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

Prognostic role of preoperative albumin to globulin ratio in predicting survival of clear cell renal cell carcinoma.

To investigate the prognostic role of preoperative albumin/globulin ratio (AGR) in predicting disease-free survival (DFS) and overall survival (OS) in localized and locally advanced clear cell renal cell carcinoma (RCC) patients

Prognostic role of preoperative albumin to globulin ratio in predicting survival of clear cell renal cell carcinoma

ABSTRACT Purpose: To investigate the prognostic role of preoperative albumin/globulin ratio (AGR) in predicting disease-free survival (DFS) and overall survival (OS) in localized and locally advanced clear cell renal cell carcinoma (RCC) patients. Patients and Methods: 162 patients who met the criteria specified were included in the study. The DFS and OS ratios were determined using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the prognostic factors affecting DFS and OS. Results: Median follow-up period was 27.5 (6-89) months. There was a statistically significant relationship between low AGR and high pathological tumor (pT) stage, presence of collecting system invasion, presence of tumor necrosis, and a high platelet count (p = 0.012, p = 0.01, p = 0.001, and p = 0.004, respectively). According to the Kaplan-Meier survival analysis, both OS and DFS were found to be significantly lower in the low AGR group (p = 0.006 and p = 0.012). In the multivariate Cox regression analysis, collecting system invasion and tumor necrosis were found to be independent prognostic factors in predicting OS and pT stage was found to be an independent prognostic factor in predicting DFS (HR: 4.08, p = 0.043; HR: 8.64, p = 0.003 and HR: 7.78, p = 0.041, respectively). Conclusion: In our study, low AGR was found to be associated with increased mortality and disease recurrence in localized and locally advanced RCC

Should targeted biopsy be performed in patients who have only Pi-rads 3 lesions?

Objective: To determine whether clinical or radiological parameters can predict clinically significant prostate cancer (csPC) in patients with the Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions. Patients and Methods: Data were obtained from 247 patients with PI-RADS 3 lesions on mpMRI and who had received a soft-ware guided transperineal/transrectal MRI/transrectal ultrasonography (MRI/TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy following mpMRI in the prostate cancer and prostate biopsy database of Turkish Uroon-cology Association, between 2016 and 2020. The cut-off values of clinical parameters were determined using receiver operating characteristic (ROC) curve analysis. Simple and multiple logistic regression analyses were performed to determine the clinical parameters in predicting csPC. Results: A total of 56 patients (22.6%) had prostate cancer, 23 (9.3%) of whom had csPC. In the lesion-based analysis, cancer detection rates (CDRs) of each lesion in targeted biopsy were found to be 6% and 5% for ISUP GG 1 and ISUP GG >= 2, respectively. In the patient-based analysis, clinically insignificant CDRs were significantly higher in systematic biopsy compared with targeted biopsy, whereas no significant difference was found in terms of clinically significant CDRs (p = 0.020 and p=0.422, respectively). The cut-off values were determined as 48.3 mL (AUC [95% CI] = 0.68 [0.53-0.82]) for prostate volume, and 0.213 ng/mL/mL (AUC [95% CI] = 0.64 (0.51-0.77]) for PSAD in predicting csPC. In the multiple logistic regression analysis, only PSAD was found to be an independent risk factor in predicting csPC (OR [95% CI]: 3.56 [1.15-10.91], p = 0.024). Conclusion: Since PSAD > 0.20 ng/mL/mL was found to be positive independent risk factor in predicting csPC, in the absence of advanced radiological parameters, PSAD could be used for the biopsy decision in patients with PI-RADS 3 lesions

Comparison of transperineal and transrectal targeted prostate biopsy using Mahalanobis distance matching within propensity score caliper method: A multicenter study of Turkish Urooncology Association

Objective To compare the clinically significant prostate cancer (csPC)-detecting results of transperineal and transrectal targeted biopsy (TPTB and TRTB, respectively) by performing matching analysis. Patients and Methods This study has used the PC and prostate biopsy database from the Turkish Urooncology Association. A total of 1143 patients with Prostate Imaging-Reporting and Data System (PI-RADS) with >= 3 lesions on multiparametric magnetic resonance imaging (mpMRI) and who had received a software-guided transperineal/transrectal MRI/transrectal ultrasound (TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy were included in this study. csPC detection rates of the TP and TR approaches were compared following Mahalanobis distance matching within propensity score caliper method. The following four variables were selected as covariates for the matching procedure: age, digital rectal examination findings, PSA density, and the index lesion PI-RADS score. Results The matched sample included 508 TR and 276 TP patients. In both the TP and the TR groups, targeted biopsy was superior to systematic biopsy in detecting csPC (27.5% vs. 24.6%, p < 0.001 and 19.5% vs. 16.3%, p < 0.0001, respectively). Both TPTB and TP systematic biopsy was found to be superior to TRTB and TR systematic biopsy in terms of csPC detection (27.5% vs. 19.5%, p = 0.012 and 24.6% vs. 16.3%, p = 0.006). In patients with an anterior index lesion, an apical index lesion, and a larger prostate, the superiority of TPTB to TRTB was found to be more prominent in terms of csPC detection (37.8% vs. 18.3%, p = 0.044; 34.6% vs. 14.7%, p = 0.002; and 25% vs. 5.1%, p = 0.033, respectively). Conclusion Targeted biopsy was found to be superior to systematic biopsy in detecting csPC in both the TP and the TR approaches. The TP approach is preferred because of its clear superiority in detecting csPC in targeted biopsy, especially in patients with anterior and apical lesions and with larger prostates

External validation of a prostate cancer nomogram on magnetic resonance/transrectal ultrasound fusion biopsy in men with prior negative systematic biopsy

Objective To observe how the nomogram, which was created by Truong et al, works in an independent patient group by performing external validation. Patients and Methods One hundred and eighty-one patients who had at least one prior negative 12-core standard systematic biopsy and lesions with PI-RADS scores of 3 or higher that were detected as a result of mpMRI were included in the study. Targeted biopsy with 12-core standard systematic biopsy was performed on all patients. Clinical and pathological features of the patients were recorded. The discrimination, calibration and decision curve analysis were performed to externally validate the nomogram. Results A total of 181 patients with previous negative 12-core systematic biopsies were analysed. One hundred and thirty-four patients (74%) had benign pathology. Radiological volume and PI-RADS scores of 4 and 5 were found as independent predictors of benign pathology. The area under the curve (CI 95%) was found to be 0.80 (0.73-0.87), indicating good discrimination. The median residual was calculated as -0.0873, the intercept as -0.0690, the slope as 0.8927 and r(2) as 0.2586, indicating good calibration. The standardised net benefit of follow-up decisions was found to be 0.54 and 0.36 at the probability threshold of 0.7 and 0.8, respectively. Conclusion The original model showed good discrimination and calibration with our data. Defining a high probability threshold for clinical use would be appropriate for centres with high benign biopsy rates similar to our centre