1
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Nemer KM, Bauman TM, Laurin Council M, Hurst EA. Surveyed dermatologists are less likely to curette invasive squamous cell carcinoma in solid organ transplant recipients. Int J Womens Dermatol 2020; 6:99-101. [PMID: 32258341 PMCID: PMC7105649 DOI: 10.1016/j.ijwd.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/07/2019] [Accepted: 10/16/2019] [Indexed: 11/27/2022] Open
Abstract
Background The risk of squamous cell carcinoma (SCC) is increased in solid organ transplant recipients (OTRs), and preferential treatment modalities vary among clinicians. Objectives The purpose of this study was to survey dermatologists regarding practice patterns for electrodesiccation and curettage (EDC) of SCC in OTRs and nontransplant patients. Methods An 18-question survey was sent to dermatologist members of the International Transplant Skin Cancer Collaborative, Association of Professors of Dermatology, and American College of Mohs Surgery. Differences in EDC practice patterns for treatment of SCC in OTRs and nontransplant patients were evaluated. Results Dermatologists in this study (N = 227) were more likely to treat SCC with EDC in nontransplant patients (67.4%) than in OTRs (48.0%; P = .0003). Dermatologists who perform EDC in both groups (n = 108) were unlikely to use EDC on the H-zone of the face; they were more likely to EDC tumors on non-H-zone areas of the face and neck in nontransplant patients compared to OTRs (P = .0007). Dermatologists were more likely to use EDC over surgery in nontransplant patients compared to OTRs with the following demographics: dementia or psychiatric disease (P = .04), multiple medical comorbidities (P = .03), or anticoagulation medications (P = .02). Conclusions In OTRs with SCC, 48% of clinicians would consider EDC. The main factors that affect the decision to perform EDC include tumor location and patient comorbidities.
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Affiliation(s)
- Kathleen M Nemer
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, United States
| | - Tyler M Bauman
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, United States
| | - M Laurin Council
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, United States
| | - Eva A Hurst
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, United States
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2
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Vellky JE, Bauman TM, Ricke EA, Huang W, Ricke WA. Incidence of androgen receptor and androgen receptor variant 7 coexpression in prostate cancer. Prostate 2019; 79:1811-1822. [PMID: 31503366 PMCID: PMC7339117 DOI: 10.1002/pros.23906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/26/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Prostate cancer (PRCA) is an androgen-driven disease, where androgens act through the androgen receptor (AR) to induce proliferation and survival of tumor cells. Recently, AR splice variant 7 (ARv7) has been implicated in advanced stages of PRCA and clinical recurrence. With the widespread use of AR-targeted therapies, there has been a rising interest in the expression of full-length AR and ARv7 in PRCA progression and how these receptors, both independently and together, contribute to adverse clinicopathologic outcomes. METHODS Despite a multitude of studies measuring the expression levels of AR and ARv7 in PRCA progression, the results have been inconsistent and sometimes contradictory due to technical and analytical discrepancies. To circumvent these inconsistencies, we used an automated multiplexed immunostaining platform for full-length AR and ARv7 in human PRCA samples and objectively quantified expression changes with machine learning-based software. With this technology, we can assess receptor prevalence both independently, and coexpressed, within specific tissue and cellular compartments. RESULTS Full-length AR and ARv7 expression increased in epithelial nuclei of metastatic samples compared to benign. Interestingly, a population of cells with undetectable AR persisted through all stages of PRCA progression. Coexpression analyses showed an increase of the double-positive (AR+ /ARv7+ ) population in metastases compared to benign, and an increase of the double-negative population in PRCA samples compared to benign. Importantly, analysis of clinicopathologic outcomes associated with AR/ARv7 coexpression showed a significant decrease in the double-positive population with higher Gleason score (GS), as well as in samples with recurrence in under 5 years. Conversely, the double-negative population was significantly increased in samples with higher GS and in samples with recurrence in under 5 years. CONCLUSIONS Changes in AR and ARv7 coexpression may have prognostic value in PRCA progression and recurrence. A better understanding of the prevalence and clinicopathologic outcomes associated with changes in these receptors' coexpression may provide a foundation for improved diagnosis and therapy for men with PRCA.
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Affiliation(s)
- Jordan E. Vellky
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave., Madison, WI, USA, 53705
- Cancer Biology Graduate Program, University of Wisconsin-Madison, Wisconsin Institute for Medical Research, 1111 Highland Ave., Madison, WI, USA, 53705
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI, USA, 53705
| | - Tyler M. Bauman
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave., Madison, WI, USA, 53705
- Division of Urology, Washington University School of Medicine, 4921 Parkview Pl., St. Louis, MO, USA 63110
| | - Emily A. Ricke
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave., Madison, WI, USA, 53705
- George M. O’Brien Research Center of Excellence, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave., Madison, WI, USA, 53705
| | - Wei Huang
- George M. O’Brien Research Center of Excellence, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave., Madison, WI, USA, 53705
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI, USA 53705
| | - William A. Ricke
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave., Madison, WI, USA, 53705
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI, USA, 53705
- George M. O’Brien Research Center of Excellence, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave., Madison, WI, USA, 53705
- Corresponding Author: Dr. William Ricke, Director of Research, Department of Urology, 7107 Wisconsin Institute of Medical Research, University of Wisconsin, 1111 Highland Ave, Madison, WI, USA 53705. Office 608-265-3202 Fax 608-265-0614,
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3
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Borregales LD, Adibi M, Thomas AZ, Reis RB, Chery LJ, Devine CE, Wang X, Potretzke AM, Potretzke T, Figenshau RS, Bauman TM, Aboshady YI, Abel EJ, Matin SF, Karam JA, Wood CG. Predicting Adherent Perinephric Fat Using Preoperative Clinical and Radiological Factors in Patients Undergoing Partial Nephrectomy. Eur Urol Focus 2019; 7:397-403. [PMID: 31685445 DOI: 10.1016/j.euf.2019.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND The decision to perform a partial nephrectomy (PN) relies largely upon the complexity of the renal mass and its surrounding anatomy. The presence of adherent perinephric fat (APF) can increase surgical complexity and extend operative times. The accurate prediction of APF may improve surgical planning and aid in decision making for the surgical approach. OBJECTIVE We sought to develop and externally validate a score that predicts APF based on preoperative clinical and radiological prognostic factors. DESIGN, SETTING, AND PARTICIPANTS We retrospectively analyzed 495 consecutive patients who underwent open or minimally invasive PN. APF was defined as the presence of "dense," "adherent," or "sticky" perinephric fat at the time of dissection by the surgeon, and this did not require subcapsular dissection. Additionally, we analyzed an independent cohort of 285 patients for external validation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A score model was developed using multivariate logistic regression analysis. Calibration of the fitted model was assessed graphically with a plot of the predicted versus the actual probability of APF, and discrimination was assessed by calculating the area under the receiver operating characteristic curve. RESULTS AND LIMITATIONS Of the 495 patients, 95 (19%) had APF. Patients with APF had longer operative (p=0.02) and arterial clamp (p=0.01) times than non-APF patients. On multivariate analyses, diabetes mellitus (p=0.009), posterior perinephric fat thickness (p<0.001), and perinephric stranding (p<0.001) were predictors of encountering APF in PN. A risk score ranging from 0 to 4 was developed based on these three variables to predict APF. The scoring system demonstrated good discrimination of 0.82 and 0.84 for the development and external validation cohorts, respectively. CONCLUSIONS The APF score can accurately predict the presence of APF in patients with a small renal mass who are planning to undergo PN. This score could aid in pre- and intraoperative planning and impact the surgical approach. PATIENT SUMMARY The presence of "sticky" fat surrounding the kidney in patients undergoing partial nephrectomy has previously been linked to longer operative times, intraoperative complications, and surgical conversion. In our study, we found that this feature is more often presented in patients with diabetes mellitus, and thicker and more inflammatory fat on renal imaging. Based on these findings, we developed a risk score that can accurately predict this feature before surgery, in order to improve surgical planning and better counsel the patients.
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Affiliation(s)
- Leonardo D Borregales
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mehrad Adibi
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arun Z Thomas
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rodolfo B Reis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lisly J Chery
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Catherine E Devine
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aaron M Potretzke
- Division of Urology, Washington University School of Medicine, St. Louis, MO, USA
| | - Theodora Potretzke
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert S Figenshau
- Division of Urology, Washington University School of Medicine, St. Louis, MO, USA
| | - Tyler M Bauman
- Division of Urology, Washington University School of Medicine, St. Louis, MO, USA
| | - Yara I Aboshady
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Edwin Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Surena F Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jose A Karam
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher G Wood
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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4
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Sehgal PD, Bauman TM, Nicholson TM, Vellky JE, Ricke EA, Tang W, Xu W, Huang W, Ricke WA. Tissue-specific quantification and localization of androgen and estrogen receptors in prostate cancer. Hum Pathol 2019; 89:99-108. [PMID: 31054895 DOI: 10.1016/j.humpath.2019.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/05/2019] [Accepted: 04/18/2019] [Indexed: 12/14/2022]
Abstract
Androgens and estrogens, working together, promote prostate cancer (PRCA) initiation and progression, with androgens acting via androgen receptor (AR) and estrogens acting primarily through estrogen receptor α (ERα). While the interplay between these steroid hormones has been established, the interaction between steroid hormone receptors in prostatic disease remains unstudied. The goal of this study was to objectively determine the incidence, stage specificity, and tissue/cell type specificity of AR and ERα expression, both independently and simultaneously, during the progression of PRCA. Using multiplexed immunohistochemistry and multispectral imaging analysis, AR, ERα, and smooth muscle α-actin expression was detected and quantitated in benign prostate tissue (BPT), high-grade prostatic intraepithelial neoplasia (HGPIN), PRCA, and metastasis (MET) from patient specimens (n=340). Epithelial AR expression was significantly increased in HGPIN, PRCA, and MET compared with BPT, whereas ERα expression in epithelial and stromal cells was highest in HGPIN. With analysis of AR and ERα coexpression, we identified a unique population of double-positive (AR+/ERα+) cells that increased in HGPIN specimens in both the stroma and the epithelium. Double-negative (AR-/ERα-) cells significantly decreased across PRCA progression, from 65% in BPT to 30% in MET. Preliminary analysis of this AR+/ERα+ population indicates potential cell type specificity in smooth muscle α-actin-negative stromal cells. This study demonstrates stage-, tissue-, and cell type-specific AR and ERα expression changes during PRCA progression, both independently and coexpressed. A more complete understanding of steroid hormones and their receptors in the initiation and progression of prostatic disease may elucidate improved strategies for PRCA prevention or therapy.
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Affiliation(s)
- Priyanka D Sehgal
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Tyler M Bauman
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; Division of Urology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Tristan M Nicholson
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; Department of Urology, University of Washington School of Medicine, Seattle, WA 98915, USA
| | - Jordan E Vellky
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; Cancer Biology Graduate Program, University of Wisconsin-Madison, Wisconsin Institute for Medical Research, Madison, WI 53705, USA; Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Emily A Ricke
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; George M. O'Brien Research Center of Excellence, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Weiping Tang
- Department of Medicinal Chemistry, University of Wisconsin School of Pharmacy, Madison, WI 53705, USA
| | - Wei Xu
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; George M. O'Brien Research Center of Excellence, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Wei Huang
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; George M. O'Brien Research Center of Excellence, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - William A Ricke
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; George M. O'Brien Research Center of Excellence, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA.
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5
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Beck EM, Bauman TM, Rosman IS. A tale of two clones: Caldesmon staining in the differentiation of cutaneous spindle cell neoplasms. J Cutan Pathol 2018; 45:581-587. [PMID: 29687929 DOI: 10.1111/cup.13259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/02/2018] [Accepted: 04/06/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND We sought to compare the sensitivity and specificity of 2 different caldesmon antibodies in differentiating leiomyosarcoma from other cutaneous spindle cell neoplasms. METHODS Representative cutaneous spindle cell neoplasms were identified, including leiomyosarcoma, atypical fibroxanthoma, dermatomyofibroma and spindle cell squamous cell carcinoma. Immunohistochemistry was performed with antibodies directed toward caldesmon, smooth-muscle actin (SMA) and desmin. Sensitivity and specificity were calculated using grades from 3 independent observers. RESULTS The sensitivity of caldesmon (Ventana) was 100% (95% CI 78.2%-100%) and the specificity was 8.3% (2.8%-18.4%). Because this stain appeared to be non-specific, additional testing was performed on the same set of specimens using a second caldesmon clone (H-caldesmon, Dako), which had a sensitivity of 53.9% (25.1%-80.8%) and specificity of 96.6% (88.1%-99.6%). The sensitivity and specificity of SMA were 85.7% (57.2%-98.2%) and 84.5% (72.6%-92.7%), respectively. The sensitivity of desmin was 53.3% (26.6%-78.7%) with a specificity of 100% (94.0%-100%). CONCLUSIONS The Ventana caldesmon clone is not specific to smooth muscle, a potential pitfall to laboratories using this clone. The staining pattern, sensitivity and specificity of the Dako H-caldesmon antibody clone are similar to results from prior studies. The sensitivity and specificity of the Dako clone support its use in smooth muscle identification as an additional marker in challenging cases.
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Affiliation(s)
| | - Tyler M Bauman
- Washington University School of Medicine, Saint Louis, Missouri
| | - Ilana S Rosman
- Division of Dermatology, Washington University School of Medicine, Saint Louis, Missouri.,Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri
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6
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Affiliation(s)
- Tyler M. Bauman
- Division of Dermatology, Washington University School of Medicine, St Louis, Missouri
| | - David M. Sheinbein
- Division of Dermatology, Washington University School of Medicine, St Louis, Missouri
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7
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Bauman TM, Rosman IS, Sheinbein DM. Extramammary Paget's disease of the scrotum with complete response to imiquimod and photodynamic therapy. BMJ Case Rep 2018; 2018:bcr-2017-221696. [PMID: 29507011 DOI: 10.1136/bcr-2017-221696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Extramammary Paget's disease (EMPD) is a rare intraepithelial neoplasm with an extremely variable clinical course. The objective of this study was to determine if combination imiquimod and photodynamic therapy could induce remission of EMPD. A 69-year-old man with EMPD was treated with topical imiquimod 5% cream at night for 5 days per week for 1 month, followed by 2 months of 5% imiquimod for three nights a week. For the following 6 months, monthly 5-aminolevulinic acid photodynamic therapy was added. After 6 months, imiquimod was discontinued and the patient continued to be treated with quarterly photodynamic therapy. Treatment resulted in significant improvement in the appearance of the lesion, and pathology revealed no evidence of residual disease. The patient has had no clinical signs of disease for >5 years. We conclude that topical imiquimod 5% cream and photodynamic therapy may aid in the treatment of some patients with EMPD.
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Affiliation(s)
- Tyler M Bauman
- Division of Dermatology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Ilana S Rosman
- Division of Dermatology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - David M Sheinbein
- Division of Dermatology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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8
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Abstract
Laryngeal involvement is a rare manifestation of mycosis fungoides (MF), with only nine reported cases of cutaneous T cell lymphoma with laryngeal or vocal cord involvement. Herein, we report the case of a patient with a 7-year history of MF who presented to the emergency department with hoarseness, throat tightness and cough, as well as erythroderma and skin tumours. Laryngoscopy and CT imaging were concerning for lymphomatous involvement of the left false vocal cord. A biopsy was taken of the false vocal cord lesion, which revealed an aberrant immunophenotype consistent with MF. The patient was started on doxorubicin with initial rapid improvement in symptoms. Within 2 months, her respiratory status and skin involvement worsened. Subsequent studies showed bone marrow involvement. The patient expired 4 months after original presentation. This report describes the patient's presentation and clinical course, and reviews the literature on vocal cord and laryngeal involvement of MF.
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Affiliation(s)
- Tyler M Bauman
- Division of Dermatology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Christian M Wichterman
- Division of Dermatology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Amy C Musiek
- Division of Dermatology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Kathleen M Nemer
- Division of Dermatology, Washington University School of Medicine, St Louis, Missouri, USA
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9
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Abel EJ, Masterson TA, Karam JA, Master VA, Margulis V, Hutchinson R, Lorentz CA, Bloom E, Bauman TM, Wood CG, Blute ML. Predictive Nomogram for Recurrence following Surgery for Nonmetastatic Renal Cell Cancer with Tumor Thrombus. J Urol 2017; 198:810-816. [DOI: 10.1016/j.juro.2017.04.066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Affiliation(s)
- E. Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Timothy A. Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jose A. Karam
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ryan Hutchinson
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - C. Adam Lorentz
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Evan Bloom
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tyler M. Bauman
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christopher G. Wood
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Michael L. Blute
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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10
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Bauman TM, Potretzke AM, Wright AJ, Vetter JM, Potretzke TA, Figenshau RS. Patient and nonradiographic tumor characteristics predicting lipid-poor angiomyolipoma in small renal masses: Introducing the BEARS index. Investig Clin Urol 2017; 58:235-240. [PMID: 28681032 PMCID: PMC5494346 DOI: 10.4111/icu.2017.58.4.235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/09/2017] [Accepted: 02/15/2017] [Indexed: 01/20/2023] Open
Abstract
Purpose To create a simple model using clinical variables for predicting lipid-poor angiomyolipoma (AML) in patients with small renal masses presumed to be renal cell carcinoma (RCC) from preoperative imaging. Materials and Methods A series of patients undergoing partial nephrectomy (PN) for renal masses ≤4 cm was identified using a prospectively maintained database. Patients were excluded if standard preoperative imaging was not consistent with RCC. Chi square and Mann-Whitney U analyses were used to evaluate differences in characteristics between patients with AML and other types of pathology. A logistic regression model was constructed for multivariable analysis of predictors of lipid-poor AML. Results A total of 730 patients were identified that underwent PN for renal masses ≤4 cm between 2007–2015, including 35 with lipid-poor AML and 620 with RCC. In multivariable analysis, the following features predicted AML: female sex (odds ratio, 6.89; 95% confidence interval, 2.35–20.92; p<0.001), age <56 years (2.84; 1.21–6.66; p=0.02), and tumor size <2 cm (5.87; 2.70–12.77; p<0.001). Sex, age, and tumor size were used to construct the BEnign Angiomyolipoma Renal Susceptibility (BEARS) index with the following point values for each particular risk factor: female sex (2 points), age <56 years (1 point), and tumor size <2 cm (2 points). Within the study population, the BEARS index distinguished AML from malignant lesions with an area under the curve of 0.84. Conclusions Young female patients with small tumors are at risk for having lipid-poor AML despite preoperative imaging consistent with RCC. Identification of these patients may reduce the incidence of unnecessary PN for benign renal lesions.
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Affiliation(s)
- Tyler M Bauman
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Alec J Wright
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Joel M Vetter
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | - R Sherburne Figenshau
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA
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11
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Bauman TM, Potretzke AM, Wright AJ, Knight BA, Vetter JM, Figenshau RS. Partial Nephrectomy for Presumed Renal-Cell Carcinoma: Incidence, Predictors, and Perioperative Outcomes of Benign Lesions. J Endourol 2017; 31:412-417. [DOI: 10.1089/end.2016.0667] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tyler M. Bauman
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Alec J. Wright
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Brent A. Knight
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Joel M. Vetter
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Robert Sherburne Figenshau
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
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12
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Bauman TM, Potretzke AM, Flores-Mireles AL, Walker JN, Park AM, Schreiber HL, Pinkner JS, Caparon MG, Hultgren SJ, Desai A. MP23-19 FIBRINOGEN DEPOSITS ON URINARY CATHETERS IN A TIME-DEPENDENT MATTER AND CO-LOCALIZES WITH
E. FAECALIS
IN PATIENTS WITH POSITIVE
E. FAECALIS
URINE CULTURES. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Potretzke AM, Potretzke TA, Bauman TM, Knight BA, Park AM, Mobley JM, Figenshau RS, Siegel CL. Computed Tomography and Magnetic Resonance Findings of Fat-Poor Angiomyolipomas. J Endourol 2017; 31:119-128. [DOI: 10.1089/end.2016.0219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Aaron M. Potretzke
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Tyler M. Bauman
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - B. Alexander Knight
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Alyssa M. Park
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jonathan M. Mobley
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Cary Lynn Siegel
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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14
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Potretzke AM, Park AM, Bauman TM, Larson JA, Vetter JM, Benway BM, Desai AC. Is extended preoperative antibiotic prophylaxis for high-risk patients necessary before percutaneous nephrolithotomy? Investig Clin Urol 2016; 57:417-423. [PMID: 27847915 PMCID: PMC5109791 DOI: 10.4111/icu.2016.57.6.417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/06/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The goal of this study was to compare the rate of systemic inflammatory response syndrome (SIRS) in high-risk patients undergoing percutaneous nephrolithotomy (PCNL) between patients who received 7, 2, or 0 days of preoperative antibiotics. MATERIALS AND METHODS We retrospectively reviewed a series of consecutive PCNLs performed at our institution. Patients with infected preoperative urine cultures were excluded. High-risk patients were defined as those with a history of previous urinary tract infection (UTI), hydronephrosis, or stone size ≥2 cm. Patients were treated with 7, 2, or 0 days of preoperative antibiotic prophylaxis prior to PCNL. All patients received a single preoperative dose of antibiotics within 60 minutes of the start of surgery. Fisher exact test was used to compare the rate of SIRS by preoperative antibiotic length. RESULTS Of the 292 patients identified, 138 (47.3%) had sterile urine and met high-risk criteria, of which 27 (19.6%), 39 (28.3%), and 72 (52.2%) received 7, 2, and 0 days of preoperative antibiotics, respectively. The 3 groups were similar in age, sex, and duration of surgery (p>0.05). There was no difference in the rate of SIRS between the groups, with 1 of 27 (3.7%), 2 of 39 (5.1%) and 3 of 72 patients (4.2%) meeting criteria in the 7, 2, and 0 days antibiotic groups (p=~1). CONCLUSIONS Extended preoperative antibiotic prophylaxis was not found to reduce the risk of SIRS after PCNL in our institutional experience of high-risk patients. For these patients, a single preoperative dose of antibiotics is sufficient.
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Affiliation(s)
- Aaron M Potretzke
- Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Alyssa M Park
- Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Tyler M Bauman
- Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jeffrey A Larson
- Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Joel M Vetter
- Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Brian M Benway
- Urology Academic Practice, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alana C Desai
- Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA
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15
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Bauman TM, Ricke EA, Drew SA, Huang W, Ricke WA. Quantitation of Protein Expression and Co-localization Using Multiplexed Immuno-histochemical Staining and Multispectral Imaging. J Vis Exp 2016. [PMID: 27167094 DOI: 10.3791/53837] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Immunohistochemistry is a commonly used clinical and research lab detection technique for investigating protein expression and localization within tissues. Many semi-quantitative systems have been developed for scoring expression using immunohistochemistry, but inherent subjectivity limits reproducibility and accuracy of results. Furthermore, the investigation of spatially overlapping biomarkers such as nuclear transcription factors is difficult with current immunohistochemistry techniques. We have developed and optimized a system for simultaneous investigation of multiple proteins using high throughput methods of multiplexed immunohistochemistry and multispectral imaging. Multiplexed immunohistochemistry is performed by sequential application of primary antibodies with secondary antibodies conjugated to horseradish peroxidase or alkaline phosphatase. Different chromogens are used to detect each protein of interest. Stained slides are loaded into an automated slide scanner and a protocol is created for automated image acquisition. A spectral library is created by staining a set of slides with a single chromogen on each. A subset of representative stained images are imported into multispectral imaging software and an algorithm for distinguishing tissue type is created by defining tissue compartments on images. Subcellular compartments are segmented by using hematoxylin counterstain and adjusting the intrinsic algorithm. Thresholding is applied to determine positivity and protein co-localization. The final algorithm is then applied to the entire set of tissues. Resulting data allows the user to evaluate protein expression based on tissue type (ex. epithelia vs. stroma) and subcellular compartment (nucleus vs. cytoplasm vs. plasma membrane). Co-localization analysis allows for investigation of double-positive, double-negative, and single-positive cell types. Combining multispectral imaging with multiplexed immunohistochemistry and automated image acquisition is an objective, high-throughput method for investigation of biomarkers within tissues.
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Affiliation(s)
- Tyler M Bauman
- Division of Urologic Surgery, Washington University in St. Louis School of Medicine; Department of Urology, University of Wisconsin School of Medicine and Public Health
| | - Emily A Ricke
- Department of Urology, University of Wisconsin School of Medicine and Public Health
| | - Sally A Drew
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health
| | - Wei Huang
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health; O'Brien Urology Research Center, University of Wisconsin School of Medicine and Public Health
| | - William A Ricke
- Department of Urology, University of Wisconsin School of Medicine and Public Health; O'Brien Urology Research Center, University of Wisconsin School of Medicine and Public Health;
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16
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Blute ML, Masterson TA, Master VA, Margulis V, Lorentz CA, Bauman TM, Karam JA, Wood CG, Abel EJ. PD41-02 NOMOGRAM TO PREDICT RECURRENCE IN NON-METASTATIC RCC WITH THROMBUS USING A MULTI-CENTER CONTEMPORARY SERIES. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1548] [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: 11/25/2022]
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17
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Bauman TM, Potretzke AM, Vetter JM, Bhayani SB, Figenshau RS. Cerebrovascular Disease and Chronic Obstructive Pulmonary Disease Increase Risk of Complications with Robotic Partial Nephrectomy. J Endourol 2016; 30:293-9. [DOI: 10.1089/end.2015.0534] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Tyler M. Bauman
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Aaron M. Potretzke
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Joel M. Vetter
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sam B. Bhayani
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
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18
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Ricke WA, Lee CW, Clapper TR, Schneider AJ, Moore RW, Keil KP, Abler LL, Wynder JL, López Alvarado A, Beaubrun I, Vo J, Bauman TM, Ricke EA, Peterson RE, Vezina CM. In Utero and Lactational TCDD Exposure Increases Susceptibility to Lower Urinary Tract Dysfunction in Adulthood. Toxicol Sci 2016; 150:429-40. [PMID: 26865671 DOI: 10.1093/toxsci/kfw009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 11/14/2022] Open
Abstract
Benign prostatic hyperplasia, prostate cancer, and changes in the ratio of circulating testosterone and estradiol often occur concurrently in aging men and can lead to lower urinary tract (LUT) dysfunction. To explore the possibility of a fetal basis for the development of LUT dysfunction in adulthood, Tg(CMV-cre);Nkx3-1(+/-);Pten(fl/+) mice, which are genetically predisposed to prostate neoplasia, were exposedin uteroand during lactation to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD, 1 μg/kg po) or corn oil vehicle (5 ml/kg) after a single maternal dose on 13 days post coitus, and subsequently were aged without further manipulation, or at 8 weeks of age were exposed to exogenous 17 β-estradiol (2.5 mg) and testosterone (25 mg) (T+E2) via slow release subcutaneous implants.In uteroand lactational (IUL) TCDD exposure in the absence of exogenous hormone treatment reduced voiding pressure in adult mice, but otherwise had little effect on mouse LUT anatomy or function. By comparison, IUL TCDD exposure followed by exogenous hormone treatment increased relative kidney, bladder, dorsolateral prostate, and seminal vesicle weights, hydronephrosis incidence, and prostate epithelial cell proliferation, thickened prostate periductal smooth muscle, and altered prostate and bladder collagen fiber distribution. We propose a 2-hit model whereby IUL TCDD exposure sensitizes mice to exogenous-hormone-induced urinary tract dysfunction later in life.
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Affiliation(s)
- William A Ricke
- *Molecular and Environmental Toxicology Center; Department of Urology; University of Wisconsin Carbone Cancer Center; George M. O'Brien Benign Urology Center of Research Excellence
| | | | | | | | | | - Kimberly P Keil
- School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53706
| | - Lisa L Abler
- School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53706
| | | | | | | | - Jenny Vo
- *Molecular and Environmental Toxicology Center
| | | | | | - Richard E Peterson
- *Molecular and Environmental Toxicology Center; University of Wisconsin Carbone Cancer Center; School of Pharmacy; and
| | - Chad M Vezina
- *Molecular and Environmental Toxicology Center; Department of Urology; University of Wisconsin Carbone Cancer Center; George M. O'Brien Benign Urology Center of Research Excellence; School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53706
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19
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Flores-Mireles AL, Walker JN, Bauman TM, Potretzke AM, Schreiber HL, Park AM, Pinkner JS, Caparon MG, Hultgren SJ, Desai A. Fibrinogen Release and Deposition on Urinary Catheters Placed during Urological Procedures. J Urol 2016; 196:416-421. [PMID: 26827873 DOI: 10.1016/j.juro.2016.01.100] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE Catheter associated urinary tract infections account for approximately 40% of all hospital acquired infections worldwide with more than 1 million cases diagnosed annually. Recent data from a catheter associated urinary tract infection animal model has shown that inflammation induced by catheterization releases host fibrinogen, which accumulates on the catheter. Further, Enterococcus faecalis catheter colonization was found to depend on EbpA (endocarditis and biofilm-associated pilus), a fibrinogen binding adhesin. We evaluated this mechanism in a human model. MATERIALS AND METHODS Urinary catheters were collected from patients hospitalized for surgical or nonsurgical urological procedures. Catheters were subjected to immunofluorescence analyses by incubation with antifibrinogen antibody and then staining for fluorescence. Fluorescence intensity was compared to that of standard catheters. Catheters were incubated with strains of Enterococcus faecalis, Staphylococcus aureus or Candida to assess binding of those strains to fibrinogen laden catheters. RESULTS After various surgical and urological procedures, 50 catheters were collected. In vivo dwell time ranged from 1 hour to 59 days. All catheters had fibrinogen deposition. Accumulation depended on dwell time but not on surgical procedure or catheter material. Catheters were probed ex vivo with E. faecalis, S. aureus and Candida albicans, which bound to catheters only in regions where fibrinogen was deposited. CONCLUSIONS Taken together, these data show that urinary catheters act as a binding surface for the accumulation of fibrinogen. Fibrinogen is released due to inflammation resulting from a urological procedure or catheter placement, creating a niche that can be exploited by uropathogens to cause catheter associated urinary tract infections.
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Affiliation(s)
- Ana L Flores-Mireles
- Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA.,Center for Women's Infectious Disease Research, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA
| | - Jennifer N Walker
- Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA.,Center for Women's Infectious Disease Research, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA
| | - Tyler M Bauman
- Division of Urologic Surgery, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA
| | - Aaron M Potretzke
- Division of Urologic Surgery, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA
| | - Henry L Schreiber
- Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA.,Center for Women's Infectious Disease Research, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA
| | - Alyssa M Park
- Division of Urologic Surgery, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA
| | - Jerome S Pinkner
- Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA.,Center for Women's Infectious Disease Research, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA
| | - Michael G Caparon
- Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA.,Center for Women's Infectious Disease Research, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA
| | - Scott J Hultgren
- Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA.,Center for Women's Infectious Disease Research, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA
| | - Alana Desai
- Division of Urologic Surgery, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA
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20
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Bauman TM, Vezina CM, Ricke EA, Halberg RB, Huang W, Peterson RE, Ricke WA. Expression and colocalization of β-catenin and lymphoid enhancing factor-1 in prostate cancer progression. Hum Pathol 2016; 51:124-33. [PMID: 27067790 DOI: 10.1016/j.humpath.2015.12.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 12/18/2015] [Accepted: 12/23/2015] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to objectively investigate β-catenin and LEF1 abundance, subcellular localization, and colocalization across benign and staged prostate cancer (PCa) specimens. A tissue microarray containing tumor-adjacent histologically benign prostate tissue (BPT; n = 48 patients), high-grade prostatic intraepithelial neoplasia (HGPIN; n = 25), localized PCa (n = 42), aggressive PCa (n = 31), and metastases (n = 22) was stained using multiplexed immunohistochemistry with antibodies toward E-cadherin, β-catenin, and LEF1. Multispectral imaging was used for quantitation, and protein expression and colocalization was evaluated across PCa progression. Stromal nuclear β-catenin abundance was greater in HGPIN and PCa compared with BPT (P < .05 for both), and epithelial nuclear β-catenin abundance was lower in metastatic PCa than in BPT (P < .05 for both). Epithelial and stromal nuclear LEF1 abundance was greater in HGPIN compared with BPT, whereas epithelial nuclear LEF1 was also greater in metastases. The proportion of epithelial and stromal nuclear double-positive β-catenin(+)/LEF1(+) cells was greater in HGPIN compared with BPT. In addition, the proportion of epithelial β-catenin(+)/LEF1(+) cells was greater in localized PCa and metastases compared with BPT. A significant amount of stromal cells were positive for LEF1 but not β-catenin. β-Catenin and LEF1 abundance were negatively correlated in the epithelium (P < .0001) but not the stroma (P > .05). We conclude that β-catenin and LEF1 colocalization is increased in HGPIN and metastasis relative to BPT, suggesting a role for β-catenin/LEF1-mediated transcription in both malignant transformation and metastasis of PCa. Furthermore, our results suggest that LEF1 abundance alone is not a reliable readout for β-catenin activity in prostate tissues.
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Affiliation(s)
- Tyler M Bauman
- Division of Urologic Surgery, Washington University School of Medicine, St Louis, MO 53705
| | - Chad M Vezina
- Department of Comparative Biosciences, University of Wisconsin School of Veterinary Medicine, Madison, WI 53705; University of Wisconsin O'Brien Urology Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705
| | - Emily A Ricke
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705
| | - Richard B Halberg
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705
| | - Wei Huang
- University of Wisconsin O'Brien Urology Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705; Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705
| | - Richard E Peterson
- Division of Pharmaceutical Sciences, University of Wisconsin School of Pharmacy, Madison, WI 53705
| | - William A Ricke
- University of Wisconsin O'Brien Urology Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705; Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705.
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21
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Borregales LD, Adibi M, Thomas AZ, Reis RB, Chery LJ, Devine CE, Wang X, Potretzke AM, Potretzke T, Figenshau RS, Bauman TM, Matin SF, Karam JA, Wood CG. Predicting adherent perinephric fat with preoperative clinical and radiological factors in partial nephrectomy: Development and validation of a risk score. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
497 Background: The decision to perform a partial nephrectomy (PN) relies largely upon the complexity of the renal mass and its surrounding anatomy. An often encountered intraoperative challenge in PN is the adherent perinephric fat (APF). The anticipation of this feature may improve preoperative risk assessment and aid in decision-making for the surgical approach. We sought to develop and externally validate a score that predicts for APF based on preoperative clinical and radiological prognostic factors. Methods: We retrospectively analyzed 495 consecutive patients that underwent open or minimally invasive PN. APF was defined as the presence of “dense”, “adherent”, or “sticky” perinephric fat at time of dissection by the surgeon and this did not required subcapsular dissection for tumor isolation. A score model was developed using multivariate logistic regression analysis. This score was further validated using an external data set with 285 patients. Discrimination and calibration were assessed by calculating the area under the receiver operating characteristic curve (AUC) and the Hosmer–Lemeshow statistic, respectively. Results: Among the 495 patients, 95 (19%) patients presented with APF. On multivariate analyses, diabetes mellitus (p = 0.009), perinephric fat thickness (p < 0.001) and perinephric stranding (p < 0.001) were predictors of encountering APF in PN. A risk score ranging from 0 to 4, was developed based on these three variables to predict for APF. Among the 285 patients in the validation cohort, 41(14.3%) presented with APF. The score demonstrated good discrimination of 0.82 and 0.84 for the development and validation cohort, respectively. The model did not show a statistically significant lack of calibration (p-values = 0.98, 0.35). Moreover, predicted probabilities of APF based on a 0.5 threshold yielded a specificity of 92.3 and 92.2 in the development and validation cohorts, respectively. Conclusions: The score can accurately predict the presence of APF in patients with small renal mass planning to undergo PN. This score could aid current algorithms of preoperative risk assessment and impact surgical approach.
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Affiliation(s)
| | - Mehrad Adibi
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Arun Z. Thomas
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rodolfo B. Reis
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lisly J Chery
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Xuemei Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Theodora Potretzke
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO
| | | | | | - Surena F. Matin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jose A. Karam
- The University of Texas MD Anderson Cancer Center, Houston, TX
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22
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Bauman TM, Potretzke TA, Potretzke AM, Siegel CL, Brandes SB. Mucinous adenocarcinoma of the bladder associated with long term suprapubic tube: a case report. BMC Urol 2015; 15:119. [PMID: 26630940 PMCID: PMC4668653 DOI: 10.1186/s12894-015-0112-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic indwelling catheters may induce histologic changes within the bladder, and these changes are sometimes pre-malignant. There are many documented cases of squamous cell carcinoma associated with indwelling catheters, but only three cases of catheter-associated adenocarcinoma have been reported. In this case report, we present radiographic findings of a case of mucinous adenocarcinoma of the bladder and suprapubic (SP) tract in a quadriplegic patient. CASE PRESENTATION A 71-year-old male with a history of spinal cord injury presented with hematuria and SP discharge after SP catheterization for 51 years. CT urography was performed and revealed an irregular, infiltrative, and heterogeneous mass arising from the anterior bladder at the level of the suprapubic catheter and extending along the SP tube tract. Cystoscopy and biopsy revealed an adenocarcinoma of the anterior bladder and stoma with extensive associated mucin production and a background of acute and chronic inflammation. Surgical therapy included cystoprostatectomy, abdominal wall resection, ileal conduit creation, and abdominal wall reconstruction. The final diagnosis was a high-grade, T2a/N0/M0 (Stage II) mucinous adenocarcinoma of the bladder. There has been no evidence of tumor recurrence over the previous 5 years. CONCLUSION Few cases of adenocarcinoma associated with long term indwelling catheter have been reported in the literature, and due to the rarity of this disease process, the prognosis with surgical therapy is not well known. The patient described herein has been free of recurrence for the previous five years, suggesting that surgery is a viable management option for these patients.
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Affiliation(s)
- Tyler M Bauman
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Theodora A Potretzke
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Aaron M Potretzke
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Cary L Siegel
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Steven B Brandes
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
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23
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Abel EJ, Margulis V, Bauman TM, Karam JA, Christensen WP, Krabbe LM, Haddad A, Golla V, Wood CG. Risk factors for recurrence after surgery in non-metastatic RCC with thrombus: a contemporary multicentre analysis. BJU Int 2015; 117:E87-94. [PMID: 26305276 DOI: 10.1111/bju.13268] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 11/28/2022]
Abstract
OBJECTIVE To determine the predictors of post-surgical recurrence for patients with non-metastatic renal cell carcinoma (RCC) and venous thrombus. METHODS Records from consecutive patients with non-metastatic RCC with tumour thrombus, treated surgically between 2000 and 2012 at one of three centres, were reviewed. Univariable and multivariable analysis were used to evaluate the association of risk factors for post-surgical recurrence. RESULTS A total of 465 patients with non-metastatic RCC were identified, including patients with thrombus present in the renal vein (257 patients, 55.3%), infrahepatic inferior vena cava (IVC; 144 patients, 31.0%) and suprahepatic IVC (64 patients, 13.8%). The median (interquartile range) follow-up was 28.3 (12.2-56.4) months, with metastatic RCC developing in 188 patients (40.5%). Independent predictors of recurrence included: body mass index ≤20 kg/m(2) (hazard ratio [HR] 2.66; 95% confidence interval [CI] 1.29-5.49), low preoperative haemoglobin (HR 1.54; 95% CI 1.07-2.20), perinephric fat invasion (HR 1.51; 95% CI 1.09-2.10), IVC thrombus height (HR 2.64; 95% CI 1.47-4.74), tumour diameter (HR 1.04 95% CI 1.00-1.09), nuclear grade (HR 1.56 95% CI 1.12-2.15) and non-clear-cell histology (HR 2.13; 95% CI 1.30-3.50). Independently predictive variables were used to create a recurrence model for three risk groups based on 0, 1-2, or >2 risk factors, respectively. The 5-year recurrence-free survival rate was significantly different in patients with favourable-risk (79.1%) compared with intermediate- (55.1%) or high-risk (22.1%) disease (P < 0.001). CONCLUSIONS Seven risk factors for recurrence were identified for patients with non-metastatic RCC with thrombus, which can be used to select patients who may benefit from increased surveillance or adjuvant therapy clinical trials.
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Affiliation(s)
- E Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tyler M Bauman
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jose A Karam
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - William P Christensen
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Laura-Maria Krabbe
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ahmed Haddad
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vishnukamal Golla
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Christopher G Wood
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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24
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Bauman TM, Becka AJ, Sehgal PD, Huang W, Ricke WA. SIGIRR/TIR8, an important regulator of TLR4 and IL-1R-mediated NF-κB activation, predicts biochemical recurrence after prostatectomy in low-grade prostate carcinomas. Hum Pathol 2015; 46:1744-51. [PMID: 26344417 DOI: 10.1016/j.humpath.2015.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 01/08/2023]
Abstract
Single Ig IL-1-related receptor (SIGIRR) is a negative regulator of toll-like receptor 4 and IL-1-mediated activation of nuclear factor κ-light-chain enhancer of activated B cells. The purpose of this study was to qualitatively and quantitatively determine SIGIRR protein expression in human prostate tissues and associate SIGIRR expression with clinical parameters. SIGIRR expression was quantified in glandular prostate tissue using immunohistochemistry and multispectral imaging, and expression was evaluated in relation to clinicopathological features of benign prostatic hyperplasia and prostate cancer (PCa). Subgroupings of low Gleason score (≤ 6 and 3 + 4) and high Gleason score (4 + 3 and ≥ 8) were used for patient outcomes. SIGIRR was predominantly expressed in the cytoplasm and nucleus of the prostatic epithelium with little expression within the stroma. Compared with normal prostate, cytoplasmic SIGIRR expression was similar in benign prostatic hyperplasia, high-grade prostatic intraepithelial neoplasia, PCa, and metastases. A decrease in nuclear expression was found in metastasis samples (P = .04). Changes in SIGIRR expression were not associated with Gleason score, pathological stage, tumor volume, surgical margin status, or serum prostate-specific antigen (P > .05). Nuclear (P = .96) and cytoplasmic (P = .89) SIGIRR expressions were not related to patient outcomes in univariable analysis, but in the analysis of patients with low Gleason scores, high cytoplasmic SIGIRR expression was associated with biochemical recurrence in both univariable (P = .01) and multivariable (hazard ratio, 2.31 [95% confidence interval 1.05-5.06]; P = .04) analyses. Similarly, in multivariable analysis of only low-stage (pT2) tumors, SIGIRR independently predicted biochemical recurrence (P = .009). We conclude that SIGIRR predicts biochemical recurrence in patients with low Gleason score and low pathological stage PCa.
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Affiliation(s)
- Tyler M Bauman
- Division of Urologic Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, MO
| | - Alexander J Becka
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Priyanka D Sehgal
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Wei Huang
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - William A Ricke
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI; George M. O'Brien Center, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Abstract
BACKGROUND CD147 is an MMP-inducing protein often implicated in cancer progression. The purpose of this study was to investigate the expression of CD147 in prostate cancer (PCa) progression and the prognostic ability of CD147 in predicting biochemical recurrence after prostatectomy. METHODS Plasma membrane-localized CD147 protein expression was quantified in patient samples using immunohistochemistry and multispectral imaging, and expression was compared to clinico-pathological features (pathologic stage, Gleason score, tumor volume, preoperative PSA, lymph node status, surgical margins, biochemical recurrence status). CD147 specificity and expression were confirmed with immunoblotting of prostate cell lines, and CD147 mRNA expression was evaluated in public expression microarray datasets of patient prostate tumors. RESULTS Expression of CD147 protein was significantly decreased in localized tumors (pT2; p = 0.02) and aggressive PCa (≥pT3; p = 0.004), and metastases (p = 0.001) compared to benign prostatic tissue. Decreased CD147 was associated with advanced pathologic stage (p = 0.009) and high Gleason score (p = 0.02), and low CD147 expression predicted biochemical recurrence (HR 0.55; 95 % CI 0.31-0.97; p = 0.04) independent of clinico-pathologic features. Immunoblot bands were detected at 44 kDa and 66 kDa, representing non-glycosylated and glycosylated forms of CD147 protein, and CD147 expression was lower in tumorigenic T10 cells than non-tumorigenic BPH-1 cells (p = 0.02). Decreased CD147 mRNA expression was associated with increased Gleason score and pathologic stage in patient tumors but is not associated with recurrence status. CONCLUSIONS Membrane-associated CD147 expression is significantly decreased in PCa compared to non-malignant prostate tissue and is associated with tumor progression, and low CD147 expression predicts biochemical recurrence after prostatectomy independent of pathologic stage, Gleason score, lymph node status, surgical margins, and tumor volume in multivariable analysis.
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Affiliation(s)
- Tyler M Bauman
- Departments of Urology ,Carbone Cancer Center, University of Wisconsin, 7107 Wisconsin Institutes of Medical Research (WIMR), 1111 Highland Ave., 53705, Madison, WI, USA.
| | - Jonathan A Ewald
- Departments of Urology ,Carbone Cancer Center, University of Wisconsin, 7107 Wisconsin Institutes of Medical Research (WIMR), 1111 Highland Ave., 53705, Madison, WI, USA.
| | - Wei Huang
- Departments of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI, USA. .,University of Wisconsin O'Brien Urology Research Center, University of Wisconsin, Madison, WI, USA. .,Carbone Cancer Center, University of Wisconsin, Madison, WI, USA.
| | - William A Ricke
- Departments of Urology ,Carbone Cancer Center, University of Wisconsin, 7107 Wisconsin Institutes of Medical Research (WIMR), 1111 Highland Ave., 53705, Madison, WI, USA. .,University of Wisconsin O'Brien Urology Research Center, University of Wisconsin, Madison, WI, USA. .,Carbone Cancer Center, University of Wisconsin, Madison, WI, USA.
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Bauman TM, Ricke EA, Huang W, Ricke WA. MP31-08 A TISSUE SPECIFIC ROLE FOR LIGAND INDEPENDENT ARV7 SIGNALING IN BENIGN PROSTATE PATHOGENESIS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1363] [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: 11/30/2022]
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Bauman TM, Ricke EA, Huang W, Ricke WA. MP6-10 TISSUE SPECIFIC EXPRESSION OF ANDROGEN RECEPTOR VARIANT 7 IN PROSTATE CANCER PROGRESSION: A POTENTIAL ROLE OF ARV7 IN CARCINOGENESIS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.257] [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: 11/16/2022]
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Bauman TM, Vezina CM, Huang W, Marker PC, Peterson RE, Ricke WA. Beta-catenin is elevated in human benign prostatic hyperplasia specimens compared to histologically normal prostate tissue. Am J Clin Exp Urol 2014; 2:313-322. [PMID: 25606577 PMCID: PMC4297327] [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] [Grants] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 12/09/2014] [Indexed: 06/04/2023]
Abstract
Benign prostatic hyperplasia (BPH) is linked to lower urinary tract symptoms (LUTS) such as incomplete bladder emptying, urinary frequency and urgency. Mechanisms responsible for BPH are not fully known. Here, we tested whether beta-catenin (CTNNB1) immunostaining intensity and distribution differ in human glandular BPH tissue specimens compared to normal prostate tissue. Multiplex immunostaining of CTNNB1, its putative transcriptional target gene lymphoid enhancer binding factor 1 (LEF1), and the epithelial marker E-cadherin were examined in clinical human prostate specimens with or without histological BPH (pure epithelial or mixed stromal-epithelial nodules). BPH specimens were obtained from 24 men who experienced LUTS and underwent transurethral resection of the prostate surgery. Control specimens were tumor-adjacent histologically normal prostate tissue from 48 patients who underwent radical prostatectomy. The resulting multispectral images were unmixed and optical densities recorded to quantify staining abundance, cellular (membranous, cytoplasmic, and nuclear) and tissue localization (stromal versus epithelial), and determination of percentage of CTNNB1-positive cells. The following CTNNB1 indices were significantly higher in BPH compared to normal prostate tissue: overall staining intensity, staining intensity in prostate stromal cell membranes, cytoplasm and nuclei, and prostate epithelial cell nuclei. The following LEF1 indices were significantly lower in BPH compared to tumor-adjacent normal prostate tissue: stromal LEF1 staining intensity, percentage of LEF1-positive stromal cells, and intensity of LEF1 staining in stromal cell membranes, cytoplasm, and nuclei. The percentage of stromal cells with CTNNB1(+)/LEF1(-) nuclei was higher and percentage of stromal cells with CTNNB1(-)/LEF1(+) nuclei was lower in BPH compared to tumor-adjacent normal prostate tissues. These results support the hypothesis that CTNNB1 expression increases in specific BPH tissue compartments. Further, since nuclear LEF1 staining does not coincide with cytoplasmic or nuclear CTNNB1 staining, it does not appear to be a reliable index of CTNNB1 activity in adult human prostate.
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Affiliation(s)
- Tyler M Bauman
- Department of Urology and Carbone Cancer Center, University of Wisconsin School of Medicine and Public HealthMadison, WI 53705, USA
| | - Chad M Vezina
- Department of Comparative Biosciences, University of Wisconsin School of Veterinary MedicineMadison, WI 53706, USA
- University of Wisconsin O’Brien Urology Research CenterMadison, WI, USA
| | - Wei Huang
- University of Wisconsin O’Brien Urology Research CenterMadison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public HealthMadison, WI 53705, USA
| | - Paul C Marker
- University of Wisconsin O’Brien Urology Research CenterMadison, WI, USA
- Division of Pharmaceutical Sciences, University of Wisconsin School of PharmacyMadison, WI 53705, USA
| | - Richard E Peterson
- Division of Pharmaceutical Sciences, University of Wisconsin School of PharmacyMadison, WI 53705, USA
| | - William A Ricke
- Department of Urology and Carbone Cancer Center, University of Wisconsin School of Medicine and Public HealthMadison, WI 53705, USA
- University of Wisconsin O’Brien Urology Research CenterMadison, WI, USA
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Bauman TM, Sehgal PD, Johnson KA, Pier T, Bruskewitz RC, Ricke WA, Huang W. Finasteride treatment alters tissue specific androgen receptor expression in prostate tissues. Prostate 2014; 74:923-32. [PMID: 24789081 PMCID: PMC4137476 DOI: 10.1002/pros.22810] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 03/20/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Normal and pathologic growth of the prostate is dependent on the synthesis of dihydrotestosterone (DHT) from testosterone by 5α-reductase. Finasteride is a selective inhibitor of 5α-reductase 2, one isozyme of 5α-reductase found in abundance in the human prostate. The objective of this study was to investigate the effects of finasteride on androgen receptor expression and tissue morphology in human benign prostatic hyperplasia specimens. METHODS Patients undergoing transurethral resection of the prostate and either treated or not treated with finasteride between 2004 and 2010 at the University of Wisconsin-Hospital were retrospectively identified using an institutional database. Prostate specimens from each patient were triple-stained for androgen receptor, prostate-specific antigen, and basal marker cytokeratin 5. Morphometric analysis was performed using the multispectral imaging, and results were compared between groups of finasteride treated and non-treated patients. RESULTS Epithelial androgen receptor but not stromal androgen receptor expression was significantly lower in patients treated with finasteride than in non-treated patients. Androgen receptor-regulated prostate-specific antigen was not significantly decreased in finasteride-treated patients. Significant luminal epithelial atrophy and basal cell hyperplasia were prevalent in finasteride treated patients. Epithelial androgen receptor expression was highly correlated to the level of luminal epithelial atrophy. CONCLUSIONS In this study, finasteride decreased the expression of epithelial androgen receptor in a tissue specific manner. The correlation between epithelial androgen receptor and the extent of luminal epithelial atrophy suggests that epithelial androgen receptor may be directly regulating the atrophic effects observed with finasteride treatment.
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Affiliation(s)
- Tyler M. Bauman
- Department of Urology, University of Wisconsin, Madison, Wisconsin
| | | | - Karen A. Johnson
- Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Thomas Pier
- Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | | | - William A. Ricke
- Department of Urology, University of Wisconsin, Madison, Wisconsin
- Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
- Correspondence to: William A. Ricke, PhD, Department of Urology and Carbone Cancer Center, University of Wisconsin, 7107 Wisconsin Institutes of Medical Research (WIMR), 1111 Highland Ave., Madison, WI 53705.
| | - Wei Huang
- Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
- Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
- Correspondence to: Wei Huang, MD, Department of Pathology and Laboratory Medicine and Carbone Cancer Center, University of Wisconsin, 1685 Highland Ave., Madison, WI 53705.
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Abel EJ, Linder BJ, Downs TM, Bauman TM, Thompson RH, Thapa P, Devon ON, Tarrell RF, Frank I, Tollefson MK, Jarrard DF, Boorjian SA. MP55-13 INTRAOPERATIVE BLOOD TRANSFUSION DURING RADICAL CYSTECTOMY INCREASES THE RISK OF DEATH FROM BLADDER CANCER COMPARED TO POSTOPERATIVE TRANSFUSION. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1561] [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: 11/26/2022]
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