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Objective: We aimed to evaluate the efficacy of tamsulosin in the treatment of lower urinary tract symptoms (LUTS) in patients under active surveillance (AS) for low-risk prostate cancer (Pca). Materials and Methods: Patients who underwent prostate biopsy between 2010 and 2014 were evaluated prospectively. Inclusion criteria for AS were PSA level below 10 ng/mL, a tumor in a maximum of two cores, a tumor core percentage below 50%, a clinical stage ≤ T2a and a Gleason score ≤6. Patients under AS with LUTS were included in the study group and patients with benign pathology results with LUTS were included in the control group. International prostate symptom score (IPSS) and uroflowmetry test were used to evaluate LUTS. The maximum flow rate (Qmax) was recorded. All patients received tamsulosin 0.4 mg once daily in a modified-release formulation (Flomax MR®, Astellas, Japan). Transurethral resection prostatectomy (TUR-P) was performed when surgical treatment was necessary for obstruction despite tamsulosin treatment. Results: The study included a total of 91 patients, 41 patients in the AS group and 50 patients in the control group. Patients were assessed after six months. There was a 30% reduction in IPSS in the AS group and 24.5% in the control group (p=0.591). Qmax increased by 20.4% in the AS group and by 20% in the control group (p=0.985). The need for TUR-P was similar between the two groups (14.6% vs 20%, p=0.503) during three-year follow-up. Conclusion: Tamsulosin can be used safely and with high efficacy for LUTS in patients under AS for low-risk Pca. The improvement in IPSS and Qmax, and the need for surgical treatment were similar to the control group. [ABSTRACT FROM AUTHOR]

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Objective: To determine the predictive value of free and bioavailable testosterone levels on the detection of high-grade prostate cancer proven by histopathological examination of transrectal prostate biopsy specimens. Material and methods: A total of 405 patients who underwent transrectal prostate biopsy due to high prostatic specific antigen (PSA) (>2.5 ng/mL) and/or abnormal findings at digital rectal examination were included in this study. Blood free and bioavailable testosterone levels were calculated by the formula recommended by International Society for the Study of the Aging Male (ISSAM). The patients were stratified according to the D'Amico classification based on PSA levels and histological outcomes of prostate biopsies as benign, low, intermediate and high-risk prostate cancer. Patients were also divided into five groups according to the percentage of cancerous cores. Results: Prostate cancer was detected in 160 of 405 (39.5%) patients. Total, free and bioavailable testosterone levels did not differ significantly between the patients with benign or malign histology. However, mean free (6.2 vs. 5.2 ng/dL, p=0.02) and bioavailable (151 vs. 125 ng/dL, p=0.001) testosterone levels were found to be significantly different in men with low-intermediate and high-risk prostate cancer. Moreover, a signifi- cant correlation was found between free, and bioavailable testosterone levels and percentage of cores with cancer (p=0.002 for free and p=0.016 for bioavailable testosterone, respectively). Conclusion: This prospective clinical study demonstrates that reduced levels of calculated blood free and bioavailable testosterone levels are associated with an increased risk of high-grade prostate cancer. Based on these findings blood free and bioavailable testosterone levels may be be thought to be an adjunctive factor in the prediction of high-risk prostate cancer. [ABSTRACT FROM AUTHOR]

Objective: To evaluate long-term outcomes of active surveillance (AS) applied in low-risk prostate cancer patients, and the impact of re-biopsy results on the prediction of progression. Material and methods: In our clinic, patients who had undergone AS for low-risk localized prostate cancer between the years 2005-2013 were included in the study. Our AS criteria are Gleason score ≤6, prostate- specific antigen (PSA) level <10 ng/mL, number of positive cores <3, maximum cancer involvement ratio <50% each core. Immediate re-biopsy (within 3 months) was performed to 65 patients who accepted AS. Finally, 43 patients who met re-biopsy criteria were included in the study. Prostate biopsy specimens were harvested from 12 cores under the guidance of transrectal ultrasound (TRUS). Re-biopsy was performed within 3 months (1-12 weeks). In rebiopsy, a total of 20 core biopsies were performed including the far lateral (6 cores) and transition zone (2 cores) in addition to standard 12 core biopsy. Our follow-up protocol is PSA measurement and digital rectal examination (DRE) every 3 months within the first 2 years, than every 6 months. Control biopsies was performed one year later and once upon every 3 years to patients whose PSA levels and DREs were normal at follow-up visits. More than 2 tumor invaded cores or 50% tumor in one core, and Gleason score exceeding 6 points were accepted as indications for definitive treatment. Patients were divided into two groups by re-biopsy results and compared according to the time to progression. We have done multivariate regression analysis to predict prognosis by using data on age, PSA level, and detection of tumor in re-biopsy specimens. Results: Patients' median age was 61 years and PSA level was 5 (2.7-9) ng/mL. Tumor was detected in 22 (34%) patients at re-biopsy and they underwent definitive treatment. Additionally tumor was detected in 9 patients, but active surveillance was maintained because their pathologic results met active surveillance criteria. Median follow time was 42 (24-117) months. Definitive treatment was performed in 9 (21%) patients. PSA recurrence was not detected in none of 9 patients during 38 months of follow up. Only the presence of tumor in re-biopsy specimens was found predictor of disease progression in multivariate analysis. Conclusion: We think that AS is safe method for low- risk localized prostate cancer patients, if it is performed in compliance with certain criteria and regular follow up, and early re-biopsy can be useful either during early period or long term follow-up. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Urology is the property of Turkish Association of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)