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Benderska-Söder N, Ecke T, Kleinlein L, Roghmann F, Bismarck E, van Rhijn BWG, Stenzl A, Witjes JA, Todenhöfer T, Hakenberg OW, Grimm MO, Goebell PJ, Burger M, Jensen JB, Schmitz-Dräger BJ. Simulation of the effects of molecular urine markers in follow-up of patients with high-risk non-muscle invasive bladder cancer. Urol Oncol 2024:S1078-1439(24)00041-3. [PMID: 38403529 DOI: 10.1016/j.urolonc.2024.01.025] [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: 11/26/2023] [Revised: 01/05/2024] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
A plethora of urine markers for the management of patients with bladder cancer has been developed and studied in the past. However, the clinical impact of urine testing on patient management remains obscure. The goal of this manuscript is to identify scenarios for the potential use of molecular urine markers in the follow-up of patients with high-risk non-muscle-invasive BC (NMIBC) and estimate potential risks and benefits. Information on the course of disease of patients with high-risk NMIBC and performance data of a point-of-care test (UBC rapid™), an MCM-5 directed ELISA (ADXBLADDER™), and 2 additional novel assays targeting alterations of mRNA expression and DNA methylation (Xpert bladder cancer monitor™, Epicheck™) were retrieved from high-quality trials and/or meta-analyses. In addition, the sensitivity of white light cystoscopy (WLC) and the impact of a urine marker result on the performance of WLC were estimated based on fluorescence cystoscopy data and information from the CeFub trial. This information was applied to different scenarios in patient follow-up and sensitivity, estimated number of cystoscopies, and the numbers needed to diagnose were calculated. The sensitivity of guideline-based regular follow-up (SOC) at 1 year was calculated at 96%. For different marker-supported strategies sensitivities ranging from 77% to 97.9% were estimated. Calculations suggest that several strategies are effective for the SOC. While for the SOC 24.6 WLCs were required to diagnose 1 tumor recurrence (NND), this NND dropped below 5 in some marker-supported strategies. Based on the results of this simulation, a marker-supported follow-up of patients with HR NMIBC is safe and offers the option to significantly reduce the number of WLCs. Further research focusing on prospective randomized trials is needed to finally find a way to implement urine markers into clinical decision-making.
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Affiliation(s)
| | - Thorsten Ecke
- Department of Urology, Helios Klinikum, Bad Saarow, Germany; Department of Urology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lisa Kleinlein
- Urologie 24, St. Theresienkrankenhaus, Nürnberg, Germany
| | - Florian Roghmann
- Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Germany
| | | | - Bas W G van Rhijn
- Department Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, University of Regensburg, Caritas-Hospital St. Josef, Regensburg, Germany
| | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls-University of Tübingen, Tübingen, Germany
| | | | | | | | | | - Peter J Goebell
- Department of Urology, Friedrich-Alexander University, Erlangen, Germany
| | - Maximilian Burger
- Department of Urology, University of Regensburg, Caritas-Hospital St. Josef, Regensburg, Germany
| | | | - Bernd J Schmitz-Dräger
- Urologie 24, St. Theresienkrankenhaus, Nürnberg, Germany; Studienpraxis Urologie, Nürtingen, Germany.
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Ecke TH, Benderska-Söder N, Bismarck E, van Rhijn BWG, Todenhöfer T, Schmitz-Dräger BJ. Considering the Effects of Modern Point-of-Care Urine Biomarker Assays in Follow-Up of Patients with High-Risk Non-muscle-Invasive Bladder Cancer. Methods Mol Biol 2023; 2684:199-212. [PMID: 37410236 DOI: 10.1007/978-1-0716-3291-8_12] [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] [Indexed: 07/07/2023]
Abstract
BACKGROUND Although a plethora of urine markers for diagnosis and follow-up of patients with bladder cancer (BC) has been developed and studied, the clinical impact of urine testing on patient management remains unclear. The goal of this manuscript is to identify scenarios for a potential use of modern point-of-care (POC) urine marker assays in the follow-up of patients with high-risk non-muscle-invasive BC (NMIBC) and estimate potential risks and benefits. METHODS To permit comparison between different assays, the results of 5 different POC assays studied in a recent prospective multicenter study including 127 patients with suspicious cystoscopy undergoing TURB were used for this simulation. For the current standard of care (SOC), a "marker-enforced" procedure, and a combined strategy sensitivity (Se), estimated number of cystoscopies, and the numbers needed to diagnose (NND) over a 1-year follow-up period were calculated. RESULTS For regular cystoscopy (SOC), a Se of 91.7% and a NND of 42.2 repetitive office cystoscopies (WLCs) for 1 recurrent tumor at 1 year were calculated. For the "marker-enforced" strategy, marker sensitivities between 94.7% and 97.1% were observed. The "combined" strategy yielded for markers with a Se exceeding 50% an overall Se at 1 year similar or superior to the current SOC. Savings regarding the number of cystoscopies in the "marker-enforced" strategy vs. the SOC were small, while, depending on the marker, up to 45% of all cystoscopies may be saved using the "combined" strategy. CONCLUSIONS Based on the results of this simulation, a marker-supported follow-up of patients with high-risk (HR) NMIBC is safe and offers options to significantly reduce the number of cystoscopies without compromising the Se. Further research focusing on prospective randomized trials is needed to finally find a way to include marker results into clinical decision-making.
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Affiliation(s)
- Thorsten H Ecke
- Department of Urology, Helios Hospital, Bad Saarow, Germany.
- Department of Urology, Universitätsmedizin Berlin Charité, Berlin, Germany.
- German Study Group of Bladder Cancer (DFBK e.V.), Munich, Germany.
| | | | | | - Bas W G van Rhijn
- Department Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Urology, University of Regensburg, Caritas-Hospital St. Josef, Regensburg, Germany
| | - Tilman Todenhöfer
- Studienpraxis Urologie, Nürtingen, Germany
- Medical Faculty, University of Tübingen, Tübingen, Germany
| | - Bernd J Schmitz-Dräger
- Urologie 24, Nürnberg, Germany
- Department of Urology, Friedrich-Alexander University, Erlangen, Germany
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Schmitz-Dräger BJ, Mühlich S, Lange C, Benderska-Söder N, Bismarck E, Starlinger R, Ottillinger B, Hakenberg OW. Effectiveness and Distribution of Testosterone Levels within First Year of Androgen Deprivation Therapy in a Real-World Setting: Results from the Non-Interventional German Cohort LEAN Study. Urol Int 2021; 105:436-445. [PMID: 33631760 DOI: 10.1159/000513073] [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: 07/20/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Observational studies generate information on real-world therapy and complement data from prospective randomized trials. LEAN is an open-label, non-interventional, multi-centre, German cohort study on leuprorelin in routine clinical practice. OBJECTIVES To extend knowledge on the use, effectiveness, and tolerability of HEXAL/Sandoz leuprorelin (in this article, the term Leuprone® HEXAL® covers Leuprorelin Sandoz® as well) solid implant in patients with prostate cancer (PCa) in a real-world setting. METHODS 959 PCa patients scheduled for androgen deprivation therapy (ADT) received leuprorelin acetate implant. Metabolism, serum prostate-specific antigen (PSA), and testosterone data, if available, were collected at baseline and follow-up visits for ≥12 months. RESULTS Of 694 patients in the modified full analysis set, 26.4% received GnRH analogues ≤6 months before enrolment. Fifty-one percent of patients were treated for locally advanced or metastatic PCa. In 19.6% of patients, ADT was used in neoadjuvant or adjuvant settings and in 28.5% with rising PSA after definite therapy. Testosterone levels <0.5 ng/mL were achieved in >90% of patients. Safety profile was in line with the summary of product characteristics. Therapy was well tolerated, with patient-triggered therapy discontinuation in 3.6%. CONCLUSIONS This interim analysis confirmed previous efficacy findings for leuprorelin implant in a real-world setting. This contemporary cohort showed a shift in the use of ADT to non-metastatic PCa stages.
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Affiliation(s)
- Bernd J Schmitz-Dräger
- Urologie 24, Nuremberg, Germany, .,Department of Urology and Pediatric Urology, Friedrich-Alexander University, Erlangen, Germany,
| | | | | | | | | | - Roland Starlinger
- Global Medical Affairs, Sandoz International GmbH, Holzkirchen, Germany
| | - Bertram Ottillinger
- Ottillinger Life Sciences, Brunnthal, Germany.,Institut Dr. Schauerte, Munich, Germany
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Schmitz-Dräger BJ, Skutetzki A, Rieker RJ, Schwab SA, Stöhr R, Bismarck E, Savov O, Ebert T, Benderska-Söder N, Hartmann A. Eosinophilic cystitis mimicking bladder cancer-considerations on the management based upon a case report and a review of the literature. Virchows Arch 2021; 479:523-527. [PMID: 33576854 DOI: 10.1007/s00428-021-03049-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 02/05/2023]
Abstract
The hypereosinophilic syndrome (HES) is a rare disorder characterized by hypereosinophilia and infiltration of various organs with eosinophils. Eosinophilic cystitis (EC), mimicking bladder cancer clinically but also in ultrasound and in radiographic imaging, is one potential manifestation of the HES occurring in adults as well as in children. This case report describes the course of disease in a 57-year-old male presenting with severe gait disorders and symptoms of a low compliance bladder caused by a large retropubic tumor. After extensive urine and serologic examination and histologic confirmation of EC the patient was subjected to medical treatment with cetirizine and prednisolone for 5 weeks. While gait disorders rapidly resolved, micturition normalized only 10 months after initiation of therapy. Based upon this course the authors recommend patience and reluctance concerning radical surgical intervention in EC. Key Points • Eosinophilic cystitis is a rare condition with app. 200 cases reported, so far. • Etiology of eosinophilic cystitis is obscure, but allergies and parasitic infections may trigger the disease. • Genetic alterations (e.g., BRAF mutations) may predispose for the disease • Corticosteroids and antihistamines are the backbone of therapy and may be complemented by antibiotics and non-steroidal anti-inflammatory drugs in case of concomitant (underlying) infections. • As recovery can occur even after a long time, radical surgery should be restricted to highly selected cases.
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Affiliation(s)
- Bernd J Schmitz-Dräger
- St. Theresienkrankenhaus, Nürnberg, Urologie 24, Nuremberg, Germany. .,Department of Urology and Pediatric Urology, Friedrich-Alexander University, Erlangen, Germany.
| | - Andreas Skutetzki
- Department of Trauma Surgery and Orthopedic Surgery, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany
| | - Ralf J Rieker
- Department of Pathology, St. Theresienkrankenhaus, Nuremberg, Germany.,Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany
| | - Siegfried A Schwab
- Radiologis, Dr. Meer und Kollegen, Oberasbach-Nuremberg, Zirndorf, Germany
| | - Robert Stöhr
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany
| | | | - Orlin Savov
- St. Theresienkrankenhaus, Nürnberg, Urologie 24, Nuremberg, Germany
| | - Thomas Ebert
- St. Theresienkrankenhaus, Nürnberg, Urologie 24, Nuremberg, Germany
| | | | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany
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Bismarck E, Hammerer P, Merseburger AS, Schrader AJ. [mHSPC-Therapie mit Apalutamid/ADT]. Oncol Res Treat 2020; 43 Suppl 2:6-12. [PMID: 32434198 DOI: 10.1159/000507054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/09/2020] [Indexed: 11/19/2022]
Affiliation(s)
| | - Peter Hammerer
- Klinik für Urologie und Uroonkologie, Städtisches Klinikum Braunschweig, Braunschweig, Deutschland
| | - Axel S Merseburger
- Klinik und Poliklinik für Urologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - Andres Jan Schrader
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster (UKM), Münster, Deutschland
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Savov O, Agaimy A, Rieker R, Bismarck E, Dörsam J, Rass GC, Ebert T, Hartmann A, Schmitz-Dräger BJ. Immunoglobulin-g4(IgG4)-rich Pseudotumor of the Kidney – A case report and review of the literature. JofIMAB 2018. [DOI: 10.5272/jimab.2018241.1872] [Citation(s) in RCA: 2] [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: 11/11/2022] Open
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Abstract
Through the last decade considerations on the role of vitamins and antioxidants in the primary prevention of genitourinary tumors have changed dramatically. In spite of all efforts, the efficacy of a specific compound has not been proven so far. In consequence, recommendations to use vitamins or other supplements for the primary prevention of urological tumors should be avoided. However, there is some evidence that moderate food consumption, reduction of dairy products and an Asian or Mediterranean diet may not only prevent prostate cancer (PCA) but also harbour additional beneficial effects on general health. Although quantification of these findings may be difficult, it becomes evident that these measures will have additional synergistic effects on cardiovascular diseases. Considering the large number of PCA patients dying not cancer-related but from concomitant diseases, primary prevention in particular of PCA should always also consider the general health of the target population. More recent studies suggest a potential effect of nutritional compounds on biochemical tumour recurrence in PCA patients after definite therapy. These observations may serve as a starting point for validation within controlled clinical trials.
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Affiliation(s)
| | - S. Sahin
- Urologie24, Schön Klinik Nürnberg Fürth, Fürth
| | - G. Lümmen
- Urologische Abteilung, St. Josef-Hospital, Troisdorf
| | - E. Bismarck
- Urologie24, Schön Klinik Nürnberg Fürth, Fürth
| | - C. Fischer
- Urologische Klinik, Klinikum Hohe Warte, Bayreuth
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Schmitz-Dräger BJ, Weiss C, Ebert T, Dörsam J, Bismarck E. Skeletal-related events in metastatic prostate cancer and the number needed to treat: a critical consideration. Urol Int 2013; 90:329-33. [PMID: 23407093 DOI: 10.1159/000346387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 12/03/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE With stage migration induced by early diagnosis of prostate-specific antigen, the course of disease for prostate cancer (PCa) patients has changed. Increasingly, patients undergo long-term androgen ablation with consecutive risks including osteoporosis and pathologic fractures. A recent randomized trial found that the RANK ligand inhibitor denosumab was more effective preventing skeletal-related events in patients with metastatic PCa as compared to treatment with the bisphosphonate zoledronic acid. This improved efficacy was linked to an increase of side effects. METHODS The present analysis compares results reported for both substances using a number needed to treat analysis approach. Based upon these findings, risk-benefit calculations were performed. RESULTS The results demonstrate that for patients with bone metastatic castration-resistant PCa, decision for or against treatment with either denosumab or zoledronic acid must not only consider efficacy but needs to balance the desired effects versus potential side effects. This is of specific relevance since life expectancy is limited in this patient cohort with end-stage disease. CONCLUSIONS Further scientific efforts are necessary to identify optimal dosing and application intervals for denosumab and zoledronic acid as well as to answer the question of optimal duration of treatment. These findings will directly impact the risk versus benefit relations for both therapeutic options.
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Schmitz-Dräger BJ, Lümmen G, Bismarck E, Fischer C. Prevention strategies for prostate cancer. MINERVA UROL NEFROL 2012; 64:225-231. [PMID: 23288209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Through the last decade consideration of the role of vitamins and minerals in primary prevention of genitourinary tumors has dramatically changed. Despite all efforts efficacy of a specific compound has not been proven, so far. In consequence, recommendations for a use of vitamins or other supplements with the intention of prostate cancer prevention should be avoided today. In contrast, there is some evidence that life style modification might be helpful: recent investigations suggest that smoking may be involved in prostate cancer carcinogenesis. In addition, there is evidence that moderate food consumption, reduction of dairy products and an Asian or Mediterranean diet might not only prevent prostate cancer but also harbors additional beneficial effects on general health. This move from single compounds to more complex diets can be considered as a change of paradigm in prostate cancer prevention and could be the starting point of future epidemiological research. Disappointing findings with regards to nutritional cancer prevention contrast with a solid evidence concerning the efficacy of chemoprevention using 5a-reductase inhibitors: Long-term use of Finasteride and Dutasteride significantly reduces prostate cancer detection. Further candidate drugs are under investigation. However, translation of these findings into urological practice remains a matter of controversial discussion.
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Schmitz-Dräger BJ, Bismarck E, Fischer C. [Supportive options in the treatment of urological tumours]. Aktuelle Urol 2012; 43:168-76. [PMID: 22639027 DOI: 10.1055/s-0031-1284023] [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: 10/28/2022]
Abstract
An ageing society with a consecutive increase of genitourinary malignancies along with remarkable changes in systemic cancer therapy provide the basis for an increasing role of supportive measures. While surgical treatment, radiation or chemotherapy are undergoing subsequent standardisation, supportive measures are still widely used on the basis of personal experience alone. However, effective support is the prerequisite for a successful systemic treatment. Within this review the most relevant side effects of systemic therapy for urological tumors are summarised and the respective therapeutic options are presented in a brief but practice-oriented way. The authors have aimed at the consideration of evidence-based measures, wherever possible.
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Schmitz-Dräger BJ, Bismarck E, Schöffski O, Fischer C. [Chemoprevention of prostate cancer - a plea]. Aktuelle Urol 2012; 43:157-61. [PMID: 22639024 DOI: 10.1055/s-0031-1284035] [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: 10/28/2022]
Abstract
The high disease prevalence, the presentation in older age, a frequently slowly progressing course of disease, and high costs make the diagnosis of and therapy for prostate cancer a special challenge for urologists. Effective prevention of the disease may help to improve some of the problems mentioned above. Two randomised, controlled studies have proved that effective chemoprevention of prostate cancer is viable using 5α-reductase inhibitors (finasteride, dutasteride). Furthermore, there is increasing evidence that other compounds, e. g., selective oestrogen receptor modulators (SERMs), NSAIDs and statins might also be effective. This review investigates potential risks and benefits of chemoprevention including a consideration of health economical aspects. The authors conclude that the options of chemoprevention should be investigated in an open and unbiased way.
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Bismarck E, Schmitz-Dräger B, Schöffski O. Was erwartet die Medizin von der Gesundheitsökonomie? Urologe A 2012; 51:533-8. [DOI: 10.1007/s00120-011-2778-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The amount and quality of available data on secondary and tertiary prevention of urological tumors are to a large extent unsatisfactory. In the areas of nutrition and supplementary diet the consumption of tomatoes and especially tomato products could have a beneficial effect on the course of the disease for patients with prostate cancer, whereas there is evidence that the consumption of foodstuffs containing calcium (milk and milk products) and linolenic acid as well as a fat-rich diet accelerate tumor progression. Despite as yet unsatisfactory data, men with urothelial tumors or prostate cancer should abstain from smoking and undertake sports activities. For medicinal measures the administration of 5-alpha-reductase inhibitors and bone-promoting substances for patients with prostate cancer are under discussion. The effectiveness of the substances zoledronate and denosumab has been demonstrated in prospective randomized studies. The authors recommend that the scientifically neglected field of tertiary prevention of urological tumors should in future be included as a core factor of scientific investigations.
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Schmitz-Dräger B, Tirsar LA, Schmitz-Dräger C, Dörsam J, Ebert T, Bismarck E. Rolle der Immunzytologie in der Abklärung von Patienten mit schmerzloser Makrohämaturie. Urologe A 2010; 49:741-6. [DOI: 10.1007/s00120-010-2248-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schmitz-Dräger B, Bismarck E, Lümmen G. Risiken und Prävention des Prostatakarzinoms. Urologe A 2010; 49:233-7. [DOI: 10.1007/s00120-010-2240-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schmitz-Dräger BJ, Tirsar LA, Schmitz-Dräger C, Beiche B, Bismarck E, Ebert T. [Analyses of the role of immunocytology in the differential diagnosis of patients with asymptomatic microhematuria]. Urologe A 2009; 47:190-4. [PMID: 18064433 DOI: 10.1007/s00120-007-1598-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
INTRODUCTION Discriminating between malignant and nonmalignant conditions remains a challenge in the evaluation of patients with asymptomatic microhematuria. In this prospective study the role of immunocytology in the assessment microhematuria was studied. MATERIAL AND METHODS uCyt is a commercially available immunocytological assay based on microscopical detection of tumor-associated antigens in urothelial cells by immunofluorescence. Between September 2000 and December 2006, 222 consecutive patients with newly diagnosed painless microhematuria without prior transitional cell carcinoma were included. All urine samples were examined cytologically and immunocytologically. A total of 211 samples (95%) were assessable. RESULTS Clinical examination by physical examination, cystoscopy, laboratory tests, and imaging yielded bladder cancer in ten cases (4%). Further diagnoses were BPH (27%), cystitis (including IC) (12%), urolithiasis (9%), urethral or ureteral strictures (6%), papilloma (2%), and"further conditions" (16%). In 52 patients (23%) reasons for hematuria were not identified. Immunocytology was positive in 8 of 10 bladder tumors (80%) and negative in 178 patients with non-tumor-related hematuria (89%). CONCLUSIONS The high sensitivity and good specificity of immunocytology is comparable with that reported in the literature despite a very low disease prevalence in this population. If assessment of these patients would have only been based on immunocytology, 180 costly and invasive diagnostic procedures would have been saved, with only 29 individuals (14%) undergoing these examinations unnecessarily. The authors conclude that these findings justify further investigation of this issue.
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Schmitz-Dräger BJ, Tirsar LA, Schmitz-Dräger C, Dörsam J, Mellan Z, Bismarck E, Ebert T. Immunocytology in the assessment of patients with asymptomatic hematuria. World J Urol 2007; 26:31-7. [PMID: 18075743 DOI: 10.1007/s00345-007-0228-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 11/11/2007] [Indexed: 10/22/2022] Open
Abstract
Painless hematuria has remained a diagnostic challenge in daily urological practice. Key problem in the assessment of these patients is the discrimination between malignant and non-malignant conditions. In this prospective study the role of immunocytology in the evaluation of patients with hematuria was investigated. Ucyt is a commercially available immunocytological assay based upon microscopical detection of tumor-associated antigens on the membrane of urothelial cells by immunofluorescence. Between October 2000 and July 2007, 301 consecutive patients with a first episode of painless hematuria without prior transitional cell carcinoma were included. Urine samples were obtained from all patients and examined cytologically and immunocytologically. Clinical assessment by physical examination, laboratory tests, endoscopy and imaging in 228 cases with microhematuria and 66 cases with gross hematuria yielded bladder cancer in 10 (4.6%) and 17 (27%) patients, respectively. Clinical workup demonstrated that composition of both groups was entirely different. Sensitivity of cystoscopy and immunocytology was similar in both groups. Furthermore, a negative finding in cystoscopy and immunocytology virtually excluded the presence of urothelial cancer. However, while predictive values of immunocytology were clearly superior to cytology in gross hematuria, cytology performed better in the microhematuria cohort. Combination of cystoscopy and immunocytology yield 100% sensitivity in the assessment of patients with painless hematuria. Based upon performance characteristics the authors recommend to replace urine cytology by a more sensitive marker like immunocytology in gross hematuria. In patients with microhematuria immunocytology could be used to select for patients at risk for urothelial cancer and thus spare negative patients from further examinations.
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Schmitz-Dräger B, Tirsar LA, Schmitz-Dräger C, Dörsam J, Bismarck E, Ebert T. Immunocytology in the assessment of patients with painless gross haematuria. BJU Int 2007; 101:455-8. [DOI: 10.1111/j.1464-410x.2007.07287.x] [Citation(s) in RCA: 5] [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: 11/30/2022]
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Abstract
The Prostate Cancer Prevention Trial (PCPT) has been the first interventional trial directly aimed at the prevention of prostate cancer. A total of 18,882 men over 55 years with a PSA serum level less than 3.0 ng/ml were randomized to receive either the 5-alpha-reductase inhibitor finasteride 5 mg/day or placebo for 7 years. Despite a 25% reduction of prostate cancers in the treatment arm the results were discussed controversially. This criticism was mainly due to the observation of significantly more high-grade cancers in the finasteride group. Meanwhile, results of extensive follow-up analyses have been published suggesting that this finding is most likely due to optimized tumor detection in smaller glands. Further work-up demonstrated that PSA diagnosis and the histopathological examination were not compromised by finasteride. Furthermore, in addition to a decrease of prostate cancer the amount of prostatic intraepithelial dysplasia (PIN) was also reduced under finasteride. Future research must now aim at defining high-risk groups specifically profiting from chemoprevention with a 5-alpha-reductase inhibitor.
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Schmitz-Dräger BJ, Beiche B, Tirsar LA, Schmitz-Dräger C, Bismarck E, Ebert T. Immunocytology in the Assessment of Patients with Asymptomatic Microhaematuria. Eur Urol 2007; 51:1582-8; discussion 1588. [PMID: 17107748 DOI: 10.1016/j.eururo.2006.10.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 10/23/2006] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Discrimination between malignant and nonmalignant conditions remains the key problem in assessing microhaematuria. This prospective study investigated the role of immunocytology in the evaluation of patients with microhaematuria. METHODS uCyt+ is a commercially available immunocytologic assay based on microscopic detection of tumour-associated antigens on the membrane of urothelial cells by immunofluorescence. Between October 2000 and August 2005, 189 consecutive patients with newly diagnosed painless microhaematuria without prior transitional cell carcinoma were included. All urine samples were examined cytologically and immunocytologically. Of the 189 samples, 178 (94%) were assessable. RESULTS Clinical assessment by physical examination, laboratory tests, endoscopy, and imaging modalities found bladder cancer in 8 patients (4%). Further diagnoses were benign prostatic hyperplasia (54 cases, 29%), cystitis (including interstitial cystitis; 20 cases, 11%), urolithiasis (18 cases, 9%), tumours of other origin (6 cases, 2%), and "further conditions" (26 cases, 13%). In 57 patients (30%) the reasons for haematuria were not disclosed. Immunocytology was positive in 7 of 8 bladder tumours (87%) and negative in 154 of 170 patients with haematuria for other reasons (91%). CONCLUSIONS The high sensitivity and good specificity of immunocytology in the diagnosis of bladder cancer was confirmed in this population with a low disease prevalence. Only one tumour of low malignant potential was missed by immunocytology. If assessment of these patients would have been based only on immunocytology, 154 costly and invasive diagnostic procedures could have been avoided, with only 16 of 170 individuals (9%) undergoing these examinations unnecessarily. The findings justify a prospective investigation of this issue.
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Kotzan S, Hüppe T, Weinknecht S, Bismarck E, Lahme S, Claussen CD. Bildgebende Diagnostik bei Induratio penis plastica. Aktuelle Urol 2001. [DOI: 10.1055/s-2001-15941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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