Güven Aslan

Is Systematic Biopsy Mandatory in Addition to Targeted Biopsy in Patients with a PI-RADS 5 Lesion Identified on Magnetic Resonance Imaging? - Bulletin of Urooncology

Purpose: To investigate the effect of metformin use on recurrence and progression in nonmuscle invasive bladder cancer patients (NMIBC). Material method: Patients who underwent primary transurethral bladder tumor resection between 2016 and 2020 were screened. Only patients with NMIBC were included in the study. The patients were divided into two groups according to the use of metformin and the groups were compared in terms of recurrence and progression. Results: According to inclusion criteria 176 NIMBC patients were included in the study. Metformin use was detected in 37 patients. The demographic characteristics and follow-up times of the patients were similar between the user and nonuser groups. Recurrence was detected in only 8.1% of the metformin user group. On the other hand, the recurrence rate was 32.4% in the nonuser group. There was no progression in the metformin user group. But in the non-user group progression rate was 8,6%. Conclusion: In our study, we found that recurrence and progression rates were lower in metformin-using patients. Prospective randomized trials are needed to understand the effects of metformin use on bladder cancer.

Background/Objectives: In non-muscle-invasive bladder cancer (NMIBC), the decision for immediate postoperative single-dose intravesical chemotherapy (SI) is based on clinical and presumed pathological features, as a definitive pathology is unknown at the time of surgery. This study aims to assess how accurately urologists can predict the pathological features of bladder tumors based solely on cystoscopic appearance and evaluate their ability to identify patients eligible for SI. Methods: A total of 104 patients with bladder masses were included. Seven senior urologists and four residents participated. Before transurethral resection, both groups predicted tumor stage, grade, and the presence of carcinoma in situ (CIS). Resident predictions were collected for all 104 patients, while senior predictions were collected for 72 patients. Based on these predictions, patient eligibility for SI was determined according to the EAU NMIBC guidelines. After final pathology reports, risk scores were recalculated and compared with the surgeons’ predictions. Cohen’s Kappa (κ) coefficient was used to assess agreement between predictions and pathology. Positive and negative predictive values were also calculated for both groups. Results: Strong agreement with final pathology could not be demonstrated for stage, grade, or CIS for either group. Urology residents’ predictions were slightly more accurate than those of senior urologists. Overall, 19.4% (14/72) (based on senior urologists’ predictions) and 18.2% (19/104) (based on resident predictions) of patients were misclassified and either overtreated or undertreated. Conclusions: Cystoscopic visual prediction alone is insufficient for determining eligibility for immediate postoperative intravesical chemotherapy, regardless of the urologist’s experience. More objective criteria are needed to improve the selection of appropriate patients for SI.

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 2,061 patients from six centers where software-based TPB was performed were used. All cancer and csPC detection rates of the RR and ER systems were compared following Mahalanobis distance matching within 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 the csPC detection rate (28.0% vs. 22.3%, p = 0.242, respectively). The detection rate of all cancers by ER compared to RR was found to be significantly higher (54.8% vs. 35.7%, p < 0.001, respectively). No statistically significant difference was found between the ER and RR groups regarding pathological upgrade (39.7% vs. 24.2%, p = 0.130, respectively). 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 in ER systems.

Purpose: To compare the oncological outcomes of clear cell RCC (ccRCC), which is common in renal cell carcinomas (RCC), and chromophobic RCC (chRCC), which is less common, and to define the factors affecting survival in the Turkish patient population for both RCC subclassifications. Materials and Methods: Patients with a pathologically confirmed RCC diagnosis after radical or partial nephrectomy in the Turkish Urooncology Association (TUOA), Urological Cancers Database-Kidney (UroCaD-K), were retrospectively reviewed. Patients with ccRCC and chRCC were included in the study. The primary outcomes of this study are recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) for each histological subtype. Results: Data from 5300 patients in the TUOA UroCaD-K are reviewed and a total of 2560 patients (2225 in the ccRCC group and 335 in the chRCC group) are included in the final analysis. In the comparison of the groups, tumor size was greater both radiologically and pathologically in chRCC (p p = 0.019 vs 0.002 respectively). Recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) rates are worse in ccRCC subgroup. In the evaluation of risk factors; pathological stage, local invasion and Fuhrmann grade were found to be significant for recurrence in ccRCC. Age, body mass index and pathological stage were the risk factors affecting overall mortality (OM). Pathological tumor size was an independent risk factor for recurrence in chRCC, while age was analyzed as the only parameter affecting OM. Conclusion: chRCC oncological data and OS, CSS and RFS rates were found to be better than ccRCC in the Turkish patient population.