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Author: search.filters.author.Doganca, TunkutHas files: No

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    Can SUVmax values of Ga-68-PSMA PET/CT scan predict the clinically significant prostate cancer?
    (LIPPINCOTT WILLIAMS \& WILKINS, 2019-01-01) Demirci, Emre; Kabasakal, Levent; Sahin, Onur E.; Akgun, Elife; Gultekin, Mehmet Hamza; Doganca, Tunkut; Tuna, Mustafa B.; Obek, Can; Kilic, Mert; Esen, Tarik; Kural, Ali R.
    Purpose The intensity of prostate-specific membrane antigen (PSMA) expression increases as the tumor grade increases and the uptake of Ga-68-PSMA is higher in high-grade tumors. The aim of the present study was to evaluate the correlation of preoperative tracer uptake of primary tumor to Gleason Score in patients who underwent prostatectomy. Patients and methods We retrospectively evaluated 141 patients who had Ga-68-PSMA positron emission tomography/computed tomography (PET/CT) imaging and who underwent prostatectomy. All patients had a diagnosis of prostate cancer on the basis of 10-24 cores transrectal ultrasound-guided biopsy (TRUS-Bx). Histological assessment was performed according to the New Contemporary Prostate Cancer Grading System. All patients had a prostate-specific antigen (PSA) level measurement within maximum of 28 days before Ga-68-PSMA PET/CT. Region of interests were drawn manually around the prostate gland, avoiding the bladder activity, to calculate the maximum standardized uptake values (SUVmax) values. Results The median PSA values for all patients were 10.0 ng/ml. PSA values for low-risk patients were significantly lower than those of high-risk patients (P<0.001). There were 41.1\% upgrades and 7.8\% downgrades following prostatectomy in terms of Grade Groups. According to the final pathology reports, 21\% (n=16) of patients moved from a low-risk level (grade groups 1+2) to a high-risk level (grade groups 3+4+5). The median SUVmax value was 8.8, ranging from 2.1 to 62.4. There was a strong correlation between SUVmax values and grade groups (Pearson rho=0.66) (P<0.001). The mean SUVmax values of high-risk patients were significantly higher than those of low-risk patients (18.9 +/- 12.1 vs. 7.16 +/- 6.2, respectively) (P<0.001). Receiver operation characteristic curve analysis of SUVmax at the cut-off value of 9.1 showed a high sensitivity (78\%) and specificity (81\%) for detection of high risk disease. Conclusion SUVmax values correlate significantly with the grade groups of the primary tumor. The intraprostatic accumulation sites may predict clinically significant cancer and potentially serve as a target for biopsy sampling in conjunction with mpMRI in selected patients.
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    Impact of Refractive Errors on Da Vinci SI Robotic System
    (SOC LAPAROENDOSCOPIC SURGEONS, 2020-01-01) Tuna, Mustafa Bilal; Kilavuzoglu, Ayse Ebru; Mourmouris, Panogiotis; Argun, Omer Burak; Doganca, Tunkut; Obek, Can; Ozisik, Ozan; Kural, Ali Riza
    Objective: To investigate the impact of refractive errors on binocular visual acuity while using the Da Vinci SI robotic system console. Methods: Eighty volunteers were examined on the Da Vinci SI robotic system console by using a near vision chart. Refractive errors, anisometropia status, and Fly Stereo Acuity Test scores were recorded. Spherical equivalent (SE) were calculated for all volunteers' right and left eyes. Visual acuity was assessed by the logarithm of the minimal angle of resolution (LogMAR) method. Binocular uncorrected and best corrected (with proper contact lens or glasses) LogMAR values of the subjects were recorded. The difference between these values (DiffLogMAR) are affected by different refractive errors. Results: In the myopia and/or astigmatism group, uncorrected SE was found to have significant impact on the DiffLogMAR (P < 0.001) and myopia greater than 1.75 diopter had significantly higher DiffLogMAR values (p < 0.05). Subjects with presbyopia had significantly higher DiffLogMAR values (p < 0.01), and we observed positive correlation between presbyopia and DiffLogMAR values (p = 0.33, p < 0.01). The cut off value of presbyopia that correlated the most with DiffLogMAR differences was found to be 1.25 diopter (P< 0.001). In 13 hypermetropic volunteers, we found significant correlation between hypermetropia value and DiffLogMAR (p > 0.7, p < 0.01). The statistical analysis between Fly test and SE revealed a significant impact of presbyopia and hypermetropia to the stereotactic view of the subject (p = -0.734, p < 0.05). Conclusion: Surgeons suffering from myopia greater than 1.75 diopter, presbyopia greater than 1.25 diopter (D), and hypermetropia regardless of grade must always perform robotic surgeries with the proper correction.
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    Can We Accomplish Better Oncological Results with Robot-Assisted Radical Prostatectomy?
    (MARY ANN LIEBERT, INC, 2017-01-01) Kural, Ali Riza; Obek, Can; Doganca, Tunkut
    Surgical removal with radical prostatectomy has been a cornerstone for the treatment of prostate cancer and is associated with level 1 evidence for survival advantage compared with watchful waiting. Since the first structured robotic program was launched in 2000, robot-assisted radical prostatectomy (RARP) has had a rapid diffusion and surpassed its open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP) counterparts in the United States and is progressively expanding in other countries. Interestingly, this common acceptance of RARP was initially driven in the paucity of robust clinical evidence. There is still lack of level 1 evidence with prospective randomized trials on the oncologic outcomes of RARP. In that scenario, the clinician has to rely on retrospective data and systemic and meta-analyses. In comparison with ORP and LRP, RARP has proven to reach at least equivalent oncological outcomes. Lower rate of positive surgical margins may probably be achieved with RARP in pT2 patients. Although urologists were initially reluctant to embrace RARP in highrisk patients and lymph node yield was low, contemporary series have revealed that RARP and extended lymphadenectomy may be safely performed with obtaining similar (or better) nodal yields compared with ORP. Surgeon experience is universally of utmost importance in obtaining good outcomes. We will need to wait for long-term results of contemporary series to comprehend the impact of RARP on cancer-specific survival and overall survival. Using novel imaging before surgery and frozen section analysis during surgery may allow for superior oncological outcomes.