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Haddad TC, Maita KC, Inselman JW, Avila FR, Torres-Guzman RA, Coffey JD, Christopherson LA, Leuenberger AM, Bell SJ, Pahl DF, Garcia JP, Manka L, Forte AJ, Maniaci MJ. Patient Satisfaction With a Multisite, Multiregional Remote Patient Monitoring Program for Acute and Chronic Condition Management: Survey-Based Analysis. J Med Internet Res 2023; 25:e44528. [PMID: 37343182 PMCID: PMC10415939 DOI: 10.2196/44528] [Citation(s) in RCA: 1] [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: 11/22/2022] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Remote patient monitoring (RPM) is an option for continuously managing the care of patients in the comfort of their homes or locations outside hospitals and clinics. Patient engagement with RPM programs is essential for achieving successful outcomes and high quality of care. When relying on technology to facilitate monitoring and shifting disease management to the home environment, it is important to understand the patients' experiences to enable quality improvement. OBJECTIVE This study aimed to describe patients' experiences and overall satisfaction with an RPM program for acute and chronic conditions in a multisite, multiregional health care system. METHODS Between January 1, 2021, and August 31, 2022, a patient experience survey was delivered via email to all patients enrolled in the RPM program. The survey encompassed 19 questions across 4 categories regarding comfort, equipment, communication, and overall experience, as well as 2 open-ended questions. Descriptive analysis of the survey response data was performed using frequency distribution and percentages. RESULTS Surveys were sent to 8535 patients. The survey response rate was 37.16% (3172/8535) and the completion rate was 95.23% (3172/3331). Survey results indicated that 88.97% (2783/3128) of participants agreed or strongly agreed that the program helped them feel comfortable managing their health from home. Furthermore, 93.58% (2873/3070) were satisfied with the RPM program and ready to graduate when meeting the program goals. In addition, patient confidence in this model of care was confirmed by 92.76% (2846/3068) of the participants who would recommend RPM to people with similar conditions. There were no differences in ease of technology use according to age. Those with high school or less education were more likely to agree that the equipment and educational materials helped them feel more informed about their care plans than those with higher education levels. CONCLUSIONS This multisite, multiregional RPM program has become a reliable health care delivery model for the management of acute and chronic conditions outside hospitals and clinics. Program participants reported an excellent overall experience and a high level of satisfaction in managing their health from the comfort of their home environment.
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Affiliation(s)
- Tufia C Haddad
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Karla C Maita
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Jonathan W Inselman
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Francisco R Avila
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Ricardo A Torres-Guzman
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Jordan D Coffey
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | | | - Angela M Leuenberger
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Sarah J Bell
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Dominick F Pahl
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - John P Garcia
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Lukas Manka
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Antonio J Forte
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
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Coffey JD, Christopherson LA, Williams RD, Gathje SR, Bell SJ, Pahl DF, Manka L, Blegen RN, Maniaci MJ, Ommen SR, Haddad TC. Development and implementation of a nurse-based remote patient monitoring program for ambulatory disease management. Front Digit Health 2022; 4:1052408. [PMID: 36588748 PMCID: PMC9794766 DOI: 10.3389/fdgth.2022.1052408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Numerous factors are intersecting in healthcare resulting in an increased focus on new tools and methods for managing care in patients' homes. Remote patient monitoring (RPM) is an option to provide care at home and maintain a connection between patients and providers to address ongoing medical issues. Methods Mayo Clinic developed a nurse-led RPM program for disease and post-procedural management to improve patient experience, clinical outcomes, and reduce health care utilization by more directly engaging patients in their health care. Enrolled patients are sent a technology package that includes a digital tablet and peripheral devices for the collection of symptoms and vital signs. The data are transmitted from to a hub integrated within the electronic health record. Care team members coordinate patient needs, respond to vital sign alerts, and utilize the data to inform and provide individualized patient assessment, patient education, medication management, goal setting, and clinical care planning. Results Since its inception, the RPM program has supported nearly 22,000 patients across 17 programs. Patients who engaged in the COVID-19 RPM program experienced a significantly lower rate of 30-day, all-cause hospitalization (13.7% vs. 18.0%, P = 0.01), prolonged hospitalization >7 days (3.5% vs. 6.7%, P = 0.001), intensive care unit (ICU) admission (2.3% vs. 4.2%, P = 0.01), and mortality (0.5% vs. 1.7%, P = 0.01) when compared with those enrolled and unengaged with the technology. Patients with chronic conditions who were monitored with RPM upon hospital discharge were significantly less likely to experience 30-day readmissions (18.2% vs. 23.7%, P = 0.03) compared with those unmonitored. Ninety-five percent of patients strongly agreed or agreed they were likely to recommend RPM to a friend or family member. Conclusions The Mayo Clinic RPM program has generated positive clinical outcomes and is satisfying for patients. As technology advances, there are greater opportunities to enhance this clinical care model and it should be extended and expanded to support patients across a broader spectrum of needs. This report can serve as a framework for health care organizations to implement and enhance their RPM programs in addition to identifying areas for further evolution and exploration in developing RPM programs of the future.
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Affiliation(s)
- Jordan D. Coffey
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Correspondence: Jordan D. Coffey
| | | | - Ryan D. Williams
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Integrity & Compliance Office, Mayo Clinic, Rochester, MN, United States
| | - Shelby R. Gathje
- Research Administrative Services, Mayo Clinic, Rochester, MN, United States
| | - Sarah J. Bell
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Dominick F. Pahl
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Lukas Manka
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - R. Nicole Blegen
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - Michael J. Maniaci
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Steve R. Ommen
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Department of Cardiology, Mayo Clinic, Rochester, MN, United States
| | - Tufia C. Haddad
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Department of Oncology, Mayo Clinic, Rochester, MN, United States
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Attia ZI, Harmon DM, Dugan J, Manka L, Lopez-Jimenez F, Lerman A, Siontis KC, Noseworthy PA, Yao X, Klavetter EW, Halamka JD, Asirvatham SJ, Khan R, Carter RE, Leibovich BC, Friedman PA. Prospective evaluation of smartwatch-enabled detection of left ventricular dysfunction. Nat Med 2022; 28:2497-2503. [PMID: 36376461 PMCID: PMC9805528 DOI: 10.1038/s41591-022-02053-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022]
Abstract
Although artificial intelligence (AI) algorithms have been shown to be capable of identifying cardiac dysfunction, defined as ejection fraction (EF) ≤ 40%, from 12-lead electrocardiograms (ECGs), identification of cardiac dysfunction using the single-lead ECG of a smartwatch has yet to be tested. In the present study, a prospective study in which patients of Mayo Clinic were invited by email to download a Mayo Clinic iPhone application that sends watch ECGs to a secure data platform, we examined patient engagement with the study app and the diagnostic utility of the ECGs. We digitally enrolled 2,454 unique patients (mean age 53 ± 15 years, 56% female) from 46 US states and 11 countries, who sent 125,610 ECGs to the data platform between August 2021 and February 2022; 421 participants had at least one watch-classified sinus rhythm ECG within 30 d of an echocardiogram, of whom 16 (3.8%) had an EF ≤ 40%. The AI algorithm detected patients with low EF with an area under the curve of 0.885 (95% confidence interval 0.823-0.946) and 0.881 (0.815-0.947), using the mean prediction within a 30-d window or the closest ECG relative to the echocardiogram that determined the EF, respectively. These findings indicate that consumer watch ECGs, acquired in nonclinical environments, can be used to identify patients with cardiac dysfunction, a potentially life-threatening and often asymptomatic condition.
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Affiliation(s)
- Zachi I. Attia
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - David M. Harmon
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.,Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN, USA
| | - Jennifer Dugan
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Lukas Manka
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA
| | | | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Peter A. Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Xiaoxi Yao
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Eric W. Klavetter
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Samuel J. Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Rita Khan
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Jacksonville, FL, USA
| | - Bradley C. Leibovich
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA.,Department of Urology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.,Correspondence and requests for materials should be addressed to Paul A. Friedman.,
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Wetterauer C, Federer-Gsponer JR, Leboutte FDJP, Mona R, Ebbing J, Rentsch CA, Manka L, Seifert HH, Wyler S, Recker F, Kwiatkowski M. Indication for Active Surveillance in the Era of MRI-Targeted Prostate Biopsies. Urol Int 2021; 106:83-89. [PMID: 34350895 DOI: 10.1159/000517300] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/19/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Active surveillance (AS) strategies were established to avoid overtreatment of low-risk prostate cancer (PCa) patients. Low tumor volume represents one indication criteria; however, applying this criterion after MRI-targeted prostate biopsies may lead to overestimation of tumor volume; wherefore, patients suitable for AS would be exposed to the risk of overtreatment. METHODS This retrospective analysis included 318 patients in which PCa was detected by MRI-TRUS fusion prostate biopsy. Classic and extended indication for AS included Gleason 6 and Gleason 3 + 4 cancer, respectively. We assessed the effect of targeted biopsies and temporary rating strategies on eligibility for AS and developed new "composite" algorithms to more accurately assess eligibility for AS. RESULTS Forty-four (13.8%) and 60 (18.9%) of the 318 patients qualified for AS according to "classic" and "extended" criteria, respectively. Application of the "composite 1" definition led to AS eligibility of 52 of 248 patients (20.97%) in the classic and of 77 of 248 patients (31.05%) in the "extended" group. CONCLUSIONS We could demonstrate that classic algorithms led to ineligibility of patients for AS. We propose a new rating algorithm to improve tumor assessment for a more accurate indication for AS.
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Affiliation(s)
| | | | | | - Robin Mona
- Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Jan Ebbing
- Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Cyrill A Rentsch
- Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Lukas Manka
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Hans H Seifert
- Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Stephen Wyler
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Franz Recker
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Maciej Kwiatkowski
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany.,Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
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5
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Kopp D, Kopp J, Bernhardt E, Manka L, Beck A, Gerullis H, Karakiewicz PI, Salomon G, Wiggermann P, Hammerer P, Schiffmann J. 68Ga-Prostate-Specific Membrane Antigen Positron Emission Tomography-Computed Tomography-Based Primary Staging and Histological Correlation after Extended Pelvic Lymph Node Dissection in Intermediate-Risk Prostate Cancer. Urol Int 2021; 106:56-62. [PMID: 33965965 DOI: 10.1159/000515651] [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: 12/17/2020] [Accepted: 03/01/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate prostate-specific membrane antigen positron emission tomography-computed tomography (PSMA PET/CT)-based primary staging in exclusively D'Amico intermediate-risk prostate cancer (PCa) patients. PATIENTS AND METHODS We relied on the Braunschweig institutional database and retrospectively identified D'Amico intermediate-risk PCa patients who were administered to 68Ga-PSMA PET/CT-based primary staging prior to consecutive radical prostatectomy and extended lymph node dissection. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the detection of lymph node metastases were analyzed per-patient (n = 39), per-pelvic side (n = 78), and per-anatomic-region (external iliac artery and vein left/right vs. obturator fossa left/right vs. internal iliac artery left/right) (n = 203), respectively. RESULTS Sensitivity, specificity, PPV, and NPV per-patient were 20.0, 94.1, 33.3, and 88.9%, respectively. Sensitivity, specificity, PPV, and NPV per-pelvic-side were 16.7, 97.2, 33.3, and 93.3%, respectively. Sensitivity, specificity, PPV, and NPV per-anatomic-region were 16.7, 99.0, 33.3, and 97.5%, respectively. CONCLUSIONS We recorded high rates of specificity and NPV for 68Ga-PSMA PET/CT-based primary staging in D'Amico intermediate-risk PCa patients. Conversely, the sensitivity and PPV were lower than anticipated. Larger and favorably prospective trials are needed to verify our results and to unravel possible bias from such smaller studies.
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Affiliation(s)
- Daniela Kopp
- Department of Radiology, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Johannes Kopp
- Department of Urology, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Eugen Bernhardt
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Lukas Manka
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Andreas Beck
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Holger Gerullis
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada.,Department of Urology, University of Montreal Health Center, Montreal, Québec, Canada
| | - Georg Salomon
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Wiggermann
- Department of Radiology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Peter Hammerer
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Jonas Schiffmann
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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6
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Pallauf M, Hempel MC, Hupe MC, May M, Haccius M, Weckermann D, Lebentrau S, Hoschke B, Necknig U, Pfitzenmaier J, Manka L, Nuhn P, Törzsök P, Lusuardi L, Merseburger AS. Adherence to the EAU Guideline Recommendations for Local Tumor Treatment in Penile Cancer: Results of the European PROspective Penile Cancer Study Group Survey (E-PROPS). Adv Ther 2020; 37:4969-4980. [PMID: 33038006 PMCID: PMC7595959 DOI: 10.1007/s12325-020-01514-8] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
Introduction Penile cancer (PeCa) is an orphan disease in European countries. The current guidelines are predominantly based on retrospective studies with a low level of evidence. In our study, we aimed to identify predictors for guideline-conform treatment and hypothesize that reference centers for PeCa and physicians' experience promote guideline compliance and therefore correct local tumor therapy. Methods This study is part of the European PROspective Penile Cancer Study (E-PROPS), an international collaboration group evaluating therapeutic management for PeCa in Central Europe. For this module, a 14-item-survey was developed and sent to 681 urologists in 45 European centers. Three questions focused on therapeutic decisions for PeCa in clinical stage Tis, Ta-T1a, and T1b. Four questions addressed potential personal confounders. Survey results were analyzed by bootstrap-adjusted stepwise multivariate linear regression analysis to identify predictors for EAU guideline-conform local treatment of PeCa. Results For local therapy of cTis 80.4% recommended guideline-conform treatment, for cTa-cT1a 87.3% and for cT1b 59.1%. In total, 42.4% chose a correct approach in all tumor stages. The number of PeCa patients treated at the hospital, a higher level of training of the physicians, resource-based answering and the option of penile-sparing surgery offered at the hospital matched with giving guideline-conform recommendations and thus accurate local tumor treatment. Conclusion Patients with PeCa are best treated by experienced physicians, in centers with a high number of cases, which also offer a wide range of local tumor therapy. This could be offered in reference centers.
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Affiliation(s)
- Maximilian Pallauf
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Marie C Hempel
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
| | - Marie C Hupe
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Matthias May
- Department of Urology, St. Elisabeth-Hospital Straubing, Straubing, Germany
| | - Marlene Haccius
- Department of Urology, St. Elisabeth-Hospital Straubing, Straubing, Germany
| | | | - Steffen Lebentrau
- Department of Urology, Brandenburg Medical School Theodor Fontane, Ruppiner Kliniken, Neuruppin, Germany
| | - Bernd Hoschke
- Department of Urology, Carl-Thiem-Clinic Cottbus, Cottbus, Germany
| | - Ulrike Necknig
- Department of Urology and Pediatric Urology, Garmisch-Partenkirchen Medical Center, Garmisch-Partenkirchen, Germany
| | | | - Lukas Manka
- Clinic of Braunschweig, Braunschweig, Germany
| | - Philipp Nuhn
- Department of Urology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Törzsök
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Lusuardi
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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7
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Steinwender T, Manka L, Grindei M, Tian Z, Winter A, Gerullis H, Karakiewicz PI, Hammerer P, Schiffmann J. Elastography Targeted Prostate Biopsy in Patients under Active Surveillance. Urol Int 2020; 104:948-953. [PMID: 32854102 DOI: 10.1159/000509256] [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: 03/10/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to examine elastography-based prostate biopsy in prostate cancer (PCa) patients under active surveillance. PATIENTS AND METHODS We relied on PCa patients who opted for active surveillance and underwent elastography targeted and systematic follow-up biopsy at the Braunschweig Prostate Cancer Center between October 2009 and February 2015. Each prostate sextant was considered as an individual case. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC) for elastography to predict follow-up biopsy results were analyzed, respectively, and 95 % confidence intervals (CIs) were carried out by using 2000 bootstrapping sample analyses. RESULTS Overall, 50 men and 300 sextants were identified. Overall, 27 (54%) men and 66 (22%) sextants harbored PCa at follow-up biopsy. Sensitivity, specificity, PPV, NPV, and ACC for elastography to predict follow-up biopsy results were: 19.7 (95% CI: 11.9-27.3), 86.8 (95% CI: 82.7-90.3), 29.6 (95% CI: 14.6-46.0), 79.3 (95% CI: 71.6-86.5), and 72.0% (95% CI: 65.7-78.3), respectively. CONCLUSIONS We recorded limited reliability of elastography-based prediction of follow-up biopsy results in active surveillance patients. Based on our analyses, we can neither recommend to rely exclusively on elastography-based targeted biopsies nor to delay or to omit follow-up biopsies based on elastography results during active surveillance.
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Affiliation(s)
- Tobias Steinwender
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Lukas Manka
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Mircea Grindei
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada
| | - Alexander Winter
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Holger Gerullis
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada.,Department of Urology, University of Montreal Health Center, Montreal, Québec, Canada
| | - Peter Hammerer
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Jonas Schiffmann
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany,
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8
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Wetterauer C, Federer Gsponer J, Leboutte F, Mona R, Ebbing J, Rentsch C, Manka L, Seifert H, Wyler S, Recker F, Kwiatkowski M. Indication for active surveillance in the era of MRI-targeted biopsies. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33624-7] [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: 11/17/2022] Open
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Abstract
BACKGROUND Androgen deprivation therapy (ADT) alone has long been the standard of care in the treatment of metastatic prostate cancer (mCSPC). A paradigm shift in the treatment of patients with mCSPC has now been initiated by the results of three major phase 3 clinical trials (CHAARTED, STAMPEDE, LATITUDE): They demonstrated a significant advantage of ADT in combination with docetaxel or abiraterone/prednisone over ADT alone. OBJECTIVES This review presents the current evidence for the use of docetaxel or abiraterone/prednisone in combination with ADT and discusses-in the absence of directly comparing studies-which patients may have an advantage of ADT plus abiraterone/prednisone over ADT plus docetaxel or vice versa. METHODS A systematic review based on bibliographic literature search was conducted. RESULTS Both the combinations of ADT with docetaxel and with abiraterone/prednisone represent a major advance in the treatment of patients with mCSPC, in particular of patients with multiple metastases. Compared to chemotherapy, the use of abiraterone in addition to ADT avoids (rare) neutropenic complications and treatment-associated deaths. Long-term oral treatment with abiraterone/prednisone as a complementary therapy to ADT replaces short-term intravenous treatment (docetaxel). CONCLUSION In patients with mCSPC, ADT plus docetaxel or ADT plus abiraterone/prednisone is recommended. In particular in patients with pre-existing cardiovascular disease, ADT should be considered with a GnRH (gonadotropin-releasing hormone) antagonist to reduce the risk of cardiotoxic side effects.
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Affiliation(s)
- P Hammerer
- Klinik für Urologie und Uroonkologie, Städtisches Klinikum Braunschweig gGmbH, Salzdahlumer Str. 90, 38126, Braunschweig, Deutschland
| | - L Manka
- Klinik für Urologie und Uroonkologie, Städtisches Klinikum Braunschweig gGmbH, Salzdahlumer Str. 90, 38126, Braunschweig, Deutschland.
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10
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Kokov D, Manka L, Beck A, Winter A, Gerullis H, Karakiewicz PI, Hammerer P, Schiffmann J. Only Size Matters in Stone Patients: Computed Tomography Controlled Stone-Free Rates after Mini-Percutaneous Nephrolithotomy. Urol Int 2019; 103:166-171. [PMID: 30844789 DOI: 10.1159/000497442] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/04/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine and predicting stone-free rates (SFRs) after minimally invasive-percutaneous nephrolithotomy (mini-PNL) based on computed tomography (CT), instead of X-ray or ultrasound control. PATIENTS AND METHODS We identified 146 mini-PNL patients with pre- and postoperative CT scans. Patient and stone characteristics were assessed. Stone-free status was defined as ≤3 mm residual fragment after mini-PNL according to postsurgery CT scan. Multivariable logistic regression analyses predicted stone-free status after mini-PNL. RESULTS Overall, 62 (42.5%) patients achieved stone-free status after mini-PNL. In multivariable analyses, stone size was the only independent predictor for stone-free status (OR 0.9; p = 0.02). Patients with stones > 20 mm were less likely to achieve stone-free status, than those harboring stones 10-20 mm (OR 0.3; p = 0.009). SFRs according to stone size categories (< 10, 10-20, and > 20 mm) were 33.3, 50.5, and 25%. Body mass index (BMI) and stone density (Houndsfield units) were no independent predictors for stone-free status after mini-PNL. CONCLUSIONS We report lower SFRs than expected. Stone size was the only independent predictor for stone-free status after mini-PNL. Patients with larger stones need to be informed about high risk of additional interventions. High BMI and high stone density do not represent a barrier for stone-free status after mini-PNL.
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Affiliation(s)
- Dmitriy Kokov
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Lukas Manka
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Andreas Beck
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Alexander Winter
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Holger Gerullis
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada.,Department of Urology, University of Montreal Health Center, Montreal, Québec, Canada
| | - Peter Hammerer
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Jonas Schiffmann
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany,
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11
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Hammerer P, Manka L. Androgen Deprivation Therapy for Advanced Prostate Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_77] [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: 10/26/2022]
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12
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Hammerer P, Manka L. Androgen Deprivation Therapy for Advanced Prostate Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42603-7_77-1] [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: 10/26/2022]
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13
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Kwiatkowski M, Lang E, Mortezavi A, Prause L, Wyler S, Grobholz R, Huber A, Manka L, Sulser T, Recker F, Eberli D. PD47-09 INFLUENCE OF STATIN INTAKE ON PSA VALUES, RISK OF PROSTATE CANCER DEVELOPMENT AND SURVIVAL IN A PROSPECTIVE SCREENING TRIAL COHORT (ERSPC AARAU). J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2369] [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: 11/27/2022]
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14
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Hammerer P, Manka L, Wirth M. Long-term androgen deprivation therapy (ADT) with leuprorelin and quality of life in patients with advanced prostate cancer (PCa). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
268 Background: LHRH analogs are the gold standard for treatment of patients with hormone-sensitive advanced PCa. In this study, we investigated the quality of life (QoL) of PCa patients under long-term treatment with leuprorelin acetate in microcapsules (1, 3, and 6 month depot formulation) for up to 19.8 years. Methods: Observational and retrospective analysis of data from 536 PCa patients treated with leuproreline and 116 patients of a control group (CG, ≥ 77 years of age, > 5 years urological treatment, no cancer, no ADT). Data was collected in 30 German office based urological practices using EORTC questionnaires QLQ-C30 and QLQ-PR25. Results: Mean treatment duration was 8.6 years (range: 4.5 - 19.8 years). Mean age ± SD of PCa patients (79.6 ± 6.3 years) was comparable to CG (80.5 ± 3.1 years), as were body height, weight, BMI, and Karnofsky-Index (88.0 ± 12.7 vs. 88.4 ± 12.0). The general health status (QLQ-C30) was comparable for PCa patients vs. CG: 64.6 ± 20.5 vs. 66.8 ± 20.3; p = 0.3117. Marginal differences were observed regarding physical functioning (73.2 ± 23.1 vs. 78.1 ± 21.0; p = 0.0402) and role functioning (70.6 ± 30.4 vs. 74.4 ± 25.7; p = 0.1648). PCa patients rated fatigue (33.6 ± 25.1 vs. 28.8 ± 23.3; p = 0.0629), dyspnoea (24.0 ± 28.5 vs. 19.6 ± 26.9; p = 0.1307), and insomnia (28.9 ± 32.6 vs. 23.7 ± 27.2; p = 0.0751) slightly worse than CG. As assessed by QLQ-PR25, PCa patients scored lower on sexual activity (12.0 ± 20.6 vs. 23.7 ± 25.7; p < 0.0001) and sexual function (43.3 ± 25.8 vs. 55.9 ± 27.0; p = 0.0067) compared to CG. PCa patients had less urinary tract symptoms (28.2 ± 19.8 vs. 31.2 ± 19.2; p = 0.1472) but stronger symptoms of androgen deprivation (21.4 ± 17.3 vs. 10.8 ± 13.2; p < 0.0001), and they had a higher need of incontinence aids (29.6 ± 34.2 vs. 16.7 ± 20.5; p = 0.0056) – however, 136 of the 536 PCa patients had a prostatectomy. Conclusions: In this study, PCa patients treated with leuprorelin for up to 19.8 years (8.6 years on average) had an overall QoL comparable to an age-matched control group. As expected, sexual activity and sexual function were lower in PCa patients under ADT. Overall, treatment with leuprorelin is a well-tolerated long-term therapy for patients with hormone-sensitive advanced PCa. Clinical trial information: ENA E005(a) / DE-N-LEU-019(a).
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Affiliation(s)
| | - Lukas Manka
- Academic Hospital Braunschweig, Braunschweig, Germany
| | - Manfred Wirth
- University Hospital Carl-Gustav Carus, Dresden, Germany
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15
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Schiffmann J, Grindei M, Tian Z, Yassin DJ, Steinwender T, Leyh-Bannurah SR, Randazzo M, Kwiatkowski M, Karakiewicz PI, Hammerer P, Manka L. Limitations of Elastography Based Prostate Biopsy. J Urol 2016; 195:1731-6. [DOI: 10.1016/j.juro.2015.12.086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Jonas Schiffmann
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Mircea Grindei
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Dany-Jan Yassin
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Tobias Steinwender
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Sami-Ramzi Leyh-Bannurah
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Marco Randazzo
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | | | - Pierre I. Karakiewicz
- Department of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Peter Hammerer
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Lukas Manka
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
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16
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Kwiatkowski M, Prause L, Wyler SF, Moeltgen T, Huber A, Grobholz R, Manka L, Seifert B, Randazzo M, Recker F. MP39-05 SWISS PROSTATE-CHECK - A POPULATION BASED RISK-CALCULATOR FOR NEXT GENERATION PROSTATE CANCER SCREENING. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.130] [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: 10/22/2022]
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17
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Kwiatkowski M, Prause L, Wyler SF, Moeltgen T, Huber A, Grobholz R, Manka L, Müller A, Randazzo M, Recker F. MP39-03 DECREASING SCREENING EFFICACY WITH INCREASING AGE: RESULTS FROM A POPULATION-BASED SCREENING TRIAL - SWISS ERSPC (AARAU). J Urol 2016. [DOI: 10.1016/j.juro.2016.02.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Kwiatkowski M, Prause L, Wyler SF, Moeltgen T, Huber A, Grobholz R, Manka L, Recker F. MP39-15 SCREENING FOR PROSTATE CANCER: RESULTS FROM THE SWISS SECTION OF THE ERSPC (AARAU). J Urol 2016. [DOI: 10.1016/j.juro.2016.02.140] [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: 10/22/2022]
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19
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Randazzo M, Müller A, Carlsson S, Eberli D, Huber A, Grobholz R, Manka L, Mortezavi A, Sulser T, Recker F, Kwiatkowski M. A positive family history as a risk factor for prostate cancer in a population-based study with organised prostate-specific antigen screening: results of the Swiss European Randomised Study of Screening for Prostate Cancer (ERSPC, Aarau). BJU Int 2015; 117:576-83. [PMID: 26332304 DOI: 10.1111/bju.13310] [Citation(s) in RCA: 30] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the value of a positive family history (FH) as a risk factor for prostate cancer incidence and grade among men undergoing organised prostate-specific antigen (PSA) screening in a population-based study. SUBJECTS AND METHODS The study cohort comprised all attendees of the Swiss arm of the European Randomised Study of Screening for Prostate Cancer (ERSPC) with systematic PSA level tests every 4 years. Men reporting first-degree relative(s) diagnosed with prostate cancer were considered to have a positive FH. Biopsy was exclusively PSA triggered at a PSA level threshold of 3 ng/mL. The primary endpoint was prostate cancer diagnosis. Kaplan-Meier and Cox regression analyses were used. RESULTS Of 4 932 attendees with a median (interquartile range, IQR) age of 60.9 (57.6-65.1) years, 334 (6.8%) reported a positive FH. The median (IQR) follow-up duration was 11.6 (10.3-13.3) years. Cumulative prostate cancer incidence was 60/334 (18%, positive FH) and 550/4 598 (12%, negative FH) [odds ratio 1.6, 95% confidence interval (CI) 1.2-2.2, P = 0.001). In both groups, most prostate cancer diagnosed was low grade. There were no significant differences in PSA level at diagnosis, biopsy Gleason score or Gleason score on pathological specimen among men who underwent radical prostatectomy between both groups. On multivariable analysis, age (hazard ratio [HR] 1.04, 95% CI 1.02-1.06), baseline PSA level (HR 1.13, 95% CI 1.12-1.14), and FH (HR 1.6, 95% CI 1.24-2.14) were independent predictors for overall prostate cancer incidence (all P < 0.001). Only baseline PSA level (HR 1.14, 95% CI 1.12-1.16, P < 0.001) was an independent predictor of Gleason score ≥7 prostate cancer on prostate biopsy. The proportion of interval prostate cancer diagnosed in-between the screening rounds was not significantly different. CONCLUSION Irrespective of the FH status, the current PSA-based screening setting detects the majority of aggressive prostate cancers and missed only a minority of interval cancers with a 4-year screening algorithm. Our results suggest that men with a positive FH are at increased risk of low-grade but not aggressive prostate cancer.
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Affiliation(s)
- Marco Randazzo
- Department of Urology, University Hospital Zürich, Zürich, Switzerland.,Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Alexander Müller
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Sigrid Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Urology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Daniel Eberli
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Andreas Huber
- Department of Laboratory Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Rainer Grobholz
- Department of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Lukas Manka
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Ashkan Mortezavi
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Tullio Sulser
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Franz Recker
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Maciej Kwiatkowski
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland.,Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
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20
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Randazzo M, Beatrice J, Huber A, Grobholz R, Manka L, Chun FK, Recker F, Kwiatkowski M. A “PSA Pyramid” for Men with Initial Prostate-specific Antigen ≤3 ng/ml: A Plea for Individualized Prostate Cancer Screening. Eur Urol 2015; 68:591-7. [DOI: 10.1016/j.eururo.2014.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 04/09/2014] [Indexed: 11/24/2022]
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21
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Schiffmann J, Mehring G, Tennstedt P, Manka L, Boehm K, Leyh-Bannurah SR, Karakiewicz PI, Hammerer P, Graefen M, Salomon G. True targeting-derived prostate biopsy: HistoScanning™ remained inadequate despite advanced technical efforts. World J Urol 2015. [PMID: 26215749 DOI: 10.1007/s00345-015-1637-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To verify the reliability of HistoScanning™-based, true targeting (TT)-derived prostate biopsy. METHODS We relied on 40 patients suspicious for prostate cancer who underwent standard and TT-derived prostate biopsy. Sensitivity, specificity, positive predictive value, negative predictive value and the area under the curve (AUC) were assessed for the prediction of biopsy results per octant by HistoScanning™, using different HistoScanning™ signal volume cutoffs (>0, >0.2 and >0.5 ml). RESULTS Overall, 319 octants were analyzed. Of those, 64 (20.1 %) harbored prostate cancer. According to different HistoScanning™ signal volume cutoffs (>0, >0.2 and >0.5 ml), the AUCs for predicting biopsy results were: 0.51, 0.51 and 0.53, respectively. Similarly, the sensitivity, specificity, positive predictive and negative predictive values were: 20.7, 78.2, 17.4 and 81.6 %; 20.7, 82.0, 20.3 and 82.3 %; and 12.1, 94.6, 33.3 and 82.9 %, respectively. CONCLUSIONS Prediction of biopsy results based on HistoScanning™ signals and TT-derived biopsies was unreliable. Moreover, the AUC of TT-derived biopsies was low and did not improve when additional signal volume cutoffs were applied (>0.2 and >0.5 ml). We cannot recommend a variation of well-established biopsy standards or reduction in biopsy cores based on HistoScanning™ signals.
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Affiliation(s)
- Jonas Schiffmann
- Department of Urology, Academic Hospital Braunschweig, Salzdahlumerstrasse 90, 38126, Brunswick, Germany.
| | - Gisa Mehring
- Department of Urology, Medical University Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre Tennstedt
- Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Manka
- Department of Urology, Academic Hospital Braunschweig, Salzdahlumerstrasse 90, 38126, Brunswick, Germany
| | - Katharina Boehm
- Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | | | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.,Department of Urology, University of Montreal Health Center, Montreal, Canada
| | - Peter Hammerer
- Department of Urology, Academic Hospital Braunschweig, Salzdahlumerstrasse 90, 38126, Brunswick, Germany
| | - Markus Graefen
- Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Salomon
- Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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22
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Sooriakumaran P, Karnes J, Stief C, Copsey B, Montorsi F, Hammerer P, Beyer B, Moschini M, Gratzke C, Steuber T, Suardi N, Briganti A, Manka L, Nyberg T, Dutton SJ, Wiklund P, Graefen M. A Multi-institutional Analysis of Perioperative Outcomes in 106 Men Who Underwent Radical Prostatectomy for Distant Metastatic Prostate Cancer at Presentation. Eur Urol 2015; 69:788-94. [PMID: 26038098 DOI: 10.1016/j.eururo.2015.05.023] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/14/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Current trials are investigating radical intervention in men with metastatic prostate cancer. However, there is a lack of safety data for radical prostatectomy as therapy in this setting. OBJECTIVE To examine perioperative outcomes and short-term complications after radical prostatectomy for locally resectable, distant metastatic prostate cancer. DESIGN, SETTING, AND PARTICIPANTS A retrospective case series from 2007 to 2014 comprising 106 patients with newly diagnosed metastatic (M1) prostate cancer from the USA, Germany, Italy, and Sweden. INTERVENTION Radical prostatectomy and extended pelvic lymphadenectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Descriptive statistics were used to present margin status, continence, and readmission, reoperation, and overall complication rates at 90 d, as well as for 21 specific complications. Kaplan-Meier plots were used to estimate survival function. Intercenter variability and M1a/ M1b subgroups were examined. RESULTS AND LIMITATIONS Some 79.2% of patients did not suffer any complications; positive-margin (53.8%), lymphocele (8.5%), and wound infection (4.7%) rates were higher in our cohort than in a meta-analysis of open radical prostatectomy performed for standard indications. At a median follow-up of 22.8 mo, 94/106 (88.7%) men were still alive. The study is limited by its retrospective design, differing selection criteria, and short follow-up. CONCLUSIONS Radical prostatectomy for men with locally resectable, distant metastatic prostate cancer appears safe in expert hands for meticulously selected patients. Overall and specific complication rates related to the surgical extirpation are not more frequent than when radical prostatectomy is performed for standard indications, and the use of extended pelvic lymphadenectomy in all of this cohort compared to its selective use in localized/locally advanced prostate cancer accounts for any extra morbidity. PATIENT SUMMARY Men presenting with advanced prostate cancer that has spread beyond the prostate are increasingly being considered for treatments directed at the prostate itself. On the basis of results for our international series of 106 men, surgery appears reasonably safe in this setting for certain patients.
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Affiliation(s)
- Prasanna Sooriakumaran
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Christian Stief
- Department of Urology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Bethan Copsey
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | | | - Peter Hammerer
- Department of Urology/Uro-oncology, Academic Hospital Braunschweig, Brunswick, Germany
| | - Burkhard Beyer
- Martini Clinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Christian Gratzke
- Department of Urology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Thomas Steuber
- Martini Clinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Lukas Manka
- Department of Urology/Uro-oncology, Academic Hospital Braunschweig, Brunswick, Germany
| | - Tommy Nyberg
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Susan J Dutton
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Uro-clinic, St. Goran Hospital, Stockholm, Sweden
| | - Markus Graefen
- Martini Clinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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Randazzo M, Hermanns T, Poyet C, Beatrice J, Huber A, Grobholz R, Manka L, Wyler S, Recker F, Kwiatkowski M. MP86-07 ASSOCIATION OF METFORMIN USE WITH PROSTATE CANCER INCIDENCE IN A PROSPECTIVE SCREENING TRIAL (ERSPC AARAU). J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1916] [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: 10/23/2022]
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24
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Randazzo M, Beatrice J, Huber A, Grobholz R, Manka L, Recker F, Kwiatkowski M. Differences among men on active surveillance for very low-risk prostate cancer detected through population-based versus opportunistic prostate-specific antigen-screening. Urol Int 2015; 94:330-6. [PMID: 25633871 DOI: 10.1159/000368417] [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: 04/28/2014] [Accepted: 09/17/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Very low-risk prostate cancer (PCa) is being increasingly managed by active surveillance (AS). Our aim was to assess the influence of the origin of diagnosis on PCa characteristics and treatment rates among men with very low-risk PCa in our prospective AS cohort. METHODS Overall, 191 men with very low-risk PCa fulfilling Epstein-criteria underwent protocol-based AS. These men originated either from the prospective population-based screening program (P-AS) or were diagnosed by opportunistic screening (O-AS). RESULTS Overall, n = 86 (45.0%) originated from the P-AS group, whereas n = 105 (55.0%) from the O-AS group. On univariate Cox regression analysis, age (HR 0.96, 95% CI 0.92-1.00; p = 0.05), origin of diagnosis (HR 0.72, 95% CI 0.41-1.28; p = 0.001), number of positive cores (HR 2.15, 95% CI 1.18-3.90; p = 0.01) and maximum core involvement (HR 1.03, 95% CI 0.99-1.05; p = 0.05) were predictors for treatment necessity. On multivariate analysis, age (HR 0.95, 95% CI 0.89-0.99; p = 0.05), number of positive cores (HR 2.07, 95% CI 1.10-3.88; p = 0.02), maximum core involvement (HR 1.03, 95% CI 1.00-1.06; p = 0.04) but not origin of diagnosis were independent predictors for treatment necessity. Four men developed biochemical recurrence (all from O-AS group [p = 0.05]). CONCLUSION The origin of PCa diagnosis in men undergoing AS had no influence on disease progression and treatment necessity.
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Affiliation(s)
- Marco Randazzo
- Department of Urology, Cantonal Hospital Aarau, Switzerland
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25
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Randazzo M, Beatrice J, Huber A, Grobholz R, Manka L, Chun FK, Kluth LA, Wyler SF, Recker F, Kwiatkowski M. Is further screening of men with baseline PSA < 1 ng ml−1worthwhile? The discussion continues-Results of the Swiss ERSPC (Aarau). Int J Cancer 2015; 137:553-9. [DOI: 10.1002/ijc.29420] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 12/12/2014] [Accepted: 12/19/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Marco Randazzo
- Department of Urology; Cantonal Hospital Aarau; Aarau Switzerland
- Department of Urology; University Hospital Zurich; Zurich Switzerland
| | - Josef Beatrice
- Department of Urology; Cantonal Hospital Aarau; Aarau Switzerland
| | - Andreas Huber
- Department of Laboratory Medicine; Cantonal Hospital Aarau; Aarau Switzerland
| | - Rainer Grobholz
- Department of Pathology; Cantonal Hospital Aarau; Aarau Switzerland
| | - Lukas Manka
- Department of Urology; Academic Hospital Braunschweig; Braunschweig Germany
| | - Felix K. Chun
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg-Eppendorf Germany
| | - Luis A. Kluth
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg-Eppendorf Germany
| | - Stephen F. Wyler
- Department of Urology; Cantonal Hospital Aarau; Aarau Switzerland
| | - Franz Recker
- Department of Urology; Cantonal Hospital Aarau; Aarau Switzerland
| | - Maciej Kwiatkowski
- Department of Urology; Cantonal Hospital Aarau; Aarau Switzerland
- Department of Urology; Academic Hospital Braunschweig; Braunschweig Germany
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Randazzo M, Beatrice J, Huber A, Grobholz R, Manka L, Wyler SF, Chun FF, Recker F, Kwiatkowski M. Influence of metformin use on PSA values, free-to-total PSA, prostate cancer incidence and grade and overall survival in a prospective screening trial (ERSPC Aarau). World J Urol 2014; 33:1189-96. [PMID: 25358675 DOI: 10.1007/s00345-014-1426-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/19/2014] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To analyze the effect of the oral antidiabetic drug metformin on PSA level, free-to-total PSA ratio (f/t-ratio), PCa incidence and grade as well as mortality in men participating in a population-based screening trial. METHODS Data from 4,314 men aged 55-70 years from a population-based PSA-screening trial (ERSPC Aarau) were analyzed. Information on metformin exposure was obtained by a self-administered questionnaire. Serum PSA threshold at ≥3 ng/ml triggered prostate biopsy. Data on PCa incidence and mortality were obtained through registry linkages. RESULTS Median follow-up time was 7.6 years. Mean age at baseline was 65.5 years (±SD 4.4). In all, n = 150 (3.5 %) men used metformin [metf+]. Mean baseline PSA levels were comparable between both groups ([metf+] 1.6 ng/ml ± 2.4 vs. [metf-] 1.8ug/l ± 2.2, p = 0.4) while f/t-ratio was slightly higher in metformin users ([metf+] 30.7 % ± 10.9 vs. [metf-] 27.3 % ± 10.9, p = 0.01). Overall, n = 372 (8.6 %) PCa cases were detected. Neither cumulative PCa incidence (n = 11; 7.3 % [metf+] vs. n = 361 8.7 % [metf-]; p = 0.5) nor d`Amico risk groups were significantly different between both groups. One man in each group (metf+ 0.7 % and metf- 0.02 %) died from PCa (p < 0.0001), respectively. All-cause mortality was significantly higher among met + compared to met- (adjusted OR 2.50, 95 %CI 1.59-3.82; p = 0.0001). CONCLUSION No significant differences in PSA levels or PCa incidence and grade were observed. The slightly higher f/t-ratio did not result in lower PCa detection rate. Metformin users were at significantly higher risk of all-cause mortality. The relatively small number of men on metformin is a main limitation of the study.
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Affiliation(s)
- Marco Randazzo
- Department of Urology, Cantonal Hospital Aarau, Aarau, 5001, Switzerland,
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Yassin DJ, Manka L, Yassin A, Hammerer P. Effect of testosterone treatment in hypogonadal men on prostate cancer risk: Results of a prospective comparative study—8 years follow-up analysis to age-matched controls. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e16051] [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: 11/20/2022] Open
Affiliation(s)
| | - Lukas Manka
- Academic Hospital Braunschweig, Braunschweig, Germany
| | - Aksam Yassin
- Institute for Urology and Andrology, Norderstedt, Germany
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Randazzo M, Beatrice J, Huber A, Grobholz R, Manka L, Recker F, Kwiatkowski M. MP69-02 THE IMPACT OF FAMILY HISTORY ON PROSTATE CANCER INCIDENCE AND -AGGRESSIVENESS IN A POPULATION-BASED SCREENING TRIAL (ERSPC AARAU). J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Randazzo M, Beatrice J, Huber A, Grobholz R, Manka L, Recker F, Kwiatkowski M. MP69-04 FUTURE RISK FOR INTERMEDIATE OR HIGH RISK PROSTATE CANCER IN MEN WITH BASELINE PSA OF 1-3NG/ML AND LOW FREE-TO-TOTAL PSA-RATIO IN A PROSPECTIVE POPULATION-BASED SCREENING TRIAL (ERSPC AARAU). J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kwiatkowski M, Randazzo M, Kluth L, Manka L, Huber A, Recker F. Prostate cancer screening: and yet it moves! Asian J Androl 2014; 17:437-8. [PMID: 25532573 PMCID: PMC4430944 DOI: 10.4103/1008-682x.143310] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The debate of prostate cancer (PCa) screening has been shaped over decades. There is a plethora of articles in the literature supporting as well as declining prostate-specific antigen (PSA) screening. Does screening decrease PCa mortality? With the long-term results of the European Randomized Study of Screening for Prostate (ERSPC) the answer is clearly YES. It moves! However, in medicine there are no benefits without any harm and thus, screening has to be performed in targeted and smart way-or in other words-in a risk-adapted fashion when compared with the way it was done in the past. Here, we discuss the main findings of the ERSPC trials and provide insights on how the future screening strategies should be implemented.
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Randazzo M, Seiler D, Beatrice J, Baumgartner M, Huber A, Grobholz R, Manka L, Ahyai S, Chun F, Recker F, Kwiatkowski M. 1934 PROSTATE SPECIFIC ANTIGEN (PSA)-PYRAMID IN MEN WITH LOW RANGE PSA: PROSTATE CANCER INCIDENCE AND MORTALITY - A PLEA FOR RISK-BASED PROSTATE CANCER SCREENING STRATEGY IN THE EUROPEAN RANDOMIZED STUDY OF SCREENING FOR PROSTATE CANCER (ERSPC), AARAU. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2353] [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: 10/27/2022]
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Ohlmann CH, Stöckle M, Pfister DA, Heidenreich A, Merseburger AS, Kuczyk M, Manka L, Hammerer P, Albers P, Arsov C, Retz M, Gschwend JE, Feyerabend S, Stenzl A, Banek S, Marin J, Gleissner J, Wirth M, Zastrow S, Heck M. Efficacy of abiraterone acetate in the treatment of castration-resistant prostate cancer: Early results from the German compassionate-use program. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e15195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15195 Background: Abiraterone acetate (AA) plus prednisone (P) has demonstrated an improved survival of patients with castration-resistant prostate cancer (CRPC) compared to placebo plus P in a large phase III trial. In Germany, patients were able to receive AA within a compassionate-use program (CUP). Here, we report the first results of the program. Methods: Patients were eligible for the CUP if they progressed on or after at least one cytotoxic chemotherapy regimens. For CUP entry, patients were considered to have disease progression if they had radiographic evidence of disease progression in soft tissue or bone with or without PSA-progression and ongoing androgen deprivation. Patients received AA 1000mg daily plus prednisone 5mg BID until progression of disease or unacceptable toxicity. Results: Between 02-05/2011, 398 patients were registered for the CUP in Germany. Data from 191/350 (47.9%) of the patients treated at 10 different sites were available for evaluation of efficacy. Median age was 70.72yrs (52.35-87.61) and patients received a median of 1 (1-4) chemotherapy lines prior to CUP entry. Median PSA at baseline was 220.5 ng/ml (0.47-4245); 168 (88%) of patients presented with bone metastasis. With regard to efficacy, 64/191 (33.5%) of the patients showed an unconfirmed PSA-response ≥50%. At a median follow-up of 5.3 months, 51/191 (26.7%) patients had died, resulting in a median PSA-progression free and overall survival of 8.3 and 10.61 months, respectively. In a subset of patients (71/191, 37.2%) data regarding objective response was available with 25/71 (35.2%) achieving an objective response. Data from 114 pts. revealed fatigue (20.3%), hot flushes (15.8%), edema (10.6%), elevated liver enzymes (8.0%) and asthenia (7.9%) being the most frequent toxicities (any grade). Conclusions: Treatment of CRPC patients with AA outside controlled clinical trials leads to considerable PSA- and objective response rates with a favourable toxicity profile, comparable to the results from COU-AA-301 registration trial. Due to the short median follow-up, conclusions regarding PSA-progression free and overall survival may not be drawn.
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Affiliation(s)
| | - Michael Stöckle
- Department of Urology, Saarland University, Homburg, Germany
| | | | | | | | | | - Lukas Manka
- Academic Hospital Braunschweig, Braunschweig, Germany
| | | | - Peter Albers
- Department of Urology, Heinrich-Heine-University, Duesseldorf, Germany
| | - Christian Arsov
- Department of Urology, Heinrich-Heine-University, Duesseldorf, Germany
| | - Margitta Retz
- Department of Urology, Rechts der Isar Medical Center, Technische Universität München, Munich, Germany
| | - Jürgen E. Gschwend
- Department of Urology, Rechts der Isar Medical Center, Technische Universität München, Munich, Germany
| | - Susan Feyerabend
- Department of Urology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | - Severine Banek
- Department of Urology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | | | | | - Manfred Wirth
- University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Matthias Heck
- Department of Urology, Rechts der Isar Medical Center, Technische Universität München, Munich, Germany
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