MiR-205-driven downregulation of cholesterol biosynthesis through SQLE-inhibition identifies therapeutic vulnerability in aggressive prostate cancer

Prostate cancer (PCa) shows strong dependence on the androgen receptor (AR) pathway. Here, we show that squalene epoxidase (SQLE), an enzyme of the cholesterol biosynthesis pathway, is overexpressed in advanced PCa and its expression correlates with poor survival. SQLE expression is controlled by micro-RNA 205 (miR-205), which is significantly downregulated in advanced PCa. Restoration of miR-205 expression or competitive inhibition of SQLE led to inhibition of de novo cholesterol biosynthesis. Furthermore, SQLE was essential for proliferation of AR-positive PCa cell lines, including abiraterone or enzalutamide resistant derivatives, and blocked transactivation of the AR pathway. Inhibition of SQLE with the FDA approved antifungal drug terbinafine also efficiently blocked orthotopic tumour growth in mice. Finally, terbinafine reduced levels of prostate specific antigen (PSA) in three out of four late-stage PCa patients. These results highlight SQLE as a therapeutic target for the treatment of advanced PCa.

[When is surgical resection of the primary tumor indicated in metastatic urothelial carcinoma of the bladder and what is the scientific rationale?]

Cisplatin-based polychemotherapy is still the standard therapy for metastatic urothelial carcinoma, although disease progression is often noted at an early time point even in patients with response. In recent years, cytoreductive surgery has been gaining increasing interest in many tumor entities in the setting of metastatic disease to improve patients outcome, but urothelial carcinoma is not regarded as a candidate for such a multimodal therapy approach. However, several retrospective studies suggest a survival benefit of radical cystectomy and/or metastasectomy for well-selected patients with metastatic urothelial carcinoma. Prognostically relevant parameters for consolidative cystectomy/metastasectomy after chemotherapy seem to be a distinct response to inductive chemotherapy and limited metastatic spread (regional lymph node, single lung metastasis).

[Positron-emission tomography in urooncology]

The use of positron emission tomography (PET) is an established method for the diagnosis of urological malignancies. Several tracers are currently available to obtain metabolic information or directly detect molecular targets. While (18)F-FDG-PET is recognized in current guidelines for the staging of seminoma, PET is not used in clinical routine in renal malignancies due to the lack of specific tracers. Despite initial promising results in bladder cancer, no relevant additional diagnostic value with PET using (18)F-FDG or choline-based tracers could be obtained in most patients and therefore should be used with caution or only within clinical trials. In prostate cancer, however, after development of new tracers that, for example, target prostate-specific membrane antigen (PSMA), a paradigm shift in imaging can be recognized. Here, (68)Ga-PSMA-PET might be included in the future as part of standard imaging work-up.

[New therapy concepts for castration-resistant prostate cancer: between hormone manipulation, targeted therapy and chemotherapy]

Within the last 2 years the therapeutic landscape of castration-resistant prostate cancer (CRPC) has dramatically changed. While chemotherapy with docetaxel has only shown a survival benefit in CRPC patients in the last 10 years, in the meantime 4 approved drugs are available for this indication and approval for immunotherapy with sipuleucel-T is expected. Docetaxel still plays a significant role in the treatment of CRPC but is also a cesura in the therapeutic sequence. For asymptomatic or minimally symptomatic, chemotherapy naive CRPC patients a significant survival benefit was shown for treatment with the androgen biosynthesis inhibitor abiraterone. Clinical data for the antiandrogen enzalutamide are expected shortly for this indication. For patients where docetaxel has failed abiraterone, enzalutamide and cabazitaxel have shown survival benefits in phase III trials. The radionuclide alpharadin not only palliated morbidity induced by bone metastases but also prolonged survival of CRPC patients. This review deals with the various drugs with respect to mode of action, clinical results and indications and will focus on new treatment options, such as targeted therapy with cabozantinib or immunotherapy with sipuleucel-T and prostvac.

Subwavelength microwave electric-field imaging using Rydberg atoms inside atomic vapor cells

We have recently shown [Nat. Phys.8, 819 (2012)] that Alkali atoms contained in a vapor cell can serve as a highly accurate standard for microwave (MW) electric field strength as well as polarization. Here we show for the first time that Rydberg atom electromagnetically induced transparency can be used to image MW electric fields with unprecedented precision. The spatial resolution of the method is far into the subwavelength regime ∼λ/650 or 66 μm at 6.9 GHz. The electric field resolutions are similar to those we have already demonstrated ∼50  μV cm(-1). Our experimental results agree with finite element calculations of test electric-field patterns.

Atom-based vector microwave electrometry using rubidium Rydberg atoms in a vapor cell

It is clearly important to pursue atomic standards for quantities like electromagnetic fields, time, length, and gravity. We have recently shown using Rydberg states that Rb atoms in a vapor cell can serve as a practical, compact standard for microwave electric field strength. Here we demonstrate for the first time that Rb atoms excited in a vapor cell can also be used for vector microwave electrometry by using Rydberg-atom electromagnetically induced transparency. We describe the measurements necessary to obtain an arbitrary microwave electric field polarization at a resolution of 0.5°. We compare the experiments to theory and find them to be in excellent agreement.

Electrical readout for coherent phenomena involving Rydberg atoms in thermal vapor cells

We present a very sensitive and scalable method to measure the population of highly excited Rydberg states in a thermal vapor cell of rubidium atoms. We detect the Rydberg ionization current in a 5 mm electrically contacted cell. The measured current is found to be in qualitatively good agreement with a theory for the Rydberg population based on a master equation for the three-level problem, including an ionization channel and the full Doppler distributions at the corresponding temperatures. The signal-to-noise ratio of the current detection is substantially better than that of purely optical techniques.

Fabrication and characterization of an electrically contacted vapor cell

We demonstrate the use of electrically contacted vapor cells to switch the transmission of a probe laser. The excitation scheme makes use of electromagnetically induced transparency involving a Rydberg state. The cell fabrication technique involves thin-film-based electric feedthroughs, which are well suited for scaling this concept to many addressable pixels like in flat panel displays.

GHz Rabi flopping to Rydberg states in hot atomic vapor cells

We report on the observation of Rabi oscillations to a Rydberg state on a time scale below 1 ns in thermal rubidium vapor. We use a bandwidth-limited pulsed excitation and observe up to 6 full Rabi cycles within a pulse duration of ∼4  ns. We find good agreement between the experiment and numerical simulations based on a surprisingly simple model. This result shows that fully coherent dynamics with Rydberg states can be achieved even in thermal atomic vapor, thus suggesting small vapor cells as a platform for room-temperature quantum devices. Furthermore, the result implies that previous coherent dynamics in single-atom Rydberg gates can be accelerated by 3 orders of magnitude.

[Oncological pelvic surgery under urological aspects: bladder carcinoma]

The aim of the treatment of invasive bladder cancer with radical cystectomy and subsequent urinary diversion is to combine a safe oncological procedure with a satisfactory quality of life. Radical cystectomy is the treatment of choice for all patients with recurrent or multifocal high grade T1 bladder cancer, T1 tumors with high risk of progression, failure of Bacillus Calmette-Guérin treatment and muscle-invasive bladder cancer. Radical cystectomy offers excellent recurrence-free and cancer-specific survival rates as well as local tumor control in patients with organ-confined and node-negative diseases. Tumor control in non-organ-confined tumors is still satisfactory with long term recurrence-free survival (RFS) rates of about 50%. Nerve-sparing cystectomy is of importance for lower urinary tract function, including continence rates after orthotopic urinary diversion and for sexual function in males and females. Orthotopic urinary reconstruction using a neobladder achieves good continence rates. Overall quality of life after radical cystectomy remains good in most patients irrespective of the type of urinary diversion.

[Natural orifices transluminal endoscopic surgery (NOTES) in Germany: summary of the working group reports of the "D-NOTES meeting 2009"]

The D-NOTES-group met in June 2009 for an evaluation of ongoing preclinical and clinical activities in natural orifice endoscopic surgery and the further coordination of research in Germany. Different working groups with various topics were formed. Consensus statements among various participants with different scientific and medical background were initiated. In summary, important topics were handled such as the correct handling of bacterial contamination and related complications, the question of the ideal entry point and a secure closure, interdisciplinary cooperation, and matters related to training and education. Furthermore, participants agreed on terminological basics. A to-do-list for medical engineering was formulated.

Two-frequency acousto-optic modulator driver to improve the beam pointing stability during intensity ramps

We report on a scheme to improve the pointing stability of the first order beam diffracted by an acousto-optic modulator (AOM). Due to thermal effects inside the crystal, the angular position of the beam can change by as much as 1 mrad when the radio-frequency power in the AOM is reduced to decrease the first order beam intensity. This is done, for example, to perform forced evaporative cooling in ultracold atom experiments using far-off-resonant optical traps. We solve this problem by driving the AOM with two radio frequencies f(1) and f(2). The power of f(2) is adjusted relative to the power of f(1) to keep the total power constant. Using this, the beam displacement is decreased by a factor of 20. The method is simple to implement in existing experimental setups, without any modification of the optics.

[Incidental carcinoma of the prostate: can we and should we recommend radical prostatectomy?]

INTRODUCTION

There is controversy regarding tumor control of incidental prostate cancer (PC). We evaluated in a large cohort if we can recommend radical prostatectomy after TURP.

MATERIAL AND METHOD

In 52 (4.3%) from a total of 1207 patients undergoing radical prostatectomy the diagnosis had been made by TURP. In a retrospective analysis we evaluated morbidity, histopathological results, and tumor control of pT1a/b tumors.

RESULTS

The number of incidentally detected PC decreased with time. In 5.8% in the TURP group and in 0.5% of the needle biopsy group, there was no residual tumor found (p<0.001). Morbidity was similar +/- TURP with the exception of operation time (206 vs 188 min) and catheter duration (19.3 vs 17.3 days). Postoperative continence was identical. There was no difference in tumor control for local recurrence-free survival and PSA-free survival with and without TURP.

CONCLUSIONS

The rate of incidentally detected PC by TURP decreases over time, but in almost all cases we found clinically relevant cancer. TURP is not an adverse prognostic factor and morbidity is similar compared with patients who were diagnosed by needle biopsy. Our data confirm that we should recommend radical prostatectomy to patients who are candidates for further curative therapy.

[The influence of different wound drainage systems in radical retropubic prostatectomy--a prospective randomized study]

INTRODUCTION

Wound drainage after radical prostatectomy is used to reduce postoperative hematomas and lymphoceles and to drain any leakage at the vesicourethral anastomosis. We evaluated two different suction-drainage systems regarding their efficacy.

MATERIAL AND METHOD

Fifty-seven patients with radical retropubic prostatectomy and pelvic lymphadenectomy were prospectively randomized. Two drains were placed bilaterally, using the Ulmer drain (16, F, Unoplast A/S, Maersk Medical) with suction. Patients with Ulmer drain were randomized to removal with and without prior shortening of the drain. The third system was the Blake silicon drain with J-VAC system (19F, Ethicon) with continuous suction.

RESULTS

Of the 57 patients, 19 were treated by J-VAC drainage (J-VAC), 19 received the Ulmer drain with drain shortening (Ulmer-with) prior to removal and 19 received the Ulmer drain without any drain shortening (Ulmer-without). Total drainage volume (mean) was statistically significantly different (p < 0.001) with 760 cc for J-VAC, 309 cc for Ulmer-without and 234 cc for Ulmer-with. Ultrasonography demonstrated 11 lymphoceles, with 5 occurring with J-VAC, 3 with Ulmer-with and 3 with Ulmer-without. These differences did not reach statistical significance (p = 0.67). Intervention was needed in 3 of the 11 patients with lymphoceles (2 with J-VAC, 1 with Ulmer-without). The mean drainage time was 3.8 days for J-VAC, 2.9 days for Ulmer-with and 2.5 days for Ulmer-without, which was statistically significant different (p = 0.005).

CONCLUSIONS

Perioperative wound drainage after radical prostatectomy with pelvic lymphadenectomy is useful to reduce perioperative complications. Different wound drainage systems demonstrate different efficacy regarding drainage volume, drainage duration and lymphocele formation. Our data are in favor of the Ulmer drain system with shortening of the drain prior to removal.

Improved urinary continence after radical retropubic prostatectomy with preparation of a long, partially intraprostatic portion of the membraneous urethra: an analysis of 1013 consecutive cases

PURPOSE

To improve the rate of full continence in our patients, we performed, since June 1997, a careful preparation of the distally intraprostatic part of the membranous urethra to obtain a long urethral stump for the vesicourethral anastomosis.

PATIENTS AND METHODS

In all, 610 patients without (group 1) and 403 patients with (group 2) a long intraprostatic stump of the urethra were asked by a self-administered questionnaire about their continence status. The rate of positive surgical margins were compared as a marker of local tumour control.

RESULTS

Full continence (no pads) was achieved in 76.02% in group 1 and in 88.84%, of all patients in group 2. Stress incontinence (SIC) I degrees was found in 12.46% and 7.44% respectively, SIC II degrees was noted in 8.69 and 3.72% and complete incontinence was seen in 2.79% in group 1 and in two patients (0.5%) in group 2. Also the time to reach the final continence status was statistically and highly significantly (P<0.001) shortened. The rate of positive margins decreased in group 2, despite intraprostatic preparation.

CONCLUSIONS

The preparation of a long, partially intraprostatic portion of the membranous urethra for vesicourethral anastomosis in radical retropubic prostatectomy leads to a statistically highly significant improvement of full continence and earlier continence in prostate cancer patients without compromising local tumour control.

[Significance of neoadjuvant therapy before radical prostatectomy]

Neoadjuvant therapy before radical prostatectomy should increase survival in patients. This is necessary especially in patients with adverse prognostic factors for locally advanced disease, because in this stage radical prostatectomy as the only treatment results in a significantly reduced rate of progression-free survival. The aim of neoadjuvant therapy protocols is to increase local tumor control because of possible downstaging effects of the tumor and to improve systemic control because of elimination of circulating tumor cells and possible micrometastases. This review discusses the present and future aspects of neoadjuvant therapies in detail. The neoadjuvant hormonal therapy prior to radical prostatectomy results in a significant downstaging that does not translate into prolonged disease-free survival. This observation was made for short-term (3 months) and long-term (8 months) hormonal therapy. Therefore, neoadjuvant hormonal therapy has only a cosmetic effect on the pathological results and should not be advocated any more. Newer protocols have shown that neoadjuvant chemotherapy or hormone chemotherapy is feasible. The results obtained in non-randomized trials with small numbers of patients do not allow analyzing the efficacy of these protocols. Theoretically, neoadjuvant chemotherapy, especially a taxane-based protocol, which has shown efficacy in hormone-refractory disease, could improve disease outcome. Clinical trials are underway to prove this hypothesis. In the future, new therapeutic strategies could also be used in the neoadjuvant setting. It can only be speculated if antibody protocols or gene therapy will be used in this respect. In conclusion, there is no standard neoadjuvant protocol prior to radical prostatectomy. Whether chemotherapy will set a new standard for care has to be elucidated by the ongoing clinical trials.

Diagnosis and monitoring of urological tumors using positron emission tomography

The purpose of this article was to critically review the diagnostic value of positron emission tomography (PET) in urological oncology. Urinary tract tumor assessment is hampered by the renal elimination of (18)F-fluorodeoxyglucose (FDG), the most commonly used PET radiopharmaceutical. PET imaging offers no significant benefits over conventional imaging modalities for renal cell and bladder carcinomas. As a result of the low metabolic activity of prostate cancer, PET does not differentiate adequately between adenoma and carcinoma, nor detect local recurrence after radical prostatectomy with sufficient sensitivity. However, lymph node staging with FDG-PET, specifically in bladder cancer, has been shown to have a potential clinical benefit. Further studies are required to determine the clinical value of retroperitoneal lymph node staging and recurrent disease detection in germ cell tumors. Finally, encouraging early results exist for the use of serial PET measurements to predict and assess therapy response to chemotherapy which may also be valuable in urological oncology.

Full scale co-digestion of organic waste

Operational results of a co-digestion facility were assessed over a period of 18 months. The organic fraction of municipal solid waste (OFMSW) contains a considerable amount of contaminants and grit (up to 6% w/w). A BTA-Pulper efficiently treated the different waste streams and converted a high amount of volatile solids (VS) into the digester feedstock. The seasonal fluctuations of the waste composition significantly influenced the biogas production. The impact of this seasonally variant degradability of VS had to be considered by evaluating the operation results. The waste streams investigated did not show any negative impact on digester performance. The hydraulic retention time (HRT) in the digester considerably affected the VS-reduction. Despite a considerable decrease of VS-degradation a reduction of HRT from 14 to 8 days slightly improves the gas production rate (GPR). An activated sludge system efficiently reduced the pollution of the effluent. The nutrient content of the anaerobic compost was favourable and the content of pollutants was low. The facility produced surplus electrical power up to 290 MJ/t. An overall energy balance shows that the facility substitutes primary energy.

[Potential malignancy of cystosarcoma phyllodes of the breast. A contribution to the histogenesis of fibrosarcoma]

The present case report, which describes the transformation of a cystosarcoma phylloides into a "borderline case" and subsequently a fibrosarcoma, makes it clear that fibrosarcoma of the breast cannot always be regarded as a tumor which has developed primarily from mesenchymal breast tissue. Just as a benign cystosarcoma can turn malignant if therapy is inadequate, it can also turn into a purely sarcomatous tumor. The clinical consequences of this are that a cystosarcoma should not only be shelled out, but excised generously, with a wide border of healthy tissue. The "borderline" type of cystosarcoma phylloides, or respectively the fibrosarcoma, requires far more aggressive therapy, i.e., mastectomy. In fibrosarcoma cases additional selective lymphadenectomy may be considered, although the metastasization pattern is predominantly hematogenic. Overall, however, the prognosis for fibrosarcoma cases is better than for those with breast cancer.