Prognostic significance of surgical margin status and gleason grade at the positive surgical margin in predicting biochemical recurrence after radical prostatectomy in a turkish patient cohort

Objective: To investigate the prognostic role of positive surgical margin (PSM) features in addition to well-defined risk factors in predicting biochemical recurrence (BCR) after radical prostatectomy. Materials and Methods: This study used the prostate cancer database from the Urooncology Association in Turkey. Clinical, surgical, pathological and follow-up data were recorded from the database. PSM features, including number, location, linear length and Gleason grade (GG) were also recorded. Kaplan-Meier survival analyses were performed to assess differences in BCR-free survival (BCR-FS). In order to identify prognostic factors affecting BCR-FS, univariate and multivariate Cox regression analyses were performed. Results: The study included 984 patients who met the eligibility criteria. The median follow-up time was 29 (minimum: 6, maximum: 210) months, and BCR was detected in 178 (18.1%) patients. BCR-FS was found to be significantly lower in patients with higher total prostate-specific antigen, higher International Society of Urological Pathology (ISUP) grade, extraprostatic extension (EPE), seminal vesicle invasion, lymphovascular invasion, lymph node involvement, PSM and GG at PSM (PSMGG) >= 4 (log-rank p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001 and p=0.005). ISUP grade, EPE and PSM were identified as independent prognostic factors in predicting BCR-FS [Hazard ratio (HR): 1.89, p=0.035 and HR: 4.65, p<0.001, HR: 1.82, p=0.030, HR: 1.77, p=0.042, respectively]. Unlike the univariate analysis, in multivariate analysis, PSMGG did not prove to be an independent prognostic factor in predicting BCR-FS. Conclusion: PSM GG >= 4 was found to be significantly associated with shorter BCR-FS. There is a need for large, randomised prospective studies to clarify the role of PSMGG to be used in nomograms as an independent predictor to determine patients who would benefit from adjuvant radiation therapy

Pre-post meal PSA values: Should it be measured in pre-meal blood serum?

Prostat kanserinin erken tanısında PSA yaygın olarak kullanılan bir tümör belirleyicisidir. Bununla birlikte serum PSA seviyesinin bir çok faktörden etkilenmesi ve prostatın kanser dışında diğer patolojilerinde de serum PSA seviyesinin değişmesi PSA'nın değerini sınırlamaktadır. Bu çalışmada serum PSA seviyesinin açlık-tokluk ile olan ilişkisi araştırıldı.Serum PSA seviyesine açlık ve tokluğun olası etkisini araştırmak amacıyla aynı öğünü alan sağlıklı 33 kişi çalışmaya alındı. Her kişiden yemekten bir saat önce, bir saat sonra ve ikinci saatte kan örnekleri alındı. Serum PSA değeri elektrokemiluminesens yöntemiyle bakıldı. İstatistiksel analizde Paired-t testi ve Pearson korelasyon katsayısı kullanıldı. Ortalama yaş 42±17.5 idi. Ortalama açlık, tokluk 1. saat ve tokluk 2. saat serum PSA değerleri sırasıyla 0.70±0.69, 0.74±0.75 ve 0.65±0.57 idi. Açlık ortalama serum PSA değeri ile yemekten sonraki gerek 1. saat ve gerek 2. saat ortalama serum PSA değerleri arasında istatistiksel anlamlı fark saptanmadı (p>0.05). Ancak yemek sonrası 1. ve 2. saat kan örneklerinde serum PSA'daki değişim istatistiksel olarak anlamlı idi (p=0.029). Bu çalışmada yemek sonrası 1. saat PSA düzeylerinde yükselme ve 2. saat düzeylerinde de anlamlı bir düşüş olduğu gösterilmiştir. Bu değişikliklerin sınır PSA değeri olan olgularda invaziv bir girişime karar vermeyi etkileyebileceği düşünülerek kan örneği elde edilmesinde hastanın aç/tok oluşu göz önüne alınmalıdır.Introduction: Prostate specific antigen (PSA) is the commonly used tumor marker in the early diagnosis of prostate cancer. Although it is highly specific for prostate, its specifity is low for prostate cancer. Since it is affected by many factors other than cancer such as diurnal variations of the secretion, existing of infections or inflammations in the prostatic tissue, volume of prostate, digital rectal examination, ejaculation or rectal manipulations and surgery of the prostate, the value of serum PSA level is limited. Serum insulin level increases and reaches maximum level at first hour due to increased glucose level after meal. Thereafter the level of serum insulin values return to its normal level at approximately two hours after meal. On the other hand, insulin suppresses the production of sex hormone binding protein in liver cells. Therefore, it is logic to investigate PSA levels due to metabolic and hormonal changes after meal. We investigated changes of PSA level after meal in this prospective study. Materials and Methods: Thirty-three healthy cases were included in this study to determine changes of serum PSA levels pre and post-meal manner. All patients were given same regular diet comprised of 700 calories (50-55% carbohydrates, 25-30% lipids and 20% proteins). Blood samples were taken an hour before meal (PSA-0), and one (PSA-1) and two (PSA-2) hours after meal. Serum PSA levels were determined by chemiluminescence method. Paired sample t test and Pearson correlation coefficient were used for statistical analysis. Results: The mean age of the patients was 42&plusmn;17.5 (Range 20-80) years. The mean PSA level at one hour before meal, one and two hours after meal were 0.70&plusmn;0.69 ngr/ml (PSA-0), 0.74&plusmn;0.75 ngr/ml (PSA-1) and 0.65&plusmn;0.57 ngr/ml, (PSA-2) respectively. There was no statistically significant difference between serum PSA-0 levels with PSA-1 (p=0.106) and PSA-2 (p=0.109) levels. However, there was a statistically significant difference between first hour and second hour after meal mean PSA levels (p=0.029). Conclusion: Serum PSA values may be affected not only from prostatic disturbances, but also the changes of its metabolism and levels of PSA binding proteins. Insulin, proinsulin, C-peptid and Zn secretion increase after meal. In contrast, glukagon, Cortisol, epinephrin, norepinephrin secretion decrease. These differences could also change the levels of detectable fractions of PSA temprorarily and may affect serum total PSA levels. The differences of serum PSA levels represent paralelisin with the changes in serum insulin levels after meal. In this study, mean PSA levels increased at first hour after meal and decreased at second hour after meal. These differences in PSA levels could affect the decision making for indication of prostate biopsy in patients with borderline PSA levels and it should be considered when the serum samples are taken whether patients are hungry or not. The determination of ideal serum PSA sampling time would be important in order to prevent false negative or positive serum PSA results. In this way, clinicians would decide not to do invasive procedures especially in patients with borderline serum PSA levels

Quality of life in benign prostatic hyperplasia

Son yıllarda yaşam kalitesinin (YK) her alanda giderek artan bir ilgi gördüğü dikkate alınarak bu derlemede YK'nin selim prostat büyümesindeki (BPH) özellikle tedaviyi yönlendirmedeki rolünün ortaya konması amaçlanmıştır. Aslında BPH hastalarında genellikle tedavide hedef hastanın semptomları olmaktadır. Dolayısıyla hastanın YK'nin bu semptomlardan ne kadar etkilendiğinin bilinmesi en uygun tedavi seçiminde esas olmalıdır. Mevcut uygulamaların özellikle semptom skorlarının YK'yi ölçmediği de bilindiğinden, sadece bunlara dayanarak bir tedavi önerilmemelidir. Bu derlemede mevcut bilgi birikimi ve gelecekteki perspektifi ile BPH'da YK irdelenmiştir.Introduction: In view of the growing tremendous interest in quality of life (QoL) in almost every field of medicine, the scope of this review was to address the place of QoL in benign prostatic hyperplasia (BPH) in terms of selecting appropriate treatment policy. Actually, the target of any proposed treatment for BPH is usually the symptoms of the patient. Therefore, it is more logical to know the status of QoL related to these symptoms for each particular patient in order to provide the most appropriate treatment. Since contemporary measures like symptom scores do not measure BPH specific QoL, they should not solely guide the physician in suggesting a treatment alternative for a BPH patient. In this review, QoL in BPH was discussed including present data and future perspective

Renal oncocytoma: A case report

Renal onkositom, tüm böbrek tümörlerinin %3-5’ini oluşturan, oldukça nadir bir tümördür. Sıklıkla asemptomatiktir ve ortalama boyut 6 cm dir. Burada, 13 cm büyüklüğünde renal onkositom tanısı almış olgu sunulmuştur.Renal oncocytoma, which is diagnosed 3-5% of all renal tumors, is rare tumor. Most renal oncocitomas are asymptomatic and median size 6 cm. Here we present a case with renal oncocytoma, which size was 13 cm

Renal oncocytoma: A case report

Renal onkositom, tüm böbrek tümörlerinin %3-5’ini oluşturan, oldukça nadir bir tümördür. Sıklıkla asemptomatiktir ve ortalama boyut 6 cm dir. Burada, 13 cm büyüklüğünde renal onkositom tanısı almış olgu sunulmuştur.Renal oncocytoma, which is diagnosed 3-5% of all renal tumors, is rare tumor. Most renal oncocitomas are asymptomatic and median size 6 cm. Here we present a case with renal oncocytoma, which size was 13 cm

Assessment of Quality of Life of Partners of Patients with Benign Prostate Hyperplasia: Does Benign Prostate Hyperplasia Disturb Female Partners?

WOS: 000287053500017Objective: Benign prostate hyperplasia (BPH) is a common health problem throughout the world. The aim of the study was to evaluate the consequence of BPH on partners by using Turkish version of a specific quality of life (QoL) scale for partners of BPH patients. Material and Methods: The study group consisted of partners of 300 BPH patients who were admitted to urology outpatient departments of two university hospitals (Duzce University and Celal Bayar University) with lower urinary tract symptoms. BPH patients were asked to fill out International Prostate Symptom Score (IPSS) form, while female partners were separately requested to complete the specific QoL questionnaire. Results: The mean age of patients with BPH was 63.8 +/- 7.2 years and it was 56.3 +/- 6.5 years for female partners. The results of the specific questionnaire showed that QoL of partners were significantly affected. Particularly, most of the the partners had the fear of cancer development and possibility of surgery for their husbands, 77% (231/300 partners) and 79% (237/300 partners), respectively. At night majority of partners woke up frequently because of their husbands, however mostly of them declared no or little disturbance in terms of being tired during the day. On the other hand, it was revealed that there was a significant correlation between QoL degrees of partners and IPSS values of BPH patients (p< 0.001; correlation coefficient 0.664). Conclusion: BPH significantly impairs the QoL of female partners. This negative impact correlates with the IPSS values of BPH patients. Therefore, the physicians should also consider burden of the female partners in the management of BPH patients