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Queissert F, Bruecher B, Schrader AJ. A New Proximal Adjustable Sling ATOMS SSP ® Implantation Technique with Focus on the Urethral Bulb: Lessons Learned from Revision Surgery. J Clin Med 2023; 12:4409. [PMID: 37445443 DOI: 10.3390/jcm12134409] [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: 06/01/2023] [Revised: 06/18/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Adjustable sling ATOMS-SSP results in ventral compression of the urethra with favorable results in the treatment of men with mild to moderate stress incontinence. However, with transobturator tunneling and mesh fixation, the surgeon has a range of options, which leads to different results and sometimes unfavorable positioning of the silicone cushion. Using retrograde urethrography (RUG), we identified ATOMS patients with considerable misplacement. We then modified the implantation technique when we performed the revision, and now present here our first experiences with this new surgical technique. METHODS Patients after ATOMS-SSP implantation at our clinic were systematically subjected to a RUG if incontinence persisted after adjustments. In case of unfavorable positioning, a revision was performed with the aim of achieving an idealized urethroproximal position of the silicone pad. During follow-up, a repeat RUG was performed, and both subjective and objective outcome parameters were recorded. RESULTS Four men met the above criteria and underwent revision with reimplantation using our new technique. All patients postoperatively experienced significantly improved continence. RUGs demonstrated an ideal ATOMS position immediately below the proximal bulbar urethra. CONCLUSIONS Our proximal implantation technique, presented here for the first time, allows optimal positioning of the ATOMS SSP, which is reflected in the objective parameters and RUG. Its use in primary implantation should also be considered and an expansion to the indication of severe stress incontinence seems possible, but this should only be done in studies.
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Affiliation(s)
- Fabian Queissert
- Clinic for Urology and Pediatric Urology, University Hospital Muenster, 48149 Münster, Germany
| | - Benedict Bruecher
- Clinic for Urology and Pediatric Urology, University Hospital Muenster, 48149 Münster, Germany
| | - Andres J Schrader
- Clinic for Urology and Pediatric Urology, University Hospital Muenster, 48149 Münster, Germany
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Queissert F, Huesch T, Kretschmer A, Kirschner-Hermanns R, Pottek T, Olianas R, Friedl A, Homberg R, Pfitzenmaier J, Naumann CM, Nyarangi-Dix J, Hofmann T, Rose A, Weidemann C, Wotzka C, Hübner W, Loertzer H, Abdunnur R, Grabbert M, Anding R, Bauer RM, Haferkamp A, Schrader AJ. Is the Standard Artificial Urinary Sphincter AMS 800 Still a Treatment Option for the Irradiated Male Patient Presenting with a Devastated Bladder Outlet? J Clin Med 2023; 12:4002. [PMID: 37373698 DOI: 10.3390/jcm12124002] [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: 02/20/2023] [Revised: 06/04/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Circular urethral compression with an artificial sphincter allows control of voiding, even in patients with severe stress urinary incontinence, but it heightens the risk of urethral atrophy and erosion. This study of one of the largest populations of patients treated with radiotherapy investigates the additive effect of the post-radiogenic stricture of the membranous urethra/bladder neck on AMS 800 artificial urinary sphincter outcomes. METHODS In a retrospective multicenter cohort study, we analyzed patients fitted with an AMS 800, comparing those who had received radiotherapy with patients presenting a devastated bladder outlet (stricture of the membranous urethra/bladder neck). We determined the correlation between these groups of patients using both univariate and stepwise adjusted multivariate regression. The revision-free interval was estimated by a Kaplan-Meier plot and compared by applying the log-rank test. A p value below 0.05 was considered statistically significant. RESULTS Of the 123 irradiated patients we identified, 62 (50.4%) had undergone at least one prior desobstruction for bladder-neck/urethra stenosis. After a mean follow-up of 21 months, the latter tended to achieve social continence less frequently (25.7% vs. 35%; p = 0.08). Revision was required significantly more often for this group (43.1% vs. 26.3%; p = 0.05) due to urethral erosion in 18 of 25 cases. A stenosis recurred in five cases; desobstruction was performed in two cases, leading to erosion in both. Multivariate analysis revealed a significantly higher risk of revision when recurrent stenosis necessitated at least two prior desobstructions (HR 2.8; p = 0.003). CONCLUSIONS A devastated bladder outlet is associated with a lower proportion of men with social continence and a significantly higher need for revision compared with irradiated patients without a history of urethral stenosis. Alternative surgical procedures should be discussed beforehand, especially in cases of recurrent urethral stenosis.
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Affiliation(s)
- Fabian Queissert
- Department of Urology and Pediatric Urology, University Hospital Münster, 48149 Münster, Germany
| | - Tanja Huesch
- Department of Urology, University Medical Center of Johannes Gutenberg University, 55131 Mainz, Germany
| | - Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians University, Campus Großhadern, 80539 Munich, Germany
| | | | - Tobias Pottek
- Department of Urology, Vivantes Hospital Am Urban, 10117 Berlin, Germany
| | - Roberto Olianas
- Department of Urology, Hospital Lüneburg, 21339 Lüneburg, Germany
| | - Alexander Friedl
- Department of Urology, Göttlicher Heiland Vienna, 1170 Vienna, Austria
| | - Roland Homberg
- Department of Urology and Pediatric Urology, St. Barbara Hospital Hamm, 59075 Hamm, Germany
| | - Jesco Pfitzenmaier
- Department of Urology, Evangelic Hospital Bethel, 42240 Bielefeld, Germany
| | - Carsten M Naumann
- Department of Urology and Pediatric Urology, St. Elisabeth Hospital, 56564 Neuwied, Germany
| | - Joanne Nyarangi-Dix
- Department of Urology and Pediatric Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Torben Hofmann
- Department of Urology, Diakonie Hospital Schwaebisch Hall, 74523 Schwaebisch Hall, Germany
| | - Achim Rose
- Department of Urology and Pediatric Urology, Helios Hospital Duisburg, 47166 Duisburg, Germany
| | - Christian Weidemann
- Department of Urology and Pediatric Urology, Catholic Hospital St. Johann Nepomuk, 99097 Erfurt, Germany
| | - Carola Wotzka
- Department of Urology, Diakonie Hospital Stuttgart, 70176 Stuttgart, Germany
| | - Wilhelm Hübner
- Department of Urology, Hospital Weinviertel Korneuburg, 2100 Korneuburg, Austria
| | - Hagen Loertzer
- Department of Urology and Pediatric Urology, Westpfalz Medical Center, 67655 Kaiserslautern, Germany
| | - Rudi Abdunnur
- Department of Urology, Helios Hospital Schwelm, 58332 Schwelm, Germany
| | - Markus Grabbert
- Department of Urology, University Hospital Freiburg, 79106 Freiburg, Germany
| | - Ralf Anding
- Department of Urology, University Hospital Basel, 4031 Basel, Switzerland
| | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians University, Campus Großhadern, 80539 Munich, Germany
| | - Axel Haferkamp
- Department of Urology, University Medical Center of Johannes Gutenberg University, 55131 Mainz, Germany
| | - Andres J Schrader
- Department of Urology and Pediatric Urology, University Hospital Münster, 48149 Münster, Germany
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Queissert F, Bruecher B, van Ophoven A, Schrader AJ. Supratrigonal cystectomy and augmentation cystoplasty with ileum or ileocecum in the treatment of ulcerative interstitial cystitis/bladder pain syndrome: a 14-year follow-up. Int Urogynecol J 2022; 33:1267-1272. [PMID: 35230481 PMCID: PMC9120102 DOI: 10.1007/s00192-022-05110-y] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/25/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study analyzes the long-term results of supratrigonal cystectomy and augmentation cystoplasty in patients with severe ulcerative interstitial cystitis/bladder pain syndrome (IC/BPS) and reduced bladder capacity. METHODS Outcome data were retrospectively and prospectively collected and analyzed in women who underwent supratrigonal cystectomy and augmentation cystoplasty for ulcerative IC/BPS at Muenster University Hospital between 1991 and 2006. We used cross-tabulation and Pearson's Chi-squared test to examine how outcome is influenced by age, preoperative functional bladder volume, and choice of augmentation material. RESULTS After a median 171-month follow-up, analysis could be done in 26 of 27 patients. Persistent pain necessitated early revision in 2 patients (7.7%). Mean postoperative O'Leary Sant IC Score was 12.7 in the prospectively questioned patients. Responses to Patient Global Impression of Improvement (PGI-I) were: "very much better" in 15 cases (65.2%) and "much better" in 7 (30.4%). Twelve patients (52.2%) emptied their augmented bladder voluntarily, whereas 7 (32%) needed intermittent self-catheterization (ISC). The rate of patients requiring ISC tended to be lower when detubularized ileocecal bowel was used. All 5 patients (19.2%) with late relapse of ulcerative IC/BPS needed ISC. CONCLUSIONS Severe ulcerative IC/BPS can be curatively treated in some patients by supratrigonal cystectomy and augmentation, which is associated with a high satisfaction rate and few long-term complications even over a very long follow-up. In our analysis, the need for ISC is a risk factor for late relapse, although ileocecal augmentation could increase the proportion of patients with sufficient voluntary micturition.
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Affiliation(s)
- Fabian Queissert
- Department of Urology and Pediatric Urology, University Hospital of Muenster, Albert Schweitzer Campus 1, 48149, Muenster, Germany.
| | - Benedict Bruecher
- Department of Urology and Pediatric Urology, University Hospital of Muenster, Albert Schweitzer Campus 1, 48149, Muenster, Germany
| | | | - Andres J Schrader
- Department of Urology and Pediatric Urology, University Hospital of Muenster, Albert Schweitzer Campus 1, 48149, Muenster, Germany
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Queissert F, Bruecher B, Ruiz S, Virseda-Chamorro M, Schrader AJ, Angulo JC. Compression or obstruction: Prospective analysis of the function of the adjustable transobturator male system (ATOMS) based on pre- and postoperative urodynamic data. Can Urol Assoc J 2021; 16:E256-E260. [PMID: 34941490 DOI: 10.5489/cuaj.7551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This analysis, based on pre- and postoperative urodynamic data, is the first to elucidate the influence of the adjustable transobturator male system (ATOMS, A.M.I. GmbH, Feldkirch, Austria) on the lower urinary tract and disclose possible obstructive properties. METHODS A prospective study was performed in patients who had stress urinary incontinence and were scheduled for ATOMS implantation after radical prostatectomy. Apart from continence assessment (24-hour pad test, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-SF]), urodynamic testing was done with International Continence Society (ICS)-standardized pressure-flow analysis before and after ATOMS implantation/adjustment. The Wilcoxon signed-rank test was used for statistical analysis. RESULTS The analysis included 12 consecutive patients from two centers (mean 69 years) with a mean followup of 246 days. Median urine leakage dropped from 240 (72-1250) to 70 (0-700) g/24 hours postoperatively, with a pad reduction of 4 to 0.9 pads/day. Pressure-flow analysis revealed a significant change only in the bladder outlet obstruction index (BOOI). The bladder contractility index, intravesical pressure conditions, and uroflowmetry were not significantly affected. None of the patients showed de novo obstruction postoperatively in the ICS analysis. CONCLUSIONS The ATOMS significantly increases the BOOI in conjunction with good continence results. However, no case reached pathological level according to the BOOI and thus there is no potential danger to the lower urinary tract or urethral integrity.
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Affiliation(s)
- Fabian Queissert
- University Hospital of Muenster, Department of Urology and Pediatric Urology, Muenster, Germany
| | - Benedict Bruecher
- University Hospital of Muenster, Department of Urology and Pediatric Urology, Muenster, Germany
| | - Sonja Ruiz
- Clinical Department, Universidad Europea de Madrid; Hospital Universitario de Getafe, Getafe, Spain
| | | | - Andres J Schrader
- University Hospital of Muenster, Department of Urology and Pediatric Urology, Muenster, Germany
| | - Javier C Angulo
- Clinical Department, Universidad Europea de Madrid; Hospital Universitario de Getafe, Getafe, Spain
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Queissert F, Hüsch T, Kretschmer A, Anding R, Kirschner-Hermanns R, Pottek T, Olianas R, Friedl A, Homberg R, Pfitzenmaier J, Naumann CM, Nyarangi-Dix J, Hofmann T, Rose A, Schweiger J, Hübner W, Loertzer H, Bauer RM, Haferkamp A, Schrader AJ. High/low-volume center experience predicts outcome of AMS 800 in male stress incontinence: Results of a large middle European multicenter case series. Neurourol Urodyn 2020; 39:1856-1861. [PMID: 32567709 DOI: 10.1002/nau.24444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/02/2020] [Accepted: 06/07/2020] [Indexed: 11/06/2022]
Abstract
AIM To analyze the influence of implantation volume of artificial sphincters (AMS 800) on outcome in a large central European multicenter cohort study. METHODS As part of the DOMINO (Debates on Male Incontinence) project, the surgical procedures and outcomes were retrospectively analyzed in a total of 473 patients who received an artificial sphincter (AMS 800) between 2010 and 2012. Clinics that implanted at least 10 AMS 800 per year were defined as high-volume centers. RESULTS Sixteen centers had a mean rate of 9.54 AMS 800/y of which five clinics were identified as high-volume centers. They implanted significantly more double cuffs (55% vs 12.1%; P < .001), used the perineal approach significantly more often (78% vs 67.7%; P = .003) and chose larger mean cuff sizes (4.63 cm vs 4.42 cm; P = .002). With a mean follow-up of 18 months, the revision rate was significantly higher at low-volume centers (38.5% vs 26.7%; P = .037), urethral erosion being the main reason for revision. Social continence (0-1 pads/24 h) was achieved significantly more often in high-volume centers (45.5% vs 24.2%; P = .002). CONCLUSIONS Our study showed significantly better continence results and lower revision rates at high-volume centers, confirming earlier results that are still true in this decade. We, therefore, recommend surgery for male incontinence at qualified centers.
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Affiliation(s)
- Fabian Queissert
- Department of Urology and Pediatric Urology, University Hospital Munster, Munster, Germany
| | - Tanja Hüsch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | | | - Ralf Anding
- Department of Urology, Pediatric Urology and Neuro-Urology, University Hospital Bonn, Bonn, Germany
| | - Ruth Kirschner-Hermanns
- Department of Urology, Pediatric Urology and Neuro-Urology, University Hospital Bonn, Bonn, Germany
| | - Tobias Pottek
- Department of Urology, Vivantes Hospital Am Urban, Berlin, Germany
| | - Roberto Olianas
- Department of Urology, Hospital Lueneburg, Lueneburg, Germany
| | - Alexander Friedl
- Department of Urology, Goettlicher Heiland Vienna, Vienna, Austria
| | - Roland Homberg
- Department of Urology and Pediatric Urology, St. Barbara Hospital Hamm, Hamm, Germany
| | | | - Carsten M Naumann
- Department of Urology and Pediatric Urology, St. Elisabeth Hospital, Neuwied, Germany
| | - Joanne Nyarangi-Dix
- Department of Urology and Pediatric Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Torben Hofmann
- Department of Urology, Diakonie Hospital Schwaebisch Hall, Schwaebisch Hall, Germany
| | - Achim Rose
- Department of Urology and Pediatric Urology, Helios Hospital Duisburg, Duisburg, Germany
| | - Josef Schweiger
- Department of Urology and Pediatric Urology, Catholic Hospital St. Johann Nepomuk, Erfurt, Germany
| | - Wilhelm Hübner
- Department of Urology, Hospital Weinviertel Korneuburg, Korneuburg, Austria
| | - Hagen Loertzer
- Department of Urology and Pediatric Urology, Westpfalz Medical Center, Kaiserslautern, Germany
| | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Andres J Schrader
- Department of Urology and Pediatric Urology, University Hospital Munster, Munster, Germany
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Bernemann C, Humberg V, Thielen B, Steinestel J, Chen X, Duensing S, Schrader AJ, Boegemann M. Comparative Analysis of AR Variant AR-V567es mRNA Detection Systems Reveals Eminent Variability and Questions the Role as a Clinical Biomarker in Prostate Cancer. Clin Cancer Res 2019; 25:3856-3864. [DOI: 10.1158/1078-0432.ccr-18-4276] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/13/2019] [Accepted: 04/11/2019] [Indexed: 11/16/2022]
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Rahbar K, Hofman MS, Schrader AJ, Bögemann M. A Self-Fulfilling Prophecy: Comparing 177Lu-PSMA Radioligand Therapy in Taxane-Naïve Versus Posttaxane Metastasized Prostate Cancer Patients? J Nucl Med 2019; 60:1494. [DOI: 10.2967/jnumed.119.228742] [Citation(s) in RCA: 1] [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] [Indexed: 11/16/2022] Open
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Polifka I, Agaimy A, Herrmann E, Spath V, Trojan L, Stöckle M, Becker F, Ströbel P, Wülfing C, Schrader AJ, Barth P, Staehler M, Stief C, Hohenfellner M, Macher-Göppinger S, Wullich B, Noldus J, Brenner W, Roos FC, Walter B, Otto W, Burger M, Höfler H, Haferkamp A, Geppert CI, Stöhr C, Hartmann A. High proliferation rate and TNM stage but not histomorphological subtype are independent prognostic markers for overall survival in papillary renal cell carcinoma. Hum Pathol 2018; 83:212-223. [PMID: 30121370 DOI: 10.1016/j.humpath.2018.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 05/18/2018] [Revised: 08/02/2018] [Accepted: 08/04/2018] [Indexed: 01/19/2023]
Abstract
Papillary renal cell carcinoma (PRCC) is currently divided in 2 subtypes. We reviewed a large cohort of PRCC and correlated subtype, morphological features and diagnostic marker expression with overall survival (OS) to uncover differences between the 2 subtypes. Three hundred seventy-six renal tumors initially diagnosed as PRCC with clinical and survival data were collected from the participating centers. Two hundred forty-six tumors were classified as PRCC1 (65.4%) and 130 as PRCC2 (34.6%) and graded according to the 2016 World Health Organization/International Society of Urological Pathology grading system. Morphological features (abundant cytoplasm, necrosis, fibrous stroma, foamy macrophages and psammoma bodies) were noted. Immunohistochemical stains (MIB1, p53, Racemase, EMA, CK7, CK20, E-Cadherin) were performed using tissue microarrays. χ2-Tests, log-rank tests and uni- and multivariate Cox regression analysis were performed. Both subtypes displayed different morphological features and immunohistochemical profiles: abundant cytoplasm was more frequent in PRCC2, while foamy macrophages were more common in PRCC1. Abundant cytoplasm and presence of psammoma bodies were associated with poorer OS. PRCC1 showed more frequent CK7 expression, PRCC2 more frequent E-Cadherin, p53 and higher MIB1 expression (>15%). Expression of Racemase and CK7 was associated with better OS, while high MIB1 (>15%) was associated with poorer OS. In multivariate analysis, the only independent predictors of OS were proliferation (MIB1), tumor stage, metastasis and age at surgery. Subtype was not an independent prognostic factor. Therefore, PRCC subtype on its own is not suitable for estimating survival. More data focusing on PRCC tumor biology is needed to define prognostic subgroups, especially in PRCC2.
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Affiliation(s)
- Iris Polifka
- Institute of Pathology, University Hospital Erlangen, Friedrich Alexander University (FAU), 91054 Erlangen, Germany.
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich Alexander University (FAU), 91054 Erlangen, Germany
| | - Edwin Herrmann
- Department of Urology, University Hospital Muenster, 48149 Muenster, Germany
| | - Verena Spath
- Institute of Pathology, University Hospital Erlangen, Friedrich Alexander University (FAU), 91054 Erlangen, Germany
| | - Lutz Trojan
- Department of Urology, University Hospital Göttingen, 37075 Göttingen, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, University of Saarland (UKS), 66421 Homburg, Germany
| | - Frank Becker
- Department of Urology and Pediatric Urology, University of Saarland (UKS), 66421 Homburg, Germany
| | - Philipp Ströbel
- Department of Pathology, University Hospital Göttingen, 37075 Göttingen, Germany
| | - Christian Wülfing
- Department of Urology, University Hospital Muenster, 48149 Muenster, Germany
| | - Andres J Schrader
- Department of Urology, University of Marburg, 35037 Marburg, Germany
| | - Peter Barth
- Department of Urology, University of Marburg, 35037 Marburg, Germany
| | - Michael Staehler
- Department of Urology, University Hospital Munich, 81337 Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital Munich, 81337 Munich, Germany
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | | | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander University (FAU), 91058 Erlangen, Germany
| | - Joachim Noldus
- Department of Urology, Marien Hospital Herne, Ruhr University Bochum, 44625 Herne, Germany
| | | | - Frederik C Roos
- Department of Urology, University Hospital Frankfurt, 60590 Frankfurt/Main, Germany
| | - Bernhard Walter
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander University (FAU), 91058 Erlangen, Germany
| | - Wolfgang Otto
- Department of Urology, University of Regensburg, 93053 Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, University of Regensburg, 93053 Regensburg, Germany
| | - Heinz Höfler
- Institute of Pathology, Technical University of Munich (TUM), 81675 Munich
| | - Axel Haferkamp
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Carol I Geppert
- Institute of Pathology, University Hospital Erlangen, Friedrich Alexander University (FAU), 91054 Erlangen, Germany
| | - Christine Stöhr
- Institute of Pathology, University Hospital Erlangen, Friedrich Alexander University (FAU), 91054 Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich Alexander University (FAU), 91054 Erlangen, Germany
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Tiedje D, Quer O, Breil B, Schrader AJ, Bothe C, Kruse K, Bögemann M, Donner-Banzhoff N, Semjonow A. [Use of the S3 guidelines for early detection of prostate cancer in urological practices]. Urologe A 2018; 56:910-916. [PMID: 28280863 DOI: 10.1007/s00120-017-0352-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The German S3 guideline on prostate cancer gives recommendations on early detection of prostate cancer. In this study we analyzed the adherence of urologists in private practice from the administrative district of Münster, Germany to this guideline. METHODS Data were collected through a semistructured survey of 22 urologists based on the COREQ checklist (Consolidated criteria for reporting qualitative research) in four focus groups consisting of five or six urologists in private practice. We developed 23 questions relating to 12 recommendations of the paragraphs of the S3 guidelines dealing with early detection of prostate cancer and prostate biopsy. The recommendations of the guideline are subdivided in nine "strong", one "optional recommendation" and two "statements". The adherence to the guideline was investigated by using frequency and qualitative content analysis (Mayring) based on a mixed methods design. RESULTS The urologists follow six of the nine "strong recommendations" of the guideline and deviate from three. Reasons for deviations from "strong recommendations" are the following: information about advantages and disadvantages of early detection for prostate cancer, recommendation of a prostate biopsy in case of PSA level ≥4 ng/ml, and indication for repeat biopsy. CONCLUSION Most of the "strong recommendations" are followed by the interviewed urologists of the administrative district of Münster. Contextually relevant deviations from "strong recommendations" are justified, e. g., the only limited transferability of the PSA threshold of 4 ng/ml derived from population-based studies of asymptomatic men to men presenting in a urologist's office.
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Affiliation(s)
- D Tiedje
- Prostatazentrum, Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland.
| | - O Quer
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Reinarzstr. 49, 47805, Krefeld, Deutschland
| | - B Breil
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Reinarzstr. 49, 47805, Krefeld, Deutschland
| | - A J Schrader
- Prostatazentrum, Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - C Bothe
- Prostatazentrum, Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - K Kruse
- Prostatazentrum, Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - M Bögemann
- Prostatazentrum, Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - N Donner-Banzhoff
- Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps-Universität Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Deutschland
| | - A Semjonow
- Prostatazentrum, Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
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Schnoeller TJ, Jentzmik F, Schrader AJ, Steinestel J. Influence of serum cholesterol level and statin treatment on prostate cancer aggressiveness. Oncotarget 2018; 8:47110-47120. [PMID: 28445145 PMCID: PMC5564548 DOI: 10.18632/oncotarget.16943] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 02/13/2017] [Accepted: 03/14/2017] [Indexed: 01/19/2023] Open
Abstract
Both cholesterol levels and the use of statins have been described to influence the development and prognosis of prostate cancer (PC). In this retrospective, cross-sectional analysis of consecutive cases from a tertiary referral center we evaluated an association between hypercholesterolemia (≥5.0mmol/l), the use of statins, and advanced/aggressive PC in 767 men with histologically confirmed, clinically localized PC awaiting radical prostatectomy. We found that patients with HCE (n=287, 37.4%) had a significantly higher incidence of poorly differentiated PC (Gleason score ≥7b, 81.1% vs. 4.9%), advanced local tumor stage (≥pT3, 57.7% vs. 22.2%), and nodal involvement (19.8% vs. 1.6%). Multivariate logistic regression analysis identified hypercholesterolemia as a risk factor for aggressive and/or advanced PC (OR 2.01, p<0.001) whereas statin intake showed an odds ratio of 0.49 (p=0.005) indicating a negative association with high-risk PC. Despite a limited number of patients using statins (~9.5%), adjusted and weighed multivariate logistic regression models revealed that preoperative hypercholesterolemia is associated with a diagnosis of high-risk PC which is negatively influenced by statin intake.
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Affiliation(s)
| | - Florian Jentzmik
- Department of Urology, Ulm University Medical Center, Ulm, Germany.,Department of Urology, St. Elisabeth Hospital, Ravensburg, Germany
| | - Andres J Schrader
- Department of Urology, Muenster University Medical Center, Muenster, Germany
| | - Julie Steinestel
- Department of Urology, Muenster University Medical Center, Muenster, Germany
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Steinestel J, Bernemann C, Schrader AJ, Lennerz JK. Re: Emmanuel S. Antonarakis, Changxue Lu, Brandon Luber, et al. Clinical Significance of Androgen Receptor Splice Variant-7 mRNA Detection in Circulating Tumor Cells of Men with Metastatic Castration-resistant Prostate Cancer Treated with First- and Second-line Abiraterone and Enzalutamide. J Clin Oncol 2017;35:2149-56: AR-V7 Testing: What's in it for the Patient? Eur Urol 2017; 72:e168-e169. [PMID: 28688614 DOI: 10.1016/j.eururo.2017.06.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 06/21/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Julie Steinestel
- Department of Urology, University Hospital Muenster, Muenster, Germany.
| | | | - Andres J Schrader
- Department of Urology, University Hospital Muenster, Muenster, Germany
| | - Jochen K Lennerz
- Department of Pathology, Center for Integrated Diagnostics, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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Bernemann C, Humberg V, Bögemann M, Schrader AJ, Steinestel J, Lennerz JK. Abstract LB-045: Cogency of AR-V7 unexpected responders determined by using distinct detection technologies. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-lb-045] [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: 11/16/2022]
Abstract
Abstract
Background: The validity of AR-V7 in CTC’s as a predictive marker for non-response to next generation ADT (abiraterone or enzalutamide) has recently been questioned. Specifically, a subset of AR-V7 positive patients showed responses to abiraterone or enzalutamide and assay performance differences could contribute to these unexpected findings. [[Unsupported Character - Codename ­]]To our knowledge a direct performance comparison has not been performed. Here we present comparative head to head analysis of different AR-V7 detection technologies with respect to specificity, accuracy and clinical sensitivity.
Methods: We performed comparison of two different AR-V7 detection technologies using either SYBR Green or TaqMan chemistry. Both assays were tested on identical in vitro samples consisting of genitourinary cancer cell lines as well as dilution series of AR-V7 positive cDNA samples. Finally, clinical samples with previously determined CTC and AR-V7 status using TaqMan chemistry were re-analyzed using SYBR Green chemistry.
Results: Both assays performed identical in detection of AR-V7 in different genitourinary cancer cell lines. Additionally, by performing dilution series analyses we observed the same diagnostic threshold of both assays. When re-analysis of clinical samples was performed, both assays performed undistinguishable in determination of the AR-V7 status of mCRPC patients, including 3 patients exhibiting unexpected response to NHT despite AR-V7 positive CTCs. Finally, loss of AR-V7 positive CTCs in serial CTC analysis of one patient during abiraterone treatment was observed using both detection assays.
Conclusion: By demonstrating nearly identical performance metrics, we excluded assay design differences as an underlying reason for the unexpected responses in a subset of AR-V7 patients. Interestingly, for the first time, we detected an AR-V7 positive mCRPC patient displaying a loss of AR-V7 positive CTCs during NHT therapy. These findings underscore that - irrespective of the method used - AR-V7 positive patients should not systematically be precluded from an otherwise safe treatment attempt.
Citation Format: Christof Bernemann, Verena Humberg, Martin Bögemann, Andres J. Schrader, Julie Steinestel, Jochen K. Lennerz. Cogency of AR-V7 unexpected responders determined by using distinct detection technologies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr LB-045. doi:10.1158/1538-7445.AM2017-LB-045
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Maertens Y, Humberg V, Steinestel J, Boegemann M, Schrader AJ, Bernemann C. Abstract 2760: Proof of principle studies for detection of circulating renal cancer cells from blood samples using diverse technologies. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2760] [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: 11/16/2022]
Abstract
Abstract
Background: During the past years, much progress has been made in detection and analysis of circulating tumor cells (CTCs) in several tumor entities, including prostate cancer, breast cancer or lung cancer. However, little is known about circulating tumor cells in patients suffering from clear cell renal cell carcinomas. The majority of technologies detecting CTCs is based on expression of epithelial markers on the surface of these cells, e.g. EpCAM. Additionally, biophysical approaches have been invented to detect CTCs based on size, invasive capacity or density. In order to be able to detect CTCs in patient samples, in vitro establishment of the most accurate isolation procedure followed by precise detection techniques has to be performed. Aim of our studies was to build a stable in vitro fundament of isolation and subsequent detection of CTCs in ccRCC patients. Methods: We made use of 4 different technologies, all of which have been approved for detection of CTCs in distinctive tumor entities. We used EpCAM based positive enrichment of CTCs, Ficoll densitiy centrifugation followed by CD45-positive cell depletion, rosette formation followed by CD45 positive cell depletion as well as size and deformability based enrichment technologies by using the Parsortix system. Furthermore, by using 4 phenotypically distinct ccRCC cell lines, we tried to detect markers unique for tumor cells in demarcation to blood cells. Results: By performing spiking experiments of renal cancer cells, we found the highest recovery rates by using the size based Parsortix system. Interestingly, the most established technique of EpCAM based isolation failed in three out of four cell lines to recover more than 40%. Expression of well-established markers for ccRCC, like carboanhydrase (CA)-9, could be detected in renal cancer cell lines. However, expression was also found in blood samples of healthy donors. Another marker used for immunohistochemical diagnosis of ccRCC, PAX8, showed weak to absent expression in established renal cancer cell lines. The highest specificity to detect renal cancer cells in blood samples was found when analyzing KRT8 or KRT 19 expression. Conclusion: Our results demonstrate that firstly, using the EpCAM based CTC enrichment, which is the basis of the CellSearch system, which up to now is the only methodology approved by the FDA, the majority of renal cancer cells will presumably not be detected in blood samples. This seems largely due to low or absent expression of EpCAM on renal cancer cells. The usage of the size based Parsortix system showed the highest recovery rates and should therefore be analyzed in more detail on samples of ccRCC patients. Secondly, an exclusive marker for defining a renal CTC is still missing. Some well-established ccRCC markers, like CA-9, failed to specifically detect renal cancer cells in blood samples, as they were either present also in healthy blood samples or absent in renal cancer cell lines.
Citation Format: Yvonne Maertens, Verena Humberg, Julie Steinestel, Martin Boegemann, Andres J. Schrader, Christof Bernemann. Proof of principle studies for detection of circulating renal cancer cells from blood samples using diverse technologies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2760. doi:10.1158/1538-7445.AM2017-2760
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Steinestel J, Bernemann C, Schrader AJ, Lennerz JK. Reply to Marcus V. Cronauer, Axel S. Merseburger, and M. Raschid Hoda's Letter to the Editor re: Christof Bernemann, Thomas J. Schnoeller, Manuel Luedeke, et al. Expression of AR-V7 in Circulating Tumour Cells Does Not Preclude Response to Next Generation Androgen Deprivation Therapy in Patients with Castration Resistant Prostate Cancer. Eur Urol 2017;71:1–3. Eur Urol 2017; 71:e107-e108. [DOI: 10.1016/j.eururo.2016.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 09/07/2016] [Indexed: 11/26/2022]
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Steinestel J, Bernemann C, Schrader AJ, Lennerz JK. Reply from Authors re: Emmanuel S. Antonarakis, Howard I. Scher. Do Patients With AR-V7–Positive Prostate Cancer Benefit from Novel Hormonal Therapies? It All Depends on Definitions. Eur Urol 2017;71:4–6. Eur Urol 2017; 71:6-7. [DOI: 10.1016/j.eururo.2016.08.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 08/31/2016] [Indexed: 11/16/2022]
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16
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Bernemann C, Schnoeller TJ, Luedeke M, Steinestel K, Boegemann M, Schrader AJ, Steinestel J. Expression of AR-V7 in Circulating Tumour Cells Does Not Preclude Response to Next Generation Androgen Deprivation Therapy in Patients with Castration Resistant Prostate Cancer. Eur Urol 2016; 71:1-3. [PMID: 27471164 DOI: 10.1016/j.eururo.2016.07.021] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [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: 06/06/2016] [Accepted: 07/14/2016] [Indexed: 12/11/2022]
Abstract
The androgen receptor splice variant AR-V7 has recently been discussed as a predictive biomarker for nonresponse to next-generation androgen deprivation therapy (ADT) in patients with castration-resistant prostate cancer. However, we recently identified one patient showing a response from abiraterone despite expression of AR-V7 in his circulating tumour cells (CTC). Therefore, we precisely assessed the response in a cohort of 21 AR-V7 positive castration-resistant prostate cancer patients who had received therapy with abiraterone or enzalutamide. We detected a subgroup of six AR-V7 positive patients showing benefit from either abiraterone or enzalutamide. Their progression free survival was 26 d (censored) to 188 d. Four patients displayed a prostate-specific antigen decrease of >50%. When analysing prior therapies, we noticed that only one of the six patients had received next-generation ADT prior to CTC collection. As a result, we conclude that AR-V7 status in CTC cannot entirely predict nonresponse to next generation ADT and AR-V7-positive patients should not be systematically denied abiraterone or enzalutamide treatment, especially as effective alternative treatment options are still limited. PATIENT SUMMARY A subgroup of patients can benefit from abiraterone and/or enzalutamide despite detection of AR-V7 splice variants in their circulating tumour cells.
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Affiliation(s)
| | | | - Manuel Luedeke
- Clinic of Urology, University Hospital Ulm, Ulm, Germany
| | - Konrad Steinestel
- Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Martin Boegemann
- Clinic of Urology, University Hospital Muenster, Muenster, Germany
| | | | - Julie Steinestel
- Clinic of Urology, University Hospital Muenster, Muenster, Germany.
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Abbas M, Steffens S, Bellut M, Eggers H, Großhennig A, Becker JU, Wegener G, Schrader AJ, Grünwald V, Ivanyi P. Intratumoral expression of programmed death ligand 1 (PD-L1) in patients with clear cell renal cell carcinoma (ccRCC). Med Oncol 2016; 33:80. [PMID: 27317388 DOI: 10.1007/s12032-016-0794-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 06/04/2016] [Accepted: 06/08/2016] [Indexed: 12/31/2022]
Abstract
The immunological checkpoints of programmed death 1 and its ligand (PD-L1) are currently in focus as novel therapeutic targets in renal cell carcinoma (RCC). The aim of this study was to evaluate the prognostic association of PD-L1 expression in clear cell (cc) RCC with clinical parameters, tumor aggressiveness and overall survival (OS). Patients who underwent renal surgery due to RCC between 1994 and 2003 were retrospectively evaluated. Tumor specimens were analyzed for PD-L1 expression by immunohistochemistry. One hundred and seventy-seven ccRCC patients were eligible for analysis, in which 140 (79.1 %) were negative and 37 (20.9 %) were positive for PD-L1 expression. PD-L1 positivity was associated with female gender (p = 0.001), lymph node metastasis (p = 0.004), distant metastasis (p = 0.002), higher AJCC stage (p = 0.004), as well as advanced disease (pT3/4 and/or N+ and/or M1) (p < 0.001). Kaplan-Meier analysis revealed a significantly diminished 5- and 10-year overall survival of 46.7 and 28.3 % for PD-L1(+) compared to PD-L1(-) tumors with 66 and 53.4 % (p = 0.005), respectively. Univariate analysis showed a significant negative association of OS with PD-L1 positivity [p = 0.005; HR: 2 (95 % CI 1.2-3.3)], even though PD-L1 positivity only tends to predict independently the OS using multivariate analyses [p = 0.066; HR: 1.6 (95 % CI 0.98-2.7)]. PD-L1 expression in ccRCC is associated with parameters of aggressiveness, as well as with poor OS, even though PD-L1 status was not identified as a significant independent prognostic parameter. However, further studies in larger cohorts are warranted.
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Affiliation(s)
- M Abbas
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - S Steffens
- Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany
| | - M Bellut
- Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany
| | - H Eggers
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - A Großhennig
- Institute for Biometrics, Hannover Medical School, Hannover, Germany
| | - J U Becker
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - G Wegener
- Tumor Center, Hannover Medical School, Hannover, Germany
| | - A J Schrader
- Department of Urology, University Hospital of Muenster, Muenster, Germany
| | - V Grünwald
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - P Ivanyi
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Abbas M, Steffens S, Bellut M, Becker JU, Großhennig A, Eggers H, Wegener G, Kuczyk MA, Kreipe HH, Grünwald V, Schrader AJ, Ivanyi P. Do programmed death 1 (PD-1) and its ligand (PD-L1) play a role in patients with non-clear cell renal cell carcinoma? Med Oncol 2016; 33:59. [PMID: 27165272 DOI: 10.1007/s12032-016-0770-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 03/20/2016] [Accepted: 04/25/2016] [Indexed: 01/17/2023]
Abstract
Clinical trials targeting programmed death 1 (PD-1) and its ligand PD-L1 (PD-L1) for metastatic renal cell cancer (RCC) are ongoing. The aim of this study is to validate their roles as prognostic markers in non-clear cell (non-cc) RCC. Sixty-four non-cc RCC tissue specimens were collected from patients undergoing renal tumor surgery. Expressions of biomarkers were assessed using immunohistochemistry and compared with clinical characteristics. Survival analyses were performed with a median follow-up of 77.5 (range: 0-176) months. No significant correlations were found for PD-1(+) tumor-infiltrating mononuclear cells (TIMC) or PD-L1(+) expression and clinical attributes in patients with non-cc RCC. Kaplan-Meier analysis revealed no differences in 5- and 10-year cancer-specific survival (CSS) for PD-1(-) TIMC compared to PD-1(+) TIMC (71.4 and 63 % versus 72.2 and 61.9 %; p = 0.88). Intratumoral expression of PD-L1 did not appear to influence the 5- and 10-year CSS significantly, even though a trend was identified (68 and 53.6 % versus 80.1 and 75.7 %; p = 0.08). In multivariate analysis, neither PD-1(+) TIMC nor intratumoral PD-L1(+) expression proved to be independent predictors of CSS (p = 0.99 and p = 0.68, respectively). Our study demonstrates that PD-1(+) TIMC and intratumoral PD-L1(+) expression did not significantly impact tumor aggressiveness or clinical outcome in non-ccRCC specimens. Due to rare incidence of non-cc RCC in particular according to PD-L1 expression, further analyzes are warranted.
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Affiliation(s)
- Mahmoud Abbas
- Institute of Pathology, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany
| | - Sandra Steffens
- Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany
| | - Maria Bellut
- Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany
| | - Jan U Becker
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Anika Großhennig
- Institute of Bimetrics, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany
| | - Hendrik Eggers
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany
| | - Gerd Wegener
- Tumor Center, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany
| | - Markus A Kuczyk
- Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany
| | - Hans H Kreipe
- Institute of Pathology, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany
| | - Viktor Grünwald
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany
| | | | - Philipp Ivanyi
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg Street 1, 30625, Hannover, Germany.
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Rahbar K, Weckesser M, Huss S, Semjonow A, Breyholz HJ, Schrader AJ, Schäfers M, Bögemann M. Correlation of Intraprostatic Tumor Extent with 68Ga-PSMA Distribution in Patients with Prostate Cancer. J Nucl Med 2016; 57:563-7. [PMID: 26769858 DOI: 10.2967/jnumed.115.169243] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/04/2015] [Indexed: 02/03/2023] Open
Affiliation(s)
- Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Matthias Weckesser
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Sebastian Huss
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Axel Semjonow
- Prostate Center, Department for Urology, University Hospital Muenster, Muenster, Germany
| | - Hans-Jörg Breyholz
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Andres J Schrader
- Prostate Center, Department for Urology, University Hospital Muenster, Muenster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany European Institute for Molecular Imaging, University of Muenster, Muenster, Germany; and Cells-in-Motion Cluster of Excellence, University of Muenster, Muenster, Germany
| | - Martin Bögemann
- Prostate Center, Department for Urology, University Hospital Muenster, Muenster, Germany
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Brasso K, Thomsen FB, Schrader AJ, Schmid SC, Lorente D, Retz M, Merseburger AS, von Klot CA, Boegemann M, de Bono J. Enzalutamide Antitumour Activity Against Metastatic Castration-resistant Prostate Cancer Previously Treated with Docetaxel and Abiraterone: A Multicentre Analysis. Eur Urol 2015; 68:317-24. [DOI: 10.1016/j.eururo.2014.07.028] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 07/21/2014] [Indexed: 12/18/2022]
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21
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Steinestel J, Luedeke M, Arndt A, Schnoeller TJ, Lennerz JK, Wurm C, Maier C, Cronauer MV, Steinestel K, Schrader AJ. Detecting predictive androgen receptor modifications in circulating prostate cancer cells. Oncotarget 2015; 10:4213-4223. [PMID: 31289619 PMCID: PMC6609250 DOI: 10.18632/oncotarget.3925] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [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: 03/20/2015] [Accepted: 04/07/2015] [Indexed: 12/12/2022] Open
Abstract
Molecular modifications of the androgen receptor (AR) can cause resistance to androgen deprivation therapy (ADT) in prostate cancer patients. Since lack of representative tumor samples hinders therapy adjustments according to emerging AR-modifications, we evaluated simultaneous detection of the two most common AR modifications (AR-V7 splice variant and AR point mutations) in circulating tumor cells (CTCs). We devised a single-tube assay to detect AR-V7 splice variants and AR point mutations in CTCs using immunomagnetic cell isolation, followed by quantitative real-time PCR and DNA pyrosequencing. We prospectively investigated 47 patients with PSA progression awaiting therapy switch. Comparison of response to newly administered therapy and CTC-AR-status allowed effect size estimation. Nineteen (51%) of 37 patients with detectable CTCs carried AR-modifications. Seventeen patients carried the AR-V7 splice variant, one harbored a p.T878A point mutation and one harbored both AR-V7 and a p.H875Y mutation. We estimated a positive predictive value for response and non-response to therapy by AR status in CTCs of ~94%. Based on a conservative calculation, we estimated the effect size for molecularly-informed therapy switches for prospective clinical trial planning to ~27%. In summary, the ability to determine key resistance-mediating AR modifications in CTCs has the potential to considerably improve prostate cancer treatment.
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Affiliation(s)
- Julie Steinestel
- Clinic of Urology, University Hospital Ulm, Ulm, Germany.,Clinic of Urology, University Hospital Muenster, Muenster, Germany
| | - Manuel Luedeke
- Clinic of Urology, University Hospital Ulm, Ulm, Germany
| | - Annette Arndt
- Institute of Pathology and Molecular Pathology, Bundeswehrkrankenhaus Ulm, Ulm, Germany
| | | | - Jochen K Lennerz
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Carina Wurm
- Clinic of Urology, University Hospital Ulm, Ulm, Germany
| | | | | | - Konrad Steinestel
- Gerhard-Domagk Institute of Pathology, University of Muenster, Muenster, Germany
| | - Andres J Schrader
- Clinic of Urology, University Hospital Ulm, Ulm, Germany.,Clinic of Urology, University Hospital Muenster, Muenster, Germany
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Steinestel J, Al Ghazal A, Arndt A, Schnoeller TJ, Schrader AJ, Moeller P, Steinestel K. The role of histologic subtype, p16(INK4a) expression, and presence of human papillomavirus DNA in penile squamous cell carcinoma. BMC Cancer 2015; 15:220. [PMID: 25885064 PMCID: PMC4392470 DOI: 10.1186/s12885-015-1268-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 10/05/2014] [Accepted: 03/25/2015] [Indexed: 12/22/2022] Open
Abstract
Background Up to 50% of penile squamous cell carcinomas (pSCC) develop in the context of high-risk human papillomavirus (HR-HPV) infection. Most of these tumours have been reported to show basaloid differentiation and overexpression of tumour suppressor protein p16INK4a. Whether HPV-triggered carcinogenesis in pSCC has an impact on tumour aggressiveness, however, is still subject to research. Methods In tissue specimens from 58 patients with surgically treated pSCC between 1995 and 2012, we performed p16INK4a immunohistochemistry and DNA extraction followed by HPV subtyping using a PCR-based approach. The results were correlated with histopathological and clinical parameters. Results 90.4% of tumours were of conventional (keratinizing) subtype. HR-HPV DNA was detected in 29.3%, and a variety of p16INK4a staining patterns was observed in 58.6% of samples regardless of histologic subtype. Sensitivity of basaloid subtype to predict HR-HPV positivity was poor (11.8%). In contrast, sensitivity and specificity of p16INK4a staining to predict presence of HR-HPV DNA was 100% and 57%, respectively. By focussing on those samples with intense nuclear staining pattern for p16INK4a, specificity could be improved to 83%. Both expression of p16INK4a and presence of HR-HPV DNA, but not histologic grade, were inversely associated with pSCC tumour invasion (p = 0.01, p = 0.03, and p = 0.71). However, none of these correlated with nodal involvement or distant metastasis. In contrast to pathological tumour stage, the HR-HPV status, histologic grade, and p16INK4a positivity failed to predict cancer-specific survival. Conclusions Our results confirm intense nuclear positivity for p16INK4a, rather than histologic subtype, as a good predictor for presence of HR-HPV DNA in pSCC. HR-HPV / p16INK4a positivity, independent of histological tumour grade, indicates a less aggressive local behaviour; however, its value as an independent prognostic indicator remains to be determined. Since local invasion can be judged without p16INK4a/HPV-detection on microscopic evaluation, our study argues against routine testing in the setting of pSCC.
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Affiliation(s)
- Julie Steinestel
- Department of Urology, Muenster University Medical Center, Albert-Schweitzer-Campus 1, A1, 48149, Muenster, Germany.
| | - Andreas Al Ghazal
- Department of Urology, University of Ulm, Prittwitzstrasse 43, 89075, Ulm, Germany.
| | - Annette Arndt
- Institute of Pathology and Molecular Pathology, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.
| | - Thomas J Schnoeller
- Department of Urology, University of Ulm, Prittwitzstrasse 43, 89075, Ulm, Germany.
| | - Andres J Schrader
- Department of Urology, Muenster University Medical Center, Albert-Schweitzer-Campus 1, A1, 48149, Muenster, Germany.
| | - Peter Moeller
- Institute of Pathology, University of Ulm, Albert-Einstein-Allee 23, 89070, Ulm, Germany.
| | - Konrad Steinestel
- Gerhard Domagk Institute of Pathology, University of Muenster, Domagkstrasse 17, 48149, Muenster, Germany.
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Schnoeller TJ, Schrader AJ, Jentzmik F, Steinestel J. MP56-13 ADIPOSIS IS AN INDEPENDENT RISK-FACTOR FOR DEVELOPING HIGH-RISK PROSTATE CANCER - A PROSPECTIVE STUDY. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2077] [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: 11/29/2022]
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Steffens S, Janssen M, Roos FC, Becker F, Steinestel J, Abbas M, Steinestel K, Wegener G, Siemer S, Thüroff JW, Hofmann R, Stöckle M, Schrader M, Hartmann A, Hasenfus A, Kuczyk MA, Junker K, Schrader AJ. The Fuhrman grading system has no prognostic value in patients with nonsarcomatoid chromophobe renal cell carcinoma. Hum Pathol 2014; 45:2411-6. [DOI: 10.1016/j.humpath.2014.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/01/2014] [Accepted: 08/05/2014] [Indexed: 10/24/2022]
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Steffens S, Roos FC, Janssen M, Becker F, Steinestel J, Abbas M, Steinestel K, Wegener G, Siemer S, Thüroff JW, Hofmann R, Stöckle M, Schrader M, Hartmann A, Junker K, Kuczyk MA, Schrader AJ. Clinical behavior of chromophobe renal cell carcinoma is less aggressive than that of clear cell renal cell carcinoma, independent of Fuhrman grade or tumor size. Virchows Arch 2014; 465:439-44. [PMID: 25178561 DOI: 10.1007/s00428-014-1648-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 06/25/2014] [Revised: 08/05/2014] [Accepted: 08/18/2014] [Indexed: 11/26/2022]
Abstract
Chromophobe renal cell carcinoma (chRCC) is the third most common subtype of RCC, after clear cell (ccRCC) and papillary RCC. Its lower incidence and frequent exclusion from clinical trials might be why chRCC characteristics have not been extensively studied. The aim of our study was to examine tumor characteristics and long-term prognosis of chRCC compared to ccRCC. We collected 4,210 evaluable patients subjected to surgery for chRCC (n = 176) or ccRCC (n = 4,034) at five centers in Germany (University Hospitals of Hannover, Homburg/Saar, Mainz, Ulm, and Marburg) between 1990 and 2010. Patients with chRCC were significantly younger (mean, 60.1 vs. 62.1 years) and tended to be more frequently female (43.8 vs. 36.5 %). Although Fuhrman grade and median tumor diameter were not significantly different, significantly fewer patients with chRCC than with ccRCC presented with high tumor stage or metastasis at diagnosis (18.5 vs. 43.8 %). Moreover, significantly more chRCC patients were treated with partial nephrectomy (41.5 vs. 26.2 %). Accordingly, 5-year cancer-specific survival (CSS) rates were 83.2 % for chRCC against 75.8 % for ccRCC patients (p = 0.014, log rank). However, in multivariate analysis, chromophobe subtype was not confirmed as a significant positive prognostic factor for RCC (HR 0.88, 95 % CI 0.63-1.24; p = 0.48 Cox regression). This is one of the largest studies to date showing that chRCC is associated with a significantly lower risk of locally invasive tumor growth and metastatic disease than ccRCC. We conclude that the clinical behavior of chRCC is less aggressive than that of ccRCC, independent of Fuhrman grade or tumor size.
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Affiliation(s)
- Sandra Steffens
- Department of Urology and Urological Oncology, Hannover University Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany,
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Breunig C, Schrader M, Schrader AJ, Zengerling F. [Organ-sparing therapy for testicular cancer]. Urologe A 2014; 53:1302-9. [PMID: 25142787 DOI: 10.1007/s00120-014-3556-7] [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: 11/29/2022]
Abstract
BACKGROUND The therapy of malignant testicular neoplasms has always been characterized by a high degree of radicality. Thanks to a number of medical achievements the cure rate of testicular cancer has notably increased through the last decades. In the meanwhile the main focus is on reducing therapy load, scrutinizing radical orchiectomy as the only adequate therapy for the primary tumour. OBJECTIVES This article discusses the question, if and under which conditions an organ-sparing approach can be used appropriately in clinical practice. MATERIALS AND METHODS A selective literature search was performed in PubMed. RESULTS A set of data suggest that endocrine and exocrine function of the testis can be preserved using an organ-sparing approach and many patients could benefit regarding their quality of life, e.g., preserving the ability to father a child at least temporarily and avoiding the need for hormone substitution. Different from kidney tumors, precancerous lesions (testicular intraepithelia neoplasia, TIN) can almost inevitably be found in the surrounding tissue of testicular tumors. This has to be considered when making a decision in favor of an organ-sparing approach, because radiation therapy on the affected testis has to be performed after tumor resection. Despite the absence of prospective data, organ-sparing surgical tumor resection can be recommended in carefully selected patients. CONCLUSION After careful selection of patients, particularly young men can profit from an organ-sparing therapy regimen. Therefore, organ preservation should always be considered in the surgical treatment of testicular masses.
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Affiliation(s)
- C Breunig
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland
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Al Ghazal A, Schnoeller TJ, Baechle C, Steinestel J, Jentzmik F, Steffens S, Hirning C, Schrader M, Schrader AJ. Capsulotomy for treatment of compartment syndrome in patients with post extracorporeal shock wave lithotripsy renal hematomas: safe and effective, but also advisable? Urol J 2014; 11:1569-1574. [PMID: 25015600] [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] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 12/21/2013] [Indexed: 06/03/2023]
Abstract
PURPOSE To examine whether surgical decompression of hematomas by capsulotomy can help to improve long-term renal function following extracorporeal shock wave lithotripsy (SWL). MATERIALS AND METHODS This study retrospectively identified 7 patients who underwent capsulotomy for post SWL renal hematomas between 2008 and 2012. The control group comprised 8 conservatively treated patients. The median follow-up time was 22 months. RESULTS The two groups were comparable in age, gender, body mass index, risk factors for developing hematomas (renal failure, urinary flow impairment, indwelling ureteral stent and diabetes mellitus) and the selected SWL modalities. Hematoma size was also similar. However, significantly more patients in the surgical group had purely intracapsular hematomas (85.7% vs. 37.5%) without a potentially pressure-relieving capsular rupture. There were no significant differences in the post-interventional drop in hemoglobin, rise in retention parameters or drop in glomerular filtration rate (GFR). No capsulotomy-related complications were observed, but surgery required a significantly longer hospital stay than conservative management (median, 9 days vs. 5 days). The two groups also showed comparable recovery of renal function at long-term follow-up (median change in GFR from baseline, 97.1% and 97.8%, respectively). CONCLUSION Since renal function did not differ between the two treatment groups, the conservative management remains the standard treatment for post-SWL renal hematoma.
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Affiliation(s)
- Andreas Al Ghazal
- Department of Urology, Ulm University Medical Center, Prittwitzstrasse43,D89075Ulm,Germany
| | - Thomas J Schnoeller
- Department of Urology, Ulm University Medical Center, Prittwitzstrasse43,D89075Ulm,Germany
| | - Christian Baechle
- Department of Urology, Ulm University Medical Center, Prittwitzstrasse43,D89075Ulm,Germany
| | - Julie Steinestel
- Department of Urology, Ulm University Medical Center, Prittwitzstrasse43,D89075Ulm,Germany
| | - Florian Jentzmik
- Department of Urology, Ulm University Medical Center, Prittwitzstrasse43,D89075Ulm,Germany
| | | | - Christian Hirning
- Department of Urology, Ulm University Medical Center, Prittwitzstrasse43,D89075Ulm,Germany
| | - Mark Schrader
- Department of Urology, Ulm University Medical Center, Prittwitzstrasse43,D89075Ulm,Germany
| | - Andres J Schrader
- Department of Urology, Ulm University Medical Center, Prittwitzstrasse43,D89075Ulm,Germany
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Jentzmik F, Schnoeller TJ, Cronauer MV, Steinestel J, Steffens S, Zengerling F, Al Ghazal A, Schrader MG, Steinestel K, Schrader AJ. Corpulence is the crucial factor: association of testosterone and/or obesity with prostate cancer stage. Int J Urol 2014; 21:980-6. [PMID: 24865433 DOI: 10.1111/iju.12494] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 04/13/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate whether low testosterone levels or obesity, or both, are directly associated with tumor stage/grade in patients with clinically localized prostate cancer. METHODS Preoperative androgen serum levels (total and free testosterone), sex hormone-binding globulin, body mass index and waist circumference were assessed in 510 consecutive European Caucasian men treated with radical prostatectomy. Hormone levels and body mass index/waist circumference were correlated with patient- and tumor-specific characteristics using multivariable logistic regression analysis. RESULTS Even though we confirmed an inverse correlation between bodyweight and testosterone levels, only overweight - but not low testosterone - was associated with advanced disease and poor differentiation of prostate cancer. Using multivariate analyses, both body mass index ≥30 kg/m(2) and waist circumference >110 cm were associated with high-grade disease (Gleason score ≥8). A waist circumference >110 cm also correlated significantly with lymph node metastasis. CONCLUSIONS This is the first study showing that obesity, but not low serum testosterone levels, is significantly associated with high grade and metastatic disease in men diagnosed with clinically localized prostate cancer. The present findings suggest that low androgen levels at diagnosis, which used to be held responsible for the development of aggressive prostate cancer, is only an epiphenomenon of obesity rather than the cause of prostate cancer development and/or progression.
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Roos FC, Steffens S, Junker K, Janssen M, Becker F, Wegener G, Brenner W, Steinestel J, Schnoeller TJ, Schrader M, Hofmann R, Thüroff JW, Kuczyk MA, Wunderlich H, Siemer S, Hartmann A, Stöckle M, Schrader AJ. Survival advantage of partial over radical nephrectomy in patients presenting with localized renal cell carcinoma. BMC Cancer 2014; 14:372. [PMID: 24885955 PMCID: PMC4038042 DOI: 10.1186/1471-2407-14-372] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 01/14/2014] [Accepted: 05/16/2014] [Indexed: 01/11/2023] Open
Abstract
Background Partial nephrectomy (PN) preserves renal function and has become the standard approach for T1a renal cell carcinoma (RCC). However, there is still an ongoing debate as to which patients will actually derive greater benefit from partial than from radical nephrectomy (RN). The aim of this study was to retrospectively evaluate the impact of the type of surgery on overall survival (OS) in patients with localized RCC. Methods Renal surgery was performed in 4326 patients with localized RCC (pT ≤ 3a N/M0) at six German tertiary care centers from 1980 to 2010: RN in 2955 cases (68.3%), elective (ePN) in 1108 (25.6%), and imperative partial nephrectomy (iPN) in 263 (6.1%) cases. The median follow-up for all patients was 63 months. Kaplan-Meier and Cox regression analyses were carried out to identify prognosticators for OS. Results PN was performed significantly more often than RN in patients presenting with lower tumor stages, higher RCC differentiation, and non-clear cell histology. Accordingly, the calculated 5 (10)-year OS rates were 90.0 (74.6)% for ePN, 83.9 (57.5)% for iPN, and 81.2 (64.7)% for RN (p < 0.001). However, multivariate analysis including age, sex, tumor diameter and differentiation, histological subtype, and the year of surgery showed that ePN compared to RN still qualified as an independent factor for improved OS (HR 0.79, 95% CI 0.66-0.94, p = 0.008). Conclusion Even allowing for the weaknesses of this retrospective analysis, our multicenter study indicates that in patients with localized RCC, PN appears to be associated with better OS than RN irrespective of age or tumor size.
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Affiliation(s)
| | - Sandra Steffens
- Department of Urology and Urological Oncology, Medical School Hannover, Hannover D-30625, Germany.
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Schrader AJ, Schrader MG, Cronauer MV. Words of wisdom. Re: androgen receptor splice variants mediate enzalutamide resistance in castration-resistant prostate cancer cell lines. Eur Urol 2014; 64:169-70. [PMID: 23746320 DOI: 10.1016/j.eururo.2013.04.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cronauer MV, Schrader MG, Schrader AJ. Re: J. Alfred Witjes. A Case of Abiraterone Acetate Withdrawal. Eur Urol 2013;64:517–8. Eur Urol 2014; 65:e10-1. [DOI: 10.1016/j.eururo.2013.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
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Mueller J, Schrader AJ, Schrader M, Schnoeller T, Jentzmik F. Management of muscle-invasive bladder cancer. MINERVA UROL NEFROL 2013; 65:235-248. [PMID: 24091477] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The incidence of muscle-invasive bladder cancer (MIBC) is increasing. Many different and multimodal novel treatment options were brought on the way since the beginning of a new era in the early 1980s, when the neobladder as a common option for urinary diversion had been induced. In addition to open radical cystectomy and urinary diversion, recently, minimal invasive surgery has been implemented in experienced centers and led to promising results in short term follow-up, awaiting confirmation in larger cohorts. Pelvic lymphnode dissection can cure patients with low metastatic load. Expansion of pelvic lymphonodal dissection and its influence on survival was discussed intensively with trends to a moderate enlargement of the standard field. Outcome in nodal positive disease is remaining poor, while 90% of patients with multiple lymphnode metastases will suffer from systemic progress 5 years after diagnosis. In the last decade, treatment regimens based on neoajuvant or adjuvant chemotherapy were published with different results on efficiency. To decide whether to treat with surgery alone, or to offer perioperative systemic cytostatic therapy, is one of the unanswered questions. Furthermore, bladder preserving techniques are still optional for patients with small unifocal lesions or the medically unfit cohort. This review summarizes current data and aims to help guiding through several available recommendations on therapy and management of MIBC.
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Affiliation(s)
- J Mueller
- Department of Urology University Hospital Ulm, Ulm, Germany -
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Schrader AJ, Schrader MG, Cronauer MV. Re: Christoph A. Von Klot, Markus A. Kuczyk, Axel S. Merseburger. No androgen withdrawal syndrome for enzalutamide: a report of disease dynamics in the postchemotherapy setting. Eur Urol 2014;65:258-9: Enzalutamide withdrawal syndrome: fact or fiction? Eur Urol 2013; 65:e22-3. [PMID: 24210913 DOI: 10.1016/j.eururo.2013.10.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 10/22/2013] [Indexed: 11/17/2022]
Affiliation(s)
| | - Mark G Schrader
- Department of Urology, Ulm University Medical Center, Ulm, Germany
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Al Ghazal A, Steffens S, Steinestel J, Lehmann R, Schnoeller TJ, Schulte-Hostede A, Wegener G, Jentzmik F, Schrader M, Kuczyk MA, Schrader AJ. Elevated C-reactive protein values predict nodal metastasis in patients with penile cancer. BMC Urol 2013; 13:53. [PMID: 24148787 PMCID: PMC4016472 DOI: 10.1186/1471-2490-13-53] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 10/15/2013] [Indexed: 11/26/2022] Open
Abstract
Background The nodal status is a strong predictor for cancer specific death in patients with penile carcinoma, and the C-reactive protein (CRP) level at diagnosis has recently been shown to be associated with poor clinical outcome in various solid malignancies. Therefore, this retrospective study was performed to evaluate the association between preoperative CRP levels and the incidence of nodal metastasis in patients with squamous cell carcinoma (SCC) of the penis. Methods The analysis included 51 penile cancer patients who underwent either radical or partial penectomy for pT1-4 penile cancer between 1990 and 2010. The nodal status was correlated with patient and tumor specific characteristics. Results Sixteen (31%) patients had lymph node metastasis at the time of penile cancer surgery. Nodal status was associated with tumor stage but did not correlate significantly with tumor grade. In contrast, high presurgical CRP levels were significantly associated with the diagnosis of nodal involvement (p = 0.04). The optimal CRP cut-off value to predict lymph node metastasis was set at 20 mg/l based on ROC analysis. Conclusions Since a high preoperative serum CRP level was closely correlated with nodal disease, it could be used as an additional marker to help identify patients with penile cancer who may benefit from inguinal lymph node dissection.
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Affiliation(s)
| | - Sandra Steffens
- Department of Urology, Hannover Medical School, Carl-Neuberg-Str, 1, D-30625 Hannover, Germany.
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Abstract
BACKGROUND The national second opinion project of the German Testicular Cancer Study Group (GTCSG) has served to improve the quality of care provided to testicular cancer patients since 2006. AIM A recent online survey was carried out to characterize the users of the second opinion offer and clarify their motivation for participating in the project. Furthermore, the aim was to identify weaknesses of the project which could be improved. A total of 440 users of the second opinion project were contacted of whom 192 participated in the survey. RESULTS In summary, the data collected showed a high degree of satisfaction among the participants who appreciated the second opinions received. Some issues with a need for improvement, predominantly in the structural organisational area, were disclosed. These served as a basis for a recently completed revision of the project immanent internet-based communication platform with a new data mask facilitating the introduction of patients with relapsed tumors. Interestingly, a high proportion of survey participants expressed the desire for establishment of a similar second opinion project for patients with penile cancer (77.1% of the participants).
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Steinestel J, Cronauer MV, Müller J, Al Ghazal A, Skowronek P, Arndt A, Kraft K, Schrader M, Schrader AJ, Steinestel K. Overexpression of p16(INK4a) in urothelial carcinoma in situ is a marker for MAPK-mediated epithelial-mesenchymal transition but is not related to human papillomavirus infection. PLoS One 2013; 8:e65189. [PMID: 23724131 PMCID: PMC3665800 DOI: 10.1371/journal.pone.0065189] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [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: 01/21/2013] [Accepted: 04/22/2013] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The role of human papillomavirus (HPV) in bladder carcinogenesis remains controversial. Overexpression of p16(INK4a), a surrogate marker for infection with oncogenic HPV in other tumours, has been described for urothelial carcinoma in situ (UCIS). Our goal was therefore to evaluate whether overexpression of p16(INK4a) is associated with HPV infection and to identify mechanisms of p16(INK4a) upregulation in UCIS. MATERIALS AND METHODS In 60 tissue specimens from a total of 45 patients (UCIS and controls), we performed p16(INK4a) immunohistochemistry followed by detection and subclassification of HPV DNA. In a subset of samples, we tested for gene amplification of p16(INK4a) applying fluorescence in situ hybridization (FISH). RAS/MAPK signalling and epithelial-mesenchymal transition (EMT) was assessed using immunohistochemistry. Finally, we transfected urothelial carcinoma cells with KRAS and examined the expression of p16(INK4a) as well as markers of EMT. RESULTS We found overexpression of p16(INK4a) in 92.6% of UCIS and in all cervical intraepithelial neoplasia (CIN) controls. In contrast, we detected high-risk HPV DNA in 80% of CIN, but none in UCIS. There was no gene amplification of p16(INK4a). High levels of phosphorylated kinases and urokinase plasminogen activator (uPA) and loss of membraneous E-cadherin were detected in UCIS. KRAS transfection of urothelial carcinoma cells led to upregulation of p16(INK4a) and uPA accompanied by loss of E-cadherin that could be inhibited by application of the kinase-inhibitor Sorafenib. CONCLUSIONS Our results show that overexpression of p16(INK4a) in UCIS is neither associated with HPV infection nor p16(INK4a) gene amplification but is a consequence of enhanced RAS/MAPK signalling that promotes EMT, possibly due to Sorafenib-sensitive paracrine secretion of the EMT activator uPA. These findings might open a novel therapeutic option for localized but aggressive urothelial cancer.
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Affiliation(s)
| | | | | | | | - Peter Skowronek
- Gemeinschaftspraxis for Pathology Augsburg, Augsburg, Germany
| | - Annette Arndt
- Institute of Pathology and Molecular Pathology, Bundeswehrkrankenhaus Ulm, Ulm, Germany
| | - Klaus Kraft
- Institute of Pathology and Molecular Pathology, Bundeswehrkrankenhaus Ulm, Ulm, Germany
| | - Mark Schrader
- Department of Urology, University of Ulm, Ulm, Germany
| | | | - Konrad Steinestel
- Bundeswehr Institute of Radiobiology, Munich, Germany
- Institute of Pathology, University of Ulm, Ulm, Germany
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Steffens S, Al Ghazal A, Steinestel J, Lehmann R, Wegener G, Schnoeller TJ, Cronauer MV, Jentzmik F, Schrader M, Kuczyk MA, Schrader AJ. High CRP values predict poor survival in patients with penile cancer. BMC Cancer 2013; 13:223. [PMID: 23642165 PMCID: PMC3649950 DOI: 10.1186/1471-2407-13-223] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 04/25/2013] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND High levels of circulating C-reactive protein (CRP) have recently been linked to poor clinical outcome in various malignancies. The aim of this study was to evaluate the prognostic significance of the preoperative serum CRP level in patients with squamous cell carcinoma (SCC) of the penis. METHODS This retrospective analysis included 79 penile cancer patients with information about their serum CRP value prior to surgery who underwent either radical or partial penectomy at two German high-volume centers (Ulm University Medical Center and Hannover Medical School) between 1990 and 2010. They had a median (mean) follow-up of 23 (32) months. RESULTS A significantly elevated CRP level (>15 vs. ≤ 15 mg/l) was found more often in patients with an advanced tumor stage (≥pT2) (38.9 vs. 11.6%, p=0.007) and in those with nodal disease at diagnosis (50.0 vs. 14.6%, p=0.007). However, high CRP levels were not associated with tumor differentiation (p=0.53). The Kaplan-Meier 5-year cancer-specific survival (CSS) rate was 38.9% for patients with preoperative CRP levels above 15 mg/l and 84.3% for those with lower levels (p=0.001). Applying multivariate analysis and focusing on the subgroup of patients without metastasis at the time of penile surgery, both advanced local tumor stage (≥pT2; HR 8.8, p=0.041) and an elevated CRP value (>15 mg/l; HR 3.3, p=0.043) were identified as independent predictors of poor clinical outcome in patients with penile cancer. CONCLUSIONS A high preoperative serum CRP level was associated with poor survival in patients with penile cancer. If larger patient populations confirm its prognostic value, its routine use could enable better risk stratification and risk-adjusted follow-up of patients with SCC of the penis.
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Affiliation(s)
- Sandra Steffens
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Andreas Al Ghazal
- Department of Urology, Ulm University Medical Center, Pritzwitzstrasse 43, Ulm, D-89075, Germany
| | - Julie Steinestel
- Department of Urology, Ulm University Medical Center, Pritzwitzstrasse 43, Ulm, D-89075, Germany
| | - Rieke Lehmann
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Gerd Wegener
- Cancer Center, Hannover Medical School, Hannover, Germany
| | - Thomas J Schnoeller
- Department of Urology, Ulm University Medical Center, Pritzwitzstrasse 43, Ulm, D-89075, Germany
| | - Marcus V Cronauer
- Department of Urology, Ulm University Medical Center, Pritzwitzstrasse 43, Ulm, D-89075, Germany
| | - Florian Jentzmik
- Department of Urology, Ulm University Medical Center, Pritzwitzstrasse 43, Ulm, D-89075, Germany
| | - Mark Schrader
- Department of Urology, Ulm University Medical Center, Pritzwitzstrasse 43, Ulm, D-89075, Germany
| | - Markus A Kuczyk
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Andres J Schrader
- Department of Urology, Ulm University Medical Center, Pritzwitzstrasse 43, Ulm, D-89075, Germany
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Abstract
Male sexuality in the elderly is an important issue with a growing relevance. In contrast to the assumption of an asexual state when becoming older, recent representative surveys show that the majority of men maintain sexual desires and fantasies into old age. Sexual activity primarily depends on the availability of a partner and on maintaining intimacy and sexuality in the face of changes in the sexual response cycle and increasing comorbidity. This review aims to clarify the normal aging process, the sexual behavior of aging males and the prevalence of sexual dysfunction.
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Affiliation(s)
- L Rinnab
- Schwerpunkt Medikamentöse Tumortherapie & Andrologie, Praxis für Urologie und Männermedizin Neu-Ulm, Augsburgerstraße 1a, 89231 Neu-Ulm, Deutschland.
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Schnoeller TJ, de Petriconi R, Hefty R, Jentzmik F, Al Ghazal A, Steinestel J, Mueller J, Zengerling F, Schrader M, Schrader AJ. [The use of Surgisis® optimizes and simplifies partial nephrectomy for large renal tumors]. Urologe A 2012. [PMID: 23178845 DOI: 10.1007/s00120-012-3050-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND With lower rates of postoperative renal failure, diabetes and cardiovascular disease, partial nephrectomy achieves longer overall survival and equally long tumor-specific survival. It is thus the current gold standard treatment for renal tumors and now also for those ≥ 4 cm in size. The main complications of nephron-sparing surgery, particularly for large and centrally located tumors, are postoperative parenchymal bleeding and urinary fistulas after opening the urinary collecting system (UCS). MATERIAL AND METHODS Between August 2003 and April 2012, 76 partial nephrectomies for tumors ≥ 4 cm in size were performed using porcine small intestinal submucosa (SIS, Surgisis®) to close the capsular, renal and in some cases, UCS defects. RESULTS The median tumor size was 5.0 cm (range 4.0-13.0 cm) and the intervention was performed with warm ischemia in 25 cases (32.8 %), with cold perfusion in 16 cases (21.2 %) and without ischemia in 35 cases (46.0 %). A total of 4 patients (5.5 %) developed postoperative urinary fistulas and 4 (5.5 %) required revision surgery because of significant postoperative bleeding. There were no local infections or allergic reactions to the foreign material. CONCLUSIONS Surgisis® enables a quick and technically uncomplicated closure of the renal defect after partial nephrectomy for tumors. It has the potential to further minimize postoperative bleeding and urinary fistulas and to facilitate the intervention to the extent that nephron-sparing surgery will gain broader acceptance even in patients with tumors ≥4 cm in size.
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Affiliation(s)
- T J Schnoeller
- Klink für Urologie, Universitätsklinikum Ulm, Prittwitzstraße 43, Ulm, Germany.
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Steffens S, Ringe KI, Schroeer K, Lehmann R, Rustemeier J, Wegener G, Schrader M, Hofmann R, Kuczyk MA, Schrader AJ. Does overweight influence the prognosis of renal cell carcinoma? Results of a multicenter study. Int J Urol 2012; 20:585-92. [DOI: 10.1111/iju.12000] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 10/08/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Sandra Steffens
- Department of Urology and Urological Oncology; Hannover Medical School; Hannover
| | - Kristina I Ringe
- Department of Diagnostic and Interventional Radiology; Hannover Medical School; Hannover
| | | | - Rieke Lehmann
- Department of Urology and Urological Oncology; Hannover Medical School; Hannover
| | - Julia Rustemeier
- Department of Urology and Pediatric Urology; Philipps University of Marburg; Marburg
| | - Gerd Wegener
- Cancer Center; Hannover Medical School; Hannover; Germany
| | - Mark Schrader
- Department of Urology; Ulm University Medical Center; Ulm
| | - Rainer Hofmann
- Department of Urology and Pediatric Urology; Philipps University of Marburg; Marburg
| | - Markus A Kuczyk
- Department of Urology and Urological Oncology; Hannover Medical School; Hannover
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Steffens S, Janssen M, Roos FC, Becker F, Schumacher S, Seidel C, Wegener G, Thüroff JW, Hofmann R, Stöckle M, Siemer S, Schrader M, Hartmann A, Kuczyk MA, Junker K, Schrader AJ. Incidence and long-term prognosis of papillary compared to clear cell renal cell carcinoma – A multicentre study. Eur J Cancer 2012; 48:2347-52. [DOI: 10.1016/j.ejca.2012.05.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 04/29/2012] [Accepted: 05/03/2012] [Indexed: 01/20/2023]
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Zengerling F, Streicher W, Schrader AJ, Schrader M, Nitzsche B, Cronauer MV, Höpfner M. Effects of sorafenib on C-terminally truncated androgen receptor variants in human prostate cancer cells. Int J Mol Sci 2012; 13:11530-11542. [PMID: 23109869 PMCID: PMC3472761 DOI: 10.3390/ijms130911530] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 09/05/2012] [Accepted: 09/06/2012] [Indexed: 01/26/2023] Open
Abstract
Recent evidence suggests that the development of castration resistant prostate cancer (CRPCa) is commonly associated with an aberrant, ligand-independent activation of the androgen receptor (AR). A putative mechanism allowing prostate cancer (PCa) cells to grow under low levels of androgens, is the expression of constitutively active, C-terminally truncated AR lacking the AR-ligand binding domain (LBD). Due to the absence of a LBD, these receptors, termed ARΔLBD, are unable to respond to any form of anti-hormonal therapies. In this study we demonstrate that the multikinase inhibitor sorafenib inhibits AR as well as ARΔLBD-signalling in CRPCa cells. This inhibition was paralleled by proteasomal degradation of the AR- and ARΔLBD-molecules. In line with these observations, maximal antiproliferative effects of sorafenib were achieved in AR and ARΔLBD-positive PCa cells. The present findings warrant further investigations on sorafenib as an option for the treatment of advanced AR-positive PCa.
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Affiliation(s)
- Friedemann Zengerling
- Department of Urology, Ulm University, Ulm 89075, Germany; E-Mails: (A.J.S.); (M.S.); (M.V.C.)
- Department of Physiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin 14195, Germany; E-Mails: (B.N.); (M.H.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +49-731-500-58036; Fax: +49-731-500-58002
| | - Wolfgang Streicher
- Institute of General Zoology and Endocrinology, Ulm University, Ulm 89069, Germany; E-Mail:
| | - Andres J. Schrader
- Department of Urology, Ulm University, Ulm 89075, Germany; E-Mails: (A.J.S.); (M.S.); (M.V.C.)
| | - Mark Schrader
- Department of Urology, Ulm University, Ulm 89075, Germany; E-Mails: (A.J.S.); (M.S.); (M.V.C.)
| | - Bianca Nitzsche
- Department of Physiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin 14195, Germany; E-Mails: (B.N.); (M.H.)
| | - Marcus V. Cronauer
- Department of Urology, Ulm University, Ulm 89075, Germany; E-Mails: (A.J.S.); (M.S.); (M.V.C.)
| | - Michael Höpfner
- Department of Physiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin 14195, Germany; E-Mails: (B.N.); (M.H.)
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Steffens S, Köhler A, Rudolph R, Eggers H, Seidel C, Janssen M, Wegener G, Schrader M, Kuczyk MA, Schrader AJ. Validation of CRP as prognostic marker for renal cell carcinoma in a large series of patients. BMC Cancer 2012; 12:399. [PMID: 22958305 PMCID: PMC3502607 DOI: 10.1186/1471-2407-12-399] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 08/27/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To evaluate the prognostic significance of the pre-operative C-reactive protein (CRP) serum level in patients with renal cell cancer (RCC). METHODS We evaluated 1,161 RCC patients with complete patient and tumour specific characteristics as well as information about their pre-operative CRP-level, who had undergone either radical nephrectomy or nephron-sparing surgery at two German high-volume centres (University Hospitals of Hannover and Ulm). The mean follow-up was 54 months. RESULTS The CRP-level, stratified to three subgroups (CRP ≤ 4, 4-10, and >10 mg/l), correlated significantly with tumour stage (p < 0.001), the risk of presenting nodal disease (2.1, 3.1, and 16.4%) and distant metastasis (2.9, 8.6, and 30.0%; p < 0.001). The Kaplan-Meier 5-year cancer specific survival (CSS) rates were 89.4, 77.9, and 49.5%, respectively (p < 0.001). Multivariate analysis identified CRP as an independent prognosticator for CSS as well as overall survival (p < 0.001). Patients with a CRP of 4-10 and >10 mg/l had a 1.67 and 2.48 fold higher risk of dying due to their RCC compared to those with a pre-operative CRP ≤4 mg/l, respectively. CONCLUSIONS A high preoperative serum CRP level is an independent predictor of poor survival in patients with RCC. Its routine use could allow better risk stratification and risk-adjusted follow-up of RCC patients.
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Affiliation(s)
- Sandra Steffens
- Department of Urology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany
| | - Astrid Köhler
- Department of Urology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany
| | - Raphael Rudolph
- Department of Urology, Ulm Medical School, Hannover, Germany
| | - Hendrik Eggers
- Department of Urology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany
| | - Christoph Seidel
- Department of Oncology, Hannover Medical School, Hannover, Germany
| | - Martin Janssen
- Department of Urology, University Clinic of Saarland, Homburg, Germany
| | - Gerd Wegener
- Cancer Center, Hannover Medical School, Hannover, Germany
| | - Mark Schrader
- Department of Urology, Ulm Medical School, Hannover, Germany
| | - Markus A Kuczyk
- Department of Urology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany
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Schrader AJ, Steffens S, Schnoeller TJ, Schrader M, Kuczyk MA. Neoadjuvant therapy of renal cell carcinoma: a novel treatment option in the era of targeted therapy? Int J Urol 2012; 19:903-7. [PMID: 22640774 DOI: 10.1111/j.1442-2042.2012.03065.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The study was carried out to evaluate the effectiveness, toxicity and optimal duration of neoadjuvant therapy for patients with organ-confined or locally advanced renal cell carcinoma in the era of targeted agents. A literature review was carried out using Medline/Pubmed articles, as well as congress reports from the last five American Society of Clinical Oncology, American Urological Association and European Association of Urology Annual Meetings. Neoadjuvant targeted therapy is feasible and shows toxicity similar to that seen in a palliative setting. Most studies recommend an application for 2-4 months. The current data situation is best for sunitinib. Surgery can apparently be carried out the day right after discontinuing the drug. However, even sunitinib leads to only a mean 10% decrease in primary tumor size, and one-quarter to one-fifth of all patients show local tumor progression during treatment. Few patients (approximately 12%) with a vena cava tumor thrombus achieve a significant decrease in its level under neoadjuvant therapy; here too, progression is observed in a significant number of cases. Even the new targeted agents show limited effectiveness in achieving relevant remissions of the primary tumor. Furthermore, tumor progression is seen in a significant percentage of patients during neoadjuvant therapy. Thus, even today in the era of targeted agents, a neoadjuvant approach should only be made in patients with localized or locally advanced renal cell carcinoma, which primarily seem to be absolutely inaccessible by (partial) nephrectomy.
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Laschak M, Spindler KD, Schrader AJ, Hessenauer A, Streicher W, Schrader M, Cronauer MV. JS-K, a glutathione/glutathione S-transferase-activated nitric oxide releasing prodrug inhibits androgen receptor and WNT-signaling in prostate cancer cells. BMC Cancer 2012; 12:130. [PMID: 22462810 PMCID: PMC3376035 DOI: 10.1186/1471-2407-12-130] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [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: 11/04/2011] [Accepted: 03/30/2012] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Nitric oxide (NO) and its oxidative reaction products have been repeatedly shown to block steroid receptor function via nitrosation of zinc finger structures in the DNA-binding domain (DBD). In consequence NO-donors could be of special interest for the treatment of deregulated androgen receptor(AR)-signaling in castration resistant prostate cancer (CRPC). METHODS Prostate cancer (PCa) cells were treated with JS-K, a diazeniumdiolate derivate capable of generating large amounts of intracellular NO following activation by glutathione S-transferase. Generation of NO was determined indirectly by the detection of nitrate in tissue culture medium or by immunodetection of nitrotyrosine in the cytoplasm. Effects of JS-K on intracellular AR-levels were determined by western blotting. AR-dimerization was analyzed by mammalian two hybrid assay, nuclear translocation of the AR was visualized in PCa cells transfected with a green fluorescent AR-Eos fusion protein using fluorescence microscopy. Modulation of AR- and WNT-signalling by JS-K was investigated using reporter gene assays. Tumor cell proliferation following JS-K treatment was measured by MTT-Assay. RESULTS The NO-releasing compound JS-K was shown to inhibit AR-mediated reporter gene activity in 22Rv1 CRPC cells. Inhibition of AR signaling was neither due to an inhibition of nuclear import nor to a reduction in AR-dimerization. In contrast to previously tested NO-donors, JS-K was able to reduce the intracellular concentration of functional AR. This could be attributed to the generation of extremely high intracellular levels of the free radical NO as demonstrated indirectly by high levels of nitrotyrosine in JS-K treated cells. Moreover, JS-K diminished WNT-signaling in AR-positive 22Rv1 cells. In line with these observations, castration resistant 22Rv1 cells were found to be more susceptible to the growth inhibitory effects of JS-K than the androgen dependent LNCaP which do not exhibit an active WNT-signaling pathway. CONCLUSIONS Our results suggest that small molecules able to inhibit WNT- and AR-signaling via NO-release represent a promising platform for the development of new compounds for the treatment of CRPC.
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Affiliation(s)
- Martin Laschak
- Department of Urology, Ulm University, Prittwitzstrasse 43, 89075, Ulm, Germany
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Streicher W, Zengerling F, Laschak M, Weidemann W, Höpfner M, Schrader AJ, Jentzmik F, Schrader M, Cronauer MV. AR-Q640X, a model to study the effects of constitutively active C-terminally truncated AR variants in prostate cancer cells. World J Urol 2012; 30:333-9. [PMID: 22362413 DOI: 10.1007/s00345-012-0842-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 02/10/2012] [Indexed: 01/20/2023] Open
Abstract
PURPOSE A recently identified mechanism allowing prostate cancer (PCa) cells to grow in the absence of androgens is the expression of constitutively active, C-terminally truncated androgen receptor (AR) variants lacking vast parts of the ligand-binding domain. These AR variants termed ARΔLBD are either products of alternative splicing, point mutations leading to premature stop codons or proteolytic cleavage of the AR. Some controversies exist about the requirement of additional full-length AR for the full transcriptional activity of the ARΔLBD. On basis of a mutated, C-terminally truncated AR termed Q640X, we developed an experimental model for the study of ARΔLBD in PCa cells. METHODS Activation of AR-dependent promoters was analyzed by reporter gene assays. Dimerization studies were conducted using a mammalian two-hybrid system. RESULTS Although Q640X/Q640X homodimers were able to induce the expression of certain AR target genes, Q640X/AR heterodimers were necessary to activate the full panel of androgen-dependent genes under androgen-deprived conditions. CONCLUSIONS The following study supports the hypothesis that castration-resistant prostate cancer (CRPC) cells are able to activate specific androgen-dependent genes by selective modulation of the ratio between ARΔLBD and their putative dimerization partners like the full-length AR or other ARΔLBD in the absence of androgens. The present data suggest that AR-mutant Q640X is a powerful experimental tool for the functional analysis of ARΔLBD in CRPC.
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Affiliation(s)
- Wolfgang Streicher
- Department of Urology, Research Laboratory, University of Ulm, Prittwitzstrasse 43, 89075, Ulm, Germany
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Jentzmik F, Schrader AJ, de Petriconi R, Hefty R, Mueller J, Doetterl J, Eickhoff A, Schrader M. The ileal neobladder in female patients with bladder cancer: long-term clinical, functional, and oncological outcome. World J Urol 2012; 30:733-9. [DOI: 10.1007/s00345-012-0837-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 01/30/2012] [Indexed: 10/14/2022] Open
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Steffens S, Schrader AJ, Vetter G, Eggers H, Blasig H, Becker J, Kuczyk MA, Serth J. Fibronectin 1 protein expression in clear cell renal cell carcinoma. Oncol Lett 2012; 3:787-790. [PMID: 22740994 DOI: 10.3892/ol.2012.566] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 12/12/2011] [Indexed: 11/05/2022] Open
Abstract
Fibronectin 1 (FN1) is a glycoprotein that is involved in cell adhesion and migration processes including embryogenesis, wound healing, blood coagulation, host defenses and metastasis. The aim of this study was to elucidate the FN1 protein expression in renal cell carcinoma (RCC) and to determine its potential prognostic relevance. A total of 270 clear cell RCC tissue specimens were collected from patients undergoing surgery for renal tumors. Biomarker expression was determined by immunohistochemistry and correlated with clinical variables. Survival analysis was carried out for 153 patients with complete follow-up data and pathologically proven clear cell carcinoma of the kidney. The follow-up group had a mean follow-up period of 83.8 months (IQR 26.2-136.2 months). The calculated median 5-year overall and tumor-specific survival rate of all 153 evaluable patients was 66.6 and 71.0%, respectively. A higher disease-related mortality rate was observed among patients with cytoplasmic FN1 expression (41.3 vs. 24.7%, p=0.039, Fisher's exact test). No significant correlation was found between FN1 staining and patient characteristics such as age, gender, tumor differentiation and visceral metastasis. However, there was a trend for FN1 expression and correlation with tumor stage and lymph node metastasis (p=0.085 and p=0.203; respectively). The Kaplan-Meier analysis revealed significant differences in the 5-year tumor-specific survival for patients with and without cytoplasmic FN1 expression (64.8 vs. 77.7%; p=0.035, log-rank test). However, results of the multivariate Cox regression analysis showed that FN1 expression was not an independent marker of either overall or tumor-specific survival. In conclusion, FN1 protein expression in RCC is associated with a higher disease-related mortality rate, indicating a possible role in RCC progression. Therefore, our data on FN1 encourage further investigations to determine the role of FN1 in RCC.
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Affiliation(s)
- S Steffens
- Department of Urology, Hannover Medical School, Hannover, Germany
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Steffens S, Schrader AJ, Blasig H, Vetter G, Eggers H, Tränkenschuh W, Kuczyk MA, Serth J. Caveolin 1 protein expression in renal cell carcinoma predicts survival. BMC Urol 2011; 11:25. [PMID: 22152020 PMCID: PMC3266190 DOI: 10.1186/1471-2490-11-25] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [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: 06/27/2011] [Accepted: 12/07/2011] [Indexed: 12/30/2022] Open
Abstract
Background Caveolae play a significant role in disease phenotypes such as cancer, diabetes, bladder dysfunction, and muscular dystrophy. The aim of this study was to elucidate the caveolin-1 (CAV1) protein expression in renal cell cancer (RCC) and to determine its potential prognostic relevance. Methods 289 clear cell RCC tissue specimens were collected from patients undergoing surgery for renal tumors. Both cytoplasmic and membranous CAV1 expression were determined by immunohistochemistry and correlated with clinical variables. Survival analysis was carried out for 169 evaluable patients with a median follow up of 80.5 months (interquartile range (IQR), 24.5 - 131.7 months). Results A high CAV1 expression in the tumor cell cytoplasm was significantly associated with male sex (p = 0.04), a positive nodal status (p = 0.04), and poor tumor differentiation (p = 0.04). In contrast, a higher than average (i.e. > median) CAV1 expression in tumor cell membranes was only linked to male sex (p = 0.03). Kaplan-Meier analysis disclosed significant differences in 5-year overall (51.4 vs. 75.2%, p = 0.001) and tumor specific survival (55.3 vs. 80.1%, p = 0.001) for patients with higher and lower than average cytoplasmic CAV1 expression levels, respectively. Applying multivariable Cox regression analysis a high CAV1 protein expression level in the tumor cell cytoplasm could be identified as an independent poor prognostic marker of both overall (p = 0.02) and tumor specific survival (p = 0.03) in clear cell RCC patients. Conclusion Over expression of caveolin-1 in the tumour cell cytoplasm predicts a poor prognosis of patients with clear cell RCC. CAV1 is likely to be a useful prognostic marker and may play an important role in tumour progression. Therefore, our data encourage further investigations to enlighten the role of CAV1 and its function as diagnostic and prognostic marker in serum and/or urine of RCC patients.
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Affiliation(s)
- Sandra Steffens
- Department of Urology, Hannover Medical School, (Carl-Neuberg-Strasse 1), Hannover, (30625), Germany.
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Steffens S, Grünwald V, Ringe KI, Seidel C, Eggers H, Schrader M, Wacker F, Kuczyk MA, Schrader AJ. Does obesity influence the prognosis of metastatic renal cell carcinoma in patients treated with vascular endothelial growth factor-targeted therapy? Oncologist 2011; 16:1565-71. [PMID: 22020210 DOI: 10.1634/theoncologist.2011-0213] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Obesity increases the risk for renal cell carcinoma (RCC). However, it has only recently been identified as an independent positive prognostic factor for localized RCC. OBJECTIVE To determine whether obesity influences long-term prognosis in metastatic RCC patients receiving vascular endothelial growth factor-targeted therapy. DESIGN, SETTING, AND PARTICIPANTS In 116 patients with metastatic RCC who received antiangiogenic agents (sunitinib, sorafenib, axitinib, bevacizumab) in 2005-2010, we evaluated whether body mass index (BMI), a body surface area (BSA) above the European average, the visceral fat area (VFA), or s.c. fat area (SFA) were of predictive relevance. MEASUREMENTS BMI was categorized based on current World Health Organization definitions. BSA was stratified according to the European average for men (1.98 m(2)) and women (1.74 m(2)). VFA and SFA were dichotomized using the median of the observed distribution as the cutoff. The primary endpoints of this study were time to progression and overall survival time. RESULTS AND LIMITATIONS The whole population had median progression-free and overall survival times of 8.3 months and 20.5 months, respectively. In contrast to BMI and BSA, higher than average VFA and SFA levels were significant predictors of longer progression-free and overall survival times. The major limitations of this study are its retrospective design and its heterogeneous patient population. CONCLUSION This is the first study to identify high VFA and SFA levels as positive predictive biomarkers for patients who receive first-line antiangiogenic agents for metastatic RCC.
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Affiliation(s)
- Sandra Steffens
- Department of Urology and Urologic Oncology, Hannover University Medical School, Hannover, Germany
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