Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Effect of Upfront Docetaxel in De Novo Metastatic Castration-Sensitive Prostate Cancer Patients with Gleason Grade Group 5(2023) Yildirim, Serkan; Yilmaz, Cengiz; 37926887Objective: To investigate whether adding docetaxel chemotherapy to androgen deprivation therapy is effective regarding progression-free and overall survival in patients with de novo metastatic castration- sensitive prostate cancer patients with Gleason Grade Group 5 (Gleason scores 9 and 10). Study Design: Observational study. Place and Duration of the Study: Department of Medical Oncology at Manisa Celal Bayar University, Izmir Ege University, Bitlis Tatvan Public Hospital, Izmir Bozyaka Education and Research Hospital, and Izmir Kent Hospital, from March 2015 to May 2020. Methodology: Patients with de novo metastatic castration-sensitive and histopathologically confirmed GGG 5 prostate cancer were evaluated retrospectively. The patients were divided into two groups. The first group included patients who were given androgen deprivation therapy alone ( ADT-only group), and the second group consisted of patients who were given ADT plus docetaxel (chemohormonal group). The two groups were compared in terms of overall survival and progression-free survival till cut-off limit. Results: A total of 194 patients with metastatic castration-sensitive and GGG 5 prostate cancer were analysed retrospectively. The chemohormonal group comprised of 72 patients, and the ADT-only group included 122 patients. Median progression-free survival was 15.7 months in the chemohormonal group and 14.8 months in the ADT-only group (p = 0.97). The median overall survival was 37.5 months in the chemohormonal group and 37.8 months in the ADT-only group (p = 0.93). Conclusion: The addition of docetaxel chemotherapy in patients with metastatic castration-sensitive and GGG 5 prostate cancer did not result in a statistically significant difference in terms of overall survival and progression-free survival. Docetaxel may be ineffective in this group of patients.Item Lympadenectomy in Prostate Cancer(2014) Kosan, MuratAim: Radical prostatectomy is the standard treatment in localized prostate cancer. The limited or extended lymph node dissection in pelvic region is additionally applied to this procedure. We aimed to review the publications about the recently popularized extended pelvic lymph node dissection (PLND). New Findings: The extended PLND is not suggested in patients with low risk prostate cancer. On the other hand, extended PLND is suggested to make a good staging and treat the micrometastasis in patients with intermediate and high risk prostate cancer. The complication rates of PLND are acceptable in comparison with the benefits. The benefits of other expansive methods for clinical staging are still lower than PLND. Conclusion: However, prospective and randomized clinical trials are needed to investigate the efficiency of PLND in localized prostate cancer, PLND has important role with good oncological results in patients with intermediate and high risk prostate cancer.Item Prostate Mucinous Carcinoma Treated with Definitive Radiotherapy and Hormonal Therapy: Case Report and Review of the Literature(2014) Guler, Ozan Cem; Onal, Cem; Erbay, Gurcan; https://orcid.org/0000-0001-6908-3412; https://orcid.org/0000-0002-2742-9021; https://orcid.org/0000-0002-1706-8680; 24365124; AAC-5654-2020; HOC-5611-2023; AAK-5370-2021Prostate mucinous carcinoma (MC) is a rare variant of prostate adenocarcinoma that is characterized by large pools of extracellular mucin, which by definition compose at least 25% of the tumor volume. Prostate MC has 3 subtypes. The most common variant is pure MC; primary signet ring cell carcinoma and MC with signet ring cell are less common variants and are more aggressive than pure MC. Because of the rarity of prostate MC and conflicting reports regarding the behavior of the disease, the optimal treatment strategy is not clear. Most series report the efficacy of surgery. We report a rare case of a patient with a large prostate MC that was treated successfully with hormone therapy (HT) and radiotherapy (RT). Treatment response was assessed by dynamic contrast-enhanced magnetic resonance imaging (MRI). (C) 2014 Elsevier Inc. All rights reserved.Item Is It Essential to Use Fiducial Markers During Cone-Beam CT-Based Radiotherapy for Prostate Cancer Patients?(2017) Yildirim, Berna A.; Onal, Cem; Dolek, Yemliha; 0000-0001-6661-4185; 0000-0002-2742-9021; 27730453; V-5717-2017; D-5195-2014; HOC-5611-2023To compare soft-tissue cone-beam computed tomography (CBCT-P) and fiducial marker (CBCT-FM)-based image guided radiotherapy in prostate cancer patients. Sixteen prostate cancer patients were treated with volumetric modulated arc therapy. Manual alignment using CBCT-P and CBCT-FM was performed for each patient. Couch shifts were calculated and compared between methods in the left-right (x), superior-inferior (y), and anterior-posterior (z) directions. CBCT-P and CBCT-FM alignments were compared using 252 scans from the 16 patients. Mean displacement from zero was 2.4 +/- 1.3, 1.7 +/- 1.2, and 1.8 +/- 1.1 mm for CBCT-P and 2.3 +/- 1.3, 1.7 +/- 1.1 and 1.8 +/- 1.1 mm for CBCT-FM in the x, y and z directions, respectively. There was no difference in median displacement between CBCT-P and CBCT-FM; however, there was a significant positive correlation between CBCT-P- and CBCT-FM-based displacements in the x (r = 0.881; p < 0.001), y (r = 0.789; p < 0.001) and z (r = 0.856; p < 0.001) directions by linear regression analysis. Systematic deviations within each group were < 1 mm; however, random and systematic errors were similar in the x and y directions but larger in the z direction. Our study demonstrated that CBCT-FM was not superior to CBCT-P for image-guided radiotherapy in prostate cancer patients.Item The prognostic value of mean apparent diffusion coefficient measured with diffusion-weighted magnetic resonance image in patients with prostate cancer treated with definitive radiotherapy(2022) Onal, Cem; Erbay, Gurcan; Guler, Ozan Cem; Oymak, Ezgi; 35753556Purpose: To assess the correlation between initial tumor apparent diffusion coefficient (ADC) values and clinicopathological parameters in prostate cancer (PCa) patients treated with definitive radiotherapy (RT). Additionally, the prognostic factors for freedom from biochemical failure (FFBF) and progressionfree survival (PFS) in this patient cohort were analyzed. Materials and methods: The clinical data of 503 patients with biopsy-confirmed PCa were evaluated retrospectively. All patients had clearly evident tumors on diffusion-weighted magnetic resonance imaging (DW-MRI) for ADC values. Univariable and multivariable analyses were used to determine prognostic factors for FFBF and PFS. Results: The median follow-up was 72.9 months. The 5-year FFBF and PFS rates were 93.2% and 86.2%, respectively. Significantly lower ADC values were found in patients with a high PSA level; advanced clinical stage; higher ISUP score, and higher risk group than their counterparts. Receiver operating characteristic (ROC) curve analysis revealed an ADC cut-off value of 0.737 x 10-3 mm2/sec for tumor recurrence. Patients who progressed had a lower mean ADC value than those who did not (0.712 +/- 0.158 vs. 1.365 +/- 0. 227 x 10-3 mm2/sec; p < 0.001). There was a significant difference in 5-year FFBF (96.3% vs. 90%; p < 0.001) and PFS rates (83.8% vs. 73.5%; p = 0.002) between patients with higher and lower mean ADC values. The FFBF and PFS were found to be correlated with tumor ADC value and ISUP grades in multivariable analysis. Additionally, older age was found to be a significant predictor of worse PFS. Conclusions: Lower ADC values were found in patients with high-risk characteristics such as a high serum PSA level, stage or grade of tumor, or high-risk disease, implying that ADC values could be used to predict prognosis. Lower ADC values and higher ISUP grades were associated with an increased risk of BF and progression, implying that treatment intensification may be required in these patients. (c) 2022 Elsevier B.V. All rights reserved. Radiotherapy and Oncology 173 (2022) 285-291Item Stereotactic radiotherapy to oligoprogressive lesions detected with Ga-68-PSMA-PET/CT in castration-resistant prostate cancer patients(2021) Onal, Cem; Ozyigit, Gokhan; Oymak, Ezgi; Guler, Ozan Cem; Tilki, Burak; Hurmuz, Pervin; Akyol, Fadil; 0000-0002-2742-9021; 33693965; D-5195-2014Purpose We assessed the outcomes of stereotactic body radiotherapy (SBRT) to treat oligoprogressive castration-resistant prostate cancer (CRPC) patients with <= 5 lesions using gallium prostate-specific membrane antigen-positron emission tomography (Ga-68-PSMA-PET/CT). Methods The clinical data of 67 CRPC patients with 133 lesions treated with Ga-68-PSMA-PET/CT-based SBRT were retrospectively analyzed. All of the patients had oligoprogressive disease during androgen-deprivation therapy (ADT). The prognostic factors for overall- (OS) and progression-free survival (PFS) and the predictive factors for switching to next-line systemic treatment (NEST) and NEST-free survival (NEST-FS) were analyzed. Results With a median follow-up of 17.5 months, the 2-year overall survival (OS) and PFS rates were 86.9% and 34.4%, respectively. The PSA response was observed in 49 patients (73.1%). Progression was observed in 37 patients (55.2%) at a median of 11.0 months following SBRT. A total of 45 patients (67.2%) remained on ADT after SBRT, and 22 patients (32.8%) had a NEST change at a median of 16.4 months after metastasis-directed treatment (MDT). Patients with a NEST change had higher post-SBRT PSA values and fewer PSA nadirs after MDT than their counterparts. In multivariate analysis, higher pre-SBRT PSA values were the only significant predictor for worse OS and NEST-FS, and no significant factor was found for PFS. No serious acute or late toxicities were observed. Conclusion This study demonstrated the feasibility of MDT using SBRT to treat oligoprogressive lesions by Ga-68-PSMA-PET/CT in CRPC patients is efficient and well-tolerated, prolonging the effectiveness of ADT by delaying NEST.Item The role of T2-weighted images in assessing the grade of extraprostatic extension of the prostate carcinoma(2020) Onay, Aslihan; Ertas, Gokhan; Vural, Metin; Colak, Evrim; Esen, Tarik; Bakir, Baris; 32002569Purpose Extraprostatic extension (EPE) is an unfavorable prognostic factor and the grade of EPE is also shown to be correlated with the prognosis of prostate cancer. The current study assessed the value of prostate magnetic resonance imaging (MRI) in measuring the radial distance (RD) of EPE and the role of T2 WI signs in predicting the grade of EPE. Materials and methods A total of 110 patients who underwent prostate MRI before radical prostatectomy are enrolled in this retrospective study. Eighty-four patients have organ confined disease and the remaining twenty-six patients have EPE all verified by histopathology. Prostate MRI examinations were conducted with 3T MRI scanner and phased array coil with the following sequences: T2 WI, T1 WI, DCE, DWI with ADC mapping, and high b-value at b = 1500 s/mm(2). The likelihood of EPE with 5-point Likert scale was assigned, several MRI features were extracted for each dominant tumor identified by using T2 WI. Tumors with Likert scales 4-5 were evaluated further to obtain MRI-based RD. The relationship between pathological and MRI-determined RD was tested. Univariate and multivariate logistic regression models were developed to detect the grade of pathological EPE. The inputs were among the 2 clinical parameters and 4 MRI features. Results There is a moderate correlation between pathological RD and MRI-determined RD (rho = 0.45, P < 0.01). In univariate and multivariate models, MRI features and clinical parameters possess varying significance levels (univariate models; P = 0.048-0.788, multivariate models; P = 0.173-0.769). Multivariate models perform better than the univariate models by offering fair to good performances (AUC = 0.69-0.85). The multivariate model that employs the MRI features offers better performance than the model employs clinical parameters (AUC = 0.81 versus 0.69). Conclusion Co-existence of T2 WI signs provide higher diagnostic value even than clinical parameters in predicting the grade of EPE. Combined use of clinical parameters and MRI features deliver slightly superior performance than MRI features alone.Item Incidental testicular doses during volumetric-modulated arc radiotherapy in prostate cancer patients(2020) Onal, Cem; Bozca, Recep; Dolek, Yemliha; Guler, Ozan Cem; Arslan, Gungor; 0000-0001-6908-3412; 0000-0002-2742-9021; 32125635; AAC-5654-2020; D-5195-2014Purpose To compare the incidental testicular doses during volumetric-modulated arc therapy (VMAT) in patients receiving prostate-only and pelvic lymphatic irradiation. Materials and methods Testicular doses in 40 intermediate- and high-risk prostate cancer patients were determined on treatment planning system (TPS) using the VMAT technique at 6 MV. Scattered testicular doses were also measured by MOSFET detectors placed on testis surface. The testicular doses of patients treated with prostate-only and pelvic field irradiation were compared. Results The median testicular doses measured per 200 cGy fraction by TPS and MOSFET detectors were 1.7 cGy (0.7-4.1 cGy) and 4.8 cGy (3.6-8.8 cGy), respectively. The TPS doses and MOSFET readings showed a significant strong correlation (Pearson r = 0.848, p < 0.001). The testicular doses measured by TPS (1.34 +/- 0.36 cGy vs. 2.60 +/- 0.95 cGy; p < 0.001) and MOSFET (4.52 +/- 0.64 cGy vs. 6.56 +/- 1.23 cGy; p < 0.001) were significantly lower in patients with prostate-only irradiation than in those with pelvic field irradiation. The mean cumulative scattered dose for prostate-only field delivering 78 Gy was 1.8 Gy and that for pelvic field irradiation was 2.6 Gy, consistent with the reported findings. Conclusions The patients with prostate-only irradiation received lower testicular doses than those with additional pelvic field irradiation possibly due to the increased scattered doses in large field irradiation using the VMAT technique. The clinical response to increased incidental testicular doses due to pelvic field irradiation remains unknown, and it warrants further investigation.Item The effect of androgen deprivation therapy on Ga-68-PSMA tracer uptake in non-metastatic prostate cancer patients(2020) Onal, Cem; Guler, Ozan Cem; Torun, Nese; Reyhan, Mehmet; Yapar, Ali Fuat; 0000-0002-5597-676X; 0000-0001-8550-3368; 0000-0003-1715-4180; 0000-0001-6908-3412; 0000-0002-2742-9021; 31732768; AAE-2718-2021; AAJ-5242-2021; AAI-8973-2021; AAC-5654-2020; D-5195-2014Purpose To evaluate the effect of neoadjuvant androgen deprivation treatment (ADT) on prostate-specific membrane antigen (PSMA) tracer uptake demonstrated in Ga-68-PSMA-positron emission tomography (PET/CT) in non-metastatic hormone-naive prostate cancer (PC) patients. Materials and methods The clinical data of 108 PC patients who received neoadjuvant ADT were retrospectively analyzed. All patients had a baseline Ga-68-PSMA-PET/CT scan, and a second scan was delivered median of 2.9 months after the initiation of ADT. The maximum standardized uptake value (SUVmax) of primary tumor (SUVp) and metastatic lymph nodes (SUVln) as well as PSA response were assessed between pre- and post-ADT Ga-68-PSMA-PET/CT scans. Results There were significant decreases in posttreatment serum PSA, SUVp, and SUVln. A decrease in SUVp was seen in 91 patients (84%) with a median value of 66% (range, 5-100%), while 17 patients (16%) had no change in or an increase in PSMA tracer uptake with a median value of 24% (range, 0-198%). Patients with Gleason score (GS) of 7 had significantly higher metabolic response rates compared to other patients. The disease progression was significantly higher only in patients with GS > 7 disease compared to GS 7 disease. The PSA response to ADT was the lowest in patients with ISUP high-grade tumors. A total of 16 patients (15%) had progressive disease, and in 9 patients (8%), radiotherapy decisions were modified according to posttreatment Ga-68-PSMA-PET/CT scans. Conclusions The current study includes the largest number of patients analyzed to date and demonstrates that ADT causes a significant decrease in serum PSA values and SUVp and SUVln. The authors demonstrate that Ga-68-PSMA-PET/CT may be used as a quantitative imaging modality after neoadjuvant ADT in hormone-naive non-metastatic PC patients.Item Retrospective correlation of (68)ga-psma uptake with clinical parameters in prostate cancer patients undergoing definitive radiotherapy(2020) Onal, Cem; Torun, Nese; Oymak, Ezgi; Guler, Ozan C.; Reyhan, Mehmet; Yapar, Ali F.; 0000-0001-6908-3412; 0000-0001-8550-3368; 0000-0003-1715-4180; 0000-0002-2742-9021; 0000-0002-5597-676X; 32221791; AAC-5654-2020; AAJ-5242-2021; AAI-8973-2021; D-5195-2014; AAE-2718-2021Objective The aim of the study is to investigate the correlation between the intensity of prostate-specific membrane antigen (PSMA) uptake in primary tumor and clinico-pathological characteristics of non-metastatic prostate cancer patients treated with definitive radiotherapy (RT). Methods Using the clinical data of 201 prostate cancer patients who were referred for (68) Ga-PSMA-positron emission tomography (PET/CT) for staging and RT planning, we analyzed the correlations among intermediate- or high-risk disease based on Gleason score (GS), prostate-specific antigen (PSA) level, D'Amico risk group classification, and maximum standardized uptake (SUVmax) of primary tumor. Results Primary tumor was visualized via (68) Ga-PSMA-PET/CT scan in 192 patients (95.5%). The median SUVmax of primary tumor and metastatic lymph node were 13.2 (range 3.3-83.7) and 11.4 (range 3.6-64.5), respectively. A significant moderate correlation was observed between PSA level and median tumor SUVmax as measured by (68) Ga-PSMA-PET/CT (Spearman = 0.425; p < 0.001). Patients with serum PSA > 10 ng/mL, GS > 7, D'Amico high-risk group classification, and pelvic lymph node metastasis had significantly higher tracer uptake in primary tumor than their counterparts. The median SUVmax of primary tumor was highest in patients with GS 9. The primary tumor detection rates of (68) Ga-PSMA-PET/CT were 83%, 92%, and 99% for patients with serum PSA <= 5.0 ng/mL (14 patients, 7%), PSA 5.1-10.0 ng/mL (45 patients, 22%), and PSA > 10 ng/mL (142 patients, 71%), respectively. Conclusions We demonstrated a correlation between prostate tumor characteristics and PSMA tracer uptake. Patients with serum PSA > 10 ng/mL, GS > 7, D'Amico high-risk group classification, and pelvic lymph node metastasis had significantly higher SUV than their counterparts. In addition, the primary tumor detection rate was higher in patients with serum PSA > 10 ng/mL and GS > 7.