Multiparametric Prostate Magnetic Resonance Imaging Before Radical Prostatectomy: Can it Predict Histopathology?

PURPOSE: We aimed to investigate the histopathological correlation of the suspected prostate malignancy detected in multiparametric prostate magnetic resonance imaging (mpMRI). MATERIALS AND METHODS: The data of 93 patients underwent radical prostatectomy and had preoperative mpMRI were examined. Age and pre-operative Prostate-Specific Antigen value were retrospectively collected from patient files. The pathology specimens were examined again and post-operative ISUP grade group, other pathological findings (seminal vesicle invasion, lymph node involvement and extraprostatic extension), pre-operative mpMRI were re-examined and PIRADS score, extracapsular extension, seminal vesicle invasion, neurovascular bundle invasion, lymph node involvement and ADC values were recorded. RESULTS: 151 (92,07%) of 164 lesions detected in mpMRI were histopathologically correlated. 80% of patients with seminal vesicle invasion (P < 0.001), 28.8% of patients with extracapsular extension (P < 0.052) and 42.9% of patients with lymph node involvement (P = .001) in mpMRI were histopathologically correlated. A significant relationship was found between PIRADS scores and ISUP grade groups (P < 0.001). There was a negative correlation between ADC values and ISUP grade groups (P < 0.001). CONCLUSION: Our study showed that the lesions detected by mpMRI showed a high histopathological correlation.

The effect of percutaneous nephrostomy implementation on the outcome of ureteroscopic stone treatment.

PURPOSE: We aimed to investigate the effect of percutaneous nephrostomy (PCN) implementation on the second ureteroscopy (URS) outcomes after a failed URS. MATERIALS AND METHODS: The data of four hundred forty-eight patients with an unsuccessful URS history were evaluated. Patients were divided into two groups; patients who underwent PCN before second URS (Group A) and patients who did not (Group B). We compared the stone access rate in the second URS between the two groups according to patient and stone characteristics and operative data. Then, group A was subdivided into two groups according to stone access as; access succeeded (Group A1) and access failed (Group A2). We also compared stone access rates between these two groups in terms of gender, age, body mass index, stone size, side, location, grade of hydronephrosis and PCN duration.  All data were available immediately after surgery and obtained from patient files and the outcome assessment was performed during the study period. RESULTS: Stone access rate was higher in group A than group B (143/196 vs 41/252, P = .0018). Mean nephrostomy duration and mean hydronephrosis grade were significantly higher and mean stone size was significantly lower in group A1 than group A2 (18.74 vs 9.62 days, P < .001; grade 3.25 vs 1.21, P = .038; and 7.286 vs 12.631 mm P < .001, respectively). CONCLUSION: PCN is a favourable intervention after a failed URS and increases the success rate of the second operation with ease of implementation and minimal morbidity.

Prognostic significance of body mass index and other tumor and patient characteristics in non-metastatic renal cell carcinoma.

PURPOSE: In this retrospective study, we aimed to investigate the prognostic effect of body mass index (BMI) in localized renal cell carcinoma (RCC) cases who underwent surgical treatment. Furthermore, the assessment of various patient and tumor characteristics and surgical methods on survival has been identified as additional targets. MATERIALS AND METHODS: Three hundred and eighty patients with localised, non-metastatic, unilateral RCC who underwent radical or partial nephrectomy in our clinic between January 2007 and December 2016 were enrolled in this study. Age, gender, height, weight, BMI, operation type and method, pathology results and tumor stage of the patients were recorded. Patients were divided into 3 groups according to body mass index (BMI): Normal weight(< 25 kg/m2), overweight (25-30 kg/m2) and obese (>30 kg/m2) as groups 1, 2 and 3, respectively. We analyzed the relation between the BMI, gender, smoking, hypertension, type and method of surgical treatment, histologic subtype, tumor stage, estimated glomerular filtration rate (eGFR) and cancer-specific (CSS) and recurrence free survival (RFS). All data analysis was performed using SPSS® Statistical Software for Windows (Version 13.0) and a P value less than 0.05 was considered to be significant. RESULTS: The effect of BMI on both CSS and RFS was statistically significant (P < .001). There was also a significant relation between smoking, operation type (partial/radical), eGFR and tumor stage and CSS and RFS. CONCLUSION: Our findings show that overweight and obese RCC patients according to the BMI have a more favorableprognosis. Multicenter, prospective studies with more cases and longer oncological follow-up period are needed to support these findings.

Whole-genome gene expression analysis in urine samples of patients with prostate cancer and benign prostate hyperplasia.

OBJECTIVE: There is an urgent need to find new biomarkers with higher specificity and sensitivity for using early detection of prostate cancer (PrCa) and reducing recurrent unnecessary biopsy rates, psychological and physical stress on the patient, and costs. Being noninvasive, urine-based tests might be suitable in routine practice. The aim of this study was to report the first whole-genome gene expression analysis in urine samples, as noninvasive method, that were obtained from PrCa, benign prostate hyperplasia (BPH), and control groups by using the microarray system from Turkey, to our knowledge. METHODS: Whole-genome gene expression profiling was conducted in urine samples of 25 patients with PrCa, 24 patients with BPH, and 11 healthy males by using the Illumina Hi Scan microarray system. RESULTS: The number of probes showing a significant change at the level of expression were 101 and 75 in PrCa-control and BPH-control comparison groups, respectively. Further, 51 of them were the same in both comparison groups. There was no significant change at the level of expression in PrCa-BPH comparison group. CONCLUSION: This study revealed several candidate biomarkers for early diagnosis of PrCa and contributed to the literature by detecting the differences of gene expression profiles in urine samples of PrCa-control and BPH-control comparison groups using the microarray. However, further studies are needed in larger groups.

Biochemical recurrence after radical prostatectomy: is the disease or the surgeon to blame?

PURPOSE: The PSA recurrence develops in 27 to 53% within ten years after radical prostatectomy (RP). We investigated the factors (disease grade and stage or the surgeon's expertise,) more likely to influence biochemical recurrence in men post-radical prostatectomy for organ-confined prostate cancer by different surgeons in the same institution. MATERIALS AND METHODS: A total of 510 patients that underwent radical prostatectomy were investigated retrospectively. Biochemical recurrence was defined as detection of a PSA level of ≥ 0.20 ng/mL by two subsequent measurements. The causes, which are likely to influence the development of PSA recurrence, were separated into two groups as those related to the disease and those related to the surgical technique. RESULTS: Biochemical recurrence was detected in 23.5% (120 cases) of 510 cases. The parameters most likely to influence biochemical recurrence were: PSA level (p < 0.0001), T stage (p < 0.0001), the presence of extracapsular invasion prostate (p < 0.0001), Gleason scores (p = 0.042, p < 0.0001) and the presence of biopsy with perineural invasion (p = 0.03). The only surgical factor that demonstrated relevance was inadvertent capsular incision during the surgery that influenced the PSA recurrence (p < 0.0001). CONCLUSION: The PSA recurrence was detected in 21.6% of patients who had been treated with radical prostatectomy within 5 years, which indicates that the parameters related to the disease and the patient have a pivotal role in the PSA recurrence.

Biochemical recurrence after radical prostatectomy: is the disease or the surgeon to blame?

PURPOSE: The PSA recurrence develops in 27 to 53 percent within ten years after radical prostatectomy (RP). We investigated the factors (disease grade and stage or the surgeon's expertise,) more likely to influence biochemical recurrence in men post-radical prostatectomy for organ-confined prostate cancer by different surgeons in the same institution. MATERIALS AND METHODS: A total of 510 patients that underwent radical prostatectomy were investigated retrospectively. Biochemical recurrence was defined as detection of a PSA level of > 0.20 ng/mL by two subsequent measurements. The causes, which are likely to influence the development of PSA recurrence, were separated into two groups as those related to the disease and those related to the surgical technique. RESULTS: Biochemical recurrence was detected in 23.5 percent (120 cases) of 510 cases. The parameters most likely to influence biochemical recurrence were: PSA level (p < 0.0001), T stage (p < 0.0001), the presence of extracapsular invasion prostate (p < 0.0001), Gleason scores (p = 0.042, p < 0.0001) and the presence of biopsy with perineural invasion (p = 0.03). The only surgical factor that demonstrated relevance was inadvertent capsular incision during the surgery that influenced the PSA recurrence (p < 0.0001). CONCLUSION: The PSA recurrence was detected in 21.6 percent of patients who had been treated with radical prostatectomy within 5 years, which indicates that the parameters related to the disease and the patient have a pivotal role in the PSA recurrence.

Prognostic factors for upper urinary tract urothelial carcinomas: stage, grade, and smoking status.

OBJECTIVES: Upper urinary tract urothelial carcinomas are relatively rare malignancies. The aim of this study was to investigate the factors affecting prognosis of patients undergoing nephroureterectomy. METHODS: Data of 140 patients undergoing nephroureterectomy were retrospectively analyzed. Age of patients, gender, focality and localization of tumor, clinical and pathological stage, relationship with bladder cancer (prior, synchronous, after), and history of smoking were retrospectively recorded. The condition of local recurrence, metastases to distant organs, and requirement of adjuvant treatment were evaluated. RESULTS: The disease-specific and recurrence-free 5-year survival rate was determined as 78.9 and 68.4%, respectively. Bladder recurrence was determined in 20 of the patients after a mean of 21 months (7-37 months). Relationship between the duration of recurrence and variables showed that patients with T2 and higher stages (P = 0.014), with high-grade tumors (P = 0.028), with multifocal tumors (P < 0.001), and patients who were cigarette smokers (P = 0.010) had significantly shorter durations of recurrence. The mean survival of the 19 (18.1%) patients who had distant metastases was 19 months. Pathological stage T2 and higher tumors (P = 0.006), nodal involvement (P = 0.04), high-grade urothelial carcinoma (P < 0.001), multifocal tumors (P < 0.001), and tumors localized in the ureter (P < 0.001) were observed to have shorter duration of metastatic development. CONCLUSIONS: Presence of T2 and higher-stage tumors, high-grade tumors, and multifocality are combined risk factors for urinary bladder recurrence and distant organ metastasis. Patients with the additional risk factors of cigarette smoking (urinary bladder recurrence) and nodal disease (distant organ metastasis) should be followed up closely after surgery.

Comparative study of extracorporeal shock wave lithotripsy outcomes for proximal and distal ureteric stones.

OBJECTIVE: To assess the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy for isolated proximal ureteral calculi and compare it to that for isolated distal calculi. PATIENT AND METHODS: We treated 68 patients with isolated ureteral stones using MPL 9000. Stones were located in the proximal and distal ureters in 44 and 24 patients, respectively. Patients were stratified according to stone burden and degree of obstruction. Data of all patients were prospectively collected for stone burden, stone localization, number of sessions, number of shock waves, stone-free rates (SFRs), complications, re-treatment rates and auxiliary procedures. Outcomes regarding ureteral localization were compared. RESULTS: The overall SFR was 85.3% with a 41.2% re-treatment and 17.6% auxiliary procedure rate. The mean number of shock waves applied for each stone was not different among the two ureteral locations. The SFRs were 86.3% and 79.1% for proximal and distal ureteral stones, respectively (P=0.17). For the group with stones <100 mm(2), the SFR was 85.4% and 89.5% for the proximal and distal ureter, respectively. Although the degree of obstruction did not affect SFR of the entire group (P=0.12) and the proximal ureter group (P=0.96), it adversely affected SFR in the distal ureter (P=0.017). CONCLUSIONS: ESWL outcomes for the ureteral calculi support the use of lithotripsy particularly for stones <100 mm(2). Treatment efficacy was not significantly different among stones localized in proximal and distal ureters. Degree of obstruction did not affect the ESWL outcomes in the proximal ureter, but it adversely affected SFR in the distal ureter.