Utku Lokman | University of Helsinki (original) (raw)

Papers by Utku Lokman

European urology focus, Dec 1, 2018

Background: Active surveillance (AS) is an option for men with low-risk prostate cancer (PCa). PT... more Background: Active surveillance (AS) is an option for men with low-risk prostate cancer (PCa). PTEN and ERG have been considered as potential biomarkers of PCa progression and survival. Objective: To study the role of ERG and PTEN status in the Prostate Cancer Research International: Active Surveillance (PRIAS) trial diagnostic biopsies (DBxs) in predicting surveillance discontinuation and adverse surgical findings in subsequent radical prostatectomy (RP). Design, setting, and participants: A total of 231 patients were recruited to the PRIAS between 2007 and 2013 in Helsinki. DBx tissue for immunohistochemistry (IHC) was available from 190 patients. Tissue microarrays (TMAs) were constructed from 57 specimens of subsequent RPs. DBxs containing grade group (GG) 1 PCa and RP TMA sections were stained with ERG and PTEN antibodies, and scored as either negative or positive. Outcome measurements and statistical analyses: Outcomes were followed up by biopsy GG upgrade (GG ! 2) and protocol-based treatment change, as well as adverse findings in RP (GG ! 3 or pathological stage ! 3). Clinical variables and biomarker status in DBx were correlated in Cox regression analysis and cumulative survival in Kaplan-Meier analysis, and finally, Gray's competing risk analysis was performed and nonprotocol-based discontinuation was considered as a competing event. Results and limitations: In both uni-and multivariate Cox regression analyses, only the number of positive cores in the DBx, the number of rebiopsy sessions, and PTEN status at diagnosis were significantly associated with rebiopsy GG upgrade, treatment change, and adverse histopathology in RP. In Kaplan-Meier analysis, PTEN loss was associated with a shorter time to GG upgrade and treatment change. Patients with PTEN loss had a higher probability for protocol-based discontinuation but not for competing risk factors compared with patients with intact PTEN. Biopsy ERG status was concordant with RP TMA ERG status, while PTEN was not. Limitations include a retrospective analysis of prospective cohort data. Conclusions: PTEN status at diagnosis is a potential biomarker for identifying patients with PCa on AS with a high risk for progression or adverse findings on subsequent RP. Patient summary: A simple diagnostic biopsy-based analysis of PTEN status may help identify patients with high risk for prostate cancer progression.

JCPSP. Journal of the College of Physicians & Surgeons Pakistan, Dec 1, 2018

The success rate of percutaneous nephrolithotomy (PNL) is about 90%, but overall complications of... more The success rate of percutaneous nephrolithotomy (PNL) is about 90%, but overall complications of this surgery have been reported in up to 83% cases. The complications are graded using Clavien classification system from grade 1 to 5. Grade 1 needs simple treatments without surgical, endoscopic, and radiologic interventions like antiemetics, antipyretics, and analgesics. Grade 5 denotes death of the patient. Calyx neck stricture is grade 3b complication with an incidence of 0.1%. In this study, a case of hydrocalyx, which is very rare complication after PNL, is presented. To the best of the authors' knowledge, there is no hydrocalyx case reported after PNL in the literature.

British Journal of Surgery, Aug 19, 2022

In our high-volume tertiary centre for renal disease, we perform in excess of 150 nephrectomies f... more In our high-volume tertiary centre for renal disease, we perform in excess of 150 nephrectomies for benign or malignant disease per annum. In this study we compare outcomes between laparoscopic and retroperitoneoscopic minimally invasive (MI) approaches. We retrospectively reviewed our database of all patients who underwent MI non-radical nephrectomy over a 3-year period. Indication for surgery, conversion rate, operative time, blood loss, length of stay and post-operative complications were examined. A total of 61 MI nephrectomies were performed by three experienced minimal access surgeons. Indications for surgery included chronic infection, stone disease, tuberculosis, and obstruction associated with pain. Mean age was 51 years (range 22-89), 72% were female. The approach was laparoscopic in 62% and retroperitoneoscopic in 38%. Median operative time 137 minutes. The overall conversion rate was 3% (2 patients). Median blood loss 50ml's with 1.5% transfusion rate. Median length of stay was 2 days (1-69). There was no significant change in the renal function (P=0.32). Four patients developed Clavien-Dindo grade 3 complication. There was no recorded mortality in our series. We acknowledge this is a retrospective study that may be subject to selection bias, however our experience of this procedure in high volume centre with experienced operators shows that both laparoscopic and retroperitoneoscopic approaches are safe in performing MI non-radical nephrectomy with very low conversion rate.

Üroonkoloji Bülteni, Jun 5, 2014

PubMed, 2019

Background: Lead exposure causes a wide range of vascular diseases through oxidative stress, symp... more Background: Lead exposure causes a wide range of vascular diseases through oxidative stress, sympathetic hyperactivity and impairment in nitric oxide bioavailability. In this study, the association between the effects of lead exposure on left ventricular diastolic indices and erectile function were assessed. Methods: A total of 94 lead-exposed workers without known cardiovascular diseases or risk factors and 30 healthy subjects were enrolled. Systolic and diastolic functions were measured using transthoracic echocardiography. All participants were non-smokers. The International Index of Erectile Function Questionnaire (IIEF-5) was used to diagnose and grade erectile dysfunction (ED). Echocardiographic parameters, IIEF-5 score and blood lead level (BLL) were analyzed. Results: The mean age and median BLL were 32.3 ± 6.4 years and 19 μg/dL in the workers, respectively. Sixty-five (69.1%) workers and 9 control subjects (30%) had ED. The IIEF-5 score was lower in the workers (17.0 ± 6.1) than in the controls (22.7 ± 2.1). In the workers, E and e' waves and E/A ratio were lower, and A wave, E/e' ratio, and left atrial volume index (LAVI) were higher than in the controls. Additionally, BLL was correlated with IIEF-5 score, e' wave, and E/e' ratio. IIEF-5 score was correlated with e' wave, E/e' ratio and LAVI. BLL was an independent risk factor for a decreased e' wave and IIEF-5 score and increased E/e' ratio in the lead-exposed workers. Conclusions: Impairment of diastolic and erectile functions, despite a younger age and in the absence of accompanying risk factors, was correlated with increased BLL.

The Prostate, Jul 7, 2020

BACKGROUND Conventional systematic prostate biopsies (SBx) have multiple limitations, and magneti... more BACKGROUND Conventional systematic prostate biopsies (SBx) have multiple limitations, and magnetic resonance imaging (MRI)-ultrasound fusion targeting is increasingly applied (fusion biopsies [FBx]). In our previous studies, we have shown that loss of the tumor suppressor gene phosphatase and tensin homolog (PTEN) in radical prostatectomy (RP) specimens predicts poor disease-specific survival, and in active surveillance (AS), PTEN loss in SBx predicts an adverse AS outcome, although SBx PTEN status does not correlate well with the corresponding RP status. Here, we have hypothesized that PTEN and erythroblast transformation-specific related gene (ERG) status in FBx correlate better with RP than they would in SBx. METHODS A total of 106 men, who had undergone FBx and subsequent RP in a single center between June 2015 and May 2017 were included. Fifty-three of the men had concomitant or previous SBx's. All biopsy and RP specimens were collected, and tissue microarrays (TMA) were constructed from RP specimens. Immunohistochemical stainings for PTEN and ERG expression were conducted on biopsies and RP TMAs and results were compared by using Fisher's exact test. RESULTS The immunohistochemical predictive power of FBx, determined by the concordance of biopsy PTEN and ERG status with RP, is superior to SBx (77.6% vs 66.7% in PTEN, 92.4% vs 66.6% in ERG). FBx was superior to SBx in correlation with RP Gleason Grade Groups and MRI prostate imaging reporting and data system scores. CONCLUSION FBx grading correlates with RP histology and MRI findings and predicts the biomarker status in the RP specimens more accurately than SBx. A longer follow-up is needed to evaluate if this translates to better prediction of disease outcomes, especially in AS and radiation therapy where prostatectomy specimens are not available for prognostication.

European Urology Supplements, Mar 1, 2011

results: The PCA3 score was strongly correlated with the tumor volume in a linear regression anal... more results: The PCA3 score was strongly correlated with the tumor volume in a linear regression analysis (p<0.001, r=0.409). The risk of having a cancer ≥0.5 cm 3 and a significant PCa was increased by 3-fold in men with a PCA3 ≥25 compared with men with a PCA3 <25 with most AS biopsy criteria used. There was a trend toward higher PCA3 scores in patients with unfavourable and non organ-confined disease and Gleason>6 cancers. In a multivariate analysis taking into account each AS criterion, the PCA3 score was an important predictive factor for a tumor volume <0.5 cm 3 (OR 5.4; p=0.010) and insignificant PCa (OR 12.7; p=0.003). Biopsy criteria and MRI findings were significantly associated with OUD (OR 3.9 and 5.0; p=0.030 and 0.025, respectively). Conclusions: The PCA3 score may be a useful maker to improve the selection for AS in addition to the current AS criteria. PCA3 score is strongly indicative for tumor volume and insignificant PCa with a predictive cutoff of 25.

European Urology Supplements, Mar 1, 2013

European Urology Supplements, Apr 1, 2015

Urologia Internationalis, Apr 6, 2017

Objective: We aimed to compare the safety and efficacy of monopolar and bipolar transurethral res... more Objective: We aimed to compare the safety and efficacy of monopolar and bipolar transurethral resection (TUR) of bladder tumors (TURBTs). Material and Methods: A total of 240 patients who underwent TURBT were prospectively included in the study from May 2011 to May 2014. All patients with suspected bladder tumors were eligible for study inclusion. Those who refused consent and those undergoing routine restaging TURBT were excluded from analysis. Patients were divided on the basis of the monopolar arm and the bipolar arm. Study outcomes included the incidence of bladder perforation and obturator jerk, decrease in hemoglobin and sodium levels, rates of re-coagulation and blood transfusion, TUR syndrome, and operation time. Results: The mean age of the patients was 62 ± 13.7 years. The incidence of obturator jerk and bladder perforation was greater in the bipolar arm. However, with a decrease in the hemoglobin and sodium levels, rates of re-coagulation and blood transfusion were greater in the monopolar arm. Statistical analysis did not show significant differences with regard to study outcomes between the groups. There was no case of TUR syndrome in the 2 arms. The residual tumors' rate was similar between the 2 groups. Conclusions: Our results showed that efficacy and safety of the monopolar and bipolar methods seems to be comparable in patients with bladder tumors.

The Journal of Urology, Apr 1, 2013

INTRODUCTION AND OBJECTIVES: Currently, the Prostate Cancer Research International: Active Survei... more INTRODUCTION AND OBJECTIVES: Currently, the Prostate Cancer Research International: Active Surveillance (PRIAS) study protocol suggests active treatment for patients with more than two positive cores or Gleason score (GS) 6 on a biopsy. However, the protocol neglects shifting cancer locations and cumulative cancer in consecutive biopsies. To our knowledge, there have been no studies analyzing relation between change in biopsy cancer location and patient outcome in prospective AS cohorts. Our objective was to analyze the impact of increasing number of cancer locations, change in cancer location and cumulative cancer length on the treatment discontinuation (TD) of AS. METHODS: Clinical and pathology data from patients enrolled in the PRIAS study was prospectively collected (n 228) since 2006. Overall, 69 (30.3%) patients discontinued AS during median follow-up of 3.2 years. 55 (79.7%) discontinued due to PRIAS protocol based criteria, 14 (20.3%) by other criteria. The anxiety related quality of life parameters or s-PSA values did not differ between the patient cohorts. Descriptive statistics were performed and data was analyzed using Mann-Whitney U, chi-square, and binary logistic regression analysis. RESULTS: Cumulative number of cancer locations (CNCL) was statistically significantly associated with TD (p 0.001). More than two cancer locations in diagnostic and follow up biopsies also statistically significantly associated with TD in Chi-square test (p 0.001). Similarly, cumulative cancer length (CCL), as well as a shift in cancer location (SCL) significantly predicted TD (p 0.001). In binary logistic regression analysis, only CNCL and CCL were statistically significantly associated with TD among variables studied (age, diagnostic PSA, GS at diagnosis and SCL). CONCLUSIONS: Cumulative follow-up biopsy data regarding cancer location and cancer length (volume) may be helpful in predicting treatment discontinuation in an AS cohort. Cancer proportion and accumulative cancer locations could be included to the current regime in order to better select patients for active treatment. The findings in consecutive biopsies should be considered as additive, not separate indicators of clinically relevant disease. Our findings warrant a study to correlate the biopsy cancer locations to RP specimen cancer distribution for further validate the accuracy of PRIAS biopsy regime. Subsequently, the value of repeat biopsy findings to predict PSA velocity and biochemical recurrence after RP needs to be delineated.

Central European Journal of Urology, 2019

includes selective serotonin reuptake inhibitors (SSRIs), phosphodiesterase type 5 inhibitors, tr... more includes selective serotonin reuptake inhibitors (SSRIs), phosphodiesterase type 5 inhibitors, tricyclic antidepressants, tramadol and topical anesthetic creams or sprays [5]. As of yet, none of these agents have been approved by the US Food and Drug Administration (FDA) for PE treatment. This has resulted in an increased 'off-label' prescription of SSRIs for the management of the sexual disorder because of the unique side effect profile observed

Harran Üniversitesi týp fakültesi dergisi, Aug 20, 2020

Background: Bladder cancer is one of the major health problems studied over the years. Emerging t... more Background: Bladder cancer is one of the major health problems studied over the years. Emerging technologies on follow-up and treatment of bladder cancer increased scientific literature worldwide. Despite this, there is limited data about the bibliometric analysis of bladder cancer. Materials and Methods: The bibliometric analysis of bladder cancer publications between 1975-2018 was performed by using the Thomson Reuters Web of Science database. The VOSviewer software tool was used for arranging and setting bibliometric networks. Results: The United States of America ranked first in this field with 7963 publications and 28.3% of the world generation, followed by the Peoples Republic of China and Germany. The University of Texas System is the leading institute in published documents with 1081 papers and 3.8% of the total literature. 15.9% of the papers were printed in The Journal of Urology with 4483 manuscripts, followed by European Urology (n=867, 3.0%) and Urology (n=810, 2.8%). Conclusions: There are relatively few articles on bibliometric analysis of urologic disorders and bladder cancer. Advanced evaluation parameters have to be defined for a more confident assessment of scientific work. Bibliometric analyses can guide young clinicians in investigating new studies.

American Journal of Obstetrics and Gynecology

European Urology Supplements, Mar 1, 2009

British Journal of Surgery, 2021

To support the global restart of elective surgery, data from an international prospective cohort ... more To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

European Urology Supplements, 2014

European urology focus, 2021

BACKGROUND Living with an untreated cancer may alter quality of life (QoL) in the long term. OBJE... more BACKGROUND Living with an untreated cancer may alter quality of life (QoL) in the long term. OBJECTIVE To prospectively study long-term changes in general, mental, and physical QoL in a contemporary active surveillance (AS) patient cohort with low-risk prostate cancer (PCa). DESIGN, SETTING, AND PARTICIPANTS The study population consisted of patients enrolled in the PRIAS trial in Helsinki University Hospital (n = 348). The RAND-36 questionnaire was used to assess general QoL at the start of AS and at 1, 3, 5, 7, 9, and 11 years during follow-up. Patients who had undergone robot-assisted laparoscopic prostatectomy (RALP; n = 88) also received the questionnaire after treatment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Changes over time were analysed using multilevel mixed-effects regression models, and reported as the mean and95% confidence interval. A rule of 0.5 × standard deviation was used to estimate changes of clinical importance. RESULTS AND LIMITATIONS Median follow-up u...

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Bladder stones are usually seen among patients with bladder outlet obstruction, especially in men... more Bladder stones are usually seen among patients with bladder outlet obstruction, especially in men over the age of 50 years. There are several risk factors for bladder stones, including urinary tract infections, abnormal urinary tract system anatomy, and presence of foreign bodies. In addition, migrating intrauterine contraceptive devices through the wall of the urinary bladder and foreign bodies such as surgical sutures may act as a nidus for developing stone formation. Here in, we report a case of bladder stone associated with surgical non-absorbable suture, used for gynecologic surgery 4 years ago, and treated endoscopically. The aim of this paper was to know gynecological association and the management of bladder stones. The patients who had a history of pelvic surgery previously and present with lower urinary tract symptoms such as dysuria, voiding difficulties, weak micturition and hematuria should be evaluated for the foreign body-associated disorders.