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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: The Cancer of the Bladder Risk Assessment (COBRA) score is a practical method that can be used to predict survival in patients who have undergone radical cystectomy (RC). We aimed to evaluate COBRA scores in our patient group. Materials and Methods: Patients were classified according to tumor stage and lymph node (TLN) involvement; mortality rates and survival were analyzed according to both the TLN classification and COBRA score from the Turkish Urooncology Association database. The chi-square test and Fisher-Freeman-Halton Exact chi-square test were used to compare qualitative data as well as descriptive statistical methods. Cox regression analysis was used for multivariate analysis. Kaplan-Meier and log-rank tests were used for survival analysis. Results: There was a statistically significant difference between the COBRA scores and survival rates in terms of cancer-specific mortality according to TLN classification (p=0.000; p<0.05). A COBRA score of 6 was associated with a lower mortality rate than a COBRA score of 5. In the Cox regression analysis of cancer-related death, a one-unit increase in the COBRA score increased the cancer-related death rate 1.54-fold [hazard ratio (HR)=1.540; 95% confidence interval (CI)=1.402-1.691] (p<0.05). When the COBRA score was compared to 0, the highest risk was observed for COBRA 5. If the COBRA score was 5, the risk of cancer-related death increased 14.63 times (HR=14.627; 95% CI=7.041-30.385) (p<0.05). If the COBRA score was 6, the risk of cancer-related death increased by 11.54 times (HR=11.547; 95% CI=5.270-25.278) (p<0.05). Conclusion: The COBRA score increased, the prognosis worsened, and our results are consistent with the first validated study. [ABSTRACT FROM AUTHOR]

Objective: In this study, we investigated the prognostic values of various pathological and inflammatory parameters in patients with high-grade lamina propriainvasive (T1G3) bladder cancer (BC). Materials and Methods: Between 2006 and 2018, patients with pathological evaluation of T1G3 bladder urothelial carcinoma in our institution who did not meet the exclusion criteria were included in the study. Parameters such as gender, tumor diameter, tumor number, lamina propria invasion depth, presence of carcinoma in situ, presence of lymphovascular invasion (LVI), presence of variant histology, lymphocyte monocyte ratio (LMR), platelet lymphocyte ratio (PLR), neutrophil lymphocyte ratio (NLR), and systemic inflammatory markers (SIM) were statistically analyzed. Results: After the exclusion criteria were evaluated, 76 patients were included in the study from 157 patients. Recurrence was observed in 37 (48.68%) patients, and progression was observed in 21 (27.63%) patients. A significant relationship was discovered between LMR (p<0,001), PLR (p<0.004), NLR (p<0.002), tumor diameter (p<0.002), number of tumors (p<0,007), and SIM score (p<0,001) with the probability of recurrence. The probability of progression was associated with NLR (p<0.023), LVI (p<0.005), tumor diameter (p<0.012) and tumor number (p<0.001). A significant relationship was found between SIM (p<0.041) and recurrencefree survival. We found a significant relationship between LVI (p<0.022) and progression-free survival. Conclusions: In this study, we found positive correlations between some inflammatory markers and recurrence/progression in patients with T1G3 BC. According to our study, inflammatory parameters such as NLR, PLR, LMR, and SIM score should be evaluated while investigating the possibility of recurrence/progression in patients with T1G3 BC. [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: 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]

Introduction: In this study, we aimed to explore using the predictive role of systemic immune inflammation index (SII) for responses of intravesical Bacillus Calmette-Guérin (BCG) therapy in patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC). Methods: From 9 centers, we reviewed the data of patients treated for intermediate- and high-risk NMIBC between 2011 and 2021. All patients enrolled in the study presented with T1 and/or high-grade tumors on initial TURB had undergone re-TURB within 4–6 weeks after initial TURB and had received at least a 6-week course of intravesical BCG induction. SII was calculated with the formula SII = (P × N)/L, where P, N, and L refer to peripheral platelet, neutrophil, and lymphocyte counts, respectively. In patients with intermediate- and high-risk NMIBC, the clinicopathological features and follow-up data were evaluated to compare SII with other systemic inflammation-based prognostic indices. These included the neutrophil-to-lymphocyte ratio (NLR), platelet-to-neutrophil ratio (PNR), and platelet-to-lymphocyte ratio (PLR). Results: A total of 269 patients were enrolled in the study. Median follow-up time was 39 months. Disease recurrence and progression were observed in 71 (26.4%) and 19 (7.1%) patients, respectively. For groups with and without disease recurrence in terms of NLR, PLR, PNR, and SII calculated prior to intravesical BCG treatment, no statistically significant differences were observed (p = 0.470, p = 0.247, p = 0.495, and p = 0.243, respectively). Moreover, there were also no statistically significant differences between the groups with and without disease progression in terms of NLR, PLR, PNR, and SII (p = 0.504, p = 0.165, p = 0.410, and p = 0.242, respectively). SII did not show any statistically significant difference between early (<6 months) and late (≥6 months) recurrence (p = 0.492) and progression groups (p = 0.216). Conclusion: For patients with intermediate- and high-risk NMIBC, serum SII levels do not present as an appropriate biomarker for the prediction of disease recurrence and progression following intravesical BCG therapy. A possible explanation for the failure of SII to predict BCG response may be found in the impact of Turkey's nationwide tuberculosis vaccination program. [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]

This study aimed to reveal the possible protective effect of dapagliflozin (DAPA) against acute kidney damage due to cyclosporine A (CsA). Thirty-two mice with an eight-week-old Balb\c albino strain were divided into four groups: control group, CsA group, DAPA group, and CsA + DAPA group. On day 9 of treatment, the animals were decapitated, and bilateral nephrectomy was performed. Oxidative stress and apoptosis were evaluated with caspase-3 activity, total oxidant status (TOS), total antioxidant status (TAS), malondialdehyde (MDA), myeloperoxidase (MPO), B-cell lymphoma-2 (Bcl-2), and Bcl-2-associated X protein (Bax) in the right kidney resection material. The left kidney resection material was evaluated histopathologically. CsA increased caspase-3 activity, Bax, TOS, MDA, TAS, and MPO levels, and the administration of DAPA with CsA significantly reduced this increase in levels (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). CsA decreased Bcl-2 levels, and administration of CsA + DAPA significantly increased Bcl-2 levels compared with only CsA administration (p < 0.001). Additionally, administration of DAPA significantly reduced the histopathological findings (parenchymal inflammation, hyaline cast formation, vacuolization, and lysis of renal tubular cells) caused by CsA. DAPA reduces oxidative stress, apoptosis, and histopathological damage caused by CsA in renal tissue. [ABSTRACT FROM AUTHOR]