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Item 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 TrialsAim 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.Item Turkey Prostate Cancer Map 2021: Turkish Urooncology Association Prostate Cancer Database Report(GALENOS YAYINCILIK, 2022-01-01) Sahin, Bahadir; Celik, Serdar; Tinay, Ilker; Eskicorapci, Saadettin; Aslan, Guven; Sozen, Sinan; Ataus, Suleyman; Turkeri, LeventObjective: This study aimed to present the data of patients with prostate cancer (PCa) whose detailed information was stored in the Urologic Cancer Database-Prostate, Urooncology Association, Turkey with the title of ``Turkey Prostate Cancer Map 2021.{''} Materials and Methods: Patient data between 1995 and 2020 were retrospectively scanned. The age of the patients, their distribution according to age groups, symptoms during diagnosis, examination findings {[}digital rectal examination (DRE)], prostate-specific antigen (PSA) values, biopsy methods in the diagnosis, metastatic disease rates, treatment methods, and progression rates at follow-up were examined. These results were compared with the results of the previous report, namely ``Prostate Cancer Incidence (Incidence) in Turkey,{''} by the Urooncology Association in Turkey in 2009. Results: This study analyzed the data of 5040 patients from 19 different centers. The mean patient age was 63.6 (37-97) years. The age distribution examination revealed that most patients (49.8\%) were aged 60-69 years. Of the patients, 51.8\% were symptomatic at the time of diagnosis. The presence of symptoms was determined in 88.6\% in 2009 data. The ORE of patients revealed that 25\% of patients had malignancy findings. The PSA distribution examination revealed a >10 ng/mL PSA value in 37.5\% of patients. With the increasing use of magnetic imaging resonance (MRI) in PCa diagnosis over the years, increased MR-fusion biopsy rates have been observed. Considering the biopsy data, 91\% of patients were diagnosed with a classical transrectal ultrasound-guided biopsy, whereas 9\% were diagnosed with MR-Fusion biopsy. Fusion biopsies revealed that 23\% of patients with Prostate Imaging-Reporting and Data System (PI-RADS) 4 lesion and 57\% with PI-RADS 5 lesion were diagnosed with cancer. Of the patients, 8.9\% of patients had metastases during the initial diagnosis. This rate was 17\% in 2009 data. The treatment methods examination after the diagnosis revealed that 73.9\% of patients had undergone radical prostatectomy. This rate was 51.8\% in 2009. Robotic and laparoscopic approaches, which are among the surgical modalities, have increased over the years. However, the most frequently applied modality in our country was open radical prostatectomy with 62.6\%. Considering the follow-up data after treatment, 8.9\% of patients had progression, of which 62.6\% was biochemical, 30.2\% was radiological, and 6.9\% was a clinical progression. Conclusion: Technological advancements for PCa diagnosis (MRI and MR-guided biopsies) are becoming a routine part of daily practice compared to the results of the ``Prostate Cancer Incidence in Turkey{''} project in 2009. The comparative study results revealed that the rate of symptomatic and metastatic disease decreases at the time of diagnosis, and laparoscopic and robotic surgery methods are used at increasing rates for localized disease.Item Estimation of secondary cancer risk after radiotherapy in high-risk prostate cancer patients with pelvic irradiation(WILEY, 2020-01-01) Haciislamoglu, Emel; Gungor, Gorkem; Aydin, Gokhan; Canyilmaz, Emine; Guler, Ozan Cem; Zengin, Ahmet Yasar; Yenice, Kamil MehmetWe aimed to estimate the risk of secondary cancer after radiotherapy (RT) in high-risk prostate cancer (HRPC) patients with pelvic irradiation. Computed tomography data of five biopsy-proven HRPC patients were selected for this study. Two different planning target volumes (PTV(1)and PTV2) were contoured for each patient. The PTV(1)included the prostate, seminal vesicles, and pelvic lymphatics, while the PTV(2)included only the prostate and seminal vesicles. The prescribed dose was 54 Gy for the PTV(1)with a sequential boost (24 Gy for the PTV2). Intensity-modulated RT (IMRT) and volumetric modulated arc therapy (VMAT) techniques were used to generate treatment plans with 6 and 10 MV photon energies with the flattening filter (FF) or flattening filter-free (FFF) irradiation mode. The excess absolute risks (EARs) were calculated and compared for the bladder, rectum, pelvic bone, and soft tissue based on the linear-exponential, plateau, full mechanistic, and specific mechanistic sarcoma dose-response model. According to the models, all treatment plans resulted in similar risks of secondary bladder or rectal cancer and pelvic bone or soft tissue sarcoma except for the estimated risk of the bladder according to the full mechanistic model using IMRT((6MVItem Computed tomography based evaluation of prostatic fiducial marker migration between the periods of insertion and simulation(AVES, 2017-01-01) Arpaci, Taner; Ugurluer, Gamze; Ispir, Emine Burcin; Eken, Alper; Akbas, Tugana; Serin, MeltemObjective: The aim of this study was to determine whether significant fiducial marker migration occurs between the periods of prostatic marker insertion and computed tomography (CT) performed for radiotherapy planning and if a waiting period is necessary. Material and methods: Thirty-nine patients with prostate adenocarcinoma underwent fiducial marker insertion before radiotherapy between June 2013 and December 2015. Three markers were inserted by one radiologist under the guidance of transrectal ultrasonography. All patients underwent CT three hours after insertion to confirm the number and position of fiducial markers. Radiotherapy planning CT was performed on an average of 11 days (range 7-20) after insertion. CT images were imported into treatment planning system to analyze the position of fiducial markers. Point-based marker match algorithm was used to find the distance of marker migration. The mean and maximum distances between each fiducial markers were calculated. Results: The mean distance of migration was 1.029+/-0.42 mm (range 0.23-1.93 mm) and the maximum distance was 1.361+/-0.59 mm (range 0.25-2.74 mm). The distance of marker migration was not statistically significant for the groups organized according to the timing of marker insertion, prostate volume, patient age, prostate specific antigen level and Gleason score. Conclusion: According to our results significant fiducial marker migration did not occur during the interval between insertion and treatment planning CT. It should be taken into consideration that performing simulation on the same day as marker insertion might prevent increased cost and delayed radiation therapy by saving the patients from extra visits to the clinic.Item Comparative Usefulness of High-frequency Doppler Ultrasonography, Serum PSA Density, and Free to Total Serum PSA Ratio in the Prediction of Prostate Cancer(GALENOS YAYINCILIK, 2020-01-01) Eren, Murat Tugrul; Guner, Numan DoguObjective: In this study, we tried to assess whether power Doppler ultrasonography (PDU) evaluation along with transrectal ultrasound (TRUS) has an additional benefit in the diagnosis of prostate cancer in patients with prostate-specific antigen (PSA) levels of 4-10 ng/mL, when combined with the other methods proposed for this range of PSA. Materials and Methods: Fifty-six patients with PSA values of 4-10 ng/mL were included in the study. Digital rectal examinations, evaluation of total and free PSA, and PDU assessments were done simultaneously with TRUS and eight-core systematic prostate biopsies. Along with the latter, additional biopsies were taken from the suspicious areas detected on PDU. The free/total PSA ratios, PSA density values, TRUS, PDU findings, and biopsy results of 56 patients were recorded and evaluated. Results: Specificity and positive predictive values in detecting prostate cancer in patients with PSA range of 4-10 ng/mL, calculated using the criteria of free/total PSA values <15\%, PSA density values >15\%, and PDU findings, were 94.87\% and 75\%, respectively. These values were significantly higher than those of 89.75\% and 69.73\%, respectively, defined for the criteria of free/total PSA values <15\% and PSA density values >15\%. Conclusion: The results of this study highlighted that PDU may be useful to detect prostate cancer, and decrease the number of unnecessary biopsy recommendations in patients with PSA values of 4-10 ng/mL, when used in combination with free/total PSA ratio and PSA density.Item Magnetic Resonance - Transrectal Ultrasound Fusion Guided Prostate Biopsy(GALENOS YAYINCILIK, 2016-01-01) Argun, Omer Burak; Obek, Can; Kural, Ali RizaProstate 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.Item The Comparison of Conventional and Retzius-Sparing Robot-Assisted Radical Prostatectomy for Clinical, Pathological, and Oncological Outcomes(GALENOS YAYINCILIK, 2022-01-01) Karsiyakali, Nejdet; Ozgen, Mahir Bulent; Ozveren, Bora; Durak, Haydar; Saglican, Yesim; Turkeri, LeventObjective: This study aimed to assess and compare the conventional and Retzius-sparing robot-assisted radical prostatectomy (cRARP and RsRARP) in term of perioperative clinical, pathological, and oncological outcomes. Materials and Methods: This study included 238 consecutive male patients who underwent RARP between May 2008 and November 2020. RARP operations were performed by a single-surgeon. Patients were divided into groups according to the surgical approach and were statistically compared in terms of perioperative clinical, final pathological, and oncological outcomes. Results: The mean age of patients was 64 +/- 7 years. cRARP was performed in 134 (56.3\%) patients, whereas RsRARP in 104 (43.7\%). The frequency of patients with the American Society of Anesthesiologists Class-2 score was higher in the RsRARP group (p<0.001). The median surgery duration was 300 (270-360) min. The median surgery duration was shorter in RsRARP group (290 vs. 330 minute) (p<0.001). No difference was found between the groups in terms of estimated blood loss and postoperative complication rates (p=0.112 and p=0.182, respectively). No difference was found between the groups when they were compared for surgical margin positivity (p=0.453). Although not statistically significant, the frequency of surgical margin positivity with pT3a/pT3b disease was higher in patients who underwent cRARP (p=0.412 and p=0.261, respectively). At a median follow-up of 13 (6-36) months, no difference was found between the groups in terms of biochemical recurrence at months-3,-6,-9,-12,-18,-24, and-30, respectively (p>0.05, for each). Conclusion: RsRARP allows a safe operation with a shorter surgical time and similar surgical margin positivity, oncological outcomes, and complication rates compared to cRARP.Item Effect of Temperature and Humidity on Serum Prostate Specific Antigen Levels in Asymptomatic Male Population(GALENOS YAYINCILIK, 2016-01-01) Eren, Murat Tugrul; Ozveri, Hakan; Cosgun, ErdalObjective To determine the possible effect of climate parameters on prostate specific anigen (PSA) levels. Materials and Methods Among 2.150 males, 757 individuals participating in a general checkup service at our hospital group in the past one year were enrolled in this study. The mean age was 48.52 and all the individuals underwent PSA screening tests, abdominal ultrasonography examinations including prostatic evaluation, and urine examinations including microscopic evaluation. The data on climate parameters including daily minimum and maximum temperatures and their average values as well as daily moisture levels were obtained from the records of the Turkish State Meteorological Service, including 2 meteorological stations existed in the Anatolian part of Istanbul. First of all, the differences in climatic parameters between the two stations were analyzed. Then, the relationship of PSA levels with daily minimum, maximum and average temperatures along with moisture levels recorded by the two stations was statistically evaluated. Results The mean age of the subjects was 48.52 (15-90) years and the percentage of individuals in age groups below 30, 31-40, 41-50 and over 50 were 5.2\%, 23.2\%, 31.8\%, and 39.8\%, respectively. The mean prostate volume measured by ultrasonography was 30.52 ml which increased with age in compatible with the literature. The mean PSA value was 1.19 ng/ml in all age groups. PSA values were higher in older participants and in those with larger prostate volume. Only PSA and mean humidity levels were statistically different between the two stations (p<0.05). When all parameters of temperature and humidity were grouped according to the months and seasons, it was found that there was no statistically significant difference in PSA levels between the groups (p>0.05 for all parameters). As for months and seasons, a statistically significant difference was observed between four seasons in all parameters of temperatures and humidity levels (p<0.001), but this finding was not valid for alterations in PSA levels in these seasonal intervals. No significant relationship was found between the presence of white blood cells in urine and PSA levels and seasons seemed to have no statistically significant effect on the presence of leukocytes in urine (p>0.18 and p>0.5, respectively). Conclusion Since any proven effect of climate on PSA will increase the sensitivity of PSA in diagnosing prostate cancer and may prevent the decision of an unnecessary biopsy, humidity with a possible influential effect on serum PSA level according to our study definitely needs clarification and confirmation. Therefore, future studies including large number of subjects with detailed data facilitating calculation of thermal sensation are needed to give clearer answers to this topic.