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Öğe Anxiety and Depression are Two Important Causes of Erectile Dysfunction after Saturation Biopsy: A Pilot Study(Galenos Yayincilik, 2014) Akbal, Cem; Türker, Polat; Şekerci, Çağrı Akın; Özgen, Mahir Bülent; Şimşek, Ferruh; Türkeri, LeventObjective To evaluate the role of the patient's mood as a possible cause of erectile dysfunction (ED) following transrectal ultrasound-guided saturation biopsy. Materials and Methods One hundred and thirty five patients who underwent a saturation biopsy due to persistently elevated levels of prostate specific antigen (PSA) were included in the study. Group 1 included 78 patients for whom the biopsy indicated that they were cancer-free, and group 2 included 57 patients for whom the biopsy indicated that they had prostate cancer and were thus on a waiting list for a radical treatment. Patients were evaluated using the International Index of Erectile Function-5 (IIEF-5) and the Hospital Anxiety-Depression Scale (HADS). Results Among the cancer-free group, 17% of patients exhibited a decline in erectile function after the biopsy according to their IIEF-5 scores. The anxiety or depression rate according to the HADS was 69% in the patients exhibiting a decrease in erectile function, which was greater than that of the rest of the cancer-free patients who had no erectile function deterioration. Patients who learned that they had cancer exhibited a statistically significant average decrease in IIEF-5 scores (p=0.04). Their scores on the HADS were significantly higher. Conclusion Although a saturation biopsy of the prostate is a safe procedure in terms of erectile function, the risk of ED after a biopsy should be discussed with patients who have had previous normal erectile function and have been diagnosed with cancer.Öğe Gas6 expression and tyrosine kinase axl sky receptors: Their relation with tumor stage and grade in patients with bladder cancer(Page Press Publications, 2021) Akgül, Murat; Baykan, Özgür; Ça?man, Zeynep; Özyürek, Mustafa; Tinay, İlker; Akbal, Cem; Türkeri, LeventObjectives: It has been shown that the dysregulation of tyrosine kinase Axl receptor and its ligand growth arrest-specific gene (Gas6) are associated with poor prognosis in various types of tumors but there is not enough study about their importance in bladder cancer (BC). We evaluated the relation of Gas6 gene expression and tyrosine- kinase Axl and Sky (Tyro 3) receptors with tumor stage and grade in patients with BC. Material and Methods: The study group consists of 55 patients whose transurethral resection of bladder (TUR-B) has been performed due to BC and the control group consists of 12 patients with normal bladder mucosa. In tissues mRNAs of Gas6, Axl, and Sky receptors were examined by quantitative (Real-Time) PCR (qPCR). Protein expression was measured by immunohistochemistry. Plasma Gas6 protein levels were compared with control group by ELISA method. Results: Patients with BC were grouped as Ta low (n=17), Ta high (n=5), T1 low (n=9), T1 high (n=8) and T2 (n=16) according to their TUR-B pathologies. The qPCR analysis showed that the expression of Gas6 gene and Axl receptor is higher in the tumor-positive group and the immune-histochemical showed that the bladder samples of the tumor-positive group stained significantly positive. When the patients are grouped according to the TUR-B pathologies, a statistical significant difference was observed among groups in the qPCR analysis ratios of Gas6 gene and Axl receptor by (p < 0.05) but no significance was found for Sky receptor (p > 0.05). When Gas6 protein levels in plasma samples were compared by ELISA method, a statistical significance was determined among groups (p = 0.001). Conclusions: Our findings indicate that mRNAs of Gas6 and Axl receptor are closely related to tumor stage and grade in patients with BC. Further studies are needed for understanding the role of Gas6 and its receptors on the neoplastic transformation in terms of novel biomarkers and potential therapeutic targets. © 2021 Edizioni Scripta Manent s.n.c.. All rights reserved.Öğe Non-Muscle Invasive Bladder Cancer Resistant to Bcg(Iniestares, S.A., 2013) Türker, Polat; Türkeri, LeventTreatment options for patients with non-muscle invasive bladder cancer (NM/BC) refractory to intravesical bacillus Calmette-Guerin (BCG) therapy is reviewed in this article based on the recent published literature. Although intravesical BCG is the best bladder sparing treatment option for NM/BC to prevent recurrence and progression, about 1/3 of cases are refractory to this treatment. At this point radical cystectomy is the standard treatment of choice. If this option is not feasible, intravesical chemotherapy with docetaxel or gemcitabine, the combination of BCG and interferon (INF)-alpha or device-assisted intravesical strategies, such as mitomycin-EMDA or chemohyperthermia are some of the candidates for further treatment.Öğe Open surgery is still gold standard for radical prostatectomy(Galenos Yayincilik, 2014) Türker, Polat; Türkeri, LeventOpen radical prostatectomy is considered as the standart of care for localised prostate cancer. It has longterm followup results and has a proven efficacy over cancer control and preservation of functional outcomes. Robot asisted laparoscopic radical prostatectomy is a minimally invasive surgical technique that brought some advantages to the field and has been adapted by urologic surgeons and patients in a very short time. Advantages of robotic surgery include decreased blood loss and transfusion rates comparable to open technique, wheras major disadvantages are high cost and absence of longterm results. In this article the main reasons for open surgery stil remaining the standart of care procedure are discussed.Öğe Presence of high grade tertiary Gleason pattern upgrades the Gleason sum score and is inversely associated with biochemical recurrence-free survival(Elsevier Science Inc, 2013) Türker, Polat; Baş, Emine; Bozkurt, Süheyla; Günlüsoy, Bülent; Sezgin, Arsenal; Postacı, Hakan; Türkeri, LeventObjectives: Tumor heterogeneity is a common finding and led to realization of a tertiary Gleason component (TGC) in prostate cancer. In an attempt to further investigate its prognostic value, we analyzed the association of tertiary Gleason pattern in Gleason score <= 7 tumors with pathologic stage and biochemical disease-free survival. Material and methods: A total of 331 radical prostatectomy specimens were analyzed retrospectively. The primary, secondary, and the tertiary patterns were evaluated by reviewing all of the pathologic slides. TGC was defined as Gleason grade pattern 4 or 5 for Gleason score <7 tumors and Gleason grade pattern 5 for Gleason score 7 tumors. The pathologic prognostic factors, (extraprostatic extension, seminal vesicle and lymph node invasion, surgical margin status) of Gleason score <7, 3+4, and 4+3 tumors with or without TGC were compared. Biochemical recurrence-free survival (BRFS) was calculated using Kaplan-Meier method with log rank test, and the influence of TGC was assessed in a Cox regression model. Results: TGC observed more frequently with higher Gleason scores (21% of the GS <7 cases, 23% of the GS 3+4 cases, and 58% of the GS 4+3 cases). In terms of adverse pathologic prognostic factors and BRFS, GS <7 tumors with TGC behaved significantly worse than GS <7 tumors without TGC (P = 0.01 and P = 0.001, respectively) with properties similar to GS 3+4 tumors without TGC. Gleason score 3+4 and 4+3 tumors without TGC were statistically similar and had better features than corresponding tumors of same Gleason score with TGC. Furthermore, Gleason score 7 tumors with TGC had similar features with GS 8-10 tumors. During follow-up, 73 (22%) subjects had PSA recurrence. In the Cox regression model TGC was an independent variable for BRFS (BR = 2.63, 95% CI = 1.39-4.98, P = 0.003). Conclusion: According to the present study, 3 different prognostic groups were observed; good prognostic group: GS <7, intermediate prognostic group: GS <7+TGC, GS 3+4, and GS 4+3, and finally bad prognostic group: GS (3+4)+TGC, GS (4+3)+TGC, GS >7. Presence of a TGC appears to upgrade the total score and adjuvant treatment decisions may further be refined by considering the tertiary pattern. (C) 2013 Elsevier Inc. All rights reserved.Öğe Prostat Kanseri Tanısında Mevcut Biyobelirteçler ve İdrar Sarkozini(2023) Arpa, Medeni; Şirikci, Önder; Akgül, Murat; Tınay, İlker; Haklar, Goncagül; Türkeri, LeventAmaç: Prostat kanseri, erkeklerde kansere bağlı ölümler arasında ikinci sırada yer almaktadır. PCa tanısında parmakla rektal muayene, serum PSA ve biyopsi kullanılan temel araçlardır. PSA’nın özgüllüğünün düşük olması gereksiz biyopsilere neden olmaktadır. Bu nedenle özgüllüğü yüksek olan biyobelirteçlere ihtiyaç vardır. Sarkozinin prostat kanseri tanısındaki rolüne ilişkin çalışmalar mevcuttur. Ancak çalışma dizaynlarındaki farklılar nedeniyle sonuçlar karşılaştırılabilir değildir. Çalışmada idrar sarkozin düzeyi ile proPSA’nın PCa tanısındaki performansını mevcut biyobelirteçlerle karşılaştırmayı amaçladık. Gereç ve Yöntem: Prostat biyopsisi yapılan toplam 105 hasta çalışmaya alındı. Bu hastaların PSA, fPSA, %fPSA, p2PSA, prostat volümü ve phi ile idrarda sarkozin düzeyleri ölçülerek karşılaştırıldı. Bu parametrelerin tanı koyma performansları ROC eğrisi analizleriyle değerlendirildi ve kesme değerleri, duyarlılık ve özgüllükleri karşılaştırıldı. Ayrıca PCa hastaları Gleason skorlarına göre (<7 ve ?7) iki gruba ayrılarak bu parametrelerin dağılımları incelendi. Bulgular: Serum PSA, p2PSA ve idrar sarkozin düzeyleri, biyopsi pozitif grupta daha yüksek olmasına rağmen istatistiksel olarak farklı değildi. Ancak phi değeri biyopsi pozitif grupta anlamlı şekilde daha yüksek, %fPSA ve PV değerleri ise daha düşüktü. Sarkozin ve PSA, GS? 7 grubunda anlamlı yüksekti. Belirteçlerin duyarlılıklarının %90 olduğu kesme değerlerinde sırasıyla %fPSA, PV ve phi’nin özgüllükleri PSA’dan yüksek idi. Sonuç: İdrar sarkozin’in PCa tanısında tek başına yeterli olmadığı, GS?7 olduğu riskli PCa hastalarında kullanılabileceği tespit edildi. Phi, %fPSA ve PV’nin PCa tanısında PSA’dan daha iyi oldukları görüldü. Bunun yanı sıra PV’nin phi’nin özgüllüğünü iyileştirebileceği tespit edildi.Öğe The Approach to High Risk Bladder Cancers in the Absence of Bacillus Calmette Guerin: What should Be the Treatment and Follow Up?(Galenos Yayincilik, 2014) Türker, Polat; Türkeri, LeventBacillus Calmette Guerin (BCG), is the optimal bladder-sparing treatment option for patients with high-risk, non-muscle invasive bladder cancer. Recently, the application of BCG has been hindered due to the problem of its availability in Turkey. Alternative treatment options are needed until this problem is solved. In this article, the recommendations about the preferred treatment options and the follow-up, are summarized in the light of the current literature.
