175 patients (standard). Additional safety analyses showed a hazard ratio of 0.40 with the upper part of the one-sided 97.5% confidence interval of 0.68, meeting a predefined stopping criterion for inferiority.

Conclusions: The reduced frequency schedule was inferior to the standard schedule regarding the time to first recurrence. Further recruitment of patients was stopped immediately to avoid harm in the reduced frequency BCG arm.

Patient Summary: After surgical removal of the tumour, patients with high-grade non-muscle-invasive bladder cancer are treated with bacillus Calmette-Guérin to prevent recurrence and progression. This is associated with significant side effects. We report the results of a clinical trial showing a reduction in the number of instillations (from 15 to nine in total) being inferior to the standard protocol. From today's perspective, complete tumour resection and a standard number of instillations remain the standard of care.
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http://dx.doi.org/10.1016/j.eururo.2020.04.066DOI Listing
November 2020

Factors Affecting Surgical Margin Positivity after Radical Prostatectomy in the Turkish Population: A Multicenter Study of the Urooncology Association.

Urol Int 2020 30;104(9-10):724-730. Epub 2020 Apr 30.

Department of Urology, Acibadem Altunizade Hospital, Mehmet Ali Aydınlar University, Istanbul, Turkey.

Background: The prediction of positive surgical margins (SM) after radical prostatectomy (RP) is important for planning the surgical modality and adjuvant therapy in patients with prostate cancer (PCa).

Objectives: To investigate factors affecting SM positivity in patients diagnosed with PCa who underwent RP using the PCa database of the Urooncology Association (Turkey).

Methods: Patients who underwent RP due to clinically T1c-T3 PCa and who had detailed SM data for the RP specimen were included in the study. Pathological data of 12 core transrectal ultrasound prostate biopsies and RP were evaluated. Patients were divided into 2 groups (SM positive and SM negative) according to SM status after RP. Data were compared between the groups. Factors affecting SM positivity, the number of positive SM sites, and the location of positive SM were separately evaluated with regression models.

Results: A total of 2,643 patients from 6 different centers (median age: 63 years) with a prostate-specific antigen (PSA) level of 7.3 ng/mL were investigated in the study. BMI, PSA, biopsy Gleason score (GS), and perineural invasion (PNI) were found to be independent predictive factors for SM positivity and the number of positive SM locations, respectively (p < 0.05). According to the positive SM location, PSA was found to be associated with positive SM in apex, anterior prostate, and bladder neck locations. Also, according to posterolateral SM status, PNI and nerve-sparing RP (nsRP) rates were 21.3 and 44% for patients with negative posterolateral SM, and rates were 35.4 and 50.6% for patients with positive posterolateral SM, respectively (p < 0.05). In patients who underwent nsRP, positive SM was present in 22.2% of patients who did not have PNI on prostate biopsy, whereas positive SM was present in 40.6% of patients with PNI (p < 0.001). Similarly, 10.9% of patients without PNI had positive posterolateral SM, whereas 17.3% of patients with PNI had positive posterolateral SM (p = 0.031).

Conclusions: BMI, PSA, biopsy GS, and biopsy PNI positivity were found to be predictive factors affecting SM positivity. The most important factors affecting posterolateral positive SM were biopsy PNI and nsRP, indicating that the nsRP approach may cause positive SM in the posterolateral margin of the prostate (neurovascular bundle location) in patients with positive PNI on biopsy.
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http://dx.doi.org/10.1159/000507268DOI Listing
May 2021

Predicting intra-operative and postoperative consequential events using machine-learning techniques in patients undergoing robot-assisted partial nephrectomy: a Vattikuti Collective Quality Initiative database study.

BJU Int 2020 09 18;126(3):350-358. Epub 2020 May 18.

Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.

Objective: To predict intra-operative (IOEs) and postoperative events (POEs) consequential to the derailment of the ideal clinical course of patient recovery.

Materials And Methods: The Vattikuti Collective Quality Initiative is a multi-institutional dataset of patients who underwent robot-assisted partial nephectomy for kidney tumours. Machine-learning (ML) models were constructed to predict IOEs and POEs using logistic regression, random forest and neural networks. The models to predict IOEs used patient demographics and preoperative data. In addition to these, intra-operative data were used to predict POEs. Performance on the test dataset was assessed using area under the receiver-operating characteristic curve (AUC-ROC) and area under the precision-recall curve (PR-AUC).

Results: The rates of IOEs and POEs were 5.62% and 20.98%, respectively. Models for predicting IOEs were constructed using data from 1690 patients and 38 variables; the best model had an AUC-ROC of 0.858 (95% confidence interval [CI] 0.762, 0.936) and a PR-AUC of 0.590 (95% CI 0.400, 0.759). Models for predicting POEs were trained using data from 1406 patients and 59 variables; the best model had an AUC-ROC of 0.875 (95% CI 0.834, 0.913) and a PR-AUC 0.706 (95% CI, 0.610, 0.790).

Conclusions: The performance of the ML models in the present study was encouraging. Further validation in a multi-institutional clinical setting with larger datasets would be necessary to establish their clinical value. ML models can be used to predict significant events during and after surgery with good accuracy, paving the way for application in clinical practice to predict and intervene at an opportune time to avert complications and improve patient outcomes.
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http://dx.doi.org/10.1111/bju.15087DOI Listing
September 2020

Correlation of Prostate-Imaging Reporting and Data Scoring System scoring on multiparametric prostate magnetic resonance imaging with histopathological factors in radical prostatectomy material in Turkish prostate cancer patients: a multicenter study of the Urooncology Association.

Prostate Int 2020 Mar 8;8(1):10-15. Epub 2020 Feb 8.

Acıbadem Altunizade Hospital, Istanbul, Turkey.

Background: Histopathological features after radical prostatectomy (RP) provide important information for the prognosis of prostate cancer (PCa). The possible correlations between Prostate-Imaging Reporting and Data Scoring System (PIRADS) scores in multiparametric magnetic resonance imaging (mpMRI) may also be predictive for prognosis. In this study, we aimed to evaluate the correlation of PIRADS scores with histopathological data.

Methods: A total of 177 patients who underwent preoperative mpMRI and RP for PCa from eight institutions were included in the study. Correlation of PIRADS score in preoperative mpMRI with adverse histopathological factors in RP specimen was investigated using univariate and multivariate analyses.

Results: The relationship between PIRADS score and postoperative extracapsular extension, lymphovascular invasion, and seminal vesicle involvement was significant ( < 0.001,  = 0.032, and  = 0.007, respectively). Although the PIRADS score was significantly correlated with the number of dissected lymph nodes (p = 0.026), it had no significant correlation with the number of positive nodes ( = 0.611). Total Gleason score, extracapsular extension, seminal vesicle invasion, and number of lymph nodes were found to be independent factors, which correlated with high PIRADS scores in ordinal logistic regression analysis.

Conclusion: PIRADS scoring system in mpMRI showed a statistically significant correlation with adverse histopathological factors in RP specimen. A higher PIRADS score may help to predict a higher Gleason score, indicating clinically important PCa as well as poor prognotic factors such as extracapsular extension, lymphovascular invasion, and seminal vesicle invasion that may indicate a higher risk of recurrence and the need for additional treatment.
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http://dx.doi.org/10.1016/j.prnil.2020.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7125386PMC
March 2020

Management of Patients with Advanced Prostate Cancer: Report of the Advanced Prostate Cancer Consensus Conference 2019.

Eur Urol 2020 04 27;77(4):508-547. Epub 2020 Jan 27.

Division of Medical Oncology, National Cancer Centre, Singapore.

Background: Innovations in treatments, imaging, and molecular characterisation in advanced prostate cancer have improved outcomes, but there are still many aspects of management that lack high-level evidence to inform clinical practice. The Advanced Prostate Cancer Consensus Conference (APCCC) 2019 addressed some of these topics to supplement guidelines that are based on level 1 evidence.

Objective: To present the results from the APCCC 2019.

Design, Setting, And Participants: Similar to prior conferences, experts identified 10 important areas of controversy regarding the management of advanced prostate cancer: locally advanced disease, biochemical recurrence after local therapy, treating the primary tumour in the metastatic setting, metastatic hormone-sensitive/naïve prostate cancer, nonmetastatic castration-resistant prostate cancer, metastatic castration-resistant prostate cancer, bone health and bone metastases, molecular characterisation of tissue and blood, inter- and intrapatient heterogeneity, and adverse effects of hormonal therapy and their management. A panel of 72 international prostate cancer experts developed the programme and the consensus questions.

Outcome Measurements And Statistical Analysis: The panel voted publicly but anonymously on 123 predefined questions, which were developed by both voting and nonvoting panel members prior to the conference following a modified Delphi process.

Results And Limitations: Panellists voted based on their opinions rather than a standard literature review or formal meta-analysis. The answer options for the consensus questions had varying degrees of support by the panel, as reflected in this article and the detailed voting results reported in the Supplementary material.

Conclusions: These voting results from a panel of prostate cancer experts can help clinicians and patients navigate controversial areas of advanced prostate management for which high-level evidence is sparse. However, diagnostic and treatment decisions should always be individualised based on patient-specific factors, such as disease extent and location, prior lines of therapy, comorbidities, and treatment preferences, together with current and emerging clinical evidence and logistic and economic constraints. Clinical trial enrolment for men with advanced prostate cancer should be strongly encouraged. Importantly, APCCC 2019 once again identified important questions that merit assessment in specifically designed trials.

Patient Summary: The Advanced Prostate Cancer Consensus Conference provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference, which has been held three times since 2015, aims to share the knowledge of world experts in prostate cancer management with health care providers worldwide. At the end of the conference, an expert panel discusses and votes on predefined consensus questions that target the most clinically relevant areas of advanced prostate cancer treatment. The results of the voting provide a practical guide to help clinicians discuss therapeutic options with patients as part of shared and multidisciplinary decision making.
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http://dx.doi.org/10.1016/j.eururo.2020.01.012DOI Listing
April 2020

Report of the third Asian Prostate Cancer study meeting.

Prostate Int 2019 Jun 14;7(2):60-67. Epub 2018 Jun 14.

Department of Strategic Investigation on Comprehensive Cancer Network, Graduate School of Interdisciplinary Information Studies, University of Tokyo, Tokyo, Japan.

The Asian Prostate Cancer (A-CaP) study is an Asia-wide initiative that was launched in December 2015 in Tokyo, Japan, with the objective of surveying information about patients who have received a histopathological diagnosis of prostate cancer (PCa) and are undergoing treatment and clarifying distribution of staging, the actual status of treatment choices, and treatment outcomes. The study aims to clarify the clinical situation for PCa in Asia and use the outcomes for the purposes of international comparison. Following the first meeting in Tokyo in December 2015, the second A-CaP meeting was held in Seoul, Korea, in September 2016. This, the third A-CaP meeting, was held on October 14, 2017, in Chiang Mai, Thailand, with the participation of members and collaborators from 12 countries and regions. In the meeting, participating countries and regions presented the current status of data collection, and the A-CaP office presented a preliminary analysis of the registered cases received from each country and region. Participants discussed ongoing challenges relating to data input and collection, institutional, and legislative issues that may present barriers to data sharing, and the outlook for further patient registrations through to the end of the registration period in December 2018. In addition to A-CaP-specific discussions, a series of special lectures were also delivered on the situation for health insurance in the United States, the correlation between insurance coverage and PCa outcomes, and the outlook for robotic surgery in the Asia-Pacific region. Members also confirmed the principles of authorship in collaborative studies, with a view to publishing original articles based on A-CaP data in the future.
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http://dx.doi.org/10.1016/j.prnil.2018.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664304PMC
June 2019

Normotensive, Oversized Pheochromocytoma in Twin-Pregnancy: Analysis of Therapeutic Challenges in a Rare Case.

Case Rep Urol 2019 22;2019:7141060. Epub 2019 May 22.

Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Urology, Turkey.

An asymptomatic, normotensive 36-year-old woman in the second trimester of a twin-gestation was diagnosed with a 11 cm adrenal pheochromocytoma. Considering the hemodynamic stability of the patient, tumor size, and gestational age, the therapeutic decision of a multidisciplinary team ensued open surgical excision without any preoperative antihypertensive preparation. Following successful removal of pheochromocytoma, the patient had a normal subsequent course of pregnancy and cesarean section delivery of healthy twins at term. This unique case of a normotensive, incidental, large-sized pheochromocytoma in a twin-pregnancy illustrates that the decisions of management in such a rare occurrence should be based on individual features of the patient. Our experience supports that -adrenergic blockade may not be essential in normotensive pheochromocytoma in pregnancy and open-surgery remains as a safe approach in the management of large adrenal tumors in twin-pregnant patients following a multidisciplinary consultation.
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http://dx.doi.org/10.1155/2019/7141060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6556236PMC
May 2019

International and Multi-institutional Assessment of Factors Associated With Performance and Quality of Lymph Node Dissection During Radical Nephrectomy.

Urology 2019 Jul 19;129:132-138. Epub 2019 Apr 19.

University of Texas, Austin, TX. Electronic address:

Objective: To determine factors associated with performance and quality of lymph node dissection during radical nephrectomy.

Materials And Methods: Using an International Data Registry, we performed multilevel logistic regression to determine the association of surgical approach (open surgery vs minimally invasive surgery), institutional experience (low, moderate, and high tertiles), and institutional preference (minimally invasive surgery, balanced, and open surgery tertiles) with the performance of lymph node dissection in subgroups by clinical stage and nodal status.

Results: Among 1,742 patients undergoing radical nephrectomy, 312 (18%) underwent lymph node dissection, which was associated with stage (28% for ≥cT2 vs 9.3% for cT1), and nodal status (68% for ≥cN1 vs 13% for cN0). Open surgery was significantly associated with performing lymph node dissection in all subgroups. Institutional experience and institutional preference had no association with performing lymph node dissection in the ≥cN1 group. The number of nodes removed was greater for open surgery (mean 5.9) vs minimally invasive surgery (mean 3.4); this held true even when stratified by stage and nodal status.

Conclusion: In this large dataset, open surgical radical nephrectomy is associated with more frequent performance and higher quality of lymph node dissection, which may owe to selection bias but also could reflect technical concerns. In the patient population in whom lymph node dissection is recommended (≥cN1), this is not explained by institutional experience or preference. Lymph node dissection may be under-utilized for ≥cN1 disease and over-utilized for cN0 disease, at least according to practice guidelines.
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http://dx.doi.org/10.1016/j.urology.2019.01.068DOI Listing
July 2019

The Relationship Between Urothelial Type Bladder Cancer, Plasma 25-Hydroxyvitamin D Levels, and Vitamin D Receptor ApaI BsmI FokI, and TaqI Polymorphisms.

Clin Lab 2019 Apr;65(4)

Background: Bladder cancer is an important health problem which ranks 4th among most frequently seen cancer types in men. In our study we aimed to investigate the correlations among urothelial type bladder cancer polymorphisms, ApaI, BsmI, FokI, and TaqI, prevalently observed in the vitamin D receptor (VDR) gene and plasma vitamin D levels in a Turkish population.

Methods: Our study included 101 patients and 109 control subjects. Plasma 25(OH)D levels were determined using a HPLC method and VDR gene polymorphisms with PCR-RFLP method.

Results: A statistically significant intergroup difference was not observed with regard to age, gender, and BMIs of the patients. Median (min - max) 25(OH)D levels in the patient and the control groups were determined as 11.9 ng/dL (1.9 - 33.0 ng/dL) and 9.7 ng/dL (2.1 - 39.5 ng/dL), respectively. A statistically significant intergroup difference was not observed with regard to 25(OH)D levels (p = 0.402). A statistically significant intergroup differ-ence was not observed with regard to genotype distribution of ApaI, BsmI, and TaqI polymorphisms and allele frequencies. Control and urothelial type bladder cancer groups showed a statistically significant difference with respect to genotype distribution of FokI polymorphism (p = 0.048). However in a binary logistic regression model, when corrected OR values were estimated by including smoking history in the model, the correlation detected be-tween the presence of FF and increased risk of disease was not statistically significant (ORadj = 1.64, 95% CI = 0.89 - 3.02, p = 0.114).

Conclusions: In the light of the data concerning Turkish population a statistically significant correlation could not be demonstrated between plasma vitamin D levels, ApaI, BsmI, FokI, and TaqI polymorphisms, and urothelial type bladder cancers. Since literature data are limited in number, further studies should be conducted in larger patient groups.
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http://dx.doi.org/10.7754/Clin.Lab.2018.180339DOI Listing
April 2019

Indications, surgical technique, and long-term results of nerve sparing.

Authors:
Levent Türkeri

Minerva Chir 2019 Feb 23;74(1):54-62. Epub 2018 Jul 23.

Acıbadem University, Altunizade Hospital, Istanbul, Turkey -

Radical prostatectomy is frequently performed as a curative approach for clinically localized prostate cancer. In order to reduce the adverse effects of this operation on erectile function, preservation of neurovascular bundles was introduced as part of this operation. The decision of nerve sparing must be carefully tailored in each patient according to the stage of the disease. Patient selection has a critical importance in performing nerve sparing radical prostatectomy. In organ-confined cancers a nerve sparing surgery can be performed in the majority of the cases without jeopardizing tumor control. Individualized decision making in each case may allow more patients to receive a nerve sparing approach, and therefore, better functional outcomes. However, it continues to be difficult to predict postoperative functional outcomes accurately due to many influencing factors.
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http://dx.doi.org/10.23736/S0026-4733.18.07756-8DOI Listing
February 2019

Management of patients with advanced prostate cancer in the Asia Pacific region: 'real-world' consideration of results from the Advanced Prostate Cancer Consensus Conference (APCCC) 2017.

BJU Int 2019 01 19;123(1):22-34. Epub 2018 Aug 19.

Monash University, Melbourne, VIC, Australia.

Objective: The Asia Pacific Advanced Prostate Cancer Consensus Conference (APAC APCCC 2018) brought together 20 experts from 15 APAC countries to discuss the real-world application of consensus statements from the second APCCC held in St Gallen in 2017 (APCCC 2017).

Findings: Differences in genetics, environment, lifestyle, diet and culture are all likely to influence the management of advanced prostate cancer in the APAC region when compared with the rest of the world. When considering the strong APCCC 2017 recommendation for the use of upfront docetaxel in metastatic castration-naïve prostate cancer, the panel noted possible increased toxicity in Asian men receiving docetaxel, which would affect this recommendation in the APAC region. Although androgen receptor-targeting agents appear to be well tolerated in Asian men with metastatic castration-resistant prostate cancer, access to these drugs is very limited for financial reasons across the region. The meeting highlighted that cost and access to contemporary treatments and technologies are key factors influencing therapeutic decision-making in the APAC region. Whilst lower cost/older treatments and technologies may be an option, issues of culture and patient or physician preference mean, these may not always be acceptable. Although generic products can reduce cost in some countries, costs may still be prohibitive for lower-income patients or communities. The panellists noted the opportunity for a coordinated approach across the APAC region to address issues of access and cost. Developments in technologies and treatments are presenting new opportunities for the diagnosis and treatment of advanced prostate cancer. Differences in genetics and epidemiology affect the side-effect profiles of some drugs and influence prescribing.

Conclusions: As the field continues to evolve, collaboration across the APAC region will be important to facilitate relevant research and collection and appraisal of data relevant to APAC populations. In the meantime, the APAC APCCC 2018 meeting highlighted the critical importance of a multidisciplinary team-based approach to treatment planning and care, delivery of best-practice care by clinicians with appropriate expertise, and the importance of patient information and support for informed patient choice.
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http://dx.doi.org/10.1111/bju.14489DOI Listing
January 2019

Pathologic Outcomes of Candidates for Active Surveillance Undergoing Radical Prostatectomy: Results from a Contemporary Turkish Patient Cohort.

Urol Int 2018 22;100(1):43-49. Epub 2017 Dec 22.

Acibadem University School of Medicine, Istanbul, Turkey.

Introduction: To evaluate the pathological outcomes of Turkish men meeting the criteria for Active Surveillance (AS), who elected to undergo immediate radical prostatectomy (RP).

Material And Methods: Retrospective analysis including 1,212 patients with clinically localized prostate cancer (PCa) who met the eligibility criteria for AS. The primary outcomes were pathological upstaging and pathological upgrading.

Results: Nine hundred ninety-one patients were eligible for analysis after the central review of the submitted data. The mean prostate-specific antigen (PSA) level was 6.89 (0.51-15) ng/mL and the mean biopsy core number was 12 (8-47). The mean tumor positive core on final biopsy pathology was 1.95 (1-6) (16.6% [2.1-33.3%]). Overall, 30.6% of the men experienced a Gleason sum (GS) upgrade and 13.2% had pathological upstaging. For GS upgrade, the percentage of tumor-positive cores and free-to-total-PSA ratio were significant both in univariate analysis and multivariate logistic regression analysis. Variables predicting pathological upstaging were percentage of tumor-positive cores and PSA density, which were significant in univariate analysis. However, only PSA density was significant in multivariate logistic regression. Although biochemical recurrence-free survival was longer in patients without GS upgrade, it was not statistically significant between patients with and without any GS upgrade (mean 133.7 vs. 148.2 months, p = 0.243). A similar observation was made for patients with or without pathological upstaging (mean 117.1 vs. 148.3 months, p = 0.190).

Conclusions: Upgrading and upstaging at RP are quite common among Turkish men with clinically low-risk PCa, who are candidates for AS, and a great majority of them experienced long-term PSA control.
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http://dx.doi.org/10.1159/000481266DOI Listing
August 2018

Re: Active Surveillance in Younger Men with Prostate Cancer.

Eur Urol 2018 05 19;73(5):807. Epub 2017 Dec 19.

Department of Urology, Acıbadem University, Istanbul, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.eururo.2017.12.012DOI Listing
May 2018

Report of the Second Asian Prostate Cancer (A-CaP) Study Meeting.

Prostate Int 2017 Sep 29;5(3):95-103. Epub 2017 Mar 29.

Department of Strategic Investigation on Comprehensive Cancer Network, Graduate School of Interdisciplinary Information Studies, University of Tokyo, Tokyo, Japan.

The Asian Prostate Cancer (A-CaP) Study is an Asia-wide initiative that has been developed over the course of 2 years. The study was launched in December 2015 in Tokyo, Japan, and the participating countries and regions engaged in preparations for the study during the course of 2016, including patient registration and creation of databases for the purpose of the study. The Second A-CaP Meeting was held on September 8, 2016 in Seoul, Korea, with the participation of members and collaborators from 12 countries and regions. Under the study, each participating country or region will begin registration of newly diagnosed prostate cancer patients and conduct prognostic investigations. From the data gathered, common research themes will be identified, such as comparisons among Asian countries of background factors in newly diagnosed prostate cancer patients. This is the first Asia-wide study of prostate cancer and has developed from single country research efforts in this field, including in Japan and Korea. At the Second Meeting, participating countries and regions discussed the status of preparations and discussed various issues that are being faced. These issues include technical challenges in creating databases, promoting participation in each country or region, clarifying issues relating to data input, addressing institutional issues such as institutional review board requirements, and the need for dedicated data managers. The meeting was positioned as an opportunity to share information and address outstanding issues prior to the initiation of the study. In addition to A-CaP-specific discussions, a series of special lectures was also delivered as a means of providing international perspectives on the latest developments in prostate cancer and the use of databases and registration studies around the world.
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http://dx.doi.org/10.1016/j.prnil.2017.03.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5551923PMC
September 2017

Clinical Case Discussion: Bilateral Synchronous Testicular Cancer and Organ-sparing Surgery.

Eur Urol Focus 2018 09 23;4(5):737-739. Epub 2016 Aug 23.

Acibadem University, School of Medicine, Department of Urology, Istanbul, Turkey.

In cases of bilateral synchronous testicular cancer, organ-sparing surgery can be performed safely, if appropriate surgical rules are respected and if a stringent follow-up protocol is obeyed. If fertility is a concern, a simultaneous TESE procedure can be performed.
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http://dx.doi.org/10.1016/j.euf.2016.08.003DOI Listing
September 2018

Stem cell therapies in post-prostatectomy erectile dysfunction: a critical review.

Can J Urol 2017 Feb;24(1):8609-8619

Department of Materials Science Engineering, Kroto Research Institute, University of Sheffield, United Kingdom.

Introduction: Erectile dysfunction (ED) is still a common complication of radical prostatectomy. Current treatments of ED are mainly symptomatic. Mesenchymal stem cells (MSCs) have been widely investigated as a potential curative treatment. Although MSC therapy consistently improved erectile functions in the pre-clinical studies the initial expectations seem to be unmet. The aim of this study is to critically review the existing studies on use of stem cells in post-prostatectomy ED and understand factors that preclude clinical translation of the available evidence.

Materials And Methods: A literature search for all pre-clinical and clinical studies investigating MSCs in the treatment of post-prostatectomy ED published between January 2009 and March 2016 was performed using the PubMed database.

Results: A total of 24 pre-clinical studies investigated MSC based treatments in cavernous nerve injury (CNI) rodent models. In the majority of these studies intracavernous injection of MSCs at the time injury improved erectile functions. There is less data on the efficacy of MSCs when applied in a chronic disease state. Allogeneic or xenogeneic MSCs were similarly effective with limited data on immunologic response. There is a lack of conclusive data on in vivo fate of MSCs and the best route of MSC administration.

Conclusion: MSC therapy consistently improved erectile functions after CNI. There seems to be a consensus on the disease model used and outcome evaluation however further studies focusing on immunologic response to MSCs, their mechanism of action and in vivo fate are needed before their widespread use in clinic.
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February 2017

Investigation of the association between mitochondrial DNA and gene mutations in transitional cell carcinoma of the bladder.

Oncol Lett 2016 Oct 11;12(4):2872-2879. Epub 2016 Aug 11.

Department of Medical Genetics, Faculty of Medicine, Marmara University, Istanbul 34890, Turkey.

Bladder carcinoma is the most common malignancy of the urinary tract. The major aim of the present study is to investigate the association between mitochondrial DNA () and gene mutations in bladder carcinoma. A total of 30 patients with transitional cell carcinoma and 27 controls were recruited for the study. Bladder cancer tissues were obtained by radical cystectomy or transurethral resection. Genomic DNA was extracted from peripheral blood. and genes were amplified by polymerase chain reaction and sequenced directly. A total of 37 polymorphisms were identified, among which, 2 mutations were significant in the patient group, and 1 mutation was significant in the control group. Additionally, 5 different moderate positive correlations between mutations and 3 different positive correlations between gene and mutations were detected. The high incidence of and gene mutations in bladder cancer suggests that these genes could be important in carcinogenesis.
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http://dx.doi.org/10.3892/ol.2016.5000DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5038862PMC
October 2016

Re: Magnetic Resonance Imaging-Ultrasound Fusion Targeted Prostate Biopsy in a Consecutive Cohort of Men with No Previous Biopsy: Reduction of Over Detection Through Improved Risk Stratification.

Authors:
Levent Türkeri

Eur Urol 2016 09 28;70(3):540-1. Epub 2016 Jun 28.

Department of Urology, Acıbadem University Kadıköy Hospital, Istanbul, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.eururo.2016.06.031DOI Listing
September 2016

Ischemia modified albumin: does it change during pneumoperitoneum in robotic prostatectomies?

Int Braz J Urol 2016 Jan-Feb;42(1):69-77

Department of Anesthesiology and Reanimation, Acibadem University, Istanbul, Turkey.

Background: The unique positioning of the patient at steep Trendelenburg with prolonged and increased intra-abdominal pressure (IAP) during robotic radical prostatectomy may increase the risk of splanchnic ischemia. We aimed to investigate the acute effects of IAP and steep Trendelenburg position on the level of ischemia modified albumin (IMA) and to test if serum IMA levels might be used as a surrogate marker for possible covert ischemia during robotic radical prostatectomies.

Patients And Methods: Fifty ASA I-II patients scheduled for elective robotic radical prostatectomy were included in this investigation.

Exclusion Criteria: The patients were excluded from the study when an arterial cannulation could not be accomplished, if the case had to be converted to open surgery or if the calculated intraoperative bleeding exceeded 300ml. All the patients were placed in steep (45 degrees) Trendelenburg position following trocar placement. Throughout the operation the IAP was maintained between 11-14mmHg. Mean arterial blood pressure (MAP), cardiac output (CO) were continuously monitored before the induction and throughout the surgery. Blood gases, electrolytes, urea, creatinine, alanine transferase (ALT), aspartate transferase (AST) were recorded. Additionally, IMA levels were measured before, during and after surgery.

Results: (1) MAP, CO, lactate and hemoglobin (Hb) did not significantly change in any period of surgery (p>0.05); (2) sodium (p<0.01), potassium (p<0.05) and urea (p<0.05) levels decreased at postoperative period, and no significant changes at creatinine, AST, ALT levels were observed in these patients; (3) At the end of surgery (180 min) pCO2, pO2, HCO3 and BE did not change compared to after induction values (p>0.05) but mild acidosis was present in these patients (p<0.01 vs. after induction); (4) IMA levels were found to be comparable before induction (0.34±0.04), after induction (0.31±0.06) and at the end of surgery (0.29±0.05) as well.

Conclusion: We did not demonstrate any significant mesenteric-splanchnic ischemia which could be detected by serum IMA levels during robotic radical prostatectomies performed under steep Trendelenburg position and when IAP is maintained in between 11-14 mmHg.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811228PMC
http://dx.doi.org/10.1590/S1677-5538.IBJU.2014.0677DOI Listing
March 2017

Simple Renal Cysts: Prevalence, Associated Risk Factors and Follow-Up in a Health Screening Cohort.

Urol J 2016 Mar 5;13(1):2569-75. Epub 2016 Mar 5.

Department of Urology, Acibadem University School of Medicine, Istanbul 34752, Turkey.

Purpose: To investigate the prevalence of simple renal cysts in an adult health-screening cohort, and to evaluate clinical characteristics, associated risk factors and the natural course.

Materials And Methods: Between April and November 2008, a thousand individuals diagnosed with simple renal cyst by ultrasonography in a check-up program were chart-reviewed for demographic-clinical characteristics and cyst features. Follow-up was done via electronic patient records. Univariate and multivariate analyses to evaluate the relationship of outcomes and correlation analysis were done to measure the degree of association between parameters.

Results: The prevalence was 7.7%. There were 123 cysts in 77 patients, followed for 3.5 years (mean). Individuals with cysts were older (P < .01). Prevalence rates were 2.7% in individuals younger than 40 years and 23.9% in older than 60. The cysts were predominantly (94.8%) detected in males and most (63.6%) were solitary. No relation with Body Mass Index and total cholesterol levels was found but serum creatinine values were significantly increased in individuals with cysts (P < .01). There was no difference in the diagnosis of hypertension and microscopic hematuria in patients with renal cysts, however diabetes/hyperglycemia were more common and increasing age correlated with higher number of cysts (all P < .05). Follow-up revealed that the number of cysts were increased and/or the same in 86.5%; the sizes of cysts were larger and/or the same in 78.4% of patients, while in 14% of patients the cyst disappeared.

Conclusion: In a cohort of adults undergoing a health-screening, the prevalence of simple renal cyst was found 7.7% by ultrasonography. Renal cysts were more common in males and elders, and associated with increased levels of serum creatinine and diabetes.
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March 2016

EORTC Nomograms and Risk Groups for Predicting Recurrence, Progression, and Disease-specific and Overall Survival in Non-Muscle-invasive Stage Ta-T1 Urothelial Bladder Cancer Patients Treated with 1-3 Years of Maintenance Bacillus Calmette-Guérin.

Eur Urol 2016 Jan 23;69(1):60-9. Epub 2015 Jul 23.

Department of Urology, Jeroen Bosch Ziekenhuis, s'-Hertogenbosch, The Netherlands.

Background: There are no prognostic factor publications on stage Ta-T1 non-muscle-invasive bladder cancer (NMIBC) treated with 1-3 yr of maintenance bacillus Calmette-Guérin (BCG).

Objective: To determine prognostic factors in NMIBC patients treated with 1-3 yr of BCG after transurethral resection of the bladder (TURB), to derive nomograms and risk groups, and to identify high-risk patients who should be considered for early cystectomy.

Design, Setting, And Participants: Data for 1812 patients were merged from two European Organization for Research and Treatment of Cancer randomized phase 3 trials in intermediate- and high-risk NMIBC.

Intervention: Patients received 1-3 yr of maintenance BCG after TURB and induction BCG.

Outcome Measurements And Statistical Analysis: Prognostic factors for risk of early recurrence and times to late recurrence, progression, and death were identified in a training data set using multivariable models and applied to a validation data set.

Results And Limitations: With a median follow-up of 7.4 yr, 762 patients recurred; 173 progressed; and 520 died, 83 due to bladder cancer (BCa). Statistically significant prognostic factors identified by multivariable analyses were prior recurrence rate and number of tumors for recurrence, and tumor stage and grade for progression and death due to BCa. T1G3 patients do poorly, with 1- and 5-yr disease-progression rates of 11.4% and 19.8%, respectively, and 1- and 5-yr disease-specific death rates of 4.8% and 11.3%. Limitations include lack of repeat transurethral resection in high-risk patients and exclusion of patients with carcinoma in situ.

Conclusions: NMIBC patients treated with 1-3 yr of maintenance BCG have a heterogeneous prognosis. Patients at high risk of recurrence and/or progression do poorly on currently recommended maintenance schedules. Alternative treatments are urgently required.

Patient Summary: Non-muscle-invasive bladder cancer patients at high risk of recurrence and/or progression do poorly on currently recommended bacillus Calmette-Guérin maintenance schedules, and alternative treatments are urgently required.

Trial Registration: Study 30911 was registered with the US National Cancer Institute clinical trials database (protocol ID: EORTC 30911). Study 30962 was registered at ClinicalTrials.gov, number NCT00002990; http://clinicaltrials.gov/ct2/show/record/NCT00002990.
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http://dx.doi.org/10.1016/j.eururo.2015.06.045DOI Listing
January 2016

Does skip metastasis or other lymph node parameters have additional effects on survival of patients undergoing radical cystectomy for bladder cancer?

Korean J Urol 2015 May 28;56(5):357-64. Epub 2015 Apr 28.

Department of Urology, Karaelmas University, School of Medicine, Zonguldak, Turkey.

Purpose: To investigate the effects of lymph node metastasis, skip metastasis, and other factors related to lymph node status on survival in patients who underwent radical cystectomy (RC) and extended lymph node dissection (eLND).

Materials And Methods: RC and eLND were performed in 85 patients with a diagnosis of bladder cancer. Disease-free survival (DFS) and overall survival (OS) were determined by using a Cox proportional hazards model that included the number of excised lymph nodes, the presence of pathological lymph node metastasis, the anatomical level of positive nodes, the number of positive lymph nodes, lymph node density, and the presence of skip metastasis.

Results: The mean number of lymph nodes removed per patient was 29.4±9.3. Lymph node positivity was detected in 85 patients (34.1%). The mean follow-up duration was 44.9±27.4 months (2-93 months). Five-year estimated OS and DFS for the 85 patients were 62.6% and 57%, respectively. Three of 29 lymph node-positive patients (10.3%) had skip metastasis. Only lymph node positivity had a significant effect on 5-year OS and DFS (p<0.001). No difference in OS and DFS was found between the three patients with skip metastasis and other lymph node-positive patients. Other factors related to lymph node status had no significant effect on 5-year OS and DFS.

Conclusions: No factors related to lymph node status predict DFS and OS, except for lymph node positivity. OS and DFS were comparable between patients with skip metastasis and other lymph node-positive patients.
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http://dx.doi.org/10.4111/kju.2015.56.5.357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426507PMC
May 2015

Effects of testosterone treatment on recovery of rat spermatogenesis after irradiation.

J Pak Med Assoc 2015 Mar;65(3):300-5

Pathology Department, Marmara University, School of Medicine, Istanbul, Turkey.

Objective: To determine the effects of two different radiation doses on sperm parameters and the role of testosterone treatment on rat spermatogenesis.

Methods: The experimental animal study was conducted at Marmara University, Istanbul, Turkey, from September 2012 to January 2013. Male Sprague Dawley 4-6 months old rats weighing 300-350g were randomely divided into 5 equal groups as control, low dose irradiation, testosterone administration following low dose irradiation, high dose irradiation, and testosterone administration following high dose irradiation. The animals were kept at a constant temperature in a room with 12h light and dark cycles. After the group-wise intervention, sperm concentration, testicular size, and histopathological examination of seminiferous tubules were noted. SPSS 10 was used for statistical analysis.

Results: The 40 rats in the study were divided in 5 groups of 8(20%) each. In low dose radiation, adverse effects were only temporarily observed with the return of almost normal testicular function at the end of two months with or without testosterone supplementation. In contrast, in high dose radiation, hormonal treatment effect was controversial.

Conclusions: Testosterone treatment had no significant effect upon recovery after irradiation. In order to prevent the untoward effects of radiation, shielding of the remaining testis in a proper manner is crucial to avoid the harmful effects of the scattered radiation.
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March 2015