To compare the expression of immune checkpoint molecules in tumor cells and tumor microenvironment and their role on prognosis among surgically treated non-metastatic clear cell renal cell carcinoma (ccRCC), papillary RCC (papRCC), and chromophobe RCC (chRCC). We retrospectively evaluated patients undergoing curative partial or radical nephrectomy for non-metastatic RCC between 2015 and 2023, who had available formalin-fixed paraffin-embedded tumor tissue and postoperative follow-up. Immunohistochemical staining was performed for PD-L1, PD-1, and CTLA-4. PD-L1 expression was evaluated using tumor proportion score, combined positive score, and immune cell score, whereas PD-1 and CTLA-4 expression were evaluated using immune cell score. Immunopositivity was defined as ≥1

Background: Transperineal magnetic resonance (MRI)/ultrasound (US) fusion-guided prostate biopsy has emerged as a promising alternative to the transrectal approach by improving lesion targeting and reducing infectious complications. However, real-world data addressing factors that influence the detection of clinically significant prostate cancer (csPCa), including imaging characteristics and procedural experience, remain limited. Objective: To evaluate the diagnostic performance, safety profile, and independent predictors of csPCa detection in patients who underwent transperineal MR/US fusion-guided prostate biopsy, with particular emphasis on PIRADS category, prostate-specific antigen (PSA) level, and procedural learning curve. Methods: In this study, patient data were prospectively recorded in a routinely maintained institutional database, while the present analysis was conducted retrospectively. A total of 136 patients with clinical suspicion of prostate cancer—defined as elevated prostate-specific antigen (PSA), abnormal digital rectal examination, or PIRADS ≥3 on multiparametric MRI—underwent transperineal MR/US fusion-guided biopsy between January 2023 and October 2024. Results: Prostate cancer was detected in 45.5% of patients, whereas csPCa was identified in 32.3%. The PIRADS category emerged as the strongest independent predictor of csPCa detection, with PIRADS-5 lesions showing a significantly greater likelihood of csPCa than PIRADS-3 lesions (OR 6.70, p = 0.006). The PSA level was also independently associated with csPCa detection (OR 1.06 per ng/mL increase, p = 0.033). Although csPCa detection rates increased across learning curve groups, procedural experience was not an independent predictor after adjustment. The procedure demonstrated a favorable safety profile, with a low rate of infectious and noninfectious complications despite minimal use of antibiotic prophylaxis. The multivariable model showed moderate explanatory power and acceptable overall classification accuracy. Conclusions: Transperineal MR/US fusion-guided prostate biopsy provides reliable detection of clinically significant prostate cancer with a low complication rate and consistent performance across different stages of institutional experience. The PIRADS category and PSA level remain key determinants of csPCa detection, supporting the integration of MRI-based risk stratification into contemporary prostate cancer diagnostic methods.

Objective: Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare, indolent renal cell carcinoma variant, rarely showing unusual histology and aggressive behavior. We aimed to document histopatho logical and clinical characteristics and their relation to survival. Materials and Methods: We retrospectively identified 20 cases diag nosed as MTSCC between 20072024 and documented the relationship between clinicopathological features and followup. Results: There were 9 males and 11 females with a mean age of 54.6 +/- 11.1 (range: 2872). Twelve (60%) underwent radical nephrectomy, 5 (25%) partial nephrectomy, 3 (15%) trucut biopsy. Eight (40%) were consultation cases, 12 (60%) were inhouse material. The median tumor diameter was 70.4 (IQR: 4.889.03) mm. The presence of hemorrhage was observed in 2 (10%), necrosis in 4 (20%), sarcomatous transformation in 2 (10%). Median number of tissue blocks per case was 13 (IQR: 817.5) and correlated with the presence of sarcomatous differentiation (r=0.561, p=0.019). Mean followup time was 82.9 +/- 63.9 months. Four patients succumbed to disease with distant metastasis and two to other causes. One showed local recurrence. Remaining patients showed no recurrence or metastasis. Among four patients who died of disease, two showed sarcomatous transformation. Sarcomatous transformation showed worse prognostic significance in univariate analysis for overall survival (p=0.028), although not validated in multi variate Cox regression model (HR: 0.607, 95% CI: 0.03012.120, p=0.744). Kaplan Meier analysis showed that survival probability was lower in patients with sarcomatous transformation (0% vs 88.9%, p=0.008). Conclusion: MTSCC is a distinct renal neoplasm typically with an indolent prognosis, though rarely metastasizes, causing death. Meticulous histopathological assessment and close followup is essential.

To determine genome-wide transcriptional coverage of well-characterized genes, gene candidates, and splice variants associated with invasive process on bladder carcinogenesis (BC), we investigated the whole-genome gene expression profile of high-grade Turkish BC patients. We collected high-grade bladder tumours (n = 12) and paired standard tissue samples (n = 12). To find differentially expressed genes related to bladder cancer's metastatic pattern, we performed the human whole-genome expression profiling through the Illumina Human HT-12 Expression Beadchip system. Ingenuity Pathway Systems (IPA), i-Pathway Guide and Cytoscape software were used to determine statistically significant genes, networks, biological pathways between tumour and control groups. Cyclin A2 (CCNA2), CDC20, CDC45, MMP1, MMP3, MMP9, MMP10, STAT1, STAT2, TNFRSF1A, TNFSF10, and TUBB3 were significantly upregulated in bladder cancer cases. We showed that biological reactions, including the degradation of collagen and extracellular matrix and matrix metalloproteinases activation reactions, were found the most statistically significant pathways in BC. We also determined that inflammation and cytokine signalling could be related to the progression of bladder carcinogenesis. The genes differentially expressed could be molecular indicators for early prediction of bladder carcinogenesis.

Purpose: Long non-coding RNAs (lncRNAs) and microRNAs (miRNAs) have emerged as important regulators of the epithelial-mesenchymal transition (EMT) and tumor progression. The present study evaluated the expression profiles of lncRNA ZEB1-AS1 and miR-200b-3p in non-muscle-invasive bladder cancer (NMIBC) tissues and investigated their associations with clinicopathological characteristics. Materials and Methods: Tumor tissues and matched adjacent normal bladder tissue were obtained from 50 patients with primary NMIBC who underwent transurethral resection of bladder tumors. Total RNA was extracted, and expression levels of ZEB1-AS1 and miR-200b-3p were measured using quantitative real-time polymerase chain reaction (qRT-PCR). Relative expression levels were calculated using the 2-ΔΔCT method. Associations between gene expression levels and clinicopathological parameters were analyzed using non-parametric statistical tests. Receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic performance. Results: ZEB1-AS1 and miR-200b-3p demonstrated significantly increased expression in tumor tissues compared with adjacent normal bladder tissue (p = 0.018 and p = 0.034, respectively). ZEB1-AS1 expression was significantly higher in high-grade tumors (p = 0.007), whereas miR-200b-3p expression was more pronounced in low-grade tumors (p = 0.015). No significant associations were identified between expression levels and tumor stage, carcinoma in situ, or variant histology. ROC analysis demonstrated modest diagnostic performance, with AUC values of 0.637 for ZEB1-AS1 and 0.624 for miR-200b-3p. Conclusions: ZEB1-AS1 and miR-200b-3p demonstrated distinct expression patterns associated with tumor grade and may contribute to EMT-associated molecular heterogeneity in NMIBC. Although the individual diagnostic performance of these markers appeared limited, the present findings provide additional insight into non-coding RNA-associated pathways and support further investigation in larger validation studies.

This study aimed to evaluate the relationship between irrigation pressure and intrarenal pressure during ureteroscopy and to assess whether intrarenal pressure trends could be inferred via the flexible ureteroscope working channel using the pump release technique, with antegrade percutaneous measurement as the reference. Pressures were recorded during ureteroscopic lithotripsy in nineteen patients undergoing endoscopic combined intrarenal surgery. Intrarenal pressure was continuously measured via an antegrade Chiba needle placed, whenever feasible, into the lower posterior calyx or otherwise into the calyx nearest to the stone, and connected to a pressure transducer. Irrigation pressure was continuously and concurrently recorded from the proximal irrigation line of the ureteroscope using a second transducer. Correlation analyses were performed. We also assessed whether intrarenal pressure could be estimated using the pump release technique, in which sudden release of the irrigation pump interrupts flow and creates a transient static column approximating intrarenal pressure. A total of 3 h and 53 min of pressure data were recorded. Mean irrigation (PIrr) and intrarenal pressures (IRP, measured via the Chiba needle) were 56.6 mmHg and 34.1 mmHg, respectively. Moderate correlations were identified between PIrr and IRP during gravity irrigation (r = 0.506) and between their peak values (r = 0.49). During PRT, a significant correlation was observed between PIrr and simultaneous IRP over brief intervals (r = 0.602–0.613). Using external pressure transducers on irrigation lines to estimate intrarenal pressure trends during ureteroscopy is feasible. Larger studies are needed to validate this method and to account for factors that may influence pressure accuracy.

Objective: This study aimed to explore whether polymorphisms in hOGG1, XRCC1, and APE1 genes influenced the initiation and progression of renal cell carcinoma (RCC) and to investigate the relationship between polymorphisms of the three base excision repair (BER) genes and cigarette smoking among RCC patients. Materials and Methods: This study involved 211 controls and 97 patients. The polymorphisms of DNA repair genes hOGG1 Ser326Cys, XRCC1 Arg399Gln, and APE1 Asp148Glu were explored using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: Our results showed no significant association between hOGG1 Ser326Cys polymorphism and RCC risk. There was a statistically significant association between the XRCC1 399 Gln allele and the APE1 148 Glu allele and RCC risk. In addition, the XRCC1 399 Gln allele significantly increased the initiation of RCC when accompanied by smoking status. The variant genotypes of hOGG1, XRCC1, and APE1 showed no significant association with RCC progression. Conclusion: Our findings suggest that XRCC1 and APE1 gene polymorphisms that contribute to BER pathway may regulate RCC susceptibility in a Turkish population.

Objective: In advanced-stage testicular cancer, postchemotherapy retroperitoneal lymph node dissection (RPLND) is performed to manage residual retroperitoneal masses. This study evaluated the histopathological features and their associations with primary tumor and clinical outcomes. Methods: Postchemotherapy RPLNDs performed between 2000 and 2024 were reviewed and classified as no tumor, teratoma, nonteratomatous germ cell tumor (NTGCT), or somatic malignancy. Corresponding orchiectomy pathology and clinical data were analyzed for primary tumor, treatment, and follow-up. Results: A total of 151 RPLNDs were evaluated. Median age was 26 years (IQR: 24.7–28.4), and mean largest clinical mass diameter was 62.4 ± 38.6 mm. Diagnoses were teratoma in 87 (57.6%), no tumor in 34 (22.5%), NTGCT and teratoma in 11 (7.3%), NTGCT in 11 (7.3%), and somatic-type malignancy in 8 (5.3%). Embryonal carcinoma in orchiectomy was significantly more frequent in patients with malignancy in RPLND (P = .018). Mean number of paraffin blocks was 10.7 ± 6.62, and malignancy was significantly higher in specimens with ≥10 blocks compared to those with <10 (P = .014). Follow-up data were available for 101 (66.9%), with median follow-up of 85.5 months (IQR: 70.7–100.1); 24 (23.8%) patients died. Mortality was significantly higher in patients with malignant tumor in RPLND (50%) compared to those without malignancy (17.3%) (P = .002). In univariate logistic regression analyses, RPLND tumor diameter (odds ratio [OR]: 1.012, 95% CI: 1.004–1.021; P = .005), malignancy in RPLND (OR: 3.787, 95% CI: 1.669–8.594; P = .001), NTGCT in RPLND (OR: 3.451, 95% CI: 1.473–8.083; P = .004), and yolk sac tumor in orchiectomy (OR: 0.220, 95% CI: 0.049–0.985; P = .048) were associated with overall mortality. In multivariate analysis, only RPLND tumor diameter remained an independent predictor (OR: 1.018, 95% CI: 1.000–1.035; P = .045). Conclusion: Postchemotherapy RPLND most frequently revealed teratoma, while larger tumor diameter independently predicted malignant findings and adequate sampling increased malignancy detection. Cite this article as: Hürdoğan Ö, Cantürk Z, Ugar M, et al. Histopathological spectrum of postchemotherapy retroperitoneal lymph node dissection in testicular cancer: the impact of sampling adequacy and viable nonteratomatous germ cell tumor. Cerrahpaşa Med J, 2026, 50, 0037, doi: 10.5152/cjm.2026.26037.

INTRODUCTION:Bladder cancer is prevalent worldwide; however, the detailed mechanisms underlying its initiation and progression remain incompletely understood. This study aimed to investigate the expression levels of long noncoding RNA activated by transforming growth factor-β (lncRNA-ATB) and microRNA-200c (miR-200c) in tumor tissues of patients with bladder cancer and to explore their association with clinicopathologic features. METHODS:The study cohort consisted of 50 patients diagnosed with non-muscle-invasive bladder cancer. Tumor tissues and adjacent normal tissues were obtained during transurethral resection of bladder tumor. The relative expression levels of lncRNA-ATB and miR-200c were determined using quantitative reverse transcriptase-polymerase chain reaction. RESULTS:LncRNA-ATB expression was substantially higher in tumor tissues than in adjacent normal tissues. Conversely, miR-200c was upregulated in tumor tissues but showed lower expression in high-grade tumors compared with low-grade tumors. A receiver operating characteristic curve analysis indicated that lncRNA-ATB (72% sensitivity, 68% specificity) and miR-200c (68% sensitivity, 64% specificity) could distinguish tumor from normal tissues. DISCUSSION:This study is the first to concurrently evaluate lncRNA-ATB and miR-200c expression in non-muscle-invasive bladder cancer. Even in early-stage bladder cancer, alterations in the lncATB/miR-200c axis appear to be associated with tumor grade and may potentially serve as an indicator of metastatic potential.

Concurrent enzalutamide may upregulate PSMA expression and enhance the efficacy of [177Lu]Lu-PSMA-617 radioligand therapy (PSMA-RLT). We evaluated outcomes of PSMA-RLT with and without concurrent enzalutamide in a real-world metastatic castration-resistant prostate cancer (mCRPC) cohort. We retrospectively evaluated 208 mCRPC patients treated with [177Lu]Lu-PSMA-617 at a single institution between June 2015 and January 2026. Among them, 106 received concurrent enzalutamide and 102 without any concurrent androgen receptor pathway inhibitor. The primary endpoint was overall survival (OS), and secondary endpoints were progression-free survival (PFS), PSA50 response, pain response, and toxicity. Median OS was 20.0 months in the concurrent enzalutamide group versus 12.4 months in the no-ARPI group (log-rank p = 0.082). In multivariable Cox analysis, concurrent enzalutamide was not independently associated with OS (hazard ratio 1.15, 95

You have accessJournal of UrologyKidney Cancer: Advanced (Including Drug Therapy) II (PD18)1 May 2024PD18-10 HOW IS THE EFFICACY OF PATIENT SELECTION CRITERIA FOR ADJUVANT PEMBROLIZUMAB AFTER CURATIVE SURGICAL TREATMENT OF CLEAR CELL RENAL CELL CARCINOMA WITH INTERMEDIATE TO HIGH RISK OF RECURRENCE? A REAL-LIFE DATA ANALYSIS FROM SINGLE INSTITUTIONAL EXPERIENCE Selcuk Erdem, Anil Tantekin, Firat Ozervarli, Rifat Ergul, Yasar Pazir, Ozge Hurdogan, Yasemin Ozluk, Oner Sanli, and Faruk Ozcan Selcuk ErdemSelcuk Erdem , Anil TantekinAnil Tantekin , Firat OzervarliFirat Ozervarli , Rifat ErgulRifat Ergul , Yasar PazirYasar Pazir , Ozge HurdoganOzge Hurdogan , Yasemin OzlukYasemin Ozluk , Oner SanliOner Sanli , and Faruk OzcanFaruk Ozcan View All Author Informationhttps://doi.org/10.1097/01.JU.0001008596.32809.c5.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Adjuvant pembrolizumab is recommended for reducing recurrence risk after curative surgical treatment of intermediate to high risk non-metastatic clear cell renal cell carcinoma (ccRCC). This study investigated the natural course of non-metastatic ccRCC after curative surgery in patients classified by the KEYNOTE-564 patient selection criteria. METHODS: A total of 531 curative and cytoreductive nephrectomies were performed between January 2015 and March 2023 in a tertiary single institution. After exclusion of 235 patients (n=201 non-ccRCC, n=20 incomplete follow-up, n=14 cytoreductive nephrectomy for metastatic renal tumor), a total of 296 non-metastatic ccRCC patients undergoing curative surgery were included into this study. The clinical, histopathological and survival parameters were retrospectively documented from prospectively collected real life database. Chi-square and Mann-Whitney U tests were used for the comparisons of parameters. Kaplan-Meier Analysis was used for survival outcomes. RESULTS: Overall, 76 (25.7%) patients were defined as eligible for adjuvant pembrolizumab (n=66, 86.8%; intermediate to high risk, n=10, 13.2%; high risk). The eligible patients had significantly larger median tumor size in clinical (7.5 vs. 3.9 cm, p<0.001) and pathological (7.8 vs. 3.65 cm, p<0.001) assessments, and underwent more often radical nephrectomy (95.9 vs 27.7%, p<0.001). Two-year recurrence free survival (RFS) was significantly lower (58.6 vs. 94.6%, p<0.001) in eligible patients. A total of 44 (14.9%) patients recurred in overall cohort at median follow-up of 18 months, 25 (32.9%) in eligible group and 19 (8.6%) in non-eligible group. Median pathologic tumor size were larger (9 vs 5 cm, p<0.001) and median time to recurrence were earlier (8 vs. 32 months, p<0.001) in eligible group. Fifty-one (67.1%) patients in eligible group did not experience any recurrence at a median follow-up of 18 months (IQRs:6-30 months). CONCLUSIONS: This real-life data showed that ccRCC recurred after curative surgery in 32.9% of patients defined eligible for adjuvant pembrolizumab, and in 8.5% of patients defined non-eligible. The remaining 67.1% of eligible patients did not recur at median follow-up of 18 months. These results suggested that patient selection criteria defined in KEYNOTE-564 needs to be improved to optimize cost-effectivity in the route of individualized treatment strategies. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e436 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Selcuk Erdem More articles by this author Anil Tantekin More articles by this author Firat Ozervarli More articles by this author Rifat Ergul More articles by this author Yasar Pazir More articles by this author Ozge Hurdogan More articles by this author Yasemin Ozluk More articles by this author Oner Sanli More articles by this author Faruk Ozcan More articles by this author Expand All Advertisement PDF downloadLoading ...

BackgroundBladder cancer is the most common malignancy of the urinary system. It is a heterogeneous type of cancer with a high potential for metastasis, approximately 25% of which occurs as muscle invasive. As with other malignancies, accurate and precise staging of bladder cancer is one of the mainstays for choosing the most appropriate treatment for the patient. Detection of metastasis is extremely important in choosing the treatment strategy. FDG PET/CT is widely used in the clinical management of various malignancies and is increasingly used in the primary staging of muscle-invasive bladder cancer and detection of recurrence after radical cystectomy. We aimed to determine the role of radiopharmaceutical uptake in the bladder neck and prostate region in preoperative FDG PET/CT in patients with muscle-invasive bladder tumors in determining the positivity of prostatic urethra surgical margins in the final pathology after cystectomy and its effect in determining the type of diversion to be chosen.MethodsThe data of male patients who underwent FDG PET/CT before radical cystectomy due to MIBC between January 2009 and January 2023 in the Department of Urology at Istanbul Faculty of Medicine were retrospectively analyzed. The correlations between the presence of radiopharmaceutical uptake in the bladder neck or prostate in FDG PET CT and the positivity of the prostatic urethra surgical margin in the postoperative final pathology of these patients and the invasion of urothelial carcinoma in the prostate were analyzed.ResultsProstatic urethra surgical margin positivity was detected in 8 of 50 male patients who had FDG PET CT in the preoperative period. Prostatic urethra surgical margin positivity was detected in 5 of 19 patients with bladder neck and prostate region involvement on FDG (p = 0.2554). Prostate involvement was seen on FDG in 6 of 9 patients with urothelial carcinoma invasion into the prostate (p = 0.1492). Prostate adenocarcinoma was observed in the final pathology of 12 patients, and 8 of these patients had FDG uptake (p = 0.106). While no statistically significant relationship was found between the presence of bladder neck and prostate region involvement on FDG and prostatic urethra surgical margin, urothelial carcinoma invasion into the prostate and prostate adenocarcinoma, a statistically significant relationship was observed between the presence of malignancy in the prostate (urothelial carcinoma and/or adenocarcinoma) (p = 0.0189).ConclusionsWhile no statistically significant relationship was found between radiopharmaceutical uptake in the bladder neck and prostate region on preoperative FDG PET CT in CIBC and prostatic urethra surgical margin positivity, urothelial carcinoma invasion into the prostate and the presence of prostate adenocarcinoma; It was found valuable in detecting the presence of malignancy in the prostate (adenocarcinoma/urothelial carcinoma).

Objective: Renal cell carcinoma (RCC) is considered as a major type of cancer of the kidney and is estimated to account for about 2-3% of all malignancies in adults. DNA repair mechanisms play a crucial role in defending genomic integrity against DNA damage, and defects in DNA repair mechanisms are associated with cancer susceptibility. The XRCC3 gene plays a pivotal role in the DNA repair system through homologous recombination and chromosomal activity. Therefore, our research aimed to clarify whether XRCC3 Thr241Met polymorphism affects the initiation and progression of RCC. Materials and Methods: This study included 129 patients with RCC and 212 healthy individuals. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique was employed to analyze XRCC3 Thr241Met gene polymorphism using SPSS 23 software to facilitate data analysis. Results: Our results revealed no remarkable differences in the genotype and allele frequencies of the Thr241Met polymorphism of XRCC3 between the patient and control groups. However, a greater risk of RCC was reported for the variant (Met/Met) genotype of XRCC3 gene polymorphism, particularly among smokers. Conclusion: Although the XRCC3 Thr241Met polymorphism may not significantly influence RCC initiation and progression in a Turkish population, smoking seems to amplify the risk associated with the (Met/Met) genotype of XRCC3 gene polymorphism.

BackgroundThe management of kidney stones, particularly those in the renal pelvis, is a critical aspect of urology. The European Association of Urology guidelines recommend Extracorporeal Shock Wave Lithotripsy or Endourology methods, encompassing Percutaneous Nephrolithotomy and Ureterorenoscopy (URS), for stones ranging from 10-20 mm. Robotic-assisted urological procedures have gained prominence in recent years, promising enhanced precision, and safety.ObjectivesThis article aims to provide a detailed account of the technical aspects and outcomes of a robotic URS (robo-URS) procedure in a 63-year-old male patient with a 15 mm renal pelvis stone, serving as a reference for urologists considering this approach.MaterialsThe patient presented with right flank pain, and an unenhanced computed tomography scan confirmed the presence of a 15x12x13 mm stone in the right renal pelvis. After assessment and preparation, robo-URS was performed using the Roboflex Avicenna robotic platform (ELMED, Ankara, Turkey) in conjunction with conventional urological instruments and laser technology.ResultsThe procedure was completed successfully in 50 minutes without any detectable blood loss or intraoperative complications.ConclusionRobotic-assisted Ureterorenoscopy (robo-URS) is a promising approach for managing renal pelvis stones. The procedure, demonstrated in this video article, underscores its technical feasibility, safety, and efficacy, making it a valuable resource for urologists seeking to expand their knowledge in stone management techniques.