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Angerer M, Hansen B, Wülfing C, Dieckmann KP. Paraneoplastic Hyperthyroidism in advanced testicular non-seminomatous germ cell tumors: Prevalence and clinical Management. Oncology 2024:000538634. [PMID: 38710175 DOI: 10.1159/000538634] [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: 12/19/2023] [Accepted: 03/21/2024] [Indexed: 05/08/2024]
Abstract
Introduction Paraneoplastic hyperthyroidism (PH) has been reported in patients with testicular germ cell tumors (GCTs), sporadically. This disorder is caused by extremely elevated serum levels of beta-human chorionic gonadotropin (bHCG). To date, little is known about the prevalence of PH, and its clinical features are poorly understood. The aim of the present study was to analyze the relative frequency and clinical features of PH in GCTs and evaluate their effects on therapeutic outcomes. Methods A cohort of 438 patients treated for testicular GCT from to 2017-2023 was retrospectively analyzed for histology, age, clinical stage, and presence of PH. The clinical features of the patients with PH were evaluated descriptively. The relative frequency of PH was compared among the subgroups using descriptive statistical methods. Results Three patients with PH were identified; all had clinical symptoms of hyperthyroidism, suppressed serum levels of thyroid-stimulating hormone (TSH), and increased levels of triiodothyronin (fT3). All the patients had advanced, metastasized, and non-seminomatous (GCTs). Serum bHCG levels ranged from 225,00 U/l to 1,520,000 U/l. The prevalence of PH was 0.7% in the entire GCT population and 60% in those with very high bHCG serum levels. All the patients received standard cisplatin-based chemotherapy along with thyrostatic treatment. The clinical symptoms of the hyperthyroidism rapidly disappeared. Thyroid-stimulating hormone (TSH) levels normalized with decreasing bHCG levels. The PH treatment did not affect the therapeutic outcomes of the patients. Conclusion PH may occur in 0,7% of all patients with GCT, but may be present in up to 60% of patients with very high levels of bHCG. Measuring serum levels of TSH and fT3 should be performed in addition to routine diagnostic measures in all patients with poor prognosis GCTs. Thyrostatic medication is recommended for patients with the clinical symptoms of hyperthyroidism. Early recognition of hyperthyroidism and prompt intervention will reduce comorbidity and help optimize therapeutic outcomes.
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Huber J, Karschuck P, Valdix J, Thomas C, Koch R, Ihrig A, Hölscher T, Krones T, Kessler E, Kliesch S, Linné C, Enders P, Michel MS, Wülfing C, Groeben C. Online decision aid for patients with prostate cancer evaluated by 11 290 patients and 91 urologists in Germany. BJU Int 2024. [PMID: 38506410 DOI: 10.1111/bju.16329] [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] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To evaluate the nationwide online decision aid 'Entscheidungshilfe Prostatakrebs' (established in 2016, >11.000 users and 60 new users/week) for patients with non-metastatic prostate cancer (PCa), from the perspective of patients and urologists. PATIENTS AND METHODS To provide personalised information, the tool collects most of the International Consortium for Health Outcomes Measurement standard set, personal preferences, psychological features, and a validated rating of the tool. To evaluate urologists' opinions, we developed a structured two-page questionnaire. All data were collected anonymously. RESULTS From June 2016 to December 2020, 11 290 patients used the PCa decision aid. Their median (interquartile range [IQR]) age was 67 (61-72) years. The median (IQR) time from initial diagnosis to using the tool was 4 (3-7) weeks. In all, 87.7% of users reported high satisfaction. In a multivariable model, predictors for considering observation were higher knowledge, using the decision aid alone, lower oncological risk, normal erectile function, and respective personal preferences. Of 194 urologists, 91 (47%) had implemented the decision aid in their clinical practice. The urologists' mean (SD) satisfaction score (1 'very good'; 6 'unsatisfactory') with it was 1.45 (0.55), and 92% recommended it. Half of the urologists reported time savings. CONCLUSION Patients and urologists report a very high level of acceptance and satisfaction with this online tool. It offers advantages in shared decision-making and time efficiency. The usage of the decision aid might improve the adoption of active surveillance and watchful waiting when indicated.
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Affiliation(s)
- Johannes Huber
- Department of Urology, Philipps University of Marburg, Marburg, Germany
| | - Philipp Karschuck
- Department of Urology, Philipps University of Marburg, Marburg, Germany
| | - Johanna Valdix
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Christian Thomas
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Rainer Koch
- Department of Urology, Philipps University of Marburg, Marburg, Germany
| | - Andreas Ihrig
- Division of Psycho-Oncology, Department of General Internal Medicine and Psychosomatic, University Hospital Heidelberg, Heidelberg, Germany
| | - Tobias Hölscher
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Tanja Krones
- Institute of Biomedical Ethics and History of Medicine University of Zürich, University Hospital Zürich, Zürich, Switzerland
| | - Elke Kessler
- ASD Concepts GmbH & Co. KG - Institut für Patientenzentrierte Versorgungsformen, Reinheim, Germany
| | - Sabine Kliesch
- Department of Clinical and Surgical Andrology, Centre for Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | | | - Paul Enders
- Prostate Cancer Patient Support Organization of Germany (BPS), Bonn, Germany
| | | | | | - Christer Groeben
- Department of Urology, Philipps University of Marburg, Marburg, Germany
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Dieckmann KP, Tharun L, Angerer M, Harms A, Wülfing C. Myoid gonadal stromal tumor of the testis-the novel subtype of testicular gonadal stromal tumors: a case report and review of the literature. J Med Case Rep 2024; 18:71. [PMID: 38383445 PMCID: PMC10882757 DOI: 10.1186/s13256-024-04393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Sex cord gonadal stromal tumors compose less than 10% of all testicular neoplasms and consist of a variety of histological subtypes. In 2016, the World Health Organization introduced a novel subtype, the myoid gonadal stromal tumor, that consists of spindle-shaped cells with immunohistologic features of muscle cells. Only few cases have been reported to date. Due to its rarity and owing to its only recent introduction, the current knowledge about myoid gonadal stromal tumor is limited, and particularly, appropriate clinical management is still ill-defined. CASE PRESENTATION A 47-year-old man of Caucasian descent presented with nonspecific scrotal discomfort. A roundish and well demarcated hypoechoic mass of 8.5 mm in diameter was detected in the cranial region of the left testis. Serum tumor marker levels were within normal ranges. Testis-sparing surgery revealed a 9-mm whitish, hard mass with sharp surgical margin. Histologically, the neoplasm consisted of microfibrillar tissue with spindle-shaped cells harboring elongated nuclei. Immunohistochemical work-up disclosed expression of desmin, small muscle actin, and S100 protein giving evidence for the myogenic nature of the neoplastic cells. There was no indication of malignancy, neither histologically nor clinically. Follow-up of 1 year was uneventful. CONCLUSION A literature survey revealed 22 previous cases of myoid gonadal stromal tumor. The median age was 37 years, the median size of the neoplasm was 20 mm, and there was no side-preponderance. Myoid gonadal stromal tumor is not much different from other subtypes of gonadal stromal tumors nor from testicular gem cell tumors regarding age and laterality; however, tumor size is smaller in myoid gonadal stromal tumors than in germ cell tumors. Although rarely performed so far, testis-sparing surgery probably constitutes an appropriate treatment of this neoplasm. Myoid gonadal stromal tumor represents an emerging novel entity of benign testicular new growths that caregivers of patients with testicular tumors should be aware of.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Testicular Cancer Unit, Department of Urology, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, 22763, Hamburg, Germany.
| | - Lars Tharun
- Medizinisches Versorgungszentrum Hanse Histologikum, Fangdieckstrasse 75a, 22547, Hamburg, Germany
| | - Markus Angerer
- Testicular Cancer Unit, Department of Urology, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, 22763, Hamburg, Germany
| | - Alexander Harms
- Medizinisches Versorgungszentrum Hanse Histologikum, Fangdieckstrasse 75a, 22547, Hamburg, Germany
| | - Christian Wülfing
- Testicular Cancer Unit, Department of Urology, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, 22763, Hamburg, Germany
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Belge G, Dumlupinar C, Nestler T, Klemke M, Törzsök P, Trenti E, Pichler R, Loidl W, Che Y, Hiester A, Matthies C, Pichler M, Paffenholz P, Kluth L, Wenzel M, Sommer J, Heinzelbecker J, Schriefer P, Winter A, Zengerling F, Kramer MW, Lengert M, Frey J, Heidenreich A, Wülfing C, Radtke A, Dieckmann KP. Detection of Recurrence through microRNA-371a-3p Serum Levels in a Follow-up of Stage I Testicular Germ Cell Tumors in the DRKS-00019223 Study. Clin Cancer Res 2024; 30:404-412. [PMID: 37967143 PMCID: PMC10792362 DOI: 10.1158/1078-0432.ccr-23-0730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/16/2023] [Accepted: 11/13/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE Surveillance of clinical stage I (CSI) testicular germ cell tumors (GCT) is hampered by low sensitivity and specificity of current biomarkers for detecting relapses. This study evaluated if serum levels of microRNA371a-3p (M371 test) can: (i) Accurately detect relapses, (ii) detect relapses earlier than conventional technology, and (iii) if elevated postoperative M371 levels may predict relapse. EXPERIMENTAL DESIGN In a multicentric setting, 258 patients with testicular CSI GCT were prospectively followed by surveillance for a median time of 18 months with serial measurements of serum M371 levels, in addition to standard diagnostic techniques. Diagnostic characteristics of M371 for detecting relapses were calculated using ROC curve analysis. RESULTS Thirty-nine patients recurred (15.1%), all with elevated M371 levels; eight without relapse had elevations, too. The test revealed the following characteristics: area under the ROC curve of 0.993, sensitivity 100%, specificity 96.3%, positive predictive value 83%, negative predictive value 100%. Earlier relapse detection with the test was found in 28%, with non-significant median time gain to diagnosis. Postoperative M371 levels did not predict future relapse. CONCLUSIONS The sensitivity and specificity of the M371 test for detecting relapses in CSI GCTs are much superior to those of conventional diagnostics. However, post-orchiectomy M371 levels are not predictive of relapse, and there is no significant earlier relapse detection with the test. In all, there is clear evidence for the utility of the M371 test for relapse detection suggesting it may soon be ready for implementation into routine follow-up schedules for patients with testicular GCT.
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Affiliation(s)
- Gazanfer Belge
- Department of Tumor Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Cansu Dumlupinar
- Department of Tumor Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Tim Nestler
- Department of Urology, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany
| | - Markus Klemke
- Department of Tumor Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Peter Törzsök
- Department of Urology and Andrology, Paracelsus Medical University, Salzburg University Hospital, Salzburg, Austria
| | | | - Renate Pichler
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | - Wolfgang Loidl
- Ordensklinikum Barmherzige Schwestern, Department Urology, Linz, Austria
| | - Yue Che
- Department of Urology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Andreas Hiester
- Department of Urology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Cord Matthies
- Department of Urology, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Martin Pichler
- Research Unit of Non-Coding RNA, Division of Oncology, Medical University of Graz, Graz, Austria
| | - Pia Paffenholz
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Luis Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Jörg Sommer
- Department of Urology, St. Franziskus Krankenhaus Lohne, Lohne, Germany
| | - Julia Heinzelbecker
- Saarland University Medical Centre and Saarland University, Department of Urology, Homburg, Germany
| | | | - Alexander Winter
- Department of Urology, University Hospital Oldenburg, Oldenburg, Germany
| | | | - Mario Wolfgang Kramer
- Department of Urology, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marie Lengert
- Department of Tumor Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Jana Frey
- miRdetect GmbH, Bremerhaven, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
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Karschuck P, Müller L, Groeben C, Aksoy C, Flegar L, Zacharis A, Baunacke M, Wülfing C, Huber J. [Patient events in German urology: trend towards hybrid formats?]. Urologie 2024; 63:75-82. [PMID: 37566223 DOI: 10.1007/s00120-023-02162-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Patient events are an important tool to respond to the increasing need of the public for health information. Through the "patient forum", the German Society of Urology (DGU) is committed to patient information and public relations at its annual congresses. The goal of the study was to evaluate the events from 2017-2019 and to compare them with the first digital patient forum in 2020. MATERIALS AND METHODS Using a two-page standardized questionnaire, we surveyed the visitors of the presence patient forums (presence group = P) of the three annual congresses of the DGU 2017-2019 as well as the users of the digital event 2020 (online group = O). RESULTS We obtained 71 records for 2017-2019 and 18 for 2020. The median age of visitors was 64 years (range 30-89). Males were 66% (P) vs. 83% (O) of participants (p = 0.005). The offer was rated overall as good to very good by both groups, i.e., 1.6 (P) vs. 1.6 (O; p = 0.7) on a scale from 1 to 6 with 1 being the highest rating. In line with the lower interaction in the digital format, the possibility to ask questions was rated worse with 1.5 (P) vs. 2.8 (O; p = 0.003). When asked about the desired future event format, two-thirds of the users of the digital patient forum were in favor of a hybrid event on-site and online. CONCLUSION Patient events are suitable means of communication for the public and are rated well by visitors. In particular, interaction with experts is highly valued. Face-to-face formats are associated with a high logistical effort and high costs, and their reach is limited. In the future, hybrid formats could be a reasonable alternative, as they combine the advantages of online and face-to-face formats.
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Affiliation(s)
- Philipp Karschuck
- Klinik für Urologie, Philipps-Universität Marburg, Baldingerstraße, 35033, Marburg, Deutschland.
| | - Laura Müller
- Klinik für Urologie, Philipps-Universität Marburg, Baldingerstraße, 35033, Marburg, Deutschland
| | - Christer Groeben
- Klinik für Urologie, Philipps-Universität Marburg, Baldingerstraße, 35033, Marburg, Deutschland
| | - Cem Aksoy
- Klinik für Urologie, Philipps-Universität Marburg, Baldingerstraße, 35033, Marburg, Deutschland
| | - Luka Flegar
- Klinik für Urologie, Philipps-Universität Marburg, Baldingerstraße, 35033, Marburg, Deutschland
| | - Aristeidis Zacharis
- Klinik für Urologie, Philipps-Universität Marburg, Baldingerstraße, 35033, Marburg, Deutschland
| | - Martin Baunacke
- Klinik und Poliklinik für Urologie, Technische Universität Dresden, Dresden, Deutschland
| | | | - Johannes Huber
- Klinik für Urologie, Philipps-Universität Marburg, Baldingerstraße, 35033, Marburg, Deutschland
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von Büren M, Wülfing C, Brookman-May SD, Gratzke C, von Büren J. Reply to Eugenio Ventimiglia, Andrea Salonia, and Francesco Montorsi's Letter to the Editor re: Moritz von Büren, Severin Rodler, Isabell Wiesenhütter, et al. Digital Real-world Data Suggest Patient Preference for Tadalafil over Sildenafil in Patients with Erectile Dysfunction. Eur Urol Focus 2022;8:794-802. Eur Urol Focus 2023; 9:846-847. [PMID: 37061364 DOI: 10.1016/j.euf.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/31/2023] [Indexed: 04/17/2023]
Affiliation(s)
- Moritz von Büren
- Department of Urology, University of Freiburg, Freiburg, Germany.
| | - Christian Wülfing
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany; Wellster Healthtech Group, Munich, Germany
| | - Sabine D Brookman-May
- Wellster Healthtech Group, Munich, Germany; Janssen Research and Development, LLC, Spring House, PA, USA; Department of Urology, Ludwig Maximilian University of Munich, Munich, Germany
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Dieckmann KP, Dumlupinar C, Grobelny F, Utschig J, Klemke M, Ahmed Saad EM, Wülfing C, Pichlmeier U, Isbarn H, Belge G. Testicular neoplasms: the interrelationships of serum levels of microRNA-371a-3p (M371) and classical tumor markers with histology, clinical staging, and age-a statistical analysis. J Cancer Res Clin Oncol 2023; 149:7079-7090. [PMID: 36869885 PMCID: PMC9985438 DOI: 10.1007/s00432-023-04664-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE In testicular neoplasms, the interrelationship of elevations of the novel serum tumor marker microRNA-371a-3p (M371) and traditional markers with other clinical features is still incompletely understood. The present study evaluated marker expression rates in relation to various other clinical parameters. METHODS The following data were retrospectively registered from 641 consecutive patients with testicular neoplasms: histology, such as seminoma (n = 365), nonseminoma (n = 179), benign tumor (n = 79), other malignant tumor (n = 18); patients age (years); clinical stage (CS1, CS2a/b, CS2c, CS3); and preoperative elevation of beta HCG, AFP, LDH, M371 (yes/no). Descriptive statistical methods were employed with comparisons of various subgroups to disclose associations of marker expression rates with age, histology and CS, and of age with histology. RESULTS The histologic subgroups revealed significantly different expression rates of tumor markers. M371 performed best with expression rates of 82.69% and 93.58% in seminoma and in nonseminoma, respectively. In germ cell tumors, all markers had significantly higher expression rates in metastasized stages than in localized disease. All markers except LDH have significantly higher expression rates in younger than in older patients. Nonseminoma is most prevalent in the youngest age category, seminoma predominates in patients > 40 years, other malignancies were restricted to patients > 50 years. CONCLUSION The study documented significant associations of serum marker expression rates with histology, age and clinical staging, with highest rates in nonseminomas, young age and advanced clinical stages. M371 showed significantly higher expression rates than other markers suggesting its superior clinical usefulness.
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Affiliation(s)
| | - Cansu Dumlupinar
- Department of Tumour Genetics, Faculty of Biology and Chemistry, University of Bremen, Leobener Strasse 2/FVG, 28359, Bremen, Germany
| | - Francesca Grobelny
- Department of Tumour Genetics, Faculty of Biology and Chemistry, University of Bremen, Leobener Strasse 2/FVG, 28359, Bremen, Germany
- Faculty of Medicine, University of Hamburg, Hamburg, Germany
| | - Julia Utschig
- Department of Urology, Asklepios Klinik Altona, 22763, Hamburg, Germany
| | - Markus Klemke
- Department of Tumour Genetics, Faculty of Biology and Chemistry, University of Bremen, Leobener Strasse 2/FVG, 28359, Bremen, Germany
| | | | - Christian Wülfing
- Department of Urology, Asklepios Klinik Altona, 22763, Hamburg, Germany
| | - Uwe Pichlmeier
- Institute of Medical Biometry and Epidemiology, Universitätsklinikum Eppendorf, 20251, Hamburg, Germany
| | - Hendrik Isbarn
- Martini Klinik, Universitätsklinikum Eppendorf, 20251, Hamburg, Germany
| | - Gazanfer Belge
- Department of Tumour Genetics, Faculty of Biology and Chemistry, University of Bremen, Leobener Strasse 2/FVG, 28359, Bremen, Germany.
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Angerer M, Wülfing C, Gübitz R, Harms A, Dieckmann KP. Unilateral, Small, Benign, Late-Onset, Large-Cell Calcifying Sertoli Cell Tumor: A Case Report. Cureus 2023; 15:e41614. [PMID: 37565109 PMCID: PMC10410189 DOI: 10.7759/cureus.41614] [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] [Accepted: 07/07/2023] [Indexed: 08/12/2023] Open
Abstract
Large-cell calcifying Sertoli cell tumor (LCCST) is a rare, testicular sex cord, gonadal stromal tumor that belongs to the histological subgroup of Sertoli cell tumors. LCCSTs may involve malignant potential. However, metastasis is a rare phenomenon. We describe a case of benign late-onset LCCST with testis-sparing surgery. Modern imaging techniques were useful for considering organ-sparing surgery. The ultrasound of a 37-year-old man disclosed a sharp demarcated and strong hyper-echoic lesion sized 1.5 cm, with broad dorsal acoustic shadowing. Testicular tumor markers, including lactate dehydrogenase (LDH), alpha-fetoprotein (AFP), and Beta-human chorionic gonadotropin (ß-HCG) did not reveal any pathological finding. Contrast-enhanced MRI of the pelvis showed a ring-shaped tumor with a strong contrast medium enhancement. Sections of the tumor showed a hard mass with a white calcified ring. A frozen section examination of the testicular tumor did not indicate malignancy. Histologic examination revealed a prominent and noticeable calcification of approximately 3 mm thickness. Tumor cells presented in the form of solid nests, tubules, and cords. Our present case differs from previously reported LCCST cases because the tumor was unilateral, smaller in size, and presented in an older patient.
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Affiliation(s)
- Markus Angerer
- Department of Urology, Asklepios Klinik Altona, Hamburg, DEU
| | | | - Raphael Gübitz
- Department of Radiology, Asklepios Klinik Altona, Hamburg, DEU
| | - Alexander Harms
- Institute of Pathology, MVZ Hanse Histologikum, Hamburg, DEU
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9
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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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10
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von Büren M, Wülfing C, Schlager D, Träger MM, Daoud M, Schröder F, Brookman-May SD, Gratzke C, von Büren J. Assessment of Patient Risk Profiles by a Male Sexual Health Direct-to-Consumer Prescription Platform: A Cross-Sectional Study. Telemed Rep 2023; 4:118-125. [PMID: 37351463 PMCID: PMC10282969 DOI: 10.1089/tmr.2023.0010] [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] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/24/2023]
Abstract
Background Direct-to-consumer (DTC) online prescription platforms (OPP) for sexual health represent a potential paradigm shift in the diagnosis and treatment for sexual dysfunctions in the way men seek care. Knowledge of patients' risk profile using these platforms is limited. Aim To assess risk profiles of patients reaching out to health care professionals through their DTC. Methods Anonymized data originally collected between February 2021 to May 2022 by a DTC platform in the men's health care space were retrospectively analyzed. Data included the content of patient requests through a communication function, as well as the corresponding responses by the attending physician on staff. Each request was then assessed by two independent urologists and categorized by the level of the risk profile as well as the need to refer the patient to further medical evaluation. Results Of 585 patient requests, 531 (90.8%) were classified as low risk. In the high-risk group, 32 patients were recommended to schedule an urgent appointment at a specialist. Only three patients (0.5%) were advised to seek emergency care. The overall referral rate for both risk groups was 52.3%. The requests of 279 patients (47.7%) were assessed as digitally treatable. Almost all patients who were digitally treatable were low risk. Side effects accounted for only 9.6% of all requests in the low-risk group, compared with 46.3% in the high-risk group. Conclusion Overall, low-risk levels in the requests of patients using a DTC platform were reported, with almost half of them suitable to be solved digitally, whereas the other half required referral to an in-person specialist.
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Affiliation(s)
- Moritz von Büren
- Department of Urology, University of Freiburg, Freiburg, Germany
| | - Christian Wülfing
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
- Wellster Healthtech Group, Munich, Germany
| | - Daniel Schlager
- Department of Urology, University of Freiburg, Freiburg, Germany
| | | | - Marcel Daoud
- Wellster Healthtech Group, Munich, Germany
- Technical University of Munich, Munich, Germany
| | | | - Sabine D. Brookman-May
- Wellster Healthtech Group, Munich, Germany
- Janssen Research and Development, LLC, Spring House, Pennsylvania, USA
- Department of Urology, Ludwig Maximilian University of Munich, Munich, Germany
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11
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Dieckmann KP, Isbarn H, Trocchi P, Kießling M, Wülfing C, Stang A. No evidence for seasonal variations of the incidence of testicular germ cell tumours in Germany. PLoS One 2023; 18:e0286309. [PMID: 37235599 DOI: 10.1371/journal.pone.0286309] [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: 08/05/2022] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
The pathogenesis of testicular germ cell tumours (GCTs) is still incompletely understood. Any progress in its understanding must derive from observational studies. Recently, it has been suggested that the incidence of GCTs may follow a seasonal pattern based on circannual changes in the Vitamin D serum levels, with maximum incidence rates in winter months. To examine this promising hypothesis, we studied monthly incidence rates of testicular GCTs in Germany by analysing 30,988 GCT cases aged 15-69 years, diagnosed during 2009-2019. Monthly incident case numbers with data regarding histology and patient age were obtained from the Robert Koch Institut, Berlin, along with annual male population counts. We used precision weighting for deriving pooled monthly incidence rates for GCTs of the period 2009-2019. We stratified pooled rates by histology (seminoma and nonseminoma) and age (15-39 and 40-69 years). By assuming a cyclical effect, we used an estimator of the intensity of seasonal occurrence and report seasonal relative risks (RR). The mean monthly incidence rate was 11.93/105 person-months. The seasonal RR for testicular cancer over-all is 1.022 (95% CI 1.000-1.054). The highest seasonal RR was found in the subgroup of nonseminoma aged 15-39 years, with a RR 1.044 (95% CI 1.000-1.112). The comparison of the pooled monthly rates of the winter months (October-March) with the summer months (April-September) revealed a maximum relative difference of 5% (95% CI 1-10%) for nonseminoma, aged 15-39 years. We conclude that there is no evidence of a seasonal variation of incidence rates of testicular cancer. Our results are at odds with an Austrian study, but the present data appear sound because the results were obtained with precision weighted monthly incidence rates in a large population of GCT cases.
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Affiliation(s)
| | - Hendrik Isbarn
- Martini Klinik, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Pietro Trocchi
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Germany
| | - Marvin Kießling
- Hodentumorzentrum, Urologische Abteilung, Asklepios Klinik Altona, Hamburg, Germany
| | - Christian Wülfing
- Hodentumorzentrum, Urologische Abteilung, Asklepios Klinik Altona, Hamburg, Germany
| | - Andreas Stang
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Germany
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
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12
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Angerer M, Wülfing C, Dieckmann KP. Familial Testicular Germ Cell Tumor in Two Brothers With Emery Dreifuss Muscular Dystrophy Caused by an FHL-1 Mutation: A Case Report. Cureus 2023; 15:e38946. [PMID: 37309342 PMCID: PMC10257954 DOI: 10.7759/cureus.38946] [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] [Accepted: 05/12/2023] [Indexed: 06/14/2023] Open
Abstract
Testicular germ cell tumor (GCT) is a rare disease, accounting for no more than 1.5% of all neoplasms in males, but represents the most common tumors in adolescents and young men in Western countries. There is also consensus about the involvement of genetic factors in the etiology of testicular GCT. Familial occurrence of testicular GCT is observed in 1-2% of all cases with GCT. We report the unique case of two brothers, both afflicted with inherited Emery-Dreifuss muscular dystrophy (EDMD) and both developing testicular GCT in young adulthood. EDMD is a rare muscular dystrophy, characterized by the triad of joint contractures, slowly progressive muscle weakness, and cardiac involvement. EDMD is not a homogeneous clinical entity because it is associated with various gene mutations. One common mutation relates to the Four and a half Limb domain protein 1 (FHL-1) gene. To date, there have been no GCT cases linked with FHL-1 mutations and no malignant disease has been found associated with EDMD.
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Affiliation(s)
- Markus Angerer
- Department of Urology, Asklepios Klinik Altona, Hamburg, DEU
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13
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Angerer M, Lübbersmeyer F, Gübitz R, Wülfing C, Dieckmann KP. Tertiary Syphilitic Gumma Mimicking Testicular Neoplasms. Cureus 2023; 15:e37392. [PMID: 37051441 PMCID: PMC10085538 DOI: 10.7759/cureus.37392] [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] [Accepted: 04/09/2023] [Indexed: 04/14/2023] Open
Abstract
Palpable testicular masses in men aged 20 to 50 years usually represent testicular germ cell tumors. Diagnostic work-up involves ultrasound examination as well as serum tumor markers alpha fetoprotein, beta-human chorionic gonadotropin and lactate dehydrogenase, and particularly the novel marker M371. Orchidectomy is mandatory for germ cell tumors. We report the rare case of testicular involvement by tertiary syphilis mimicking testicular neoplasms with testis-sparing management. A 46-year-old Caucasian male presented with a painless firm mass in the right testicle and multiple cutaneous plaques at the skin of the scrotum, penis and right forearm. Testicular serum tumor markers were negative. Syphilis Rapid Plasma Reagin test and Treponema pallidum immunoglobulin antibodies tests were positive. Radiological examination revealed bilateral testicular lesions as well as bipulmonal pleural-based opacities. Conservative management was attempted and treatment with ceftriaxone (2 g/day) intravenously for 14 days was administered. The testicular findings improved rapidly and significantly during antibiotic treatment. Radiological follow-up examinations after two weeks and two months showed further regression of the testicular and pulmonary lesions. This case represents an extremely rare testicular manifestation of tertiary syphilis. Due to rising syphilis incidence in Europe, tertiary syphilis with formation of gumma should be a differential diagnosis of testicular tumor. Thus, syphilis-specific treatment is safe and orchidectomy can be avoided.
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Affiliation(s)
- Markus Angerer
- Department of Urology, Asklepios Klinik Altona, Hamburg, DEU
| | | | - Raphael Gübitz
- Department of Radiology, Asklepios Klinik Altona, Hamburg, DEU
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Dieckmann KP, Tribius S, Angerer M, Salzbrunn A, von Kopylow K, Mollenhauer M, Wülfing C. Testicular germ cell tumour arising 15 years after radiotherapy with 18 Gy for germ cell neoplasia in situ. Strahlenther Onkol 2023; 199:322-326. [PMID: 36441172 DOI: 10.1007/s00066-022-02025-x] [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: 07/05/2022] [Accepted: 10/20/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Germ cell neoplasia in situ (GCNis), the precursor of adult testicular germ cell tumours (GCTs), is found in 5-6% of contralateral testicles in patients with testicular GCT and in the tumour-surrounding tissue of > 90% of testes undergoing testis-sparing surgery (TSS) for GCT. Local radiotherapy to the testis with 18-20 Gy eradicates GCNis while preserving Leydig cells. The frequency of treatment failures is so far unknown. METHODS A 22-year-old patient with right-sided seminoma clinical stage I and contralateral GCNis received radiotherapy with 18 Gy to his left testicle. Fifteen years later he underwent orchiectomy of the irradiated testis for seminoma with adjacent GCNis. The patient is well 1 year postoperatively while on testosterone-replacement therapy. The literature was searched for further cases with GCTs arising despite local radiotherapy. RESULTS Six failures of radiotherapy have been reported previously. An estimated total number of 200 and 100 radiotherapeutic regimens with 18-20 Gy applied to cases with contralateral GCNis and with TSS, respectively, are documented in the literature. CONCLUSION Cumulative experience suggests that radiotherapy with 18-20 Gy to the testis may fail with an estimated frequency of around 1%. Reasons for failure are elusive. A primary radioresistant subfraction of GCNis is hypothesized as well as technical failures regarding application of the radiotherapeutic dose volume in small and mobile testes. Caregivers of patients with TSS and contralateral GCNis should be aware of local relapses occurring after intervals of > 10 years.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Urologische Abteilung, Hodentumorzentrum, Asklepios Klinik Altona, Paul Ehrlich Str. 1, 22763, Hamburg, Germany.
| | - Silke Tribius
- Hermann Holthusen Institut für Strahlentherapie, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | - Mathias Angerer
- Urologische Abteilung, Hodentumorzentrum, Asklepios Klinik Altona, Paul Ehrlich Str. 1, 22763, Hamburg, Germany
| | - Andrea Salzbrunn
- Klinik und Poliklinik für Dermatologie und Venerologie Bereich Andrologie, Universitätsklinikum Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Kathrein von Kopylow
- Klinik und Poliklinik für Dermatologie und Venerologie Bereich Andrologie, Universitätsklinikum Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | | | - Christian Wülfing
- Urologische Abteilung, Hodentumorzentrum, Asklepios Klinik Altona, Paul Ehrlich Str. 1, 22763, Hamburg, Germany
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Lamersdorf T, Netsch C, Becker B, Wülfing C, Anheuser P, Engel O, Gross AJ, Rosenbaum CM. Influence of Prostate Cancer on Thulium Vapoenucleation of the Prostate-A Multicentre Analysis. J Clin Med 2023; 12:jcm12031174. [PMID: 36769821 PMCID: PMC9918181 DOI: 10.3390/jcm12031174] [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: 12/27/2022] [Revised: 01/10/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Purpose: Prostate cancer (PCa) and benign prostatic hyperplasia (BPH) are common in elderly men. Data on the laser-based surgery known as thulium vapoenucleation of the prostate (ThuVEP) in PCa patients are rare. Our objective was to analyse the feasibility, safety and functional outcome of ThuVEP in patients with lower urinary tract symptoms (LUTS) and PCa. Methods: Multicentre study, including 1256 men who underwent ThuVEP for LUTS. Maximum urinary flow rate (Qmax) and post-void residual volume (PVR) were measured perioperatively. The International Prostate Symptome Score (IPSS) was measured perioperatively and at follow-up (FU). Perioperative complications were captured. Reoperation rate was captured at FU. Results: Of 994 men with complete data, 286 (28.8%) patients had PCa. The most common Gleason score was 3 + 3 in 142 patients (49.7%). Most common was low-risk PCa (141 pts; 49.3%). PCa patients were older, had smaller prostates and had higher prostate-specific antigen (PSA) values (all p < 0.001). Comparing non-PCa and PCa patients, no differences occurred perioperatively. IPSS, quality of life and PVR decreased (all p < 0.001) and Qmax improved (p < 0.001) in both groups. Reoperation rates did not differ. The results of low- vs. intermediate-/high-risk PCa patients were comparable. Conclusion: ThuVEP is a safe and long-lasting treatment option for patients with LUTS with or without PCa. No differences occurred when comparing low- to intermediate-/high-risk PCa patients.
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Affiliation(s)
- Tobias Lamersdorf
- Department of Urology, Asklepios Hospital Barmbek, 22307 Hamburg, Germany
| | - Christopher Netsch
- Department of Urology, Asklepios Hospital Barmbek, 22307 Hamburg, Germany
| | - Benedikt Becker
- Department of Urology, Asklepios Hospital Barmbek, 22307 Hamburg, Germany
| | - Christian Wülfing
- Department of Urology, Asklepios Hospital Altona, 22763 Hamburg, Germany
| | - Petra Anheuser
- Department of Urology, Asklepios Hospital Wandsbek, 22043 Hamburg, Germany
| | - Oliver Engel
- Department of Urology, Asklepios Hospital Harburg, 21075 Hamburg, Germany
| | - Andreas J. Gross
- Department of Urology, Asklepios Hospital Barmbek, 22307 Hamburg, Germany
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16
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Dieckmann KP, Isbarn H, Grobelny F, Dumlupinar C, Utschig J, Wülfing C, Pichlmeier U, Belge G. Testicular Neoplasms: Primary Tumour Size Is Closely Interrelated with Histology, Clinical Staging, and Tumour Marker Expression Rates-A Comprehensive Statistical Analysis. Cancers (Basel) 2022; 14:cancers14215447. [PMID: 36358866 PMCID: PMC9653836 DOI: 10.3390/cancers14215447] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
The role of primary tumour size (TS) in the clinical course of testicular tumours is incompletely understood. We retrospectively evaluated 641 consecutive patients with testicular neoplasms with regard to TS, histology, clinical stage (CS), serum tumour marker (STM) expression and patient age using descriptive statistical methods. TS ≤ 10 mm was encountered in 13.6% of cases. Median TS of 10 mm, 30 mm, 35 mm, and 53 mm were found in benign tumours, seminomas, nonseminomas, and other malignant tumours, respectively. In cases with TS ≤ 10 mm, 50.6% had benign tumours. Upon receiver operating characteristics analysis, TS of > 16 mm revealed 81.5% sensitivity and 81.0% specificity for detecting malignancy. In subcentimeter germ cell tumours (GCTs), 97.7% of cases had CS1, and CS1 frequency dropped with increasing TS. Expression rates of all STMs significantly increased with TS. MicroRNA-371a-3p (M371) serum levels had higher expression rates than classical STMs, with a rate of 44.1% in subcentimeter GCTs. In all, TS is a biologically relevant factor owing to its significant associations with CS, STM expression rates and histology. Importantly, 50% of subcentimeter testicular neoplasms are of benign nature, and M371 outperforms the classical markers even in subcentimeter tumours.
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Affiliation(s)
| | - Hendrik Isbarn
- Martini Klinik, Universitätsklinikum Eppendorf, Martinistrasse 52, D-20251 Hamburg, Germany
| | - Francesca Grobelny
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
| | - Cansu Dumlupinar
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
| | - Julia Utschig
- Department of Urology, Asklepios Klinik Altona, D-22763 Hamburg, Germany
| | - Christian Wülfing
- Department of Urology, Asklepios Klinik Altona, D-22763 Hamburg, Germany
| | - Uwe Pichlmeier
- Institute of Medical Biometry und Epidemiology, Universitätsklinikum Eppendorf, Martinistrasse 52, D-20251 Hamburg, Germany
| | - Gazanfer Belge
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
- Correspondence: ; Tel.: +49-421-218-615-70
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17
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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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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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Dieckmann KP, Klemke M, Grobelny F, Radtke A, Dralle-Filiz I, Wülfing C, Belge G. Serum Levels of MicroRNA-371a-3p (M371) Can Predict Absence or Presence of Vital Disease in Residual Masses After Chemotherapy of Metastatic Seminoma. Front Oncol 2022; 12:889624. [PMID: 35600346 PMCID: PMC9121896 DOI: 10.3389/fonc.2022.889624] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRadiological evaluation of postchemotherapy residual masses of metastatic seminoma is characterized by poor diagnostic accuracy. Serum levels of microRNA-371a-3p (M371) involve high specificity and sensitivity for the primary diagnosis of seminoma. We evaluated if M371 levels can indicate the presence of vital disease in postchemotherapy residual masses in patients with metastatic seminoma.MethodsTwenty-three seminoma patients (median age 52 years) with residual masses had posttreatment measurements of serum M371 levels (group A), fourteen of whom had measurements also beforehand. The posttreatment results were compared with the clinical outcome during follow-up. Eleven patients with complete remission after treatment of metastatic seminoma (group B) and 33 men with non-malignant testicular diseases (group C) served as controls. M371 serum levels were measured by quantitative real-time PCR using miR-30b-5p as endogenous control. An evaluation was performed with descriptive statistical methods.ResultsTwenty-two patients of Group A had uneventful follow-up so far, twenty-one of whom had M371 level <5, and one other had a mildly elevated level below relative quantity (RQ) = 10. One patient with a level of RQ = 26.2 rapidly progressed. The median posttreatment M371 level of the non-progressing patients of group A is not significantly different from the median level of the control group with complete remission (B). Before treatment, the median M371 levels in groups A and B were 507.6 and 143.9, respectively. In both groups, significant drops in M371 levels resulted from treatment.ConclusionNormal M371 serum levels at the time of completion of treatment of metastatic seminoma indicate the absence of vital seminoma in residual masses, while elevated levels >RQ = 10 predict the presence of disease. The optimal timing of M371 measurement after chemotherapy and the appropriate cutoff level still need to be determined. Based on the present results, measuring serum M371 levels involves the potential of a novel tool for assessing postchemotherapy residual masses of metastatic seminoma.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
- Department of Urology, Albertinen Krankenhaus, Hamburg, Germany
| | - Markus Klemke
- Faculty of Biology & Chemistry, University of Bremen, Bremen, Germany
| | | | | | | | | | - Gazanfer Belge
- Faculty of Biology & Chemistry, University of Bremen, Bremen, Germany
- *Correspondence: Gazanfer Belge,
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von Büren M, Rodler S, Wiesenhütter I, Schröder F, Buchner A, Stief C, Gratzke C, Wülfing C, von Büren J. Digital Real-world Data Suggest Patient Preference for Tadalafil over Sildenafil in Patients with Erectile Dysfunction. Eur Urol Focus 2022; 8:794-802. [PMID: 34006491 DOI: 10.1016/j.euf.2021.04.019] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/06/2021] [Accepted: 04/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) is a major care problem worldwide. Tadalafil and sildenafil are the two most common phosphodiesterase-5 inhibitors (PDE5is) used to treat ED. OBJECTIVE This study aimed to evaluate patient data of a large online prescription platform (OPP), specifically analyzing preference for tadalafil over sildenafil. DESIGN, SETTING, AND PARTICIPANTS Data from a prospectively collected German OPP were retrospectively analyzed. This dataset included patients with a history of taking one or both substances (n = 26 821). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS ED patient baseline characteristics were derived from medical questionnaires for PDE5i prescriptions between May 2019 and May 2020. Order behavior was analyzed in patients who ordered both substances over time. We applied Kruskal-Wallis tests, χ² tests, and fisher's exact tests for statistical analysis. RESULTS AND LIMITATIONS Baseline characteristics were comparable for both PDE5is in patients with a median age of 49 yr (sildenafil [interquartile range {IQR} 38-57]; tadalafil [IQR 39-56]), a median body mass index (BMI) of 26 kg/m² (sildenafil [IQR 24.54-29.03]; tadalafil [IQR 24.49-28.69]), ED onset time of >12 mo (sildenafil [87%]; tadalafil [88%]), and the presence of morning erections (sildenafil [62%]; tadalafil [61%]). Tadalafil prescriptions increased significantly from 30% (first order) to 80% (last order) in patients who had already tested both drugs. Patients with age ≤40 yr, BMI ≤25 kg/m², and sustained morning erections preferred tadalafil to sildenafil. CONCLUSIONS Using database information from an OPP, preference for tadalafil was shown for patients who had tested both PDE5is. This preference was particularly pronounced in patients with age ≤40 yr, BMI ≤25 kg/m², and sustained morning erections. A well-managed OPP can be used for research on more complex health services. PATIENT SUMMARY Analysis of large online prescription platforms provide the benefit of identifying young treatment-naïve patients with early-stage disease, which is highlighted by the fact that about two-thirds of our patients analyzed still maintained spontaneous morning erections. Patients who had tested tadalafil once developed preference for this drug.
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Affiliation(s)
- Moritz von Büren
- Department of Urology, University of Freiburg, Freiburg, Germany.
| | - Severin Rodler
- Department of Urology, University of Munich, Munich, Germany
| | - Isabell Wiesenhütter
- Munich University Institute for Psychological Psychotherapy Training (MUNIP), Munich, Germany
| | | | | | - Christian Stief
- Department of Urology, University of Munich, Munich, Germany
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Dieckmann KP, Ruf CG, Gübitz R, Wülfing C, Zengerling F. [Follow-up of testicular germ cell tumors-historical aspects and current recommendations]. Urologe A 2022; 61:484-494. [PMID: 35384479 DOI: 10.1007/s00120-022-01815-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/28/2022]
Abstract
Systematic follow-up examinations of patients cured of testicular cancer first gained attention by caregivers in the 1980s only after the management of the disease had significantly been improved by the introduction of cisplatin-based chemotherapy and almost synchronously, by the implementation of computerized tomography (CT) and serum tumor markers. Follow-up involves three aims: early diagnosis of recurrence, detection of treatment-related toxicity, and detection of secondary diseases. As the clinical presentation of testicular cancer is very heterogeneous, there is no uniform follow-up for the disease. Instead, risk-adapted follow-up schedules are required. Since the release of the German AWMF S3 guideline for the management of testicular cancer in 2019, high level evidence has accumulated for the noninferiority of magnetic resonance imaging (MRI) to CT with regard to abdominal imaging. Therefore, it is appropriate to modify the recommendations for follow-up given in the 2019 issue of the S3 guidelines. The modifications recommended herein relate to three issues: (1) Only three risk groups (instead of formerly four) are identified, i.e., seminoma (all stages); nonseminoma clinical stage 1b (i.e., pT2, with lymphovascular invasion) on surveillance; nonseminoma all other stages. All patients cured from poor risk disease or from relapses require individual follow-up schedules not included in the recommendations tabulated herein. (2) CT and abdominal sonography are replaced by MRI. (3) Chest X‑ray imaging during follow-up of seminoma patients is no longer recommended.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Urologische Abteilung, Hodentumorzentrum, Asklepios Klinik Altona, Paul Ehrlich Straße 1, 22763, Hamburg, Deutschland.
| | | | - Raphael Gübitz
- Institut für Radiologie und Neuroradiologie, Asklepios Klinik Altona, Hamburg, Deutschland
| | - Christian Wülfing
- Urologische Abteilung, Hodentumorzentrum, Asklepios Klinik Altona, Paul Ehrlich Straße 1, 22763, Hamburg, Deutschland
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Dieckmann KP, Pokrivcak T, Geczi L, Niehaus D, Dralle-Filiz I, Matthies C, Dienes T, Zschäbitz S, Paffenholz P, Gschliesser T, Pichler R, Mego M, Bader P, Zengerling F, Heinzelbecker J, Krausewitz P, Krege S, Aurilio G, Aksoy C, Hentrich M, Seidel C, Törzsök P, Nestler T, Majewski M, Hiester A, Buchler T, Vallet S, Studentova H, Schönburg S, Niedersüß-Beke D, Ring J, Trenti E, Heidenreich A, Wülfing C, Isbarn H, Pichlmeier U, Pichler M. Single-course bleomycin, etoposide, and cisplatin (1xBEP) as adjuvant treatment in testicular nonseminoma clinical stage 1: outcome, safety, and risk factors for relapse in a population-based study. Ther Adv Med Oncol 2022; 14:17588359221086813. [PMID: 35386956 PMCID: PMC8977693 DOI: 10.1177/17588359221086813] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Clinical stage 1 (CS1) nonseminomatous (NS) germ cell tumors involve a 30% probability of relapse upon surveillance. Adjuvant chemotherapy with one course of bleomycin, etoposide, and cisplatin (1xBEP) can reduce this risk to <5%. However, 1xBEP results are based solely on five controlled trials from high-volume centers. We analyzed the outcome in a real-life population. Patients and Methods: In a multicentric international study, 423 NS CS1 patients receiving 1xBEP were retrospectively evaluated. Median follow-up was 37 (range, 6–89) months. Primary end points were relapse-free and overall survival evaluated after 5 years. We also looked at associations of relapse with clinico-pathological factors using stratified Kaplan–Meier methods and Cox regression models. Treatment modality and outcome of recurrences were analyzed descriptively. Results: The 5-year relapse-free survival rate was 96.2%. Thirteen patients (3.1%; 95% confidence interval, 1.65–5.04%) relapsed after a median time of 13 months, of which 10 were salvaged (77%). Relapses were mostly confined to retroperitoneal nodes. Three patients succumbed, two to disease progression and one to toxicity of chemotherapy. Pathological stage >pT2 was significantly associated with relapse rate. Conclusion: The relapse rate of 3.1% found in this population of NS CS1 patients treated with 1xBEP at the routine care level was not inferior to the median rate of 2.3% reported from a meta-analysis of controlled trials. Also, the cure rate of relapses of 77% is consistent with the previously reported rate of 80%. This study clearly shows that the 1xBEP regimen represents a safe treatment for NS CS1 patients.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Department of Urology, Hodentumorzentrum, Asklepios Klinik Altona, Paul Ehrlich Straße 1, 22763 Hamburg, Germany
- Department of Urology, Albertinen-Krankenhaus, Hamburg, Germany
| | - Tomas Pokrivcak
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
| | - Lajos Geczi
- National Institute of Oncology, Budapest, Hungary
| | - David Niehaus
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | | | - Cord Matthies
- Department of Urology, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Tamas Dienes
- National Institute of Oncology, Budapest, Hungary
| | - Stefanie Zschäbitz
- Department of Medical Oncology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Pia Paffenholz
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | | | - Renate Pichler
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Pia Bader
- Department of Urology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | | | - Julia Heinzelbecker
- Department of Urology and Pediatric Urology, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Philipp Krausewitz
- Department of Urology and Pediatric Urology, Universitätsklinikum Bonn, Bonn, Germany
| | - Susanne Krege
- Department of Urology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Gaetano Aurilio
- Medical Oncology Division of Urogenital and Head and Neck Tumours, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Cem Aksoy
- Klinik und Poliklinik für Urologie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital, Munich, Germany
| | - Christoph Seidel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Péter Törzsök
- Department of Urology and Andrology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tim Nestler
- Department of Urology, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany
| | | | - Andreas Hiester
- Department of Urology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Tomas Buchler
- Department of Oncology, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Sonia Vallet
- Department of Internal Medicine II, Universitätsklinikum Krems, Krems, AustriaDepartment of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | - Hana Studentova
- Department of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | - Sandra Schönburg
- Department of Urology, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | | | - Julia Ring
- Department of Urology, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Emanuela Trenti
- Department of Urology, Central Hospital Bolzano, Bolzano, Italy
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | | | - Hendrik Isbarn
- Martini-Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Pichlmeier
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Pichler
- Division of Oncology, Medical University of Graz, Graz, Austria
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Eismann L, Bohn L, Buchner A, Casuscelli J, Volz Y, Weinhold P, Wülfing C, Waidelich R, Stief CG, Schlenker B, Rodler S. Age and ECOG Performance Status as Predictors of Survival of Patients with Upper Urinary Tract Urothelial Carcinoma Undergoing Radical Nephroureterectomy. Urol Int 2022; 107:72-79. [PMID: 35279663 DOI: 10.1159/000522295] [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: 11/02/2021] [Accepted: 01/18/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION This study aimed to evaluate the impact of chronological and biological age on perioperative complications and survival after radical nephroureterectomy (RNU). Elderly patients with upper-tract urothelial carcinoma might be overtreated by RNU. METHODS We retrospectively analyzed patients undergoing RNU. To evaluate the perioperative risk, patients were divided into four groups (<75; 75-79; 80-84; ≥85 years). The endpoints are perioperative complications and survival (overall survival [OS]). We calculated a risk score including chronological and biological age (Eastern cooperative oncology group performance status). Statistical analysis was performed by Kruskal-Wallis, Mann-Whitney U, χ2, log-rank, and Breslow tests. RESULTS 194 patients were included in the study. Median follow-up was 25.5 months. Elderly cohorts ≥2 presented a higher number of days in intensive care unit following RNU (p < 0.001). Complication rates increased from cohort 1-4 with rates of 48.8%; 55.2%; 92.0%; 85.7% (p < 0.001). Median survival was 115, 55, 28, and 20 months for cohorts 1, 2, 3, and 4, respectively. The combined risk score revealed a significant 5-year OS benefit for patients with score 0 (82.3%) compared to score 1 (46.0%) and score 2 (15.0%; p < 0.001). DISCUSSION/CONCLUSION We evaluated the impact of chronological and biological age on perioperative complications and survival after RNU. A combined risk score of chronological and biological age correlates with survival after RNU.
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Affiliation(s)
- Lennert Eismann
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, München, Germany
| | - Lucas Bohn
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, München, Germany
| | - Alexander Buchner
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, München, Germany
| | - Jozefina Casuscelli
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, München, Germany
| | - Yannic Volz
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, München, Germany
| | - Philipp Weinhold
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, München, Germany
| | | | - Raphaela Waidelich
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, München, Germany
| | - Christian G Stief
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, München, Germany
| | - Boris Schlenker
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, München, Germany
| | - Severin Rodler
- Klinik und Poliklinik für Urologie, Klinikum der Universität München, München, Germany
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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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Merseburger AS, Bannowsky A, Becker K, Bokemeyer C, Eichenauer R, Lehmann J, Mickisch G, Steuber T, von Amsberg G, von Kügelgen T, Wülfing C. [CARD study: relevance for the treatment of advanced prostate cancer]. Aktuelle Urol 2022; 53:54-59. [PMID: 32968994 DOI: 10.1055/a-1247-4155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Various life-prolonging therapy options are available for the treatment of metastatic castration-resistant prostate cancer (mCRPC). OBJECTIVE The optimal therapy sequence for mCRPC has been discussed for years. With the final results of the CARD study, important prospective data are available to enlighten the discussion about the therapy sequence. MATERIAL AND METHOD CARD is a randomised phase IV trial in patients with mCRPC who were previously treated with docetaxel and an anti-androgen receptor (ARTA). The study showed significant efficacy benefits in favour of further treatment with cabazitaxel versus a second ARTA therapy. The study results are presented and discussed in the context of previous study data with regard to their importance for everyday clinical practice. RESULTS The CARD study data confirm cabazitaxel as an effective therapy option for mCRPC patients previously treated with docetaxel and an ARTA. Cabazitaxel was safe to apply. The study results confirm the cross resistance between the two ARTAs Abiraterone and Enzalutamide. CONCLUSION In mCRPC patients eligible for chemotherapy, the therapy sequence should be chosen so that the patients also receive cabazitaxel. A direct therapy sequence with two ARTAs should be avoided or, at least, only considered if other substances are contraindicated.
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Affiliation(s)
| | | | - Klaus Becker
- Onkologie Lerchenfeld, Onkologie Lerchenfeld, Hamburg
| | - Carsten Bokemeyer
- Universitätsklinikum Hamburg Eppendorf Medizinische Klinik und Poliklinik II Onkologie Hämatologie, Zentrum für Onkologie, Hamburg
| | | | - Jan Lehmann
- Gesundheitszentrum Kiel-Mitte, Urologische Gemeinschaftspraxis Prüner Gang, Kiel
| | - Gerald Mickisch
- Centrum für Operative Urologie Bremen, Centrum für Operative Urologie Bremen, Bremen
| | - Thomas Steuber
- Universitätsklinikum Hamburg-Eppendorf, Martini-Klinik, Prostatakrebszentrum, Hamburg
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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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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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28
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Marghawal D, Wülfing C, Utschig J. [62/f obese with pollakiuria, nocturia and urgent urination : Preparation for the medical specialist examination: part 27]. Urologe A 2021; 61:97-102. [PMID: 34846544 DOI: 10.1007/s00120-021-01690-7] [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: 09/28/2021] [Indexed: 11/28/2022]
Affiliation(s)
- David Marghawal
- Abteilung für Urologie, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Deutschland.
| | - Christian Wülfing
- Abteilung für Urologie, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Deutschland
| | - Julia Utschig
- Abteilung für Urologie, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Deutschland
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29
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Dieckmann KP, Dumlupinar C, Radtke A, Matthies C, Pichler R, Paffenholz P, Sommer J, Winter A, Zengerling F, Hennig F, Wülfing C, Belge G. Associations of serum levels of microRNA-371a-3p (M371) with risk factors for progression in nonseminomatous testicular germ cell tumours clinical stage 1. World J Urol 2021; 40:317-326. [PMID: 34775512 PMCID: PMC8921024 DOI: 10.1007/s00345-021-03876-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/30/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose Lymphovascular invasion (LV1) and presence of > 50% embryonal carcinoma (> 50% EC) represent risk factors for progression in patients with clinical stage 1 (CS1) nonseminomatous (NS) testicular germ cell tumours. As serum levels of microRNA-371a-3p (M371) are capable of detecting small amounts of GCT, we evaluated if LV1 and > 50% EC are associated with M371 levels. Methods M371 serum levels were measured postoperatively in 153 NS CS1 patients and both pre- and postoperatively in 131 patients. We registered the following factors: age, tumour size, LV status, > 50% EC, teratoma in primary, preoperative elevation of classical tumour markers. M371 expression was compared among subgroups. The ability of M371 to predict LV1 was calculated by receiver operating characteristics (ROC) curves. Multiple regression analysis was used to look for associations of M371 levels with other factors. Results Postoperatively elevated M371 levels were found in 29.4% of the patients, but were neither associated with LV status nor with > 50% EC. Likewise, relative decrease of M371 was not associated. ROC analysis of postoperative M371 levels revealed an AUC of 0.5 for the ability to predict LV1 while preoperative M371 had an AUC of 0.732. Multiple regression analysis revealed significant associations of preoperative M371 levels with LV status (p = 0.003), tumour size (p = 0.001), > 50% EC (p = 0.004), and teratoma component (p = 0.045). Conclusion Postoperatively elevated M371 levels are not associated with risk factors for progression in NS CS1 patients. However, the significant association of preoperative M371 expression with LV1 deserves further evaluation.
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Affiliation(s)
| | - Cansu Dumlupinar
- Faculty of Biology and Chemistry, University Bremen, Leobener Strasse 2/FVG, 28359, Bremen, Germany
| | | | - Cord Matthies
- Department of Urology, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Renate Pichler
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | - Pia Paffenholz
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Jörg Sommer
- Department of Urology, St. Franziskus Krankenhaus Lohne, Lohne, Germany
| | - Alexander Winter
- Department of Urology, University Hospital Oldenburg, Oldenburg, Germany
| | | | - Finja Hennig
- Faculty of Biology and Chemistry, University Bremen, Leobener Strasse 2/FVG, 28359, Bremen, Germany
| | | | - Gazanfer Belge
- Faculty of Biology and Chemistry, University Bremen, Leobener Strasse 2/FVG, 28359, Bremen, Germany.
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30
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de Wit R, Wülfing C, Castellano D, Kramer G, Eymard JC, Sternberg CN, Fizazi K, Tombal B, Bamias A, Carles J, Iacovelli R, Melichar B, Sverrisdóttir Á, Theodore C, Feyerabend S, Helissey C, Foster MC, Ozatilgan A, Geffriaud-Ricouard C, de Bono J. Baseline neutrophil-to-lymphocyte ratio as a predictive and prognostic biomarker in patients with metastatic castration-resistant prostate cancer treated with cabazitaxel versus abiraterone or enzalutamide in the CARD study. ESMO Open 2021; 6:100241. [PMID: 34450475 PMCID: PMC8390550 DOI: 10.1016/j.esmoop.2021.100241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/05/2021] [Accepted: 07/21/2021] [Indexed: 01/04/2023] Open
Abstract
Background There is growing evidence that a high neutrophil-to-lymphocyte ratio (NLR) is associated with poor overall survival (OS) for patients with metastatic castration-resistant prostate cancer (mCRPC). In the CARD study (NCT02485691), cabazitaxel significantly improved radiographic progression-free survival (rPFS) and OS versus abiraterone or enzalutamide in patients with mCRPC previously treated with docetaxel and the alternative androgen-receptor-targeted agent (ARTA). Here, we investigated NLR as a biomarker. Patients and methods CARD was a multicenter, open-label study that randomized patients with mCRPC to receive cabazitaxel (25 mg/m2 every 3 weeks) versus abiraterone (1000 mg/day) or enzalutamide (160 mg/day). The relationships between baseline NLR [< versus ≥ median (3.38)] and rPFS, OS, time to prostate-specific antigen progression, and prostate-specific antigen response to cabazitaxel versus ARTA were evaluated using Kaplan–Meier estimates. Multivariable Cox regression with stepwise selection of covariates was used to investigate the prognostic association between baseline NLR and OS. Results The rPFS benefit with cabazitaxel versus ARTA was particularly marked in patients with high NLR {8.5 versus 2.8 months, respectively; hazard ratio (HR) 0.43 [95% confidence interval (CI) 0.27-0.67]; P < 0.0001}, compared with low NLR [7.5 versus 5.1 months, respectively; HR 0.69 (95% CI 0.45-1.06); P = 0.0860]. Higher NLR (continuous covariate, per 1 unit increase) independently associated with poor OS [HR 1.05 (95% CI 1.02-1.08); P = 0.0003]. For cabazitaxel, there was no OS difference between patients with high versus low NLR (15.3 versus 12.9 months, respectively; P = 0.7465). Patients receiving an ARTA with high NLR, however, had a worse OS versus those with low NLR (9.5 versus 13.3 months, respectively; P = 0.0608). Conclusions High baseline NLR predicts poor outcomes with an ARTA in patients with mCRPC previously treated with docetaxel and the alternative ARTA. Conversely, the activity of cabazitaxel is retained irrespective of NLR. Baseline NLR was evaluated as a biomarker in patients with mCRPC treated with cabazitaxel versus abiraterone or enzalutamide. High baseline NLR predicted poor outcomes with abiraterone or enzalutamide in patients with mCRPC. Clinical benefit from cabazitaxel was retained in higher baseline NLR patients.
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Affiliation(s)
- R de Wit
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - C Wülfing
- Department of Urology, Asklepios Tumorzentrum, Hamburg, Germany
| | - D Castellano
- Department of Medical Oncology, University Hospital 12 de Octubre, Madrid, Spain
| | - G Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - J-C Eymard
- Department of Medical Oncology, Institute Jean Godinot, Reims, France
| | - C N Sternberg
- Division of Hematology and Medical Oncology, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, USA
| | - K Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France; University of Paris Saclay, Saint-Aubin, France
| | - B Tombal
- Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium
| | - A Bamias
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - J Carles
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - R Iacovelli
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy; Department of Medical Oncology, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - B Melichar
- Department of Oncology, Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | - Á Sverrisdóttir
- Department of Oncology, Landspitali University Hospital, Reykjavik, Iceland
| | - C Theodore
- Department of Oncology, Foch Hospital, Suresnes, France
| | | | - C Helissey
- Hôpital d'Instruction des Armées Bégin, Saint Mandé, France
| | - M C Foster
- Global Medical Oncology, Sanofi, Cambridge, USA
| | - A Ozatilgan
- Global Medical Oncology, Sanofi, Cambridge, USA
| | | | - J de Bono
- Division of Clinical Studies, The Institute of Cancer Research, London, UK; Prostate Targeted Therapy Group, Royal Marsden Hospital, London, UK
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Dieckmann KP, Andura O, Pichlmeier U, Otte KM, Isbarn H, Wülfing C. Correction to: Are serum levels of 25-hydroxy vitamin D reduced following orchiectomy in testicular cancer patients? Basic Clin Androl 2021; 31:18. [PMID: 34182920 PMCID: PMC8240186 DOI: 10.1186/s12610-021-00136-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Klaus-Peter Dieckmann
- Department of Urology, Testis Cancer Unit, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, Hamburg, Germany.
| | - Osama Andura
- Department of Urology, Testis Cancer Unit, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, Hamburg, Germany
| | - Uwe Pichlmeier
- Institut für Medizinische Biometrie und Statistik, Zentrum für Experimentelle Medizin, Universitätsklinikum Eppendorf, Hamburg, Germany
| | | | - Hendrik Isbarn
- Universitätsklinikum Eppendorf, Martini Klinik, Hamburg, Germany
| | - Christian Wülfing
- Department of Urology, Testis Cancer Unit, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, Hamburg, Germany
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Dieckmann KP, Andura O, Pichlmeier U, Otte KM, Isbarn H, Wülfing C. Revised manuscript R2, clean version are serum levels of 25-hydroxy vitamin D reduced following orchiectomy in testicular cancer patients? Basic Clin Androl 2021; 31:14. [PMID: 34107893 PMCID: PMC8190859 DOI: 10.1186/s12610-021-00132-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background The testis represents one place where the progenitor of vitamin D is converted into its active form. Loss of one testis was suggested to result in reduced vitamin D serum levels. Vitamin D deficiency would represent a significant health problem in the long-term course of patients with testicular germ cell tumors (GCTs) since most of them survive. The purpose of this study was to look to the serum 25(OH)-Vitamin D (25OHD) levels in patients with GCTs before and after orchiectomy. A total of 177 GCT patients underwent measurements of serum 25OHD levels, thereof 83 with preoperative measurements and 94 with measurements at six particular time-points from immediate postoperatively to >24 months. Longitudinal assessments of 25OHD serum levels were performed in individual patients with repeated measurements. A second analysis involved patient cohorts with measurements at six postoperative time-points. Serum levels of patients were also compared with 2 control groups, one consisting of 84 patients with non-neoplastic testicular diseases and another with 237 patients with non-neoplastic urologic diseases. We also looked to associations of 25OHD levels with levels of testosterone, follicle stimulating hormone (FSH), age, histology of GCT and season. Descriptive statistical methods were employed to compare groups and to analyze changes over time. Results Normal serum levels of 25OHD were found in 21.7%, 23.1%, 20.2%, 21.9% in GCT patients preoperatively, after >2 years, in control group 1 and control group 2, respectively. Levels were significantly higher in spring and summer, but no association was found with other parameters. We found a significant transient decrease of 25OHD levels with a nadir at 6-12 months after orchiectomy and a recovery thereafter. Conclusion Contrasting with previous studies we found no permanent reduction of serum 25OHD levels after orchiectomy but transient postoperative drop of 25OHD levels. There were no associations of 25OHD levels with age, and levels of testosterone or FSH. Our results may point to a particular role of the testis in vitamin D metabolism and may thus enhance the understanding of the diverse physiological roles of the testis.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Department of Urology, Testis Cancer Unit, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, Hamburg, Germany.
| | - Osama Andura
- Department of Urology, Testis Cancer Unit, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, Hamburg, Germany
| | - Uwe Pichlmeier
- Institut für Medizinische Biometrie und Statistik, Zentrum für Experimentelle Medizin, Universitätsklinikum Eppendorf, Hamburg, Germany
| | | | - Hendrik Isbarn
- Universitätsklinikum Eppendorf, Martini Klinik, Hamburg, Germany
| | - Christian Wülfing
- Department of Urology, Testis Cancer Unit, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, Hamburg, Germany
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Suzuki H, Castellano D, de Bono J, Sternberg CN, Fizazi K, Tombal B, Wülfing C, Foster MC, Ozatilgan A, Geffriaud-Ricouard C, de Wit R. Cabazitaxel versus abiraterone or enzalutamide in metastatic castration-resistant prostate cancer: post hoc analysis of the CARD study excluding chemohormonal therapy for castrate-naive disease. Jpn J Clin Oncol 2021; 51:1287-1297. [PMID: 33738495 PMCID: PMC8521736 DOI: 10.1093/jjco/hyab028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/14/2021] [Accepted: 02/16/2021] [Indexed: 11/12/2022] Open
Abstract
Background In the CARD study (NCT02485691), cabazitaxel significantly improved clinical outcomes versus abiraterone or enzalutamide in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel and the alternative androgen-signalling-targeted inhibitor. However, some patients received docetaxel or the prior alternative androgen-signalling-targeted inhibitor in the metastatic hormone-sensitive (mHSPC) setting. Therefore, the CARD results cannot be directly translated to a Japanese population. Methods Patients (N = 255) received cabazitaxel (25 mg/m2 IV Q3W, prednisone, G-CSF) versus abiraterone (1000 mg PO, prednisone) or enzalutamide (160 mg PO) after prior docetaxel and progression ≤12 months on the alternative androgen-signalling-targeted inhibitor. Patients who received combination therapy for mHSPC were excluded (n = 33) as docetaxel is not approved in this setting in Japan. Results A total of 222 patients (median age 70 years) were included in this subanalysis. Median number of cycles was higher for cabazitaxel versus androgen-signalling-targeted inhibitors (7 versus 4). Clinical outcomes favoured cabazitaxel over abiraterone or enzalutamide including, radiographic progression-free survival (rPFS; median 8.2 versus 3.4 months; P < 0.0001), overall survival (OS; 13.9 versus 11.8 months; P = 0.0102), PFS (4.4 versus 2.7 months; P < 0.0001), confirmed prostate-specific antigen response (37.0 versus 14.4%; P = 0.0006) and objective tumour response (38.9 versus 11.4%; P = 0.0036). For cabazitaxel versus androgen-signalling-targeted inhibitor, grade ≥ 3 adverse events occurred in 55% versus 44% of patients, with adverse events leading to death on study in 2.7% versus 5.7%. Conclusions Cabazitaxel significantly improved outcomes including rPFS and OS versus abiraterone or enzalutamide and are reflective of the Japanese patient population. Cabazitaxel should be considered the preferred treatment option over abiraterone or enzalutamide in this setting.
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Affiliation(s)
- Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Chiba, Japan
| | - Daniel Castellano
- Medical Oncology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Johann de Bono
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden Hospital, London, UK
| | - Cora N Sternberg
- Division of Hematology and Medical Oncology, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Karim Fizazi
- Department of Cancer Medicine, Gustave Roussy Institute and Paris Sud University, Villejuif, France
| | - Bertrand Tombal
- Division of Urology, Université Catholique de Louvain, Louvain, Belgium
| | | | | | - Ayse Ozatilgan
- Global Medical Affairs Oncology, Sanofi, Cambridge, MA, USA
| | | | - Ronald de Wit
- Department Medical Oncology, Erasmus University Hospital, Rotterdam, the Netherlands
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Eismann L, Mumm JN, Bohn L, Wülfing C, Knüchel-Clarke R, Casuscelli J, Waidelich R, Stief CG, Schlenker B, Rodler S. The Impact of Fluorescence in situ Hybridization on the Staging of Upper Tract Urothelial Carcinoma. Urol Int 2021; 105:631-636. [PMID: 33582671 DOI: 10.1159/000513459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/28/2020] [Accepted: 11/28/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the impact of fluorescence in situ hybridization (FISH) diagnostics on the T stage in final histology specimen of patients undergoing radical nephroureterectomy (RNU) due to upper tract urothelial carcinoma (UTUC) at a large tertiary care center. METHODS We retrospectively analyzed patients who underwent RNU at our center between 2008 and 2020. Inclusion criteria were RNU due to UTUC. Urine cytologies were used for FISH analysis to detect chromosomal abnormalities. Pre-FISH group was defined as patients without access to routine preoperative urinary FISH testing (2008-2014), and FISH group was defined as patients with access to routine FISH testing. Primary outcome was T stage in final histology. Statistical analysis was performed by χ2 test and Mann-Whitney U test. RESULTS Out of 212 patients who underwent RNU at our center between 2008 and 2020, 155 patients were included into the final analysis. The median age was 71 (range 33-90) years, and 108 (69.7%) patients were male and 47 (30.3%) female. Age and gender were not differently distributed in both groups (age: p = 0.925; gender: p = 0.682). Organ-confined disease was found in 37/72 patients in the pre-FISH cohort and in 48/83 patients in the FISH cohort (p = 0.422). Within organ-confined disease, 18/37 patients revealed a T stage smaller than T1 in the pre-FISH cohort and 35/48 patients in the FISH cohort (p = 0.022). CONCLUSIONS Preoperative FISH diagnostics add important information to preoperative diagnostic workup of patients with UTUC. Within organ-confined disease, a significant shift toward T stages lower than T1 is observed. Further research is required to determine the impact of this shift on survival in UTUC.
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Affiliation(s)
- Lennert Eismann
- Department of Urology, Klinikum der Universität München, Munich, Germany,
| | - Jan-Niclas Mumm
- Department of Urology, Klinikum der Universität München, Munich, Germany
| | - Lucas Bohn
- Department of Urology, Klinikum der Universität München, Munich, Germany
| | - Christian Wülfing
- Department of Urology, Asklepios Klinik Hamburg Altona, Hamburg, Germany
| | | | | | - Raphaela Waidelich
- Department of Urology, Klinikum der Universität München, Munich, Germany
| | - Christian G Stief
- Department of Urology, Klinikum der Universität München, Munich, Germany
| | - Boris Schlenker
- Department of Urology, Klinikum der Universität München, Munich, Germany
| | - Severin Rodler
- Department of Urology, Klinikum der Universität München, Munich, Germany
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Brinkmann M, Tallone EM, Würschmidt F, Wülfing C, Dieckmann KP. [Myocardial infarction in a young patient with seminoma during chemotherapy with cisplatinum, etoposide, and bleomycin]. Aktuelle Urol 2021; 52:54-57. [PMID: 30064153 DOI: 10.1055/a-0649-4878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION More than 90 % of all patients with testicular germ cell tumours can be cured effectively. The mainstay of treatment is chemotherapy with cisplatin, etoposide and bleomycin (PEB). This regimen is usually well tolerated and does not lead to serious adverse events. Cardiovascular complications are encountered very rarely, but have gained increasing attention in recent years. CASE DESCRIPTION A 33-year-old man with a testicular seminoma, clinical stage 2b, was subjected to PEB chemotherapy. At the end of the first treatment course, he had an acute ST-elevation myocardial infarction. Coronary angiography revealed a circumscribed stenosis of the left circumflex branch of the left coronary artery with intima dissection and thrombotic deposits. No atherosclerotic changes were found. Management consisted of placement of a drug-eluting coronary stent. Chemotherapy was discontinued and the seminoma treatment completed by radiotherapy with 30 Gy applied to the retroperitoneal mass and a paraaortic template. Complete remission was achieved. 6 months thereafter, the patient was doing well and was disease-free. COMMENT About 0.3 % of all testis cancer patients undergoing cisplatin-based chemotherapy develop cardiovascular complications. Cisplatin-related endothelial damage with secondary thrombotic clotting is assumed to be etiologic in these cases. As there is little comorbidity, the prognostic outlook is favourable in most cases. Caregivers in charge of testis cancer management should be vigilant regarding cardiovascular complications to ensure immediate diagnostic and therapeutic measures in incident cases.
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Wülfing C, Goebell PJ, Eichenauer R, Lange C, Machtens S, Schwentner C, Todenhöfer T, Tauber R, Schostak M. [Advanced prostate cancer: sequence of androgen receptor-targeted substances and chemotherapy determines long-term survival]. Urologe A 2020; 60:212-221. [PMID: 33346857 DOI: 10.1007/s00120-020-01411-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
The treatment of advanced prostate cancer is changing. New study data and the resulting new therapeutic options have led to increasingly differentiated treatment decisions. Despite the changing therapy landscape, taxane-based chemotherapy-being a life-prolonging treatment-remains an indispensable therapeutic component for chemotherapy-fit patients in the metastatic setting. The current results of the randomized study CARD show that cabazitaxel has a higher oncological effectiveness, including a significant survival benefit and no negative impact on quality of life parameters, compared to a second androgen receptor targeted agent (ARTA) in patients with metastatic castration-resistant prostate cancer (mCRPC) who progressed after treatment with docetaxel and an androgen receptor-targeted agent (ARTA). In mCNPC the combination therapies of ADT (androgen deprivation therapy) plus docetaxel or of ADT plus ARTA have been established. In addition, three ARTAs tested in recent phase III studies in a clinical setting for patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) showed that their use significantly prolongs metastasis-free survival and overall survival. The potential early use of ARTAs also has implications for the treatment of mCNPC. The aim of this publication is to provide guidance for clinical routine and to develop criteria for individual therapy decisions with a special focus on the use of chemotherapy.
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Affiliation(s)
- Christian Wülfing
- Asklepios Tumorzentrum, Abteilung für Urologie, Asklepios Klinik Altona, Paul-Ehrlich-Straße 1, 22763, Hamburg, Deutschland.
| | - Peter J Goebell
- Urologische und Kinderurologische Universitätsklinik, Erlangen, Deutschland
| | - Rolf Eichenauer
- Urologikum Hamburg MVZ, Standort Alstertal, Hamburg, Deutschland
| | | | - Stefan Machtens
- Klinik für Urologie und Kinderurologie, GFO Kliniken Rhein Berg, Betriebsstätte, Marien-Krankenhaus, Bergisch Gladbach, Deutschland
| | | | | | - Robert Tauber
- Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Martin Schostak
- Klinik für Urologie, Uroonkologie, robotergestützte und fokale Therapie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
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Dieckmann KP, Marghawal D, Pichlmeier U, Wülfing C. Thromboembolic Events in Patients with Testicular Germ Cell Tumours Are Predominantly Triggered by Advanced Disease and by Central Venous Access Systems. Urol Int 2020; 105:257-263. [PMID: 33333524 DOI: 10.1159/000512055] [Citation(s) in RCA: 2] [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: 07/31/2020] [Accepted: 10/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thromboembolic events (TEEs) may significantly complicate the clinical management of patients with testicular germ cell tumours (GCTs). We analysed a cohort of GCT patients for the occurrence of TEEs and looked to possible pathogenetic factors. PATIENTS, METHODS TEEs occurring within 6 months after diagnosis were retrospectively analysed in 317 consecutive patients with testicular GCT (median age 37 years, 198 seminoma, 119 nonseminoma). The following factors were analysed for association with TEE: histology, age, clinical stage (CS), chemotherapy, use of a central venous access device (CVA). Data analysis involved descriptive statistical methods with multivariable analysis to identify independent risk factors. RESULTS Twenty-three TEEs (7.3%) were observed, 18 deep vein thromboses, 4 pulmonary embolisms, and 1 myocardial infarction. Univariable risk calculation yielded the following odds ratios (ORs) : >CS1 OR = 43.7 (95% confidence intervals [CIs] 9.9-191.6); chemotherapy OR = 7.8 (95% CI 2.3-26.6); CVA OR = 30.5 (95% CI 11.0-84.3). Multivariable analysis identified only CS > 1 (OR = 16.9; 95% CI 3.5-82.4) and CVA (OR = 9.0; 95% CI 2.9-27.5) as independent risk factors. CONCLUSIONS Patients with CSs >CS1 are at significantly increased risk of TEEs even without chemotherapy. Particular high risk is associated with the use of CVA devices for chemotherapy. Caregivers of GCT patients must be aware of the particular risk of TEEs.
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Affiliation(s)
| | - David Marghawal
- Asklepios Klinik Altona, Urologische Abteilung, Hamburg, Germany
| | - Uwe Pichlmeier
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Eppendorf, Hamburg, Zentrum für Experimentelle Medizin, Hamburg, Germany
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Belge G, Grobelny F, Radtke A, Bodes J, Matthies C, Wülfing C, Dieckmann KP. Serum levels of microRNA-371a-3p are not elevated in testicular tumours of non-germ cell origin. J Cancer Res Clin Oncol 2020; 147:435-443. [PMID: 33200255 PMCID: PMC7817581 DOI: 10.1007/s00432-020-03429-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 09/15/2020] [Accepted: 10/12/2020] [Indexed: 11/28/2022]
Abstract
Purpose Serum levels of microRNA-371a-3p (M371) have been shown to be a highly sensitive and specific biomarker for testicular germ cell tumours (TGCT). Little information exists on the expression of this marker in testicular neoplasms deriving from the gonadal stroma or other structures of the gonad. This study presents an expression analysis of the novel TGCT-biomarker M371 in a large cohort of testicular non-germ cell tumours. Methods The M371 expression was measured by quantitative real time PCR in serum of 99 patients with testicular tumours of non-germ cell origin, thereof 30 patients with malignant testicular lymphomas and 61 patients with gonadal stroma tumours such as Leydig cell tumours, Sertoli cell tumours and 8 cases with miscellaneous benign testicular tumours. Their M371 levels were compared to those of 20 patients with TGCT and to 37 tumour-free male controls. Results The median expression levels of benign testicular tumours and testicular lymphoma are close to zero, thus, identical with those of controls and significantly lower than those of TGCT. In summary, this study provides further evidence for the notion that M371 is exclusively expressed by germ cell tumours and not by testicular neoplasms of the non-germ cell subtypes. Conclusion Clinically, the test might be of value in preoperative characterization of benign testicular tumours eligible for conservative surgery.
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Affiliation(s)
- Gazanfer Belge
- Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | | | - Arlo Radtke
- Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Jacqueline Bodes
- Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Cord Matthies
- Department of Urology, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Christian Wülfing
- Department of Urology, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Germany
| | - Klaus-Peter Dieckmann
- Department of Urology, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Germany.
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Marghawal D, Wülfing C, Dieckmann KP. [23/m with painful enlargement of the right testicle : Preparation for the specialist examination: case 3]. Urologe A 2020; 59:175-179. [PMID: 33125533 DOI: 10.1007/s00120-020-01359-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- David Marghawal
- Abteilung für Urologie, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Deutschland.
| | - Christian Wülfing
- Abteilung für Urologie, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Deutschland
| | - Klaus-Peter Dieckmann
- Abteilung für Urologie, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Deutschland
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Dieckmann KP, Hennig F, Anheuser P, Gehrckens R, Viehweger F, Wülfing C, Belge G. High Expression of microRNA-371a-3p in Cystic Fluid of Post-Chemotherapy Teratoma with Concurrent Normal Serum Levels in Patients with Non-Seminomatous Testicular Germ Cell Tumours. Urol Int 2020; 105:21-26. [PMID: 33049748 DOI: 10.1159/000510760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND MicroRNA-371a-3p (miR-371), the novel serum biomarker of testicular germ cell tumours (GCTs), is produced by undifferentiated subtypes of GCTs but not by teratoma. Cystic teratoma developing from retroperitoneal metastases of GCT subsequent to chemotherapy had been shown to contain high levels of classical serum tumour markers of GCT in the presence of normal marker levels in serum. To date, no information is available regarding the presence of miR-371 in the cystic fluid of residual teratoma after chemotherapy. METHODS Four patients (age 18-26 years) undergoing retroperitoneal lymph node dissection (RPLND) for cystic residual masses resulting from chemotherapy of bulky retroperitoneal GCT had measurements of miR-371 in both serum and cystic fluid aspirated from surgical specimens. Measurement of the miR was performed with quantitative real-time PCR using miR-30b-5p as reference. Results were tabulated and analysed in a descriptive manner. RESULTS Histologically, all of the surgical specimens involved teratoma only with no evidence of vital undifferentiated GCT tissue. All patients were cured. Prior to RPLND, miR-371 serum levels were not measurable or close to zero in all of the patients. Cystic fluid revealed elevated levels of miR-371 in 3 patients and traces of miR in one. CONCLUSIONS The detection of miR-371 in the cystic fluid of teratoma is somewhat enigmatic since this GCT subtype usually does not express the miR. Two hypotheses may explain the finding: First, miR-371 molecules were released into the cystic fluid by active GCT tissue prior to chemotherapy. High levels were kept after regression of vital GCT tissue because the cystic lumen is without a specific drainage system. Second, teratoma cells lining the interior cyst wall may shed small amounts of miR-371 into the lumen. Because of the lacking drainage system, even small levels may accumulate. The present finding adds to the understanding of the biology of the novel biomarker of GCT.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Urologische Abteilung, Asklepios Klinik Altona, Hamburg, Germany, .,Klinik für Urologie, Albertinen-Krankenhaus, Hamburg, Germany,
| | - Finja Hennig
- Fachbereich Biologie, Universität Bremen, Bremen, Germany
| | - Petra Anheuser
- Klinik für Urologie, Albertinen-Krankenhaus, Hamburg, Germany
| | - Ralf Gehrckens
- Abteilung Diagnostische Radiologie, Albertinen-Krankenhaus Hamburg, Hamburg, Germany
| | - Florian Viehweger
- Institut für Pathologie, Universitätsklinikum Eppendorf, Hamburg, Germany
| | | | - Gazanfer Belge
- Fachbereich Biologie, Universität Bremen, Bremen, Germany
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Harke NN, Radtke JP, Hadaschik BA, Bach C, Berger FP, Blana A, Borgmann H, Distler FA, Edeling S, Egner T, Engels CL, Farzat M, Haese A, Hein R, Kuczyk MA, Manseck A, Moritz R, Musch M, Peters I, Pokupic S, Rocco B, Schneider A, Schumann A, Schwentner C, Sighinolfi CM, Buse S, Stolzenburg JU, Truß MC, Waldner M, Wülfing C, Zimmermanns V, Witt JH, Wagner C. To defer or not to defer? A German longitudinal multicentric assessment of clinical practice in urology during the COVID-19 pandemic. PLoS One 2020; 15:e0239027. [PMID: 32931510 PMCID: PMC7491711 DOI: 10.1371/journal.pone.0239027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/30/2020] [Indexed: 01/19/2023] Open
Abstract
Introduction After the outbreak of COVID-19 unprecedented changes in the healthcare systems worldwide were necessary resulting in a reduction of urological capacities with postponements of consultations and surgeries. Material and methods An email was sent to 66 urological hospitals with focus on robotic surgery (RS) including a link to a questionnaire (e.g. bed/staff capacity, surgical caseload, protection measures during RS) that covered three time points: a representative baseline week prior to COVID-19, the week of March 16th-22nd and April 20th-26th 2020. The results were evaluated using descriptive analyses. Results 27 out of 66 questionnaires were analyzed (response rate: 41%). We found a decrease of 11% in hospital beds and 25% in OR capacity with equal reductions for endourological, open and robotic procedures. Primary surgical treatment of urolithiasis and benign prostate syndrome (BPS) but also of testicular and penile cancer dropped by at least 50% while the decrease of surgeries for prostate, renal and urothelial cancer (TUR-B and cystectomies) ranged from 15 to 37%. The use of personal protection equipment (PPE), screening of staff and patients and protection during RS was unevenly distributed in the different centers–however, the number of COVID-19 patients and urologists did not reach double digits. Conclusion The German urological landscape has changed since the outbreak of COVID-19 with a significant shift of high priority surgeries but also continuation of elective surgical treatments. While screening and staff protection is employed heterogeneously, the number of infected German urologists stays low.
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Affiliation(s)
- Nina N Harke
- Department of Urology and Urologic Oncology, Hanover Medical School, Hanover, Germany
| | - Jan P Radtke
- Department of Urology, University of Duisburg-Essen, Essen, Germany
| | | | - Christian Bach
- Department of Urology, RWTH Aachen University, Aachen, Germany
| | - Frank P Berger
- Department of Urology, University of Jena, Jena, Germany
| | - Andreas Blana
- Department of Urology, Fürth Hospital, Fürth, Germany
| | - Hendrik Borgmann
- Department of Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Florian A Distler
- Department of Urology, Paracelsus Medical University, Nuremberg, Germany
| | | | - Tobias Egner
- Department of Urology, Klinikum Würzburg Mitte, Würzburg, Germany
| | | | - Mahmoud Farzat
- Department of Urology, Diakonie Klinikum, Siegen, Germany
| | - Alexander Haese
- Martini-Klinik Prostate Cancer Center, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Hein
- Department of Urology, Klinikum Magdeburg, Magdeburg, Germany
| | - Markus A Kuczyk
- Department of Urology and Urologic Oncology, Hanover Medical School, Hanover, Germany
| | - Andreas Manseck
- Department of Urology, Klinikum Ingolstadt, Ingolstadt, Germany
| | - Rudolf Moritz
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Michael Musch
- Department of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Inga Peters
- Department of Urology and Urologic Oncology, Hanover Medical School, Hanover, Germany
| | - Sasa Pokupic
- Department of Urology, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Andreas Schneider
- Department of Urology, Main-Kinzig-Kliniken Standort Gelnhausen, Gelnhausen, Germany
| | - André Schumann
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Germany
| | | | - Chiara M Sighinolfi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephan Buse
- Department of Urology and Urologic Oncology, Alfried Krupp Krankenhaus, Essen, Germany
| | | | - Michael C Truß
- Department of Urology, Klinikum Dortmund, Dortmund, Germany
| | - Michael Waldner
- Department of Urology, St. Elisabeth Krankenhaus Köln-Hohenlind, Köln, Germany
| | | | | | - Jörn H Witt
- Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital Gronau, Gronau, Germany
| | - Christian Wagner
- Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital Gronau, Gronau, Germany
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de Wit R, Wülfing C, Castellano Gauna D, Kramer G, Eymard JC, Sternberg C, Fizazi K, Tombal B, Bamias A, Carles J, Iacovelli R, Melichar B, Sverrisdóttir Á, Theodore C, Feyerabend S, Helissey C, Poole E, Ozatilgan A, Geffriaud-Ricouard C, de Bono J. 629P Neutrophil-lymphocyte ratio (NLR) as a prognostic and predictive biomarker in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with cabazitaxel (CBZ) vs abiraterone or enzalutamide in the CARD study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Necknig UH, Wolff I, Bründl J, Kriegmair MC, Marghawal D, Wagener N, Hegemann M, Eder E, Wülfing C, Burger M, Leyh H, May M, Kiesewetter J, Weidenbusch M. [Impact of the experience of urological senior physicians in Germany on professional and personal aspects]. Aktuelle Urol 2020; 53:331-342. [PMID: 32722826 DOI: 10.1055/a-1194-3611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Urological senior physicians in Germany are a heterogeneous group with various clinical priorities and career objectives. To date, there are no reliable data concerning the impact of the time span for which senior physicians have been holding their position on professional, personal and position-linked aspects. MATERIAL AND METHODS The objective of this study was a comparative analysis of perspectives, private and professional settings, specific job-related activities and individual professional goals of urological senior physicians in Germany based on their experience in this position assessed as number of years (dichotomised at 8 years as senior physician). As part of a cross-sectional study, a 55-item web-based questionnaire was designed, which was sent via a link to members of a mailing list of the German Society of Urology. The survey was available for urological senior physicians between February and April 2019. Group differences were evaluated using multivariate regression models. RESULTS 107 of 192 evaluable questionnaires were completed by senior physicians holding this position for less than 8 years (< 8y senior physicians), 85 were completed by senior physicians holding this position for at least 8 years (≥ 8y senior physicians). < 8y senior physicians worked significantly more often at university hospitals (42.1 % vs. 18.8 %, p = 0.002). Overall, 82.4 % of ≥ 8y senior physicians assessed themselves autonomously safe in performing open surgery, compared to 39.3 % among < 8y senior physicians (p < 0.001). No significant differences concerning the self-assessment were found for endourological procedures (94.1 % vs. 87.9 %) and for the overall lower-rated self-assessment concerning laparoscopy (29.4 % vs. 20.6 %) and robotic surgery (14.1 % vs. 10.3 %). Despite the high management responsibility associated with their position, only about one third of participants (34.8 %) had received specific postgraduate education preparing them for managing and executive tasks. CONCLUSION This study shows significant differences among senior physicians regarding surgical skills depending on the time span they hold their position. Moreover, there is considerable dissatisfaction regarding the development of leadership skills and the preparation for managing tasks. In order to ensure availability of senior staff members for the field of urology in the future, it is important to consider their professional needs and to overcome existing shortcomings by education programs within well-orchestrated human resources development strategies.
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Affiliation(s)
- Ulrike H. Necknig
- Klinikum Garmisch-Partenkirchen GmbH, Abteilung für Urologie & Kinderurologie, Garmisch-Partenkirchen
| | - Ingmar Wolff
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Urologie, Greifswald
| | - Johannes Bründl
- Universitätsklinikum Regensburg, Klinik für Urologie, Caritas-Krankenhaus St. Josef, Regensburg
| | | | | | - Nina Wagener
- Asklepios Klinik Altona, Abteilung für Urologie, Hamburg
| | - Miriam Hegemann
- Klinikverbund Südwest GmbH, Urologische Klinik Sindelfingen, Sindelfingen
| | - Elisabeth Eder
- Klinikum Ingolstadt GmbH, Klinik für Urologie, Ingolstadt
| | | | - Maximilian Burger
- Universitätsklinikum Regensburg, Klinik für Urologie, Caritas-Krankenhaus St. Josef, Regensburg
| | - Herbert Leyh
- Klinikum Garmisch-Partenkirchen GmbH, Abteilung für Urologie & Kinderurologie, Garmisch-Partenkirchen
| | - Matthias May
- St. Elisabeth Klinikum Straubing, Klinik für Urologie, Straubing
| | - Jan Kiesewetter
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der LMU München, München
| | - Marc Weidenbusch
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der LMU München, München
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Erlmeier F, Steffens 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, Ivanyi P. Characterization of PD-1 and PD-L1 Expression in Papillary Renal Cell Carcinoma: Results of a Large Multicenter Study. Clin Genitourin Cancer 2020; 19:53-59.e1. [PMID: 32778505 DOI: 10.1016/j.clgc.2020.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/27/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) play a decisive role as prognostic markers in clear-cell renal cell carcinoma (RCC). To date, the role of PD-1/PD-L1 as a prognostic marker in papillary RCC (pRCC) remains scarce. PATIENTS AND METHODS Patients' sample collection was a joint collaboration of the nationwide PANZAR consortium - a multicenter study. Medical history and tumor specimens were collected from 245 and 129 patients with pRCC types 1 and 2, respectively. Expression of PD-1 and PD-L1 was determined by immunohistochemistry in pRCC and tumor-infiltrating mononuclear cells. RESULTS Of 374 pRCC specimens, 204 type 1 and 97 type 2 were evaluable for PD-1 and PD-L1 expression analysis. In total, PD-1 and PD-L1 expression were found in 8 (4.9%) of 162 and 12 (7.2%) of 166 evaluable pRCC type 1 specimens. Comparably, PD-1 and PD-L1 expression were found in 2 (2.4%) of 83 and 5 (6.2%) of 81 evaluable pRCC type 2 specimens. Hardly any clinically relevant associations between PD-1 and PD-L1 positivity and clinicopathologic or clinical courses were observed, neither in pRCC type 1 nor type 2. CONCLUSION The analysis of a large pRCC cohort from a multicenter consortium revealed no impact of PD-1/PD-L1 expression on prognosis in patients with pRCC with predominantly limited disease status, neither for type 1 nor type 2. However, the impact of PD-1 and PD-L1 in more advanced pRCC disease needs further elucidation.
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Affiliation(s)
- Franziska Erlmeier
- Institute of Pathology, University Hospital Erlangen, Friedrich Alexander University (FAU), Erlangen, Germany
| | - Sandra Steffens
- Department of Urology, University Hospital Muenster, Muenster, Germany; Immune Cooperativ Oncology Group (ICOG) of the Comprehensive Cancer Center Lower-Saxoney (CCC-N), Hannover Medical School, Hannover, Germany.
| | - Christine Stöhr
- Institute of Pathology, University Hospital Erlangen, Friedrich Alexander University (FAU), Erlangen, Germany
| | - Edwin Herrmann
- Department of Urology, University Hospital Muenster, Muenster, Germany
| | - Iris Polifka
- Institute of Pathology, University Hospital Erlangen, Friedrich Alexander University (FAU), Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, 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
- Department of Urology, University Hospital Muenster, Muenster, 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 Heidelberg, Heidelberg, Germany
| | | | | | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander University (FAU), 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, Friedrich Alexander University (FAU), 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, Friedrich Alexander University (FAU), Erlangen, Germany
| | - Philipp Ivanyi
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Immune Cooperativ Oncology Group (ICOG) of the Comprehensive Cancer Center Lower-Saxoney (CCC-N), Hannover Medical School, Hannover, Germany
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Sternberg CN, Castellano D, De Bono JS, Fizazi K, Tombal BF, Wülfing C, Kramer G, Eymard JC, Bamias A, Carles J, Iacovelli R, Melichar B, Sverrisdottir A, Theodore C, Feyerabend S, Helissey C, Poole E, Ozatilgan A, Geffriaud-Ricouard C, De Wit R. Efficacy and safety in older patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) receiving cabazitaxel (CBZ) versus abiraterone (ABI) or enzalutamide (ENZ) in the CARD study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.5559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5559 Background: In the CARD (NCT02485691) study, radiographic PFS (rPFS), PFS and OS were significantly improved with CBZ vs. androgen-signaling-targeted agents (ARTA; ABI or ENZ) in pts with mCRPC who had received docetaxel (DOC) and progressed within 12 months (mo) on an alternative ARTA. This analysis evaluated the impact of age (< 70 vs. ≥ 70 years) on the efficacy and safety of CBZ and ARTAs in CARD. Methods: 255 pts with mCRPC were randomized 1:1 to CBZ (25 mg/m2 IV Q3W + prednisone [P] + G-CSF) vs. ABI (1000 mg PO + P) or ENZ (160 mg PO) until disease progression, unacceptable toxicity or pt request. Pts were eligible if they had received ≥ 3 cycles of DOC and progressed ≤ 12 mo on the previous alternative ARTA. Primary endpoint was rPFS. Subgroup analysis of older (≥ 70 years; n = 135) and younger (< 70 years; n = 120) pts was pre-specified for rPFS; others were post hoc. Results: rPFS was significantly improved vs. ARTA in both older (median 8.2 vs. 4.5 mo; HR 0.58; 95% CI 0.38–0.89) and younger pts (median 7.4 vs. 3.2 mo; HR 0.47; 95% CI 0.30–0.74). Median OS for CBZ vs. ARTA was 13.9 vs. 9.4 mo (HR 0.66; 95% CI 0.41–1.06) in older pts and 13.6 vs. 11.8 mo (HR 0.66; 95% CI 0.41–1.08) in younger pts. PFS, tumor, PSA and pain responses also favored CBZ, regardless of age. Grade ≥ 3 adverse events (AEs) occurred in 57.8% vs. 49.3% of older pts receiving CBZ vs. ARTA and 48.4% vs. 42.1% in younger pts. AEs leading to death were more frequent with ARTA, mainly due to disease progression. Conclusions: CBZ had improved efficacy outcomes vs. ARTA in pts with mCRPC previously treated with DOC and the alternative ARTA, regardless of age. Grade ≥ 3 cardiac AEs were more frequent in older pts treated with ARTA. A higher rate of AEs was reported in older vs. younger pts, for ARTA and CBZ. CBZ and ARTA had different safety profiles in older compared with younger pts. Clinical trial information: NCT02485691 . Funding: Sanofi. [Table: see text]
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Affiliation(s)
- Cora N. Sternberg
- Englander Institute of Precision Medicine, Weill Cornell Medicine, New York, NY
| | | | - Johann S. De Bono
- The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Karim Fizazi
- Institut Gustave Roussy and University of Paris Sud, Villejuif, France
| | - Bertrand F. Tombal
- Institut d Recherche Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Christian Wülfing
- Asklepios Klinik Altona, Hamburg, Abteilung Urologie, Hamburg, Germany
| | - Gero Kramer
- University Clinic for Urology, Vienna, Austria
| | | | | | - Joan Carles
- Vall d'Hebron Institute of Oncology, Vall d’Hebron University Hospital, Barcelona, Spain
| | | | - Bohuslav Melichar
- Fakultni Nemocnice Olomouc/Onkologicka Klinika, Pavlova, Czech Republic
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Rodler S, von Büren J, Buchner A, Stief C, Elkhanova K, Wülfing C, Jungmann S. Epidemiology and Treatment Barriers of Patients With Erectile Dysfunction Using an Online Prescription Platform: A Cross-Sectional Study. Sex Med 2020; 8:370-377. [PMID: 32434669 PMCID: PMC7471089 DOI: 10.1016/j.esxm.2020.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/20/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Erectile dysfunction (ED) is a highly common sexual dysfunction of men but often undertreated as patients experience high treatment barriers. Aim The aims of this study were to characterize patients with ED using an online prescription platforms (OPPs) and determine treatment barriers that might prevent patients from seeking care in conventional health care settings. Methods Data from a German OPP were retrospectively analyzed with focus on patients suffering from ED with at least one online prescription of phosphodiesterase-5 (PDE5) inhibitors between May 2019 and November 2019. In addition, a voluntary questionnaire was used to assess additional social features and prior treatment barriers. Main Outcome Measure The main outcome measures were the epidemiological data, prescription metadata, and follow-up questionnaires. Results A total of 11,456 male patients received prescriptions via the OPP (mean age: 49 years [95% CI 46.92–47.45]). Patients lived mainly in rural areas (69%) and frequently sought prescriptions outside the average office times of German urologists (49%). From all patients that responded to a follow-up questionnaire (n = 242), the majority were employed full-time (81%), married (50%), and native German (94%); 63.5% had not used PDE5 inhibitors before. From all repeat users, 41% had received them from unreliable sources. Reasons to seek treatment via the OPP were convenience (48%), shame (23%), and lack of discretion (13%). Conclusion In this first study, to epidemiologically characterize ED patients of an OPP, it was confirmed that inconvenience is a treatment barrier, along with shame and perceived lack of discretion. This is the first evidence that OPPs reduce treatment barriers and ease access for patients to the medical system. Rodler S, von Büren J, Buchner A, et al. Epidemiology and Treatment Barriers of Patients With Erectile Dysfunction Using an Online Prescription Platform: A Cross-Sectional Study. Sex Med 2020;8:370–377.
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Affiliation(s)
- Severin Rodler
- Department of Urology, University of Munich, Munich, Germany.
| | | | | | - Christian Stief
- Department of Urology, University of Munich, Munich, Germany
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Fizazi K, Kramer G, Eymard JC, De Bono JS, Sternberg CN, TOMBAL BF, Castellano D, Wülfing C, Liontos M, Carles J, Iacovelli R, Melichar B, Sverrisdottir A, Theodore C, Feyerabend S, Helissey C, Picard P, Ozatilgan A, Geffriaud-Ricouard C, De Wit R. Pain response and health-related quality of life (HRQL) analysis in patients with metastatic castration-resistant prostate cancer (mCRPC) receiving cabazitaxel (CBZ) versus abiraterone or enzalutamide in the CARD study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16 Background: The CARD NCT02485691 study reported superior rPFS and OS with CBZ vs abiraterone or enzalutamide in patients with mCRPC who progressed on docetaxel and within 12 months on a previous alternative androgen-signaling-targeted inhibitor (ARTA). This analysis evaluated changes in pain and HRQL associated with CBZ and ARTA during the CARD study. Methods: Pain response was defined as a decrease > 30% from baseline in BPI-SF pain intensity score with no increased analgesic use. HRQL was assessed using the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire. Patients were evaluable if they had received at least one dose of CBZ or ARTA and had a baseline FACT-P score plus at least one subsequent FACT-P measurement. A clinically meaningful improvement or deterioration of total FACT-P score was defined as a difference of ± 10 points from baseline. Clinically meaningful changes in HRQL and pain response were confirmed at two consecutive evaluations ≥ 3 weeks apart during the on-treatment period. Survival curves were generated by Kaplan–Meier estimates. Results: Of the 255 patients randomized, 172 (67.5%) had moderate to severe pain at randomization. Pain response and HRQL were evaluable for 111 (86.0%) and 108 (83.7%) for CBZ and 109 (86.5%) and 114 (90.5%) for ARTA. Pain response was 45.9% vs 19.3% for CBZ vs ARTA (p < 0.0001). The probability of not having pain progression after 12 months was 66.2% vs 45.3% CBZ vs ARTA (HR 0.55; 95% CI 0.32–0.97; p = 0.0348). An improvement in total FACT-P score from baseline was reported by 27 (25.0%) patients vs 26 (22.8%) for CBZ vs ARTA. FACT-P score was maintained or improved for 81 (75.0%) patients with CBZ and 86 (75.4%) patients with ARTA. A deterioration in FACT-P from baseline was reported by 22.2% with CBZ vs 24.6% with ARTA. Median time to FACT-P deterioration was 14.8 months for CBZ vs 8.9 months for ARTA (HR 0.72; 95% CI 0.44–1.20; p = 0.2072). Conclusions: CBZ was associated with a greater pain response and delayed pain progression vs ARTA. CBZ and ARTA were associated with similar trends in HRQL but time to FACT-P deterioration was longer with CBZ vs ARTA. Clinical trial information: NCT02485691.
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Affiliation(s)
- Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - Gero Kramer
- Department of Urology, Medical University Vienna, Vienna, Austria
| | | | | | - Cora N. Sternberg
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY
| | - Bertrand F. TOMBAL
- Institut d Recherche Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Daniel Castellano
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Christian Wülfing
- Asklepios Klinik Altona, Hamburg, Abteilung Urologie, Hamburg, Germany
| | - Michail Liontos
- Alexandra Hospital,National and Kapodistrian University of Athens, Athens, Greece
| | - Joan Carles
- Vall d’Hebron University Hospital, Barcelona, Spain
| | - Roberto Iacovelli
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Bohuslav Melichar
- Fakultni Nemocnice Olomouc/Onkologicka Klinika, Pavlova, Czech Republic
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de Wit R, de Bono J, Sternberg CN, Fizazi K, Tombal B, Wülfing C, Kramer G, Eymard JC, Bamias A, Carles J, Iacovelli R, Melichar B, Sverrisdóttir Á, Theodore C, Feyerabend S, Helissey C, Ozatilgan A, Geffriaud-Ricouard C, Castellano D. Cabazitaxel versus Abiraterone or Enzalutamide in Metastatic Prostate Cancer. N Engl J Med 2019; 381:2506-2518. [PMID: 31566937 DOI: 10.1056/nejmoa1911206] [Citation(s) in RCA: 328] [Impact Index Per Article: 65.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The efficacy and safety of cabazitaxel, as compared with an androgen-signaling-targeted inhibitor (abiraterone or enzalutamide), in patients with metastatic castration-resistant prostate cancer who were previously treated with docetaxel and had progression within 12 months while receiving the alternative inhibitor (abiraterone or enzalutamide) are unclear. METHODS We randomly assigned, in a 1:1 ratio, patients who had previously received docetaxel and an androgen-signaling-targeted inhibitor (abiraterone or enzalutamide) to receive cabazitaxel (at a dose of 25 mg per square meter of body-surface area intravenously every 3 weeks, plus prednisone daily and granulocyte colony-stimulating factor) or the other androgen-signaling-targeted inhibitor (either 1000 mg of abiraterone plus prednisone daily or 160 mg of enzalutamide daily). The primary end point was imaging-based progression-free survival. Secondary end points of survival, response, and safety were assessed. RESULTS A total of 255 patients underwent randomization. After a median follow-up of 9.2 months, imaging-based progression or death was reported in 95 of 129 patients (73.6%) in the cabazitaxel group, as compared with 101 of 126 patients (80.2%) in the group that received an androgen-signaling-targeted inhibitor (hazard ratio, 0.54; 95% confidence interval [CI], 0.40 to 0.73; P<0.001). The median imaging-based progression-free survival was 8.0 months with cabazitaxel and 3.7 months with the androgen-signaling-targeted inhibitor. The median overall survival was 13.6 months with cabazitaxel and 11.0 months with the androgen-signaling-targeted inhibitor (hazard ratio for death, 0.64; 95% CI, 0.46 to 0.89; P = 0.008). The median progression-free survival was 4.4 months with cabazitaxel and 2.7 months with an androgen-signaling-targeted inhibitor (hazard ratio for progression or death, 0.52; 95% CI, 0.40 to 0.68; P<0.001), a prostate-specific antigen response occurred in 35.7% and 13.5% of the patients, respectively (P<0.001), and tumor response was noted in 36.5% and 11.5% (P = 0.004). Adverse events of grade 3 or higher occurred in 56.3% of patients receiving cabazitaxel and in 52.4% of those receiving an androgen-signaling-targeted inhibitor. No new safety signals were observed. CONCLUSIONS Cabazitaxel significantly improved a number of clinical outcomes, as compared with the androgen-signaling-targeted inhibitor (abiraterone or enzalutamide), in patients with metastatic castration-resistant prostate cancer who had been previously treated with docetaxel and the alternative androgen-signaling-targeted agent (abiraterone or enzalutamide). (Funded by Sanofi; CARD ClinicalTrials.gov number, NCT02485691.).
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Affiliation(s)
- Ronald de Wit
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Johann de Bono
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Cora N Sternberg
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Karim Fizazi
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Bertrand Tombal
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Christian Wülfing
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Gero Kramer
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Jean-Christophe Eymard
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Aristotelis Bamias
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Joan Carles
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Roberto Iacovelli
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Bohuslav Melichar
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Ásgerður Sverrisdóttir
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Christine Theodore
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Susan Feyerabend
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Carole Helissey
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Ayse Ozatilgan
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Christine Geffriaud-Ricouard
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
| | - Daniel Castellano
- From the Erasmus Medical Center, Rotterdam, the Netherlands (R.W.); the Institute of Cancer Research and the Royal Marsden Hospital, London (J.B.); Englander Institute for Precision Medicine, Weill Cornell Medicine, New York (C.N.S.); Institut Gustave Roussy and University of Paris Sud, Villejuif (K.F.), Jean Godinot Institute and Reims Champagne-Ardenne University, Reims (J.-C.E.), Foch Hospital, Suresnes (C.T.), Hôpital d'Instruction des Armées Bégin, Saint Mandé (C.H.), and Sanofi, Europe Medical Oncology, Paris (C.G.-R.) - all in France; Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium (B.T.); the Department of Urology, Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg (C.W.), and Studienpraxis Urologie, Nürtingen (S.F.) - both in Germany; the Medical University of Vienna, Vienna (G.K.); Alexandra Hospital, National and Kapodistrian University of Athens, Athens (A.B.); Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona (J.C.); Azienda Ospedaliera Universitaria Integrata, Verona, and Fondazione Policlinico Agostino Gemelli IRCCS, Rome - both in Italy (R.I.); Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic (B.M.); Landspitali University Hospital, Reykjavik, Iceland (Á.S.); Sanofi, Global Medical Oncology, Cambridge, MA (A.O.); and 12 de Octubre University Hospital, Madrid (D.C.)
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Albers P, Bögemann M, Machtens S, Merseburger AS, Schostak M, Steuber T, Wülfing C, De Santis M. [Changes in the treatment of metastatic prostate cancer-new data and open questions]. Urologe A 2019; 59:307-317. [PMID: 31781782 DOI: 10.1007/s00120-019-01072-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The availability of taxane-based chemotherapy and androgen-receptor-targeted agents (ARTAs) have significantly broadened the therapeutic options for patients with metastatic prostate cancer and may also result in longer patient survival. The therapeutic sequence of ARTAs and taxanes may influence outcome and therefore decisions should be made on an individual basis. This article provides guidance for therapeutic decision-making in daily clinical practice by working out criteria that can be used to support individual therapeutic decisions. The focus is on metastatic castration-naive prostate cancer, oligometastatic disease as well as non-metastatic and metastatic castration-resistant prostate cancer.
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Affiliation(s)
- P Albers
- Klinik für Urologie und Universitätstumorzentrum, Comprehensive Cancer Center, Universitätsklinikum, Medizinische Fakultät Heinrich-Heine-Universität, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - M Bögemann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Münster, Deutschland
| | - S Machtens
- Klinik für Urologie und Kinderurologie, GFO Kliniken Rhein Berg, Betriebsstätte, Marien-Krankenhaus, Bergisch Gladbach, Deutschland
| | - A S Merseburger
- Klinik für Urologie, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - M Schostak
- Klinik für Urologie und Kinderurologie, Universitätsklinik Magdeburg, Magdeburg, Deutschland
| | - T Steuber
- Martini-Klinik, Prostatakrebszentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - C Wülfing
- Abteilung für Urologie, Asklepios Klinik Altona, Hamburg, Deutschland
| | - M De Santis
- Klinik für Urologie, Interdisziplinäre Uro-Onkologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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50
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Necknig U, Wolff I, Bründl J, Kriegmair MC, Marghawal D, Wülfing C, Burger M, May M. Gender-Specific Variations in Professional and Personal Aspects among Senior Urology Physicians at German Centers: Results of a Web-Based Survey. Urol Int 2019; 104:309-322. [PMID: 31715601 DOI: 10.1159/000503869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/30/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Senior urology physicians represent a heterogeneous group covering various clinical priorities and career objectives. No reliable data on gender-specific variations among senior urology physicians are available concerning professional and personal aspects. METHODS The objective of this study was to analyze professional perspectives, professional and personal settings, and individual career goals. A Web-based survey containing 55 items was designed which was available for senior physicians at German urologic centers between February and April 2019. Gender-specific differences were evaluated using bootstrap-adjusted multivariate logistic regression models. RESULTS One hundred and ninety-two surveys were evaluable including 29 female senior physicians (15.1%). Ninety-five percent would choose urology again as their field of specialization - with no significant gender-specific difference. 81.2% of participants rate the position of senior physician as a desirable career goal (comparing sexes: p = 0.220). Based on multivariate models, male participants self-assessed themselves significantly more frequently autonomously safe performing laparoscopic, open, and endourologic surgery. Male senior physicians declared 7 times more often to run for the position of head of department/full professor. CONCLUSION This first study on professional and personal aspects among senior urology physicians demonstrates gender-specific variations concerning self-assessment of surgical expertise and future career goals. The creation of well-orchestrated human resources development strategies especially adapted to the needs of female urologists seems advisable.
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Affiliation(s)
- Ulrike Necknig
- Department of Urology and Pediatric Urology, Hospital Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany,
| | - Ingmar Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Johannes Bründl
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany
| | | | - David Marghawal
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | | | - Maximilian Burger
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany
| | - Matthias May
- Department of Urology, St. Elisabeth Hospital Straubing, Straubing, Germany
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