Fakülteler / Faculties
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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 Role of Vascular Endothelial Growth Factor in Clinically Localized Prostate Cancer Treated with Radiation Therapy(2014) Erkal, Eda Yirmibesoglu; Bora, Huseyin; Tepeoglu, Merih; Akmansu, MugeBackground: Anti-vascular endothelial growth factor (Anti-VEGF) agents are a promising approach to increase the efficacy of treatment for treatment-resistant prostate cancer. Aims: To correlate vascular endothelial growth factor (VEGF) expression and outcome following radiation therapy in the treatment of clinically localized prostate cancer. Study Design: Retrospective observational study. Methods: Forty-one patients and clinically localized disease that were treated with radiation therapy were analyzed. For VEGF expression, immunoreactivity scores (IRS) were calculated using percent scores and intensity scores. Twenty-four patients were classified as having low (0 to 4 IRS) and 17 patients were classified as having high (5 to 8 IRS) VEGF expression. Results: The median age was 71 years, median follow-up was 5.4 years and median radiation therapy dose was 70 Gy. VEGF expression was calculated as low in 24 patients and high in 17 patients. Higher VEGF expression was observed in 6/26 patients with a low Gleason score versus 11/15 patients with a high Gleason score (p=0.02). Biochemical failure (BF) was observed in 2/24 patients with low VEGF expression versus 7/17 patients with high VEGF expression (p=0.01). In univariate analysis, having a higher Gleason score (p<0.01), being in the high risk group (p=0.03) and having higher VEGF expression (p=0.01) predicted BF after definitive radiation therapy. The biochemical failure-free survival rate at 5 years tended to be different (91% vs. 53%) when patients were grouped according to VEGF expression (p=0.06). Conclusion: In attempt to define patients with clinically localized disease that are not sensitive to standard treatment modalities, cellular and/or molecular biological markers may be requiredItem Can We Predict the Surgical Margin Positivity in Patients Treated with Radical Prostatectomy? A Multicenter Cohort of Turkish Association of Uro-Oncology(2015) Dirim, AyhanObjective To analyze the parameters that predict the surgical margin positivity after radical prostatectomy for localized prostate cancer. Materials and Methods In this multicenter study, the data of 1607 consecutive patients undergoing radical prostatectomy for localized prostate cancer in 12 different clinics in Turkey between 1993-2011 were assessed. Patients who had neoadjuvant treatment were excluded. We assessed the relationship between potential predictive factors and surgical margin status after radical prostatectomy such as age, cancer characteristics, history of transurethral prostate resection, surgical experience and nerve-sparing technique by using univariate and multivariate Cox regression analyses and t test. Results The overall surgical margin positivity rate was 22.6% (359 patients). In univariate analyses, preoperative prostate specific antigen level, clinical stage, biopsy Gleason score, percentage of tumor involvement per biopsy specimen, transurethral prostate resection history, surgical experience and nerve-sparing technique were significantly associated with positive surgical margin rate. In multivariate analyses, preoperative prostate specific antigen level (OR: 1.03, p=0.06), percentage of tumor involvement per biopsy specimen (OR: 7,14, p<0,001), surgical experience (OR: 2.35, p=0.011) and unilateral nerve-sparing technique (OR: 1.81, p=0.018) were independent predictive factors for surgical margin positivity. Conclusion Preoperative prostate specific antigen level, percentage of tumor involvement per biopsy specimen, surgical experience and nerve-sparing technique are the most important predictive factors of surgical margin positivity in patients undergoing radical prostatectomy for localized prostate cancer.Item Evaluation of the Current Situation Tissue and Serum Biomarkers in Prostate Cancer(2015) Kervancioglu, Enis; Kosan, MuratProstate cancer, is the most commonly diagnosed cancer in the United States and in many parts of the world and ranks 2nd in death from cancer among men. Lifetime risk of developing prostate cancer is 16%. Currently the only accepted screening tool Prostate Specific Antigen (PSA) and Digital Rectal Examination (DRE). PSA is a specific biomarker but non-specific for prostate cancer. In diseases such as Benign Prostatic Hyperplasia (BPH) and prostatitis high serum PSA levels can be detected. Therefore, identifying prostate cancer only with serum PSA measurement has lower specificity and may lead to false positive results and unnecessary biopsies. Some encountered problems such as unnecessary diagnoses of clinically insignificant cancer and the non-diagnosis of early stage cancers can take. In recent years there are too many studies to investigate new biomarkers for replacing or helping PSA. The aim of this article was the evaluation of the current situation for PSA and non-PSA tissue and serum biomarkers which are published.Item Three Dimensional Conformal Radiotherapy and Androgen Deprivation Therapy in Patients with Clinically Localized Prostate Cancer; Hacettepe University Experience(2015) Ozdemir, Yurday; Akyol, Fadil; Ozyiğit, Gokhan; Hurmuz, Pervin; Onal, Cem; Selek, Ugur; Karabulut, ErdemThe aim of this study into evaluate the treatment results of three dimensional conformal radiotherapy (3DCRT) and androgen deprivation therapy (ADT) in patients with clinically localized prostate cancer (CLPC). Between June 1998 and December 2011, 577 patients with the diagnosis of CLPC were treated. ADT was started 3 months prior to radiotherapy (RT). 3DCRT was delivered to prostate and the seminal vesicles (SV) to a total dose of 70Gy. Additionally, patients with lymph node (LN) positivity received 50.4Gy RT to pelvic LN's. Median follow up time was 65 months. Five-ten years overall survival (OS), cause specific survival (CSS), PSA relapse-free survival (PSA-RFS) and distant metastasis-free survival (DMFS) rates were 92-74%, 97-91%, 77-55% and 94-88%, respectively. OS was negatively affected from LN positivity (p < 0.001). In the subgroup of patients With GS 8, there was no significant difference between < 1 years and 1 years of ADT in terms of CSS, PSA-RFS and DMFS. OS was better in patients with < 1 years of ADT (p = 0.01). Five year OS (p = 0.02), CSS (p = 0.05), PSA-RFS (p = 0.01) and DMFS (p = 0.07) rates were inferior in the high risk group patients that used ADT 1 year. Acute and late RTOG grade III/IV gastrointestinal system toxicity rates were 1.7% and 5% and acute and chronic RTOG grade III/IV genitourinary system toxicity rates were 1.4% and 5%, respectively. 3DCRT and ADT combination is an effective treatment modality with acceptable toxicities in patients with clinically localized prostate cancer.Item Correlation of Clinical Risk Factors with Diffusion-Weighted Magnetic Resonance Images in Prostate Cancer Patients Treated with Definitive Radiotherapy(2015) Erbay, Gurcan; Onal, Cem; Guler, Ozan C.; Karadeli, Elif; Koc, ZaferThis study is aimed to correlate apparent diffusion coefficient (ADC) values and clinical T-stage, serum PSA, pathology Gleason scores. We also further analyzed whether ADC values could be used to appropriately define the risk groups. 135 biopsy-proven, radiotherapy-(RT)-treated, prostate cancer patients who underwent pre-RT DW-MRI and standard T2W pelvic MRI were included. ADC and normalized ADC (nADC) values were calculated from DW-MRI delivered a median 8.1 weeks after prostate biopsy. ADC values were correlated with clinical risk factor values by using Pearson correlation test. ADCs in low-, intermediate-, and high-risk patients were 0.873 +/- 0.122X10(-3) mm(2)/s, 0.763 +/- 0.124X10(-3) mm(2)/s, and 0.701 +/- 0.132X10(-3) mm(2)/s (p = 0.001), respectively. Patients with preRT PSA <10 ng/mL had significantly higher ADCs than patients with preRT PSA 10-20 ng/mL (p = 0.02) or >20 ng/mL (p < 0.001). Mean ADC for patients with Gleason score <7 was significantly higher than patients scoring 7 (p = 0.001) or >7 (p < 0.001). Clinical stageItem The Role of Radical Prostatectomy in the Treatment of Patients with High-Risk Prostate Cancer(2015) Kuzgunbay, Baris; Yaycioglu, OzgurHigh-risk prostate cancer (PCa), which is defined as PSA > 20 ng/mL or Gleason Score (GS) > 7 or >= cT3a, accounts for up to 40% of newly diagnosed cases and carries a significant risk of progression and death. However, the best management approach for patients with high-risk PCa is still under debate. Recently, radical prostatectomy (RP) with extended lymphadenectomy (LND) has become popular for the treatment of high-risk PCa with good prognosis in selected patients in the context of multimodal approach. However, decision should be made after all treatments have been discussed by a multidisciplinary team and the patient should be informed about the likelihood of a multimodal approach. On the other hand, necessity of sufficient surgical expertise for RP to keep the level of morbidity acceptable in high-risk PCa patients should be kept in mind.Item Predictive values of vascular endothelial growth factor and microvessel-density levels in initial biopsy for prostate cancer(2016) Kervancioglu, Enis; Kosan, Murat; Erinanc, Hilal; Gonulalan, Umut; Oguzulgen, Ahmet Ibrahim; Coskun, Esra Zeynep; Ozkardes, Hakan; 26944325Angiogenesis is an important factor in the development and progression of prostate cancer (PCA). We aimed to investigate the values of vascular-endothelial-growth-factor (VEGF) expression level and microvessel density (MVD) in the prediction of PCA diagnosis at repeated prostate biopsy (re-PBx). We retrospectively evaluated 167 patients with re-PBx according to elevated prostate-specific antigen levels, suspicious digital rectal examination, and the presence of premalignant lesions. Patients with PCA on re-PBx were included in the cancer group (n = 17). Patients with benign prostatic hyperplasia or normal tissues on re-PBx were included in the control group (n = 21). The groups were compared according to the expression level of VEGF and MVD in initial prostate biopsy. There was no statistically significant difference between groups according to age and serum prostate-specific-antigen values. The mean VEGF scores of the cancer and control groups were 232.64 +/- 11.14 and 183.09 +/- 14.56, respectively (p < 0.05). The mean MVD of the biopsy samples in the cancer and control groups were 246.47 +/- 17.59 n/mm(2) and 197.33 +/- 16.26 n/mm(2), respectively (p < 0.05). The cutoff values of VEGF scores and MVD were set as 200 and 215, respectively, for PCA detection in our study. Our results showed that the expression level of VEGF and MVD significantly increased in the initial prostate-biopsy samples of patients with PCA diagnosed with re-PBx. The evaluation of VEGF expression level and MVD might have an important value in the prediction of PCA at re-PBx. The expression level of VEGF and MVD should be kept in mind as PCA-related histopathological changes that indicate the increased angiogenesis in prostatic tissue. Copyright (C) 2015, Kaohsiung Medical University. Published by Elsevier Taiwan LLC.Item Is Preoperative Neutrophil Lymphocyte Ratio a Reliable Prognostic Parameter for Localized Prostate Cancer?(2017) Ipekci, Tumay; Tunckiran, Ahmet; Yuksel, Mustafa; Ucar, Murat; Kozacioglu, Zafer; Akman, Ramazan Yavuz; 0000-0001-7303-7064; 0000-0002-2755-0526; V-6440-2019; AAB-2986-2020; AAD-3028-2020Objective: In spite of all efforts, prostate cancer is still the 2nd highest cause of cancer-related deaths in men. For this reason new developments are needed in diagnosis, treatment and follow-up of prostate cancer. Neutrophil/lymphocyte (N/L) ratio is a cheap and effective parameter used for research into many solid tumors; but there are not enough studies on the reliability of this parameter in prostate cancer. In this study we researched the efficacy of N/L ratio in localized prostate cancer. Materials and Methods: Between March 9, 2012 and April 23, 2017, the data of 140 patients who underwent radical prostatectomy with localized prostate cancer were screened retrospectively. The patients' ages, preoperative prostate specific antigen (PSA) and N/L ratio, pathologic stage, pathologic Gleason score, tumor volume, lymph node involvement, surgical margin positivity and presence or absence of 3rd month biochemical recurrence were noted. The correlations between N/L ratio with age, PSA, pathologic parameters, surgical margin positivity and biochemical recurrence were investigated. Results: The mean age of patients was 63.0 +/- 5.9 years, mean PSA value was 10.8 +/- 8.5 ng/mL and mean N/L ratio was 2.5 +/- 1.9. There was no correlation found between N/L ratio and PSA, pathologic stage, Gleason score, lymph node involvement, tumor volume, surgical margin positivity and biochemical recurrence (p>0.05). Conclusion: In our study investigating 140 patients with localized prostate cancer, we did not identify any correlation between N/L ratio and PSA, surgical stage and Gleason score, surgical margin positivity, and 3rd month biochemical recurrence. When the literature is investigated, it appears that N/L ratio is effective for metastatic prostate cancer. To provide a more accurate judgment of the role of N/L ratio in localized prostate cancer, there is a need for new studies with broader patient series.