ASO Author Reflections: It Does Not Matter Whether Radical Prostatectomy is Performed in High-Risk Localized Disease or at the Oligometastatic Stage.

Radical prostatectomy (RP) alone has traditionally been considered insufficient for patients with high-risk localized prostate cancer (HRPC) owing to the frequent need for adjuvant salvage radiotherapy or androgen deprivation therapy (ADT) following surgery. Previously, systemic therapy, such as ADT, was the standard treatment for metastatic prostate cancer (PC) patients; RP was not considered viable for these patients. However, since 2015, there has been a recognition that metastatic PC patients can be categorized based on the extent of their metastases, leading to the consideration of RP for some metastatic cases. In recent years, the concept of cytoreductive RP has gained traction; studies suggest that it may improve survival rates in metastatic PC patients through mechanisms, such as tumor debulking and enhancement of the immune response. A meta-analysis of retrospective studies has shown that cytoreductive RP is associated with higher cancer-specific survival rates at 1-year, 3-year, and 5-year intervals compared with systemic therapy alone. In our study, which followed HRPC and oligometastatic PC patients for an average of 46 months, we observed biochemical recurrence in 17.8% of HRPC and 13% of oligometastatic patients, with overall survival rates of 96.4% and 87%, respectively. Although prospective or randomized studies are still lacking, current retrospective studies, including our own, suggest promising outcomes for RP in HRPC and oligometastatic patients. With the increasing prevalence of robotic surgery, improved pelvic anatomy observation, and growing surgical confidence, the realization of prospective randomized study results may not be far off.

Comparison of Complications and Mid-term Results for Patients who Underwent Open Radical Prostatectomy for High-Risk and Oligometastatic Prostate Cancer: A Cross-Sectional Study from a Tertiary Reference Center.

BACKGROUND: This study aimed to evaluate perioperative complications and oncologic results for high-risk and oligometastatic prostate cancer patients. METHODS: The data of patients who underwent surgery for prostate cancer in the authors' clinic between January 2012 and March 2022 were analyzed retrospectively. According to D'amico classification, 28 patients with high-risk prostate cancer and 23 patients in the oligometastatic stage were included in the study. The patients were divided into two groups: group 1 (high-risk prostate cancers) and group 2 (oligometastatic cancer). Demographic characteristics, oncologic data, pathologic data, and complications of the patients were recorded. RESULTS: The mean age of the patients was 67.84 years (range, 52-79 years). The average follow-up period was 45.48 months for group 1 and 46.36 months for group 2 (p = 0.84). The mean hemoglobin decrease was 1.53 g/dL in group 1 and 0.69 g/dL in group 2 (p = 0.046). Five patients (17.8%) in group 1 had biochemical recurrence at 14.55 months, whereas three patients (13%) in group 2 had biochemical recurrence at 9.87 months (p = 0.646). According to Clavien-Dindo classification, major complications developed in 7.2% of the group 1 patients and in 8.6% of the group 2 patients. Surgical margin positivity was detected in 6 group 1 patients (21.4%) and 12 group 2 patients (52.2%) (p = 0.023). During the follow-up period, four patients died. Only one of the patients died of cancer. CONCLUSION: The authors think that oligometastatic and high-risk prostate cancer surgeries do not differ significantly in terms of complications.

Comparison of HoLEP, ThuLEP and ThuFLEP in the treatment of benign prostatic obstruction: a propensity score-matched analysis.

PURPOSE: To compare the efficacy and safety of Holmium laser enucleation of the prostate (HoLEP), Thulium laser enucleation of prostate (ThuLEP) and Thulium fibre laser enucleation of prostate (ThuFLEP) by performing propensity score matched analysis (PSM). METHODS: We retrospectively analysed the patients who underwent HoLEP (Group 1, n = 696), ThuLEP (Group 2, n = 146) and ThuFLEP (Group 3, n = 193) surgery because of benign prostatic obstruction (BPO). A 1:1:1 HoLEP: ThuLEP: ThuFLEP group matching was performed using PSM analysis. Perioperative, postoperative functional outcomes and complications were analysed and compared. RESULTS: We observed significant improvement in functional parameters regarding IPSS, Qmax, PVR and quality of life in all groups compared to baseline values at the 1st, 6th and 12th postoperative months. There was no significant difference between different laser types in terms of urge (UUI) and stress urinary incontinence (SUI) at 1st postoperative month. In all three groups, no patient had postoperative SUI or UUI at 6th and 12th postoperative months. In addition, no significant difference was observed between laser types in terms of postoperative complications. CONCLUSION: HoLEP, ThuLEP and ThuFLEP are safe and effective LEP methods with improvement in functional parameters and low complication rates. Similar results in terms of functional outcomes and complications clearly show that these surgeries are alternatives to each other for the patients with BPO. Experts' opinions, practices and enucleation techniques should also be taken into consideration when choosing a laser for BPO surgery.

Does Formalin Disinfection Reduce Bacterial Colonization of Biopsy Needle? A Prospective Study.

OBJECTIVE: To investigate the efficacy of formalin disinfection of the needle tip in transrectal prostate biopsy (TRB) procedure to reduce infectious complications. The primary aim is to assess the impact of formalin on bacterial contamination of biopsy needle tips and its association with post-biopsy infective events. MATERIALS AND METHODS: We have employed a bacterial culture-based observational cohort design in this study. Two groups, formalin disinfection and non-formalin group, both underwent systematic 12-core TRB. In the formalin group, the biopsy needle tip was immersed in 10% formalin solution after each core, while in the non-formalin group, no formalin solution immersion was used. The primary outcomes include bacterial growth on biopsy needle tips and post-biopsy infective events. RESULTS: Formalin disinfection significantly reduced bacterial growth on needle tips (P <.001). The formalin group had no post-biopsy infections or sepsis, while the non-formalin group experienced a 7.5% infective event rate after TRB. CONCLUSION: Formalin disinfection of biopsy needle tip significantly reduces bacterial growth on biopsy needle and urinary tract infectious complications developed secondary to TRB. Further multicenter randomized controlled studies with larger cohorts are warranted to validate and establish formalin disinfection as a routine practice in TRB procedures.

Initial Experiences of Laparoscopic Nephrectomy in a Tertiary Oncology Center: An Analysis of 142 Cases.

INTRODUCTION: Kidney tumors have an important place among urological malignancies. The increased utilization of imaging methods has led to a rise in renal cell carcinoma (RCC) diagnoses, albeit with declining mortality rates, particularly in developed countries. Radical nephrectomy remains the gold standard treatment. The aim of this study was to share a tertiary oncology hospital's initial experiences with laparoscopic nephrectomy. MATERIALS AND METHODS: This retrospective study analyzes data from patients who underwent laparoscopic nephrectomy, focusing on demographic characteristics, tumor features, and operative outcomes. Information regarding age, gender, tumor size, operative details, and pathology results was collected and analyzed. RESULTS: One hundred forty-two patients were included in the study; 69 (48.60%) were female and 73 (51.40%) were male. The mean age of the patients was 57.11 ± 12.6 years, with tumors primarily located on the left kidney (52.80%). The mean tumor size was 53.01 ± 24.01 mm. Intraoperative complications included the need for conversion to open surgery in five cases and vascular, pneumothorax, or duodenal injuries in a subset of patients. However, postoperative complications, such as sepsis or mortality, were not observed. DISCUSSION: Despite an initial learning curve associated with longer operation times, laparoscopic techniques offer benefits, including reduced blood loss, faster recovery, and improved cosmetic outcomes. Histologically, clear cell RCC was the most common tumor type encountered. This study underscores the safety and efficacy of laparoscopic radical nephrectomy, advocating for its widespread adoption while emphasizing the importance of surgeon experience and patient selection in optimizing outcomes.

Does the Distance of the Tumor from the Surgical Margin Affect Biochemical Recurrence in Patients with Pathological Organ-Confined Prostate Cancer?

OBJECTIVE: To investigate the effect of the distance between tumor and surgical margin on biochemical recurrence in patients with organ-confined prostate cancer. MATERIAL AND METHOD: The data of 208 patients, who underwent radical prostatectomy between 2012-2018, were retrospectively analyzed. The surgical margin status of 147 pathologically organ-confined patients was categorized as positive, close ( < 1mm) and negative. Surgical margin status and parameters affecting biochemical recurrence were examined. Furthermore, multivariate analysis was done to determine the parameters associated with biochemical recurrence. RESULTS: Biochemical recurrence was detected in 21 (14.2%) of 147 patients. 38 (27.9%) men had negative surgical margins, 68 (46.2%) had close surgical margins and 41 (25.9%) had positive surgical margins. Tumor volume and ISUP grade were found to be statistically significant for positive surgical margin and close surgical margin patients compared to negative surgical margin patients. Close surgical margin was not statistically associated with biochemical recurrence. Preoperative high PSA (p < 0.001) and positive surgical margin (p=0.021) were independent risk factors for biochemical recurrence. CONCLUSION: According to our results, it is not necessary to include the presence of a close surgical margin in the pathology reports in patients with pathological organ-confined tumors and negative surgical margins.

Impact of diabetes mellitus on urinary continence after holmium laser enucleation of the prostate due to lower urinary tract symptoms: a retrospective study.

INTRODUCTION: Diabetes mellitus (DM) is known as a risk factor of stress urinary incontinence after Holmium laser enucleation of the prostate (HoLEP). We aimed to compare the postoperative continence status of patients with and without DM, after HoLEP surgery. MATERIAL AND METHODS: A total of 214 patients who underwent HoLEP between January 2017 and January 2020 were retrospectively assessed. Functional outcomes, perioperative total operation time (TOT)(min), enucleation time (ET)(min), enucleation efficiency (EE)(g/min), enucleated tissue weight (ETW)(g), morcellation efficiency (ME)(g/min), morcellation time (MT)(min), continence status, intraoperative and postoperative complications according to Clavien-Dindo classification were recorded. RESULTS: A total of 96 patients had DM additional to benign prostate hyperplasia (BPH) (Group 1), while 118 patients had only benign prostate hyperplasia without DM (Group 2). When comparing preoperative and postoperative functional outcomes, a statistically significant improvement was observed in both groups from baseline to the 1st and 6th month follow-up (p ≤0.001). There were no statistically significant differences between groups in postoperative stress urinary incontinence at postoperative months 1 and 6 (1.7% vs 2.1%, p = 1 and 0.8% vs 1%, p = 1; respectively). There was no significant difference between groups in intraoperative and postoperative complications (p >0.05). CONCLUSIONS: HoLEP is safe to perform in patients with DM at low complication and urinary incontinence rates.