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Hajdinjak T, Pelzer AE. Re: What Are We Missing? False-negative Cancers at Multiparametric MR Imaging of the Prostate. Eur Urol 2017; 73:637. [PMID: 29273407 DOI: 10.1016/j.eururo.2017.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/05/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Tine Hajdinjak
- Department of Urology, Klinikum Wels-Grieskirchen, Wels, Austria
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Schneidewind L, Kranz J, Schlager D, Pelzer AE. [Nationwide survey among institutes of microbiology in academic medicine : Is the interdisciplinary approach the right way to treat patients with urogenital infections?]. Urologe A 2017; 56:779-784. [PMID: 28144694 DOI: 10.1007/s00120-017-0328-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasing antibiotic resistance is a current and severe problem in medicine, especially in urology. Multidisciplinary antibiotic stewardship programmes are an important approach to counteract increasing resistance rates. This approach includes collaboration between urologists and microbiologists. OBJECTIVES The primary endpoint was to describe the current setting of interdisciplinary work of urologists and microbiologists in university hospitals in Germany. The secondary endpoints were the identification of problems of this interdisciplinary approach in daily routine and implications for the future in patient treatment. MATERIALS AND METHODS A newly developed, 24-item questionnaire was sent to 34 German microbiology departments at medical universities between June and October 2016; the departments were contacted up to four times. Only complete questionnaires were included in our analysis. RESULTS The response rate was 50.0%. In the majority of the urological cases a microbiologist was only contacted sporadically and asked for advice, but on the other hand most of the microbiologists think that this contact and discussion about the patient is reasonable and preferable. Of the respondents, 82.4% think that with a consequent interdisciplinary approach there might be lower antibiotic resistance rates in the future. One essential problem of ideal microbial diagnostics and therapeutic advice is that the microbiologist does not receive all relevant information upon request. This might be the case in up to 76.5%. Other problems are of economic nature or shortage of manpower. CONCLUSION Interdisciplinary patient care between urologists and microbiologists is reasonable and preferable. This approach has the potential of decreasing antibiotic resistance rates in the future.
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Affiliation(s)
- L Schneidewind
- Institut für Virologie, Universitätsklinikum des Saarlandes Universität des Saarlandes, Kirrberger Straße 100, 66424, Homburg/Saar, Deutschland.
| | - J Kranz
- St.-Antonius-Hospital Eschweiler, Klinik für Urologie und Kinderurologie, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | - D Schlager
- Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg (Brsg.), Deutschland
| | - A E Pelzer
- Klinik für Urologie, Hospital Wels-Grieskirchen, Wels, Österreich
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Huppertz N, Kranz J, Mühlstädt S, Schneidewind L, Barski D, Grabbert M, Queissert F, Pelzer AE. [GeSRU Academics research group "BPS & functional urology"]. Urologe A 2016; 55:818-20. [PMID: 27246470 DOI: 10.1007/s00120-016-0127-0] [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: 10/21/2022]
Affiliation(s)
- N Huppertz
- Neuro-Urologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - J Kranz
- Klinik für Urologie und Kinderurologie, St.-Antonius Hospital, Eschweiler, Deutschland
| | - S Mühlstädt
- Klinik für Urologie, Universitätsklinikum Halle, Halle, Deutschland
| | - L Schneidewind
- Institut für Virologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - D Barski
- Urologische Klinik, Lukaskrankenhaus Neuss, Neuss, Deutschland
| | - M Grabbert
- Urologische Klinik und Poliklinik, Klinikum der Universität München, München, Deutschland
| | - F Queissert
- Klinik für Urologie, Universitätsklinik Münster, Münster, Deutschland
| | - A E Pelzer
- Urologische Klinik, Klinikum Ingolstadt, Krumenauerstraße 25, 85049, Ingolstadt, Deutschland.
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Ritter M, Krombach P, Martinschek A, Siegel FP, Schmitt M, Weiss C, Häcker A, Pelzer AE. Radiation Exposure During Endourologic Procedures Using Over-the-Table Fluoroscopy Sources. J Endourol 2012; 26:47-51. [DOI: 10.1089/end.2011.0333] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Manuel Ritter
- Department of Urology, University Medical Center Mannheim, Mannheim, Germany
| | - Patrick Krombach
- Department of Urology, University Medical Center Mannheim, Mannheim, Germany
| | - Andreas Martinschek
- Department of Urology, University Medical Center Mannheim, Mannheim, Germany
| | - Fabian P. Siegel
- Department of Urology, University Medical Center Mannheim, Mannheim, Germany
| | - Martin Schmitt
- Department of Urology, University Medical Center Mannheim, Mannheim, Germany
| | - Christel Weiss
- Department of Biomathematics and Medical Statistics, Medical Faculty of Heidelberg University, Mannheim, Germany
| | - Axel Häcker
- Department of Urology, University Medical Center Mannheim, Mannheim, Germany
| | - Alexandre E. Pelzer
- Department of Urology, University Medical Center Mannheim, Mannheim, Germany
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Bedke J, Pelzer AE. Words of wisdom. Re: efficacy of sunitinib and sorafenib in metastatic papillary and chromophobe renal cell carcinoma. Eur Urol 2008; 54:1200-1. [PMID: 19051381 DOI: 10.1016/j.eururo.2008.07.065] [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: 11/26/2022]
Affiliation(s)
- Jens Bedke
- Department of Urology, Eberhard-Karls-University Tübingen, Germany
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Pelzer AE. Re: Under Diagnosis and Over Diagnosis of Prostate Cancer. Eur Urol 2008; 54:234-5. [DOI: 10.1016/j.eururo.2008.03.064] [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: 10/22/2022]
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Schwentner C, Oswald J, Lunacek A, Pelzer AE, Fritsch H, Schlenck B, Karatzas A, Bartsch G, Radmayr C. Extracellular microenvironment and cytokine profile of the ureterovesical junction in children with vesicoureteral reflux. J Urol 2008; 180:694-700. [PMID: 18554644 DOI: 10.1016/j.juro.2008.04.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Indexed: 11/16/2022]
Abstract
PURPOSE Vesicoureteral reflux is caused by a defective valve mechanism of the ureterovesical junction. Previous studies have revealed structural and metabolic changes in the intravesical ureter, impairing its contractile properties. Smooth musculature and nerves are replaced by collagen, while matrix degrading enzymes are over expressed. We investigated the presence of regulating cytokines and the extracellular matrix composition to elucidate further the pathophysiology of vesicoureteral reflux. MATERIALS AND METHODS Ureteral endings were obtained from 28 children during antireflux surgery, and 14 age matched autopsy specimens served as controls. Routine histological sections were immunostained for insulin-like growth factor-1, nerve growth factor, transforming growth factor-beta1, tumor necrosis factor-alpha and vascular endothelial growth factor. Smooth muscle staining was supplemented by tenascin C, tetranectin and fibronectin detection. Staining patterns were investigated using computer assisted, high power field magnification analyses. RESULTS Tumor necrosis factor-alpha and transforming growth factor-beta1 were significantly more abundant in vesicoureteral reflux samples, whereas insulin-like growth factor-1, nerve growth factor and vascular endothelial growth factor were more prevalent in healthy controls. Fibronectin was intensely expressed in refluxing ureters, while it was scarce in healthy children. Tenascin C was notable within the urothelium of both groups. Only vesicoureteral reflux samples displayed tenascin C in the musculature and connective tissue. Tetranectin staining was only detected in vesicoureteral reflux. CONCLUSIONS Several cytokines are differentially expressed in primary refluxing ureters, indicating an ongoing tissue remodeling process in the ureterovesical junction region. Additionally, the smooth muscle coat is widely lacking, while extracellular matrix proteins typical for tissue shrinkage and reorganization are over expressed. These alterations are likely to contribute to the malfunctioning active ureteral valve mechanism in primary vesicoureteral reflux.
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Affiliation(s)
- C Schwentner
- Department of Pediatric Urology, Medical University Innsbruck, Innsbruck, Austria.
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Horninger W, Pelzer AE, Bektic J, Colleselli D, Schafer G, Bartsch G. TRANSURETHRAL RESECTION OF THE PROSTATE WITH THE “COAGULATING INTERMITTENT CUTTING DEVICE”(CIC): IMPACT ON HEMOSTATIC COMPLICATIONS – AN UPDATE ON A 7 YEAR EXPERIENCE. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61967-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mitterberger M, Colleselli D, Pelzer AE, Horninger W, Bartsch G, Pallwein L, Frauscher F. CONTRAST ENHANCED COLOR DOPPLER TARGETED BIOPSY: VALUE OF BLOOD FLOW RATING SCALE FOR PROSTATE CANCER DETECTION. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61981-3] [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: 10/22/2022]
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Bektic J, Pelzer AE, Colleselli D, Schafer G, Bartsch G, Horninger W. PREDICTIVE VALUE OF PROSTATE SPECIFIC ANTIGEN VELOCITY IN THE DIAGNOSIS OF PROSTATE CANCER: RESULTS OF THE TYROL SCREENING PROJECT. J Urol 2008. [DOI: 10.1016/s0022-5347(08)62111-4] [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: 10/22/2022]
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Horninger W, Tewari AK, Pelzer AE, Klocker H, Bartsch G. CLINICAL AND PATHOLOGICAL CHARACTERISTICS OF PROSTATE CANCER IN MEN YOUNGER THAN 45 YEARS: RESULTS FROM THE TYROL PSA SCREENING PROJECT. J Urol 2008. [DOI: 10.1016/s0022-5347(08)60442-5] [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: 11/29/2022]
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Schwentner C, Pelzer AE, Oswald J, Bartsch G, Radmayr C. THE SINGLE STAGE DORSAL INLAY SKIN GRAFT FOR HYPOSPADIAS REOPERATIONS: LONG-TERM FOLLOW-UP. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61198-2] [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: 11/29/2022]
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Colleselli D, Pelzer AE, Steiner E, Schafer G, Bektic J, Horninger W, Tewari AK, Bartsch G. OUTCOME OF RADICAL PROSTATECTOMY IN LOW, INTERMEDIATE AND HIGH RISK PROSTATE CANCER PATIENTS: A COMPARISON BETWEEN A SCREEN AND NON SCREEN POPULATION. J Urol 2008. [DOI: 10.1016/s0022-5347(08)62009-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pelzer AE, Colleselli D, Bektic J, Steiner E, Ramoner R, Mitterberger M, Schwentner C, Schaefer G, Ongarello S, Bartsch G, Horninger W. Pathological features of Gleason score 6 prostate cancers in the low and intermediate range of prostate-specific antigen level: is there a difference? BJU Int 2008; 101:822-5. [DOI: 10.1111/j.1464-410x.2008.07454.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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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Bektic J, Pelzer AE, Colleselli D, Schafer G, Bartsch G, Horninger W. DISCREPANCIES IN GLEASON SCORING OF PROSTATE BIOPSIES AND RADICAL PROSTATECTOMY SPECIMENS AND THE PROGNOSTIC VALUE OF PSAV ON SCORING ACCURACY. TEN YEAR EXPERIENCE IN A SINGLE CENTRE. J Urol 2008. [DOI: 10.1016/s0022-5347(08)60155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pallwein L, Mitterberger M, Gradl J, Aigner F, Colleselli D, Pelzer AE, Horninger W, Bartsch G, Frauscher F. MICROVASCULAR IMAGING (MVI) OF THE PROSTATE DURING CONTRAST-ENHANCED ULTRASOUND: INITIAL EXPERIENCE. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61979-5] [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: 11/16/2022]
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Schwentner C, Pelzer AE, Oswald J, Baka-Ostrovska M, Czyz J, Bartsch G, Radmayr C. LONG-TERM CLINICAL AND SURGICAL OUTCOME OF SEVERELY UNDERVIRILIZED MALES — IMPLICATIONS FOR INITIAL MANAGEMENT. J Urol 2008. [DOI: 10.1016/s0022-5347(08)60274-8] [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: 10/22/2022]
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Fuchsberger C, Kofler K, Hammerer M, Wieder W, Ongarello S, Feuerstein I, Bonn GK, Bartsch G, Pelzer AE, Klocker H. IMAGING OF PROSTATE TISSUE SECTIONS BY MALDI PROTEIN MASS SPECTROMETRY – TISVIS, A TOOL FOR THE VISUAL DATA PROCESSING. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61140-4] [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: 10/22/2022]
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Mitterberger M, Colleselli D, Pelzer AE, Horninger W, Bartsch G, Strasser H, Pallwein L, Gradl J, Frauscher F. EVALUATION OF INVESTIGATOR DEPENDENCY IN TRANSRECTAL CONTRAST ENHANCED COLOR DOPPLER TARGETED BIOPSY. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61982-5] [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: 11/29/2022]
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Schafer G, Horninger W, Pelzer AE, Brunner A, Mikuz G, Bektic J, Bartsch G. ONE CORE GLEASON SCORE 6 PROSTATE CANCER: CLINICALLY INSIGNIFICANT PROSTATE CANCER? J Urol 2008. [DOI: 10.1016/s0022-5347(08)62095-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pelzer AE, Colleselli D, Bektic J, Schaefer G, Ongarello S, Schwentner C, Pallwein L, Mitterberger M, Steiner E, Bartsch G, Horninger W. Clinical and pathological features of screen vs non-screen-detected prostate cancers: is there a difference? BJU Int 2008; 102:24-7. [PMID: 18341623 DOI: 10.1111/j.1464-410x.2008.07566.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the clinical and pathological characteristics of screen vs non-screen-detected prostate cancers, to determine if there is a difference in the same prostate-specific antigen (PSA) range. PATIENTS AND METHODS In all, 997 patients who had had a radical prostatectomy were evaluated; 806 were Tyrolean screening volunteers, and 191 were from outside Tyrol, representing the 'referred prostate cancer' group. PSA level, age, prostate volume and pathological characteristics were assessed, as was the amount of over- and under-diagnosis. RESULTS There were no statistically significant differences in patient age or PSA levels in the two groups. Even in the same PSA range there were statistically significantly more extraprostatic cancers in the referral group, at 31.7% and 17.4%, respectively. In the referred and screening groups there was over-diagnosis in 7.9% and 16.8%, and under-diagnosis in 40.8% and 27.8%, respectively. CONCLUSION This study suggests that screening volunteers have a statistically significantly higher rate of organ-confined prostate cancers, and a statistically significantly lower rate of extracapsular extension and positive surgical margins than their counterparts in the referral group even in the same PSA range. As the pathological stage and surgical margin status are significant predictors of recurrence, these findings support the concept of PSA screening.
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Schwentner C, Oswald J, Lunacek A, Schlenck B, Pelzer AE, Schwentner I, Hofer S, Bartsch G, Radmayr C. Health-related quality of life in children with vesicoureteral reflux - impact of successful endoscopic therapy. J Pediatr Urol 2008; 4:20-6. [PMID: 18631887 DOI: 10.1016/j.jpurol.2007.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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] [Received: 05/22/2007] [Accepted: 08/03/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Endoscopic therapy for vesicoureteral reflux (VUR) using dextranomer/hyaluronic acid (Dx/HA) has become increasingly popular, but the subjective impact of this therapy and subsequent reflux resolution on health-related quality of life (HRQoL) remains unclear. The aim of this study was to address this issue. MATERIALS AND METHODS One hundred children (65 girls, 35 boys; mean age 4.46 years) cured of primary VUR by endoscopic treatment were retrospectively reviewed. The Glasgow children's benefit inventory (GCBI) - a validated, reproducible, post-interventional questionnaire consisting of four subscales - supplemented by sociodemographic and disease-specific questions was employed. The HRQoL benefit was calculated on a scale ranging from -100 (complete failure) to +100 (complete success) and correlated with supplementary data. RESULTS Total response rate was 88%. Mean total GCBI score was 28.4+/-20.3 representing a significant HRQoL amelioration. All GCBI subscores improved with the physical health subscale being most relevant. A gender-specific, significant difference in relative GCBI scores was discovered. Correlation with critical life events and time since operation proved the positive effect on HRQoL to be durable. CONCLUSIONS Resolution of primary VUR secondary to Dx/HA treatment significantly improves HRQoL. HRQoL is positively affected in many areas and not only in those directly associated with VUR. These improvements are not temporary, suggesting that successful Dx/HA therapy may be superior to medical management in terms of children's quality of life.
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Affiliation(s)
- C Schwentner
- Department of Paediatric Urology, Medical University, Anichstr. 35, 6020 Innsbruck, Austria
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Pelzer AE, Colleselli D, Bektic J, Schaefer G, Ongarello S, Schwentner C, Aigner F, Mitterberger M, Steiner E, Bartsch G, Horninger W. Over-diagnosis and under-diagnosis of screen- vs non-screen-detected prostate cancers with in men with prostate-specific antigen levels of 2.0-10.0 ng/mL. BJU Int 2008; 101:1223-6. [PMID: 18190631 DOI: 10.1111/j.1464-410x.2007.07367.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate possible over- and under-diagnosis of prostate cancer in a screened vs a referral population in the same range of prostate-specific antigen (PSA). PATIENTS AND METHODS In all, 1445 patients undergoing radical prostatectomy and with a PSA level of <10 ng/mL were evaluated; 237 were from outside Tyrol (Austria) and represented the unscreened group, and 1208 were Tyrolean screening volunteers. Over-diagnosis was defined as a pathological stage of pT2a and a Gleason score of <7 with no positive surgical margins. Under-diagnosis was defined as a pathological stage of >or=pT3a or positive surgical margins. The chi-square test was used to assess the differences, with P < 0.05 considered to indicate statistical significance. RESULTS There were no significant differences in patient age or PSA levels between the study groups. There was over-diagnosis in the screening and referral groups in 17.4% and 8.9%, respectively, and under-diagnosis in 18.6% and 42.2%, respectively. CONCLUSION This study suggests that patients with prostate cancer participating in a screening programme are less likely to be under-diagnosed or have extracapsular disease than their counterparts in a referral population, even in the same PSA range, after radical prostatectomy. Furthermore, there was more under-diagnosis in the referral group than over-diagnosis in the screened group.
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Colleselli D, Bektic J, Schaefer G, Frauscher F, Mitterberger M, Brunner A, Schwentner C, Bartsch G, Horninger W, Pelzer AE. The influence of prostate volume on prostate cancer detection using a combined approach of contrast-enhanced ultrasonography-targeted and systematic grey-scale biopsy. BJU Int 2007; 100:1264-7. [PMID: 17850369 DOI: 10.1111/j.1464-410x.2007.07174.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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: 11/28/2022]
Abstract
OBJECTIVE To evaluate the influence of prostate volume (PV) on the detection of prostate cancer using a combined approach of contrast-enhanced ultrasonography (CEUS) and grey-scale US-guided systematic biopsy (SB). PATIENTS AND METHODS We evaluated 345 patients with prostate cancer and a total prostate-specific antigen (PSA) level of >/= 1.32 ng/mL (1.32-35.3, mean 6.6). Biopsies were taken by two independent examiners; one took five CEUS (Doppler) targeted biopsies of hypervascular regions in the peripheral zone, and subsequently the other took 10 systematic prostate biopsies. We assessed the cancer detection rates for the five different subgroups of prostate volumes, i.e. <20, 20-30, 30-40, 40-50 and > 50 mL. RESULTS Each technique, SB and CEUS, detected 73.4% and 77.1% of all detected cancers, respectively, but there were statistically significant differences in detection rate only in small glands. Only 69.0% and 70.4% of all cancers were detected by SB in glands of <20 and 20-30 mL, respectively, whereas 88.1% and 80.8% were detected by CEUS. CONCLUSION The prostate cancer detection rate for CEUS was significantly higher in prostates of <30 mL (48.1% of the study population) than for SB. Therefore the combined approach of CEUS and SB allows improved cancer detection in patients with small glands and low total PSA values.
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Akkad T, Pelzer AE, Mitterberger M, Rehder P, Leonhartsberger N, Bartsch G, Strasser H. Influence of intravesical potassium on pelvic floor activity in women with recurrent urinary tract infections: comparative urodynamics might lead to enhanced detection of dysfunctional voiding. BJU Int 2007; 100:1071-4. [PMID: 17784889 DOI: 10.1111/j.1464-410x.2007.07120.x] [Citation(s) in RCA: 5] [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: 12/01/2022]
Abstract
OBJECTIVES To investigate the influence of intravesical potassium on pelvic floor activity (PFA) during voiding in women with recurrent urinary tract infections (rUTIs) by using comparative urodynamics (CUD). PATIENTS AND METHODS CUD was conducted in 49 women (mean age 34.6 years, range 15-82) with rUTI. Every patient had two sessions of pressure-flow studies with simultaneous measurement of PFA by perineal surface electromyography (EMG); the first was with 0.9% saline and in the second the bladder was filled with 0.2 m KCl solution. All patients had voiding cysto-urethrography, and dysfunctional voiding (DV) was diagnosed when significant PFA was measured by EMG during voiding. RESULTS Overall, DV was diagnosed in 37 patients (76%) using CUD; 16 (32%) had DV with saline on the pelvic floor EMG. In all these patients there were significantly greater EMG signals in the presence of KCL. In 21 patients (43%) DV was only detected using KCL; this improvement in the detection rate of DV was statistically significant (P = 0.006). Filling with KCl also prompted a statistically significant difference (P < 0.05) in maximum bladder capacity, maximum and average flow rates and in postvoid residual urine volume. CONCLUSION The present data show that DV is present in most women with rUTI but cannot sufficiently be diagnosed by conventional urodynamics with standard 0.9% saline. The present study suggests that CUD might enhance the detection rates of DV.
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Affiliation(s)
- Thomas Akkad
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
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Pelzer AE, Bektic J, Akkad T, Ongarello S, Schaefer G, Schwentner C, Frauscher F, Bartsch G, Horninger W. Under diagnosis and over diagnosis of prostate cancer in a screening population with serum PSA 2 to 10 ng/ml. J Urol 2007; 178:93-7; discussion 97. [PMID: 17499288 DOI: 10.1016/j.juro.2007.03.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE Since the implementation of widespread serum total prostate specific antigen based screening, the risk of prostate cancer over diagnosis has become a concern. We evaluated the amount of possible over and under diagnosis of prostate cancer in an asymptomatic screening population with a total prostate specific antigen of 2.0 to 3.9 (lower range) and 4.0 to 10.0 ng/ml (higher range). MATERIALS AND METHODS A total of 680 patients with prostate cancer were included. Possible over diagnosis was defined as Gleason score less than 7, pathological stage pT2a and negative surgical margins. Under diagnosis was defined as pathological stage pT3 or greater, or positive surgical margins. Furthermore, insignificant tumors according to the Epstein criteria were evaluated in a small subset of patients for whom cancer volume information was available. RESULTS In the lower and higher total prostate specific antigen ranges there was an over diagnosis rate of 19.7% and 16.5%, and an under diagnosis rate of 18.9%* and 36.7%, respectively (p<0.05). In the prostate specific antigen range of 2.0 to 10.0 ng/ml combined the rates of over and under diagnosis were 17.6% and 30.3%, respectively. In addition, 8.7% of tumors with total prostate specific antigen 2.0 to 10.0 ng/ml met the Epstein criteria for insignificance. CONCLUSIONS These data show that the reported estimates of over diagnosis in the low total prostate specific antigen group are exaggerated in a screening population. Using our criteria prostate cancer under diagnosis occurs more frequently than over diagnosis in the total prostate specific antigen range of 4.0 to 10 ng/ml.
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Affiliation(s)
- Alexandre E Pelzer
- Department of Urology, Medical University Innsbruck and Institute of Analytical Chemistry and Radiochemistry, Innsbruck, Austria.
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Rehder P, Pinggera GM, Mitterberger M, Pelzer AE, Gozzi C, Herwig R. Urethral support with PelviSoft™ after artificial urinary sphincter erosion at revision procedures. Wien Med Wochenschr 2007; 157:170-2. [PMID: 17492414 DOI: 10.1007/s10354-007-0406-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Accepted: 03/09/2007] [Indexed: 10/23/2022]
Abstract
An artificial urinary sphincter cuff (AMS 800) is regarded the gold standard for surgically treating urinary incontinence without residual sphincter function. After erosion of an AMS 800 into the urethral lumen the whole system has to be explanted. When the urethral wall is supported and covered after healing with a porcine dermal acellular collagen matrix BioMesh (PelviSoft), a new artificial urinary sphincter may be implanted. The follow-up of up to two years seems promising in preventing erosion of the new cuff through the strengthened urethra wall, without compromising the functionality of the artificial urinary sphincter.
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Affiliation(s)
- Peter Rehder
- Neurology Unit, Medical University of Innsbruck, Innsbruck, Austria,
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Pelzer AE, Bektic J, Akkad T, Schaefer G, Steiner E, Schwentner C, Bartsch G, Horninger W. 1761: Underdiagnosis and Overdiagnosis of Prostate Cancer in a Screening Population with PSA-Values of 2 - 10ng/ml. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31949-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bektic J, Pelzer AE, Schaefer G, Bartsch G, Horninger W, Leonhartsberger N. 1749: Correlation between Initial total PSA and PSA Velocity in men with and without Biopsy-Proven Prostate Cancer. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31937-2] [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: 11/25/2022]
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Bartsch G, Horninger W, Klocker H, Pelzer AE, Oberaigner W, Schaefer G, Brunner A, Frauscher F, Robertson C, Boyle P. 1756: The Tyrol Prostate Cancer Demonstration Project (1988-2006): Early Detection, Treatment, Outcome, Incidence and Mortality. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31944-x] [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: 11/16/2022]
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Pelzer AE, Bektic J, Harninger W, Schaefer G, Schwentner C, Bartsch G, Frauscher F. 1685: The Impact of Prostate Volume for Prostate Cancer Detection Using a Combined Approach of Contrast Enhanced Ultrasonography Targeted and Systematic Grey Scale Biopsy. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31873-1] [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: 11/24/2022]
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Schwentner C, Oswald J, Lunacek A, Pelzer AE, Schlenck B, Schwentner I, Hofer S, Bartsch G, Radmayr C. 522: Quality of Life Assessment in Children Treated Endoscopically for Vesicoureteral Reflux. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30762-6] [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: 11/25/2022]
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Pelzer AE, Bektic J, Steiner E, Schaefer G, Bartsch G, Horninger W. 1887: Overdiagnosis and Underdiagnosis of Screen vs. Non Screen Detected Prostate Cancers with TPSA Values of 2.0- 10.0 NG/ML. J Urol 2007. [DOI: 10.1016/s0022-5347(18)32060-3] [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: 10/17/2022]
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Bektic J, Pelzer AE, Schaefer G, Bartsch G, Horninger W. 1428: The Role of Prostate-Specific Antigen Velocity in Predicting Non-Organ-Confined Prostate Cancers in Patients Undergoing Radical Prostatectomy. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31629-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Horninger W, Pelzer AE, Bektic J, Schaefer G, Brunner A, Klocker H, Bartsch G. 1733: Transurethral Prostatectomy: Long Term Morbidity after a follow up of 15 Years. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31921-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Horninger W, Klocker H, Bektic J, Pelzer AE, Schaefer G, Brunner A, Achleitner R, Bartsch G. 607: Low PSA Levels Cannot Rule out Prostate Cancer:Prostate Cancer Detection Rates with Respect to PSA Levels Results from a PSA Based Screening Cohort. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30847-4] [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: 10/17/2022]
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Pelzer AE, Bektic J, Steiner E, Schaefer G, Akkad T, Schwentner C, Bartsch G, Horninger W. 851: Clinical and Pathological Features of Screen VS. Non Screen Detected Prostate Cancers: Is there a Difference? J Urol 2007. [DOI: 10.1016/s0022-5347(18)31091-7] [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: 11/29/2022]
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Hominger W, Pelzer AE, Bektic J, Achleitner R, Frauscher F, Pallwein L, Schaefer G, Brunner A, Klocker H, Bartsch G. 1963: Complication Rates of 7074 Transrectal, Ultrasound (TRUS) Guided Biopsies of the Prostate: Results from the Tyrol PSA Screening Project. J Urol 2007. [DOI: 10.1016/s0022-5347(18)32123-2] [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: 10/17/2022]
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Ongarello S, Steiner E, Achleitner R, Feuerstein I, Stenzel B, Fuchsberger C, Cobelli C, Toffolo G, Horninger W, Bartsch G, Bonn GK, Klocker H, Pelzer AE. 154: Integration of TPSA and High-Throughput Mass Spectrometry Data Improves Prostate Cancer Prediction. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30419-1] [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: 10/17/2022]
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Chang P, Tewari AK, Gold HT, Hominger W, Pelzer AE, Demers R, Crawford ED, Gamito EJ, Divine G, Johnson CC, Bartsch G, Menon M. 385: Impact of Socioeconomic Factors on long-term Survival in Patients with Clinically Localized Prostate Cancer. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30638-4] [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: 11/29/2022]
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Bektic J, Pelzer AE, Schaefer G, Bartsch G, Horninger W. 1746: Prostate Cancer Risk: The Significance of age-related Differences in PSA Velocity between Men with and without Biopsy-Proven Prostate Cancers. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31934-7] [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: 11/25/2022]
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Bektic J, Pelzer AE, Schaefer G, Bartsch G, Horninger W. 1422: Increased PSAV is Significantly Associated with Higher Gleason Scores in Patients Undergoing Radical Prostatectomy. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31623-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Pelzer AE, Feuerstein I, Fuchsberger C, Ongarello S, Bektic J, Schwentner C, Klocker H, Bartsch G, Bonn GK. Influence of blood sampling on protein profiling and pattern analysis using matrix-assisted laser desorption/ionisation mass spectrometry. BJU Int 2007; 99:658-62. [PMID: 17407520 DOI: 10.1111/j.1464-410x.2006.06678.x] [Citation(s) in RCA: 5] [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: 11/29/2022]
Abstract
OBJECTIVE To describe the influence of blood sampling/sampling tubes on mass spectrometric and clustering results, and on clinical blood variables, in blood samples collected from healthy volunteers and patients with prostate cancer. PATIENTS, SUBJECTS AND METHODS Two venous blood samples were taken from 12 healthy volunteers and 12 patients with localized prostate cancer. Two blood samples were taken from each participant using two different venepuncture systems (group A and group B). The Kolmogorov-Smirnov test was used to identify the peaks distinguishing the different groups. In a 10-fold cross-validation study, decision trees for identifying discriminatory peaks that separate the benign from the malignant were constructed. RESULTS The decision tree separated samples measured by matrix-assisted laser desorption/ionization mass spectrometry (MALDI MS) from healthy volunteers from those of patients with prostate cancer, with a sensitivity of 93.6% and a specificity of 91.6%. Of special interest is that one peak at 6941 m/z was produced during blood sample preparation and had a very powerful influence on the results of the classification. CONCLUSION The results clearly showed that blood-sampling systems have a great influence on the recorded MALDI MS traces, and thus can markedly influence and confound the results of the MS analysis, whereas clinical variables might remain unchanged. MS profiling is a promising method of marker discovery, but as it could be shown well-designed studies are critical to allow proper interpretation for the identification of key variables as well as for the clinical use.
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Affiliation(s)
- Alexandre E Pelzer
- Department of Urology, Innsbruck Medical University, Anichstrasse 35, 6020-Innsbruck, Austria.
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Berger AP, Deibl M, Strasak A, Bektic J, Pelzer AE, Klocker H, Steiner H, Fritsche G, Bartsch G, Horninger W. Large-scale study of clinical impact of PSA velocity: long-term PSA kinetics as method of differentiating men with from those without prostate cancer. Urology 2007; 69:134-8. [PMID: 17270635 DOI: 10.1016/j.urology.2006.09.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 06/02/2006] [Accepted: 09/07/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the longitudinal prostate-specific antigen (PSA) changes in a screening population with or without prostate cancer during a 10-year period. METHODS Serial PSA measurements performed during a 10-year period were evaluated in 4272 participants of a screening program who had no evidence of prostate malignancy and 528 men who eventually developed prostate cancer. RESULTS Of the 4272 men with no evidence of prostate cancer, the mean total PSA level increased from 1.16 to 1.49 ng/mL during the 10 years, corresponding to a PSA velocity (PSAV) of 0.03 ng/mL/yr. Younger men had lower total PSA values throughout the 10-year period. Of the 528 patients with prostate cancer, the total PSA level increased from 2.19 at 10 years before diagnosis to 6.09 ng/mL at the time of positive biopsy findings, corresponding to a PSAV of 0.39 ng/mL/yr. The PSAV increased in the years before diagnosis (0.225 ng/mL/yr in the 8 to 10 years before diagnosis compared with 0.98 ng/mL/yr in the 2 years before diagnosis). The PSAV was greater in patients with Stage pT3-T4 cancer than in men with organ-confined tumors (median 0.53 versus 0.32 ng/mL/yr; P <0.001). CONCLUSIONS In men with prostate cancer, the PSAV was significantly greater than in those without prostate cancer and correlated with pathologic stage and Gleason score but not with prostate volume. In the patients with prostate cancer, the PSAV increased in the years before the diagnosis. In contrast, men without prostate cancer had only slight PSA changes over time. Hence, PSA kinetics may help identify men with potentially curable prostate cancer.
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Affiliation(s)
- Andreas P Berger
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria.
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Rehder P, Müller T, Pelzer AE. Traumatic kidney injury before and after reconstruction. Wien Klin Wochenschr 2006; 118:738. [PMID: 17186168 DOI: 10.1007/s00508-006-0713-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Peter Rehder
- Department of Urology, Medical University Innsbruck, Austria.
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Pelzer AE, Bektic J, Haag P, Berger AP, Pycha A, Schäfer G, Rogatsch H, Horninger W, Bartsch G, Klocker H. The expression of transcription factor activating transcription factor 3 in the human prostate and its regulation by androgen in prostate cancer. J Urol 2006; 175:1517-22. [PMID: 16516039 DOI: 10.1016/s0022-5347(05)00651-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Indexed: 01/08/2023]
Abstract
PURPOSE ATF3 is a member of the basic leucine zipper/cyclic adenosine monophosphate responsive element binding protein family of transcription factors. There is overwhelming evidence that it is a stress inducible factor acting in a signal-type and cell-type dependent manner, and it is involved in cell proliferation and survival. We found that ATF3 was differently expressed in an in vitro prostate cancer tumor progression model and we investigated the possible role of ATF3 in prostate cancer. MATERIALS AND METHODS ATF3 up-regulation in vivo/in vitro and androgen regulation were assessed by immunohistochemistry and immunoblot analysis. Results after forced ATF3 transfection were evaluated by proliferation assay and cell cycle analysis. RESULTS Immunohistochemistry and immunoblot analysis revealed ATF3 up-regulation in prostate cancer in vitro and in vivo, and stimulation of expression by androgens. Antiandrogen treatment decreased ATF3 expression in androgen sensitive cells but acted as a stimulator in long-term androgen ablated cells representing a model for therapy refractory disease. Expression in tumors increased with higher Gleason scores and highest expression was observed in samples of therapy refractory tumor tissue. Forced ATF3 over expression in a prostate cancer cell line induced cell proliferation and accelerated cell cycle progression from G1 to S-phase. CONCLUSIONS These data provide new insight into the role of ATF3 in prostate cancer development and/or progression. They indicate that ATF3 is an androgen regulated gene that is highly expressed in prostate tumors and stimulating cell proliferation. It represents a possible target for prostate cancer therapy.
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Affiliation(s)
- Alexandre E Pelzer
- Department of Urology, Innsbruck Medical University, Innsbruck, Austria.
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Pelzer AE, Akkad T, Schwentner C, Schwenter C, Strasser H, Bartsch G, Rehder P. Treatment of adult female epispadias without exstrophy in the presence of rhabdosphincter function. Int J Urol 2006; 13:321-2. [PMID: 16643639 DOI: 10.1111/j.1442-2042.2006.01292.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/30/2022]
Abstract
Female epispadias without exstrophy is a very rare entity. Symptoms of female epispadias are primary urinary incontinence and anatomical abnormal features. A 24-year-old married women with two children presented with primary urinary incontinence. Due to previous failure of correct diagnosis and ineffective medical treatment, the patient developed psychological problems (anxiety and depression). In the presence of minimal rhabdosphincter function we could achieve socially acceptable urinary continence by bladder neck plication and a Burch colposuspension. The patient did not consent to a major reconstruction.
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Akkad T, Gozzi C, Deibl M, Müller T, Pelzer AE, Pinggera GM, Bartsch G, Steiner H. Tumor Recurrence in the Remnant Urothelium of Females Undergoing Radical Cystectomy for Transitional Cell Carcinoma of the Bladder: Long-Term Results From a Single Center. J Urol 2006; 175:1268-71; discussion 1271. [PMID: 16515977 DOI: 10.1016/s0022-5347(05)00643-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE We analyzed the risk factors and incidence of secondary TCC of the remnant urothelium in women following radical cystectomy for TCC of the bladder. MATERIALS AND METHODS A total of 85 women with a mean age of 64.5 years with clinically localized TCC of the bladder underwent radical cystectomy between 1992 and 2004. Orthotopic bladder substitution was performed in 46 females, while 39 underwent nonorthotopic urinary diversion. Of the entire cohort 22 (26%) patients underwent cystectomy for multifocal or recurrent TCC. Followup examinations were performed at 6-month intervals. RESULTS Mean followup in the entire cohort was 49.8 months (median 42). Intraoperative frozen sections obtained from the urethra and distal ureters were negative for TCC and CIS in all patients. Four women (4.7%) had TCC in the remnant urothelium at a mean of 56 months postoperatively. These patients had undergone cystectomy for multifocal or recurrent TCC (4 of 22 or 18%). No secondary TCC was seen in the 63 patients with solitary invasive or nonrecurrent bladder cancer (p <0.05). Urethral recurrence was found in 2 patients (4.3%) 65 and 36 months after orthotopic neobladder surgery, respectively. In the orthotopic group 1 patient (2.1%) had an upper urinary tract tumor 76 months after surgery, while in the nonorthotopic group 1 (2.5%) was found to have an upper urinary tract tumor 48 months postoperatively. CONCLUSIONS Recurrent or multifocal TCC may represent a risk factor for secondary TCC of the remnant urothelium after cystectomy. In our series all recurrent tumors were late recurrences (more than 36 months postoperatively). Because the rate of urethral recurrence in the current series corresponds to that reported in men (2% to 6%), urethra sparing cystectomy with orthotopic bladder replacement does not appear to compromise the oncological outcome in women.
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Affiliation(s)
- Thomas Akkad
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
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Akkad T, Gozzi C, Deibl M, Mueller T, Pelzer AE, Pinggera GM, Bartsch G, Steiner H. 1225: Tumor Recurrence in the Remnant Urothelium after Radical Cystectomy for Transitional Cell Carcinoma of the Bladder in Females: Long Term Results of a Single Center. J Urol 2006. [DOI: 10.1016/s0022-5347(18)33438-4] [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: 11/16/2022]
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