Browsing by Author "Turkeri, Levent"

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A Case of Unclassified Renal Cell Carcinoma Initially Considered as Translocation RCC and Review of Literature
(GALENOS YAYINCILIK, 2021-01-01) Karsiyakali, Nejdet; Ozgen, Mahir Bulent; Ozveren, Bora; Ekici, Isin Dogan; Turkeri, Levent
This case report aimed to review the literature on translocation renal cell carcinoma (tRCC), which is a rare form of kidney cancer and was the initial diagnosis of a recently treated patient. We report our findings in a 30-year-old female who underwent robot-assisted radical nephrectomy for an incidental right renal mass, which was reported as unclassified RCC at final pathologic evaluation after eliminating tRCC as differential diagnosis, and discuss the main aspects of tRCC based on current literature.
A New Era in Metastatic Prostate Cancer: ``The Combination of Chemotherapy and Hormonal Treatment as Initial Treatment''
(GALENOS YAYINCILIK, 2016-01-01) Tinay, Ilker; Turkeri, Levent
In recent years, studies have been reported about the combination of androgen deprivation therapy (ADT) and different chemotherapy modalities as the initial therapy in newly-diagnosed patients with hormone-sensitive metastatic prostate cancer and recently, possible effects of docataxel chemotherapy in combination with ADT was evaluated in the 2 multi-institutional randomized trials from North America (CHAARTED) and Europe (GETUG-AFU-15). We reviewed the data for the current use of chemo-hormonal therapy as the initial treatment modality in castration-sensitive metastatic prostate cancer. New findings of CHAARTED trial showed that combination of ADT with docetaxel chemotherapy conferred a significant median over-all survival benefit over ADT alone and patients with high-volume disease derived a 17-month gain in median over-all survival. However in GETUG trial, while no over-all survival benefit was observed between two groups however combination therapy was associated with an improvement in biochemical and clinical progression-free survivals. The combination of docetaxel-based chemotherapy with ADT as the initial treatment seems as a promising treatment alternative in patients with hormone-sensitive metastatic prostate cancer, especially in patients with ``high-volume{''} disease.
Abdominal or Transrectal Ultrasonographic Prostate Volume and Cystoscopic Prostatic Urethral Length Measurements to Determine the Surgical Technique for Prostatectomy in Patients with Benign Prostate Hyperplasia
(GALENOS YAYINCILIK, 2016-01-01) Demir, Aslan; Karadag, Mert Ali; Cecen, Kursat; Turkeri, Levent
Objective We aimed to determine the most suitable technique for prostate volume (PV) measurement to decide for the most appropriate surgical approach - endoscopic or open - by establishing the relationship between imaging techniques and the resected tissue weight (RTW). Materials and Methods Sixty men aged 49-95 years with lower urinary tract symptoms, who were scheduled for transurethral resection, were enrolled. The relationship of RTW with PV determined by preoperative abdominal ultrasonography as well as transrectal ultrasonography (TRUS) performed at the table just before surgery, and prostatic urethral length (PUL) measured at the time of cystoscopy was analyzed. Two groups were established with respect to PV, (less than or equal to 75 cc and greater than 75 cc, respectively), and according to PUL (less than or equal to 2.5 cm and longer than 2.5 cm, respectively). Statistical analyses were performed between the groups to identify the best correlation between resected tissue weight and pre-surgical volume determination methods. Results The strongest correlation between RTW and prostatic volume measurements was established for the TRUS measurements (r=0.79
An Independent Validation of 2010 Tumor-Node-Metastasis Classification for Renal Cell Carcinoma: A Multi-center Study by the Urooncology Association of Turkey Renal Cancer-Study Group
(GALENOS YAYINCILIK, 2017-01-01) Ozkan, Tayyar Alp; Eskicorapci, Saadettin; Yaycioglu, Ozgur; Akdogan, Bulent; Gogus, Cagatay; Dirim, Ayhan; Can, Cavit; Yildirim, Asif; Ozen, Haluk; Turkeri, Levent; Renal, Urooncology Assoc Turkey
Objective: The American Joint Committee on Cancer tumor-node-metastasis (TNM) classification has been updated by the 7th edition in 2010. The objective of the study was to evaluate cancer-specific survival (CSS) in patients with renal cell carcinoma (RCC) and assess the concordance of 2002 and novel 2010 TNM primary tumor classifications. Materials and Methods: A retrospective analysis of RCC registries from 25 institutions of the Urooncology Association of Turkey Renal CancerStudy Group was performed. Patients with RCC had a radical or partial nephrectomy. The database consisted of 1889 patients. Results: Median follow-up time was 25 months (interquartile range: 11.2-47.8). The 5-year CSS rate for pT1a, pT1b, pT2a, pT2b, pT3a and pT4 tumors were 97\% {[}95\% confidence interval (CI): 0.93-0.99], 94\% (95\% CI: 0.91-0.97), 88\% (95\% CI: 0.81-0.93), 77\% (95\% CI: 0.64-0.86) 74\% (95\% CI: 0.65-0.81) and 66\% (95\% CI: 0.51-0.77), respectively according to the 2010 TNM classification (p<0.001). CSS comparisons between pT1a-pT1b (p=0.022), pT1b-pT2a (p=0.030), pT3a-pT3b (p<0.001) and pT3b-pT4 (p=0.020) were statistically significant. Conversely, pT2a-pT2b (p=0.070) and pT2b-pT3a (p=0.314) were not statistically significant. Multivariable analyses revealed the pT stage in the 2010 TNM classification as an independent prognostic factor for CSS (p for trend=0.002). C-indexes for 2002 and 2010 TNM classifications were 0.8683 and 0.8706, respectively. Conclusion: Subdividing pT2 does not have a CSS advantage. Moving adrenal involvement to pT4 yielded a more accurate prognosis prediction. T stage and LNI are independent prognostic factors for CSS in RCC. Overall, the novel 2010 TNM classification is slightly improved over the former one. However, shown by C-index values, this improvement is not sufficient to state that 2010 TNM outperforms the 2002 TNM.
Are the Recommended Criteria for Clinically Insignificant Prostate Cancer Applicable to 12-core Prostate Biopsy Scheme? A Multicentre Study of Urooncology Association, Turkey
(GALENOS PUBL HOUSE, 2021-01-01) Celik, Serdar; Kizilay, Fuat; Yorukoglu, Kutsal; Ozen, Haluk; Akdogan, Bulent; Izol, Volkan; Bayazit, Yildirim; Aslan, Guven; Sozen, Sinan; Baltaci, Sumer; Muezzinoglu, Talha; Narter, Fehmi; Turkeri, Levent; Assoc, Urooncology
Objective: The aim of this study is to investigate the relevance of the Epstein criteria for the 12-core transrectal prostate biopsy (TRUS-Bx) scheme with the evaluation of clinicopathologic data recorded in the Urologic Cancer Database - Prostate (UroCaD-P), Urooncology Association, Turkey (UOAT). Materials and Methods: Patients with detailed pathological 12-core TRUS-Bx data for each biopsy core and who underwent RP due to PCa were included in this study. A total of 1167 patients from seven different centres were analysed. TRUS-Bx pathological findings were separately evaluated in the areas matching the sextant biopsy (6-core paramedian-lateral) scheme and in all 12-core biopsy areas (12-core biopsy scheme). Overall detection rates of PCa and ratios of clinically significant (sPCa) and insignificant PCa (insPCa) after RP were defined and compared between the biopsy schemes. Biopsy findings, according to the Epstein criteria, were also compared between the two schemes. A model for each biopsy scheme was created, including the Epstein criteria and additional biopsy findings using logistic regression analysis to predict clinically sPCa after RP. Results: There was a high correlation for the prediction of clinically insPCa between the two biopsy schemes in the same population. However, 7.3\% of PCa could not be diagnosed in the 6-core TRUS-Bx scheme. Also, 69.4\% of these had clinically sPCa according to the Epstein criteria in 12-core TRUS-Bx scheme and 51.8\% of these were clinically sPCa after RP. The presence of perineural invasion (PNI) in 12-core biopsy was also significant regarding predicting sPCa (p<0.001). Conclusion: The Epstein criteria in 12-core prostate biopsy provide a better prediction of clinically sPCa than the 6-core biopsy scheme. Biopsy PNI findings appeared to improve the effectiveness of 12-core prostate biopsy, in addition to the Epstein criteria.
Can We Predict the Surgical Margin Positivity in Patients Treated with Radical Prostatectomy? A Multicenter Cohort of Turkish Association of Uro-Oncology
(GALENOS YAYINCILIK, 2015-01-01) Bolat, Deniz; Eskicorapci, Saadettin; Karabulut, Erdem; Baltaci, Sumer; Yildirim, Asif; Sozen, Sinan; Ates, Ferhat; Sekerci, Cagri Akin; Kurtulus, Fatih; Dirim, Ayhan; Muezzioglu, Talha; Can, Cavit; Bozlu, Murat; Gemalmaz, Hakan; Ekici, Sinan; Ozen, Haluk; Turkeri, Levent
Objective To analyze the parameters that predict the surgical margin positivity after radical prostatectomy for localized prostate cancer. Materials and Methods In this multicenter study, the data of 1607 consecutive patients undergoing radical prostatectomy for localized prostate cancer in 12 different clinics in Turkey between 1993-2011 were assessed. Patients who had neoadjuvant treatment were excluded. We assessed the relationship between potential predictive factors and surgical margin status after radical prostatectomy such as age, cancer characteristics, history of transurethral prostate resection, surgical experience and nerve-sparing technique by using univariate and multivariate Cox regression analyses and t test. Results The overall surgical margin positivity rate was 22.6\% (359 patients). In univariate analyses, preoperative prostate specific antigen level, clinical stage, biopsy Gleason score, percentage of tumor involvement per biopsy specimen, transurethral prostate resection history, surgical experience and nerve-sparing technique were significantly associated with positive surgical margin rate. In multivariate analyses, preoperative prostate specific antigen level (OR: 1.03, p=0.06), percentage of tumor involvement per biopsy specimen (OR: 7,14, p<0,001), surgical experience (OR: 2.35, p=0.011) and unilateral nerve-sparing technique (OR: 1.81, p=0.018) were independent predictive factors for surgical margin positivity. Conclusion Preoperative prostate specific antigen level, percentage of tumor involvement per biopsy specimen, surgical experience and nerve-sparing technique are the most important predictive factors of surgical margin positivity in patients undergoing radical prostatectomy for localized prostate cancer.
Comparison of TRUS and combined MRI-targeted plus systematic prostate biopsy for the concordance between biopsy and radical prostatectomy pathology
(WILEY, 2021-01-01) Aslan, Guven; Celik, Serdar; Sozen, Sinan; Akdogan, Bulent; Izol, Volkan; Bilen, Cenk Yucel; Sahin, Bahadir; Turkeri, Levent; Assoc, Urooncology
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.
Gas6 expression and Tyrosine kinase Axl Sky receptors: Their relation with tumor stage and grade in patients with bladder cancer
(PAGEPRESS PUBL, 2021-01-01) Akgul, Murat; Baykan, Ozgur; Cagman, Zeynep; Ozyurek, Mustafa; Tinay, Ilker; Akbal, Cem; Uras, Fikriye; Turkeri, Levent
Objectives: It has been shown that the dys-regulation of tyrosine kinase Axl receptor and its ligand growth arrest-specific gene (Gas6) are associated with poor prognosis in various types of tumors but there is not enough study about their importance in bladder cancer (BC). We evaluated the relation of Gas6 gene expression and tyrosine-kinase Axl and Sky (Tyro 3) receptors with tumor stage and grade in patients with BC. Material and Methods: The study group consists of 55 patients whose transurethral resection of bladder (TUR-B) has been performed due to RC and the control group consists of 12 patients with normal bladder mucosa. In tissues mRNAs of Gas6, Axl, and Sky receptors were examined by quantitative (Real-Time) PCR (qPCR). Protein expression was measured by immunohistochemistry. Plasma Gas6 protein levels were compared with control group by ELISA method. Results: Patients with BC were grouped as Ta low (n=17), Ta high (n=5), T1 low (n=9), T1 high (n=8) and T2 (n=16) according to their TUR-B pathologies. The qPCR analysis showed that the expression of Gas6 gene and AxI receptor is higher in the tumor-positive group and the immune-histochemical showed that the bladder samples of the tumor-positive group stained significantly positive. When the patients are grouped according to the TUR-B pathologies, a statistical significant difference was observed among groups in the qPCR analysis ratios of Gas6 gene and Axl receptor by (p < 0.05) but no significance was found for Sky receptor (p > 0.05). When Gas6 protein levels in plasma samples were compared by ELISA method, a statistical significance was determined among groups (p = 0.001). Conclusions: Our findings indicate that mRNAs of Gas6 and Axl receptor are closely related to tumor stage and grade in patients with BC. Further studies are needed for understanding the role of Gas6 and its receptors on the neoplastic transformation in terms of novel biomarkers and potential therapeutic targets.
Increased Prostate Imaging-Reporting and Data System Scores in Multiparametric Magnetic Resonance Imaging May Predict More Extensive Disease in Radical Prostatectomy Specimens
(GALENOS YAYINCILIK, 2021-01-01) Karsiyakali, Nejdet; Ozgen, Mahir Bulent; Ozveren, Bora; Akbal, Cem; Dincer, Alp; Durak, Haydar; Turkeri, Levent
Objective: This study aimed to investigate the correlation between index lesion prostate imaging-reporting and data system (PI-RADS) version-2 score and histopathological outcomes of prostatectomy specimens. Materials and Methods: A total of 78 male patients with prostate cancer (PCa) treated with robot-assisted radical prostatectomy between August 2015 and June 2020 were included in this study. In this cohort, suspicious lesions on multiparametric magnetic resonance imaging (mpMRI) were scored according to PI-RADS version-2 criteria. MpMRI-targeted prostate biopsy was performed for all suspicious lesions with a PI-RADS score of >= 3 followed by systematic prostate biopsy. The relationship between index lesion PI-RADS score and histopathological outcomes of prostatectomy specimens were evaluated statistically. Results: The mean age of the patients was 65.0 +/- 7.0 years. The distribution of PI-RADS scores of 3, 4, and 5 of the index lesions were 6 (7.7\%), 29 (37.2\%), and 43 (55.1\%), respectively. Lower tumor volume and tumor volume ratio were observed in patients with a PI-RADS score of 3 when they were compared with patients with PI-RADS scores of 4 and PI-RADS-5 (p<0.001, for each). No significant correlation was found between index lesion PI-RADS score in mpMRI and clinically significant PCa in prostatectomy specimens (r<0.200, p>0.05). However, a significant correlation was observed between index lesion PI-RADS score and extracapsular extension (ECE), as well as seminal vesicle invasion (SVI) and pT stage (r=0.327, p=0.004
Initial Outcomes and Assessment of the Transperineal Multiparametric-Magnetic Resonance Imaging/Ultrasonography Fusion Biopsy Method in Diagnosing Clinically-significant Prostate Cancer
(GALENOS YAYINCILIK, 2017-01-01) Ozgen, Mahir B.; Ozveren, Bora; Uzel, Sertac; Altug, Ugur; Turkeri, Levent
Objective: In this study, it was aimed to investigate the success of transperineal multiparametric magnetic resonance imaging (mp-MRI)/transrectal ultrasonography (USG) fusion prostate biopsy method in prostate cancer diagnosis and detection of clinically significant cancer. Materials and Methods: All patients signed written informed consent then patients with an indication for prostate cancer, therefore biopsy was planned for the last year underwent 3 Tesla mp-MRI retrospectively. All the lesions of patients with Prostate Imaging, Reporting and Data System (PIRADS) 3, 4 and 5 lesions were marked using MIM (TM) Symphony software by a single radiologist. All patients underwent transperineal MRI/USG fusion biopsy under general anesthesia. In the prostate MRI evaluation of the targeted lesions with a PIRADS score of 3-4-5 were sampled with 2 to 5 cores followed by random biopsies of both of the prostate lobes. Results: Prostate adenocarcinoma was diagnosed in 20 of 59 patients (33.8\%) having fusion biopsy. No difference was observed in prostate-specific antigen levels of patients whose biopsy results were benign and malignant. In 63\% of patients, only PIRADS 3 lesions were found, whereas PIRADS 4 and/or 5 lesions were reported in 22 (37\%) patients. The fusion biopsy of PIRADS 3 lesions revealed cancer in 7 patients (19\%), of which 6 had clinically-insignificant prostate cancer criteria. Adenocarcinoma was diagnosed in 59\% who had PIRADS 4 and/or 5 lesions. All these tumors had clinically-significant cancer characteristics. Lesion-targeted fusion biopsies missed 1 clinically-insignificant adenocarcinoma (1/7
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
(WILEY, 2019-01-01) Chiong, Edmund; Murphy, Declan G.; Akaza, Hideyuki; Buchan, Nicholas C.; Chung, Byung Ha; Kanesvaran, Ravindran; Khochikar, Makarand; Letran, Jason; Lojanapiwat, Bannakij; Ng, Chi-fai; Ong, Teng; Pu, Yeong-Shiau; Saad, Marniza; Schubach, Kathryn; Turkeri, Levent; Umbas, Rainy; Chuyen, Vu Le; Williams, Scott; Ye, Ding-Wei; Davis, Ian D.; Grp, A.N.Z.U.P. Canc Trials
ObjectiveThe 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). FindingsDifferences 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-naive 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. ConclusionsAs 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.
Management of Patients with Advanced Prostate Cancer: Report from the Advanced Prostate Cancer Consensus Conference 2021
(ELSEVIER, 2022-01-01) Gillessen, Silke; Armstrong, Andrew; Attard, Gert; Beer, Tomasz M.; Beltran, Himisha; Bjartell, Anders; Bossi, Alberto; Briganti, Alberto; Bristow, Robert G.; Bulbul, Muhammad; Caffo, Orazio; Chi, Kim N.; Clarke, Caroline S.; Clarke, Noel; Davis, Ian D.; de Bono, Johann S.; Duran, Ignacio; Eeles, Ros; Efstathiou, Eleni; Efstathiou, Jason; Ekeke, Onyeanunam Ngozi; Evans, Christopher P.; Fanti, Stefano; Feng, Felix Y.; Fizazi, Karim; Frydenberg, Mark; George, Dan; Gleave, Martin; Halabi, Susan; Heinrich, Daniel; Higano, Celesta; Hofman, Michael S.; Hussain, Maha; James, Nick; Jones, Robert; Kanesvaran, Ravindran; Khauli, Raja B.; Klotz, Laurence; Leibowitz, Raya; Logothetis, Chris; Maluf, Fernando; Millman, Robin; Morgans, Alicia K.; Morris, Michael J.; Mottet, Nicolas; Mrabti, Hind; Murphy, Declan G.; Murthy, Vedang; Oh, William K.; Ost, Piet; O'Sullivan, Joe M.; Padhani, Anwar R.; Parker, Chris; Poon, Darren M. C.; Pritchard, Colin C.; Rabah, Danny M.; Rathkopf, Dana; Reiter, Rob E.; Rubin, Mark; Ryan, Charles J.; Saad, Fred; Sade, Juan P.; Sartor, Oliver; Scher I, Howard; Shore, Neal; Skoneczna, Iwona; Small, Eric; Smith, Matthew; Soule, Howard; Spratt, Daniel E.; Sternberg, Cora N.; Suzuki, Hiroyoshi; Sweeney, Christopher; Sydes, Matthew R.; Taplin, Mary-Ellen; Tilki, Derya; Tombal, Bertrand; Turkeri, Levent; Uemura, Hiroji; Uemura, Hirotsugu; van Oort, Inge; Yamoah, Kosj; Ye, Dingwei; Zapatero, Almudena; Omlin, Aurelius
Background: Innovations in treatments, imaging, and molecular characterisation in advanced prostate cancer have improved outcomes, but various areas of management still lack high-level evidence to inform clinical practice. The 2021 Advanced Prostate Cancer Consensus Conference (APCCC) addressed some of these questions to supplement guidelines that are based on level 1 evidence. Objective: To present the voting results from APCCC 2021. Design, setting, and participants: The experts identified three major areas of controversy related to management of advanced prostate cancer: newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC), the use of prostate-specific membrane antigen ligands in diagnostics and therapy, and molecular characterisation of tissue and blood. A panel of 86 international prostate cancer experts developed the programme and the consensus questions. Outcome measurements and statistical analysis: The panel voted publicly but anonymously on 107 pre-defined questions, which were developed by both voting and nonvoting panel members prior to the conference following a modified Delphi process. Results and limitations: The voting reflected the opinions of panellists and did not incorporate a standard literature review or formal meta-analysis. The answer options for the consensus questions received varying degrees of support from panellists, as reflected in this article and the detailed voting results reported in the Supplementary material. Conclusions: These voting results from a panel of experts in advanced prostate cancer can help clinicians and patients to navigate controversial areas of management for which high-level evidence is scant. However, diagnostic and treatment decisions should always be individualised according to patient characteristics, such as the extent and location of disease, prior treatment(s), comorbidities, patient preferences, and treatment recommendations, and should also incorporate current and emerging clinical evidence and logistic and economic constraints. Enrolment in clinical trials should be strongly encouraged. Importantly, APCCC 2021 once again identified salient questions that merit evaluation in specifically designed trials. Patient summary: The Advanced Prostate Cancer Consensus Conference is a forum for discussing current diagnosis and treatment options for patients with advanced prostate cancer. An expert panel votes on predefined questions focused on the most clinically relevant areas for treatment of advanced prostate cancer for which there are gaps in knowledge. The voting results provide a practical guide to help clinicians in discussing treatment options with patients as part of shared decision-making. (c) 2022 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Management of Patients with Advanced Prostate Cancer: Report of the Advanced Prostate Cancer Consensus Conference 2019
(ELSEVIER, 2020-01-01) Gillessena, Silke; Attard, Gerhardt; Beer, Tomasz M.; Beltran, Himisha; Bjartell, Anders; Bossi, Alberto; Briganti, Alberto; Bristow, Rob G.; Chi, Kim N.; Clarke, Noel; Davis, Ian D.; de Bono, Johann; Drake, Charles G.; Duran, Ignacio; Eeles, Ros; Efstathiou, Eleni; Evans, Christopher P.; Fanti, Stefano; Feng, Felix Y.; Fizazi, Karim; Frydenberg, Mark; Gleave, Martin; Halabi, Susan; Heidenreich, Axel; Heinrich, Daniel; Higano, Celestia (Tia) S.; Hofman, Michael S.; Hussain, Maha; James, Nicolas; Kanesvaran, Ravindran; Kantoff, Philip; Khauli, Raja B.; Leibowitz, Raya; Logothetis, Chris; Maluf, Fernando; Millman, Robin; Morgans, Alicia K.; Morris, Michael J.; Mottet, Nicolas; Mrabti, Hind; Murphy, Declan G.; Murthy, Vedang; Oh, William K.; Ost, Piet; OSullivan, Joe M.; Padhani, Anwar R.; Parker, Chris; Poon, Darren M. C.; Pritchard, Colin C.; Reiter, Robert E.; Roach, Mack; Rubin, Mark; Ryan, Charles J.; Saad, Fred; Sade, Juan Pablo; Sartor, Oliver; Scher I, Howard; Shore, Neal; Small, Eric; Smith, Matthew; Soule, Howard; Sternberg, Cora N.; Steuber, Thomas; Suzuki, Hiroyoshi; Sweeneyh, Christopher; Sydes, Matthew R.; Taplinh, Mary-Ellen; Tombal, Bertrand; Turkeri, Levent; van Oort, Inge; Zapatero, Almudena; Omlind, Aurelius
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/naive 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. (C) 2020 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology.
Management of Patients with Urological Cancers in Turkey during the COVID-19 Pandemic: Recommendations of Uro-oncology Association
(GALENOS YAYINCILIK, 2020-01-01) Celik, Serdar; Tinay, Ilker; Narter, Fehmi; Eskicorapci, Saadettin; Ataus, Suleyman; Turkeri, Levent; Baltaci, Sumer
Coronavirus disease-19 (COVID-19) has been declared as a pandemic by the World Health Organization. The number of cases has increased over time in correlation with the increasing number of testing worldwide. In order to use the available resources for COVID-19 treatment, urological practice has been limited only to emergency procedures and certain uro-oncological surgeries. In this report, we aim to share our recommendations for the daily uro-oncology practice in light of local circumstances in Turkey.
Managing advanced prostate cancer in the Asia Pacific region: ``Real-world'' application of Advanced Prostate Cancer Consensus Conference 2019 statements
(WILEY, 2022-01-01) Chiong, Edmund; Murphy, Declan G.; Buchan, Nicholas C.; Chua, Melvin L. K.; Hakim, Lukman; Hamid, Agus Rizal; Hong, Sung K.; Horvath, Lisa G.; Kanesvaran, Ravi; Khochikar, Makarand; Letran, Jason; Lojanapiwat, Bannakij; Malek, Rohan; Ng, Anthony C. F.; Vinh, Nguyen Tuan; Pang, See-Tong; Poon, Darren M. C.; Ong, Teng Aik; Saad, Marniza; Schubach, Kathryn; Shiroki, Ryoichi; Turkeri, Levent; Williams, Scott; Wong, Alvin; Ye, Dingwei; Davis, Ian D.; Grp, A.N.Z.U.P. Canc Trials
Aim The second Asia-Pacific Advanced Prostate Cancer Consensus Conference (APAC APCCC 2020) gathered insights into the real-world application in the Asia-Pacific (APAC) region of consensus statements from the 3rd Advanced Prostate Cancer Consensus Conference (APCCC 2019). Methods The 4-h our virtual meeting in October 2020 brought together 26 experts from 14 APAC countries to discuss APCCC 2019 recommendations. Presentations were prerecorded and viewed prior to the meeting. A postmeeting survey gathered views on current practice. Results The meeting and survey highlighted several developments since APAC APCCC 2018. Increased access and use in the region of PSMA PET/CT imaging is providing additional diagnostic and staging information for advanced prostate cancer and influencing local and systemic therapy choices. Awareness of oligometastatic disease, although not clearly defined, is increasing. Novel androgen receptor pathway antagonists are expanding treatment options. Cost and access to contemporary treatments and technologies continue to be a significant factor influencing therapeutic decisions in the region. With treatment options increasing, multidisciplinary treatment planning, shared decision making, and informed choice remain critical. A discussion on the COVID-19 pandemic highlighted challenges for diagnosis, treatment, and clinical trials and new service delivery models that will continue beyond the pandemic. Conclusion APAC-specific prostate cancer research and data are important to ensure that treatment guidelines and recommendations reflect local populations and resources. Facilitated approaches to collaboration across the region such as that achieved through APAC APCCC meetings continue to be a valuable mechanism to ensure the relevance of consensus guidelines within the region.
Massive rectal bleeding after prostate biopsy controlled by endoclipping in a patient using acetylsalicylic acid
(CANADIAN UROLOGICAL ASSOCIATION, 2013-01-01) Ozveren, Bora; Turkeri, Levent
A case of severe rectal bleeding following transurethral ultrasound (TRUS)-guided prostate biopsy is reported. Rectal bleeding is considered a minor, transient complication of this standard diagnostic procedure that can usually be controlled successfully by conservative measures. In this case where the patient had been taking acetylsalicylic acid (ASA), massive bleeding required hospitalization and blood transfusions. Conservative treatment attempts were not succesful, and profuse rectal bleeding was eventually treated by colonoscopy and endoclipping of the bleeding vessel. Although generally regarded as a less significant complication, rectal bleeding may rarely be encountered as a life-threatening situation. Furthermore, conservative therapeutic approach to this minor complication may be ineffective in patients taking ASA. Early endoscopic intervention may be necessary to prevent blood transfusion and prolonged hospitalization in severe rectal bleeding after TRUS biopsy.
Perioperative outcomes following robot-assisted partial nephrectomy for complex renal masses: A Vattikuti Collective Quality Initiative database study
(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2022-01-01) Sharma, Gopal; Shah, Milap; Ahluwalia, Puneet; Dasgupta, Prokar; Challacombe, Benjamin J.; Bhandari, Mahendra; Ahlawat, Rajesh; Rawal, Sudhir; Buffi, Nicolo M.; Sivaraman, Ananthakrishnan; Porter, James R.; Rogers, Craig; Mottrie, Alexandre; Abaza, Ronney; Rha, Khoon Ho; Moon, Daniel; Thyavihally, Yuvaraja B.; Parekh, Dipen J.; Capitanio, Umberto; Maes, Kris K.; Porpiglia, Francesco; Turkeri, Levent; Gautam, Gagan
Introduction: Outcomes of robot-assisted partial nephrectomy (RAPN) depend on tumor complexity, surgeon experience and patient profile among other variables. We aimed to study the perioperative outcomes of RAPN for patients with complex renal masses using the Vattikuti Collective Quality Initiative (VCQI) database that allowed evaluation of multinational data. Methods: From the VCQI, we extracted data for all the patients who underwent RAPN with preoperative aspects and dimensions used for an anatomical (PADUA) score of >= 10. Multivariate logistic regression was conducted to ascertain predictors of trifecta (absence of complications, negative surgical margins, and warm ischemia times {[}WIT] <25 min or zero ischemia) outcomes. Results: Of 3,801 patients, 514 with PADUA scores >= 10 were included. The median operative time, WIT, and blood loss were 173 (range 45-546) min, 21 (range 0-55) min, and 150 (range 50-3500) ml, respectively. Intraoperative complications and blood transfusions were reported in 2.1\% and 6\%, respectively. In 8.8\% of the patients, postoperative complications were noted, and surgical margins were positive in 10.3\% of the patients. Trifecta could be achieved in 60.7\% of patients. Clinical tumor size, duration of surgery, WIT, and complication rates were significantly higher in the group with a high (12 or 13) PADUA score while the trifecta was significantly lower in this group (48.4\%). On multivariate analysis, surgical approach (retroperitoneal vs. transperitoneal) and high PADUA score (12/13) were identified as predictors of the trifecta outcomes. Conclusion: RAPN may be a reasonable surgical option for patients with complex renal masses with acceptable perioperative outcomes.
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
(WILEY, 2020-01-01) Bhandari, Mahendra; Nallabasannagari, Anubhav Reddy; Reddiboina, Madhu; Porter, James R.; Jeong, Wooju; Mottrie, Alexandre; Dasgupta, Prokar; Challacombe, Ben; Abaza, Ronney; Rha, Koon Ho; Parekh, Dipen J.; Ahlawat, Rajesh; Capitanio, Umberto; Yuvaraja, Thyavihally B.; Rawal, Sudhir; Moon, Daniel A.; Buffi, Nicolo M.; Sivaraman, Ananthakrishnan; Maes, Kris K.; Porpiglia, Francesco; Gautam, Gagan; Turkeri, Levent; Meyyazhgan, Kohul Raj; Patil, Preethi; Menon, Mani; Rogers, Craig
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
Prognostic Significance of Surgical Margin Status and Gleason Grade at the Positive Surgical Margin in Predicting Biochemical Recurrence After Radical Prostatectomy in a Turkish Patient Cohort
(GALENOS YAYINCILIK, 2021-01-01) Koparal, Murat Yavuz; Sozen, Tevfik Sinan; Aslan, Guven; Baltaci, Sumer; Suer, Evren; Muezzinoglu, Talha; Akdogan, Bulent; Turkeri, Levent
Objective: To investigate the prognostic role of positive surgical margin (PSM) features in addition to well-defined risk factors in predicting biochemical recurrence (BCR) after radical prostatectomy. Materials and Methods: This study used the prostate cancer database from the Urooncology Association in Turkey. Clinical, surgical, pathological and follow-up data were recorded from the database. PSM features, including number, location, linear length and Gleason grade (GG) were also recorded. Kaplan-Meier survival analyses were performed to assess differences in BCR-free survival (BCR-FS). In order to identify prognostic factors affecting BCR-FS, univariate and multivariate Cox regression analyses were performed. Results: The study included 984 patients who met the eligibility criteria. The median follow-up time was 29 (minimum: 6, maximum: 210) months, and BCR was detected in 178 (18.1\%) patients. BCR-FS was found to be significantly lower in patients with higher total prostate-specific antigen, higher International Society of Urological Pathology (ISUP) grade, extraprostatic extension (EPE), seminal vesicle invasion, lymphovascular invasion, lymph node involvement, PSM and GG at PSM (PSMGG) >= 4 (log-rank p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001 and p=0.005). ISUP grade, EPE and PSM were identified as independent prognostic factors in predicting BCR-FS {[}Hazard ratio (HR): 1.89, p=0.035 and HR: 4.65, p<0.001, HR: 1.82, p=0.030, HR: 1.77, p=0.042, respectively]. Unlike the univariate analysis, in multivariate analysis, PSMGG did not prove to be an independent prognostic factor in predicting BCR-FS. Conclusion: PSM GG >= 4 was found to be significantly associated with shorter BCR-FS. There is a need for large, randomised prospective studies to clarify the role of PSMGG to be used in nomograms as an independent predictor to determine patients who would benefit from adjuvant radiation therapy.
Report of the Second Asian Prostate Cancer (A-CaP) Study Meeting
(ELSEVIER INC, 2017-01-01) Kim, Choung-Soo; Lee, Ji Youl; Chung, Byung Ha; Kim, Wun-Jae; Fai, Ng Chi; Hakim, Lukman; Umbas, Rainy; Ong, Teng Aik; Lim, Jasmine; Letran, Jason L.; Chiong, Edmund; Wu, Tong-lin; Lojanapiwat, Bannakij; Turkeri, Levent; Murphy, Declan G.; Gardiner, Robert A.; Moretti, Kim; Cooperberg, Matthew; Carroll, Peter; Mun, Seong Ki; Hinotsu, Shiro; Hirao, Yoshihiko; Ozono, Seiichiro; Horie, Shigeo; Onozawa, Mizuki; Kitagawa, Yasuhide; Kitamura, Tadaichi; Namiki, Mikio; Akaza, Hideyuki
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. (C) 2017 Asian Pacific Prostate Society, Published by Elsevier Korea LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).