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Author: search.filters.author.Kural, Ali RizaHas files: Yes

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    Non-muscle invasive bladder cancer tissues have increased base excision repair capacity
    (NATURE PORTFOLIO, 2020-01-01) Somuncu, Berna; Keskin, Selcuk; Antmen, Fatma Merve; Saglican, Yesim; Ekmekcioglu, Aysegul; Ertuzun, Tugce; Tuna, Mustafa Bilal; Obek, Can; Wilson, David M.; Ince, Umit; Kural, Ali Riza; Muftuoglu, Meltem
    The molecular mechanisms underlying the development and progression of bladder cancer (BC) are complex and have not been fully elucidated. Alterations in base excision repair (BER) capacity, one of several DNA repair mechanisms assigned to preserving genome integrity, have been reported to influence cancer susceptibility, recurrence, and progression, as well as responses to chemotherapy and radiotherapy. We report herein that non-muscle invasive BC (NMIBC) tissues exhibit increased uracil incision, abasic endonuclease and gap-filling activities, as well as total BER capacity in comparison to normal bladder tissue from the same patient (p<0.05). No significant difference was detected in 8-oxoG incision activity between cancer and normal tissues. NMIBC tissues have elevated protein levels of uracil DNA glycosylase, 8-oxoguanine DNA glycosylase, AP endonuclease 1 and DNA polymerase beta protein. Moreover, the fold increase in total BER and the individual BER enzyme activities were greater in high-grade tissues than in low-grade NMIBC tissues. These findings suggest that enhanced BER activity may play a role in the etiology of NMIBC and that BER proteins could serve as biomarkers in disease prognosis, progression or response to genotoxic therapeutics, such as Bacillus Calmette-Guerin.
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    Water Vapor Thermal Therapy (RezumTM) for Benign Prostate Hyperplasia: Initial Experience from Turkiye
    (GALENOS PUBL HOUSE, 2022-01-01) Tuna, Mustafa Bilal; Doganca, Tunkut; Argun, Omer Burak; Pirdal, Betul Zehra; Tufek, Ilter; Obek, Can; Kural, Ali Riza
    Objective: Rezumn{''} system is a safe minimal invasive treatment modality for benign prostate hyperplasia (BPH) treatment. The aim of this study was to evaluate the short-term results of Rezumn{''} therapy in our center.Materials and Methods: We retrospectively collected the data of 28 patients with symptomatic BPH who underwent RezumTM therapy in our center. All patients' pre-operative and post-operative
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    Is robotic radical nephroureterectomy a safe alternative to open approach: The first prospective analysis
    (PAGEPRESS PUBL, 2021-01-01) Mourmouris, Panagiotis; Argun, Omer Burak; Tzelves, Lazaros; Tuna, Mustafa Bilal; Gourtzelidou, Maria; Tziotis, Andreas; Kural, Ali Riza; Skolarikos, Andreas
    Purpose: To test the efficacy and safety profile of robotic radical nephroureterectomy compared to the open approach. Methods: We enrolled 45 consecutive patients who suffered from non-metastatic, upper urinary tract urothelial carcinoma from September 2019 to March 2021 and underwent radical nephroureterectomy. Patients were divided in two groups: group A consisted of 29 patients (open approach) and group B consisted of 16 patients (robotic approach). The factors which were taken into consideration were age, sex, body mass index, tumour size, side and grade, cancer stage, ASA score, operation time, drain removal time, foley time, hospitalization time, estimated blood loss, surgical margins, preoperative and postoperative creatinine, Hct and bladder recurrences. Statistical analysis was performed with the use of SPSS version 26 and p < 0.05 was the cut-off for reaching statistical significance. Results: The mean age in group 1 was 67.12 years and in group 2 68.12 years, whereas the mean body mass index (BMI) in group 1 was 26.54 kg/m(2) and in group 2 25.20 kg/m(2). Operative time was better in group A (124 vs 186 mins p < 0.001) and estimated blood loss were better in group B compared to group A (137 vs 316 ml p < 0.001). Length of stay (LOS) was significantly less in the robotic group (5.75 vs 4.3 days p = 0.003) and the same applied for time required for drain removal (4.5 vs 33 days p = 0.006). Conclusions: Robotic radical nephroureterectomy is a safe and efficient alternative to open approach. It provides a favorable perioperative profile in patients suffering from upper urinary tract carcinoma without metastasis.
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    Magnetic resonance image-guided adaptive stereotactic body radiotherapy for prostate cancer: preliminary results of outcome and toxicity
    (BRITISH INST RADIOLOGY, 2021-01-01) Ugurluer, Gamze; Atalar, Banu; Mustafayev, Teuta Zoto; Gungor, Gorkem; Aydin, Gokhan; Sengoz, Meric; Abacioglu, Ufuk; Tuna, Mustafa Bilal; Kural, Ali Riza; Ozyar, Enis
    Objective: Using moderate or ultra-hypofractionation, which is also known as stereotactic body radiotherapy (SBRT) for treatment of localized prostate cancer patients has been increased. We present our preliminary results on the clinical utilization of MRI-guided adaptive radiotherapy (MRgRT) for prostate cancer patients with the workflow, dosimetric parameters, toxicities and prostate-specific antigen (PSA) response. Methods: 50 prostate cancer patients treated with ultrahypofractionation were included in the study. Treatment was performed with intensity-modulated radiation therapy (step and shoot) technique and daily plan adaptation using MRgRT. The SBRT consisted of 36.25 Gy in 5 fractions with a 7.25 Gy fraction size. The time for workflow steps was documented. Patients were followed for the acute and late toxicities and PSA response. Results: The median follow-up for our cohort was 10 months (range between 3 and 29 months). The median age was 73.5 years (range between 50 and 84 years). MRgRT was well tolerated by all patients. Acute genitourinary (GU) toxicity rate of Grade 1 and Grade 2 was 28 and 36\%, respectively. Only 6\% of patients had acute Grade 1 gastrointestinal (GI) toxicity and there was no Grade 2G1 toxicity. To date, late Grade 1 GU toxicity was experienced by 24\% of patients, 2\% of patients experienced Grade 2 GU toxicity and 6\% of patients reported Grade 2 GI toxicity. Due to the short follow-up, PSA nadir has not been reached yet in our cohort. Conclusion: In conclusion, MRgRT represents a new method for delivering SBRT with markerless soft tissue visualization, online adaptive planning and real-time tracking. Our study suggests that ultra-hypofractionation has an acceptable acute and very low late toxicity profile. Advances in knowledge: MRgRT represents a new markerless method for delivering SBRT for localized prostate cancer providing online adaptive planning and real-time tracking and acute and late toxicity profile is acceptable.
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    Magnetic Resonance - Transrectal Ultrasound Fusion Guided Prostate Biopsy
    (GALENOS YAYINCILIK, 2016-01-01) Argun, Omer Burak; Obek, Can; Kural, Ali Riza
    Prostate has remained as the single solid organ for which biopsy cannot be performed from a lesion for decades. Lately, the groundbreaking magnetic resonance imaging (MRI) techniques have emerged to scan prostate cancer and have become an important diagnostic tool in the diagnosis of prostate cancer. Efforts to improve the accuracy of the standard biopsy methods have led to the emergence of target-oriented biopsy methods. Today, MRI-transrectal ultrasound (TRUS) fusion guided biopsy methods are being used increasingly, especially for patients with an increasing prostate specific antigen level after a previous negative biopsy result and for patients under follow-up with active surveillance protocols. Even though it is not yet suggested in guidelines, our view and practice are in line with the fact that MRI-TRUS fusion guided biopsy is the most ideal biopsy method in any patient scheduled for a prostate biopsy with a significant lesion on MRI.
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    5-Hydroxyuracil Incision Activity Varies According to the Histological Grade of Non-muscle-invasive Bladder Cancer
    (GALENOS YAYINCILIK, 2021-01-01) Keskin, Selcuk; Antmen, Fatma Merve; Somuncu, Berna; Saglican, Yesim; Doganca, Tunkut; Obek, Can; Ince, Umit; Kural, Ali Riza; Muftuoglu, Meltem
    Objective: High levels of endonuclease III-like 1 (NTHL1) DNA glycosylase, which plays a role in the first step of the base excision repair pathway, has been related to cancer initiation and progression. 5-hydroxyuracil (5-OHU) oxidative base damage is a substrate for NTHL1 and endonuclease VIII-like 1 enzyme 1 (NEIL1) DNA glycosylases. This study investigates the association of 5-OHU incision activity with the risk of disease progression in patients with non-muscle-invasive bladder cancer (NMIBC) regarding grade and stage. Materials and Methods: During transurethral resection of 17 NMIBC patients, the papillary tumour before monopolar resection and healthy bladder mucosal tissue from the same person were obtained using cold cup biopsy. Both the normal mucosa and NMIBC tumour were pathologically confirmed. The histological grade and stage were also determined. The 5-OHU incision activity of all tissues was measured using a radiolabelled 5-OHU modified base containing DNA substrate. Results: 5-OHU incision activity was significantly higher in all high-grade NMIBC tissue extracts compared with the corresponding normal tissues (p=0.001). However, we found no significant difference in 5-OHU incision activity in low-grade NMIBC tissues (p=0.89). There was also a significant increase in 5-OHU incision activity at the Ta/T1 stage compared with the corresponding normal tissue (p=0.001). Conclusion: The increase in 5-OHU incision activity according to the histological grade of NMIBC tissue indicates that this activity (mainly performed by NTHL1 and NEIL1 DNA glycosylases) might play a role in NMIBC prognosis. Thus, it could be used as a potential prognostic biomarker for NMIBC.
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    Management of prostate cancer patients during COVID-19 pandemic
    (SPRINGERNATURE, 2020-01-01) Obek, Can; Doganca, Tunkut; Argun, Omer Burak; Kural, Ali Riza
    Prostate cancer patients' management demands prioritization, adjustments, and a tailored approach during the unprecedented SARS-CoV-2 pandemic. Benefit of care from treatment must be carefully weighed against the potential of infection and morbidity from COVID-19. Furthermore, urologists need to be cognizant of their obligation for wise consumption of restricted healthcare resources and protection of the safety of their coworkers. Nonurgent in-person clinic visits should be postponed or conducted remotely via phone or teleconference. Prostate cancer screening, imaging, and biopsies may be suspended in general. Treatment may be safely deferred in low and intermediate risk patients. Surgery may be delayed in most high-risk patients and neoadjuvant ADT is generally not advocated prior to surgery. Initiation of long-term ADT coupled with EBRT subsequent to the pandemic may be favored as a feasible alternative in high-risk and very high-risk disease. In patients with cN1 disease, treatment within 6 weeks is advocated. Presurgery assessment should include testing for COVID-19 and preferably a chest imaging. In the presence of SARS-CoV-2 infection, surgery should be postponed whenever possible. All protective measurements suggested by national/international authorities must to be diligently followed during perioperative period. Strict precautions specific to laparoscopic/robotic surgery are required, considering the unproven but potential risk of aerosolization of SARS-CoV-2 virus and spillage with pneumoperitoneum. Regarding radiotherapy, shortest safe EBRT regimen should be favored and prophylactic whole pelvic RT and brachytherapy avoided. Chemotherapy should be avoided whenever possible.