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Item Association between focal adhesion kinase and matrix metalloproteinase-9 expression in prostate adenocarcinoma and their influence on the progression of prostatic adenocarcinoma(2020) Atilgan, Alev Ok; Ozdemir, B. Handan; Akcay, Eda Yilmaz; Tepeoglu, Merih; Borcek, Pelin; Dirim, Ayhan; 0000-0002-7528-3557; 0000-0001-8595-8880; 0000-0002-9894-8005; 0000-0001-6831-9585; 0000-0003-2898-485X; 32106037; X-8540-2019; AAK-3333-2021; AAK-5222-2021; AAK-1960-2021; AAJ-5689-2021Focal adhesion kinase (FAK), a member of the non-receptor cytoplasmic tyrosine kinase family, is associated with the development and progression of cancer. Matrix metalloproteinase-9 (MMP-9) is directly involved in the degradation of the extracellular matrix, and basement membrane components promote cancer cell migration and invasion. There is a functional interaction among FAK, MMP-9 and vascular endothelial growth factor (VEGF), which leads to enhanced cancer angiogenesis, cancer cell invasion and progression of malignancy. FAK, MMP-9, VEGF and CD34-positive microvessel density (MVD) were examined in 100 patients with prostate adenocarcinoma using immunohistochemistry. The relationship among these proteins and their impact on angiogenesis and clinicopathological parameters were also evaluated. The FAK expression was found to be positively correlated with the Gleason score, WHO grade group, tumour stage, extracapsular extension and perineural invasion. The MMP-9 expression was positively correlated with the WHO grade group, tumour stage, extracapsular extension, positive surgical margin and lymphovascular and perineural invasion. The FAK expression was also positively correlated with MMP-9 expression and MVD. However, no correlation between FAK and VEGF expression was identified. The MMP-9 expression was positively correlated with FAK expression and MVD. Strong MMP-9 expression was associated with shorter disease-free survival. These results suggest that strong MMP-9 and FAK expressions play an essential role in the progression of prostate adenocarcinoma. Further investigations should be conducted to determine the importance of these proteins as therapeutic targets for patients with prostate adenocarcinomas.Item Outcome of loco-regional radiotherapy in metastatic castration-resistant prostate cancer patients treated with abiraterone acetate(2019) Yildirim, Berna Akkus; Onal, Cem; Kose, Fatih; Oymak, Ezgi; Sedef, Ali Murat; Besen, Ali Ayberk; Aksoy, Sercan; Guler, Ozan Cem; Sumbul, Ahmet Taner; Mualloglu, Sadik; Mertsoylu, Huseyin; Ozyigit, Gokhan; 30701292Purpose To evaluate the potential benefit of curative radiotherapy (RT) to the primary tumor in metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone. Materials and methods The clinical parameters of 106 mCRPC patients treated with abiraterone were retrospectively evaluated. Patients were either oligometastatic (<= 5 metastases) at diagnosis or became oligometastatic after the systemic treatment was analyzed. Local RT to the primary tumor and pelvic lymphatics was delivered in 44 patients (41%), and 62 patients (59%) did not have RT to the primary tumor. After propensity match analysis, a total of 92 patients were analyzed. Resultsn Median follow-up time was 14.2 months (range: 2.3-54.9 months). Median overall survival (OS) was higher in patients treated with local RT to the primary tumor than in those treated without local RT with borderline significance (24.1 vs. 21.4 months; p=0.08). Local RT to the prostate and pelvic lymphatics significantly diminished the local recurrence rate (16 patients, 31% vs. 2 patients, 5%; p=0.003). In multivariate analysis, the prostate specific antigen (PSA) response >= 50% of the baseline obtained 3 weeks after abiraterone therapy was the only significant prognostic factor for better OS and progression-free survival (PFS). Patients treated with primary RT to the prostate had significantly less progression under abiraterone and a longer abiraterone period than those treated without local prostate RT. Conclusions Local prostate RT significantly improved OS and local control in mCRPC patients treated with abiraterone. The patients treated with primary RT had significantly less progression under abiraterone and a longer abiraterone period than those treated without local prostate RT.Item Prostate Biopsy in the Elderly: Histologic Findings and Treatment Necessity(2014) Akman, Ramazan Yavuz; Koseoglu, Hikmet; Oguzulgen, Ahmet Ibrahim; Sen, Erhan; Yaycioglu, Ozgur; 25374232The aim of this study is to determine results of high prostate specific antigen (PSA) or abnormal digital rectal examination driven prostate biopsies performed in our Department in men aged 75 or more and to show the characteristics of pathology results. The hospital records of the patients who had high PSA or abnormal digital rectal examination driven prostate biopsy in two common university based research hospitals have been reviewed retrospectively. Patients aged 75 years or older at the date of biopsy whose records provided pathology results and full medical history were evaluated for the study. A total of 103 patients were evaluated with a mean age of 79.4 +/- 3.4 years. More than half of the patients (55.1%) were in their seventh decade and the rest were in the eighth decade. Median PSA value was 15.0 (range 2.1-4500) ng/ml. In most of the biopsies (67%), PSA levels were lower than 20 ng/ml. In almost half of the patients (48%), digital rectal examination was abnormal. In 68.9% of the patients, there were at least one or more associated co-morbid diseases. Gleason scores were 7 or higher in 73%, and 8 or higher in 37% of the patients with prostate cancer. Four of the 70 (6%) patients had bone metastases. Castrations were applied to most of the patients with prostate adenocarcinoma (% 79). High percentage of high grade (Gleason 7 or more) prostate adenocarcinoma in the elderly refutes the perception of prostate cancer in this age group as clinically insignificant. Therefore, it is to be kept in mind that prostate cancer in the elderly an be clinically significant and prostate biopsies are to be performed when necessary.Item Ductal Adenocarcinoma: A Rare Entity of Prostate Gland in a Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Patient(2015) Ozgur, Tumay; Rifaioglu, Murat Mehmet; Sumbul, Ahmet Taner; Aydogan, Fusun; Atci, NesrinProstate cancer is the most common malignancy in men and ductal adenocarcinoma is a pathologic subtype with specific histological and clinical features. Seventy-six year-old male patient with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) admitted to our hospital with lower urinary tract symptoms. The last prostate specific antigen (PSA) level was 26 ng/ml and serial transrectal ultrasound guided biopsies were administered and benign prostate hyperplasia and non-specific prostatitis were the results of pathology reports. Due to the persistence of the symptoms transurethral resection of the prostate was performed. In the pathologic evaluation of the material adenocarcinoma focuses without stroma has been observed between the hyperplasic prostate tissues. The tumor has been diagnosed as ductal adenocarcinoma with 4 + 4 Gleason pattern score. Bone scintigraphy was revealed activity uptake on lomber vertebral column due to metastasis. Computerized tomography was revealed previous bilateral inguinal and right iliac lymphadenopathy due to CLL/SLL. Total androgen deprivation therapy and bilateral orchiectomy was applied. After three mounts according to biochemical and imaging results, radiotherapy cure began. Ductal adenocarcinoma is a rare subtype of prostate carcinoma with clinical behavior from that seen in conventional adenocarcinoma. On the other hand it is worth to point out the occurence of this entity as second malignancy during follow-up of CLL/SLL.Item Monopolar and Bipolar Modalities of Transurethral Prostate Resection(2015) Koseoglu, Hikmet; Akman, Ramazan YavuzBenign prostate hyperplasia (BPH) related lower urinary tract symptoms (LUTS) is among the most common diseases in the aging male. Both medical and surgical treatment modalities have been improved strikingly in the last 20 years. Transurethral resection of the prostate (TUR-P) is still the gold standard for the surgical treatment for the prostates with the volume of 30-80 ml. Today, besides monopolar classical TUR-P systems which are still widely used, bipolar TUR-P systems are also being used in the increasing numbers. Results of recent meta-analyses did not determine difference between monopolar and bipolar systems in terms of clinical efficacy, in addition, showed bipolar advantages in terms of bleeding and clot retention. Both monopolar and bipolar systems shall better be used until the results of multi-centered prospective studies which compare both modalities with high number of patients together with controlling surgeon factors.Item Inflammatory Myofibroblastic Tumor of the Prostate(2016) Kocer, Nazim Emrah; Bal, Nebil; Gul, Umit; Aydin, HakanInflammatory myofibroblastic tumors (IMT) of the prostate are very rare lesions that may mimic sarcomas and spindle carcinomas both clinically and histopathologically. The case presented here is a 63-year-old patient, with normal prostate specific antigen levels and a chronic history of complaints, who underwent to suprapubic prostatectomy due to the infravesical obstruction symptoms that are resistant to medical therapy. Histopathological examination of the excision material revealed a well demarcated spindle cell lesion with focal nuclear polymorphism, hyperchromasia, mononuclear inflammatory infiltration and myxoid areas. Mitosis was rare. Immunohistochemically smooth muscle actin and vimentin were positive, anaplastic lymphoma kinase-1 was focal positive, S-100 and pancytokeratin were negative. The lesion was diagnosed as an inflammatory pseudotumor. Differential diagnosis of the IMT from malignant spindle cell tumors of the prostate is crucial to prevent overtreatment.Item Holmium laser enucleation of the prostate: surgical, functional, and quality-of-life outcomes upon extended follow-up(2016) Alkar, Ilter; Ozveri, Hakan; Akin, Yigit; Ipekci, Tumay; Alican, Yusuf; 27256184Objectives: To evaluate the long-term surgical, functional, and quality-of-life (QoL) outcomes after Holmium laser enucleation of the prostate (HoLEP) in patients with symptomatic benign prostatic hyperplasia (BPH). Materials and Methods: We retrospectively reviewed recorded data on patients who underwent HoLEP between June 2002 and February 2005. Ninety-six patients were enrolled. Demographic, perioperative, and postoperative data were recorded. On follow-up, International Prostate Symptom Scores (IPSSs), prostate-specific antigen (PSA) levels, QoL scores, peak uroflowmetric data (Q(max) values), and post-voiding residual urine volumes (PVR volumes), were recorded. Complications were scored using the Clavien system. Statistical significance was set at p<0.05. Results: The mean follow-up time was 41.8 +/- 34.6 months and the mean patient age 73.2 +/- 8.7 years. The mean prostate volume was 74.6 +/- 34.3mL. Significant improvements in Q(max) values, QoL, and IPSSs and decreases in PSA levels and PVR volumes were noted during follow-up (all p values=0.001). The most common complication was a requirement for re-catheterisation because of urinary retention. Two patients had concomitant bladder tumours that did not invade the muscles. Eight patients (8.3%) required re-operations; three had residual adenoma, three urethral strictures, and two residual prostate tissue in the bladder. Stress incontinence occurred in one patient (1%). All complications were of Clavien Grade 3a. We noted no Clavien 3b, 4, or 5 complications during follow-up. Conclusions: HoLEP improved IPSSs, Q(max) values, PVR volumes, and QoL and was associated with a low complication rate, during extended follow-up. Thus, HoLEP can be a viable option to transurethral resection of the prostate.