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Knipper S, Lischewski F, Koehler D, Eiber M, Van Leeuwen F, De Barros H, Berrens A, Van Leeuwen P, Van Der Poel H, Falkenbach F, Budäus L, Steuber T, Graefen M, Gschwend J, Tennstedt P, Horn T, Heck M, Maurer T. Complete biochemical response below 0.1 ng/ml predicts long-term therapy-free survival of patients treated with salvage lymph node dissection via PSMA-radioguided surgery. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01160-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Ambrosini F, Pose R, Tilki D, Chun F, Steuber T, Salomon G, Michl U, Heinzer H, Maurer T, Isbarn H, Budäus L, Huland H, Terrone C, Tennstedt P, Graefen M, Haese A. Nerve-Sparing Radical Prostatectomy (NSRP) using the NeuroSAFE technique is oncologically safe: Results after 20 years of experience. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00530-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Pose R, Knipper S, Hohenhorst L, Beyer B, Haese A, Heinzer H, Salomon G, Steuber T, Budäus L, Tilki D, Isbarn H, Maurer T, Tennstedt P, Graefen M, Michl U. Impact of peritoneal bladder flap on the risk of lymphoceles after robotic radical prostatectomy: Results of a prospective controlled trial. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Knipper S, Mehdi Irai M, Simon R, Köhler D, Isabel R, Eiber M, Van Leeuwen F, Van Leeuwen P, Budäus L, Steuber T, Graefen M, Tennstedt P, Heck M, Horn T, Maurer T. Cohort study of oligorecurrent prostate cancer patients: Oncological outcomes of patients treated with salvage lymph node dissection via PSMA radioguided surgery. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00594-2] [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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Preisser F, Pose R, Heinze A, Steuber T, Michl U, Salomon G, Chun F, Graefen M, Tilki D, Michl. Impact of persistent PSA in salvage radical prostatectomy patients for recurrent prostate cancer. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00270-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hoeh B, Wenzel M, Humke C, Wittler C, Hohenhorst J, Volckmann-Wilde M, Köllermann J, Steuber T, Graefen M, Derya T, Karakiewicz P, Becker A, Kluth L, Chun F, Mandel P. Correlation of urine loss after catheter removal and early continence in men undergoing radical prostatectomy. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01215-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Steuber T, Maurer T, Miller K. [Metachronous oligometastatic prostate cancer-the more the better or only local treatment?]. Urologe A 2021; 60:1534-1545. [PMID: 34734294 DOI: 10.1007/s00120-021-01701-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prostate cancer metastases may occur at diagnosis (de novo) or metachronous after treatment for localized disease. OBJECTIVE To describe location, prognosis, and individual treatment concepts for metachronous oligometastatic prostate cancer. MATERIALS AND METHODS Analysis of current treatment guidelines and literature for hormone sensitive, metachronous metastatic prostate cancer. RESULTS Modern imaging modalities lead to earlier diagnosis of metachronous oligometastatic prostate cancer, which offers the opportunity to develop metastasis-directed treatment concepts. Oligometastatic recurrence may occur in locoregional lymph nodes (N1) or as distant disease (M1). N1 disease is predominantly treated by salvage lymph node dissection or radiation. Distant metastasis may be radiated in order to delay systemic treatment. The combination of androgen deprivation and novel androgen receptor-targeted drugs such as apalutamide or enzalutamide are associated with a significant survival benefit compared to castration alone in bone or visceral oligometastatic metachronous disease. CONCLUSION Metachronous oligometastatic prostate cancer is heterogeneous with slow progression compared to men with high volume metastasis. Individual treatment concepts may decrease risk of progression and, thus, delay time to medical treatment. Multimodal approaches are currently being evaluated in clinical trials.
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Affiliation(s)
- T Steuber
- Martini-Klinik, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Gebäude Ost 46, 20246, Hamburg, Deutschland.
| | - T Maurer
- Martini-Klinik, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Gebäude Ost 46, 20246, Hamburg, Deutschland
| | - K Miller
- Klinik für Urologie, Universitätsklinikum Charite Berlin, Berlin, Deutschland
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Maurer T, Van Leeuwen F, Van Oosterom M, Steuber T, Haese A, Van Leeuwen P, Van Der Poel H, Graefen M. Robotic minimal-invasive PSMA-radioguided lymph node dissection using a reusable DROP-IN gamm probe. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02289-8] [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: 10/19/2022] Open
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Oudard S, Bevans K, Attard G, Efstathiou E, Flaig T, Franke F, Goodman O, De Giorgi U, Pieczonka C, Yeruva K, De Porre P, Brookman-May S, Dibaj S, Wu D, Mundle S, McCarthy S, Steuber T, Suzuki H, Rathkopf D, Saad F. 584P Health-related quality of life (HRQoL) in ACIS: A phase III trial of apalutamide with abiraterone acetate and prednisone (APA + AAP) vs AAP in metastatic castration-resistant prostate cancer (mCRPC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1097] [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] Open
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Preisser F, Pose R, Heinze A, Steuber T, Michl U, Salomon G, Chun F, Graefen M, Tilki D. Validation of EAU recommendation for salvage radical prostatectomy candidates. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01564-5] [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: 10/20/2022]
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Morote Robles J, Campistol Torres M, Celma A, Regis L, Planas J, Santamaria A, Trilla E, Schiess R, Steuber T. Retrospective evaluation of Proclarix for the detection of clinically significant prostate cancer together with mpMRI. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01390-7] [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]
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Morote Robles J, Campistol Torres M, Celma A, Regis L, Planas J, Santamaria A, Trilla E, Schiess R, Pye H, Whitaker H, Steuber T, Ahmed H, Emberton M. Retrospective evaluation of Proclarix as a companion to mpMRI for the detection of clinically significant prostate cancer. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01384-1] [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: 11/26/2022]
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Michl U, Haese A, Heinzer H, Salomon G, Steuber T, Budäus L, Tilki D, Isbarn H, Maurer T, Tennstedt P, Graefen M. Halving the risk of symptomatic lymphoceles after radical prostatectomy: Results of a randomised-controlled study including 1080 patients. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33707-1] [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: 10/23/2022] Open
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Stolzenbach L, Mandel P, Löcherbach F, Tennstedt P, Heinzer H, Michl U, Steuber T. Oncological outcome of localized, lymph node-positive prostate carcinoma after radical prostatectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32723-3] [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] Open
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Albers P, Bögemann M, Machtens S, Merseburger AS, Schostak M, Steuber T, Wülfing C, De Santis M. [Changes in the treatment of metastatic prostate cancer-new data and open questions]. Urologe A 2019; 59:307-317. [PMID: 31781782 DOI: 10.1007/s00120-019-01072-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The availability of taxane-based chemotherapy and androgen-receptor-targeted agents (ARTAs) have significantly broadened the therapeutic options for patients with metastatic prostate cancer and may also result in longer patient survival. The therapeutic sequence of ARTAs and taxanes may influence outcome and therefore decisions should be made on an individual basis. This article provides guidance for therapeutic decision-making in daily clinical practice by working out criteria that can be used to support individual therapeutic decisions. The focus is on metastatic castration-naive prostate cancer, oligometastatic disease as well as non-metastatic and metastatic castration-resistant prostate cancer.
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Affiliation(s)
- P Albers
- Klinik für Urologie und Universitätstumorzentrum, Comprehensive Cancer Center, Universitätsklinikum, Medizinische Fakultät Heinrich-Heine-Universität, Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - M Bögemann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Münster, Deutschland
| | - S Machtens
- Klinik für Urologie und Kinderurologie, GFO Kliniken Rhein Berg, Betriebsstätte, Marien-Krankenhaus, Bergisch Gladbach, Deutschland
| | - A S Merseburger
- Klinik für Urologie, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - M Schostak
- Klinik für Urologie und Kinderurologie, Universitätsklinik Magdeburg, Magdeburg, Deutschland
| | - T Steuber
- Martini-Klinik, Prostatakrebszentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - C Wülfing
- Abteilung für Urologie, Asklepios Klinik Altona, Hamburg, Deutschland
| | - M De Santis
- Klinik für Urologie, Interdisziplinäre Uro-Onkologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Wülfing C, Bögemann M, Goebell PJ, Hammerer P, Machtens S, Pfister D, Schwentner C, Steuber T, von Amsberg G, Schostak M. [Treatment situation in metastastic Castration Naive Prostate Cancer (mCRPC) and the implications on clinical routine]. Urologe A 2019; 58:1066-1072. [PMID: 31041460 DOI: 10.1007/s00120-019-0925-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
There is an ongoing change of paradigm in the treatment of metastatic prostate cancer (mPC). Taxan-based chemotherapy demonstrated a prolonged survival of patients in several randomized phase III trials. This is true in the situation of metastatic castration-resistent prostate cancer (mCRPC) as well as in the hormone-naïve stage (metastatic castration-naive PC [mCNPC]). In patients with mCNPC, treatment with docetaxel in combination with androgen deprivation therapy (ADT) prolonged the median total survival time by 15 months in comparison to ADT alone. Comparable results were obtained by the endocrine combination treatment with ADT/abiraterone. With the current data in mind it seems to be useful to discuss the value of early combination therapy with ADT/docetaxel or ADT/abiraterone as well as the impact on further treatment options in the mCRPC setting and to define criteria for treatment decisions in clinical practice.
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Affiliation(s)
- C Wülfing
- Abteilung für Urologie, Asklepios Klinik Altona, Paul-Ehrlich-Straße 1, 22763, Hamburg, Deutschland.
| | - M Bögemann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Münster, Münster, Deutschland
| | - P J Goebell
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - P Hammerer
- Klinik für Urologie und Uro-Onkologie, Städtisches Klinikum Braunschweig, Braunschweig, Deutschland
| | - S Machtens
- Klinik für Urologie und Kinderurologie, GFO Kliniken Rhein Berg, Betriebsstätte, Marien-Krankenhaus Bergisch Gladbach, Bergisch Gladbach, Deutschland
| | - D Pfister
- Klinik für Urologie, Uro-Onkologie, Roboter-assistierte und Spezielle Urologische Chirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - C Schwentner
- Urologische Klinik, Diakonie-Klinikum Stuttgart, Stuttgart, Deutschland
| | - T Steuber
- Martini-Klinik, Prostatakrebszentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - G von Amsberg
- Klinik für Onkologie, Hämatologie und Knochenmarkstransplantation, Onkologisches Zentrum, Universitätsklinikum Hamburg, Hamburg, Deutschland
| | - M Schostak
- Klinik für Urologie und Kinderurologie, Universitätsklinik Magdeburg, Magdeburg, Deutschland
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Knipper S, Tilki D, Mansholt J, Klutmann S, Bernreuther C, Steuber T, Maurer T, Graefen M. Metastases-yield and PSA-kinetics following salvage lymph node dissection: A comparison between conventional surgical approach and radio-guided surgery. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)33635-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Steuber T, Jilg C, Tennstedt P, De Bruycker A, Tilki D, Decaestecker K, Zilli T, Jereczek-Fossa BA, Wetterauer U, Grosu AL, Schultze-Seemann W, Heinzer H, Graefen M, Morlacco A, Karnes RJ, Ost P. Standard of Care Versus Metastases-directed Therapy for PET-detected Nodal Oligorecurrent Prostate Cancer Following Multimodality Treatment: A Multi-institutional Case-control Study. Eur Urol Focus 2018. [PMID: 29530632 DOI: 10.1016/j.euf.2018.02.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Most prostate cancer (PCa) patients with a biochemical failure following primary multimodality treatment (surgery and postoperative radiotherapy) relapse in the nodes. OBJECTIVE To perform a matched-case analysis in men with lymph node recurrent PCa comparing standard of care (SOC) with metastasis-directed therapy (MDT). DESIGN, SETTING, AND PARTICIPANTS PCa patients with a prostate-specific antigen (PSA) progression following multimodality treatment were included in this retrospective multi-institutional analysis. INTERVENTION The SOC cohort (n=1816) received immediate or delayed androgen deprivation therapy administered at PSA progression. The MDT cohort (n=263) received either salvage lymph node dissection (n=166) or stereotactic body radiotherapy (n=97) at PSA progression to a positron emission tomography-detected nodal recurrence. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint, cancer-specific survival (CSS), was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. RESULTS AND LIMITATIONS At a median follow-up of 70 (interquartile range: 48-98) mo, MDT was associated with an improved CSS on univariate (p=0.029) and multivariate analysis (hazard ratio: 0.33, 95% confidence interval [CI]: 0.17-0.64) adjusted for the year of radical prostatectomy (RP), age at RP, PSA at RP, time from RP to PSA progression, Gleason score, surgical margin status, pT- and pN-stage. In total, 659 men were matched (3:1 ratio). The 5-yr CSS was 98.6% (95% CI: 94.3-99.6) and 95.7% (95% CI: 93.2-97.3) for MDT and SOC, respectively (p=0.005, log-rank). The main limitations of our study are its retrospective design and lack of standardization of systemic treatment in the SOC cohort. CONCLUSIONS MDT for nodal oligorecurrent PCa improves CSS as compared with SOC. These retrospective data from a multi-institutional pooled analysis should be considered as hypothesis-generating and inform future randomized trials in this setting. PATIENT SUMMARY Prostate cancer patients experiencing a lymph node recurrence might benefit from local treatments directed at these lymph nodes.
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Affiliation(s)
- T Steuber
- Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - C Jilg
- Department of Urology, Albert Ludwig University Hospital, Freiburg, Germany
| | - P Tennstedt
- Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - A De Bruycker
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - D Tilki
- Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany; Department of Urology, University-Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - K Decaestecker
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - T Zilli
- Department of Radiotherapy, Geneva University Hospital, Geneva, Switzerland
| | | | - U Wetterauer
- Department of Urology, Albert Ludwig University Hospital, Freiburg, Germany
| | - A L Grosu
- Department of Radiation Oncology, Albert Ludwig University hospital, Freiburg, Germany
| | - W Schultze-Seemann
- Department of Urology, Albert Ludwig University Hospital, Freiburg, Germany
| | - H Heinzer
- Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - M Graefen
- Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - A Morlacco
- Department of Urology, Mayo-Clinic, Rochester, MN, USA
| | - R J Karnes
- Department of Urology, Mayo-Clinic, Rochester, MN, USA
| | - P Ost
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
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Carles J, Davis I, de Bono J, Fizazi K, Gerritsen W, Rathkopf D, Ryan C, Saad F, Steuber T, Wilding G, Park Y, Charnas R, De Porre P, Van Poppel H. Safety of long-term (LT) treatment (tmt) of chemotherapy (chemo)-naïve metastatic castration-resistant prostate cancer (mCRPC) patients (pts) with abiraterone acetate plus prednisone (AA + P) for ≥ 4 years (yrs). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.24] [Citation(s) in RCA: 1] [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: 11/14/2022] Open
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20
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Abstract
Prostate cancer (PCa) with distant metastasis at diagnosis (M1) is associated with an unfavourable prognosis. Therefore, according to current treatment guidelines, local treatment (radical prostatectomy or irradiation of the prostate gland) is not recommended in men with M1 disease. However, M1 patients inevitably develop castration-resistant disease progression leading to local complications in half of men. Hence, local treatment, if reconcilable with a good quality of life, would have the potential to prevent future local symptoms. Furthermore, evolving data from genomic studies suggest that local treatment might have the potential to reduce further spread of lethal cancer clones by eliminating the primary tumour or nodal metastasis. This leads to the experimental concept of cytoreductive preventative local treatment. According to large US-American and German cancer registries, there is a growing body of evidence pointing towards a survival benefit for M1 patients who receive local treatment in combination with systemic therapy. These data provide the basis to generate the hypothesis of a better response to systemic tumour therapy in metastatic prostate cancer, which would be the rationale for prospective randomised trials, but would not suffice for a treatment recommendation to be given. While there is a dynamic paradigm shift in the systemic treatment of hormone-naive M1 prostate cancer, local treatment for primary tumours will only have a chance to be established in this indication if prospective randomised trials are successfully completed.
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Affiliation(s)
- T. Steuber
- Martini-Klinik, Prostatakarzinomzentrum am Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - B. Beyer
- Martini-Klinik, Prostatakarzinomzentrum am Universitätsklinikum Hamburg-Eppendorf, Hamburg
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21
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Schiffmann J, Haese A, Leyh-Bannurah SR, Salomon G, Steuber T, Schlomm T, Boehm K, Beyer B, Larcher A, Michl U, Heinzer H, Huland H, Graefen M, Karakiewicz PI. Adherence of the indication to European Association of Urology guideline recommended pelvic lymph node dissection at a high-volume center: Differences between open and robot-assisted radical prostatectomy. Eur J Surg Oncol 2015; 41:1547-53. [PMID: 26117216 DOI: 10.1016/j.ejso.2015.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 12/07/2014] [Revised: 04/01/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Contemporary adherence of the indication to European Association of Urology (EAU) guideline recommendation for pelvic lymph node dissection (PLND) at either open (ORP) or robot-assisted radical prostatectomy (RARP) at a high-volume center is unknown. To assess guideline recommended and observed PLND rates in a high-volume center cohort. METHODS We relied on the Martini-Clinic database and focused on patients treated with either ORP or RARP, between 2010 and 2013. Actual performed PLND was compared to European Association of Urology (EAU) guideline recommendation defined by nomogram predicted risk of lymph node invasion >5%. Categorical and multivariable logistic regression analyses targeted two endpoints: 1) probability of guideline recommended PLND and 2) probability of no PLND, when not recommended by EAU guideline. RESULTS Within 7868 PCa patients, adherence to EAU PLND guideline recommendation was 97.1% at ORP and 96.8% at RARP (p = 0.7). When PLND was not recommended, it was more frequently performed at RARP (71.6%) than at ORP (66.2%) (p = 0.002). Gleason score, PSA and number of positive biopsy cores were independent predictors for both either PLND when recommended, or no PLND when not recommended (all p < 0.05). Clinical tumor stage, age and surgical approach were also independent predictors for no PLND when not recommended (all p < 0.05). CONCLUSIONS Adherence of the indication to EAU guideline recommended PLND is high at this high-volume center. Neither ORP nor RARP represent a barrier for PLND, when recommended. However, a high number of patients underwent PLND despite absence of guideline recommendation. Possible staging advantages and PLND related complications needs to be individually considered, especially, when LNI risk is low.
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Affiliation(s)
- J Schiffmann
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
| | - A Haese
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - G Salomon
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Steuber
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Schlomm
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Boehm
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - B Beyer
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Larcher
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - U Michl
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Heinzer
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Huland
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Graefen
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - P 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
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von Amsberg G, Stroelin P, Bokemeyer C, Steuber T. Aktuelle Therapiekonzepte bei kastrationsresistenten Prostatakarzinom. Dtsch Med Wochenschr 2014. [DOI: 10.1055/s-0034-1374729] [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: 10/24/2022]
Affiliation(s)
- G. von Amsberg
- Klinik für Onkologie, Hämatologie und Knochenmarkstransplantation mit Sektion Pneumologie, Onkologisches Zentrum, Universitätsklinikum Hamburg-Eppendorf
| | - P. Stroelin
- Martini-Klinik am UKE GmbH, Universitätsklinikum Hamburg-Eppendorf
| | - C. Bokemeyer
- Klinik für Onkologie, Hämatologie und Knochenmarkstransplantation mit Sektion Pneumologie, Onkologisches Zentrum, Universitätsklinikum Hamburg-Eppendorf
| | - T. Steuber
- Martini-Klinik am UKE GmbH, Universitätsklinikum Hamburg-Eppendorf
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von Amsberg G, Stroelin P, Bokemeyer C, Steuber T. Aktuelle Therapiekonzepte bei kastrationsresistenten Prostatakarzinom. Dtsch Med Wochenschr 2014; 139:2086-90. [DOI: 10.1055/s-0034-1387276] [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: 10/24/2022]
Affiliation(s)
- G. von Amsberg
- Klinik für Onkologie, Hämatologie und Knochenmarkstransplantation mit Sektion Pneumologie, Onkologisches Zentrum, Universitätsklinikum Hamburg-Eppendorf
| | - P. Stroelin
- Martini-Klinik am UKE GmbH, Universitätsklinikum Hamburg-Eppendorf
| | - C. Bokemeyer
- Klinik für Onkologie, Hämatologie und Knochenmarkstransplantation mit Sektion Pneumologie, Onkologisches Zentrum, Universitätsklinikum Hamburg-Eppendorf
| | - T. Steuber
- Martini-Klinik am UKE GmbH, Universitätsklinikum Hamburg-Eppendorf
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Regier M, Seiwerts C, Leyh-Bannurah S, Salomon G, Steuber T, Heinzer H, Haese A, Graefen M, Laqmani A, Adam G, Budäus L. Identifikation eines Schwellenwertes des Apparenten-Diffusionskoeffizienten (ADC) in der Diffusionsgewichteten MRT (DWI) zur Beurteilung pelviner Lymphknoten (LK) bei histologisch gesichertem Prostata. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346365] [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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Schmitges J, Trinh QD, Jonas L, Budäus L, Larbig R, Schlomm T, Karakiewicz P, Heinzer H, Huland H, Graefen M, Steuber T. Influence of low-molecular-weight heparin dosage on red blood cell transfusion, lymphocele rate and drainage duration after open radical prostatectomy. Eur J Surg Oncol 2012; 38:1082-8. [DOI: 10.1016/j.ejso.2012.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 07/08/2012] [Accepted: 08/02/2012] [Indexed: 11/28/2022] Open
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Budäus L, Isbarn H, Schriefer P, Chun F, Fisch M, Steuber T, Salomon G, Huland H, Heinzer H, Graefen M. MP-13.01 Radical Prostatectomy in Men with Continued Oral Aspirin Medication: Revisiting an Old Paradigm? Urology 2011. [DOI: 10.1016/j.urology.2011.07.300] [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: 10/15/2022]
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Isbarn H, Kellermann S, Salomon G, Steuber T, Huland H, Graefen M. [Type and extent of preoperative imaging before radical prostatectomy]. Urologe A 2010; 49:396-400. [PMID: 20238482 DOI: 10.1007/s00120-009-2207-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND According to current guidelines, in cases of newly diagnosed prostate cancer the type and extent of imaging to be performed should be based on the patient's risk profile. We investigated the rate of computed tomography (CT), magnetic resonance imaging (MRI), and bone scintigraphy carried out before radical prostatectomy (RP) depending on the individual risk profile. PATIENTS AND METHOD Between 1 January 2006 and 31 December 2007, a total of 1,018 consecutive patients who had not received neoadjuvant hormone therapy were treated with RP in our department. We determined the preoperative rates of CT, MRI, and bone scintigraphy by reviewing the medical charts. The patients were stratified according to the D'Amico criteria into low-risk, intermediate-risk, and high-risk groups. RESULTS Of the 1,018 subjects, 493 (48%) were classified as low-risk, 403 (40%) as intermediate-risk, and 122 (12%) as high-risk patients, respectively. The rate of preoperative abdominal CT/MRI and bone scintigraphy was 17 and 23% in the low-risk group, 25 and 39% in the intermediate-risk patients, and 39 and 57% in the high-risk group. CONCLUSION The rate of preoperative CT and bone scintigraphy is extremely high in the low-risk group. In contrast the rate in the high-risk patients more likely appears to be too low. The discrepancy between the rates of preoperative imaging subject to the patient's risk profile shows that precisely formulated guidelines addressing this issue are needed.
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Affiliation(s)
- H Isbarn
- Martini-Klinik, Universitäres Prostatakarzinomzentrum Hamburg-Eppendorf, Hamburg.
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Steuber T, Schlomm T, Heinzer H, Zacharias M, Ahyai S, Chun K, Haese A, Klutmann S, Köllermann J, Sauter G, Mester J, Mikecz P, Fisch M, Huland H, Graefen M, Salomon G. [F18]-fluoroethylcholine combined in-line PET-CT scan for detection of lymph-node metastasis in high risk prostate cancer patients prior to radical prostatectomy: Preliminary results from a prospective histology-based study. Eur J Cancer 2010; 46:449-55. [DOI: 10.1016/j.ejca.2009.11.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 09/21/2009] [Accepted: 11/12/2009] [Indexed: 10/20/2022]
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Friedrich MG, Toma MI, Chun JKHF, Steuber T, Budäus L, Isbarn H, Huland H. [DNA methylation on urinalysis and as a prognostic marker in urothelial cancer of the bladder]. Urologe A 2007; 46:761-8. [PMID: 17522834 DOI: 10.1007/s00120-007-1360-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION AND OBJECTIVES Detection of promoter hypermethylation has been proposed as a promising tool for cancer diagnosis and as a prognostic marker in various cancers. We studied the versatility of DNA methylation for noninvasive diagnosis and as a prognostic marker for non-muscle-invasive bladder carcinoma. METHODS Tumor specimens were microdissected and DNA was extracted from 105 paraffin-embedded paraffin specimens from patients undergoing transurethral resection for non-muscle-invasive bladder carcinoma. Urine specimens were collected from patients undergoing cystectomy for bladder cancer and from healthy volunteers. Methylation status was assessed with the real-time quantitative methylation-sensitive PCR (MethyLight). We checked a panel of 20 cancer-associated genes (p14ARF, p16 CDKN2A, STAT-1, SOCS-1, DR-3, DR-6, PIG-7, BCL-2, H-TERT, BAX, EDNRB, DAPK, RASSF-1A, FADD, TMS-1, E-CADHERIN, ICAM-1, TIMP-3, MLH-1, COX-2) for DNA methylation. RESULTS Follow-up data were available in 95 of 105 patients (91.4%). A tumor recurrence was observed in 26 patients (27.3%). We could identify six genes (SOCS-1, STAT-1, BCL-2, DAPK, TIMP-3, E-cadherin), where methylation was associated with tumor recurrence. In Kaplan-Meier analysis, TIMP-3 showed a significant association with recurrence-free survival. Methylation of TIMP-3 predicted prolonged disease-free interval. Regarding urinalysis we could identify a pattern of methylation markers including DAPK, BCL-2, and H-TERT that yielded a sensitivity of 81.1% with a specificity of 100% in a cancer-free control population CONCLUSIONS We present data on the clinical usefulness of methylation analysis in bladder carcinoma. Our data confirm that methylation analysis is a promising tool for bladder cancer diagnosis and prognosis.
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Affiliation(s)
- M G Friedrich
- Klinik und Poliklinik für Urologie, Universität Hamburg,Universitätsklinikum Hamburg Eppendorf, Hamburg.
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Ahyai S, Steuber T, Walz J, Chun K, Thorsten S, Haese A, Karakiewicz P, Huland H, Graefen M. PROSTATE CANCER DETECTION RATE IN PATIENTS WITH LOW SERUM PROSTATE SPECIFIC ANTIGEN AND NORMAL DIGITAL RECTAL EXAMINATION IN A EUROPEAN REFERRAL POPULATION. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s1569-9056(06)60863-4] [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: 11/28/2022]
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Steuber T, Karakiewicz PI, Augustin H, Erbersdobler A, Lange I, Haese A, Chun KHF, Walz J, Graefen M, Huland H. Transition zone cancers undermine the predictive accuracy of Partin table stage predictions. J Urol 2005; 173:737-41. [PMID: 15711259 DOI: 10.1097/01.ju.0000152591.33259.f9] [Citation(s) in RCA: 38] [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] [Indexed: 11/25/2022]
Abstract
PURPOSE The Partin tables represent the most widely used predictor of pathological stage in men with localized prostate cancer (PCa). The accuracy and performance of the tables have been tested across different populations. However, to our knowledge the potential limitations that may stem from differences between transition zone (TZ) and peripheral zone (PZ) prostate cancers has not been explored. We tested the predictive accuracy and performance of the Partin tables according to TZ vs PZ tumor predominance. MATERIALS AND METHODS Preoperative serum prostate specific antigen, clinical stage and biopsy Gleason sum data on 1,990 patients treated with radical retropubic prostatectomy were used to define the 2001 Partin probabilities of organ confinement and seminal vesicle invasion (SVI). Data on 1,320 patients who underwent staging pelvic lymphadenectomy and radical retropubic prostatectomy were used to define the probabilities of lymph node invasion (LNI) and organ confined disease (OC). ROC area under the curve was used to assess the predictive accuracy of the 2001 Partin tables relative to observed extracapsular extension (ECE), SVI, LNI and OC. Performance characteristics for each prediction were explored graphically with local regression, nonparametric smoothing plots. Results were compared between 222 TZ cancers and 1,768 PZ cancers. RESULTS The 1,990 radical retropubic prostatectomy specimens demonstrated ECE in 689 cases (34.6%) (TZ in 58 or 27.1% and PZ in 631 or 35.8%) and SVI in 224 (TZ in 13 or 6.1% and PZ in 211 or 11.9%). The 1,320 lymphadenectomy specimens demonstrated LNI in 56 cases (TZ in 2 or 0.9% and PZ in 54 or 4.6%). OC was found in 784 cases (59.4%) (TZ in 95 or 69.9% and PZ in 689 or 58.2%). Predictive accuracy was for ECE 76.4% (TZ 69.0% and PZ 77.2%), 78.0% for SVI (TZ 73.5% and PZ 78.3%), 78.6% for LNI (TZ 44.5% and PZ 79.9%) and 79.4% for OC (TZ 73.8% and PZ 80.0%). CONCLUSIONS The biological tumor characteristics of TZ PCa differ from those of PZ PCa. These differences appear to undermine the accuracy of pathological stage predictions.
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Affiliation(s)
- T Steuber
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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Steuber T, Graefen M, Perrotte P, Chun K, Haese A, Karakiewicz P, Huland H. 258Prediction of side specific extracapsular extension at radical prostatectomy in European patients: Accuracy of a novel, internally validated logistic regression-based nomogram vs. tree structured regression analysis. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s1569-9056(05)80266-0] [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: 10/25/2022]
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Haese A, Noldus J, Steuber T, Huland H, Lilja H. Isoformen des freien prostataspezifischen Antigens. Urologe A 2004; 43:675-9. [PMID: 15221148 DOI: 10.1007/s00120-004-0584-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Detection of prostate-specific antigen remains the mainstay in the early detection of prostate cancer. A problem yet unsolved is the lack of specificity of this organ- but not cancer-specific marker, which generates subsequent, invasive procedures in a high number of patients without detecting prostate cancer. While the separate detection of free PSA and the ratio of free to total PSA has significantly improved specificity while maintaining high sensitivity, the number of patients undergoing unnecessary further diagnostics is still of concern. In this context, the evolving knowledge on isoforms of free PSA is a major focus of current research. Isoforms of free PSA are variants of free PSA that circulate, e.g., as precursor forms, internally cleaved variants of intact molecules, and are suggested to be either more associated with cancer or more with benign diseases. This article describes biochemical and clinical properties of the isoforms of free PSA.
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Affiliation(s)
- A Haese
- Urologischen Klinik und Poliklinik, Universitätskrankenhaus Eppendorf, Hamburg.
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Haese A, Graefen M, Steuber T, Becker C, Pettersson K, Piironen T, Noldus J, Huland H, Lilja H. Human glandular kallikrein 2 levels in serum for discrimination of pathologically organ-confined from locally-advanced prostate cancer in total PSA-levels below 10 ng/ml. Prostate 2001; 49:101-9. [PMID: 11582588 DOI: 10.1002/pros.1123] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND We measured serum levels of human glandular kallikrein 2 (hK2) in patients treated with radical retropubic prostatectomy (rrP) for clinically localized prostate cancer (PCa) with a total PSA (tPSA)-level below 10 ng/ml to investigate whether hK2 can be applied to preoperatively distinguish organ-confined (pT2a/b) from nonorgan-confined (> or = pT3a)-PCa more accurately than total PSA. Further, we evaluated hK2, free- and tPSA-concentrations in all pathologic stages of PCa. METHODS 161 serum samples from men scheduled for rrP were collected 1 day before surgery prior to any prostatic manipulation. Pathologic work-up revealed > or = pT3a-PCa in 48 and pT2a/b-PCa in 113 patients. HK2-levels in serum were measured using an immunofluorometric assay with an analytical sensitivity of 0.5 pg/ml, a functional sensitivity of 5 pg/ml and insignificant cross-reactivity with PSA (< 0.005%). Total (tPSA) and free PSA (fPSA) levels were measured using a commercially available assay from which we calculated %fPSA and an algorithm that combined hK2 and PSA-levels [hK2] x [tPSA/fPSA]. Means, medians, and ranges were calculated for pT2a/b vs. >/= pT3a-PCa and for all pathologic stages. Statistical significance of differences was calculated using Mann-Whitney-U and Kruskal-Wallis tests. Calculation of receiver-operator-characteristic (ROC) curves were performed for hK2, [hK2] x [tPSA/fPSA] and tPSA to compare diagnostic performance. RESULTS A mean tPSA level in serum of 6.12 ng/ml in > or = pT3a-PCa was not significantly different (P = 0.366) from 5.78 ng/ml in pT2a/b-PCa. Also, there were no statistically significantly different levels of fPSA (P = 0.947) or %fPSA (0.292) for these two groups. By contrast, mean hK2-level in pT2a/b-PCa of 80 pg/ml was significantly different (P = 0.004) from a mean hK2 level of 120 pg/ml in > or = pT3a-PCa as shown by Mann-Whitney-analysis Moreover, the algorithm of [hK2] x [tPSA/fPSA] was significantly lower (P = 0.0004) in pT2a/b-PCa vs. > or = pT3a-PCa. Calculation of areas under curve (AUC) by receiver-operator-characteristics (ROC) demonstrated that the AUC for hK2 (0.64) was larger and the AUC for [hK2] x [tPSA/fPSA] (=0.68) significantly larger (P = 0.007) compared to the AUC of tPSA (0.55). Furthermore, Kruskal-Wallis Test revealed a highly significant correlation to pathologic stage using hK2 (P = 0.008) and [hK2] x [tPSA/fPSA] (P = 0.0015) compared to no significant differences in serum concentration of tPSA (P = 0.296). Also at tPSA-levels from 10-20 ng/ml, the hK2-levels in pT2a/b-PCa were close to significantly different (P = 0.051) from those in men with >/= pT3a-PCa, while the algorithm of [hK2] x [tPSA/fPSA] in that tPSA-range was significantly lower (P = 0.002) in pT2a/b-PCa compared to > or = pT3a0-PCa. CONCLUSIONS Highly significant differences in serum concentration enable hK2 to be a powerful predictor of organ-confined disease and pathologic stage of clinically localized prostate cancer, especially in the PSA-range below 10 ng/ml. As such, there are important clinical consequences for the application of hK2 for the adequate treatment of prostate cancer patients, i.e., the option of nerve-sparing surgery. (c) 2001 Wiley-Liss, Inc.
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Affiliation(s)
- A Haese
- Department of Urology, University Clinic Eppendorf, Hamburg, Germany.
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Abstract
Chemoprevention of prostate cancer is the administration of agents to prevent, inhibit, or delay progression of prostate cancer. Asian men have a much lower incidence of prostate cancer than men in Europe or the USA. Asian food includes low-fat, high-fiber diets, which provide a rich supply of weak dietary estrogens. These estrogens have been proposed as chemopreventive agents. In addition to their estrogenic activity, many of these plant compounds can interfere with steroid metabolism and bioavailability and can also inhibit enzymes, such as tyrosine kinase or topoisomerase, which are important for cellular proliferation. In addition, nutritional factors such as reduced fat intake, vitamin E, vitamin D, and selenium may have a protective effect against prostate cancer. The fact was proven in large epidemiological studies as well as experimental observations. In the animal model, the progression of established tumors can be inhibited by these agents. A number of studies to investigate the effect of possible chemopreventive agents for men at high risk of prostate cancer are established. End points for evaluation are mainly based on changes in PSA, changes of histological precursors, or time of onset of clinical disease. The concept of chemoprevention in prostate cancer might have a significant impact on the incidence and mortality of this disease.
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Affiliation(s)
- P Hammerer
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg Eppendorf
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Steuber C, Panzner B, Steuber T, Krause A, Teichmann W, Mende T. [Open foramen ovale in patients with arterial vascular occlusions of the retina and optic nerve]. Ophthalmologe 1997; 94:871-6. [PMID: 9487756 DOI: 10.1007/s003470050214] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND We examined the frequency and significance of persistent foramen ovale (PFO) in patients with ocular circulatory disturbance. PATIENTS AND METHODS Forty patients with acute arterial occlusions of the posterior bulb segment were investigated by means of transthoracic and transesophageal echocardiography (TEE). The parallel presence of cerebral ischemia was clarified on the basis of existing CCT findings and by additional HMPAO-SPECT investigation. RESULTS PFO was identified in nine of the patients investigated. The probability of paradoxical embolism arises from further findings: eight of those with PFO (89%) showed echocardiographic signs of right heart strain, indicating previous pulmonary embolism, compared with only three of those without PFO (10%). Five of those with PFO showed a potential source of embolism, two of them with phlebothromboses in their clinical history and three with additional atrial septal aneurysm. Cardiovascular risk factors were prevalent in the group without PFO. Both groups had a mean age of approximately 60 years. Signs of cerebral ischemia were present in the SPECT or CT findings for four of the patients with PFO and nine of those without. CONCLUSIONS From our findings, it appears highly probable that ocular arterial occlusion is caused by paradoxical embolism. PFO should be taken into account in establishing a diagnosis, including diagnosis in elderly patients.
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Affiliation(s)
- C Steuber
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg
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