A Retrospective Analysis of 83 Patients with Testicular Mass Who Underwent Testis-Sparing Surgery: The Eurasian Uro-oncology Association Multicenter Study.

INTRODUCTION: Herein, we analyzed the histopathological, oncological and functional outcomes of testis-sparing surgery (TSS) in patients with distinct risk for testicular cancer. METHODS: This is a multicenter retrospective study on consecutive patients who underwent TSS. Patients were categorized in high- or low-risk testicular germ cell tumor (TGCT) according to the presence/absence of features compatible with testicular dysgenesis syndrome. Histology was categorized per size and risk groups. RESULTS: TSS was performed in 83 patients (86 tumors) of them, 27 in the high-risk group. Fifty-nine patients had a non-tumoral contralateral testis present. Sixty masses and 26 masses were benign and TGCTs, respectively. No statistical differences were observed in mean age (30.9 ± 10.32 years), pathological tumor size (14.67 ± 6.7 mm) between risk groups or between benign and malignant tumors (p = 0.608). When categorized per risk groups, 22 (73.3%) and 4 (7.1%) of the TSS specimens were malignant in the high- and low-risk patient groups, respectively. Univariate analysis showed that the only independent variable significantly related to malignant outcome was previous history of TGCT. During a mean follow-up of 25.5 ± 22.7 months, no patient developed systemic disease. Local recurrence was detected in 5 patients and received radical orchiectomy. Postoperative testosterone levels remained normal in 88% of those patients with normal preoperative level. No erectile dysfunction was reported in patients with benign lesions. CONCLUSION: TSS is a safe and feasible approach with adequate cancer control, and preservation of sexual function is possible in 2/3 of patients harboring malignancy. Incidence of TGCT varies extremely between patients at high and low risk for TGCT requiring a careful consideration and counseling.

Effects of Androgen Deprivation Therapy on the Extraocular Muscles, Retrobulbar Orbital Fat and the Optic Nerve in Patients with Prostate Cancer.

INTRODUCTION: To evaluate radiologically the effects of long-term Luteinizing hormone-releasing hormone (LHRH) agonist therapy on extraocular muscle thickness, retrobulbar orbital fat (ROF), and optic nerve (ON) in prostate cancer (PCa) patients. METHODS: This retrospective study included patients with primary or recurrent PCa who received androgen deprivation therapy (ADT) for at least 12 months. Each patient underwentallium-68 prostate-specific membrane antigen positron emission tomography-computed tomography (Ga-68 PSMA PET/CT) both before and at the end of the 12-month treatment. Thickness of the ON, lateral rectus muscle (LRM), medial rectus muscle (MRM), superior rectus muscle (SRM) and the inferior rectus muscle (IRM) were measured by using the coronal CT sections in soft tissue window. ROF, ocular protrusion and ON length were measured in sagittal and coronal planes. Changes in these anatomical structures induced by LHRH analogs were investigated by comparing pre- and post-treatment measurements. RESULTS: A total of 57 patients were included in the study. Median PSA and TT values of the patients before treatment were 36.5 ng/mL (range, 19.6-51.2) and 614.0 ng/dL (range, 472.0-743.0), respectively, and these values decreased significantly after the treatment (10.6 [range, 5.2-14.2] ng/mL and 36.5 [range, 19.6-51.2] ng/dL, p<0.001 for both). After the treatment, there was a statistically significant decrease in the areas of IRM, SRM, LRM, and MRM (for each, p<0.001), while significant increases were observed in ROF (11.9%, p<0.001) and ON thickness (14.3%, p=0.004). The amount of ocular protrusion also showed a significant increase of approximately 14% after the treatment (14.0 [range, 12.0-16.0] mm vs. 16.0 [range, 14.0-17.2] mm, p<0.001). DISCUSSION/CONCLUSION: Our findings indicated for the first time that ADT causes a decrease in extraocular muscle mass and an increase in ROF with ocular protrusion. It can be asserted that these changes are similar to the changes in skeletal muscle and fat mass in other body parts. Further studies with a higher level of evidence are needed to clinically evaluate the increase in ocular protrusion and ON enlargement, which are likely to be caused by the increase in ROF.

Multiple Endoclip Retraction Technique (MERT) in Laparoscopic Burch.

Background and Objectives: The multiple endoclip retraction technique (MERT) was developed based on our experience with suturing renal parenchyma in laparoscopic partial nephrectomy. In this study we prospectively evaluated the one-year results of cases treated by transperitoneal laparoscopic Burch with the MERT. Methods: The patients were evaluated with stress test, one-hour pad test, and were requested to complete the International Continence Society Incontinence Questionnaire short form (ICIQ-SF) in the postoperative period. The follow-up periods were postoperative 3, 6, and 12 months. Results: The primary outcome of this study was surgical success, defined as being cured of stress urinary incontinence (SUI) (no symptoms), experiencing improved symptoms of SUI in ICIQ-SF and negative stress test, and less than 2g urine leakage in a one-hour pad test.No statistically significant difference was found in terms of age, number of children, and body mass index (BMI) in patients according to the results of the 12 month postoperative stress test. We found statistically significant improvements at all control months in terms of stress test and pad weight. ICIQ-SF results showed a significant decrease at three months in patients who recovered after the operation. This rate has not changed in following control months. However, there was no statistical change in ICIQ-SF values in patients who did not recover after the operation. Conclusion: MERT seems to be one of the safe and effective modifications in the management of SUI with good one year outcomes when performed by suitably trained experienced surgeons.

A Prospective Study and Single-Center Experience: Effectivity of Fusion Prostate Biopsy in Biopsy-Naïve Patients.

Objective Fusion prostate biopsy (FPB) has become a popular technique in biopsy-naïve patients, though not accepted as a standard approach (yet). In this study, we aimed to present the clinical outcomes of biopsy-naïve patients who underwent FPB. Material and methods The study included 400 biopsy-naïve patients aged 45-75 years who had a prostate-specific antigen (PSA) level of 2-10 ng/ml and were detected with a Prostate Imaging-Reporting and Data System (PIRADS) ≥3 lesion on multiparametric prostate magnetic resonance imaging (mpMRI)-guided FPB. A combined biopsy (CB) was performed in each patient, in which 2-4 cores were obtained for suspicious lesions by targeted biopsy (TB) and then 12-core standard prostate biopsy (SPB) was conducted in the same session. Cancer detection rates, clinically significant prostate cancer (csPCa) detection rates, histological upgrading rates, and false negative rates were determined. Results The 400 patients had a mean age of 62.01±7.00 years and a mean PSA value of 6.84±1.87 ng/ml. Overall PCa detection rate was 50% (200/400). The csPCa detection rates for TB, SPB, and CB were 25.0%, 31.8%, and 44.0%, respectively (p<0.001). In PIRADS 3, 4, and 5 lesions, CB had a csPCa detection rate of 29.2%, 54%, and 64.8%, respectively (p<0.001). The ratio of false negativity was significantly higher for TB compared to SPB (43.2% vs. 27.8%, p=0.003), whereas no significant difference was found between these two techniques with regard to upgrading rates although TB had a higher rate (19.6% vs. 13.7%, p=0.144). Conclusion FPB, a combined approach involving TB and SPB, was revealed as the most successful technique in biopsy-naïve patients with PSA<10 ng/ml due to its high cancer detection rates and low false negative rates.

Is Tadalafil an Effective Treatment Option for Interstitial Cystitis/Painful Bladder Syndrome? A Report of a Challenging Case.

Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic pelvic pain (CPP) syndrome that is frequently seen in female patients. Since its molecular mechanism and etiopathogenesis are not clearly elucidated, its treatment options are limited. Phosphodiesterase-5 (PDE-5) inhibitors act on nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) and are an effective treatment option in some CPP syndromes. We discuss the case of a 44-year-old female patient who presented to our clinic with a two-year history of frequent urination and pain in the pelvic area. The cystoscopy of the patient, who did not benefit from first- and second-line treatments, was normal. With the diagnosis of IC/PBS, she was started on tadalafil (oral) 5 mg/day. At the end of a total of 12 months of follow-up, it was observed that the patient's symptoms significantly regressed. Based on our findings, the relaxing effect of PDE-5 inhibitors on the bladder neck/detrusor muscle and the vasodilator effect on the blood supply to the pelvic organs may have improved the patient's symptoms. In this case report, for the first time in the literature, we present the clinical outcomes of treatment with tadalafil (5 mg/day), which is a PDE-5 inhibitor, in a female patient with IC/PBS who did not respond to first-and second-line treatments. The results indicated that tadalafil, which shows activity through the NO-cGMP and prostaglandin pathway, is a potential alternative in IC/PBS patients resistant to conventional first- and second-line treatments.

Risk Factors for Early Urethral Stricture After Mono-Polar Transurethral Prostate Resection: A Single-Center Experience.

Aim This study aimed to investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate (TURP) and the risk factors affecting the development of urethral stricture in patients treated in our clinic. Material and methods This retrospective study included patients who underwent TURP due to benign prostate hyperplasia (BPH) and had complete postoperative follow-up data of at least 12 months. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between urethral stricture and eight parameters (age, body mass index [BMI], prostate volume, number of comorbidities, amount of tissue removed, operative time, perioperative blood loss, and catheterization duration). Results Of the 3069 patients who underwent TURP in our clinic during the study period, 1740 patients with complete clinical data were included in the study. Mean age was 67.83 ± 5.80 years and mean body mass index (BMI) was 27.63 ± 4.31 kg/m2. Median preoperative prostate volume was 50.0 (range, 41.0-62.0) mm3 and the average amount of tissue removed during surgery was 20.0 (range, 12.0-30.0) g. Urethral stricture was detected in 3.9% (67/1740) of the patients during a minimum of 12 months of follow-up period after TURP. In multivariate analysis, prolonged operative time and high comorbidity burden were found to be risk factors for urethral stricture (p<0.001 for both). Conclusion Early urethral stricture remains an important complication of TURP. Our results show that prolonged operative time and high comorbidity burden are factors that increase the risk of urethral stricture.

Clinical factors for predicting malignancy in patients with PSA < 10 ng/mL and PI-RADS 3 lesions.

AIM: To determine clinical risk factors in patients with PI-RADS 3 lesions and prostate-specific antigen (PSA) < 10 ng/mL. METHODS: In this prospective study, all patients underwent multiparametric magnetic resonance imaging. Following the 2-5 core fusion-targeted biopsy, standard 12-core prostate biopsy was performed in each patient (combined biopsy). The cutoff values were calculated with receiver-operating characteristic analysis. First, univariate logistic regression analysis was used to evaluate the relationship between total eight parameters and prostate cancer. Subsequently, multiple logistic regression analysis was performed to the parameters associated with prostate cancer. RESULTS: Two hundred and eighty-eight patients were included in the study. Some clinical parameters are determined to be significant in univariate and multiple logistic regression analyses, including PSA, free/total PSA ratio, PSA density (PSA/total prostate volume), positive family history of PCa, and PI-RADS 3 lesion diameter. Patients were classified between 0 and 5 according to the number of risk factors. While the risk of cancer was 7.1% in patients with one or less risk factors, the PCA rate was 45.2% among patients with all risk factors. CONCLUSION: In patients with PI-RADS 3 lesion and PSA < 10 ng/mL, histopathological results of biopsy can be estimated with higher accuracy using some clinical parameters.

Comparison of the Effects of Four Treatment Techniques Commonly Used in Ureteral Stone Treatment on Patients' Daily Physical Functioning: An Observational Randomized-Controlled Study.

Objective: To investigate the effect of four different techniques used in the treatment of ureteral stones on patients' daily physical functioning (PF) and quality of life (QoL). Materials and Methods: Patients who underwent ureterorenoscopy (URS)-with or without Double-J stenting (DJS)-and extracorporeal shock wave lithotripsy (SWL) were divided into four groups: Group I: SWL (n = 29), Group II: URS (n = 43), Group III: URS +4.8F DJS (n = 39), Group IV: URS +6F DJS (n = 42), and Group V: Control (n = 30). Short Form-36 (SF-36) was administered to each participant both preoperatively and 14 days after operation. Based on the SF-36 results, the changes in patients' PF and QoL were evaluated. Results: Ureteral stone treatment was performed in 202 patients. Of these, 153 patients who underwent an effective SWL or URS procedure in the first attempt were included in the study. Success rates in the first session were 53.7% (29/54) and 83.8% (124/148) for SWL and URS, respectively (p < 0.001). All the four groups were similar with regard to age, gender, body mass index, stone size, preoperative PF, and QoL. However, although postoperative PF, role limitations due to physical health, and energy/fatigue scores were similar in Group I, III, and IV, they were significantly higher in Group II. No major complication associated with SWL or URS occurred in any patient. However, in Group 2, DJS was inserted in three (7.7%) patients in the early postoperative period (within the first 48 hours) due to renal colic attacks secondary to ureterovesical junction mucosal edema. Conclusion: URS without DJS seems to be the most advantageous technique in the treatment of ureteral stones in terms of daily PF and QoL. However, it should be noted that patients undergoing URS may require postoperative emergency stenting, although rarely.

What is the ideal number of biopsy cores per lesion in targeted prostate biopsy?

BACKGROUND: The number of cores to be obtained in targeted biopsy (TB) is important. This study aimed to evaluate the TB outcomes in suspicious prostate lesions classified according to the Prostate Imaging Reporting and Data System (PI-RADS) and to determine the ideal number of biopsy cores per lesion. METHODS: This retrospective study included patients who underwent multiparametric magnetic resonance imaging-guided fusion prostate biopsy owing to increased serum prostate-specific antigen (PSA) levels and suspicious digital rectal examination outcomes in our institute. Patients with PI-RADS <3 lesions, PSA levels >10 ng/ml, and a prior diagnosis of prostate cancer (PCa) (active surveillance) were excluded from the study. The number of biopsy cores to be obtained from each lesion was determined by the clinician. RESULTS: The study included a total of 418 patients and 684 lesions. Among PI-RADS 3 lesions, clinically significant PCa (sPCa) detection rate was similar in the lesions from which 2 and 3 cores were obtained (9.1% and 10.0%, respectively), whereas it was relatively higher in the lesions from which 4 biopsy cores were obtained (18.5%). Among PI-RADS 4 lesions, sPCa detection rate was similar in the lesions from which 3 and 4 cores were obtained (35.6% and 32.3%, respectively), whereas it was relatively lower in the lesions from which 2 biopsy cores were obtained (17.9%). Among PI-RADS 5 lesions, however, sPCa detection rate was similar in the lesions from which 2, 3, or 4 cores were obtained (47.6%, 46.0%, 48.9%, respectively). CONCLUSION: The results indicated that the ideal number of cores to be obtained from each suspicious lesion in TB depends on the characteristics of the lesions. Accordingly, while obtaining 2-3 biopsy cores could be adequate in PI-RADS 4 and 5 lesions, which have a serious risk of cancer, a minimum of 4 biopsy cores should be obtained from PI-RADS 3 lesions to ensure accurate histopathological results.Clinical trial number (ClinicalTrials.gov)NCT03936296.

Symptomatic paraganglioma of the urinary bladder: A rare case treated with a combined surgical approach.

Pheochromocytomas are tumors of the embryonic chromaffin cells, originating from the embryonic neural crest. The pheochromocytomas developing at extra-adrenal locations are termed paragangliomas, which are extremely rare and account for almost 0.06% of all bladder tumors. In this report, we present a 23-year-old woman who presented with a one-year history of repeated episodes of dizziness, hypertension, intermittent hematuria, and nausea/vomiting that occurred during urination and was operatively treated due to a diagnosis of paraganglioma of the urinary bladder.

Turkish Urologists' preferences regarding antibiotic prophylaxis for transrectal prostate biopsy.

OBJECTIVE: Antibiotic prophylaxis for transrectal prostate biopsy (PB) is very important in preventing infectious complications, and in this study, we aimed to evaluate the antibiotic preferences of Turkish urologist for transrectal PB. MATERIAL AND METHODS: The survey about PB and antibiotic prophylaxis behaviors was administered to urologists working in Turkey who had previously participated in at least one international and one national congress. RESULTS: A total of 237 urologists were included in the study. Antibiotic prophylaxis prior to PB was performed by 234 (98.7%) participants. Rectal swabbing prior to PB was not performed by 227 (95.8%) participants. The most common complication associated with PB was prostatitis (63%), followed by urinary tract infection (29%). Only 25.7% of Turkish urologists reported a single dose of antibiotic prophylaxis. Our participants often administered antibiotic prophylaxis for a period of 3, 5, or 7 days (16%, 21.1%, 35.9%, respectively). The most common antibiotic agent preferred for prophylaxis was ciprofloxacin (65%). CONCLUSION: The biopsy behavior of Turkish urologists was mostly compatible with the literature, but it was revealed that Turkish urologists do not prefer single-dose antibiotic therapy, and their practice patterns regarding the administration of pre-biopsy rectal swabbing are inconsistent with the literature.

Comparison of pain levels in fusion prostate biopsy and standard TRUS-Guided biopsy.

OBJECTIVES: Fusion prostate biopsy (FPB) has recently emerged as a popular and successful biopsy technique on diagnosis of prostate cancer. The aim of this study was to compare the pain levels in TRUS-guided standard 12-core prostate biopsy (SPB) and MpMRI-guided FPB. MATERIALS AND METHODS: Patients detected with a PI-RADS (Prostate Imaging Reporting and Data System) ≥3 lesion on MpMRI underwent MpMRI-guided FPB (Group I) and the patients who had no suspected lesions or had a PI-RADS<3 lesion on MpMRI underwent TRUS-guided SPB (Group II). Pain assessment was performed using Visual Analog Scale (VAS) five minutes after the procedure. Following the procedure, the patients were asked to indicate the most painful biopsy step among the three steps. RESULTS: 252 patients were included in this study (Group I=159, Group II=93). The mean number of cores and the malignancy detection rate were significantly higher in Group I compared to Group II (p<0.001, p=0.043, respectively). No significant difference was found between the two groups with regard to VAS scores (p=0.070). The most painful part of the whole procedure was revealed to be the insertion of the probe into the rectum. However, no significant difference was found between the two groups with regard to the most painful biopsy step (p=0.140). CONCLUSION: FPB, with a relatively higher cancer detection rate, leads to the same pain level as SPB although it increases the number of biopsy cores and involves a more complex procedure compared to SPB. Further prospective studies with larger patient series are needed to substantiate our findings.

Risk factors associated with pain in fusion prostate biopsy.

BACKGROUND: Multiparametric prostate magnetic resonance imaging (mpMRI)-guided fusion prostate biopsy is an emerging technique in the diagnosis of prostate cancer and provides extensive information on the prebiopsy anatomy of the prostate, anus, and rectum. We aimed to investigate the clinical and anatomical risk factors aggravating the pain experienced by patients undergoing mpMRI-guided fusion prostate biopsy. METHODS: The prospective study included 319 patients aged 45-75 years who had a prostate-specific antigen <10 ng/ml and a Prostate Imaging Reporting and Data System ≥3 lesion and underwent combined biopsy (targeted biopsy + 12-core standard prostate biopsy) under local anesthesia (intrarectal lidocaine gel + periprostatic nerve block). Immediately after the biopsy procedure, pain assessment was achieved using Visual Analog Scale (VAS). The relationship between the VAS and 13 clinical parameters was evaluated using ordinal logistic regression analysis. RESULTS: The 319 patients had a mean age of 62.39 ± 6.98 years and a median prostate-specific antigen level of 7.20 (range, 5.20-8.50) ng/ml. The VAS was found to be correlated with 4 of 13 parameters, including (i) a shorter prostate-anus surface distance (cutoff value, 55.5 mm), (ii) a narrower anorectal angle (cutoff value, 106.5°), (iii) a larger total prostate volume (cutoff, 61.6 mm3), and (iv) having no history of prior biopsy (biopsy-naive patients). CONCLUSION: Anatomical measurements that can be achieved by using mpMRI images (TPV, PASD and ARA) may be useful in the identification of patients at an increased risk of pain during biopsy and also in taking analgesic precautions in such patients.

A Comparative Study: Has MRI-guided Fusion Prostate Biopsy Changed the Prostate-specific Antigen Gray-zone Range?

Objective The gray-zone prostate-specific antigen (PSA) range is accepted to be 4-10 ng/ml and is considered to vary according to age. We aimed to investigate whether fusion prostate biopsy (FPB), which has been reported to have relatively higher cancer detection rates, has an effect on gray-zone PSA cut-off value. Material and methods This retrospective study included patients that underwent standard prostate biopsy (SPB) or multiparametric magnetic resonance imaging (MpMRI)-guided FPB (SPB+ targeted biopsy). All the patients included in the study were detected with a Prostate Imaging Reporting and Data System (PI-RADS) ≥3 lesion on MpMRI (the FPB group only). The demographics, clinical characteristics, and histopathological diagnoses were recorded for each patient. Results A total of 1,628 patients comprising 1,208 patients in the SPB group and 420 patients in the FPB group were included in the study. The mean PSA level was 9.75±6.68 ng/ml in the FBP group and 10.46±6.46 ng/ml in the SPB group (p=0.053). Prostate cancer (PCa) detection rate was significantly higher in the FPB group as compared to the SPB group (42.4% vs. 36.4%). The PSA cut-off value for PCa was 9.75 ng/ml (sensitivity and specificity, 81%) in the SPB group and was 7.55 ng/ml (sensitivity and specificity, 81% and 84%, respectively) in the FPB group. In the FPB group, the cancer detection rate among the patients with a PSA level of 7.55-10.00 ng/ml was 56.1%. Conclusion The results indicated that the introduction of FPB into clinical practice, which has relatively higher cancer detection rates, has further lowered the upper limit for gray-zone PSA.

Comparison of the Upgrading Rates of International Society of Urological Pathology Grades and Tumor Laterality in Patients Undergoing Standard 12-Core Prostate Biopsy versus Fusion Prostate Biopsy for Prostate Cancer.

BACKGROUND: Histopathological discrepancies between biopsy and radical prostatectomy (RP) specimens may lead to unnecessary, excessive, or incomplete treatment in prostate cancer (PCa) patients. OBJECTIVES: To compare the upgrading rates of International Society of Urological Pathology (ISUP) grades and tumor laterality in patients that underwent standard 12-core transrectal ultrasound-guided standard prostate biopsy (SPB) versus multiparametric magnetic resonance-guided fusion prostate biopsy (FPB) for PCa. METHODS: This retrospective study included 152 patients that underwent prostate biopsy and RP in our clinic. The patients were divided into 2 groups: Group A (n = 90) included patients that underwent SPB and Group B (n = 62) included patients that underwent FPB (targeted biopsy + standard biopsy). Upgrading of ISUP grades, tumor laterality, and upgrading of tumor laterality were compared between the 2 groups. Upgrading of tumor laterality defined as detection of tumor at both lobes in RP pathology while it was at unilateral lobe in biopsy pathology. RESULTS: ISUP grade 1 was the most common histopathology in both groups. The ISUP upgrading rate on final pathology was significantly lower in the FPB group compared to the SPB group (22.7 vs. 37.7%; p < 0.048). Similarly, the upgrading rate of tumor laterality was lower in the FPB group compared to the SPB group (37.7 vs. 9.7%; p < 0.001). CONCLUSION: The results suggested that FPB can provide more accurate results compared to SPB.

Can the expression level of PIWIL 2 gene be a serum marker for prostate cancer? A single-center prospective study.

OBJECTIVE: The aim of the present study was to evaluate the predictive value of the serum expression level of Piwi-like 2 (PIWIL2), a stem cell protein, for prostate cancer (PCa). MATERIALS AND METHOD: This randomized and prospective study included a total of 60 volunteers between 50 and 75 years old. Cases were assigned to three groups according to prostate-specific antigen (PSA) elevations and pathology reports, with 20 participants in each group. The first group included patients with a PSA level of >4 ng/dL and with PCa, the second group included patients with a PSA level of >4 ng/dL and with benign prostate hyperplasia, and the third group included patients with a PSA level of ≤4 ng/dL and with benign prostate hyperplasia. The levels of serum PSA and PIWIL2 expressions were compared between the groups. RESULTS: The median serum PSA levels were 28.5 (4.6-98.1) ng/mL, 8.89 (4.3-24.1) ng/mL, and 2.4 (0.3-3.8) ng/mL for groups 1, 2, and 3, respectively. The PSA levels were significantly different between the groups (p<0.001). The median PIWIL2 gene expression levels were 2.54 (0.28-9.27), 2.27 (0.6-9.38), and 1.17 (0.26-3.07) for groups 1, 2, and 3, respectively. The PIWIL2 gene expression level was found to be lower in patients with a PSA level of <4 (p=0.02). No significant difference was observed between patients with and without cancer among those with a PSA level of ≥4 (p>0.05). Patients diagnosed with cancer were grouped according to the criteria of the International Society of Urological Pathology (ISUP), and PIWIL2 gene expression was observed to be significantly higher among patients with ISUP of >3 than among those with ISUP of ≤3 (p=0.04). CONCLUSION: In our study, it was observed that the serum level of PIWIL2 gene expression could not be a diagnostic indicator of PCa; however, it could be a beneficial prognostic indicator particularly for progressed disease.

Multiparametric MRI fusion-guided prostate biopsy in biopsy naive patients: Preliminary results from 80 patients.

OBJECTIVE: The aim of this prospective study was to evaluate the early results of transrectal prostate biopsies performed under the guidance of multiparametric prostate magnetic resonance imaging (mpMRI) in biopsy naive patients. MATERIAL AND METHODS: Biopsy naive patients who had prostate-specific antigen level 4-10 ng/mL and/or abnormal digital rectal examination findings and provided informed consent were examined using mpMRI. The study included 80 patients with an MRI-defined lesion with a Prostate Imaging and Reporting and Data System (PIRADS) score of ≥3. All mpMRIs were reported by the same uro-radiologist according to PIRADS version 2. An MRI-targeted biopsy was performed by an ultrasonography system with rigid fusion registration software. The first two to five core biopsies per MRI-defined lesions were obtained, and then a standard random 12-core biopsy was performed. Transrectal biopsies were performed under local anesthesia or sedoanalgesia. RESULTS: Of the 80 patients, 29 (36.3%) were found to have cancer using the conventional 12-core biopsy, but only 20 (25%) were found to have prostate cancer using the MRI-targeted prostate biopsy. Combining the two biopsy methods (conventional+MRI-targeted), cancer detection rate increased to 43.8% (35/80 patients). The cancer detection rate using the combined method was statistically higher than that using the conventional biopsy method (p=0.03). Using the conventional biopsy method, 960 core biopsies were collected from 80 patients. Of the 960 core biopsies, 111 (11.6%) were found to be cancer. Further, 101 suspected lesions were detected using mpMRI in 80 patients. In addition, 397 core biopsies were obtained from these lesions. Of the 397 core biopsies, 62 (15.6%) were reported as prostate cancer. The core positivity rate of MR-targeted biopsy was statistically higher than that of conventional biopsy (p=0.04). CONCLUSION: The preliminary results of MRI-targeted prostate biopsy combined with conventional biopsy suggested that the combined biopsy method was crucial in prostate cancer diagnosis especially in patients with prostate cancer suspicion and no biopsy history. However, larger sample prospective studies are needed to validate the effectiveness of MRI-targeted biopsy and combined biopsy methods.

A Single-center Experience: Does MRI-guided Target Prostate Biopsy Meet Expectations?

Objective Target biopsy (TB) was defined to detect a higher rate of cancer with fewer cores. Today, however, the combined biopsy (CB; TB + standard prostate biopsy (SPB)) with even more cores has become more popular. We aimed to compare CB results with those of TB and SPB in patients in the gray zone and, based on the outcomes, to determine whether TB has achieved its goal based on the expectation that higher cancer detection rates can be attained with fewer cores. Materials and methods This prospective study included patients with a prostate imaging reporting and data system (PI-RADS) ≥3 lesion and serum prostate-specific antigen (PSA) <10 ng/ml who underwent CB. All patients underwent two to five core biopsies per suspicious lesion (TB). Then, an SPB was administered to the same patients and in the same sessions. For fusion biopsy procedures, a fusion ultrasonography device with rigid software was used. Results A total of 404 patients were included in the study. The rate of clinically significant prostate cancer (sPCa) detection in TB, SPB, and CB was 30.2%, 25.5%, and 38.4%, respectively (p<0.05). The highest sPCa detection rate per core was detected in TB. For these patients, the CB results were accepted as the reference standard and then the histopathological upgrading of the lesions detected by SPB and TB was determined. Accordingly, higher histopathological upgrade rates were detected in SPB (10% and 25.7%). Conclusion We can say that the philosophy of detecting more cancers with a low number of cores, which was created when defining TB, was partially unsuccessful.