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Item What Experts Think About Prostate Cancer Management During the COVID-19 Pandemic: Report from the Advanced Prostate Cancer Consensus Conference 2021(ELSEVIER, 2022-01-01) Turco, Fabio; Armstrong, Andrew; Attard, Gerhardt; Beer, Tomasz M.; Beltran, Himisha; Bjartell, Anders; Bossi, Alberto; Briganti, Alberto; Bristow, Rob G.; Bulbul, Muhammad; Caffo, Orazio; Chi, Kim N.; Clarke, Caroline; Clarke, Noel; Davis, Ian D.; de Bono, Johann; Duran, Ignacio; Eeles, Ros; Efstathiou, Eleni; Efstathiou, Jason; Evans, Christopher P.; Fanti, Stefano; Feng, Felix Y.; Fizazi, Karim; Frydenberg, Mark; George, Dan; Gleave, Martin; Halabi, Susan; Heinrich, Daniel; Higano, Celestia; Hofman, Michael S.; Hussain, Maha; James, Nicholas; Jones, Rob; Kanesvaran, Ravindran; Khauli, Raja B.; Klotz, Laurence; Leibowitz, Raya; Logothetis, Christopher; Maluf, Fernando; Millman, Robin; Morgans, Alicia K.; Morris, Michael J.; Mottet, Nicolas; Mrabti, Hind; Murphy, Declan G.; Murthy, Vedang; Oh, William K.; Onyeanunam, Ngozi Ekeke; Ost, Piet; O'Sullivan, Joe M.; Padhani, Anwar R.; Parker, Christopher; Poon, Darren M. C.; Pritchard, Colin C.; Rabah, Danny M.; Rathkopf, Dana; Reiter, Robert E.; Rubin, Mark; Ryan, Charles J.; Saad, Fred; Pablo Sade, Juan; Sartor, Oliver; Scher I, Howard; Shore, Neal; Skoneczna, Iwona; Small, Eric; Smith, Matthew; Soule, Howard; Spratt, Daniel; Sternberg, Cora N.; Suzuki, Hiroyoshi; Sweeney, Christopher; Sydes, Matthew; Taplin, Mary-Ellen; Tilki, Derya; Tombal, Bertrand; Turkeri, Levent; Uemura, Hiroji; Uemura, Hirotsugu; van Oort, Inge; Yamoah, Kosj; Ye, Dingwei; Zapatero, Almudena; Gillessen, Silke; Omlin, AureliusPatients with advanced prostate cancer (APC) may be at greater risk for severe illness, hospitalisation, or death from coronavirus disease 2019 (COVID-19) due to male gender, older age, potential immunosuppressive treatments, or comorbidities. Thus, the optimal management of APC patients during the COVID-19 pandemic is complex. In October 2021, during the Advanced Prostate Cancer Consensus Conference (APCCC) 2021, the 73 voting members of the panel members discussed and voted on 13 questions on this topic that could help clinicians make treatment choices during the pandemic. There was a consensus for full COVID-19 vaccination and booster injection in APC patients. Furthermore, the voting results indicate that the expert's treatment recommendations are influenced by the vaccination status: the COVID-19 pandemic altered management of APC patients for 70\% of the panellists before the vaccination was available but only for 25\% of panellists for fully vaccinated patients. Most experts (71\%) were less likely to use docetaxel and abiraterone in unvaccinated patients with metastatic hormone-sensitive prostate cancer. For fully vaccinated patients with high-risk localised prostate cancer, there was a consensus (77\%) to follow the usual treatment schedule, whereas in unvaccinated patients, 55\% of the panel members voted for deferring radiation therapy. Finally, there was a strong consensus for the use of telemedicine for monitoring APC patients. Patient summary: In the Advanced Prostate Cancer Consensus Conference 2021, the panellists reached a consensus regarding the recommendation of the COVID-19 vaccine in prostate cancer patients and use of telemedicine for monitoring these patients. (c) 2022 The Authors. 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/).Item 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, HideyukiThe 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/).Item Report of the third Asian Prostate Cancer study meeting(ELSEVIER INC, 2019-01-01) Lojanapiwat, Bannakij; Lee, Ji Youl; Gang, Zhu; Kim, Choung-Soo; Fai, Ng Chi; Hakim, Lukman; Umbas, Rainy; Ong, Teng Aik; Lim, Jasmine; Letran, Jason L.; Chiong, Edmund; Lee, Seung Hwan; Turkeri, Levent; Murphy, Declan G.; Moretti, Kim; Cooperberg, Matthew; Carlile, Robert; Hinotsu, Shiro; Hirao, Yoshihiko; Kitamura, Tadaichi; Horie, Shigeo; Onozawa, Mizuki; Kitagawa, Yasuhide; Namiki, Mikio; Fukagai, Takashi; Miyazaki, Jun; Akaza, HideyukiThe 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. (C) 2018 Asian Pacific Prostate Society, Published by Elsevier Korea LLC.Item 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, LeventObjective 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.Item Prostate volume effect on Gleason score upgrading in active surveillance appropriate patients(PAGEPRESS PUBL, 2019-01-01) Camur, Emre; Coskun, Alper; Kavukoglu, Ovunc; Can, Utku; Kara, Onder; Camur, Arzu Develi; Sarica, Kemal; Narter, Kamil FehmiIntroduction: Gleason Score (GS) upgrading rates in the literature are reported to be around 33-45\%. The relationship between prostate volume and GS upgrading should be defined, aiming to reduce upgrading rates in patients with low risk groups who are eligible for active surveillance (AS) or minimally invasive treatment, by varying biopsy cores, or lengths of cores according to prostate volumes. In this regard, the aim of our study was to establish the relationship between prostate volume and GS upgrading. Materials and methods: We retrospectively analyzed the medical records of 78 patients, who were appropriate for AS between 2011-2016 at our hospital. Inclusion criteria were patient age under 65 years, PSA level under 10 ng/ml, GS (3 + 3) or (3 + 4), and 3 or less positive cores, clinical stages <= T2. GS increase in radical prostatectomy specimen was considered as `upgrading' and in addition, score reported by biopsy as 3 + 4 but in surgical specimen as 4 + 3 were also considered as `upgrading'. The effect of prostate volume on Gleason grade upgrading was examined by calculating upgrading rates separately for patients with prostate volume 30 ml or less, those with 30 to 60 ml, and those over 60 ml. Results: As a result of the analysis of the data, upgrading was seen in 35 (44.8\%) of 78 patients included in the study. In the cohort mean prostate volume was 49.8 (+/- 26.3) ml. Twenty-two patients (28.2\%) had prostate volume 30 ml or less, 34 (43.6\%) 30 to 60 ml, and 22 (28.2\%) 60 ml or more. The patients were divided into two groups as those with and without GS upgrading. Between the groups prostate volume and prostate volume range (0-30/31-60/> 60) were not significantly different (p value > 0.05). Conclusions: Gleason grade upgrading causes patients to be classified in a lower risk group than they actually are, and may lead to inappropriate treatment. This condition has a direct effect on the decision of active surveillance. Therefore, it is important to define the factors that can predict GS upgrading in active surveillance appropriate patients. In this study, we found that prostate volume has no significant effect on upgrading in active surveillance appropriate patients.Item 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, UrooncologyObjective: 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.Item Risk Factors of Patients with Prostate Cancer Upgrading for International Society of Urological Pathology Grade Group 1 After Radical Prostatectomy(GALENOS YAYINCILIK, 2022-01-01) Ozgur, Abdurrahman; Ozgur, Gunal; Sahin, Bahadir; Filinte, Deniz; Tinay, Ilker; cam, Haydar Kamil; Turkeri, LeventObjective: This study aimed to determine the predictive factors for patients whose International Society of Urological Pathology (ISUP) score was upgraded in radical prostatectomy (RP) pathologies with a prostate biopsy pathology of ISUP grade group 1. Materials and Methods: Among patients who underwent RP in our clinic within 10 years, 158 patients with prostate biopsy pathology of ISUP grade group 1 were examined retrospectively. Age, serum prostate-specific antigen (PSA) level, prostate biopsy ISUP grade group, number of cores taken in the prostate biopsy, number of tumor-positive cores, RP pathology ISUP grade group, and pathological stage were evaluated. Results: The mean age (+/- standard) of the 158 patients whose prostate biopsy pathology was ISUP grade group 1 were 64.07 (+/- 6.6). ISUP group upgrading was detected in 47 patients (29.7\%). The mean PSA value of these patients was 10.6 ng/mL (+/- 6.9). The mean PSA value of the other 111 patients without ISUP group upgrading was 7.98 ng/mL (+/- 4.9). The serum PSA level was significantly higher in patients with upgraded ISUP in the RP pathology (p=0.02). The percentage of tumor-positive cores in the group with ISUP group upgrading (37\%) was significantly higher than that in the group without ISUP group upgrading (27\%) (p=0.01). The detection rates of surgical margin positivity (42.6\% vs. 18\%), capsule invasion (55.3\% vs. 19.8\%), and seminal vesicle invasion (23.6\% vs. 3.6\%) were also significantly higher in the upgraded ISUP group after RP (p<0.05). Conclusion: The results of this trial suggest that active surveillance may not be an appropriate option for patients with biopsy ISUP grade group 1 with PSA level >10 ng/mL. Moreover, the presence of a higher number and percentage of tumor-positive cores constituted risks of ISUP group upgrading with concomitant poor pathological outcomes such as surgical margin positivity, capsule invasion, and seminal vesicle invasion.Item Focal Therapy for Prostate Cancer: Current Status of HIFU(GALENOS YAYINCILIK, 2015-01-01) Ozkan, Tayyar Alp; Eskicorapci, SaadettinFirst choice treatment options for Prostate Cancer (PCa) are Radical Prostatectomy (RP), brachytherapy and pelvic radiation therapy in current guidelines. The aim of this paper was to review effectiveness and oncological results of high intensity frequency ultrasound treatment (HIFU) in patients with localized PCa. HIFU technology is based on a principle of focused ultrasound (US) waves in an area-sized 3x3x11 mm with a convex ultrasound probe. HIFU ablation was first successfully used in 1995 for 29 pre-radical prostatectomy patients with unilateral tumors (T2-T2b). This treatment option mostly used in Europe in US it has not been approved yet by Food and Drug Administration (FDA) and is used only for clinical trials. HIFU is a relatively new treatment method and 10 years of mid-term results for survival were began to emerge. HIFU biopsy success rates are about 80\%. There need to be more accurate and improved results in order to define it as a new definitive treatment option for prostate cancer. Although it has low success rates, it can be used for all risk groups (low, medium, high), it can be used as a rescue treatment after unsuccessful HIFU treatment, radiotherapy and brachytherapy.Item Laparoscopic Extraperitoneal Radical Prostatectomy(GALENOS YAYINCILIK, 2020-01-01) Tekin, Ali; Yuksel, Alpaslan; Taskiran, Arda Taskin; Senoglu, Yusuf; Kayikci, Muhammet AliRadical prostatectomy (RP) involves removing the entire prostate with its capsule intact and the seminal vesicles (SV). In this video article, we summarized the extraperitoneal laparoscopic RP with pelvic lymph node dissection procedure along with a video presentation of a case. The patient is placed in a Trendelenburg position. Through a small transverse infraumblical incision, the anterior rectus aponeurosis is identified and incised. The extraperitoneal surgical field is developed bluntly by a balloon dilator, and a 10 mm trocar is placed for the camera. CO2 insufflation at a 12-15 mmHg pressure is established, and the remaining trocars are placed. The fatty tissue is swept laterally to create a wide operative field. The endopelvic fascia is incised on both sides. The levator ani muscle fibers are separated from the lateral surface of the prostate. Dorsal vascular complex (DVC) is ligated with 2 consecutive sutures. Identification of the bladder neck (BN) is critical for proper dissection between the prostate and the BN. BN is incised until the catheter is seen. The urethral catheter is removed and a Bougie dilator is inserted through the urethra to elevate the prostate. With posterior oblique dissection, the vasa deferentia are exposed and clip-ligated, and SVs are identified and freed. Then, lateral pedicles are ligated with hemoclips and divided. Lateral dissection proceeds with an anterolateral incision from the base to the prostatic apex. The neurovascular bundles lie posterolateral to the prostate. Apical dissection and division of the DVC and urethra is a critical step to ensure a safe surgical margin and good postoperative erectile function and continence. The urethra is divided with a small rim on the prostate. The gland is totally freed, put into an endobag, and extracted. The vesicourethral anastomosis is done using two 3-0 monocryl sutures in a running fashion, starting from the posterior in both direction and tied together at the 12 o'clock position, anteriorly.Item 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, LeventObjective: 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