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OBJECTIVE To compare two different doses of lidocaine used for periprostatic nerve block on pain perception during transrectal ultrasound (TRUS) guided prostate biopsy. MATERIAL AND METHODS A total of 288 patients with elevated prostate specific antigen (PSA) levels and/or abnormal digital rectal examination who underwent TRUS-guided prostate biopsy were included in the study. The patients were divided into 3 groups: Group 1 (n=103) prostate biopsy were performed after administering perianal intrarectal application of 10 mL 2% lidocaine gel, Group 2 (n=98) 2 mL of 2% lidocaine injection on each side following rectal installation of lidocaine gel and Group 3 (n=87) 4 mL of 2% lidocaine injection on each side after rectal instillation of lidocaine gel. Patients' pain scores during biopsy procedure were reported using visual analogue score (VAS). Independent sample t test, ANOVA test and Tukey test were used for statistical evaluation. RESULTS The mean age, prostate volume and PSA level were 65.6±8.4 years, 58.2±34.8 mL, and 11.8±3.4 ng/mL respectively. There were no statistically significant differences in baseline characteristics between the groups. The mean VAS scores were 2.4±1.8 in Group 1, 2.5±1.9 in Group 2 and 1.6±1.6 in Group 3. Patients in Group 3, reported significant pain reduction compared with patients in Groups 1 and 2 (p=0.002, and 0.001, respectively). However, there was no statistically significant difference in VAS scores between Groups 1 and 2 (p=0.815). CONCLUSION According to our results we recommend the use of perianal intrarectal lidocain gel application, and periprostatic nerve block with injection of 4 ml 2% lidocaine per side combination in TRUS-guided prostate biopsies. Further large-scale randomized control studies are needed to validate these finding.

Objective: Our aim was to evaluate and determine the frequency of Transmembrane protease, serine 2 (TMPRSS2)-ERG fusion in Turkish patients with clinically localized prostate cancer by using immunohistochemistry and reveal its relationship with clinicopathologic variables. Material and methods: Radical prostatectomy specimens of 99 patients, who underwent radical retropubic prostatectomy for localized cancer, between January 2002 and December 2011 were analyzed in the study. To detect ERG fusions, monoclonal ERG antibodyclone ID: EPR3864 (Epitomics, San Diego, CA, USA) and monoclonal anti-ERG antibody (9FY) (BiocareMedical, LLC, USA) were used. The immunistochemical expression of ERG protein was assessed as positive or negative regardless of stain intensity. Patients’ age, total and primary Gleason scores, PSA levels, prostate volumes, tumor volumes, tumor stages and perineural invasion status were analysed retrospectively. Total fusion rate and correlation between the variables and fusion were evaluated. Results: Mean age, prostate volume, tumor volume, PSA value of 99 patients were 62.02 years (±5.93), 50.02 cc (±20.67), 3.19 cc (±4.16), and 9.34 ng/mL (±3.37) respectively. TMPRSS2-ERG fusion was seen in 46 (46.5%) of 99 patients. When the variables analysed with independent samples t test to predict fusion (+) status, none of them was found to be statistically significant. When evaluated by logistic regression analysis for (+) or (-) status, only tumor stage was found to be statistically significantly correlated with fusion (p=0.049). Conclusion: The incidence of TMPRSS-ERG fusion in patients with localised prostate cancer in our study with Turkish population was found as 46.5%. Only tumor stage correlated with TMPRSS2-ERG fusion.

OBJECTIVE: Active surveillance has become a management option for low-risk prostate cancer patients, while keeping the curative treatment option available. In this study, we evaluated the our results of active surveillance for localized prostate cancer patients. MATERIAL AND METHODS: Patients diagnosed with localized prostate cancer who chose an active surveillance protocol were followed with PSA measurements, digital rectal examinations, and TRUS-guided biopsies. The patients' data and rebiopsy results were evaluated. The results were compared with the results of the patients who had definitive treatment. RESULTS: Forty-one patients on active surveillance and 34 patients with at least one rebiopsy were included in the study. Twenty-seven patients who had more than one rebiopsy were followed for an average of 27.7 (12-78) months. Twelve patients (44.4%) had undergone definitive treatment including radical prostatectomy (n=9), and radiotherapy (n=3). There were 17 patients under surveillance after a second biopsy, and 9 (33%) of them had a third biopsy. Among these 9 patients, 7 patients were kept under surveillance, and 2 (7%) them had a fourth biopsy. Active surveillance of 15 out of 17 patients who have not undergone definitive treatment is still ongoing. CONCLUSION: Active surveillance is a treatment option refrains low-risk prostate cancer patients from the complications of an early or unnecessary definitive treatment and related reduction in the quality of their lives. while keeping the curative treatment option available. Active surveillance can be applied safely with the appropriate patient selection, regular examinations and tests.