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Duwe G, Schmitteckert M, Haack M, Sparwasser P, Dotzauer R, Thomas A, Tsaur I, Brandt MP, Kurosch M, Mager R, Haferkamp A, Boehm K, Höfner T. Value of perilesional biopsies in multiparametric magnetic resonance imaging-targeted biopsy and systematic biopsy in detection of prostate cancer: results of a prospective, non-randomized, surgeon-blinded study. World J Urol 2024; 42:297. [PMID: 38709326 DOI: 10.1007/s00345-024-05000-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/13/2024] [Indexed: 05/07/2024] Open
Abstract
PURPOSE The goal of this study is to address if detection rates of clinically significant prostate cancer (csPCa) can be increased by additional perilesional biopsies (PB) in magnetic resonance (MR)/ultrasound fusion prostate biopsy in biopsy-naïve men. METHODS This prospective, non-randomized, surgeon-blinded study was conducted between February 2020 and July 2022. Patients were included with PSA levels < 20 ng/ml and ≥ one PI-RADS lesion (grades 3-5) per prostate lobe. Prostate biopsy was performed by two urologists. The first performed the MR-fusion biopsy with 3-5 targeted biopsies (TB) and 6 PB in a standardized pattern. The second performed the systematic (12-fold) biopsy (SB) without knowledge of the MR images. Primary outcome of this study is absence or presence of csPCa (≥ ISUP grade 2) comparing TB, PB and SB, using McNemar test. RESULTS Analyses were performed for each PI-RADS lesion (n = 218). There was a statistically significant difference in csPC detection rate of TB + SB between PI-RADS 3, 4 and 5 lesions (18.0% vs. 42.5% vs. 82.6%, p < 0.001) and TB + PB (19.7% vs. 29.1% vs. 78.3%). Comparing only maximum ISUP grade per lesion, even SB plus TB plus PB did not detect more csPCa compared to SB plus TB (41.3% vs. 39.9%, p > 0.05). CONCLUSION We present prospective study data investigating the role of perilesional biopsy in detection of prostate cancer. We detected no statistically significant difference in the detection of csPCa by the addition of PB. Therefore, we recommend continuing 12-fold bilateral SB in addition to TB.
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Affiliation(s)
- Gregor Duwe
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Melanie Schmitteckert
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Maximilian Haack
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Peter Sparwasser
- Department of Urology, University Hospital and Faculty of Medicine Eberhard Karls University, Tübingen, Germany
| | - Robert Dotzauer
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Igor Tsaur
- Department of Urology, University Hospital and Faculty of Medicine Eberhard Karls University, Tübingen, Germany
| | - Maximilian Peter Brandt
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Martin Kurosch
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Rene Mager
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Katharina Boehm
- Department of Urology, University Hospital Carl Gustav-Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Thomas Höfner
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
- Department of Urology, Ordensklinikum Linz Elisabethinen, Fadinger Strasse 1, 4020, Linz, Austria
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Duwe G, Boehm K, Becker G, Ruckes C, Sparwasser P, Haack M, Dotzauer R, Thomas A, Mager R, Tsaur I, Neumann CCM, Feick G, Carl G, Brandt MP, Haferkamp A, Höfner T. Individualized center-based analysis of urinary and sexual functional outcome after radical prostatectomy based on the prostate cancer outcome study: a post hoc pathway to patient outcome measurement analysis for quality improvement. World J Urol 2024; 42:236. [PMID: 38619659 DOI: 10.1007/s00345-024-04950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 02/08/2024] [Indexed: 04/16/2024] Open
Abstract
PURPOSE We evaluate differences of patient-reported outcome measurements (PROM) based urinary continence and sexual function 12 months after radical prostatectomy (RPE) based on perioperative, surgical, and patient-specific characteristics in a large European academic urology center. MATERIALS AND METHODS All men enrolled in the Prostate Cancer Outcome Study (PCO) study who were treated with RPE between 2017 and 2021 completed EPIC-26 information surveys before and 12 months after RPE. Survey data were linked to clinical data of our institution. Logistic regression analyses were performed to examine the correlation between individual surgeons, patient characteristics, patient clinical data, and their urinary continence and sexual function. RESULTS In total, data of 429 men were analyzed: unstratified mean (SD) EPIC-26 domain score for urinary function decreased from 93.3 (0.7) to 60.4 (1.5) one year after RPE, respectively for sexual function from 64.95 (1.6) to 23.24 (1.1). Patients with preoperative adequate urinary function (EPIC-26 score > 80) reported significantly different mean urinary function scores between 53.35 (28.88) and 66.25 (25.15), p= 0.001, stratified by surgeons experience. On binary logistic regression analyses, only nerve sparing techniques (OR: 1,83, 95% CI: 1.01;3.21; p = 0.045) and low body mass index (OR: 0.91, CI: 0.85;0.99, p= 0.032) predicted adequate postoperative urinary function. CONCLUSIONS The results show how using provider-specific data from a larger cohort study enables to develop institution-specific analysis for functional outcomes after RPE. These models can be used for internal quality improvement as well as enhanced and provider-specific patient communication and shared decision making.
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Affiliation(s)
- Gregor Duwe
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Katharina Boehm
- Department of Urology, University Hospital Carl Gustav-Carus, TU Dresden, 01307, Dresden, Germany
| | - Gerrit Becker
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials Mainz, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Peter Sparwasser
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Maximilian Haack
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Robert Dotzauer
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Rene Mager
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Christopher C M Neumann
- Department of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10117, Berlin, Germany
| | - Günther Feick
- Federal Association of German Prostate Cancer Patient Support Groups, Thomas-Mann Strasse 40, 55311, Bonn, Germany
| | - Günter Carl
- Federal Association of German Prostate Cancer Patient Support Groups, Thomas-Mann Strasse 40, 55311, Bonn, Germany
| | - Maximilian Peter Brandt
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Thomas Höfner
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
- Department of Urology, Ordensklinikum Linz Elisabethinen, Fadingerstrasse 1, 4020, Linz, Austria
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Ziewers S, Dotzauer R, Thomas A, Brandt MP, Haferkamp A, Frees S, Zugor V, Kajaia D, Labanaris A, Kouriefs C, Radu C, Radavoi D, Jinga V, Mirvald C, Sinescu I, Surcel C, Tsaur I. Robotic-assisted vs. open ureteral reimplantation: a multicentre comparison. World J Urol 2024; 42:194. [PMID: 38530438 DOI: 10.1007/s00345-024-04875-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 02/09/2024] [Indexed: 03/28/2024] Open
Abstract
PURPOSE Open ureteral reimplantation is considered the standard surgical approach to treat distal ureteral strictures or injuries. These procedures are increasingly performed in a minimally invasive and robotic-assisted manner. Notably, no series comparing perioperative outcomes and safety of the open vs. robotic approach are available so far. METHODS In this retrospective multi-center study, we compared data from 51 robotic ureteral reimplantations (RUR) with 79 open ureteral reimplantations (OUR). Both cohorts were comparatively assessed using different baseline characteristics and perioperative outcomes. Moreover, a multivariate logistic regression for independent predictors was performed. RESULTS Surgery time, length of hospital stay and dwell time of bladder catheter were shorter in the robotic cohort, whereas estimated blood loss, postoperative blood transfusion rate and postoperative complications were lower than in the open cohort. In the multivariate linear regression analysis, robotic approach was an independent predictor for a shorter operation time (coefficient - 0.254, 95% confidence interval [CI] - 0.342 to - 0.166; p < 0.001), a lower estimated blood loss (coefficient - 0.390, 95% CI - 0.549 to - 0.231, p < 0.001) and a shorter length of hospital stay (coefficient - 0.455, 95% CI - 0.552 to - 0.358, p < 0.001). Moreover, robotic surgery was an independent predictor for a shorter dwell time of bladder catheter (coefficient - 0.210, 95% CI - 0.278 to - 0.142, p < 0.001). CONCLUSION RUR represents a safe alternative to OUR, with a shorter operative time, decreased blood loss and length of hospital stay. Prospective research are needed to further define the extent of the advantages of the robotic approach over open surgery.
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Affiliation(s)
- Stefanie Ziewers
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Robert Dotzauer
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Maximilian P Brandt
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Sebastian Frees
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Vahudin Zugor
- Clinic for Urology, Pediatric Urology and Robot-Assisted Minimally Invasive Urology, Clinical Center Bamberg, Bamberg, Germany
| | - David Kajaia
- Clinic for Urology, Pediatric Urology and Robot-Assisted Minimally Invasive Urology, Clinical Center Bamberg, Bamberg, Germany
| | | | | | - Cosmin Radu
- "Prof. Dr. Theodor Burghele" Clinical Hospital, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Daniel Radavoi
- "Prof. Dr. Theodor Burghele" Clinical Hospital, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Viorel Jinga
- "Prof. Dr. Theodor Burghele" Clinical Hospital, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Cristian Mirvald
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Ioanel Sinescu
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Cristian Surcel
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Igor Tsaur
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
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Duwe G, Haferkamp A, Höfner T. Author reply on the Letter to the Editor on "Standardized reports of focal-HIFU results is paramount: a closer look at the Duwe et al.'s cohort on focal HIFU for localized prostate cancer". World J Urol 2024; 42:190. [PMID: 38530446 DOI: 10.1007/s00345-024-04928-z] [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] [Received: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/28/2024] Open
Affiliation(s)
- Gregor Duwe
- Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Thomas Höfner
- Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
- Department of Urology, Ordensklinikum Linz Elisabethinen, Fadinger Strasse 1, 4020, Linz, Austria
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Xie H, Rutz J, Maxeiner S, Grein T, Thomas A, Juengel E, Chun FKH, Cinatl J, Haferkamp A, Tsaur I, Blaheta RA. Sulforaphane Inhibits Adhesion and Migration of Cisplatin- and Gemcitabine-Resistant Bladder Cancer Cells In Vitro. Nutrients 2024; 16:623. [PMID: 38474751 DOI: 10.3390/nu16050623] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Only 20% of patients with muscle-invasive bladder carcinoma respond to cisplatin-based chemotherapy. Since the natural phytochemical sulforaphane (SFN) exhibits antitumor properties, its influence on the adhesive and migratory properties of cisplatin- and gemcitabine-sensitive and cisplatin- and gemcitabine-resistant RT4, RT112, T24, and TCCSUP bladder cancer cells was evaluated. Mechanisms behind the SFN influence were explored by assessing levels of the integrin adhesion receptors β1 (total and activated) and β4 and their functional relevance. To evaluate cell differentiation processes, E- and N-cadherin, vimentin and cytokeratin (CK) 8/18 expression were examined. SFN down-regulated bladder cancer cell adhesion with cell line and resistance-specific differences. Different responses to SFN were reflected in integrin expression that depended on the cell line and presence of resistance. Chemotactic movement of RT112, T24, and TCCSUP (RT4 did not migrate) was markedly blocked by SFN in both chemo-sensitive and chemo-resistant cells. Integrin-blocking studies indicated β1 and β4 as chemotaxis regulators. N-cadherin was diminished by SFN, particularly in sensitive and resistant T24 and RT112 cells, whereas E-cadherin was increased in RT112 cells (not detectable in RT4 and TCCSup cells). Alterations in vimentin and CK8/18 were also apparent, though not the same in all cell lines. SFN exposure resulted in translocation of E-cadherin (RT112), N-cadherin (RT112, T24), and vimentin (T24). SFN down-regulated adhesion and migration in chemo-sensitive and chemo-resistant bladder cancer cells by acting on integrin β1 and β4 expression and inducing the mesenchymal-epithelial translocation of cadherins and vimentin. SFN does, therefore, possess potential to improve bladder cancer therapy.
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Affiliation(s)
- Hui Xie
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany
| | - Jochen Rutz
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Sebastian Maxeiner
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Timothy Grein
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Eva Juengel
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Felix K-H Chun
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany
| | - Jindrich Cinatl
- Institute of Medical Virology, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Roman A Blaheta
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany
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Ziewers S, Fischer ND, Börner JH, Kaufmann L, Tamm A, Yang Y, Jungmann F, Dotzauer R, Sparwasser P, Hoefner T, Tsaur I, Haferkamp A, Mager R. Clinical impact and management of incidental renal findings on pre-TAVI CT-scan from the urologist's perspective. Urol Int 2024:000537808. [PMID: 38354722 DOI: 10.1159/000537808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION To investigate prevalence and impact of incidental renal masses (IRM) accompanying increasing computed tomography (CT) work-up for symptomatic aortic valve stenosis (sAVS) of the elderly with regard to the relevance of urological consultation for overall survival (OS). METHODS A retrospective analysis of pre-transcatheter aortic-valve implantations (TAVI) CT scans of patients with sAVS (N=1253) harboring IRM was performed for 2014-2019. According to the clinical management, groups 1 (urologic consultation) and 2 (findings ignored) were formed and analyzed in terms of OS. RESULTS The prevalence of IRM was 9% (119/1253). In 19% (23/119) urological advice was sought (group 1). At baseline, group 1 showed a significantly higher rate of malignancy-specific lesions compared to 2 (p<0.01). Other clinical parameters (e.g. age, cardiological scores, comorbidities) did not differ between groups (p>0.05). In group 1, 4 (17%) findings were histologically confirmed, of which 3 (13%) underwent surgery. There was no significant difference in median OS at a median follow-up of 24.7 months between group 1 and 2 with 35.7 (95%-CI, 5.9; 65.4] and 47.4 months (95%-CI [33.0; 61.7], respectively (p=0.4). In Cox regression analysis, chronic kidney disease but not urologic work-up or chronic obstructive pulmonary disease or heart failure emerged as an independent unfavorable predictor of OS (HR 2.44, 95% CI 1.37; 4.36, p=0.003). CONCLUSION For the first time, a TAVI population with IRM was analyzed from the urologist's perspective. Urologic co-evaluation and work-up does not confer a significant benefit in terms of OS in this particular population.
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Haferkamp A, Tsaur I. Thrombektomie bei Nierentumoren: Level-I und -II-Thrombus. Aktuelle Urol 2024; 55:65-74. [PMID: 38330955 DOI: 10.1055/a-2155-0941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
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Haack M, Fischer ND, Frey L, Sparwasser P, Dotzauer R, Duwe G, Haferkamp A, Borgmann H. Digital informed consent for urological surgery - randomized controlled study comparing multimedia-supported vs. traditional paper-based informed consent concerning satisfaction, anxiety, information gain and time efficiency. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00737-4. [PMID: 37925488 DOI: 10.1038/s41391-023-00737-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION Due to a lack of time and staff, informed consent (IC) in clinical practice often lacks clarity, comprehensibility and scope of information. Digital media offer great potential to enhance IC. Aim of this study is to evaluate the effectiveness of multimedia-supported compared to traditional paper-based IC. METHODS In the randomized, controlled, three-arm DICon (Digital Informed Consent for urological surgery) study 70 patients with an indication for prostate biopsy were randomized 1:1:1 to receive traditional paper-based IC vs. multimedia-supported information before IC vs. multimedia-supported information during IC. Patient satisfaction, anxiety and information gain were measured by validated questionnaires 2 weeks and directly before the procedure and time efficiency was recorded. Statistical analysis was performed using Kruskal-Wallis and Dunn's test (one-way ANOVA) and two-way ANOVA (with bonferroni post-test). RESULTS Multimedia information prior to the consultation saved 32.9% time compared to paper-based (5.3 min. vs. 9.5 min; p < 0.05) and 60.4% time compared to shared multimedia information (5.3 min. vs. 13.9 min.; p < 0.001), with no difference in satisfaction (62.6 vs. 62.7 vs. 68.6 of max. 80; p = 0.07), anxiety (8 vs. 8.1 vs. 7 of max. 16; p = 0.35), or information gain (6.5 vs. 5.7 vs. 6.7 of max. 10; p = 0.23). Results on satisfaction (56.6 vs. 62.6 vs. 66; p = 0.06), anxiety (7.2 vs. 7.2 vs. 6.8; p = 0.84), and information gain (7 vs. 6.4 vs. 5.9; p = 0.43) remained stable over time. CONCLUSIONS Multimedia-supported IC prior to consultation provided improved time efficiency (33% gain) compared to traditional paper-based IC, with comparable satisfaction, anxiety and information gain. Multimedia-supported information materials should therefore be used more frequently in patient education.
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Affiliation(s)
- Maximilian Haack
- Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany.
| | - Nikita D Fischer
- Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany
| | - Lisa Frey
- Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany
| | - Peter Sparwasser
- Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany
| | - Robert Dotzauer
- Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany
| | - Gregor Duwe
- Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany
| | - Hendrik Borgmann
- Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany
- Department of Urology and Pediatric Urology, University Medical Center, Brandenburg an der Havel, Germany
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Juengel E, Rutz J, Meiborg M, Markowitsch SD, Maxeiner S, Grein T, Thomas A, Chun FKH, Haferkamp A, Tsaur I, Vakhrusheva O, Blaheta RA. Mistletoe Extracts from Different Host Trees Disparately Inhibit Bladder Cancer Cell Growth and Proliferation. Cancers (Basel) 2023; 15:4849. [PMID: 37835543 PMCID: PMC10571756 DOI: 10.3390/cancers15194849] [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: 09/14/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
Extracts of European mistletoe (Viscum album) are popular as a complementary treatment for patients with many different cancer types. However, whether these extracts actually block bladder cancer progression remains unknown. The influence of different mistletoe extracts on bladder cancer cell growth and proliferation was investigated by exposing RT112, UMUC3, and TCCSup cells to mistletoe from hawthorn (Crataegi), lime trees (Tiliae), willow trees (Salicis), or poplar trees (Populi). The tumor cell growth and proliferation, apoptosis induction, and cell cycle progression were then evaluated. Alterations in integrin α and β subtype expression as well as CD44 standard (CD44s) and CD44 variant (CD44v) expressions were evaluated. Cell cycle-regulating proteins (CDK1 and 2, Cyclin A and B) were also investigated. Blocking and knock-down studies served to correlate protein alterations with cell growth. All extracts significantly down-regulated the growth and proliferation of all bladder cancer cell lines, most strongly in RT112 and UMUC3 cells. Alterations in CD44 expression were not homogeneous but rather depended on the extract and the cell line. Integrin α3 was, likewise, differently modified. Integrin α5 was diminished in RT112 and UMUC3 cells (significantly) and TCCSup (trend) by Populi and Salicis. Populi and Salicis arrested UMUC3 in G0/G1 to a similar extent, whereas apoptosis was induced most efficiently by Salicis. Examination of cell cycle-regulating proteins revealed down-regulation of CDK1 and 2 and Cyclin A by Salicis but down-regulation of CDK2 and Cyclin A by Populi. Blocking and knock-down studies pointed to the influence of integrin α5, CD44, and the Cyclin-CDK axis in regulating bladder cancer growth. Mistletoe extracts do block bladder cancer growth in vitro, with the molecular action differing according to the cell line and the host tree of the mistletoe. Integrating mistletoe into a guideline-based treatment regimen might optimize bladder cancer therapy.
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Affiliation(s)
- Eva Juengel
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany; (E.J.); (S.D.M.); (A.T.); (A.H.); (I.T.); (O.V.)
| | - Jochen Rutz
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany; (J.R.); (M.M.); (S.M.); (T.G.); (F.K.-H.C.)
| | - Moritz Meiborg
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany; (J.R.); (M.M.); (S.M.); (T.G.); (F.K.-H.C.)
| | - Sascha D. Markowitsch
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany; (E.J.); (S.D.M.); (A.T.); (A.H.); (I.T.); (O.V.)
| | - Sebastian Maxeiner
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany; (J.R.); (M.M.); (S.M.); (T.G.); (F.K.-H.C.)
| | - Timothy Grein
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany; (J.R.); (M.M.); (S.M.); (T.G.); (F.K.-H.C.)
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany; (E.J.); (S.D.M.); (A.T.); (A.H.); (I.T.); (O.V.)
| | - Felix K.-H. Chun
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany; (J.R.); (M.M.); (S.M.); (T.G.); (F.K.-H.C.)
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany; (E.J.); (S.D.M.); (A.T.); (A.H.); (I.T.); (O.V.)
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany; (E.J.); (S.D.M.); (A.T.); (A.H.); (I.T.); (O.V.)
| | - Olesya Vakhrusheva
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany; (E.J.); (S.D.M.); (A.T.); (A.H.); (I.T.); (O.V.)
| | - Roman A. Blaheta
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany; (E.J.); (S.D.M.); (A.T.); (A.H.); (I.T.); (O.V.)
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany; (J.R.); (M.M.); (S.M.); (T.G.); (F.K.-H.C.)
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10
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Börner JH, Neuberger S, Juengel E, Ziewers S, Dotzauer R, Sparwasser P, Höfner T, Tsaur I, Haferkamp A, Mager R. Impact of primary resistance to front-line targeted therapy in metastatic renal cell carcinoma on subsequent immune-checkpoint-inhibition. Discov Oncol 2023; 14:178. [PMID: 37740836 PMCID: PMC10517909 DOI: 10.1007/s12672-023-00791-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/16/2023] [Indexed: 09/25/2023] Open
Abstract
INTRODUCTION Synergistic effects have been discussed for tyrosine kinase (TKI) and immune checkpoint inhibitors (ICI). Primary resistance to TKI might disturb subsequent ICI effectiveness. The objective was to investigate, if primary resistance to 1st line TKI monotherapy predicts response to ICI in subsequent therapy lines and impacts overall survival (OS) in advanced renal cell carcinoma (aRCC). MATERIALS AND METHODS Retrospectively, aRCC patients which received front-line TKI from 2016 to 2019 were analyzed for the outcomes primary resistance (1LR), response to sequential ICI therapy, progression free survival (PFS) and overall survival (OS). Kaplan-Meier-estimates, Cox proportional hazards and logistic regression were used. RESULTS Primary resistance to front-line TKI was observed in 27 (53%) of 51 patients. Groups with disease control (DC) and 1st line TKI resistance (1LR) were not different at baseline with regard to clinicopathological features. Median duration on 1st line therapy was significantly shorter in the 1LR (5.1 months) than in the DC (14.7 months) group (p = 0.01). Sequential therapy was started in 21 (75%) and 12 (52%) patients of 1LR and DC groups using nivolumab in 16 (76%) vs. 11 (92%) cases (p > 0.05). Logistic regression revealed that 1LR status, neutrophil-to-lymphocyte ratio < 3, IMDC favorable prognosis and clear cell histology had no significant impact on responsiveness to ICI in subsequent therapy lines. Cox proportional hazards demonstrated no significant association of 1LR status with PFS and OS in patients who received subsequent ICI treatment. CONCLUSION Primary TKI resistance of aRCC was neither significantly associated with responsiveness to ICI during sequential therapy nor with PFS and OS. This adds the evidence for ICI based sequential therapy in primary TKI resistant aRCC.
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Affiliation(s)
- J H Börner
- Department of Urology and Paediatric Urology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - S Neuberger
- Department of Urology and Paediatric Urology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - E Juengel
- Department of Urology and Paediatric Urology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - S Ziewers
- Department of Urology and Paediatric Urology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - R Dotzauer
- Department of Urology and Paediatric Urology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - P Sparwasser
- Department of Urology and Paediatric Urology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - T Höfner
- Department of Urology and Paediatric Urology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - I Tsaur
- Department of Urology and Paediatric Urology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - A Haferkamp
- Department of Urology and Paediatric Urology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - R Mager
- Department of Urology and Paediatric Urology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
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11
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Haack M, Reisen K, Ghazy A, Stroh K, Frey L, Sparwasser P, Duwe G, Mager R, Haferkamp A, Borgmann H. Understanding tumor localization in multiparametric MRI of the prostate-effectiveness of 3D printed models. Front Surg 2023; 10:1264164. [PMID: 37799119 PMCID: PMC10547869 DOI: 10.3389/fsurg.2023.1264164] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Understanding tumor localization in multiparametric MRI (mpMRI) of the prostate is challenging for urologists but of great importance in mpMRI-fused prostate biopsy or radical prostatectomy. The aim was to evaluate the effectiveness of 3D printed models of the prostate to help urologists to locate tumors. Methods and Participants 20 urologists from University Medical Center Mainz (Germany) were asked to plot the location of a cancer suspicious lesion (PI-RADS ≥ 4) on a total of 30 mpMRI on a prostate sector diagram. The following 3 groups (as matched triplets) were divided into: mpMRI only, mpMRI with radiological report and mpMRI with 3D printed model (scaled 1:1). Statistical analysis was performed using one-way and two-way ANOVA (with bonferroni post-test). Results Overall, localization of the suspicious lesion was superior with the radiological report (median of max. 10 [IQR]: MRI 2 [IQR 1;5], MRI + report: 8 [6.3;9], MRI + 3D model 3 [1.3;5.8]; p < 0.001). Residents with <1 year of experience had a significantly higher detection rate using a 3D printed model [5 (5;5.8)] compared to mpMRI alone [1.5 (1;3.5)] (p < 0.05). Regarding the estimation of index lesion extension, the 3D model showed a significant benefit (mean percentage difference [95% CI]: MRI alone 234% [17.1;451.5], MRI + report 114% [78.5;149.6], MRI + 3D model 17% [-7.4;41.3] (p < 0.01). Conclusion Urologists still need the written radiological report for a sufficient understanding of tumor localization. The effectiveness of the 3D printed model regarding tumor localization is particularly evident in young residents (<1 year) and leads to a better overall assessment of the tumor extension.
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Affiliation(s)
- Maximilian Haack
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Katja Reisen
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Ahmed Ghazy
- Department of Cardiovascular Surgery, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Kristina Stroh
- Department of Diagnostic and Interventional Radiology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Lisa Frey
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Peter Sparwasser
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Gregor Duwe
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Rene Mager
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
| | - Hendrik Borgmann
- Department of Urology and Pediatric Urology, Johannes-Gutenberg-University Medical Center, Mainz, Germany
- Department of Urology, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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12
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Duwe G, Müller L, Ruckes C, Fischer ND, Frey LJ, Börner JH, Rölz N, Haack M, Sparwasser P, Jorg T, Neumann CCM, Tsaur I, Höfner T, Haferkamp A, Hahn F, Mager R, Brandt MP. Change in Splenic Volume as a Surrogate Marker for Immunotherapy Response in Patients with Advanced Urothelial and Renal Cell Carcinoma-Evaluation of a Novel Approach of Fully Automated Artificial Intelligence Based Splenic Segmentation. Biomedicines 2023; 11:2482. [PMID: 37760923 PMCID: PMC10526098 DOI: 10.3390/biomedicines11092482] [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: 07/08/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND In the treatment of advanced urothelial (aUC) and renal cell carcinoma (aRCC), biomarkers such as PD-1 and PD-L1 are not robust prognostic markers for immunotherapy (IO) response. Previously, a significant association between IO and a change in splenic volume (SV) was described for several tumour entities. To the best of our knowledge, this study presents the first correlation of SV to IO in aUC and aRCC. METHODS All patients with aUC (05/2017-10/2021) and aRCC (01/2012-05/2022) treated with IO at our academic centre were included. SV was measured at baseline, 3 and 9 months after initiation of IO using an in-house developed convolutional neural network-based spleen segmentation method. Uni- and multivariate Cox regression models for overall survival (OS) and progression-free survival (PFS) were used. RESULTS In total, 35 patients with aUC and 30 patients with aRCC were included in the analysis. Lower SV at the three-month follow-up was significantly associated with improved OS in the aRCC group. CONCLUSIONS We describe a new, innovative artificial intelligence-based approach of a radiological surrogate marker for IO response in aUC and aRCC which presents a promising new predictive imaging marker. The data presented implicate improved OS with lower follow-up SV in patients with aRCC.
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Affiliation(s)
- Gregor Duwe
- Department of Urology and Pediatric Urology, University Medical Center, Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center, Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials Mainz, University Medical Center, Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Nikita Dhruva Fischer
- Department of Urology and Pediatric Urology, University Medical Center, Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Lisa Johanna Frey
- Department of Urology and Pediatric Urology, University Medical Center, Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Jan Hendrik Börner
- Department of Urology and Pediatric Urology, University Medical Center, Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Niklas Rölz
- Department of Urology and Pediatric Urology, University Medical Center, Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Maximilian Haack
- Department of Urology and Pediatric Urology, University Medical Center, Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Peter Sparwasser
- Department of Urology and Pediatric Urology, University Medical Center, Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Tobias Jorg
- Department of Diagnostic and Interventional Radiology, University Medical Center, Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Christopher C. M. Neumann
- Department of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10117 Berlin, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medical Center, Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Thomas Höfner
- Department of Urology and Pediatric Urology, University Medical Center, Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
- Department of Urology, Ordensklinikum Linz Elisabethinen, Fadingerstraße 1, 4020 Linz, Austria
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center, Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Felix Hahn
- Department of Diagnostic and Interventional Radiology, University Medical Center, Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Rene Mager
- Department of Urology and Pediatric Urology, University Medical Center, Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Maximilian Peter Brandt
- Department of Urology and Pediatric Urology, University Medical Center, Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
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13
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Sparwasser P, Frey L, Fischer ND, Thomas A, Dotzauer R, Surcel C, Brandt MP, Mager R, Höfner T, Haferkamp A, Tsaur I. ASO Visual Abstract: First Comparison of Retroperitoneal Versus Transperitoneal Robot-Assisted Nephroureterectomy with Bladder Cuff: A Single-Center Study. Ann Surg Oncol 2023; 30:4540. [PMID: 37165290 DOI: 10.1245/s10434-023-13441-3] [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: 05/12/2023]
Affiliation(s)
- Peter Sparwasser
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany.
| | - L Frey
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - N D Fischer
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - A Thomas
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - R Dotzauer
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - C Surcel
- Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - M P Brandt
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - R Mager
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - T Höfner
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - A Haferkamp
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - I Tsaur
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
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14
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Hüsch T, Ober S, Haferkamp A, Schneidewind L, Saar M, Kranz J. Digital health information on surgical treatment options for overactive bladder is underrepresented. World J Urol 2023; 41:1891-1896. [PMID: 37272960 PMCID: PMC10352412 DOI: 10.1007/s00345-023-04447-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/17/2023] [Indexed: 06/06/2023] Open
Abstract
PURPOSE Digital health information gains growing importance in the medical landscape. Despite its opportunities, there is a risk of patient misinformation which may adversely influence the patient-physician relationship. This investigation aimed to identify and compare differences in the content and quality of online health information on overactive bladder (OAB) between different digital platforms. METHODS The platforms Google search, Facebook, Instagram, LinkedIn, and YouTube were searched for the keyword OAB. The search result links were classified as useful or misleading, advertisement and personal experience. Information regarding the organization of the source and available content on treatment modalities was collected. Descriptive analysis was applied. Univariate and multivariate analyses were performed to evaluate heterogeneity regarding the distribution of information depending on the source. A p value < 0.05 was considered statistically significant. RESULTS The source with the highest quantity of useful content was YouTube (100%) and Google (100%), whereas LinkedIn included mostly misleading content (73%). YouTube and Google provided the greatest variety of health information and were dominated by professional associations. Surgical procedures for treating OAB were only described in 32% and 48% of Google and YouTube results, respectively. On Google, sacral neuromodulation and OnabotulinumtoxinA were described in 26% and bladder augmentation in only 16% of the search results. In contrast, alternative medicine was present in 76%. CONCLUSIONS A large gap in the information on surgical treatments of OAB could be identified independently from the utilized source. In contrast, conservative treatments and alternative medicine dominate the current informational sources.
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Affiliation(s)
- Tanja Hüsch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes-Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Sita Ober
- Department of Urology and Pediatric Urology, University Medical Center of Johannes-Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- Department of Obstetrics and Gynecology, Hospital Darmstadt, Darmstadt, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center of Johannes-Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Laila Schneidewind
- Department of Urology, University Medical Center Rostock, Rostock, Germany
| | - Matthias Saar
- Department of Urology and Pediatric Urology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jennifer Kranz
- Department of Urology and Pediatric Urology, University Hospital RWTH Aachen, Aachen, Germany
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
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15
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Mikuteit M, Zschäbitz S, Stöhr C, Herrmann E, Polifka I, Agaimy A, Trojan L, Ströbel P, Becker F, Wülfing C, Barth P, Stöckle M, Staehler M, Stief C, Haferkamp A, Hohenfellner M, Duensing S, Macher-Göppinger S, Wullich B, Noldus J, Brenner W, Roos F, Walter B, Otto W, Burger M, Erlmeier M, Schrader AJ, Hartmann A, Erlmeier F, Steffens S. Evaluation of Gas 6 as a Prognostic Marker in Papillary Renal Cell Carcinoma. Urol Int 2023; 107:713-722. [PMID: 37348477 PMCID: PMC10413799 DOI: 10.1159/000529898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/06/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Growth arrest-specific protein 6 (Gas 6) is a ligand that plays a role in proliferation and migration of cells. For several tumor entities, high levels of Gas 6 are associated with poorer survival. We examined the prognostic role of Gas 6 in renal cell carcinoma (RCC), especially in papillary RCC (pRCC), which is still unclear. METHODS The patients' sample collection is a joint collaboration of the PANZAR consortium. Patients' medical history and tumor specimens were collected from n = 240 and n = 128 patients with type 1 and 2 pRCC, respectively. Expression of Gas 6 was determined by immunohistochemistry. RESULTS In total, Gas 6 staining was evaluable in 180 of 240 type 1 and 110 of 128 type 2 pRCC cases. Kaplan-Meier analysis disclosed no significant difference in 5-year overall survival for all pRCC nor either subtype. Also, Gas+ and Gas- groups did not significantly differ in any tumor or patient characteristics. CONCLUSION Gas 6 was not found to be an independent prognostic marker in pRCC. Future studies are warranted to determine if Gas 6 plays a role as prognostic marker or therapeutic target in pRCC.
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Affiliation(s)
- Marie Mikuteit
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- Dean’s Office, Curriculum Development, Hannover Medical School, Hannover, Germany
| | - Stefanie Zschäbitz
- Department of Medical Oncology, National Center of Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Christine Stöhr
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), Erlangen, Germany
| | - Edwin Herrmann
- Department of Urology, University Hospital Muenster, Muenster, Germany
| | - Iris Polifka
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), Erlangen, Germany
| | - Lutz Trojan
- Department of Urology, University Hospital Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Department of Pathology, University Hospital Göttingen, Göttingen, Germany
| | - Frank Becker
- Department of Urology and Pediatric Urology, University of Saarland (UKS), Homburg, Germany
| | - Christian Wülfing
- Institute of Pathology, University Hospital Göttingen, Göttingen, Germany
| | - Peter Barth
- Department of Urology, University of Marburg, Marburg, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, University of Saarland (UKS), Homburg, Germany
| | - Michael Staehler
- Department of Urology, University Hospital Munich, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital Munich, Munich, Germany
| | - Axel Haferkamp
- Department of Urology, University Hospital Mainz, Mainz, Germany
| | | | - Stefan Duensing
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Joachim Noldus
- Department of Urology, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Walburgis Brenner
- Clinic for Obstretics and Woman's Health and Department of Urology, University Medical Center, Mainz, Germany
- Department of Urology, University of Mainz, Mainz, Germany
| | - Frederik Roos
- Department of Urology, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Bernhard Walter
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Wolfgang Otto
- Department of Urology, University of Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, University of Regensburg, Regensburg, Germany
| | | | | | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), Erlangen, Germany
| | - Franziska Erlmeier
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), Erlangen, Germany
| | - Sandra Steffens
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- Dean’s Office, Curriculum Development, Hannover Medical School, Hannover, Germany
| | - German Network of Kidney Cancer
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- Dean’s Office, Curriculum Development, Hannover Medical School, Hannover, Germany
- Department of Medical Oncology, National Center of Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), Erlangen, Germany
- Department of Urology, University Hospital Muenster, Muenster, Germany
- Department of Urology, University Hospital Göttingen, Göttingen, Germany
- Department of Pathology, University Hospital Göttingen, Göttingen, Germany
- Department of Urology and Pediatric Urology, University of Saarland (UKS), Homburg, Germany
- Institute of Pathology, University Hospital Göttingen, Göttingen, Germany
- Department of Urology, University of Marburg, Marburg, Germany
- Department of Urology, University Hospital Munich, Munich, Germany
- Department of Urology, University Hospital Mainz, Mainz, Germany
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
- Institute of Pathology, University Hospital Mainz, Mainz, Germany
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Urology, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
- Clinic for Obstretics and Woman's Health and Department of Urology, University Medical Center, Mainz, Germany
- Department of Urology, University of Mainz, Mainz, Germany
- Department of Urology, University Hospital Frankfurt, Frankfurt/Main, Germany
- Department of Urology, University of Regensburg, Regensburg, Germany
- Department of Urology, München Klinik Bogenhausen, Munich, Germany
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16
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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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Duwe G, Boehm K, Haack M, Sparwasser P, Brandt MP, Mager R, Tsaur I, Haferkamp A, Höfner T. Single-center, prospective phase 2 trial of high-intensity focused ultrasound (HIFU) in patients with unilateral localized prostate cancer: good functional results but oncologically not as safe as expected. World J Urol 2023; 41:1293-1299. [PMID: 36920492 PMCID: PMC10188406 DOI: 10.1007/s00345-023-04352-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/26/2023] [Indexed: 03/16/2023] Open
Abstract
PURPOSE Focal therapy (FT) for localized prostate cancer (PCa) is only recommended within the context of clinical trials by international guidelines. We aimed to investigate oncological follow-up and safety data of focal high-intensity focused ultrasound (HIFU) treatment. METHODS We conducted a single-center prospective study of 29 patients with PCa treated with (focal) HIFU between 2016 and 2021. Inclusion criteria were unilateral PCa detected by mpMRI-US-fusion prostate biopsy and maximum prostate specific antigen (PSA) of 15 ng/ml. Follow-up included mpMRI-US fusion-re-biopsies 12 and 24 months after HIFU. No re-treatment of HIFU was allowed. The primary endpoint was failure-free survival (FFS), defined as freedom from intervention due to cancer progression. RESULTS Median follow-up of all patients was 23 months, median age was 67 years and median preoperative PSA was 6.8 ng/ml. One year after HIFU treatment PCa was still detected in 13/ 29 patients histologically (44.8%). Two years after HIFU another 7/29 patients (24.1%) were diagnosed with PCa. Until now, PCa recurrence was detected in 11/29 patients (37.93%) which represents an FFS rate of 62%.One patient developed local metastatic disease 2 years after focal HIFU. Adverse events (AE) were low with 70% of patients remaining with sufficient erectile function for intercourse and 97% reporting full maintenance of urinary continence. CONCLUSION HIFU treatment in carefully selected patients is feasible. However, HIFU was oncologically not as safe as expected because of progression rates of 37.93% and risk of progression towards metastatic disease. Thus, we stopped usage of HIFU in our department.
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Affiliation(s)
- Gregor Duwe
- Department of Urology and Pediatric Urology, University Medical Center Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Katharina Boehm
- Department of Urology, Carl-Gustav-Carus University Medical Center, Dresden, Germany
| | - Maximilian Haack
- Department of Urology and Pediatric Urology, University Medical Center Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Peter Sparwasser
- Department of Urology and Pediatric Urology, University Medical Center Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Maximilian Peter Brandt
- Department of Urology and Pediatric Urology, University Medical Center Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Rene Mager
- Department of Urology and Pediatric Urology, University Medical Center Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medical Center Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Thomas Höfner
- Department of Urology and Pediatric Urology, University Medical Center Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
- Department of Urology, Ordensklinikum Linz Elisabethinen, Linz, Austria
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Sparwasser P, Frey L, Fischer ND, Thomas A, Dotzauer R, Surcel C, Brandt MP, Mager R, Höfner T, Haferkamp A, Tsaur I. First Comparison of Retroperitoneal Versus Transperitoneal Robot-Assisted Nephroureterectomy with Bladder Cuff: A Single Center Study. Ann Surg Oncol 2023:10.1245/s10434-023-13363-0. [PMID: 37099087 DOI: 10.1245/s10434-023-13363-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 04/27/2023]
Abstract
INTRODUCTION After recent presentation of the first complete robot-assisted retroperitoneal nephroureterectomy with bladder cuff (RRNU) for patients with upper tract urothelial cancer (UTUC), we aimed to compare this new surgical technique with robot-assisted transperitoneal nephroureterectomy (TRNU) representing the current standard of care. METHODS Robot-assisted nephroureterectomies (NUs) were retrospectively analyzed and compared based on two groups: transperitoneal versus retroperitoneal approach. Baseline data were collected for patient demographics, tumor characteristics, intra- (EAUiaiC) and postoperative (Clavien-Dindo) complications, and perioperative variables. Tumor characteristics included grade of malignancy, clinical stage, and surgical margin status. Short-term follow-up data including 30-day readmission rates were collected. Statistical analyses were performed assuming a significant p-value of < 0.05. RESULTS The analysis includes perioperative patient data after proven UTUC of 24 TRNU versus 12 RRNU (mean age: 70 versus 71 years; BMI: 25.9 versus 26.1 kg/m2; CCI score ≥ 4: 83% versus 75%; ASA score ≥ 3: 37% vs 33%). Intraoperative (16.4% vs 0%, p = 0.35) and postoperative (25% vs 12.5%, p = 0.64) complications demonstrated no significant discrepancy. Notably, RRNU demonstrated significantly shorter surgery time (p < 0.05) and length of stay (p < 0.05). There was no significant difference in histopathological tumor characteristics, whereas significantly more lymph nodes were removed through RRNU (11.0±3.3 vs. 6.4±5.1, p < 0.05). Finally, no statistical difference was shown in short-term follow-up. CONCLUSION We report the first head-to-head comparison between RRNU and TRNU. RRNU proves to be a safe and feasible approach which appears to be non-inferior to TRNU. RRNU expands the spectrum of minimally invasive treatment options, particularly for patients with major previous abdominal surgery.
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Affiliation(s)
- P Sparwasser
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany.
| | - L Frey
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - N D Fischer
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - A Thomas
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - R Dotzauer
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - C Surcel
- Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - M P Brandt
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - R Mager
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - T Höfner
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - A Haferkamp
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - I Tsaur
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
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Bartsch G, Thomas C, Tsaur I, Schnabel M, Haferkamp A, Gorbulev S, Ruckes C, Kronfeld K. Cabozantinib in patients with locally advanced or metastatic urothelial cell carcinoma who have progressed after cisplatin-based chemotherapy and anti-PD-1/PD-L1 therapy or after anti-PD-1/PD-L1 therapy only. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.525] [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: 03/15/2023] Open
Abstract
525 Background: Cabozantinib inhibits c-Met , AXL, RET, and VEGFR and has been FDA and EMA approved for the treatment of medullary thyroid cancer, hepatocellular carcinoma and renal cell carcinoma. In this trial (NCT04066595) we wanted to gain more insights about the potential of Cabozantinib in patients with advanced urothelial carcinoma (UC) ineligible for cisplatin-based chemotherapy and in patients with chemo and/or PD-1- and PD-L1 resistant UC. Methods: This investigator-sponsored Phase II multicenter single-arm trial assessed ORR to Cabozantinib in patients with locally advanced or metastatic UC, who have been pre-treated with checkpoint inhibitors only (cohort 1) or cisplatin-based chemotherapy and checkpoint inhibitors (cohort 2). Secondary outcome measurements were PFS, OS, CBR, DOR, and patient safety. All radiologic findings were determined using RECIST 1.1. Patients commenced treatment with Cabozantinib 60 mg given per os once per day continuously. Participants continued on trial as long as their cancer was not worsened and side effects were not too severe. For the assessment of side effects the severity was qualified in accordance with NCI CTCAE, version 5.0. The primary outcome measure of ORR was reported as percentages and associated 95% confidence interval for each cohort. For planning Simon's two-stage minimax design (Simon, 1989) was used. A total of 44 patients (total 88 patients) were planned to be included into each cohort. Results: Seven patients were included in cohort 2. The patients in cohort 2 (N = 7) had a median age of 69 y, 6 male patients and one female patient. All patients had an ECOG PS 0 (n=2) or 1 (n=5). All tumors were originated from the urinary bladder, two of them showing histological subtypes. PD-L1 status was available in two patients. Visceral metastases were evident in 3 patients. At December 20th 2021 data cutoff no patient was alive. The overall response rate was 0%. The median progression free survival was 2,9 months (range 1-5,4 months). The median overall survival was 3 months (range 1-18,3 months) 3 patients showed a stable disease. All patients (n=7) revealed TRAEs, 3 patients each (43%) showed endocrine disorders, metabolic and nutrition disorders and nervous system disorders. In 5 patients (71%) respiratory AEs and in 86% (n=6) gastrointestinal AEs were evident. In 86% of patients (n=6) SAEs led to treatment dose reduction or discontinuation. In 43% of patients (n=3) grade 5 SAEs were evident. Treatment-related SAEs were notified in 57% of patients (n=4). Conclusions: Cabozantinib was administered in 7 patients without clinical response. Due to low patient recruitment and no adequate response rates the study was discontinued early. Cabozantinib in this study does not reveal a clinical benefit for patients with metastatic UC with prior chemotherapy and IO. Clinical trial information: NCT04066595 .
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Affiliation(s)
| | | | - Igor Tsaur
- Department of Urology and Pediatric Urology, University of Mainz;, Mainz, Germany
| | - Marco Schnabel
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University of Mainz, Mainz, Germany
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Duwe G, Junker M, Mercier D, Seiz W, Debruin N, Sharma O, Hochheimer A, Scheele J, Dengel A, Haferkamp A, Hoefner T. KITTU: Artificial intelligence supported clinical decisions in uro-oncology – an interdisciplinary study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00564-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Duwe G, Fischer ND, Haack M, Höfner T, Haferkamp A, Brandt MP. Solitary cardiac metastasis of urothelial carcinoma of the urinary bladder with squamous cell differentiation - a rare manifestation. Urol Case Rep 2023; 46:102318. [PMID: 36632283 PMCID: PMC9827352 DOI: 10.1016/j.eucr.2023.102318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/03/2023] Open
Abstract
We present a case of bladder cancer with a singular cardiac metastasis. A 51-year-old female patient was referred to our department for painless macrohematuria. We confirmed the diagnosis of muscle-invasive urothelial carcinoma of the urinary bladder with partial squamous cell differentiation. Computed tomography (CT) staging demonstrated a singular cardiac metastasis. Two months after receiving six cycles of chemotherapy control CT scan revealed massive tumour progression. The singular cardiac metastasis size increased to approximately two thirds of right ventricle size. Singular cardiac metastases of urothelial carcinoma are extremely rare and show rapid progression, hence introduction to therapy should not be delayed.
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Affiliation(s)
- Gregor Duwe
- Corresponding author. Department of Urology and Pediatric Urology, Johannes-Gutenberg University Medical Center, Langenbeckstrasse 1, 55131, Mainz, Germany.
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Boehm K, Fischer ND, Qwaider M, Haferkamp A, Schröder A. Contralateral testicular hypertrophy is associated with a higher incidence of absent testis in children with non-palpable testis. J Pediatr Urol 2022; 19:214.e1-214.e6. [PMID: 36460587 DOI: 10.1016/j.jpurol.2022.11.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of our study is to examine the impact of monorchism on contralateral testicular size in children with non-palpable testis (NPT). Enhanced contralateral testicular volume or longitudinal diameter (length) serves as a predictor of monorchism. In the present study, we assessed the ability of ultrasound measured enlarged contralateral testicular length for predicting monorchism (and hence a testicular nubbin) in children with NPT. Furthermore, we evaluated the general prevalence of viable versus non-viable testes in patients referred to our institution with unilateral undescended testis between 2005 and 2020. STUDY DESIGN We analysed the records of 54 patients who underwent diagnostic laparoscopy for NPT between 2005 and 2020 in a European tertiary care centre. Testicular lengths (longitudinal diameter) and testicular volume of the contralateral testis, as well as surgeon (surgeon 1 vs surgeon 2 vs others) and age at surgery (months) were assessed and stratified according to intraoperative findings (presence or absence of a testicular nubbin). Testicular length and volume were evaluated by ultrasound examination in office prior to surgery. Chi-square and t-test for descriptive analyses as well as uni- and multivariable logistic regression analyses were performed using R Version 3.1.0 (R Project for Statistical Computing, www.R-project.org). RESULTS A total of 15 children presented with viable testes and 39 patients with testicular nubbin. Mean age was 20.5 months in the overall cohort and 22.6 vs 19.7 months in children with viable testis vs testicular nubbin (p = 0.4). In patients with presence of a testicular nubbin, the contralateral testis was larger (median length 17 mm (16-19.2)) as compared to patients with a viable testis (median length 15 mm (14-17), p = 0.001). Similarly, contralateral testicular volume was lower in patients with a present viable testis (0.6 ccm vs 0.8 ccm; p < 0-001). This effect remained statistically significant when logistic regression analyses were adjusted for age and weight at surgery, year of surgery, surgeon, and laterality. OR (odds ratio) for presence of a testicular nubbin was 1.6 (per mm) [95% CI (confidence interval) 1.13-2.17; p = 0.007]. CONCLUSION Patients with preoperative increased length and volume of the contralateral testis in the ultrasound examination are at significantly higher risk of monorchism than their counterparts with lower testicular length. This should be emphasized during counselling of the parents prior to surgery. In our experience parents cope more easily with the diagnosis of monorchism, once this has already been discussed and explained thoroughly prior to surgery.
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Affiliation(s)
- Katharina Boehm
- Department of Urology, University Medical Center, Carl-Gustav-Carus University, Dresden.
| | - Nikita Dhruva Fischer
- Department of Urology and Pediatric Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Mohammad Qwaider
- Department of Urology and Pediatric Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany; Department of Urology, Klinikum Darmstadt, Darmstadt, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Annette Schröder
- Department of Urology and Pediatric Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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Savko O, Kurosch M, Rothe N, Dotzauer R, Haferkamp A, Mager R. Comparative assessment of multiple-tract vs single-tract percutaneous nephrolithotomy. Asian J Endosc Surg 2022; 15:774-780. [PMID: 35676821 DOI: 10.1111/ases.13092] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/02/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To investigate the efficacy and safety of multi-tract percutaneous nephrolithotomy (PNL) against the benchmark of the single-tract approach. METHODS A retrospective analysis of 391 consecutive PNL procedures was conducted in our tertiary referral center between April 2016 and March 2020. Clinical outcome parameters such as stone-free rate, operation time, postoperative complications according to Clavien-Dindo, length of hospital stay and time to ipsilateral recurrence resulting in active treatment were assessed. RESULTS Multi-tract PNL and single-tract PNL were performed in 37 (9%) and 354 (91%) cases respectively. At baseline, compared to single-tract PNL, multi-tract PNL cases were characterized by significantly larger stone burden (2.62 vs 0.97 cm3 , P < .00), lower Hounsfield units (HU) (751 vs 1017 HU, P < .01), a more complex S.T.O.N.E. (size, tract length, obstruction, number of calyces, essence) score (P < .00) and a higher rate of high-risk stone formers (59 vs 19%, P < .00). Analysis of outcome revealed shorter operation time and length of hospital stay for single-tract PNL compared to multi-tract PNL (P < .01). However, the difference in terms of stone-free rates (92% vs 88%), complication rates (43% vs 28%) and time to active retreatment due to ipsilateral recurrence was not statistically significant (P > .05). CONCLUSION In this retrospective single-center analysis, a multi-tract PNL has been proved to be an efficient and safe expansion of single-tract PNL for large stone burden and complex kidney stone disease. Future prospective research should focus on the procedure's potential effectiveness in reducing the number of interventions until stone-free status in patients with massive stone disease.
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Affiliation(s)
- Olga Savko
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Martin Kurosch
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Nina Rothe
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Robert Dotzauer
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Rene Mager
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
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Xie H, Rutz J, Maxeiner S, Grein T, Thomas A, Juengel E, Chun FKH, Cinatl J, Haferkamp A, Tsaur I, Blaheta RA. Plant-Derived Sulforaphane Suppresses Growth and Proliferation of Drug-Sensitive and Drug-Resistant Bladder Cancer Cell Lines In Vitro. Cancers (Basel) 2022; 14:cancers14194682. [PMID: 36230603 PMCID: PMC9564120 DOI: 10.3390/cancers14194682] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary The natural compound sulforaphane is highly popular among tumor patients, since it is suggested to prevent oncogenesis and cancer progression. However, knowledge about its precise mode of action, particularly when drug resistance has been established, remains poor. The present study demonstrates the proliferation-blocking effects of SFN on a panel of drug-resistant bladder cancer cell lines. Abstract Combined cisplatin–gemcitabine (GC) application is standard for treating muscle-invasive bladder cancer. However, since rapid resistance to treatment often develops, many patients turn to supplements in the form of plant-based compounds. Sulforaphane (SFN), derived from cruciferous vegetables, is one such compound, and the present study was designed to investigate its influence on growth and proliferation in a panel of drug-sensitive bladder cancer cell lines, as well as their gemcitabine- and cisplatin-resistant counterparts. Chemo-sensitive and -resistant RT4, RT112, T24, and TCCSUP cell lines were exposed to SFN in different concentrations, and tumor growth, proliferation, and clone formation were evaluated, in addition to apoptosis and cell cycle progression. Means of action were investigated by assaying cell-cycle-regulating proteins and the mechanistic target of rapamycin (mTOR)/AKT signaling cascade. SFN significantly inhibited growth, proliferation, and clone formation in all four tumor cell lines. Cells were arrested in the G2/M and/or S phase, and alteration of the CDK–cyclin axis was closely associated with cell growth inhibition. The AKT/mTOR signaling pathway was deactivated in three of the cell lines. Acetylation of histone H3 was up-regulated. SFN, therefore, does exert tumor-suppressive properties in cisplatin- and gemcitabine-resistant bladder cancer cells and could be beneficial in optimizing bladder cancer therapy.
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Affiliation(s)
- Hui Xie
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany
| | - Jochen Rutz
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Sebastian Maxeiner
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Timothy Grein
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Eva Juengel
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Felix K.-H. Chun
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany
| | - Jindrich Cinatl
- Institute of Medical Virology, University Hospital, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Roman A. Blaheta
- Department of Urology and Pediatric Urology, University Medical Center Mainz, 55131 Mainz, Germany
- Correspondence:
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Zschäbitz S, Mikuteit M, Stöhr C, Herrmann E, Polifka I, Agaimy A, Trojan L, Ströbel P, Becker F, Wülfing C, Barth P, Stöckle M, Staehler M, Stief C, Haferkamp A, Hohenfellner M, Duensing S, Macher-Göppinger S, Wullich B, Noldus J, Brenner W, Roos FC, Walter B, Otto W, Burger M, Schrader AJ, Hartmann A, Erlmeier F, Steffens S. Expression of nectin-4 in papillary renal cell carcinoma. Discov Oncol 2022; 13:90. [PMID: 36136143 PMCID: PMC9500133 DOI: 10.1007/s12672-022-00558-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/13/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Nectin-4 contributes to tumor proliferation, lymphangiogenesis and angiogenesis in malignant tumors and is an emerging target in tumor therapy. In renal cell carcinoma (RCC) VEGF-directed tyrosine kinase inhibitors and checkpoint inhibitors are currently treatments of choice. Enfortumab vedotin-ejf (EV) is an antibody drug conjugate that targets Nectin-4. The aim of our study was to investigate the expression of Nectin-4 in a large cohort of papillary RCC specimens. PATIENTS AND METHODS Specimens were derived from the PANZAR consortium (Erlangen, Heidelberg, Herne, Homburg, Mainz, Mannheim, Marburg, Muenster, LMU Munich, TU Munich, and Regensburg). Clinical data and tissue samples from n = 190 and n = 107 patients with type 1 and 2 pRCC, respectively, were available. Expression of Nectin-4 was determined by immunohistochemistry (IHC). RESULTS In total, Nectin-4 staining was moderately or strongly positive in of 92 (48.4%) of type 1 and 39 (36.4%) type 2 of pRCC cases. No associations between Nectin-4 expression and age at diagnosis, gender, grading, and TNM stage was found. 5 year overall survival rate was not statistically different in patients with Nectin-4 negative versus Nectin-4 positive tumors for the overall cohort and the pRCC type 2 subgroup, but higher in patient with Nectin-4 positive pRCC type 1 tumors compared to Nectin-4 negative tumors (81.3% vs. 67.8%, p = 0.042). CONCLUSION Nectin-4 could not be confirmed as a prognostic marker in pRCC in general. Due to its high abundance on pRCC specimens Nectin-4 is an interesting target for therapeutical approaches e.g. with EV. Clinical trials are warranted to elucidate its role in the pRCC treatment landscape.
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Affiliation(s)
- Stefanie Zschäbitz
- Dept. of Medical Oncology, National Center of Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Marie Mikuteit
- Department of Rheumatology and Immunology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Dean’s Office – Curriculum Development, Hanover Medical School, 30625 Hannover, Germany
| | - Christine Stöhr
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), 91054 Erlangen, Germany
| | - Edwin Herrmann
- Department of Urology, University Hospital Muenster, 48149 Muenster, Germany
- Present Address: Institute of Urology, Prosper-Hospital GmbH, 45659 Recklinghausen, Germany
| | - Iris Polifka
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), 91054 Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), 91054 Erlangen, Germany
| | - Lutz Trojan
- Department of Urology, University Hospital Göttingen, 37075 Göttingen, Germany
| | - Philipp Ströbel
- Department of Pathology, University Hospital Göttingen, 37075 Göttingen, Germany
| | - Frank Becker
- Department of Urology and Pediatric Urology, University of Saarland (UKS), 66421 Homburg, Germany
- Present Address: Urological Group and Clinic Derouet/Pönicke/Becker, Boxberg Centre, 66538 Neunkirchen, Germany
| | - Christian Wülfing
- Department of Urology, University Hospital Muenster, 48149 Muenster, Germany
- Present Address: Department of Urology, Asklepios Clinics Altona, 22763 Hamburg, Germany
| | - Peter Barth
- Department of Urology, University of Marburg, 35037 Marburg, Germany
- Present Address: Institute of Pathology/Gerhard-Domagk Institute, University Hospital Muenster, 48149 Muenster, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, University of Saarland (UKS), 66421 Homburg, Germany
| | - Michael Staehler
- Department of Urology, University Hospital Munich, 81337 Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital Munich, 81337 Munich, Germany
| | - Axel Haferkamp
- Department of Urology, University Hospital Mainz, 55131 Mainz, Germany
- Present Address: Department of Urology and Pediatric Urology, University Hospital Mainz, 55131 Mainz, Germany
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Stefan Duensing
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | | | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Joachim Noldus
- Department of Urology, Marien Hospital Herne, Ruhr University Bochum, 44625 Herne, Germany
| | - Walburgis Brenner
- Department of Urology, University Hospital Mainz, 55131 Mainz, Germany
- Present Address: Department of Gynecology, University of Mainz, 55131 Mainz, Germany
| | - Frederik C. Roos
- Department of Urology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Bernhard Walter
- Department of Urology and Pediatric Urology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Present Address: Department of Urology, Kreiskliniken Altötting-Burghausen, 84489 Burghausen, Germany
| | - Wolfgang Otto
- Department of Urology, Caritas St. Josef and University, 93053 Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef and University, 93053 Regensburg, Germany
| | - Andres Jan Schrader
- Department of Urology, University Hospital Muenster, 48149 Muenster, Germany
- Present Address: Department of Rheumatology and Immunology, Medical School Hannover, 30625 Hannover, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), 91054 Erlangen, Germany
| | - Franziska Erlmeier
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), 91054 Erlangen, Germany
| | - Sandra Steffens
- Department of Rheumatology and Immunology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Dean’s Office – Curriculum Development, Hanover Medical School, 30625 Hannover, Germany
- Present Address: Department of Rheumatology and Immunology, Hanover Medical School, 30625 Hannover, Germany
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Hüsch T, Ober S, Haferkamp A, Naumann G, Tunn R, Saar M, Kranz J. Comparison of online health information between different digital platforms for pelvic organ prolapse. World J Urol 2022; 40:2529-2534. [PMID: 36006445 PMCID: PMC9512708 DOI: 10.1007/s00345-022-04129-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/07/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To identify differences in the content and quality of online health information for pelvic organ prolapse (POP) presented in social media and digital search engines to sustainably enhance patient guidance for adequate platforms for seeking online health information on POP. Methods The platforms Google search, Facebook, Instagram, LinkedIn, and YouTube were searched for the keyword “pelvic organ prolapse”. Results were categorized as useful, misleading, advertising, and personal experience. Data were categorized into healthcare professionals, professional organisations, industry, patients, and individuals. The readability score and Health On the Net (HON) code seal were analyzed for Google. Descriptive and univariate analysis was performed. Results The source with the highest quantity of useful content was YouTube whereas LinkedIn included mostly advertisement and misleading content. YouTube and Google provided the greatest variety of health information. Social media platforms identified emotional distress and sleep disturbances as a common side effect of POP which is limited considered in clinical practice and provide novel insights of bothersome symptoms related to the disease. The spectrum of different surgical techniques was limited in all platforms. Only 12 (40.0%) were HON-qualified websites with a mean readability score of 10.4 which is considered fairly difficult to read. Conclusion Besides Google search, YouTube was identified as a valuable online source for POP information. However, encompassing information of surgical techniques was limited in all platforms. Urogynecological association may contribute to improve patient information by providing online health information which is complete and easy to understand. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-04129-6.
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Affiliation(s)
- Tanja Hüsch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Sita Ober
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.,Department of Obstetrics and Gynecology, Hospital Darmstadt, Darmstadt, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Gert Naumann
- Department of Gynecology and Obstetrics, Helios Hospital Erfurt, Erfurt, Germany
| | - Ralf Tunn
- Department of Urogynecology, St. Hedwig Hospital, Berlin, Germany
| | - Matthias Saar
- Department of Urology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jennifer Kranz
- Department of Urology, University Hospital RWTH Aachen, Aachen, Germany.,Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
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Sparwasser P, Haack M, Frey L, Boehm K, Boedecker C, Huber T, Stroh K, Brandt MP, Mager R, Höfner T, Tsaur I, Haferkamp A, Borgmann H. Assessment of a novel smartglass-based point-of-care fusion approach for mixed reality-assisted targeted prostate biopsy: A pilot proof-of-concept study. Front Surg 2022; 9:892170. [PMID: 35937598 PMCID: PMC9354482 DOI: 10.3389/fsurg.2022.892170] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose While several biopsy techniques and platforms for magnetic resonance imaging (MRI)-guided targeted biopsy of the prostate have been established, none of them has proven definite superiority. Augmented and virtual reality (mixed reality) smartglasses have emerged as an innovative technology to support image-guidance and optimize accuracy during medical interventions. We aimed to investigate the benefits of smartglasses for MRI-guided mixed reality-assisted cognitive targeted biopsy of the prostate. Methods For prospectively collected patients with suspect prostate PIRADS lesions, multiparametric MRI was uploaded to a smartglass (Microsoft® Hololens I), and smartglass-assisted targeted biopsy (SMART TB) of the prostate was executed by generation of a cognitive fusion technology at the point-of-care. Detection rates of prostate cancer (PCA) were compared between SMART TB and 12-core systematic biopsy. Assessment of SMART-TB was executed by the two performing surgeons based on 10 domains on a 10-point scale ranging from bad (1) to excellent (10). Results SMART TB and systematic biopsy of the prostate were performed for 10 patients with a total of 17 suspect PIRADS lesions (PIRADS 3, n = 6; PIRADS 4, n = 6; PIRADS 5, n = 5). PCA detection rate per core was significant (p < 0.05) higher for SMART TB (47%) than for systematic biopsy (19%). Likelihood for PCA according to each core of a PIRADS lesion (17%, PIRADS 3; 58%, PIRADS 4; 67%, PIRADS 5) demonstrated convenient accuracy. Feasibility scores for SMART TB were high for practicality (10), multitasking (10), execution speed (9), comfort (8), improvement of surgery (8) and image quality (8), medium for physical stress (6) and device handling (6) and low for device weight (5) and battery autonomy (4). Conclusion SMART TB has the potential to increase accuracy for PCA detection and might enhance cognitive MRI-guided targeted prostate biopsy in the future.
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Affiliation(s)
- P. Sparwasser
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
- Correspondence: Peter Sparwasser
| | - M. Haack
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - L. Frey
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - K. Boehm
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - C. Boedecker
- Department of General, Visceral and Transplant Surgery, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - T. Huber
- Department of General, Visceral and Transplant Surgery, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - K. Stroh
- Department of Radiology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - M. P. Brandt
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - R. Mager
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - T. Höfner
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - I. Tsaur
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - A. Haferkamp
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - H. Borgmann
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
- Department of Urology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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Brandt MP, Goller J, Staatz G, GROßMANN A, Fischer N, Haferkamp A, Stein R, Schröder A. A comparison of patient and parental experiences and diagnostic quality of suprapubic versus transurethral voiding cystourethrogram in children. Minerva Pediatr (Torino) 2022:S2724-5276.22.06824-0. [PMID: 35785922 DOI: 10.23736/s2724-5276.22.06824-0] [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: 02/18/2024]
Abstract
INTRODUCTION Voiding cystourethrogram (VCUG) used in the radiologic evaluation of the upper and lower urinary tract can be performed by suprapubic puncture (SP) or by transurethral catheterization (TC). Data on which instillation technique is superior are scarce. VCUG tends to be a distressing procedure for both parents and children. METHODS We evaluated the experience of VCUG analyzing 417 families with focus on contrast medium instillation in groups of single and repeated VCUGs and assessed quality and complication rate. The median age of children who had undergone VCUG was 38.6 months (0 - 159 months). Satisfaction with informed consent (IC), degree of fear and pain in parents and children prior and during VCUG were recorded. VCUG was compared to blood withdrawal and vaccination. RESULTS Satisfaction with IC was higher for repeated VCUG (p= 0.024) which resulted in a lower degree of fear in parents and children. The fear of children during VCUG was lower when SP was performed rather than TC. This was in contrast to parental fear of SP (all p< 0.05). In repeated VCUGs, children who underwent SP were less afraid. Better diagnostic quality was more commonly reported with SP, yet the complication rate was higher (p=0.035). CONCLUSIONS Our study highlights the importance of IC as a pivotal necessity before VCUG is conducted. SP might be beneficial over TC in terms of fear and distress in the case of repeated VCUGs. Diagnostic quality is comparable, both methods are safe and complications are low.
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Affiliation(s)
- Maximilian P Brandt
- Department of Urology and Pediatric Urology, Mainz University Medical Center, Mainz, Germany
| | - Julia Goller
- Department of Urology and Pediatric Urology, Mainz University Medical Center, Mainz, Germany
| | - Gundula Staatz
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology, Mainz University Medical Center, Mainz, Germany
| | - Allegra GROßMANN
- Department of Urology and Pediatric Urology, Mainz University Medical Center, Mainz, Germany
| | - Nikita Fischer
- Department of Urology and Pediatric Urology, Mainz University Medical Center, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, Mainz University Medical Center, Mainz, Germany
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University of Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Annette Schröder
- Department of Urology and Pediatric Urology, Mainz University Medical Center, Mainz, Germany -
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29
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Becker C, Burger M, Haferkamp A. [Research management and promoting young academics in the DGU]. Urologie 2022; 61:715-721. [PMID: 35925242 DOI: 10.1007/s00120-022-01853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Christoph Becker
- Forschungskoordination, Deutsche Gesellschaft für Urologie (DGU) e. V., Uerdinger Str. 64, 40474, Düsseldorf, Deutschland.
- Forschungskoordination, Deutsche Gesellschaft für Urologie, Berlin, Deutschland.
| | - Maximilian Burger
- Klinik für Urologie, Caritas-Krankenhaus St. Josef, Universität Regensburg, Regensburg, Deutschland
| | - Axel Haferkamp
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Mainz, Deutschland
- Ressort Forschungsförderung, Deutsche Gesellschaft für Urologie, Düsseldorf, Deutschland
- Ressort Forschungsförderung, Deutsche Gesellschaft für Urologie, Berlin, Deutschland
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Tsaur I, Thomas A, Monecke M, Zugelder M, Rutz J, Grein T, Maxeiner S, Xie H, Chun FKH, Rothweiler F, Cinatl J, Michaelis M, Haferkamp A, Blaheta RA. Amygdalin Exerts Antitumor Activity in Taxane-Resistant Prostate Cancer Cells. Cancers (Basel) 2022; 14:cancers14133111. [PMID: 35804883 PMCID: PMC9265127 DOI: 10.3390/cancers14133111] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 05/29/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Despite recent advances in the treatment of metastatic prostate cancer (PCa), resistance development after taxane treatments is inevitable, necessitating effective options to combat drug resistance. Previous studies indicated antitumoral properties of the natural compound amygdalin. However, whether amygdalin acts on drug-resistant tumor cells remains questionable. An in vitro study was performed to investigate the influence of amygdalin (10 mg/mL) on the growth of a panel of therapy-naïve and docetaxel- or cabazitaxel-resistant PCa cell lines (PC3, DU145, and LNCaP cells). Tumor growth, proliferation, clonal growth, and cell cycle progression were investigated. The cell cycle regulating proteins (phospho)cdk1, (phospho)cdk2, cyclin A, cyclin B, p21, and p27 and the mammalian target of rapamycin (mTOR) pathway proteins (phospho)Akt, (phospho)Raptor, and (phospho)Rictor as well as integrin β1 and the cytoskeletal proteins vimentin, ezrin, talin, and cytokeratin 8/18 were assessed. Furthermore, chemotactic activity and adhesion to extracellular matrix components were analyzed. Amygdalin dose-dependently inhibited tumor growth and reduced tumor clones in all (parental and resistant) PCa cell lines, accompanied by a G0/G1 phase accumulation. Cell cycle regulating proteins were significantly altered by amygdalin. A moderate influence of amygdalin on tumor cell adhesion and chemotaxis was observed as well, paralleled by modifications of cytoskeletal proteins and the integrin β1 expression level. Amygdalin may, therefore, block tumor growth and disseminative characteristics of taxane-resistant PCa cells. Further studies are warranted to determine amygdalin’s value as an antitumor drug.
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Affiliation(s)
- Igor Tsaur
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (I.T.); (A.H.); (R.A.B.)
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (I.T.); (A.H.); (R.A.B.)
- Correspondence: ; Tel.: +49-6131-172312; Fax: +49-6131-173827
| | - Michelle Monecke
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany; (M.M.); (M.Z.); (J.R.); (T.G.); (S.M.); (H.X.); (F.K.-H.C.)
| | - Marion Zugelder
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany; (M.M.); (M.Z.); (J.R.); (T.G.); (S.M.); (H.X.); (F.K.-H.C.)
| | - Jochen Rutz
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany; (M.M.); (M.Z.); (J.R.); (T.G.); (S.M.); (H.X.); (F.K.-H.C.)
| | - Timothy Grein
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany; (M.M.); (M.Z.); (J.R.); (T.G.); (S.M.); (H.X.); (F.K.-H.C.)
| | - Sebastian Maxeiner
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany; (M.M.); (M.Z.); (J.R.); (T.G.); (S.M.); (H.X.); (F.K.-H.C.)
| | - Hui Xie
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany; (M.M.); (M.Z.); (J.R.); (T.G.); (S.M.); (H.X.); (F.K.-H.C.)
| | - Felix K.-H. Chun
- Department of Urology, Goethe-University, 60590 Frankfurt am Main, Germany; (M.M.); (M.Z.); (J.R.); (T.G.); (S.M.); (H.X.); (F.K.-H.C.)
| | - Florian Rothweiler
- Institute of Medical Virology, Goethe-University, 60596 Frankfurt am Main, Germany; (F.R.)
- Petra Joh-Forschungshaus, 60528 Frankfurt am Main, Germany
| | - Jindrich Cinatl
- Institute of Medical Virology, Goethe-University, 60596 Frankfurt am Main, Germany; (F.R.)
- Petra Joh-Forschungshaus, 60528 Frankfurt am Main, Germany
| | - Martin Michaelis
- Industrial Biotechnology Centre, School of Biosciences, University of Kent, Canterbury CT2 7NJ, UK;
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (I.T.); (A.H.); (R.A.B.)
| | - Roman A. Blaheta
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (I.T.); (A.H.); (R.A.B.)
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Juengel E, Markowitsch SD, Vakhrusheva O, Akele Y, Kitanovic J, Schupp P, Slade KS, Thomas A, Tsaur I, Mager R, Efferth T, Haferkamp A. Abstract 5384: Cell growth of sunitinib-resistant renal cell carcinoma was inhibited by Shikonin through necroptosis induction and Akt/mTOR signaling inhibition. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5384] [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
Despite the establishment of new therapy options during the last decades, advanced renal cell carcinoma (RCC) remains an uncurable disease, due to evolving drug-resistance. New, more efficient treatment strategies are still in urgent demand. Shikonin (SHI) from Traditional Chinese Medicine has exhibited anti-tumor properties in several tumor entities. Thus, in the current investigation we evaluated the impact of SHI on progressive growth and metastatic behavior, not only in therapy-sensitive (parental) but also in therapy-resistant RCC cells. Parental and sunitinib-resistant RCC cells, Caki-1, 786-O, KTCTL-26, and A498, were treated with SHI. Tumor cell growth, proliferation, clonogenic capacity, cell cycle phase distribution, induction of cell death (apoptosis and necroptosis) and the expression and activity of regulating and signaling proteins were evaluated. Moreover, the adhesion and chemotactic activity of the RCC cells after exposure to SHI were investigated. SHI did not affect cell motility but led to significant inhibition of progressive tumor cell growth in both therapy-sensitive and therapy-resistant RCC cells. Thereby, SHI significantly inhibited the growth, proliferation and clone formation in parental and sunitinib-resistant RCC cells by G2/M phase arrest through down-regulation of cell cycle activating proteins, blocking cell division. Furthermore, SHI induced apoptosis and necroptosis by activating necrosome complex proteins. Concomitantly, SHI impaired the Akt/mTOR pathway, pivotal for cell survival and growth. Thus, SHI may hold promise as an additive option in treating patients with advanced and therapy-resistant RCC.
Citation Format: Eva Juengel, Sascha D. Markowitsch, Olesya Vakhrusheva, Yasminn Akele, Jovanna Kitanovic, Patricia Schupp, Kimberly S. Slade, Anita Thomas, Igor Tsaur, Rene Mager, Thomas Efferth, Axel Haferkamp. Cell growth of sunitinib-resistant renal cell carcinoma was inhibited by Shikonin through necroptosis induction and Akt/mTOR signaling inhibition [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5384.
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Affiliation(s)
- Eva Juengel
- 1University Medical Center Mainz, Mainz, Germany
| | | | | | | | | | | | | | - Anita Thomas
- 1University Medical Center Mainz, Mainz, Germany
| | - Igor Tsaur
- 1University Medical Center Mainz, Mainz, Germany
| | - Rene Mager
- 1University Medical Center Mainz, Mainz, Germany
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Mondorf Y, Mikuteit M, Ivanyi P, Stöhr C, Herrmann E, Polifka I, Agaimy A, Trojan L, Ströbel P, Becker F, Wülfing C, Barth P, Stöckle M, Staehler M, Stief CG, Haferkamp A, Hohenfellner M, Macher-Göppinger S, Wullich B, Noldus J, Brenner W, Roos FC, Walter B, Otto W, Burger M, Schrader AJ, Hartmann A, Steffens S, Erlmeier F. The Prognostic Impact of PD-L2 in Papillary Renal-Cell Carcinoma. Urol Int 2022; 106:1168-1176. [PMID: 35654002 DOI: 10.1159/000525016] [Citation(s) in RCA: 1] [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] [Received: 01/04/2022] [Accepted: 05/05/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Programmed death-1 ligand (PD-L1) has been often studied in different types of renal-cell carcinoma (RCC). For example, in clear-cell renal carcinoma it is well established that programmed death-1 receptor and PD-L1 are important prognostic markers. In contrast, the role of programmed death-2 ligand (PD-L2) as prognostic marker remains unclear. The aim of this study was to evaluate if PD-L2 expression could play a role as a prognostic marker for papillary RCC (pRCC). METHODS The patients' sample collection was a joint collaboration of the PANZAR consortium. Patients' medical history and tumor specimens were collected from n = 240 and n = 128 patients with type 1 and 2 pRCC, respectively. Expression of PD-L2 was determined by immunohistochemistry. In total, PD-L2 staining was evaluable in 185 of 240 type 1 and 99 of 128 type 2 pRCC cases. RESULTS PD-L2 staining was positive in 67 (36.2%) of type 1 and in 31 (31.3%) of type 2 pRCC specimens. The prevalence of PD-L2+ cells was significantly higher in high-grade type 1 tumors (p = 0.019) and in type 2 patients with metastasis (p = 0.002). Kaplan-Meier analysis disclosed significant differences in 5-year overall survival (OS) for patients with PD-L2- compared to PD-L2+ in pRCC type 1 of 88.4% compared to 73.6% (p = 0.039) and type 2 of 78.8% compared to 39.1% % (p < 0.001). However, multivariate analysis did not identify the presence of PD-L2+ cells neither in type 1 nor type 2 pRCC as an independent predictor of poor OS. DISCUSSION/CONCLUSION PD-L2 expression did not qualify as an independent prognostic marker in pRCC. Future studies will have to determine whether anti-PD-L2-targeted treatment may play a role in pRCC and expression can potentially serve as a predictive marker for these therapeutic approaches.
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Affiliation(s)
- Yvonne Mondorf
- Department of Neurology and Neurorehabilitation, BDH Hospital Hessisch Oldendorf, Hessisch Oldendorf, Germany
| | - Marie Mikuteit
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Philipp Ivanyi
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Christine Stöhr
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), Erlangen, Germany
| | - Edwin Herrmann
- Department of Urology, University Hospital Münster, Münster, Germany
| | - Iris Polifka
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), Erlangen, Germany
| | - Lutz Trojan
- Department of Urology, University Hospital Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Department of Pathology, University Hospital Göttingen, Göttingen, Germany
| | - Frank Becker
- Department of Urology and Pediatric Urology, University Hospital Saarland (UKS), Homburg, Germany
| | - Christian Wülfing
- Department of Urology, University Hospital Münster, Münster, Germany
| | - Peter Barth
- Department of Urology, University Hospital Marburg, Marburg, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, University Hospital Saarland (UKS), Homburg, Germany
| | - Michael Staehler
- Department of Urology, University Hospital Munich, Munich, Germany
| | | | - Axel Haferkamp
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Joachim Noldus
- Department of Urology, Marien-Hospital Herne, Ruhr University Bochum, Herne, Germany
| | | | - Frederik C Roos
- Department of Urology, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Bernhard Walter
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Wolfgang Otto
- Department of Urology, University Hospital Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, University Hospital Regensburg, Regensburg, Germany
| | | | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), Erlangen, Germany
| | - Sandra Steffens
- Department of Urology, University Hospital Münster, Münster, Germany.,Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Franziska Erlmeier
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), Erlangen, Germany
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Sparwasser P, Haack M, Epple S, Frey L, Zeymer S, Dotzauer R, Jungmann F, Böhm K, Höfner T, Tsaur I, Haferkamp A, Borgmann H. Smartglass augmented reality-assisted targeted prostate biopsy using cognitive point-of-care fusion technology. Int J Med Robot 2022; 18:e2366. [PMID: 35034415 DOI: 10.1002/rcs.2366] [Citation(s) in RCA: 2] [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: 09/22/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION MRI-guided targeted biopsy has become standard of care for diagnosis of prostate cancer, with establishment of several biopsy techniques and platforms. Augmented reality smart glasses have emerged as novel technology to support image-guided interventions. We aimed to investigate its usage while prostate biopsy. METHODS MRI with PIRADS-lesions ≥3 was uploaded to smart glasses (Vuzix BladeR ) and augmented reality smart glasses-assisted targeted biopsy (SMART-TB) of the prostate was performed using cognitive fusion technology at the point of care. Detection rates were compared to systematic biopsy. Feasibility for SMART-TB was assessed (10 domains from bad [1] to excellent [10]). RESULTS SMART-TB was performed for four patients. Prostate cancer detection was more likely for SMART-TB (46%; 13/28) than for systematic biopsy (27%; 13/48). Feasibility scores were high [8-10] for practicality, multitasking, execution speed, comfort and device weight and low [1-4] for handling, battery and image quality. Median execution time: 28 min; Investment cost smart glass: 1017 USD. CONCLUSION First description of SMART-TB demonstrated convenient feasibility. This novel technology might enhance diagnosis of prostate cancer in future.
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Affiliation(s)
- Peter Sparwasser
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Maximilian Haack
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Stefan Epple
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Lisa Frey
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Steffen Zeymer
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Robert Dotzauer
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Florian Jungmann
- Department of Radiology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Katharina Böhm
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Höfner
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Igor Tsaur
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Hendrik Borgmann
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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Thomas A, Slade KS, Blaheta RA, Markowitsch SD, Stenzel P, Tagscherer KE, Roth W, Schindeldecker M, Michaelis M, Rothweiler F, Cinatl J, Dotzauer R, Vakhrusheva O, Albersen M, Haferkamp A, Juengel E, Cinatl J, Tsaur I. Value of c-MET and Associated Signaling Elements for Predicting Outcomes and Targeted Therapy in Penile Cancer. Cancers (Basel) 2022; 14:cancers14071683. [PMID: 35406455 PMCID: PMC8997038 DOI: 10.3390/cancers14071683] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary No relevant improvement in patient outcomes could be achieved in the last decade in metastasized penile cancer due to insufficient identification of molecular hubs crucial for tumor evolution. We investigated the potential of the cellular receptor c-MET and selected other proteins linked to its activity to predict outcomes and for exploitation in targeted treatment. Assessing tumor tissue as well as primary cells both naïve and resistant to systemic drugs, we illustrate the most promising role of c-MET. Indeed, its elevated expression was strongly associated with inferior tumor-related survival. Moreover, its upregulation in treatment-resistant cell lines compared to naïve cells was observed. Treating cell lines with the c-MET inhibitors cabozantinib and tivantinib mediated an effective decrease in cell growth, while the first agent was more efficacious in the naïve cells and the second agent in the resistant cells. Therefore, c-MET blockade warrants further investigation in the setting of metastasized penile cancer. Abstract Whereas the lack of biomarkers in penile cancer (PeCa) impedes the development of efficacious treatment protocols, preliminary evidence suggests that c-MET and associated signaling elements may be dysregulated in this disorder. In the following study, we investigated whether c-MET and associated key molecular elements may have prognostic and therapeutic utility in PeCa. Formalin-fixed, paraffin-embedded tumor tissue from therapy-naïve patients with invasive PeCa was used for tissue microarray (TMA) analysis. Immunohistochemical staining was performed to determine the expression of the proteins c-MET, PPARg, β-catenin, snail, survivin, and n-MYC. In total, 94 PeCa patients with available tumor tissue were included. The median age was 64.9 years. High-grade tumors were present in 23.4%, and high-risk HPV was detected in 25.5%. The median follow-up was 32.5 months. High expression of snail was associated with HPV-positive tumors. Expression of β-catenin was inversely associated with grading. In both univariate COX regression analysis and the log-rank test, an increased expression of PPARg and c-MET was predictive of inferior disease-specific survival (DSS). Moreover, in multivariate analysis, a higher expression of c-MET was independently associated with worse DSS. Blocking c-MET with cabozantinib and tivantinib induced a significant decrease in viability in the primary PeCa cell line UKF-PeC3 isolated from the tumor tissue as well as in cisplatin- and osimertinib-resistant sublines. Strikingly, a higher sensitivity to tivantinib could be detected in the latter, pointing to the promising option of utilizing this agent in the second-line treatment setting.
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Affiliation(s)
- Anita Thomas
- Department of Urology and Pediatric Urology, University Medicine Mainz, 55131 Mainz, Germany; (K.S.S.); (R.A.B.); (S.D.M.); (R.D.); (O.V.); (A.H.); (E.J.); (I.T.)
- Correspondence: ; Tel.: +49-6131-172312; Fax: +49-6131-173827
| | - Kimberly Sue Slade
- Department of Urology and Pediatric Urology, University Medicine Mainz, 55131 Mainz, Germany; (K.S.S.); (R.A.B.); (S.D.M.); (R.D.); (O.V.); (A.H.); (E.J.); (I.T.)
| | - Roman A. Blaheta
- Department of Urology and Pediatric Urology, University Medicine Mainz, 55131 Mainz, Germany; (K.S.S.); (R.A.B.); (S.D.M.); (R.D.); (O.V.); (A.H.); (E.J.); (I.T.)
| | - Sascha D. Markowitsch
- Department of Urology and Pediatric Urology, University Medicine Mainz, 55131 Mainz, Germany; (K.S.S.); (R.A.B.); (S.D.M.); (R.D.); (O.V.); (A.H.); (E.J.); (I.T.)
| | - Philipp Stenzel
- Department of Pathology, University Medicine Mainz, 55131 Mainz, Germany; (P.S.); (K.E.T.); (W.R.); (M.S.)
| | - Katrin E. Tagscherer
- Department of Pathology, University Medicine Mainz, 55131 Mainz, Germany; (P.S.); (K.E.T.); (W.R.); (M.S.)
| | - Wilfried Roth
- Department of Pathology, University Medicine Mainz, 55131 Mainz, Germany; (P.S.); (K.E.T.); (W.R.); (M.S.)
| | - Mario Schindeldecker
- Department of Pathology, University Medicine Mainz, 55131 Mainz, Germany; (P.S.); (K.E.T.); (W.R.); (M.S.)
| | - Martin Michaelis
- Industrial Biotechnology Centre, School of Biosciences, University of Kent, Canterbury CT2 7NJ, UK;
| | - Florian Rothweiler
- Institute of Medical Virology, Goethe-University, 60596 Frankfurt am Main, Germany; (F.R.); (J.C.); (J.C.J.)
- Dr. Petra Joh-Forschungshaus, 60528 Frankfurt am Main, Germany
| | - Jaroslav Cinatl
- Institute of Medical Virology, Goethe-University, 60596 Frankfurt am Main, Germany; (F.R.); (J.C.); (J.C.J.)
| | - Robert Dotzauer
- Department of Urology and Pediatric Urology, University Medicine Mainz, 55131 Mainz, Germany; (K.S.S.); (R.A.B.); (S.D.M.); (R.D.); (O.V.); (A.H.); (E.J.); (I.T.)
| | - Olesya Vakhrusheva
- Department of Urology and Pediatric Urology, University Medicine Mainz, 55131 Mainz, Germany; (K.S.S.); (R.A.B.); (S.D.M.); (R.D.); (O.V.); (A.H.); (E.J.); (I.T.)
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, 28046 Leuven, Belgium;
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medicine Mainz, 55131 Mainz, Germany; (K.S.S.); (R.A.B.); (S.D.M.); (R.D.); (O.V.); (A.H.); (E.J.); (I.T.)
| | - Eva Juengel
- Department of Urology and Pediatric Urology, University Medicine Mainz, 55131 Mainz, Germany; (K.S.S.); (R.A.B.); (S.D.M.); (R.D.); (O.V.); (A.H.); (E.J.); (I.T.)
| | - Jindrich Cinatl
- Institute of Medical Virology, Goethe-University, 60596 Frankfurt am Main, Germany; (F.R.); (J.C.); (J.C.J.)
- Dr. Petra Joh-Forschungshaus, 60528 Frankfurt am Main, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medicine Mainz, 55131 Mainz, Germany; (K.S.S.); (R.A.B.); (S.D.M.); (R.D.); (O.V.); (A.H.); (E.J.); (I.T.)
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Mikuteit M, Zschäbitz S, Stöhr C, Herrmann E, Polifka I, Agaimy A, Trojan L, Ströbel P, Becker F, Wülfing C, Barth P, Stöckle M, Staehler M, Stief C, Haferkamp A, Hohenfellner M, Macher-Göppinger S, Wullich B, Noldus J, Brenner W, Roos FC, Walter B, Otto W, Burger M, Schrader AJ, Hartmann A, Steffens S, Erlmeier F. The prognostic impact of Claudin 6 in papillary renal cell carcinoma. Pathol Res Pract 2022; 231:153802. [DOI: 10.1016/j.prp.2022.153802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 11/25/2022]
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Markowitsch SD, Vakhrusheva O, Schupp P, Akele Y, Kitanovic J, Slade KS, Efferth T, Thomas A, Tsaur I, Mager R, Haferkamp A, Juengel E. Shikonin Inhibits Cell Growth of Sunitinib-Resistant Renal Cell Carcinoma by Activating the Necrosome Complex and Inhibiting the AKT/mTOR Signaling Pathway. Cancers (Basel) 2022; 14:cancers14051114. [PMID: 35267423 PMCID: PMC8909272 DOI: 10.3390/cancers14051114] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 02/01/2023] Open
Abstract
Therapy resistance remains a major challenge in treating advanced renal cell carcinoma (RCC), making more effective treatment strategies crucial. Shikonin (SHI) from traditional Chinese medicine has exhibited antitumor properties in several tumor entities. We, therefore, currently investigated SHI's impact on progressive growth and metastatic behavior in therapy-sensitive (parental) and therapy-resistant Caki-1, 786-O, KTCTL-26, and A498 RCC cells. Tumor cell growth, proliferation, clonogenic capacity, cell cycle phase distribution, induction of cell death (apoptosis and necroptosis), and the expression and activity of regulating and signaling proteins were evaluated. Moreover, the adhesion and chemotactic activity of the RCC cells after exposure to SHI were investigated. SHI significantly inhibited the growth, proliferation, and clone formation in parental and sunitinib-resistant RCC cells by G2/M phase arrest through down-regulation of cell cycle activating proteins. Furthermore, SHI induced apoptosis and necroptosis by activating necrosome complex proteins. Concomitantly, SHI impaired the AKT/mTOR pathway. Adhesion and motility were cell line specifically affected by SHI. Thus, SHI may hold promise as an additive option in treating patients with advanced and therapy-resistant RCC.
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Affiliation(s)
- Sascha D. Markowitsch
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.D.M.); (O.V.); (P.S.); (Y.A.); (J.K.); (K.S.S.); (A.T.); (I.T.); (R.M.); (A.H.)
| | - Olesya Vakhrusheva
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.D.M.); (O.V.); (P.S.); (Y.A.); (J.K.); (K.S.S.); (A.T.); (I.T.); (R.M.); (A.H.)
| | - Patricia Schupp
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.D.M.); (O.V.); (P.S.); (Y.A.); (J.K.); (K.S.S.); (A.T.); (I.T.); (R.M.); (A.H.)
| | - Yasminn Akele
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.D.M.); (O.V.); (P.S.); (Y.A.); (J.K.); (K.S.S.); (A.T.); (I.T.); (R.M.); (A.H.)
| | - Jovana Kitanovic
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.D.M.); (O.V.); (P.S.); (Y.A.); (J.K.); (K.S.S.); (A.T.); (I.T.); (R.M.); (A.H.)
| | - Kimberly S. Slade
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.D.M.); (O.V.); (P.S.); (Y.A.); (J.K.); (K.S.S.); (A.T.); (I.T.); (R.M.); (A.H.)
| | - Thomas Efferth
- Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg University Mainz, 55128 Mainz, Germany;
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.D.M.); (O.V.); (P.S.); (Y.A.); (J.K.); (K.S.S.); (A.T.); (I.T.); (R.M.); (A.H.)
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.D.M.); (O.V.); (P.S.); (Y.A.); (J.K.); (K.S.S.); (A.T.); (I.T.); (R.M.); (A.H.)
| | - René Mager
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.D.M.); (O.V.); (P.S.); (Y.A.); (J.K.); (K.S.S.); (A.T.); (I.T.); (R.M.); (A.H.)
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.D.M.); (O.V.); (P.S.); (Y.A.); (J.K.); (K.S.S.); (A.T.); (I.T.); (R.M.); (A.H.)
| | - Eva Juengel
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.D.M.); (O.V.); (P.S.); (Y.A.); (J.K.); (K.S.S.); (A.T.); (I.T.); (R.M.); (A.H.)
- Correspondence: ; Tel.: +49-6131-17-5433; Fax: +49-6131-17-4410
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Vakhrusheva O, Erb HHH, Bräunig V, Markowitsch SD, Schupp P, Baer PC, Slade KS, Thomas A, Tsaur I, Puhr M, Culig Z, Cinatl J, Michaelis M, Efferth T, Haferkamp A, Juengel E. Artesunate Inhibits the Growth Behavior of Docetaxel-Resistant Prostate Cancer Cells. Front Oncol 2022; 12:789284. [PMID: 35198441 PMCID: PMC8859178 DOI: 10.3389/fonc.2022.789284] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 10/04/2021] [Accepted: 01/10/2022] [Indexed: 01/31/2023] Open
Abstract
Novel therapeutic strategies are urgently needed for advanced metastatic prostate cancer (PCa). Phytochemicals used in Traditional Chinese Medicine seem to exhibit tumor suppressive properties. Therefore, the therapeutic potential of artesunate (ART) on the progressive growth of therapy-sensitive (parental) and docetaxel (DX)-resistant PCa cells was investigated. Parental and DX-resistant PCa cell lines DU145, PC3, and LNCaP were incubated with artesunate (ART) [1-100 µM]. ART-untreated and ‘non-cancerous’ cells served as controls. Cell growth, proliferation, cell cycle progression, cell death and the expression of involved proteins were evaluated. ART, dose- and time-dependently, significantly restricted cell growth and proliferation of parental and DX-resistant PCa cells, but not of ‘normal, non-cancerous’ cells. ART-induced growth and proliferation inhibition was accompanied by G0/G1 phase arrest and down-regulation of cell cycle activating proteins in all DX-resistant PCa cells and parental LNCaP. In the parental and DX-resistant PC3 and LNCaP cell lines, ART also promoted apoptotic cell death. Ferroptosis was exclusively induced by ART in parental and DX-resistant DU145 cells by increasing reactive oxygen species (ROS). The anti-cancer activity displayed by ART took effect in all three PCa cell lines, but through different mechanisms of action. Thus, in advanced PCa, ART may hold promise as a complementary treatment together with conventional therapy.
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Affiliation(s)
- Olesya Vakhrusheva
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Holger H. H. Erb
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
- Department of Urology, University of Dresden, Dresden, Germany
| | - Vitus Bräunig
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Sascha D. Markowitsch
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Patricia Schupp
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Patrick C. Baer
- Department of Internal Medicine III, Nephrology, University Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Kimberly Sue Slade
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Martin Puhr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Zoran Culig
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jindrich Cinatl
- Institute of Medical Virology, Goethe-University, Frankfurt am Main, Germany
| | - Martin Michaelis
- Industrial Biotechnology Centre and School of Biosciences, University of Kent, Canterbury, United Kingdom
| | - Thomas Efferth
- Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Eva Juengel
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
- *Correspondence: Eva Juengel,
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Thomas A, Huck S, Slade K, Vakhrusheva O, Michaelis M, Cinatl J, Cinatl J, Rothweiler F, Haferkamp A, Juengel E, Tsaur I. Impact of resistance to cisplatin and osimertinib on dissemination properties of penile cancer cells. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00760-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tsaur I, Thomas A, Dotzauer R, Haferkamp A, Sparwasser P. First clinical experience with a novel approach of robot-assisted completely retroperitoneal nephroureterectomy with bladder cuff. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01275-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sparwasser P, Epple S, Thomas A, Dotzauer R, Boehm K, Brandt MP, Mager R, Borgmann H, Kamal MM, Kurosch M, Höfner T, Haferkamp A, Tsaur I. First completely robot-assisted retroperitoneal nephroureterectomy with bladder cuff: a step-by-step technique. World J Urol 2022; 40:1019-1026. [PMID: 35037964 PMCID: PMC8994743 DOI: 10.1007/s00345-021-03920-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/26/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction While various surgical techniques have been reported for open and minimally invasive treatment of upper tract urothelial cancer (UTUC), the procedure of robot-assisted nephroureterectomy (NU) with bladder cuff has never been reported using only retroperitoneum without entering abdominal cavity. We developed a novel port placement and technique allowing to perform robot-assisted NU by a unique retroperitoneal approach. Methods Between February and June 2021 patients with history of UTUC were treated by robot-assisted NU completely restricted to retroperitoneal space using a singular trocar placement and a two-step docking without relocation of the surgical robot. Patient characteristics, perioperative outcomes and short-term follow-up were prospectively analyzed. Results The analysis included five patients [median age: 73 years; BMI: 27.2 kg/m2; Charlson comorbidity index 5]. All five patients had UTUC with a mean tumor size of 3.02 cm (range 0.9–6.0). UTUC was localized to distal ureter in two and to kidney in three cases. No positive surgical margins were noted for all patients with UTUC [1 low-grade and 4 high-grade]. Retroperitoneal lymphadenectomy in three patients did not reveal positive nodes. No intraoperative adverse events exceeding EAUiaiC classification ≥ 2 were observed, while median EBL was 150 ml (IQR 100–250). No patient experienced postoperative complications exceeding Clavien–Dindo classification ≥ 3a. Median hospital stay was 5.4d without any 30-d readmission. Conclusion We demonstrate safety and feasibility of the first entire robot-assisted retroperitoneal nephroureterectomy (RRNU) with bladder cuff. This surgical technique is easily reproducible, while surgical outcomes are similar to other established techniques. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03920-1.
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Affiliation(s)
- P Sparwasser
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - S Epple
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - A Thomas
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - R Dotzauer
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - K Boehm
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - M P Brandt
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - R Mager
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - H Borgmann
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - M M Kamal
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - M Kurosch
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - T Höfner
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - A Haferkamp
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - I Tsaur
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
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Erlmeier F, Bruecher B, Stöhr C, Herrmann E, Polifka I, Agaimy A, Trojan L, Ströbel P, Becker F, Wülfing C, Barth P, Stöckle M, Staehler M, Stief C, Haferkamp A, Hohenfellner M, Macher-Göppinger S, Wullich B, Noldus J, Brenner W, Roos FC, Walter B, Otto W, Burger M, Schrader AJ, Hartmann A, Mondorf Y, Ivanyi P, Mikuteit M, Steffens S. cMET - a prognostic marker in papillary renal cell carcinoma? Hum Pathol 2022; 121:1-10. [PMID: 34998840 DOI: 10.1016/j.humpath.2021.12.007] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND The tyrosine-protein kinase c-Met plays a decisive role in numerous cellular processes, as a proto-oncogene that supports aggressive tumor behavior. It is still unknown whether c-Met could be relevant for prognosis of papillary RCC (pRCC). PATIENTS AND METHODS Specimen collection were a collaboration of the PANZAR consortium. Patients' medical history and tumor specimens were collected from n=197 and n=110 patients with type 1 and 2 pRCC, respectively. Expression of cMET was determined by immunohistochemistry (IHC). RESULTS In total, cMET staining was evaluable in of 97/197 type 1 and 63/110 type 2 of pRCC cases. Five-years overall survival reviled no significant difference in dependence of cMET positivity (cMET- vs. cMET+: pRCC type 1: 84.8 % vs. 80.3 %, respectively (p=0.303, log-rank); type 2: 71.4 % vs. 64.4 % respectively (p= 0.239, log-rank)). Interestingly, the subgroup analyses showed a significant difference for cMET expression in T stage and metastases of the pRCC type 2 (p=0.014, p=0.022, chi-square). The cMET positive type 2 collective developed more metastases compared to the cMET negative cohort (pRCC Typ 2 M+: cMET-: 2 (4.3%) vs. cMET+: 12 (19%)). CONCLUSION CMET expression did not qualify as a prognostic marker in pRCC for overall survival.
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Affiliation(s)
- Franziska Erlmeier
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), 91054 Erlangen, Germany
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| | - Benedict Bruecher
- Department of Urology, University Hospital Muenster, 48149 Muenster, Germany
| | - Christine Stöhr
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), 91054 Erlangen, Germany
| | - Edwin Herrmann
- Department of Urology, University Hospital Muenster, 48149 Muenster, Germany
| | - Iris Polifka
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), 91054 Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), 91054 Erlangen, Germany
| | - Lutz Trojan
- Department of Urology, University Hospital Göttingen, 37075 Göttingen, Germany
| | - Philipp Ströbel
- Department of Pathology, University Hospital Göttingen, 37075 Göttingen, Germany
| | - Frank Becker
- Department of Urology and Pediatric Urology, University of Saarland (UKS), 66421
Homburg, Germany
| | - Christian Wülfing
- Department of Urology, University Hospital Muenster, 48149 Muenster, Germany
| | - Peter Barth
- Department of Urology, University of Marburg, 35037 Marburg, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, University of Saarland (UKS), 66421
Homburg, Germany
| | - Michael Staehler
- Department of Urology, University Hospital Munich, 81337 Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital Munich, 81337 Munich, Germany
| | - Axel Haferkamp
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, 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
| | - Andres Jan Schrader
- Department of Urology, University Hospital Muenster, 48149 Muenster, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen-Nuernberg, Friedrich Alexander University (FAU), 91054 Erlangen, Germany
| | - Yvonne Mondorf
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, 30625 Hannover, Germany
| | - Philipp Ivanyi
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, 30625 Hannover, Germany
| | - Marie Mikuteit
- Hannover Medical School: Medizinische Hochschule Hannover, Hannover, Germany
| | - Sandra Steffens
- Department of Urology, University Hospital Muenster, 48149 Muenster, Germany
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Hüsch T, Haferkamp A, Thomas C, Steffens J, Fornara P, Kranz J. Gender gap at a large European urological congress: still at the beginning. World J Urol 2022; 40:257-262. [PMID: 34219179 PMCID: PMC8813805 DOI: 10.1007/s00345-021-03777-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Women are underrepresented at scientific conferences, decreasing the visibility of female role models, which are vital for aspiring young female scientists. This investigation aimed to evaluate female representation at the German Society of Urology's (GSoU) annual meeting. METHODS The programs of the GSoU meeting of 2011, 2018, 2019 and the virtual conference in 2020 were retrospectively quantified by gender and categorized by chair or speaker, type, and topic of the session. Descriptive analysis was applied. Univariate and multivariate analyses were performed to identify gender inequity and variables influencing gender distribution. A p value of < 0.05 was considered significant. RESULTS A total of 2.504 chairs and speakers were invited to the GSoU meeting in 2018 and 2019. Female speakers or chairs were represented in 17.8%, indicating a gender gap of 64.7%. There were significant differences between session type, topic, and gender distribution for chairs and speakers. The topic surgical techniques were independent variables for both, underrepresented female chairs and speakers, respectively (p < 0.001). Vocational policy and plenary session were not represented by any female chair in 2011, 2018, and 2019. In comparison, the gender gap in 2011 was 74.2%, indicating a gap reduction of 1.2% per year. In a selected virtual program in 2020, the gender gap increased to 70.4%. CONCLUSION There is still a significant discrepancy between gender representation at the GSoU annual meetings, and gender equity is currently not expected before 50 years. Future efforts should address the implementation of established guidelines for achieving gender equity at urological conferences.
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Affiliation(s)
- Tanja Hüsch
- grid.410607.4Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Axel Haferkamp
- grid.410607.4Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Christian Thomas
- grid.412282.f0000 0001 1091 2917Department of Urology, University Hospital Dresden, Dresden, Germany
| | - Joachim Steffens
- grid.459927.40000 0000 8785 9045Department of Urology and Pediatric Urology, St. Antonius-Hospital gGmbH, Eschweiler, Germany
| | - Paolo Fornara
- grid.9018.00000 0001 0679 2801Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
| | - Jennifer Kranz
- grid.459927.40000 0000 8785 9045Department of Urology and Pediatric Urology, St. Antonius-Hospital gGmbH, Eschweiler, Germany ,grid.9018.00000 0001 0679 2801Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
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Zschäbitz S, Erlmeier F, Stöhr C, Herrmann E, Polifka I, Agaimy A, Trojan L, Ströbel P, Becker F, Wülfing C, Barth P, Stöckle M, Staehler M, Stief C, Haferkamp A, Hohenfellner M, Macher-Göppinger S, Wullich B, Noldus J, Brenner W, Roos FC, Walter B, Otto W, Burger M, Schrader AJ, Mondorf Y, Hartmann A, Ivanyi P, Steffens S. Expression of Prostate-specific Membrane Antigen (PSMA) in Papillary Renal Cell Carcinoma - Overview and Report on a Large Multicenter Cohort. J Cancer 2022; 13:1706-1712. [PMID: 35399715 PMCID: PMC8990413 DOI: 10.7150/jca.63509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/28/2022] [Indexed: 11/05/2022] Open
Abstract
Prostate specific membrane antigen (PSMA) is an emerging diagnostic and therapeutic target in prostate cancer. 68Ga-PSMA-labeled hybrid imaging is used for the detection of prostate primary tumors and metastases. Therapeutic applications such as Lutetium-177 PSMA radionuclide therapy or bispecific antibodies that target PSMA are currently under investigation within clinical trials. The expression of PSMA, however, is not specific to prostate-tissue. It has been described in the neovascular endothelium of different types of cancer such as breast cancer, and clear cell renal cell carcinoma (ccRCC). The aim of this study was to analyze PSMA expression in papillary RCC (pRCC) type 1 and type 2, the most common non-ccRCC subtypes, and to evaluate the potential of PSMA-targeted imaging and treatment in pRCC. Formalin-fixed, paraffin-embedded tissue samples of primary tumors were analyzed for PSMA expression by immunohistochemistry. Out of n=374 pRCC specimens from the multicenter PANZAR consortium, n=197 pRCC type 1 and n=110 type 2 specimens were eligible for analysis and correlated with clinical data. In pRCC type 1 PSMA staining was positive in 4 of 197 (2.0%) samples whereas none (0/110) of the pRCC type 2 samples were positive for PSMA in this large cohort of pRCC patients. No significant PSMA expression was detected in pRCC. Reflecting current clinical evaluation of PMSA expression in RCC do not encourage further analysis in papillary subtypes.
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44
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Haack M, Miksch V, Tian Z, Duwe G, Thomas A, Borkowetz A, Stroh K, Thomas C, Haferkamp A, Höfner T, Boehm K. Negative multiparametric magnetic resonance imaging for prostate cancer: further outcome and consequences. World J Urol 2022; 40:2947-2954. [PMID: 36318314 PMCID: PMC9712318 DOI: 10.1007/s00345-022-04197-8] [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: 08/15/2022] [Accepted: 10/17/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE EAU guidelines recommend multiparametric MRI of the prostate (mpMRI) prior to biopsy to increase accuracy and reduce biopsies. Whether biopsy can be avoided in case of negative mpMRI remains unclear. Aim of this study is to evaluate predictors of overall prostate cancer (PCa) in negative mpMRI. METHODS A total of 216 patients from 2018 to 2020 with suspicion of PCa and negative mpMRI (PI-RADS ≤ 2) were interviewed by telephone about outcome and further follow-up. Clinically significant PCa (csPCa) was defined as ISUP ≥ 2. Patients with vs. without biopsy and with vs. without PCa were compared. Univariate and multivariate analyses were performed to evaluate predictors of PCa occurrence in patients with negative mpMRI. RESULTS 15.7% and 5.1% of patients with PI-RADS ≤ 2 on mpMRI showed PCa and csPCa, respectively. PCa patients had higher PSAD (0.14 vs. 0.09 ng/ml2; p = 0.001) and lower prostate volume (50.5 vs. 74.0 ml; p = 0.003). Patients without biopsy (25%) after MRI were older (69 vs. 65.5 years; p = 0.027), showed lower PSA (5.7 vs. 6.73 ng/ml; p = 0.033) and lower PSA density (0.09 vs. 0.1 ng/ml2; p = 0.027). Multivariate analysis revealed age (OR 1.09 [1.02-1.16]; p = 0.011), prostate volume (OR 0.982 [0.065; 0.997]; p = 0.027), total PSA level (OR 1.22 [1.01-1.47], p = 0.033), free PSA (OR 0.431 [0.177; 0.927]; p = 0.049) and no PI-RADS lesion vs PI-RADS 1-2 lesion (OR 0.38 [0.15-0.91], p = 0.032.) as predictive factors for the endpoint presence of PCa. CONCLUSIONS Biopsy for selected patient groups (higher age, prostate volume and free PSA as well as lower PSA-Density) with negative mpMRI can be avoided, if sufficient follow-up care is guaranteed. Detailed counseling regarding residual risk for undetected prostate cancer should be mandatory.
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Affiliation(s)
- Maximilian Haack
- Department of Urology and Pediatric Urology, Johannes-Gutenberg University Medical Center, Mainz, Germany
| | - Vanessa Miksch
- Department of Urology and Pediatric Urology, Johannes-Gutenberg University Medical Center, Mainz, Germany
| | - Zhe Tian
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Gregor Duwe
- Department of Urology and Pediatric Urology, Johannes-Gutenberg University Medical Center, Mainz, Germany
| | - Anita Thomas
- Department of Urology and Pediatric Urology, Johannes-Gutenberg University Medical Center, Mainz, Germany
| | - Angelika Borkowetz
- Department of Urology and Pediatric Urology, Carl-Gustav-Carus University Medical Center, Dresden, Germany
| | - Kristina Stroh
- Department of Diagnostic and Interventional Radiology, Johannes-Gutenberg University Medical Center, Mainz, Germany
| | - Christian Thomas
- Department of Urology and Pediatric Urology, Carl-Gustav-Carus University Medical Center, Dresden, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, Johannes-Gutenberg University Medical Center, Mainz, Germany
| | - Thomas Höfner
- Department of Urology and Pediatric Urology, Johannes-Gutenberg University Medical Center, Mainz, Germany
| | - Katharina Boehm
- Department of Urology and Pediatric Urology, Johannes-Gutenberg University Medical Center, Mainz, Germany ,Department of Urology and Pediatric Urology, Carl-Gustav-Carus University Medical Center, Dresden, Germany
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Abstract
Zwar haben jeher technologische Weiterentwicklungen die medizinische Versorgung in deren stetigem Wandel optimiert, so waren diese jedoch immer noch für den Anwender weitestgehend fassbar. Getrieben durch immense finanzielle Anstrengungen sind innovative Produkte und technische Lösungen entstanden, die den medizinischen Alltag transformieren und diesen in Zukunft um eine Dimension erweitern werden: die Virtual und Augmented Reality. Dieser Übersichtsartikel fasst die aktuellen wissenschaftlichen Projekte und den zukünftigen Nutzen von Virtual und Augmented Reality im Fachgebiet der Urologie zusammen.
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Affiliation(s)
- P Sparwasser
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - M Haack
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - L Frey
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - A Haferkamp
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - H Borgmann
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Deutschland
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46
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Schulz S, Woerl AC, Jungmann F, Glasner C, Stenzel P, Strobl S, Fernandez A, Wagner DC, Haferkamp A, Mildenberger P, Roth W, Foersch S. Multimodal Deep Learning for Prognosis Prediction in Renal Cancer. Front Oncol 2021; 11:788740. [PMID: 34900744 PMCID: PMC8651560 DOI: 10.3389/fonc.2021.788740] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Clear-cell renal cell carcinoma (ccRCC) is common and associated with substantial mortality. TNM stage and histopathological grading have been the sole determinants of a patient's prognosis for decades and there are few prognostic biomarkers used in clinical routine. Management of ccRCC involves multiple disciplines such as urology, radiology, oncology, and pathology and each of these specialties generates highly complex medical data. Here, artificial intelligence (AI) could prove extremely powerful to extract meaningful information to benefit patients. OBJECTIVE In the study, we developed and evaluated a multimodal deep learning model (MMDLM) for prognosis prediction in ccRCC. DESIGN SETTING AND PARTICIPANTS Two mixed cohorts of non-metastatic and metastatic ccRCC patients were used: (1) The Cancer Genome Atlas cohort including 230 patients and (2) the Mainz cohort including 18 patients with ccRCC. For each of these patients, we trained the MMDLM on multiscale histopathological images, CT/MRI scans, and genomic data from whole exome sequencing. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outcome measurements included Harrell's concordance index (C-index) and also various performance parameters for predicting the 5-year survival status (5YSS). Different visualization techniques were used to make our model more transparent. RESULTS The MMDLM showed great performance in predicting the prognosis of ccRCC patients with a mean C-index of 0.7791 and a mean accuracy of 83.43%. Training on a combination of data from different sources yielded significantly better results compared to when only one source was used. Furthermore, the MMDLM's prediction was an independent prognostic factor outperforming other clinical parameters. INTERPRETATION Multimodal deep learning can contribute to prognosis prediction in ccRCC and potentially help to improve the clinical management of this disease. PATIENT SUMMARY An AI-based computer program can analyze various medical data (microscopic images, CT/MRI scans, and genomic data) simultaneously and thereby predict the survival time of patients with renal cancer.
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Affiliation(s)
- Stefan Schulz
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Ann-Christin Woerl
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
- Institute of Computer Science, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Florian Jungmann
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
| | - Christina Glasner
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Philipp Stenzel
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Stephanie Strobl
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Aurélie Fernandez
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | | | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Peter Mildenberger
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
| | - Wilfried Roth
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Sebastian Foersch
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
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Becker C, Haferkamp A. [The 2021 DGU research fellowships]. Urologe A 2021; 60:1461-1465. [PMID: 34648047 DOI: 10.1007/s00120-021-01699-y] [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] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- C Becker
- Ressort Forschungsförderung, Düsseldorf/Berlin, Forschungskoordination, Deutsche Gesellschaft für Urologie, Uerdinger Straße 64, 40474, Düsseldorf, Deutschland.
| | - A Haferkamp
- Ressort Forschungsförderung, Düsseldorf/Berlin, Forschungskoordination, Deutsche Gesellschaft für Urologie, Uerdinger Straße 64, 40474, Düsseldorf, Deutschland.,Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Mainz, Deutschland
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48
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Mager R, Brauers C, Kurosch M, Dotzauer R, Borgmann H, Haferkamp A. Outcomes for Geriatric Urolithiasis Patients aged ≥80 Years Compared to Patients in Their Seventies. Eur Urol Focus 2021; 8:1103-1109. [PMID: 34454851 DOI: 10.1016/j.euf.2021.08.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Demographic changes are leading to an increase in geriatric urolithiasis patients aged ≥70 yr. Published data regarding their management remain sparse. In particular, for the subgroup of patients aged ≥80 yr there is a lack of evidence supporting the hypothesis that stone-removing treatment is effective, safe, and beneficial. OBJECTIVE To examine the efficiency and safety of stone-removing treatment in geriatric urolithiasis patients aged ≥80 yr compared to their younger geriatric counterparts aged 70-79 yr against the background of their respective life expectancy. DESIGN, SETTING, AND PARTICIPANTS Data for the study cohort were extracted from an institutional review board-approved retrospective database with 325 patients aged ≥70 yr (70-79 yr: n = 241; ≥80 yr: n = 84) consecutively admitted to hospital because of symptomatic urolithiasis from 2013 to 2018. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Baseline characteristics, outcome and follow-up data, and survival were compared using Wilcoxon-Mann-Whitney U tests, χ2 tests, Kaplan-Meier estimation, log-rank tests, and Cox regression. RESULTS AND LIMITATIONS At baseline, the incidence of infected hydronephrosis was greater among patients aged ≥80 yr (p < 0.05), whereas the median stone burden and Charlson comorbidity index did not differ between the groups. Outcome analysis revealed no significant differences in terms of complication, stone-free, and 6-mo readmission rates (p > 0.05). Survival analysis for the two groups demonstrated a 2-yr overall survival (OS) rate of 0.91 (95% confidence interval [CI] 0.75-1) for patients aged ≥80 yr and 0.97 (95% CI 0.88-1), for those aged 70-79 yr (p < 0.01). Multivariable Cox analysis revealed age ≥80 yr (hazard ratio [HR] 3.3, 95% CI 1.3-8.5) and infected hydronephrosis (HR 2.8, 95% CI 1.0-7.8) as predictors of all-cause mortality (p < 0.05). The study is limited by its retrospective design. CONCLUSIONS Stone-removing treatment for patients aged ≥80 yr proved to be as effective and safe as for patients in their seventies. Although characterized by shorter remaining life expectancy, excellent 2-yr OS for patients aged ≥80 yr supports the hypothesis of equal benefit from stone-removing treatment when compared to septuagenarians. PATIENT SUMMARY There is a lack of evidence supporting the benefit of urinary stone-removing treatment for patients older than 80 yr. Our study included geriatric patients older than 70 yr with symptomatic urinary stone disease for which urinary drainage or stone removal is indicated. We compared treatment outcomes and survival between two age groups: patients aged 70-79 yr and those aged 80 yr or older. We found equivalent outcomes for the two groups and excellent 2-yr overall survival of 91% for those older than 80 yr. The study strengthens the evidence that active stone-removing therapy is safe and beneficial for these patients.
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Affiliation(s)
- Rene Mager
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany.
| | - Carlos Brauers
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Martin Kurosch
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Robert Dotzauer
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Hendrik Borgmann
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
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Markowitsch SD, Juetter KM, Schupp P, Hausschulte K, Vakhrusheva O, Cinatl J, Michaelis M, Efferth T, Haferkamp A, Juengel E. Abstract 1423: Shikonin impairs the growth of docetaxel-resistant prostate cancer cells by necroptosis. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-1423] [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
Introduction: Prostate carcinoma (PCa) is the most common malignancy in men. Androgen-targeted therapy and chemotherapy are currently the treatment of choice for advanced stages. Due to resistance towards these therapies, prognosis remains poor and new treatment options are urgently required. Shikonin (SHI) from Traditional Chinese Medicine (TCM) might be promising, since it induces anti-tumor effects in different tumor entities. However, data on PCa are few, and data on resistant PCa are not existent.
Material and Methods: Parental (=sensitive) and docetaxel-resistant PCa cell lines, PC3, DU145, LNCaP, and 22Rv1 were exposed to SHI [0.1 - 1.5 μM] for 24, 48, or 72 hours. Untreated cells served as controls. Tumor cell growth, proliferation, cell cycle, and the expression of cell cycle regulating proteins were assessed. Several cell deaths, like apoptosis, necrosis and necroptosis as well as the metabolic activity were evaluated.
Results: Time- and dose-dependent exposure to SHI significantly reduced tumor cell growth and proliferation in parental and docetaxel-resistant PCa cells, compared to the untreated controls. This was accompanied by cell cycle arrest in the G2/M phase in parental PC3 and docetaxel-resistant DU145 and S phase arrest in resistant 22Rv1, associated with modulated expression of cell cycle regulating proteins. Significant apoptotic effects were observed in parental and docetaxel-resistant PC3, DU145, 22Rv1, and resistant LNCaP. Moreover, SHI induced necroptosis in all parental and resistant PCa cells, as shown by additional application to the necroptosis inhibitor necrostatin-1. In line with this, RIP-1 expression enhanced under SHI exposure. In contrast, SHI did not alter the metabolic activity of the PCa cells.
Conclusion: Significant anti-tumor effects are apparent in parental but also in docetaxel-resistant PCa cells after SHI application. Thus, adding SHI to standard therapies might be a promising treatment strategy for patients with advanced prostate cancer. Further investigations are necessary to verify our findings.
Funding: Friedrich-Spicker-Stiftung (2017).
Acknowledgments: The main portion of the results presented here are part of the MD thesis of Kira M. Juetter at the Department of Urology and Pediatric Urology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
Citation Format: Sascha D. Markowitsch, Kira M. Juetter, Patricia Schupp, Kristine Hausschulte, Olesya Vakhrusheva, Jindrich Cinatl, Martin Michaelis, Thomas Efferth, Axel Haferkamp, Eva Juengel. Shikonin impairs the growth of docetaxel-resistant prostate cancer cells by necroptosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1423.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Eva Juengel
- 1University Medical Center Mainz, Mainz, Germany
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Sparwasser P, Brandt MP, Haack M, Dotzauer R, Boehm K, Gheith MK, Mager R, Jäger W, Ziebart A, Höfner T, Tsaur I, Haferkamp A, Borgmann H. Robotic surgery can be safely performed for patients and healthcare workers during COVID-19 pandemic. Int J Med Robot 2021; 17:e2291. [PMID: 34050598 PMCID: PMC8209902 DOI: 10.1002/rcs.2291] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/22/2021] [Accepted: 05/27/2021] [Indexed: 11/08/2022]
Abstract
Objectives To investigate the safety of robotic surgery during COVID‐19 pandemic concerning new‐acquired COVID‐19 infections for patients and healthcare workers. Patients We performed a retrospective single‐centre cohort study of patients undergoing robotic surgery in initial period of COVID‐19 pandemic. Patients and healthcare workers COVID‐19 infection status was assessed by structured telephone follow‐up and/or repeated nasopharyngeal swabs. Results After 61 robotic surgeries (93,5% cancer surgery), one patient (1.6%) had COVID‐19 infection. Sixty healthcare workers cumulatively exposed to 1187 h of robotic surgery had no infection. One patient with postoperative proof of SARS‐CoV‐2 had complete recovery. After this potentially contagious robotic surgery, eight healthcare workers had no COVID‐19 infection after follow‐up with each three nasopharyngeal swabs. Conclusions Early clinical experience of robotic surgery during COVID‐19 pandemic shows that robotic surgery can be safely performed for patients and healthcare workers. Despite our results we recommend elective surgery only for verified COVID‐19 negative patients.
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Affiliation(s)
- Peter Sparwasser
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Maximillian P Brandt
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Maximillian Haack
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Robert Dotzauer
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Katharina Boehm
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Mohammed Kamal Gheith
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Rene Mager
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Wolfgang Jäger
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Alexander Ziebart
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Höfner
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Igor Tsaur
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Hendrik Borgmann
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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