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Kafka M, Giannini G, Artamonova N, Neuwirt H, Ofner H, Kramer G, Bauernhofer T, Luger F, Höfner T, Loidl W, Griessner H, Lusuardi L, Bergmaier A, Berger A, Winder T, Weiss S, Bauinger S, Krause S, Drerup M, Heinrich E, Schneider M, Madersbacher S, Vallet S, Stoiber F, Laimer S, Hruby S, Schachtner G, Nagele U, Lenart S, Ponholzer A, Pfuner J, Wiesinger C, Kamhuber C, Müldür E, Bektic J, Horninger W, Heidegger I. Real-World Evidence of Triplet Therapy in Metastatic Hormone-Sensitive Prostate Cancer: An Austrian Multicenter Study. Clin Genitourin Cancer 2024; 22:458-466.e1. [PMID: 38267304 DOI: 10.1016/j.clgc.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/20/2023] [Accepted: 12/31/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Two randomized trials demonstrated a survival benefit of triplet therapy (androgen deprivation therapy [ADT]) plus androgen receptor pathway inhibitor [ARPI] plus docetaxel) over doublet therapy (ADT plus docetaxel), thus changing treatment strategies in metastatic hormonesensitive prostate cancer (mHSPC). PATIENTS AND METHODS We conducted the first real-world analysis comprising 97 mHSPC patients from 16 Austrian medical centers, among them 79.4% of patients received abiraterone and 17.5% darolutamide treatment. Baseline characteristics and clinical parameters during triplet therapy were documented. Mann-Whitney U test for continuous or X²-test for categorical variables was used. Variables on progression were tested using logistic regression analysis and tabulated as hazard ratios (HR), 95% confidence interval (CI). RESULTS Of 83.5% patients with synchronous and 16.5% with metachronous disease were included. 83.5% had high-volume disease diagnosed by conventional imaging (48.9%) or PSMA PET-CT (51.1%). While docetaxel and ARPI were administered consistent with pivotal trials, prednisolone, prophylactic gCSF and osteoprotective agents were not applied guideline conform in 32.5%, 37%, and 24.3% of patients, respectively. Importantly, a nonsimultaneous onset of chemotherapy and ARPI, performed in 44.3% of patients, was associated with significantly worse treatment response (P = .015, HR 0.245). Starting ARPI before chemotherapy was associated with significantly higher probability for progression (P = .023, HR 15.781) than vice versa. Strikingly, 15.6% (abiraterone) and 25.5% (darolutamide) low-volume patients as well as 14.4% (abiraterone) and 17.6% (darolutamide) metachronous patients received triplet therapy. Adverse events (AE) occurred in 61.9% with grade 3 to 5 in 15% of patient without age-related differences. All patients achieved a PSA decline of 99% and imaging response was confirmed in 88% of abiraterone and 75% of darolutamide patients. CONCLUSIONS Triplet therapy arrived in clinical practice primarily for synchronous high-volume mHSPC. Regardless of selected therapy regimen, treatment is highly effective and tolerable. Preferably therapy should be administered simultaneously, however if not possible, chemotherapy should be started first.
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Affiliation(s)
- Mona Kafka
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Giulia Giannini
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Hannes Neuwirt
- Department of Internal Medicine IV, Medical University Innsbruck, Innsbruck, Austria
| | - Heidemarie Ofner
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - Gero Kramer
- Department of Urology, Medical University Vienna, Vienna, Austria
| | | | - Ferdinand Luger
- Department of Urology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Thomas Höfner
- Department of Urology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Wolfgang Loidl
- Department of Urology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | | | | | - Antonia Bergmaier
- Department of Urology, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Andreas Berger
- Department of Urology, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Thomas Winder
- Department of Oncology, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Sarah Weiss
- Department of Urology, Kepler University Linz, Linz, Austria
| | | | - Steffen Krause
- Department of Urology, Kepler University Linz, Linz, Austria
| | - Martin Drerup
- Department of Urology, Barmherzige Brüder Salzburg, Salzburg, Austria
| | - Elmar Heinrich
- Department of Urology, Barmherzige Brüder Salzburg, Salzburg, Austria
| | | | | | - Sonia Vallet
- Division of Internal Medicine 2, Karl Landsteiner University of Health Sciences, University Hospital Krems, Krems, Austria
| | - Franz Stoiber
- Department of Urology, Salzkammergut Klinikum Vöcklabruck, Vöcklabruck, Austria
| | - Sarah Laimer
- Department of Urology, Tauernklinikum, Zell am See, Austria
| | - Stephan Hruby
- Department of Urology, Tauernklinikum, Zell am See, Austria
| | - Gert Schachtner
- Department of Urology, Landeskrankenhaus Hall, Innsbruck, Austria
| | - Udo Nagele
- Department of Urology, Landeskrankenhaus Hall, Innsbruck, Austria
| | - Sebastian Lenart
- Department of Urology, Barmherzige Brüder Vienna, Vienna, Austria
| | - Anton Ponholzer
- Department of Urology, Barmherzige Brüder Vienna, Vienna, Austria
| | - Jacob Pfuner
- Department of Urology, Klinikum Wels-Grieskirchen, Wels, Austria
| | | | - Christoph Kamhuber
- Department of Oncology, Kardinal Schwarzenberg Klinikum, Schwarzach, Austria
| | - Ecan Müldür
- Department of Oncology, Klinik Ottakring, Vienna, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
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Gruber L, Klinglmair G, Deeg J, Schmitz K, Ludwig W, Walochnik J, Aigner F, Bektic J. [The first case of a Dirofilaria immitis infection presenting as a rapidly growing inguinal canal mass confirmed by DNA sequencing]. ROFO-FORTSCHR RONTG 2024; 196:292-294. [PMID: 37582386 DOI: 10.1055/a-2123-3957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Affiliation(s)
- Leonhard Gruber
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerald Klinglmair
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Deeg
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Katja Schmitz
- Innpath Institute for Pathology, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Wilhelm Ludwig
- Department or Specific Prophylaxis and Tropical Medicine, Centre for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Wien, Austria
| | - Julia Walochnik
- Department or Specific Prophylaxis and Tropical Medicine, Centre for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Wien, Austria
| | - Friedrich Aigner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
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Kafka M, Horninger A, di Santo G, Virgolini I, Neuwirt H, Unterrainer LM, Kunte SC, Deiss E, Paffenholz P, Heidenreich A, Rasul S, Einspieler H, Shariat SF, Rajwa P, Dozauer R, Tsaur I, Medlock E, Rölz N, Rausch S, la Fougère C, Trautwein N, Roesch MC, Merseburger AS, Zattoni F, Sepulcri M, Ladurner M, Bektic J, Gandaglia G, Horninger W, Heidegger I. Real-world Outcomes and Predictive Biomarkers for 177Lutetium Prostate-specific Membrane Antigen Ligand Treatment in Metastatic Castration-resistant Prostate Cancer: A European Association of Urology Young Academic Urologists Prostate Cancer Working Group Multi-institutional Observational Study. Eur Urol Oncol 2023:S2588-9311(23)00161-X. [PMID: 37604763 DOI: 10.1016/j.euo.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The European Association of Urology guidelines include the lutetium-177 (177Lu) PSMA-617 prostate-specific membrane antigen (PSMA) ligand as a therapy option for metastatic castration-resistant prostate cancer (mCRPC). A major challenge in clinical practice is to pursue a personalized treatment approach based on robust predictive biomarkers. OBJECTIVE To assess the performance of 177Lu PSMA in real-world practice and to elaborate clinical biomarkers for evaluating treatment responses. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective observational study including 233 patients with mCRPC treated with 177Lu PSMA in eight high-volume European centers. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Baseline characteristics and clinical parameters during and after 177Lu PSMA treatment were documented. Correlations to treatment response were analyzed using χ2 and log-rank tests, with differences between groups with and without disease progression calculated using a Mann-Whitney U test. Univariate and multivariate-adjusted hazard ratios (HRs) were measured using Cox proportional hazards models. RESULTS AND LIMITATIONS A prostate-specific antigen (PSA) decrease of ≥30% was observed in 41.7%, 63.5%, and 77.8% of patients after the first, second, and third treatment cycle, respectively. Restaging performed via PSMA positron emission tomography-computed tomography revealed that 33.7% of patients had an imaging-based response, including two patients with a complete response, while 13.4% had stable disease. The median time to progression was 5 mo and the median time until the start of a consecutive antineoplastic therapy was 8.5 mo. Of importance, a PSA decrease ≥30% after the first two cycles of 177Lu PSMA (1 cycle: p = 0.0003; 2 cycles: p = 0.004), absolute PSA after the first three cycles (1 cycle: p = 0.011; 2 cycles: p = 0.0005; 3 cycles: p = 0.002), and a PSA doubling time >6 mo (p = 0.009) were significantly correlated to treatment response. Furthermore, gamma-glutamyl transferase ≤31 U/L at the start of 177Lu PSMA therapy was correlated with 1.5 times higher risk of progression for patients without but not with visceral metastases (p = 0.046). CONCLUSIONS 177Lu PSMA is an effective treatment option in mCRPC in the real-world setting. A PSA decrease ≥30% after the first two cycles is an early marker of response that can be easily implemented in clinical practice. PATIENT SUMMARY 177Lu PSMA is a radioactive agent approved for treatment of advanced prostate cancer. We reviewed its use outside of clinical trials for patients treated at eight European centers. We found that 177Lu PSMA is an effective treatment option in real-world practice. A PSA (prostate-specific antigen) decrease of ≥30% after the first two therapy cycles is an early indicator of response to treatment and can be used in personalizing treatments for patients.
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Affiliation(s)
- Mona Kafka
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Horninger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Gianpaolo di Santo
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Hannes Neuwirt
- Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Lena M Unterrainer
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Sophie C Kunte
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Emil Deiss
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Pia Paffenholz
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Sazan Rasul
- Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Holger Einspieler
- Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Weill Cornell Medicine, New York, NY, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czechia; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Pawel Rajwa
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Robert Dozauer
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Ellen Medlock
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Niklas Rölz
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Steffen Rausch
- Department of Urology, University Hospital Tübingen, Tübingen, Germany
| | | | - Nils Trautwein
- Department of Nuclear Medicine University Hospital Tübingen, Tübingen, Germany
| | - Marie C Roesch
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Fabio Zattoni
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Padova, Italy
| | - Matteo Sepulcri
- Radiation Oncology Unit, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Michael Ladurner
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
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Kafka M, Burtscher T, Fritz J, Schmitz M, Bektic J, Ladurner M, Horninger W, Heidegger I. Real-world comparison of Docetaxel versus new hormonal agents in combination with androgen-deprivation therapy in metastatic hormone-sensitive prostate cancer descrying PSA Nadir ≤ 0.05 ng/ml as marker for treatment response. World J Urol 2023; 41:2043-2050. [PMID: 36287244 PMCID: PMC10415491 DOI: 10.1007/s00345-022-04189-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/06/2022] [Indexed: 11/26/2022] Open
Abstract
PROPOSE Using Docetaxel chemotherapy or new hormonal agents (NHT) to intensify upfront systemic therapy resulted in improved survival rates compared to androgen deprivation monotherapy (ADT). Hence, combination therapies have become the new standard of care (SOC) in metastatic hormone-sensitive prostate cancer (mHSPC). However, head-to-head trails comparing different therapies as well as treatment-guiding biomarkers are still lacking. Thus, the aim of the present study was to compare clinical outcomes of Docetaxel versus NHT therapy in the real-world setting as well as to elaborate biomarkers predicting clinical outcome. METHODS We retrospectively assessed overall-survival (OS), progression-free survival 1 and 2 (PFS1/2) and time to progression (TTP) in 42 patients treated by either ADT + NHT or ADT + Docetaxel. In addition, we investigated clinical prognostic biomarkers. RESULTS Our survival analysis revealed 3-year OS of 89.4% in the NHT group compared to 82.4% in the Docetaxel group. 3-year PFS1 was 59.6% in the NHT group compared to 32.2% in the Docetaxel group and the TTP was 53.8% vs 32.2% (pOS = 0.189; pPFS1 = 0.082; pTTP = 0.055). In addition, castration-resistance occurred more often in the Docetaxel group (78.6% vs 25%, p = 0.004). Interestingly, a PSA-Nadir ≤ 0.05 ng/ml during therapy was associated with increased survival rates (p < 0.001) while PSA levels at primary diagnosis had no influence on therapy outcome. Furthermore, a thyroid-stimulating hormone (TSH) increase during therapy was associated with improved clinical outcome (p = 0.06). CONCLUSION We observed a trend towards a higher benefit of NHT as first-line treatment compared to Docetaxel in men with mHSPC. Of note, a PSA-Nadir ≤ 0.05 ng/ml or a TSH-increase during therapy were predictors for therapy response.
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Affiliation(s)
- Mona Kafka
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Burtscher
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | | | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Ladurner
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
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Faiß L, Klocker H, Steiner E, Kafka M, Ladurner M, Burtscher T, Bektic J, Horninger W, Heidegger I. The influence of RAS-inhibitors on prostate cancer aggressiveness. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01967-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Lunacek A, Tischler M, Mrstik C, Hebenstreit D, Oeser R, Bektic J, Klocker H, Horninger W, Plas E. Effects of cycling and rowing on serum concentrations of prostate-specific antigen: A randomized study of 101 male subjects. Prostate 2022; 82:804-808. [PMID: 35192201 DOI: 10.1002/pros.24322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/07/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the effects if cycling and rowing on serum prostate-specific antigen (PSA) levels. METHODS Male volunteers (n = 101), aged 20-80 (mean, 49.9) years were randomized to exercise at the first or second study visit. They performed 1 h of either cycling or rowing on a stationary machine. To determine exercise-induced effects on the PSA level, serum total PSA (tPSA) and free PSA (fPSA) concentrations were evaluated before and after exercise and another sampling was performed at the second study visit. Pre-exercise and postexercise tPSA and fPSA concentrations were compared using the Wilcoxon matched-pairs test. The results were analyzed using the Mann-Whitney U-test. RESULTS A significant (p < 0.001) average increase in tPSA after exercise (1.14 ± 1.11 ng/ml to 1.24 ± 1.26 ng/ml [mean, +8.8%]) was observed after both cycling and rowing, without significant differences between the sports (p = 0.54). The exercise-induced increase in PSA concentration affected participants aged ≥50 years (difference, 0.16 ± 0.37; p < 0.001), but not those aged <50 years (difference, 0.01 ± 0.06; p = 0.23). The effect size was clinically irrelevant in all except two outliers, in whom a distinct increase of PSA level by averages of 1.80 ng/ml (+55%) for tPSA and 1.25 ng/ml (+227%) for fPSA following cycling was observed. CONCLUSION Rowing and cycling generally do not have a clinically relevant effect on PSA levels. However, outliers exist. Our findings do not support abstaining from exercise during the days approaching PSA sampling.
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Affiliation(s)
| | | | | | | | - Reinhard Oeser
- Department of Urology, Hanusch Krankenhaus, Vienna, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Helmut Klocker
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Eugen Plas
- Department of Urology, Hanusch Krankenhaus, Vienna, Austria
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Lotterstätter M, Seklehner S, Wimpissinger F, Gombos J, Bektic J, Stolzlechner P, Laimer S, Herrmann TRW, Madersbacher S, Lusuardi L, Sieberer M, Ramesmayer C. Transurethral resection of the prostate in 85+ patients: a retrospective, multicentre study. World J Urol 2022; 40:3015-3020. [PMID: 36239811 PMCID: PMC9712300 DOI: 10.1007/s00345-022-04179-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/01/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To determine the safety and efficacy of transurethral resection of the prostate (TUR-P) in patients 85 years or older. METHODS In this retrospective, multicentre study, patients equal or older than 85 years at the time of surgery (2015-2020) were included. Several pre-, peri- and postoperative parameters were collected. The main outcome criterion was spontaneous voiding with a post-void residual (PVR) volume < 100 ml at dismission and at 12 months after surgery. RESULTS One hundred sixty-eight patients (median age: 87 years, interquartile range [IQR]: 86-89) were recruited. The patients took on average 5.2 permanent medications (3-8), 107 (64%) were anticoagulated preoperatively and neurological co-morbidities were present in 29 (17%). The indication for surgery was recurrent urinary retention in 66.3% (n = 110) with a mean retention volume of 849 ml. The mean PVR volume of the remaining 35% was 146 ml. Surgery was successfully completed in all patients. A perioperative surgical revision had to be performed in 3% and 13 patients (7.7%) required blood transfusion. After catheter removal, 85% of patients were able to void spontaneously with a PVR < 100 ml, and 14.3% were dismissed with a catheter. Twelve months data were available for 93 patients (55%). Of this cohort, 78 (83.9%) were able to void spontaneously with a PVR < 100 ml, 12 (12.9%) were on permanent catheterization. One patient (0.6%) died perioperatively. The only significant factor associated with an unsuccessful outcome was the number of permanent medications (6.8 vs. 5.0, p = 0.005). CONCLUSION This retrospective multicentre study documents the safety and efficacy of TURP (monopolar and bipolar) in the old-old cohort.
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Affiliation(s)
| | - Stephan Seklehner
- Department of Urology, Landesklinikum Baden-Mödling, Baden, Austria ,Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Florian Wimpissinger
- Department of Urology, Landesklinikum Mistelbach, Mistelbach, Austria ,Department of Urology, Rudolfstiftung Hospital, Vienna, Austria
| | - Jozsef Gombos
- Department of Urology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Sarah Laimer
- Department of Urology, Tauernklinikum Zell am See, Zell am See, Austria
| | - Thomas R. W. Herrmann
- Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland ,Urology Stellenbosch University, Western Cape, South Africa ,Hannover Medical Scholl MHH, Carl Neuberg Str. 1 30625, Hannover, Germany
| | | | - Lukas Lusuardi
- Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Manuela Sieberer
- Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Christian Ramesmayer
- Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria
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Tsaur I, Heidegger I, Bektic J, Kafka M, Van Den Bergh R, Hunting J, Thomas A, Brandt M, Höfner T, Debedde E, Thibault C, Ermacora P, Zattoni F, Foti S, Kretschmer A, Rodler S, Ploussard G, Von Amsberg G, Tilki D, Surcel C, Rosenzweig B, Gadot M, Gandaglia G, Dotzauer R. Docetaxel versus abiraterone acetate for metastatic hormone-sensitive prostate cancer: a real-life analysis. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)03138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Steinkohl F, Luger AK, Gruber L, Hochleitner M, Pichler R, Heidegger-Pircher I, Bektic J, Aigner F. Acceptance of female urologists among patients with suspected prostate disease. Transl Androl Urol 2021; 10:2938-2943. [PMID: 34430396 PMCID: PMC8350231 DOI: 10.21037/tau-21-131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/11/2021] [Indexed: 11/22/2022] Open
Abstract
Backgrounds The number of practicing female urologists is rising. The aim of this study is to evaluate the acceptance of female urologists by male patients and their partners. Methods Men who underwent a prostate MRI or a prostate biopsy between January and December 2018 and their partners, were sent questionnaires prior to the examination. Two types of questionnaires were used. One questionnaire asked “I want to be seen by: (I) a male urologist or (II) a female urologist or (III) no preference” (Groupnp), the other questionnaire only offered two possible answers: “I want to be seen by: (I) a male urologist or (II) a female urologist” (Groupm,f). All other questions were on prostate MRI and prostate biopsies. Results Overall, 377 questionnaires were sent to patients. One hundred and ninety-six questionnaires (52.0%) were returned. In Groupnp, 34.7% wanted to be seen by a male urologist, 60.8% of patients chose “no preference”. The answers of the patients’ female partners in Groupnp did not differ statistically significant (57.3% chose “no preference”, 0% chose a female urologist). In Groupm,f, 54.5% of patients preferred a male urologist, one patient wanted to be seen by a female urologist, 44.3% did not answer the question. In Groupm,f, there was no statistically significant difference in preference in regard to the doctor’s gender between the patients and their female partners (57% of partners wanted a male urologist, 0% wanted a female urologist). Conclusions A large number of patients with prostate disease and their partners prefer male urologists rather than female urologists.
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Affiliation(s)
| | | | - Leonhard Gruber
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
| | - Margarethe Hochleitner
- Department of Internal Medicine, Gender Medicine Unit, Innsbruck Medical University, Innsbruck, Austria
| | - Renate Pichler
- Department of Urology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Jasmin Bektic
- Department of Urology, Innsbruck Medical University, Innsbruck, Austria
| | - Friedrich Aigner
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
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Ladurner M, Wieser M, Eigentler A, Seewald M, Dobler G, Neuwirt H, Kafka M, Heidegger I, Horninger W, Bektic J, Klocker H, Obrist P, Eder IE. Validation of Cell-Free RNA and Circulating Tumor Cells for Molecular Marker Analysis in Metastatic Prostate Cancer. Biomedicines 2021; 9:biomedicines9081004. [PMID: 34440208 PMCID: PMC8391593 DOI: 10.3390/biomedicines9081004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 12/22/2022] Open
Abstract
Since tissue material is often lacking in metastatic prostate cancer (mPCa), there is increasing interest in using liquid biopsies for treatment decision and monitoring therapy responses. The purpose of this study was to validate the usefulness of circulating tumor cells (CTCs) and plasma-derived cell-free (cf) RNA as starting material for gene expression analysis through qPCR. CTCs were identified upon prostate-specific membrane antigen and/or cytokeratin positivity after enrichment with ScreenCell (Westford, Massachusetts, USA) filters or the microfluidic ParsortixTM (Guildford, Surrey, United Kingdom) system. Overall, 50% (28/56) of the patients had ≥5 CTCs/7.5 mL of blood. However, CTC count did not correlate with Gleason score, serum PSA, or gene expression. Notably, we observed high expression of CD45 in CTC samples after enrichment, which could be successfully eliminated through picking of single cells. Gene expression in picked CTCs was, however, rather low. In cfRNA from plasma, on the other hand, gene expression levels were higher compared to those found in CTCs. Moreover, we found that PSA was significantly increased in plasma-derived cfRNA of mPCa patients compared to healthy controls. High PSA expression was also associated with poor overall survival, indicating that using cfRNA from plasma could be used as a valuable tool for molecular expression analysis.
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Affiliation(s)
- Michael Ladurner
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.L.); (A.E.); (G.D.); (M.K.); (I.H.); (W.H.); (J.B.); (H.K.)
| | - Manuel Wieser
- Tyrolpath Obrist Brunhuber GmbH, 6511 Zams, Austria; (M.W.); (M.S.); (P.O.)
| | - Andrea Eigentler
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.L.); (A.E.); (G.D.); (M.K.); (I.H.); (W.H.); (J.B.); (H.K.)
| | - Martin Seewald
- Tyrolpath Obrist Brunhuber GmbH, 6511 Zams, Austria; (M.W.); (M.S.); (P.O.)
| | - Gabriele Dobler
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.L.); (A.E.); (G.D.); (M.K.); (I.H.); (W.H.); (J.B.); (H.K.)
| | - Hannes Neuwirt
- Department of Internal Medicine IV-Nephrology and Hypertension, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Mona Kafka
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.L.); (A.E.); (G.D.); (M.K.); (I.H.); (W.H.); (J.B.); (H.K.)
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.L.); (A.E.); (G.D.); (M.K.); (I.H.); (W.H.); (J.B.); (H.K.)
| | - Wolfgang Horninger
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.L.); (A.E.); (G.D.); (M.K.); (I.H.); (W.H.); (J.B.); (H.K.)
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.L.); (A.E.); (G.D.); (M.K.); (I.H.); (W.H.); (J.B.); (H.K.)
| | - Helmut Klocker
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.L.); (A.E.); (G.D.); (M.K.); (I.H.); (W.H.); (J.B.); (H.K.)
| | - Peter Obrist
- Tyrolpath Obrist Brunhuber GmbH, 6511 Zams, Austria; (M.W.); (M.S.); (P.O.)
| | - Iris E. Eder
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.L.); (A.E.); (G.D.); (M.K.); (I.H.); (W.H.); (J.B.); (H.K.)
- Correspondence: ; Tel.: +43-512-504-24819; Fax: +43-512-504-24817
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11
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Tsaur I, Heidegger I, Bektic J, Kafka M, van den Bergh RCN, Hunting JCB, Thomas A, Brandt MP, Höfner T, Debedde E, Thibault C, Ermacora P, Zattoni F, Foti S, Kretschmer A, Ploussard G, Rodler S, von Amsberg G, Tilki D, Surcel C, Rosenzweig B, Gadot M, Gandaglia G, Dotzauer R. A real-world comparison of docetaxel versus abiraterone acetate for metastatic hormone-sensitive prostate cancer. Cancer Med 2021; 10:6354-6364. [PMID: 34374489 PMCID: PMC8446402 DOI: 10.1002/cam4.4184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/11/2022] Open
Abstract
Background Docetaxel (D) or secondary hormonal therapy (SHT) each combined with androgen deprivation therapy (ADT) represent possible treatment options in males with metastasized hormone‐sensitive prostate cancer (mHSPC). Real‐world data comparing different protocols are lacking yet. Thus, our objective was to compare the efficacy and safety of abiraterone acetate (AA)+ADT versus D+ADT in mHSPC. Methods In a retrospective multicenter analysis including males with mHSPC treated with either of the aforementioned protocols, overall survival (OS), progression‐free survival 1 (PFS1), and progression‐free survival 2 (PFS2) were assessed for both cohorts. Median time to event was tested by Kaplan–Meier method and log‐rank test. The Cox‐proportional hazards model was used for univariate and multivariate regression analyses. Results Overall, 196 patients were included. The AA+ADT cohort had a longer PFS1 in the log‐rank testing (23 vs. 13 mos., p < 0.001), a longer PFS2 (48 vs. 33 mos., p = 0.006), and longer OS (80 vs. 61 mos., p = 0.040). In the multivariate analyses AA+ADT outperformed D+ADT in terms of PFS1 (HR = 0.34, 95% CI = 0.183–0.623; p = 0.001) and PFS2 (HR = 0.33 95% CI = 0.128–0.827; p = 0.018), respectively, while OS and toxicity rate were similar between both groups. Conclusions AA+ADT is mainly associated with a similar efficacy and overall toxicity rate as D+ADT. Further prospective research is required for validation of the clinical value of the observed benefit of AA+ADT for progression‐free end‐points.
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Affiliation(s)
- Igor Tsaur
- Department of Urology and Pediatric Urology, University Medicine Mainz, Mainz, Germany
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Mona Kafka
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Jarmo C B Hunting
- Department of Urology, St Antonius Hospital, Utrecht, The Netherlands
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medicine Mainz, Mainz, Germany
| | - Maximilian P Brandt
- Department of Urology and Pediatric Urology, University Medicine Mainz, Mainz, Germany
| | - Thomas Höfner
- Department of Urology and Pediatric Urology, University Medicine Mainz, Mainz, Germany
| | - Eliott Debedde
- Department of Medical Oncology, European Georges Pompidou Hospital, Assistance Publique des Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Constance Thibault
- Department of Medical Oncology, European Georges Pompidou Hospital, Assistance Publique des Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Paola Ermacora
- Unit of Urology, Santa Maria della Misericordia Academic Medical Center Hospital, Udine, Italy
| | - Fabio Zattoni
- Unit of Urology, Santa Maria della Misericordia Academic Medical Center Hospital, Udine, Italy
| | - Silvia Foti
- Division of Oncology/Unit of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, Toulouse, France.,Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | - Severin Rodler
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Gunhild von Amsberg
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,Department of Urology, University Hospital-Hamburg Eppendorf, Hamburg, Germany
| | - Christian Surcel
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Barak Rosenzweig
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Gadot
- Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Robert Dotzauer
- Department of Urology and Pediatric Urology, University Medicine Mainz, Mainz, Germany
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Kafka M, Mayr F, Temml V, Möller G, Adamski J, Höfer J, Schwaiger S, Heidegger I, Matuszczak B, Schuster D, Klocker H, Bektic J, Stuppner H, Eder IE. Dual Inhibitory Action of a Novel AKR1C3 Inhibitor on Both Full-Length AR and the Variant AR-V7 in Enzalutamide Resistant Metastatic Castration Resistant Prostate Cancer. Cancers (Basel) 2020; 12:E2092. [PMID: 32731472 PMCID: PMC7465893 DOI: 10.3390/cancers12082092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 11/23/2022] Open
Abstract
The expanded use of second-generation antiandrogens revolutionized the treatment landscape of progressed prostate cancer. However, resistances to these novel drugs are already the next obstacle to be solved. Various previous studies depicted an involvement of the enzyme AKR1C3 in the process of castration resistance as well as in the resistance to 2nd generation antiandrogens like enzalutamide. In our study, we examined the potential of natural AKR1C3 inhibitors in various prostate cancer cell lines and a three-dimensional co-culture spheroid model consisting of cancer cells and cancer-associated fibroblasts (CAFs) mimicking enzalutamide resistant prostate cancer. One of our compounds, named MF-15, expressed strong antineoplastic effects especially in cell culture models with significant enzalutamide resistance. Furthermore, MF-15 exhibited a strong effect on androgen receptor (AR) signaling, including significant inhibition of AR activity, downregulation of androgen-regulated genes, lower prostate specific antigen (PSA) production, and decreased AR and AKR1C3 expression, indicating a bi-functional effect. Even more important, we demonstrated a persisting inhibition of AR activity in the presence of AR-V7 and further showed that MF-15 non-competitively binds within the DNA binding domain of the AR. The data suggest MF-15 as useful drug to overcome enzalutamide resistance.
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Affiliation(s)
- Mona Kafka
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.K.); (J.H.); (I.H.); (H.K.); (J.B.)
| | - Fabian Mayr
- Institute of Pharmacy/Pharmacognosy, Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, 6020 Innsbruck, Austria; (F.M.); (V.T.); (S.S.); (H.S.)
| | - Veronika Temml
- Institute of Pharmacy/Pharmacognosy, Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, 6020 Innsbruck, Austria; (F.M.); (V.T.); (S.S.); (H.S.)
| | - Gabriele Möller
- Research Unit Molecular Endocrinology and Metabolism, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (G.M.); (J.A.)
| | - Jerzy Adamski
- Research Unit Molecular Endocrinology and Metabolism, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (G.M.); (J.A.)
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 637551, Singapore
- Lehrstuhl für Experimentelle Genetik, Technische Universität München, 85354 Freising-Weihenstephan, Germany
| | - Julia Höfer
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.K.); (J.H.); (I.H.); (H.K.); (J.B.)
| | - Stefan Schwaiger
- Institute of Pharmacy/Pharmacognosy, Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, 6020 Innsbruck, Austria; (F.M.); (V.T.); (S.S.); (H.S.)
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.K.); (J.H.); (I.H.); (H.K.); (J.B.)
| | - Barbara Matuszczak
- Institute of Pharmacy/Pharmaceutical Chemistry, Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, 6020 Innsbruck, Austria; (B.M.); (D.S.)
| | - Daniela Schuster
- Institute of Pharmacy/Pharmaceutical Chemistry, Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, 6020 Innsbruck, Austria; (B.M.); (D.S.)
- Institute of Pharmacy, Department of Pharmaceutical and Medicinal Chemistry, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Helmut Klocker
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.K.); (J.H.); (I.H.); (H.K.); (J.B.)
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.K.); (J.H.); (I.H.); (H.K.); (J.B.)
| | - Hermann Stuppner
- Institute of Pharmacy/Pharmacognosy, Center for Molecular Biosciences Innsbruck (CMBI), University of Innsbruck, 6020 Innsbruck, Austria; (F.M.); (V.T.); (S.S.); (H.S.)
| | - Iris E. Eder
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (M.K.); (J.H.); (I.H.); (H.K.); (J.B.)
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Maffey-Steffan J, Scarpa L, Svirydenka A, Nilica B, Mair C, Buxbaum S, Bektic J, von Guggenberg E, Uprimny C, Horninger W, Virgolini I. The 68Ga/ 177Lu-theragnostic concept in PSMA-targeting of metastatic castration-resistant prostate cancer: impact of post-therapeutic whole-body scintigraphy in the follow-up. Eur J Nucl Med Mol Imaging 2020; 47:695-712. [PMID: 31776632 PMCID: PMC7005064 DOI: 10.1007/s00259-019-04583-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/15/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION A new therapeutic option for metastatic castration-resistant prostate cancer (mCRPC) of heavily pre-treated patients lies in 177Lu-PSMA-617 radioligand therapy. METHODS On the basis of PSMA-targeted 68Ga-PSMA-11 PET/CT, 32 consecutive mCRPC patients were selected for 177Lu-PSMA-617 therapy (6 GBq/cycle, 2 to 6 cycles, 6-10 weeks apart) and followed until death. Post-therapy whole-body (WB) dosimetry and 68Ga-PSMA-11 PET/CT data were compared and related to progression free and overall survival. RESULTS 177Lu-PSMA-617 dosimetry after the first cycle indicated high tumor doses for skeletal (4.01 ± 2.64; range 1.10-13.00 Gy/GBq), lymph node (3.12 ± 2.07; range 0.70-8.70 Gy/GBq), and liver (2.97 ± 1.38; range 0.76-5.00 Gy/GBq) metastases whereas the dose for tissues/organs was acceptable in all patients for an intention-to-treat activity of 24 GBq. Any PSA decrease after the first cycle was found in 23/32 (72%), after the second cycle in 22/32 (69%), after the third cycle in 16/28 (57%), and after the fourth cycle in 8/18 (44%) patients. Post-therapy 24 h WB scintigraphy showed decreased tumor-to-background ratios in 24/32 (75%) after the first therapy cycle, after the second cycle in 17/29 (59%), and after the third cycle in 13/21 (62%) patients. The median PFS was 7 months and the median OS 12 months. In the group of PSA responders (n = 22) the median OS was 17 months versus 11 months in the group of non-responders (n = 10), p < 0.05. Decreasing SUVmax values were found for parotid (15.93 ± 6.23 versus 12.33 ± 4.07) and submandibular glands (17.65 ± 7.34 versus 13.12 ± 4.62) following treatment, along with transient (n = 6) or permanent (n = 2) xerostomia in 8/32 (25%) patients. In 3/32 patients, nephrotoxicity changed from Grade 2 to 3, whereas neither Grade 4 nephrotoxicity nor hematotoxicity was found. In most patients a good agreement was observed for the visual interpretation of the tracer accumulation between 24 h WB and PET/CT scans. However, no significance could be calculated for baseline-absorbed tumor doses and SUVmax values of tumor lesions. 5/32 (16%) patients showed a mixed response pattern, which resulted in disease progression over time. CONCLUSION Serial PSA measurements and post-therapy 24 h WB scintigraphy seems to allow a sufficiently accurate follow-up of 177Lu-PSMA-617-treated mCRPC patients whereas 68Ga-PSMA-11 PET/CT should be performed for patient selection and final response assessment.
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Affiliation(s)
- Johanna Maffey-Steffan
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Lorenza Scarpa
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | | | - Bernhard Nilica
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christian Mair
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Sabine Buxbaum
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Elisabeth von Guggenberg
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christian Uprimny
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
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Maffey-Steffan J, Scarpa L, Svirydenka A, Nilica B, Mair C, Buxbaum S, Bektic J, von Guggenberg E, Uprimny C, Horninger W, Virgolini I. Correction to: The 68Ga/ 177Lu-theragnostic concept in PSMA-targeting of metastatic castration-resistant prostate cancer: impact of post-therapeutic whole-body scintigraphy in the follow-up. Eur J Nucl Med Mol Imaging 2019; 47:740. [PMID: 31863137 DOI: 10.1007/s00259-019-04660-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The author name Bernhard Nilica was inadvertently interchanged in the original version of this article.
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Affiliation(s)
- Johanna Maffey-Steffan
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Lorenza Scarpa
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Anna Svirydenka
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Bernhard Nilica
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christian Mair
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Sabine Buxbaum
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Elisabeth von Guggenberg
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christian Uprimny
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
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Steinkohl F, Luger AK, Pichler R, Bektic J, Rehder P, Lebovici A, Aigner F. Visibility of MRI prostate lesions on B-mode transrectal ultrasound. Med Ultrason 2018; 20:441-445. [PMID: 30534650 DOI: 10.11152/mu-1602] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM Prostate biopsies are usually done with transrectal ultrasound (TRUS) in B-mode (B TRUS) but multiparametric MRI (mpMRI) is the gold imaging standard for the visualization of clinically significant prostate cancer (PCa), since a lowPCa detection rate is reported for B TRUS. The aim of this study was to assess the visibility of MRI lesions on B TRUS and to determine which factors may influence the visibility on B TRUS. MATERIAL AND METHODS 142 men with 148 lesions reported on mpMRI underwent a B TRUS/mpMRI fusion targeted biopsy of the prostate and were included in this retrospective study. During the biopsy, images were obtained and stored in the institution's PACS. These images were reviewed by two radiologists to determine, whether an mpMRI lesion was or was not visible on B TRUS. RESULTS Overall 92 from 148 mpMRI lesions (62.2%) were visible on B TRUS. The location of the lesion in the prostate, the PIRADS classification of the lesions and the size of the lesion had no significant influence on the visibility on B TRUS. Only the prostate volume had a significant influence on visibility: in smaller prostates significantly more lesions were visible on B TRUS than in large glands (p+0.041; 45.1 ml vs 54 ml). CONCLUSION The use of newer high-end ultrasound units as well as experience gained from fusion biopsies enables us to see 62.2 % of all suspicious mpMRI lesions on B TRUS. B TRUS images merit a thorough examination during a conventional biopsy setting.
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Affiliation(s)
- Fabian Steinkohl
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
| | | | - Renate Pichler
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Rehder
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrei Lebovici
- Department of Radiology, County Emergency Hospital Cluj-Napoca, Romania
| | - Friedrich Aigner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
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Junker D, Steinkohl F, Fritz V, Bektic J, Tokas T, Aigner F, Herrmann TRW, Rieger M, Nagele U. Comparison of multiparametric and biparametric MRI of the prostate: are gadolinium-based contrast agents needed for routine examinations? World J Urol 2018; 37:691-699. [PMID: 30078170 DOI: 10.1007/s00345-018-2428-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/31/2018] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To investigate, if and how omitting gadolinium-based contrast agents (GBCA) and dynamic contrast-enhanced imaging (DCE) influences diagnostic accuracy and tumor detection rates of prostate MRI. METHODS In this retrospective study, 236 patients were included. The results of biparametric (bpMRI) and multiparametric magnetic resonance imaging (mpMRI) were compared using the PI-RADS version 2 scoring system. The distribution of lesions to PIRADS score levels, tumor detection rates, diagnostic accuracy and RoC analysis were calculated and compared to the results of histopathological analysis or 5-year follow-up for benign findings. RESULTS Omitting DCE changed PI-RADS scores in 9.75% of patients, increasing the number of PI-RADS 3 scores by 8.89% when compared to mpMRI. No change of more than one score level was observed. BpMRI did not show significant differences in diagnostic accuracy or tumor detection rates. (AuC of 0.914 vs 0.917 in ROC analysis). Of 135 prostate carcinomas (PCa), 94.07% were scored identically, and 5.93% were downgraded only from PI-RADS 4 to PI-RADS 3 by bpMRI. All of them were low-grade PCa with Gleason Score 6 or 7a. No changes were observed for PCa ≥ 7b. CONCLUSION Omitting DCE did not lead to significant differences in diagnostic accuracy or tumor detection rates when using the PI-RADS 2 scoring system. According to these data, it seems reasonable to use a biparametric approach for initial routine prostate MRI. This could decrease examination time and reduce costs without significantly lowering the diagnostic accuracy.
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Affiliation(s)
- Daniel Junker
- Department of Radiology, Community Hospital Hall in Tirol, Milser Straße 10, 6060, Hall in Tirol, Austria. .,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
| | - Fabian Steinkohl
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Veronika Fritz
- Department of Urology, Community Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.,Department of Urology, Community Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Friedrich Aigner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas R W Herrmann
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.,Department of Urology, Klinik für Urologie, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Michael Rieger
- Department of Radiology, Community Hospital Hall in Tirol, Milser Straße 10, 6060, Hall in Tirol, Austria
| | - Udo Nagele
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.,Department of Urology, Community Hospital Hall in Tirol, Hall in Tirol, Austria
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17
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Steinkohl F, Gruber L, Bektic J, Nagele U, Aigner F, Herrmann TRW, Rieger M, Junker D. Retrospective analysis of the development of PIRADS 3 lesions over time: when is a follow-up MRI reasonable? World J Urol 2017; 36:367-373. [PMID: 29243110 DOI: 10.1007/s00345-017-2135-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/16/2017] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Often PIRADS 3 findings are usually followed up with further MRIs of the prostate. Current guidelines do not state an optimal interval between the initial MRI and the follow-up MRI. The aim of this study was to find out if PIRADS 3 lesions evolve over time and to determine how long the optimal interval between initial MRI and follow-ups should be. METHODS In this retrospective study, 141 consecutive patients were included who underwent at least one follow-up MRI after an initial PIRADS 3 finding. Changes in PIRADS score and the interval between the first and the follow-up MRI were recorded. An optimal duration was calculated. RESULTS Of all patients, 76.6% had a change from PIRADS 3 to either 2 or 4 in the first follow-up MRI. Reclassifications to PIRADS 4 happened earlier than reclassifications to PIRADS 2 (after 366.5 ± 217.9 days and after 534.2 ± 253.0 days, respectively). An optimal point of time for a follow-up to distinguish between changes to PIRADS 2 versus PIRADS 4 turned out to be 379 days (12.4 months, AUC 0.734, p = 0.0001). Of all patients with a PIRADS 3 lesion 14.8% harboured a prostate carcinoma. CONCLUSION Performing follow-up mpMRI rather than immediate biopsy may be beneficial for patients with PIRADS 3, as most lesions can be reclassified after a manageable period of time. Upgrades to PIRADS 4 seem to happen earlier and within fewer follow-ups than downgrades to PIRADS 2. The optimal interval for follow-up MRIs seems to be 12.4 months.
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Affiliation(s)
- Fabian Steinkohl
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Leonhard Gruber
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Udo Nagele
- Department of Urology, Landeskrankenhaus Hall in Tirol, Hall in Tirol, Austria.,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Friedrich Aigner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas R W Herrmann
- Department of Urology, Hannover Medical School, Hannover, Germany.,Department of Urology, Kantonspital Thurgau, Frauenfeld, Switzerland.,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Michael Rieger
- Department of Radiology, Landeskrankenhaus Hall in Tirol, Milser Straße 10, 6060, Hall in Tirol, Austria
| | - Daniel Junker
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria. .,Department of Radiology, Landeskrankenhaus Hall in Tirol, Milser Straße 10, 6060, Hall in Tirol, Austria.
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18
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Heinrich D, Bektic J, Bergman AM, Caffo O, Cathomas R, Chi KN, Daugaard G, Keizman D, Kindblom J, Kramer G, Olmos D, Omlin A, Sridhar SS, Tucci M, van Oort I, Nilsson S. The Contemporary Use of Radium-223 in Metastatic Castration-resistant Prostate Cancer. Clin Genitourin Cancer 2017; 16:S1558-7673(17)30275-6. [PMID: 29079165 DOI: 10.1016/j.clgc.2017.08.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/14/2017] [Accepted: 08/31/2017] [Indexed: 12/29/2022]
Abstract
Radium-223 dichloride (radium-223) was approved for the treatment of patients with castration-resistant prostate cancer (CRPC) and symptomatic bone metastases in the United States and Europe in 2013. This followed a reported overall survival benefit for patients treated with radium-223 and best standard of care (BSoC) when compared with placebo and BSoC in the ALpharadin in SYMptomatic Prostate CAncer (ALSYMPCA) trial. At that time, docetaxel was the standard first-line choice for patients with metastatic CRPC (mCRPC). Since then, the treatment landscape has changed dramatically with new hormonal agents (abiraterone and enzalutamide) considered to be the first-line choice for many patients. The optimal patient profile for radium-223 in the modern setting, and its best use either in sequence or in combination with other approved agents are unclear, with few definitive guidelines available. This article reports on the views of a group of urologists and medical oncologists experienced in treating patients with mCRPC with radium-223 in routine clinical practice. The aim is to provide an overview of the current use of radium-223 in the treatment of patients with mCRPC, and to discuss best practices for patient selection and on-treatment monitoring. Where agreement was reached, guidance on the optimal use of radium-223 is provided.
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Affiliation(s)
- Daniel Heinrich
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway.
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Andries M Bergman
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Orazio Caffo
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Richard Cathomas
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - Kim N Chi
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daniel Keizman
- Genitourinary Oncology Service, Department of Oncology, Meir Medical Center, Kfar Saba, Israel; Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jon Kindblom
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gero Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - David Olmos
- Medical Oncology Department, CNIO-IBIMA Genito-Urinary Cancer Unit, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain; Prostate Cancer Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | - Aurelius Omlin
- Department of Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Department of Oncology and Haematology, University Hospital Berne, Berne, Switzerland
| | - Srikala S Sridhar
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada
| | - Marcello Tucci
- Department of Oncology, Medical Oncology, University of Turin at San Luigi Hospital, Orbassano, Italy
| | - Inge van Oort
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Sten Nilsson
- Department of Oncology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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Uprimny C, Kroiss AS, Fritz J, Decristoforo C, Kendler D, von Guggenberg E, Nilica B, Maffey-Steffan J, di Santo G, Bektic J, Horninger W, Virgolini IJ. Early PET imaging with [68]Ga-PSMA-11 increases the detection rate of local recurrence in prostate cancer patients with biochemical recurrence. Eur J Nucl Med Mol Imaging 2017; 44:1647-1655. [DOI: 10.1007/s00259-017-3743-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/24/2017] [Indexed: 11/27/2022]
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20
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Scarpa L, Buxbaum S, Kendler D, Fink K, Bektic J, Gruber L, Decristoforo C, Uprimny C, Lukas P, Horninger W, Virgolini I. The 68Ga/ 177Lu theragnostic concept in PSMA targeting of castration-resistant prostate cancer: correlation of SUV max values and absorbed dose estimates. Eur J Nucl Med Mol Imaging 2017; 44:788-800. [PMID: 28083690 DOI: 10.1007/s00259-016-3609-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/23/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION A targeted theragnostic approach based on increased expression of prostate-specific membrane antigen (PSMA) on PC cells is an attractive treatment option for patients with metastatic castration-resistant prostate cancer (mCRPC). METHODS Ten consecutive mCRPC patients were selected for 177Lu-PSMA617 therapy on the basis of PSMA-targeted 68Ga-PSMA-HBED-CC PET/CT diagnosis showing extensive and progressive tumour load. Following dosimetry along with the first therapy cycle restaging (68Ga-PSMA-HBED-CC and 18F-NaF PET/CT) was performed after 2 and 3 therapy cycles (each 6.1 ± 0.3 GBq, range 5.4-6.5 GBq) given intravenously over 30 minutes, 9 ± 1 weeks apart. PET/CT scans were compared to 177Lu-PSMA617 24-hour whole-body scans and contrast-enhanced dual-phase CT. Detailed comparison of SUVmax values and absorbed tumour doses was performed. RESULTS 177Lu-PSMA617 dosimetry indicated high tumour doses for skeletal (3.4 ± 1.9 Gy/GBq; range 1.1-7.2 Gy/GBq), lymph node (2.6 ± 0.4 Gy/GBq; range 2.3-2.9 Gy/GBq) as well as liver (2.4 ± 0.8 Gy/GBq; range 1.7-3.3 Gy/GBq) metastases whereas the dose for tissues/organs was acceptable in all patients for an intention-to-treat activity of 18 ± 0.3 GBq. Three patients showed partial remission, three mixed response, one stable and three progressive disease. Decreased 177Lu-PSMA617 and 68Ga-PSMA-HBED-CC uptake (mean SUVmax values 20.2 before and 15.0 after 2 cycles and 11.5 after 3 cycles, p < 0.05) was found in 41/54 skeletal lesions, 12/13 lymph node metastases, 3/5 visceral metastases and 4/4 primary PC lesions. CONCLUSION Due to substantial individual variance, dosimetry is mandatory for a patient-specific approach following 177Lu-PSMA617 therapy. Higher activities and/or shorter treatment intervals should be applied in a larger prospective study.
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Affiliation(s)
- Lorenza Scarpa
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Sabine Buxbaum
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Dorota Kendler
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Katharina Fink
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.,Department of Radiotherapy / Radiation Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Leonhard Gruber
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Clemens Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christian Uprimny
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Peter Lukas
- Department of Radiotherapy / Radiation Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
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21
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Uprimny C, Kroiss AS, Decristoforo C, Fritz J, Warwitz B, Scarpa L, Roig LG, Kendler D, von Guggenberg E, Bektic J, Horninger W, Virgolini IJ. Early dynamic imaging in 68Ga- PSMA-11 PET/CT allows discrimination of urinary bladder activity and prostate cancer lesions. Eur J Nucl Med Mol Imaging 2016; 44:765-775. [PMID: 27900519 DOI: 10.1007/s00259-016-3578-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/18/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE PET/CT with 68Ga-labelled prostate-specific membrane antigen (PSMA)-ligands has been proven to establish a promising imaging modality in the work-up of prostate cancer (PC) patients with biochemical relapse. Despite a high overall detection rate, the visualisation of local recurrence may be hampered by high physiologic tracer accumulation in the urinary bladder on whole body imaging, usually starting 60 min after injection. This study sought to verify whether early dynamic 68Ga-PSMA-11 (HBED-CC)PET/CT can differentiate pathologic PC-related tracer uptake from physiologic tracer accumulation in the urinary bladder. METHODS Eighty consecutive PC patients referred to 68Ga -PSMA-11 PET/CT were included in this retrospective analysis (biochemical relapse: n = 64; primary staging: n = 8; evaluation of therapy response/restaging: n = 8). In addition to whole-body PET/CT acquisition 60 min post injection early dynamic imaging of the pelvis in the first 8 min after tracer injection was performed. SUVmax of pathologic lesions was calculated and time-activity curves were generated and compared to those of urinary bladder and areas of physiologic tracer uptake. RESULTS A total of 55 lesions consistent with malignancy on 60 min whole body imaging exhibited also pathologic 68Ga-PSMA-11 uptake during early dynamic imaging (prostatic bed/prostate gland: n = 27; lymph nodes: n = 12; bone: n = 16). All pathologic lesions showed tracer uptake within the first 3 min, whereas urinary bladder activity was absent within the first 3 min of dynamic imaging in all patients. Suvmax was significantly higher in PC lesions in the first 6 min compared to urinary bladder accumulation (p < 0.001). In the subgroup of PC patients with biochemical relapse the detection rate of local recurrence could be increased from 20.3 to 29.7%. CONCLUSIONS Early dynamic imaging in 68Ga-PSMA-11 PET/CT reliably enables the differentiation of pathologic tracer uptake in PC lesions from physiologic bladder accumulation. Performance of early dynamic imaging in addition to whole body imaging 60 min after tracer injection might improve the detection rate of local recurrence in PC patients with biochemical relapse referred for 68Ga-PSMA-11 PET/CT.
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Affiliation(s)
- Christian Uprimny
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria.
| | - Alexander Stephan Kroiss
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - Clemens Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - Josef Fritz
- Department for Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Boris Warwitz
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - Lorenza Scarpa
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - Llanos Geraldo Roig
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - Dorota Kendler
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - Elisabeth von Guggenberg
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Irene Johanna Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 32, 6020, Innsbruck, Austria
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22
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Auer T, Edlinger M, Bektic J, Nagele U, Herrmann T, Schäfer G, Aigner F, Junker D. Performance of PI-RADS version 1 versus version 2 regarding the relation with histopathological results. World J Urol 2016; 35:687-693. [PMID: 27510762 DOI: 10.1007/s00345-016-1920-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/04/2016] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Aim of this study was to compare the diagnostic performance of PI-RADS version 1 (v1) and version 2 (v2) in the detection of prostate cancer (PCa). METHODS Multiparametric MRIs (mpMRI) of 50 consecutive patients with biopsy proven PCa, which had originally been evaluated according to PIRADS v1, were now retrospectively re-evaluated, comparing PI-RADS v1 and v2. MpMRI data were evaluated in comparison with histopathological whole-mount step-section slides. MRI examinations included T2-weighted, diffusion-weighted, and dynamic contrast-enhanced MRI. RESULTS Overall PI-RADS v1 showed a significantly larger discriminative ability of tumor detection: PI-RADS v1 AUC 0.96 (95 % CI 0.94-0.98) and v2 AUC 0.90 (95 % CI 0.86-0.94). For peripheral zone lesions, PI-RADS v1 showed a significantly larger ability of PCa discrimination: v1 AUC 0.97 (95 % CI 0.95-0.99) and v2 AUC 0.92 (95 % CI 0.88-0.96). For transition zone lesions, PI-RADS v1 showed more discrimination: v1 AUC 0.96 (95 % CI 0.92-1.00) and v2 0.90 (95 % CI 0.83-0.97), but the difference was not significant. PI-RADS v2 resulted in significantly more false negative results (3 % in v1, 14 % in v2) and a comparable number of true positive results (82 % in v1, 80 % in v2). CONCLUSION PI-RADS v2 uses a simplified approach, but shows a lower diagnostic accuracy. This could lead to a higher rate of false negative results with the risk of missing tumors within low PI-RADS score levels. Therefore, its use cannot be recommended unconditionally, and further improvement should be considered.
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Affiliation(s)
- Thomas Auer
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Michael Edlinger
- Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Schöpfstraße 41/1, 6020, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Udo Nagele
- Landeskrankenhaus Hall, Abteilung für Urologie und Andrologie, Milser Straße 10, 6060, Hall in Tirol, Austria
| | - Thomas Herrmann
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Georg Schäfer
- Department of Pathology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Friedrich Aigner
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Daniel Junker
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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Heidegger I, Fritz J, Steiner H, Bektic J, Pichler R. Hydronephrosis Predicts Successful Catheter Removal after Painful Urinary Retention - Preliminary Results of a Prospective Single Center Study. Urol Int 2015; 97:84-90. [PMID: 26571370 DOI: 10.1159/000441127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/16/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The study aims to identify candidates who can be managed conservatively after the first episode of spontaneous painful acute urinary retention (AUR). METHODS A total of 20 patients with primary spontaneous painful AUR were prospectively included in the study. Twenty-four hours after AUR, the catheter was removed. When residual urinary volume was <100 ml, patients were referred without catheter, when residual urinary volume was ≥100 ml, the catheter was replaced and removed again at day 4, 7 or 10 after AUR, respectively. Receiver operating characteristic curves, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to assess predictors for successful catheter removal. RESULTS Thirteen out of 20 (65%) patients had a successful catheter removal until day 10 after AUR. Among them 12 of 13 (93.2%) had a successful catheter removal until day 4 of AUR. Hydronephrosis urinary volume and Qmax at the time of AUR were significant numeric predictors for failure of successful catheter removal. In addition, we calculated a prediction model combing age + prostate volume + urinary volume + Qmax that highly predicts successful catheter removal (sensitivity 100%, specificity 69%, PPV 64%, NPV 100%). CONCLUSION We found for the first time a significant association between hydronephrosis and successful catheter removal. Successful catheter removal until day 4 after AUR can safely be managed without immediate transurethral resection of the prostate.
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Affiliation(s)
- Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
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Heidegger I, Fritz J, Klocker H, Pichler R, Bektic J, Horninger W. Age-Adjusted PSA Levels in Prostate Cancer Prediction: Updated Results of the Tyrol Prostate Cancer Early Detection Program. PLoS One 2015. [PMID: 26218594 PMCID: PMC4517762 DOI: 10.1371/journal.pone.0134134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To reduce the number of unnecessary biopsies in patients with benign prostatic disease, however, without missing significant PCa the present study re-evaluates the age-dependent PSA cut-offs in the Tyrol Prostate Cancer (PCa) early detection program. Patients and Methods The study population included 2225 patients who underwent prostate biopsy due to elevated PSA levels at our department. We divided our patient collective into four age groups: ≤49 years (n = 178), 50-59 years (n = 597), 60-69 years (n = 962) and ≥70 years (n = 488). We simulated different scenarios for PSA cut-off values between 1.25 and 6 ng/mL and fPSA% between 15 and 21% for all four age groups and calculated sensitivity, specificity, confidence intervals and predictive values. Results PCa was detected in 1218 men (54.7%). We found that in combination with free PSA ≤21% the following PSA cut-offs had the best cancer specificity: 1.75 ng/ml for men ≤49 years and 50-59 years, 2.25 ng/ml for men aged 60-69 years and 3.25 ng/ml for men ≥70 years. Using these adjusted PSA cut-off values all significant tumors are recognized in all age groups, yet the number of biopsies is reduced. Overall, one biopsy is avoided in 13 to 14 men (number needed to screen = 13.3, reduction of biopsies = 7.5%) when decision regarding biopsy is done according to the “new” cut-off values instead of the “old” ones. For the different age groups the number needed to screen to avoid one biopsy varied between 9.2 (≤49 years) and 17.4 (50-59 years). Conclusion With “new”, fine-tuned PSA cut-offs we detect all relevant PCa with a significant reduction of biopsies compared to the “old” cut-off values. Optimization of age-specific PSA cut-offs is one step towards a smarter strategy in the Tyrol PCa Early Detection Program.
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Affiliation(s)
- Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria; Department of Urology, Division of Experimental Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Helmut Klocker
- Department of Urology, Division of Experimental Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
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Junker D, Herrmann TRW, Bader M, Bektic J, Henkel G, Kruck S, Sandbichler M, Schilling D, Schäfer G, Nagele U. Evaluation of the 'Prostate Interdisciplinary Communication and Mapping Algorithm for Biopsy and Pathology' (PIC-MABP). World J Urol 2015; 34:245-52. [PMID: 26129626 DOI: 10.1007/s00345-015-1627-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/20/2015] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Experience from interdisciplinary cooperation revealed the need for a prostate mapping scheme to communicate multiparametric MRI (mpMRI) findings between radiologists, urologists, and pathologists, which should be detailed, yet easy to memorize. For this purpose, the 'Prostate interdisciplinary communication and mapping algorithm for biopsy and pathology' (PIC-MABP) was developed. This study evaluated the accuracy of the PIC-MABP system. METHODS PIC-MABP was tested and validated in findings of 10 randomly selected patients from routine clinical practise with 18 histologically proven cancer lesions. Patients received an mpMRI of the prostate prior to prostatectomy. After surgery the prostates were prepared as whole-mount step sections. Cancer lesions, which were found suspicious on mpMRI, were assigned to the according PIC-MABP sectors by a radiologist. MpMRI slides were masked and sent to seven urologists from different centres, providing only the PIC-MABP location of each lesion. Urologists marked the accordant regions. Then mpMRI slides were unmasked, and the correctness of each mark was evaluated. RESULTS One hundred and seventeen of the 126 marks (93%) were correctly assigned. Detection rates differed for lesions >0.5 cc compared with lesions <0.5 cc (p < 0.005): 3/7 (43%) marks were correctly assigned in lesions <0.3 cc, 16/21 (76%) in lesions with 0.3-0.5 cc, and 98/98 (100%) in lesions >0.5 cc. Interobserver agreement was good for lesions >0.5 cc and poor for lesions <0.3 cc (Fleiss Kappa 1 vs. 0.0175). CONCLUSION PIC-MABP seems to be a reliable system to communicate the location of mpMRI findings >0.5 cc between different disciplines and can be a useful guidance for cognitive mpMRI/TRUS fusion biopsy.
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Affiliation(s)
- Daniel Junker
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Thomas R W Herrmann
- Department of Urology and Urooncology, Hanover Medical School [MHH], Carl Neuberg Str. 1, 30625, Hannover, Germany.
| | - Markus Bader
- UroClinic München Giesing, Tegernseer Landstraße 44a, 81541, Munich, Germany.
| | - Jasmin Bektic
- Department of Urology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Gregor Henkel
- Urologic Practice Dr. Gregor Henkel, Prof. Sinwel Weg 4/2, 6330, Kufstein, Austria.
| | - Stephan Kruck
- University Hospital for Urology Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Markus Sandbichler
- Urologic Practice Dr. Sandbichler, Speckbacherstraße 20, 6380, St. Johann in Tirol, Austria.
| | - David Schilling
- University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany.
| | - Georg Schäfer
- Department of Pathology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Udo Nagele
- Landeskrankenhaus Hall, Abteilung für Urologie und Andrologie, Milser Straße 10, 6060, Hall in Tirol, Austria.
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Heidegger I, Klocker H, Pichler R, Horninger W, Bektic J. PSA Isoforms' Velocities for Early Diagnosis of Prostate Cancer. Anticancer Res 2015; 35:3567-3570. [PMID: 26026127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Free prostate-specific antigen (fPSA) and its molecular isoforms are suggested for enhancement of PSA testing in prostate cancer (PCa). In the present study we evaluated whether PSA isoforms' velocities might serve as a tool to improve early PCa diagnosis. Our study population included 381 men who had undergone at least one ultrasound-guided prostate biopsy whose pathologic examination yielded PCa or showed no evidence of prostatic malignancy. Serial PSA, fPSA, and proPSA measurements were performed on serum samples covering 7 years prior to biopsy using Beckmann Coulter Access immunoassays. Afterwards, velocities of PSA (PSAV), fPSA% (fPSA%V), proPSA% (proPSA%V) and the ratio proPSA/PSA/V were calculated and their ability to discriminate cancer from benign disease was evaluated. Among 381 men included in the study, 202 (53%) were diagnosed with PCa and underwent radical prostatectomy at our Department. PSAV, fPSA%V, proPSA%V as well as proPSA/PSA/V were able to differentiate significantly between PCa and non-cancerous prostate. The highest discriminatory power between cancer and benign disease has been observed two and one year prior to diagnosis with all measured parameters. Among all measured parameters, fPSA%V showed the best cancer specificity of 45.3% with 90% of sensitivity. In summary, our results highlight the value of PSA isoforms' velocity for early detection of PCa. Especially fPSA%V should be used in the clinical setting to increase cancer detection specificity.
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Affiliation(s)
- Isabel Heidegger
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Helmut Klocker
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Renate Pichler
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
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Ceci F, Uprimny C, Nilica B, Geraldo L, Kendler D, Kroiss A, Bektic J, Horninger W, Lukas P, Decristoforo C, Castellucci P, Fanti S, Virgolini IJ. (68)Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate? Eur J Nucl Med Mol Imaging 2015; 42:1284-94. [PMID: 25975367 DOI: 10.1007/s00259-015-3078-6] [Citation(s) in RCA: 214] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/28/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the association between PSA levels, PSA kinetics and other factors and a pathological (68)Ga-PSMA PET/CT scan in patients with recurrent prostate cancer (rPCa) with biochemical relapse (BR) after radical therapy. METHODS Seventy consecutive rPCA patients referred for (68)Ga-PSMA PET/CT, matching all the following criteria, were retrospectively evaluated: (a) previous radical prostatectomy or primary radiotherapy with curative intent; (b) BR or persisting high PSA levels after primary treatment; and (c) complete clinical and imaging information. The mean ± SD PSA level was 3.5 ± 5.3 ng/mL (median 1.7, range 0.2 - 32.2 ng/mL), the mean ± SD PSA doubling time (PSAdt) was 6.5 ± 5.5 months (median 5.5, range 1.3 - 31.6 months), and the mean ± SD PSA velocity was 7.9 ± 20.5 (median 2.1, range 0.2 - 147.5 ng/mL/year). Statistical analysis was performed to assess which factors were associated with the detection of rPCa on (68)Ga-PSMA PET/CT. RESULTS (68)Ga-PSMA PET/CT was positive in 52 of 70 patients (74.2%). In 30 patients (42.8%) lesions limited to the pelvis were detected. Distant lesions were observed in 8 of patients (11.4%). Local plus systemic lesions were detected in 14 patients (20%). PSA level (p = 0.017) and PSAdt (p = 0.0001) were significantly different between PET-positive patients (higher PSA level, shorter PSAdt) and PET-negative patients (lower PSA, longer PSAdt). ROC analysis showed that PSAdt 6.5 months and PSA 0.83 ng/mL were optimal cut-off values. In multivariate analysis PSAdt was associated with (68)Ga-PSMA PET/CT positivity. (68)Ga-PSMA PET/CT was positive in 17 of 20 patients (85%) with PSA <2 ng/mL and PSAdt <6.5 months, and in 3 of 16 patients (18.7%) with PSA <2 ng/mL and PSAdt ≥6.5 months. CONCLUSION The great potential of (68)Ga-PSMA PET/CT in patients with rPCa and BR was confirmed. PSA and PSAdt were valuable predictors of pathological (68)Ga-PSMA PET/CT findings.
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Affiliation(s)
- Francesco Ceci
- Department of Nuclear Medicine, Medizinische Universität Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria,
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Heidegger I, Skradski V, Steiner E, Klocker H, Pichler R, Pircher A, Horninger W, Bektic J. High risk of under-grading and -staging in prostate cancer patients eligible for active surveillance. PLoS One 2015; 10:e0115537. [PMID: 25658878 PMCID: PMC4319730 DOI: 10.1371/journal.pone.0115537] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/25/2014] [Indexed: 11/18/2022] Open
Abstract
Background Active surveillance (AS) is increasingly offered to patients with low risk prostate cancer. The present study was conducted to evaluate the risk of tumor under-grading and -staging for AS eligibility. Moreover, we analyzed possible biomarkers for predicting more unfavorable final tumor histology. Methods 197 patients who underwent radical prostatectomy (RPE) but would have met the EAU (European Association of Urology) criteria for AS (PSA<10 ng/ml, biopsy GS ≤6, ≤2 cancer-positive biopsy cores with ≤50% of tumor in any core and clinical stage ≤T2a) were included in the study. These AS inclusion parameters were correlated to the final histology of the RPE specimens. The impact of preoperative PSA level (low PSA ≤4 ng/ml vs. intermediate PSA of >4–10 ng/ml), PSA density (<15 vs. ≥ 15 ng/ml) and the number of positive biopsy cores (1 vs. 2 positive cores) on predicting upgrading and final adverse histology of the RPE specimens was analyzed in uni- and multivariate analyses. Moreover, clinical courses of undergraded patients were assessed. Results In our patient cohort 41.1% were found under-graded in the biopsy (final histology 40.1% GS7, 1% GS8). Preoperative PSA levels, PSA density or the number of positive cores were not predictive for worse final pathological findings including GS >6, extraprostatic extension and positive resection margin (R1) or correlated significantly with up-grading and/or extraprostatic extension in a multivariate model. Only R1 resections were predictable by combining intermediate PSA levels with two positive biopsy cores (p = 0.004). Sub-analyses showed that the number of biopsy cores (10 vs. 15 biopsy cores) had no influence on above mentioned results on predicting biopsy undergrading. Clinical courses of patients showed that 19.9% of patients had a biochemical relapse after RPE, among all of them were undergraded in the initial biopsy. Conclusion In summary, this study shows that a multitude of patients fulfilling the criteria for AS are under-diagnosed. The use of preoperative PSA levels, PSA density and the number of positive cores were not predictable for undergrading in the present patient collective.
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Affiliation(s)
- Isabel Heidegger
- Medical University of Innsbruck, Department of Urology, Innsbruck, Austria
| | - Viktor Skradski
- Medical University of Innsbruck, Department of Urology, Innsbruck, Austria
| | - Eberhard Steiner
- Medical University of Innsbruck, Department of Urology, Innsbruck, Austria
| | - Helmut Klocker
- Medical University of Innsbruck, Department of Urology, Innsbruck, Austria
| | - Renate Pichler
- Medical University of Innsbruck, Department of Urology, Innsbruck, Austria
| | - Andreas Pircher
- Medical University of Innsbruck, Department of Haematology and Oncology, Innsbruck, Austria
| | - Wolfgang Horninger
- Medical University of Innsbruck, Department of Urology, Innsbruck, Austria
| | - Jasmin Bektic
- Medical University of Innsbruck, Department of Urology, Innsbruck, Austria
- * E-mail:
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Junker D, Schäfer G, Heidegger I, Bektic J, Ladurner M, Jaschke W, Aigner F. Multiparametric Magnetic Resonance Imaging/Transrectal Ultrasound Fusion Targeted Biopsy of the Prostate: Preliminary Results of a Prospective Single-Centre Study. Urol Int 2015; 94:313-8. [DOI: 10.1159/000365489] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 06/24/2014] [Indexed: 11/19/2022]
Abstract
Purpose: To evaluate multiparametric magnetic resonance imaging/transrectal ultrasound (mpMRI/TRUS) fusion targeted biopsy (TB) of the prostate for prostate cancer (PCa) diagnosis. Patients and Methods: From April 2013 to January 2014, 53 men were included in this prospective single-centre study. The degree of PCa suspicion from mpMRI findings was classified according to the PI-RADS scoring system. Of these, 50 patients underwent both an mpMRI/TRUS fusion TB and a 10-core systematic biopsy (SB) of the prostate and were eligible for analysis. Results: 225 targeted and 500 systematic cores were included in this study. PCa was histologically confirmed in 52.0% of patients (26/50), whereas TB revealed PCa in 46.0% (23/50) and SB in 36.0% (18/50). TB identified PCa in 16.0% of all patients (8/50) that were missed by SB. All told, the targeted core was 2.8 times more likely to be PCa-positive than the systematic core (29.3 vs. 10.4%). Conclusions: mpMRI/TRUS fusion TB of the prostate is safe, practicable and may improve PCa diagnosis using fewer biopsy cores compared to SB.
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Heidegger I, Pichler R, Schäfer G, Zelger B, Zelger B, Aigner F, Bektic J, Horninger W. Long-term follow up of renal anastomosing hemangioma mimicking renal angiosarcoma. Int J Urol 2014; 21:836-8. [PMID: 24650180 DOI: 10.1111/iju.12433] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/04/2014] [Indexed: 12/19/2022]
Abstract
Anastomosing hemangioma of the kidney is a very rare neoplasm, currently 19 cases have been reported in the literature. First described in 2009, histopathologically anastomosing hemangioma is similar to aggressive angiosarcoma. No long-term follow-up data of anastomosing hemangioma have been described yet. Here, we present the case of a healthy 56-year-old man diagnosed in 2002 with a 7 × 5-cm anastomosing hemangioma mimicking an aggressive renal angiosarcoma. The patient underwent nephrectomy and has been followed up disease free for 13 years.
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Affiliation(s)
- Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
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Heidegger I, Nagele U, Pircher A, Pichler R, Horninger W, Bektic J. Latent hypothyreosis as a clinical biomarker for therapy response under abiraterone acetate therapy. Anticancer Res 2014; 34:307-311. [PMID: 24403479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Abiraterone acetate (AA) is a selective oral inhibitor of Steroid-17α-Hydroxylase, for patients with castration-resistant prostate cancer. Not all patients respond to therapy, however, there are no biomarkers predicting response to AA therapy. The aim of the present study was the identification of a biomarker for patients who are likely to respond to AA therapy. PATIENTS AND METHODS We measured thyroid parameters in a collective of 30 patients before and during AA therapy. For statistical analyses, paired and unpaired t-tests were used. RESULTS During AA therapy, responders developed a significant increase in thyroid stimulating hormone (TSH) compared to non-responders (p=0.03). In the subgroup of responders, 16 out of 21 patients (76.1%) had a significant increase in TSH level (p=0.001), suggesting that TSH increase is predictive of therapy response. Non-responders showed no change in TSH level during AA therapy. CONCLUSION Hypothyreosis may serve as a simple predictive biomarker for therapy response under AA therapy.
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Affiliation(s)
- Isabel Heidegger
- Associate Professor of Urology, Department of Urology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
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Pichler R, Heidegger I, Leonhartsberger N, Stöhr B, Aigner F, Bektic J, Horninger W, Steiner H. The need for repeated urological evaluation in low-risk patients with microscopic hematuria after negative diagnostic work-up. Anticancer Res 2013; 33:5525-5530. [PMID: 24324092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To evaluate the role of repeated urological evaluation after negative initial diagnostic work-up of asymptomatic microhematuria (AMH) in low-risk patients. PATIENTS AND METHODS Criteria for patient inclusion were a complete negative initial diagnostic assessment including ultrasound (US), cystoscopy, upper urinary tract (UUT) imaging using intravenous urography (IVU) or multiphasic computed tomography (CT), absence of risk factors and a follow-up period of at least three years. Based on our institutional practice, urinalysis was repeated yearly; cystoscopy with US was repeated three years after initial work-up. The oncological outcome was evaluated across a mean follow-up of 8 (range: 3.7-10.2) years. RESULTS A case series of 87 (32.2% of 270) low-risk patients, 56 women and 31 men, with a mean age of 52.4 (range: 19-87) years was studied. Three years after initial work-up, cystoscopy confirmed no bladder carcinoma in any of these 87 patients. Prostate cancer was diagnosed in one (1.1%) patient. In five (5.6%) patients, nephrological evaluation due to concomitant proteinuria on follow-up demonstrated chronic renal insufficiency (n=3), IgA nephropathy (n=1) and papillary necrosis of the kidney (n=1). CONCLUSION Low-risk patients with persistent AMH after negative urological evaluation have a neglectable risk of developing bladder cancer on follow-up. Newly-discovered proteinuria on follow-up should be clarified by a nephrologist, as proteinuria could be a sign of significant glomerular disease.
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Affiliation(s)
- Renate Pichler
- Associate Professor of Urology, Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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Heidegger I, Massoner P, Eder IE, Pircher A, Pichler R, Aigner F, Bektic J, Horninger W, Klocker H. Novel therapeutic approaches for the treatment of castration-resistant prostate cancer. J Steroid Biochem Mol Biol 2013; 138:248-56. [PMID: 23792785 PMCID: PMC3834152 DOI: 10.1016/j.jsbmb.2013.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/28/2013] [Accepted: 06/04/2013] [Indexed: 11/10/2022]
Abstract
Prostate cancer is a leading cause of cancer death in men in developed countries. Once the tumor has achieved a castration-refractory metastatic stage, treatment options are limited with the average survival of patients ranging from two to three years only. Recently, new drugs for treatment of castration-resistant prostate cancer (CRPC) have been approved, and others are in an advanced stage of clinical testing. In this review we provide an overview of the new therapeutic agents that arrived in the clinical praxis or are tested in clinical studies and their mode of action including hormone synthesis inhibitors, new androgen receptor blockers, bone targeting and antiangiogenic agents, endothelin receptor antagonists, growth factor inhibitors, novel radiotherapeutics and taxanes, and immunotherapeutic approaches. Results and limitations from clinical studies as well as future needs for improvement of CRPC treatments are critically discussed.
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Affiliation(s)
- Isabel Heidegger
- Department of Urology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Petra Massoner
- Department of Urology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Iris E. Eder
- Department of Urology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Andreas Pircher
- Department of Hematology and Oncology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Renate Pichler
- Department of Urology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Friedrich Aigner
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Jasmin Bektic
- Department of Urology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Helmut Klocker
- Department of Urology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
- Corresponding author at: Department of Urology, Division of Experimental Urology, Anichstrasse 35, 6020 Innsbruck, Austria. Tel.: +43 512 504 24818; fax: +43 512 504 24817.
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Eder IE, Egger M, Neuwirt H, Seifarth C, Maddalo D, Desiniotis A, Schäfer G, Puhr M, Bektic J, Cato ACB, Klocker H. Enhanced inhibition of prostate tumor growth by dual targeting the androgen receptor and the regulatory subunit type iα of protein kinase a in vivo. Int J Mol Sci 2013; 14:11942-62. [PMID: 23736698 PMCID: PMC3709765 DOI: 10.3390/ijms140611942] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 05/29/2013] [Accepted: 05/29/2013] [Indexed: 12/02/2022] Open
Abstract
Progression to castration resistance is a major problem in the treatment of advanced prostate cancer and is likely to be driven by activation of several molecular pathways, including androgen receptor (AR) and cyclic AMP-dependent protein kinase A (PKA). In this study, we examined the therapeutic efficacy of a combined inhibition of the AR and the regulatory subunit type Iα (RIα) of protein kinase A with second generation antisense oligonucleotides (ODNs) in androgen-sensitive LNCaP and castration-resistant LNCaPabl tumors in vivo. We found that targeting the AR alone inhibited LNCaP, as well as LNCaPabl tumors. Combined inhibition resulted in an improved response over single targeting and even a complete tumor remission in LNCaPabl. Western blot analysis revealed that both ODNs were effective in reducing their target proteins when administered alone or in combination. In addition, treatment with the ODNs was associated with an induction of apoptosis. Our data suggest that dual targeting of the AR and PKARIα is more effective in inhibiting LNCaP and LNCaPabl tumor growth than single treatment and may give a treatment benefit, especially in castration-resistant prostate cancers.
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Affiliation(s)
- Iris E. Eder
- Division of Experimental Urology, Innsbruck Medical University, 6020 Innsbruck, Anichstraße 35, Austria; E-Mails: (M.E.); (C.S.); (A.D.); (G.S.); (M.P.); (J.B.); (H.K.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +43-512-504-24819; Fax: +43-512-504-24817
| | - Martina Egger
- Division of Experimental Urology, Innsbruck Medical University, 6020 Innsbruck, Anichstraße 35, Austria; E-Mails: (M.E.); (C.S.); (A.D.); (G.S.); (M.P.); (J.B.); (H.K.)
| | - Hannes Neuwirt
- Department of Internal Medicine IV—Nephrology and Hypertension, Innsbruck Medical University, 6020 Innsbruck, Anichstraße 35, Austria; E-Mail:
| | - Christof Seifarth
- Division of Experimental Urology, Innsbruck Medical University, 6020 Innsbruck, Anichstraße 35, Austria; E-Mails: (M.E.); (C.S.); (A.D.); (G.S.); (M.P.); (J.B.); (H.K.)
- Oncotyrol Center for Personalized Cancer Medicine GmbH, Karl-Kapferer-Straße 5, 6020 Innsbruck, Austria
| | - Danilo Maddalo
- Karlsruhe Institute of Technology, Institute of Toxicology and Genetics, Toxicology and Genetics, Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany; E-Mails: (D.M.); (A.C.B.C.)
| | - Andreas Desiniotis
- Division of Experimental Urology, Innsbruck Medical University, 6020 Innsbruck, Anichstraße 35, Austria; E-Mails: (M.E.); (C.S.); (A.D.); (G.S.); (M.P.); (J.B.); (H.K.)
| | - Georg Schäfer
- Division of Experimental Urology, Innsbruck Medical University, 6020 Innsbruck, Anichstraße 35, Austria; E-Mails: (M.E.); (C.S.); (A.D.); (G.S.); (M.P.); (J.B.); (H.K.)
| | - Martin Puhr
- Division of Experimental Urology, Innsbruck Medical University, 6020 Innsbruck, Anichstraße 35, Austria; E-Mails: (M.E.); (C.S.); (A.D.); (G.S.); (M.P.); (J.B.); (H.K.)
| | - Jasmin Bektic
- Division of Experimental Urology, Innsbruck Medical University, 6020 Innsbruck, Anichstraße 35, Austria; E-Mails: (M.E.); (C.S.); (A.D.); (G.S.); (M.P.); (J.B.); (H.K.)
| | - Andrew C. B. Cato
- Karlsruhe Institute of Technology, Institute of Toxicology and Genetics, Toxicology and Genetics, Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany; E-Mails: (D.M.); (A.C.B.C.)
| | - Helmut Klocker
- Division of Experimental Urology, Innsbruck Medical University, 6020 Innsbruck, Anichstraße 35, Austria; E-Mails: (M.E.); (C.S.); (A.D.); (G.S.); (M.P.); (J.B.); (H.K.)
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Ladurner Rennau M, Klocker H, Heidegger I, Skardski V, Schäfer G, Horninger W, Bektic J, Bektic J. 1491 IMMUNOHISTOCHEMICAL ERG STATUS IS NOT PREDICTIVE FOR BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY WITH POSITIVE SURGICAL MARGIN. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pichler R, Djedovic G, Klocker H, Heidegger I, Strasak A, Loidl W, Bektic J, Skradski V, Horninger W, Oswald J. Quantitative measurement of the androgen receptor in prepuces of boys with and without hypospadias. BJU Int 2013; 112:265-70. [DOI: 10.1111/j.1464-410x.2012.11731.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Renate Pichler
- Department of Urology and Pediatric Urology; Medical University of Innsbruck; Linz; Austria
| | - Gabriel Djedovic
- Department of Plastic, Reconstructive and Aesthetic Surgery; St. Vincent's Hospital; Linz; Austria
| | - Helmut Klocker
- Department of Urology and Pediatric Urology; Medical University of Innsbruck; Linz; Austria
| | - Isabel Heidegger
- Department of Urology and Pediatric Urology; Medical University of Innsbruck; Linz; Austria
| | - Alexander Strasak
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck; St. Vincent's Hospital; Linz; Austria
| | - Wolfgang Loidl
- Department of Urology; St. Vincent's Hospital; Linz; Austria
| | - Jasmin Bektic
- Department of Urology and Pediatric Urology; Medical University of Innsbruck; Linz; Austria
| | - Viktor Skradski
- Department of Urology and Pediatric Urology; Medical University of Innsbruck; Linz; Austria
| | - Wolfgang Horninger
- Department of Urology and Pediatric Urology; Medical University of Innsbruck; Linz; Austria
| | - Josef Oswald
- Department of Urology and Pediatric Urology; Medical University of Innsbruck; Linz; Austria
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Schaefer G, Mosquera JM, Ramoner R, Park K, Romanel A, Steiner E, Horninger W, Bektic J, Ladurner-Rennau M, Rubin MA, Demichelis F, Klocker H. Distinct ERG rearrangement prevalence in prostate cancer: higher frequency in young age and in low PSA prostate cancer. Prostate Cancer Prostatic Dis 2013; 16:132-8. [PMID: 23381693 PMCID: PMC3655380 DOI: 10.1038/pcan.2013.4] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: The TMPRSS2-ERG gene fusion resulting in ERG overexpression has been found in around 50% of prostate cancers (PCa) and is a very early event in tumorigenesis. Most studies have reported on selected surgical cohorts with inconsistent results. We hypothesized that ERG gene rearrangements impact tumor development and investigated the frequency of ERG overexpression in the context of clinicopathological tumor characteristics. Methods: ERG overexpression (ERG+ or ERG-) was determined by immunohistochemistry (IHC) in 1039 radical prostatectomy (RP) tumors and association with PSA, D'Amico risk score, histopathology, biochemical recurrence, body mass index and age of PCa cases was analyzed. Results: ERG+ was associated with younger age at diagnosis (P<0.0001), lower serum PSA (P=0.002) and lower prostate volume (PV) (P=0.001). It was most frequent in the youngest age quartile (⩽55 years, 63.9% ERG+) and decreased constantly with increasing age to 40.8% in the oldest age quartile (⩾67 years, P<0.0001). In the PSA range <4 ng ml−1 the frequency of ERG positivity was 60.2% compared with 47.5 and 49.1% in the PSA ranges 4–10 and ⩾10 ng ml−1, respectively. In the first age quartile, ERG+ patients had lower median serum PSA and fPSA% and smaller PV. In the highest age quartile tumor volume (TV) was increased. Similar differences were observed in the low PSA range. Multivariate analysis identified the first age quartile as a predictor for ERG status (odds ratios (OR) 2.05, P=0.007). No association was found with the D'Amico progression risk score and with biochemical tumor recurrence. Conclusions: ERG+ tumors manifest clinically at lower PSA levels and their prevalence is age dependent. This suggests acceleration of tumor development by ERG overexpression that results in earlier tumor detection in young patients. Long-term results are warranted to determine the impact of ERG overexpression on disease outcome.
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Affiliation(s)
- G Schaefer
- Department of Urology, Innsbruck Medical University, Innsbruck, Austria
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Junker D, Schäfer G, Aigner F, Schullian P, Pallwein-Prettner L, Bektic J, Horninger W, Halpern EJ, Frauscher F. Potentials and limitations of real-time elastography for prostate cancer detection: a whole-mount step section analysis. ScientificWorldJournal 2012; 2012:193213. [PMID: 23346015 PMCID: PMC3549343 DOI: 10.1100/2012/193213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 12/17/2012] [Indexed: 11/24/2022] Open
Abstract
Objectives. To evaluate prostate cancer (PCa) detection rates of real-time elastography (RTE) in dependence of tumor size, tumor volume, localization and histological type. Materials and Methods. Thirdy-nine patients with biopsy proven PCa underwent RTE before radical prostatectomy (RPE) to assess prostate tissue elasticity, and hard lesions were considered suspicious for PCa. After RPE, the prostates were prepared as whole-mount step sections and were compared with imaging findings for analyzing PCa detection rates. Results. RTE detected 6/62 cancer lesions with a maximum diameter of 0–5 mm (9.7%), 10/37 with a maximum diameter of 6–10 mm (27%), 24/34 with a maximum diameter of 11–20 20 mm (70.6%), 14/14 with a maximum diameter of >20 mm (100%) and 40/48 with a volume ≥0.2 cm3 (83.3%). Regarding cancer lesions with a volume ≥ 0.2 cm³ there was a significant difference in PCa detection rates between Gleason scores with predominant Gleason pattern 3 compared to those with predominant Gleason pattern 4 or 5 (75% versus 100%; P = 0.028). Conclusions. RTE is able to detect PCa of significant tumor volume and of predominant Gleason pattern 4 or 5 with high confidence, but is of limited value in the detection of small cancer lesions.
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Affiliation(s)
- Daniel Junker
- Department of Radiology, Medical University of Innsbruck, Anichstraß 35, 6020 Innsbruck, Austria
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Heidegger I, Ladurner M, Skradski V, Klocker H, Schäfer G, Horninger W, Bektic J. Adverse pathological findings in needle biopsy gleason score 6 prostate cancers with low and intermediate preoperative PSA levels following radical prostatectomy. Anticancer Res 2012; 32:5481-5485. [PMID: 23225455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM We retrospectively analyzed the risk associated with undergrading Gleason score 6 (GS6) prostate cancer (PCa) at biopsy, in patients with preoperative PSA levels of 2-3,99 and 4-10 ng/ml. PATIENTS AND METHODS A total of 674 patients with needle biopsy-diagnosed GS6 PCa, who underwent radical prostatectomy (RP) between 1995 and 2011, were evaluated. Patients were stratified by preoperative PSA levels into low PSA (2-3,99 ng/ml) and an intermediate PSA of 4-10 ng/ml. Subsequently, the percentage of patients with extracapsular disease (pathological stage ≥pT3a) and/or positive surgical margins was determined among those whose RP GS was still 6 and compared to undergraded cases. RESULTS Out of 674 patients with needle biopsy-diagnosed GS6 PCa, 36.2% had no difference between biopsy and RP GS while 11.4% had been overgraded and 52.4% of patients were undergraded at biopsy. Stratified according to preoperative PSA levels, there was a significantly higher incidence of undergrading in the intermediate PSA group. Among those with ≥pT3a tumors, 74.1 % were undergraded in needle biopsy, out of which 67.7% had intermediate PSA levels and 32.3% low PSA levels. Among patients with R1 resections 75.1 % were underdiagnosed, out of which 75.9% had intermediate PSA levels. Stratifying these data according to preoperative PSA levels, ≥pT3a tumors and R1 resection were found significantly more often in the intermediate-PSA group. CONCLUSION The incidence of adverse pathological findings, including extraprostatic extension and positive surgical margins, is significantly higher in patients with undergraded biopsy GS6. Low preoperative PSA levels improved the correlation between primary and final GS and led to the reduction of unfavorable pathological findings.
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Affiliation(s)
- Isabel Heidegger
- Associate Professor of Urology, Department of Urology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
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Skradski V, Bektic J, Ladurner-Rennau M, Horninger W. 1332 CORRELATION OF BIOPSY GLEASON SCORE AND GLEASON SCORE OF THE CORRESPONDING RADICAL PROSTATECTOMY SPECIMEN IN PATIENTS WHO MET THE INCLUSION CRITERIA FOR ACTIVE SURVEILLANCE. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sooriakumaran P, John M, Christos P, Bektic J, Bartsch G, Leung R, Herman M, Scherr D, Tewari A. Models to Predict Positive Prostate Biopsies Using the Tyrol Screening Study. Urology 2011; 78:924-9. [DOI: 10.1016/j.urology.2011.05.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 05/07/2011] [Accepted: 05/07/2011] [Indexed: 10/17/2022]
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Pichler R, Buttazzoni A, Bektic J, Schlenck B, Radmayr C, Rehder P, Oswald J. Endoscopic treatment of vesicoureteral reflux using dextranomer/hyaluronic acid copolymer in children: results of postoperative follow-up with real-time 3D sonography. Urol Int 2011; 87:192-8. [PMID: 21865656 DOI: 10.1159/000327609] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 03/18/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We evaluated whether real-time 3D ultrasound (4D-US) together with clinical evaluation is an alternative to voiding cystourethrography (VCUG) after endoscopic treatment of vesicoureteral reflux (VUR) in children at postoperative follow-up. MATERIAL AND METHODS We reviewed 178 children who underwent endoscopic therapy with dextranomer/hyaluronic acid copolymer in grade II or III VUR between 2002 and 2005. 4D-US was performed in all patients 1 day and 3, 9 and 18 months after endoscopic therapy. Only children with postoperative urinary tract infections (UTIs) and/or nonorthotopic position of the bulking agent were referred for VCUG. RESULTS In 93% of the ureteral units, the depot could be detected in the orthotopic position after 3, 9 and 18 months. None of these children developed UTIs in the postoperative follow-up. Twelve children demonstrated a shifting of the depot, indicating a possible therapy failure. Eight of these 12 patients (66.7%) presented a positive VCUG, and 50% of them sustained UTIs. CONCLUSIONS 4D-US seems to be a sufficient protocol in the follow-up of children after endoscopic treatment of low-grade VUR. VCUG should be performed in cases of a shifted position of the depot; invasive investigations are unnecessary in asymptomatic children with orthotopic bulk.
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Affiliation(s)
- Renate Pichler
- Department of Urology and Pediatric Urology, Medical University Innsbruck, Innsbruck, Austria.
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Sooriakumaran P, John M, Bektic J, Bartsch G, Herman M, Scherr D, Tewari A. Nomograms based on the Tyrol screening data of 2,271 patients to predict prostate cancer biopsy positivity. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
203 Background: There are no published nomograms that predict prostate cancer in a screened population. We describe three nomograms that predict for prostate cancer on biopsy derived from a large screening population. Methods: Patients from the Tyrol screening study of known age, total prostate-specific antigen (tPSA), digital rectal examination (DRE), prostate volume, and percent free PSA (%fPSA), and who underwent an initial prostate biopsy from January 1992 to June 2004, were included (n=2271). Multivariable logistic regression models were used to develop the biopsy positivity predictive nomograms: nomogram 1- age, DRE, tPSA; nomogram 2- age, DRE, tPSA, prostate volume; nomogram 3- age, DRE, tPSA, prostate volume, %fPSA. The predictive accuracy of the models was assessed in terms of discrimination and calibration. External validation of the nomograms was performed by comparison with a urologically referred population of patients who underwent prostate biopsy (n=599). Results: All three nomograms discriminated well between biopsy positive and biopsy negative patients for both the screening and urologically referred cohorts (nomogram 3 better than nomogram 2 better than nomogram 1). All three nomograms were well calibrated internally, but the nomograms under-predicted the probability of a positive biopsy in the urologically referred cohort. Conclusions: Our nomogram based on age, total PSA, and DRE has a good predictive ability to differentiate between screened patients that will show cancer on initial prostate biopsy and those that will not. Adding prostate volume and percent free PSA improves this predictive power further. All three nomograms under-predict prostate cancer in a urologically referred cohort. These simple nomograms may be of value in counseling screened men with raised PSA and/or abnormal DRE regarding the need for biopsy. No significant financial relationships to disclose.
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Affiliation(s)
- P. Sooriakumaran
- Weill Cornell Medical College, New York, NY; University of Innsbruck, Innsubruck, Austria; University of Southern California Institute of Urology, Los Angeles, CA
| | - M. John
- Weill Cornell Medical College, New York, NY; University of Innsbruck, Innsubruck, Austria; University of Southern California Institute of Urology, Los Angeles, CA
| | - J. Bektic
- Weill Cornell Medical College, New York, NY; University of Innsbruck, Innsubruck, Austria; University of Southern California Institute of Urology, Los Angeles, CA
| | - G. Bartsch
- Weill Cornell Medical College, New York, NY; University of Innsbruck, Innsubruck, Austria; University of Southern California Institute of Urology, Los Angeles, CA
| | - M. Herman
- Weill Cornell Medical College, New York, NY; University of Innsbruck, Innsubruck, Austria; University of Southern California Institute of Urology, Los Angeles, CA
| | - D. Scherr
- Weill Cornell Medical College, New York, NY; University of Innsbruck, Innsubruck, Austria; University of Southern California Institute of Urology, Los Angeles, CA
| | - A. Tewari
- Weill Cornell Medical College, New York, NY; University of Innsbruck, Innsubruck, Austria; University of Southern California Institute of Urology, Los Angeles, CA
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Kloss-Brandstätter A, Schäfer G, Erhart G, Hüttenhofer A, Coassin S, Seifarth C, Summerer M, Bektic J, Klocker H, Kronenberg F. Somatic mutations throughout the entire mitochondrial genome are associated with elevated PSA levels in prostate cancer patients. Am J Hum Genet 2010; 87:802-12. [PMID: 21129724 DOI: 10.1016/j.ajhg.2010.11.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 10/15/2010] [Accepted: 11/02/2010] [Indexed: 12/16/2022] Open
Abstract
The genetic etiology of prostate cancer, the most common form of male cancer in western countries, is complex and the interplay of disease genes with environmental factors is far from being understood. Studies on somatic mitochondrial DNA (mtDNA) mutations have become an important aspect of cancer research because these mutations might have functional consequences and/or might serve as biosensors for tumor detection and progression. We sequenced the entire mitochondrial genome (16,569 bp) from 30 prospectively collected pairs of macrodissected cancerous and benign cells from prostate cancer patients and compared their genetic variability. Given recent concerns regarding the authenticity of newly discovered mtDNA mutations, we implemented a high-quality procedure for mtDNA whole-genome sequencing. In addition, the mitochondrial genes MT-CO2, MT-CO3, MT-ATP6, and MT-ND6 were sequenced in further 35 paired samples from prostate cancer patients. We identified a total of 41 somatic mutations in 22 out of 30 patients: the majority of these mutations have not previously been observed in the human phylogeny. The presence of somatic mutations in transfer RNAs (tRNAs) was found to be associated with elevated PSA levels (14.25 ± 5.44 versus 7.15 ± 4.32 ng/ml; p = 0.004). The level and degree of heteroplasmy increased with increasing tumor activity. In summary, somatic mutations in the mitochondrial genome are frequent events in prostate cancer. Mutations mapping to mitochondrial tRNAs, ribosomal RNAs, and protein coding genes might impair processes that occur within the mitochondrial compartment (e.g., transcription, RNA processing, and translation) and might finally affect oxidative phosphorylation.
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Affiliation(s)
- Anita Kloss-Brandstätter
- Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Austria.
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Jansen F, van Schaik R, Kurstjens J, Horninger W, Klocker H, Bektic J, Wildhagen M, Roobol M, Bangma C, Bartsch G. 2127 P2PSA IN COMBINATION WITH TOTAL PSA AND FREE PSA IMPROVES DIAGNOSTIC ACCURACY IN PROSTATE CANCER DETECTION. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.2215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jansen FH, van Schaik RHN, Kurstjens J, Horninger W, Klocker H, Bektic J, Wildhagen MF, Roobol MJ, Bangma CH, Bartsch G. Prostate-specific antigen (PSA) isoform p2PSA in combination with total PSA and free PSA improves diagnostic accuracy in prostate cancer detection. Eur Urol 2010; 57:921-7. [PMID: 20189711 DOI: 10.1016/j.eururo.2010.02.003] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 02/03/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Novel markers for prostate cancer (PCa) detection are needed. Total prostate-specific antigen (tPSA) and percent free prostate-specific antigen (%fPSA=tPSA/fPSA) lack diagnostic specificity. OBJECTIVE To evaluate the use of prostate-specific antigen (PSA) isoforms p2PSA and benign prostatic hyperplasia-associated PSA (BPHA). DESIGN, SETTING, AND PARTICIPANTS Our study included 405 serum samples from the Rotterdam arm of the European Randomised Study of Screening for Prostate Cancer and 351 samples from the Urology Department of Innsbruck Medical University. MEASUREMENTS BPHA, tPSA, fPSA, and p2PSA levels were measured by Beckman-Coulter Access Immunoassay. In addition, the Beckman Coulter Prostate Health Index was calculated: phi=(p2PSA/fPSA)×√(tPSA). RESULTS AND LIMITATIONS The p2PSA and phi levels differed significantly between men with and without PCa. No difference in BPHA levels was observed. The highest PCa predictive value in both cohorts was achieved by phi with areas under the curve (AUCs) of 0.750 and 0.709, a significant increase compared to tPSA (AUC: 0.585 and 0.534) and %fPSA (AUC: 0.675 and 0.576). Also, %p2PSA (p2PSA/fPSA) showed significantly higher AUCs compared to tPSA and %fPSA (AUC: 0.716 and 0.695, respectively). At 95% and 90% sensitivity, the specificities of phi were 23% and 31% compared to 10% and 8% for tPSA, respectively. In both cohorts, multivariate analysis showed a significant increase in PCa predictive value after addition of p2PSA to a model consisting of tPSA and fPSA (increase in AUC from 0.675 to 0.755 and from 0.581 to 0.697, respectively). Additionally, the specificity at 95% sensitivity increased from 8% to 24% and 7% to 23%, respectively. Furthermore, %p2PSA, phi, and the model consisting of tPSA and fPSA with or without the addition of p2PSA missed the least of the tumours with a biopsy or pathologic Gleason score ≥7 at 95% and 90% sensitivity. CONCLUSIONS This study shows significant increases in PCa predictive value and specificity of phi and %p2PSA compared to tPSA and %fPSA. p2PSA has limited additional value in identifying aggressive PCa (Gleason score ≥7).
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Affiliation(s)
- Flip H Jansen
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
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Ho H, Horninger W, Steiner E, Bektic J, Schaefer G, Bartsch G. THE ABILITY OF SINGLE POSITIVE PROSTATE BIOPSY CORE TO PREDICT UNILATERAL PROSTATE CANCER: RESULT FROM TYROL SCREENING PROGRAMME. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61709-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Malinowska K, Neuwirt H, Cavarretta IT, Bektic J, Steiner H, Dietrich H, Moser PL, Fuchs D, Hobisch A, Culig Z. Interleukin-6 stimulation of growth of prostate cancer in vitro and in vivo through activation of the androgen receptor. Endocr Relat Cancer 2009; 16:155-69. [PMID: 19011039 DOI: 10.1677/erc-08-0174] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
It is hypothesized that ligand-independent activation of the androgen receptor is one of the mechanisms implicated in tumour progression. However, supportive evidence is limited to the effect of HER-2/neu that stimulates prostate cancer progression through activation of the androgen receptor. In the present study, we have asked whether the proinflammatory cytokine interleukin-6 (IL-6), which is known to stimulate androgen receptor activity and expression of its downstream target genes, may also induce growth of androgen-sensitive cells. We have found that IL-6 differentially regulates proliferation of LAPC-4 and MDA PCa 2b cells. In MDA PCa 2b cells, growth stimulation by IL-6 was reversed by administration of either the non-steroidal anti-androgen bicalutamide or the inhibitor of the mitogen-activated protein kinase pathway PD98059. Neither cell line was found to express endogenous IL-6. Interestingly, the treatment of those prostate cancer cells did not increase phosphorylation of STAT3. The effect of IL-6 on stimulation of androgen receptor activity in MDA PCa 2b cells was lower than that of androgen, comparable with findings reported by other researchers. However, growth of MDA PCa 2b xenografts in castrated animals treated with IL-6 was similar to that in non-castrated animals. In addition, bicalutamide showed an inhibitory effect on IL-6-regulated growth in vivo. Taken together, data in the present study demonstrate that IL-6 may cause growth of androgen receptor-positive tumours in vitro and in vivo through activation of the androgen receptor.
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Affiliation(s)
- Kamilla Malinowska
- Department of Urology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
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Horninger W, Pelzer AE, Bektic J, Colleselli D, Schafer G, Bartsch G. TRANSURETHRAL RESECTION OF THE PROSTATE WITH THE “COAGULATING INTERMITTENT CUTTING DEVICE”(CIC): IMPACT ON HEMOSTATIC COMPLICATIONS – AN UPDATE ON A 7 YEAR EXPERIENCE. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61967-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pinggera GM, Mitterberger M, Buttazzoni A, Bektic J, Strasser H, Dalpiaz O, Pallwein L, Aigner F, Bartsch G. MALE POST-ORGASMIC PAIN: A CHALLENGING TREATMENT ISSUE. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61263-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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