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Background/aim: This study aims to compare the success rates of rigid registration (RR) and elastic registration (ER) systems in diagnosing all cancers and clinically significant prostate cancer (csPC) in software-based targeted prostate biopsies (TPBs) by performing matching analysis. Materials and methods: The data of 2061 patients from six centers where software-based TPB is performed were used. All cancer and csPC detection rates of the RR and ER systems were compared following Mahalanobis distance matching with the propensity score caliper method. Logistic regression analysis was applied to identify factors predicting clinically insignificant prostate cancer (ciPC) and csPC diagnoses. Additionally, the International Society of Urological Pathology Grade Group (ISUP GG) upgrade rates of RR and ER systems were compared between biopsy and radical prostatectomy pathologies. Results: The matched sample included 157 RR and 157 ER patients. No statistically significant difference was found between ER and RR in terms of csPC detection rate (28.0% vs. 22.3% respectively, p = 0.242). The detection rate of all cancers by ER compared to RR was found to be significantly higher (54.8% vs. 35.7% respectively p < 0.001,). No statistically significant difference was found between the ER and RR groups regarding pathological upgrade (39.7% vs. 24.2% respectively, p = 0.130). In the logistic regression analysis performed to determine the factors predicting ciPC, decreased prostate volume and ER system use were found to be independent predictive factors. Conclusion: While the detection rate of csPC was similar for the RR and ER systems, the detection rate of all cancers and ciPC was significantly higher with the ER systems. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the long-term surveillance outcomes (biochemical recurrance, survival) and adequacy of active surveillance criteria to detect low-risk prostate cancer patients who were eligible for active surveillance but underwent radical prostatectomy. Materials and Methods: Data of patients who underwent radical prostatectomy for prostate cancer between January 2005 and January 2019 were retrospectively evaluated. Upstaging, upgrading, surveillance periods, and survival status of patients with clinical stage T1c and T2a, serum prostate-specific antigen below 10 ng/mL, International Society of Urological Pathology grade 1, number of tumor-positive cores in biopsy 2 and below, tumor percentage in tumor-positive cores 50 and below were inclusion criteria for active surveillance. Results: The study included 606 patients. Of these patients, 184 (30.4%) met the inclusion criteria for active surveillance. Upgrading was detected in 77 (41.8%) patients and upstaging in 29 (15.8%) patients who met the criteria for active surveillance. The prostate-specific antigen (PSA) and PSA density values of the patients who met the active surveillance criteria were significantly lower than those of the other patients (p<0.05). The mean surveillance period was 127.6±49.6 (8-227) months, and 123 patients died during this period. Among them, 18 (3%) patients died because of related causes of prostate cancer. None of the patients who met the criteria for active surveillance died because of prostate cancer (p=0.018). Conclusion: No cancer-related deaths were observed in patients who is eligible for active surveillance but underwent radical prostatectomy. This may suggest that active surveillance criteria are suitable for detecting low-risk prostate cancer patients. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of surgical delay in localized prostate cancer (PCa) on adverse pathological features and oncological outcomes. Materials and Methods: Patients who underwent surgery for localized PCa were included from the Turkish Urooncology Association PCa database. History of previous treatment or active surveillance was considered an exclusion criterion. Patients were divided into two groups according to the time period between the diagnosis and surgery; less than or equal to 90 days (group 1) or longer than 90 days (group 2). Surgical pathology results and oncological outcomes were compared between the groups. Results: In total, 2454 out of 3646 patients were assessed. Pathological findings of radical prostatectomy specimens were similar between the two groups. However, there was slightly more seminal vesicle invasion in the final surgical pathology in group 1 (12.9% vs. 9.3%, respectively p=0.042). The 5-year biochemical recurrence-free survival times were similar across all D'Amico risk categories between the two groups. The regression analysis demonstrated seminal vesicle invasion as the only factor affecting the time to prostate-specific antigen progression in high-risk patients (p<0.001 HR=2.51 confidence interval=1.58-4.45). Conclusion: In conclusion, our results in this large cohort suggest that surgical delay does not cause a deterioration in PCa surgical outcomes, even in high-risk patients. These findings may be helpful for planning limited healthcare resources especially in conditions like the coronavirus disease-2019 pandemic where the availability and optimal use of healthcare system resources are crucial. [ABSTRACT FROM AUTHOR]

Objective: Perineural invasion (PNI) is a histopathological finding which represents invasion of the nerves and surroundings by cancer cells. Several studies have reported that PNI in prostate cancer (PCa) is a poor prognostic factor. However, there are insufficient data in literature related to the use of PNI status in the biopsy at the stage of making a decision for nerve-sparing surgery. This research aimed to investigate the impact of PNI identified in prostate biopsies on the biochemical recurrence-free survival (RFS) in individuals who underwent nerve-sparing radical prostatectomy (RP) for PCa. Materials and Methods: The data of 972 patients who underwent nerve-sparing RP due to a clinically localized PCa diagnosis were retrospectively examined. Patients were divided into two groups as PNI (+) and PNI (-) according to PRI status in prostate biopsy pathology. Results: Evaluation was made of 747 patients with suitable data for analysis. PNI was determined in the prostate biopsy of 162 patients and not in the biopsies of 585 patients. The 5-year biochemical RFS rates were 90% for PNI (+) patients and 89.6% for the PNI (-) group, and the difference between the two groups was not statistically significant. When the PNI positive and negative groups were compared in respect of surgical margin positivity, the surgical margin was determined as positive in 42 (25.9%) of the group with PNI and in 84 (14.4%) of the group without PNI. Surgical margin positivity was determined to be statistically significantly greater in the PNI (+) group. Biochemical RFS rates were compared according to the surgical margin positivity status, and 5-year biochemical RFS was found to be 81.5% in those with surgical margin positivity and 91.6% in those with surgical margin negativity, no statistically meaningful distinction was found between the groups Conclusions: The findings of this study indicated that PNI determined in prostate biopsy did not affect 5-year RFS following nerve-sparing RP. [ABSTRACT FROM AUTHOR]

Objective: Diagnoses of variant histopathology (VH) in bladder cancer (BC) are increasing, and although there is a standard treatment algorithm for BC, the guidelines lack a standardized approach for treating VH in BC. We aimed to compare the survival results of the treatment algorithm applied to patients with BC with VH in the first transurethral resection of the bladder (TUR-B) procedure. Materials and Methods: We retrospectively assessed data on patients with VH of BC in the first TUR-B between January 2000 and January 2021. After the first TUR-B, we determined TUR-B+/-BCG, radical cystectomy (RC), and trimodal therapy (TMT) as the three potential treatments for patients according to the initial plans applied by the clinics. Results: A total of 289 patients with VH of BC in the first TUR-B were included in the study. Their mean age was 66.7±10.1 years, and most (246, 85.1%) were male. We found that TMT was associated with lower survival, and BCG administration offered no advantage in terms of overall survival (OS) or cancer specific survival (CSS) among patients with non-muscle-invasive bladder cancer (NMIBC). In patients with MIBC, immediate RC provided a significant advantage over other treatment methods in terms of both OS and CSS. Conclusions: There is still no standard treatment for patients with VH of BC. Patients are less likely to survive TMT than other treatment modalities. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of the International Society of Urological Pathology (ISUP) grade group 4 (GG4) and ISUP GG5 subgroups according to prostate biopsy on biochemical recurrence (BCR). Materials and Methods: Patients who underwent radical prostatectomy (RP) after being diagnosed with GG4 and GG5 prostate cancer according to prostate biopsy and who had follow-up data were retrospectively evaluated. Patient data were obtained from the Urologic Cancer Database-Prostate of the Turkish Urooncology Association. GG4 and GG5 pathologies were evaluated using Gleason subgroups. The effect of clinicopathological parameters on BCR after RP was investigated separately in the GG4 and GG5 patient groups. Results: In GG4, 73 of 188 patients developed BCR. When GG4 patients were evaluated for BCR, only lymphovascular invasion was significant for BCR (p=0.004). In addition, seminal vesicle invasion (SVI) and high ISUP grade according to RP pathology were significant in patients with BCR (p=0.004 and p=0.005). In the follow-up of 145 patients with GG5, 80 patients developed BCR. When GG5 patients were evaluated for BCR, no predictive factor was found for developing BCR. However, surgical margin positivity, extraprostatic extension, and SVI after RP were found to be significant in patients with BCR (p=0.031, p=0.011 and p=0.007). Conclusion: According to our results, the ISUP GG system, which does not include Gleason subgroups, is an appropriate classification system for GG4 and GG5 patients for the prediction of BCR in the Turkish patient population, in parallel with the current literature. [ABSTRACT FROM AUTHOR]

Objective: Some prognostic models have been described for localized and metastatic renal cell carcinoma (RCC). The European Association of Urology guidelines on RCC recommend using these models. However, there is no model for T1 and T2. The study evaluated the risk factors for recurrence in T1 and T2 RCC. Materials and Methods: Data of 4823 renal tumor patients from the Renal Tumor Database of the Association of Urooncology in Turkey were evaluated. Of 4823 patients, 1845 RCC patients with pathological T1 or T2 were included in this study. The patients were divided into two groups according to the recurrence status. Anatomical, histological, and clinical prognostic factors were statistically compared between the groups. Afterwards, multivariate analysis was performed for the variables that were found to be statistically significant. Results: The mean follow-up time was 30 (4-180) months. Of 1845 RCC patients, 117 (6.3%) had recurrence. Univariate analysis revealed statistically significant differences between age, preoperative hemoglobin, albumin, neutrophil, alkaline phosphates, platelet and calcium values, histological subtype, Fuhrman grade, surgical technique (radical or partial), and pathological stage in the groups. However, in multivariate analysis, only pathological stage was found to be a risk factor for recurrence (2.17 95%, 1.25-3.77). Conclusions: The results of our study show that it is difficult to design a prognostic model for the recurrence of pT1 and pT2 RCC. We suggest that patients with a higher tumor diameter should be followed up more frequently. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus disease-2019 pandemic has shown us that postponing elective surgeries that include nephrectomy due to renal cell carcinomas (RCC) was undertaken by the physicians to use hospital facilities in a balanced way. However, both urologists and patients were concerned about postponements that may increase the risk of progression. To determine the optimal threshold of postponement time-period for surgery (PTP) and according to the clinical T stages in patients who underwent nephrectomy due to RCC, we used the Urologic Cancer Database-Kidney. Materials and Methods: Patients who underwent detailed clinical T stage analysis with admission and surgery dates were included in the study. PTP was calculated using the dates of definitive preoperative diagnosis and surgery date. Recurrence, overall mortality (OM), recurrence-free survival, and overall survival (OS) were evaluated. The effects of PTP on oncological outcome according to tumor diameter and clinical T stages were also evaluated. We also analyzed the optimal cut-offs of PTP based on clinical T stages. Results: Among 3.258 patients, in the evaluation of 2.946 clinically localized patients, PTP and tumor diameter were found to be important predictors of recurrence (p=0.037 and p<0.001). The optimal PTP of 30 days was found to be an important significant threshold time for the T1 stage and 20 days for T2-4 stage tumors. Patients with longer PTP according to the thresholds shown in this study had higher upstaging for clinical T1a, T2a, and T3 stages; higher recurrence rates for T1b and T2b stages; and higher OM for T2a and T3 tumors. The survival have also shown that more than 20 days of PTP affected OSs for clinical-stage T1 (p=0.019), T2 (p=0.021) and T3 (p=0.007) tumors. Conclusions: All patients with tumors, including clinical T1 tumors, had worsening oncological results as the PTP increased (>20-30 days). [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between smoking status and clinicopathological characteristics and oncological outcome in bladder cancer (BC) patients and those with concomitant BC and lung cancer (LC) who developed BC or LC as a second primary cancer during their survivorship. Materials and Methods: A total of 2621 BC patients registered in the Turkish Urooncology Association Bladder Cancer Database between 2001 and 2021 were retrospectively analyzed. Patients were divided into two groups: those with BC only (BC group, n=2568) and those with concomitant BC and LC (BLC group, n=53). Data on patient demographics and smoking status (active smoker, former smoker, non-smoker) were recorded, as were the clinicopathological characteristics and oncological outcomes with respect to smoking status. Results: Active smokers comprised 50.5% and 49.1% of patients in the BC and BLC groups, respectively. The percentage of former smokers was 14.3% and 13.2% and percentage of non-smokers was 31.4% and 18.9% in the BC and BLC groups, respectively. In both BC and BLC groups, a higher percentage of males than females were active smokers (45.8% vs. 4.6% in BC and 47.2% vs. 1.9% in BLC). In the BLC group, the percentages of active smokers, former smokers and nonsmokers in the BC first group were 56.0%, 24.0% and 20.0%, respectively, whereas the corresponding ratios in the LC first group were 50.0%, 8.3%, and 41.7%, respectively. The presence of smoking (active or former) vs. non-smoker status was associated with more advanced clinicopathological characteristics and poor oncological outcomes in both BC and BCL groups. Conclusions: This population-based registry study in patients with BC revealed the presence of smoking history (active or former) in almost two-thirds of patients in both BC and BLC groups, which was associated with more advanced clinicopathological characteristics and poor oncological outcomes in both BC and BCL groups. [ABSTRACT FROM AUTHOR]

Objective: Coronavirus disease-2019 (COVID-19) has detrimental effects on both physical and mental health of patients. Since sleep quality is closely related to the health status of a person, deterioration in sleep is expected in these patients. The aim of this study was to detect sleep problems in 19 consecutive inpatients and compare them with other inpatients with different diagnoses in order to determine whether being a pandemic patient makes a significant difference. Materials and Methods: Pittsburgh Sleep Quality Index has a value between 0 and 21 points. High values indicate poor sleep quality and a high level of sleep disturbance. If the total score is above 5, it indicates that the sleep quality is clinically poor. The hospital anxiety depression scale is a self-report scale and consists of 14 items, 7 of which investigate depression and 7 anxiety symptoms. Results: Fifty one inpatients were included in this study as the control group (group 1). Fifty COVID-19 positive patients hospitalized in need of oxygen (group 3) and 50 COVID-19 positive patients hospitalized with no need for oxygen (group 2) were enrolled in the study. The oxygen need of patients was found to be significantly related to the presence of chronic diseases. Conclusion: Depression rates were found to be significantly higher in COVID-19 patients compared with the control group. Further studies with an increased number of cases are needed to establish a better link between oxygen need and sleep disorders. [ABSTRACT FROM AUTHOR]

Objective: In this study, we investigated the correlation between prostate imaging reporting and data scoring system (PIRADS) grades of patients' prostate lesions detected by multiparametric prostate magnetic resonance imaging (MpMRI) and prostate specific antigen (PSA) values obtained before prostate biopsy and its role in predicting clinically significant cancer in prostatectomy specimens. Materials and Methods: Patients who underwent biopsy and were diagnosed with prostate cancer (PCa) because of positive or negative MpMRI were evaluated. Histopathological factors were recorded, and the relationship between the PIRADS grading system and PSA values was analyzed in patients who underwent radical prostatectomy and preoperative MpMRI. PSA cut-off values predicting clinically significant PCa (CSPCa) in MpMRI were calculated. Results: A total of 1,319 patients were included in the study. MR-fusion biopsy was performed in 58% of the patients, and malignant histopathology was detected in 49% of the patients. While 87% of the patients had CSPCa, 13% had clinically insignificant PCa. The sensitivity and specificity of the PSA 4 ng/mL cut-off value were 88.6% and 15.1% in all patient groups, respectively. In predicting CSPCa, sensitivity was 88.9% and specificity was 18.8% for PSA 4 ng/mL cut-off value in MpMRI-negative patients. If PSA >4 ng/mL in MpMRI-negative patients, there is a >45% PCa detection rate in biopsy, but biopsy is more appropriate for PSA >10 ng/mL for CSPCa. In MpMRI-positive patients, if PSA is >2.5 ng/mL, biopsy provides a >50% PCa and >30% CSPCa diagnosis. If there are PIRADS 5 lesions and PSA is >2.5 ng/mL, biopsy has a >70% PCa and >60% CSPCa detection rate. Conclusions: It may be appropriate to consider higher PSA cut-off values (PSA >10 ng/mL) to make a biopsy decision in patients with negative MpMRI, whereas it may be possible to detect CSPCa at lower PSA values in patients with positive MpMRI findings and high PIRADS grade. [ABSTRACT FROM AUTHOR]

Objective: This report examined the approaches to low-risk patients using the data from the Urologic Cancer Database - Prostate, Urooncology Association. Materials and Methods: In this study, there were 920 patients with low-risk prostate cancer according to the current guidelines of the European Urology Association. Patient data were obtained from the Urological Cancer Database - Prostate, the Turkish Urooncology Association (UroCaD-P) from records of the years 1995-2021. Ethics committee approval was obtained for this study to publish in the form of a database report. Results: Our study was conducted with 920 patients with low-risk prostate cancer. Therefore, at the time of diagnosis, all patients in the study were ISUP 1, had a prostate specific antigen (PSA) level lower than 10 ng/mL, and clinically T1-T2a. Surgical treatment was used in 750 (81.5%) of the patients. At the time patients were retrieved from the database for the study, 140 patients (15.2%) were in the active surveillance (AS) process. Thirty patients (3.2%) in the study received their local treatment as radiotherapy (RT). The mean age value at cancer detection in the study was 61.9. The mean ages of the patients who were under AS and who underwent radical prostatectomy (RP) were 61.3 and 61.7 years, respectively. In the RT group, the mean age was 66.7 years. The mean PSA value of the whole group was 5.81 ng/mL. While it was 5.94 in AS patients, it was calculated as 5.89 in patients who underwent radical surgery. The mean PSA value of the RT group was 5.40. The pathological upgrade was detected in 225 patients (30%) after surgery. Surgical margin positivity was in 160 of the patients (21.3%) who underwent surgery. In addition, 100 patients (13.3%) had extracapsular disease. The seminal vesicle invasion was detected in 25 patients (3.3%) after surgery. Conclusion: We predict that the incidence of low-risk prostate cancer will increase over time due to the aging of the population, the use of PSA, advances in imaging modalities, and increasing biopsy success rates. Therefore, the importance of the existence of multicentric databases containing this patient group is undeniable. More studies are needed with these databases, including both patient demographics and treatment outcomes. Hopefully, this database report will be an important step in this direction. [ABSTRACT FROM AUTHOR]