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Kafka M, Giannini G, Artamonova N, Neuwirt H, Ofner H, Kramer G, Bauernhofer T, Luger F, Höfner T, Loidl W, Griessner H, Lusuardi L, Bergmaier A, Berger A, Winder T, Weiss S, Bauinger S, Krause S, Drerup M, Heinrich E, Schneider M, Madersbacher S, Vallet S, Stoiber F, Laimer S, Hruby S, Schachtner G, Nagele U, Lenart S, Ponholzer A, Pfuner J, Wiesinger C, Kamhuber C, Müldür E, Bektic J, Horninger W, Heidegger I. Real-World Evidence of Triplet Therapy in Metastatic Hormone-Sensitive Prostate Cancer: An Austrian Multicenter Study. Clin Genitourin Cancer 2024; 22:458-466.e1. [PMID: 38267304 DOI: 10.1016/j.clgc.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/20/2023] [Accepted: 12/31/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Two randomized trials demonstrated a survival benefit of triplet therapy (androgen deprivation therapy [ADT]) plus androgen receptor pathway inhibitor [ARPI] plus docetaxel) over doublet therapy (ADT plus docetaxel), thus changing treatment strategies in metastatic hormonesensitive prostate cancer (mHSPC). PATIENTS AND METHODS We conducted the first real-world analysis comprising 97 mHSPC patients from 16 Austrian medical centers, among them 79.4% of patients received abiraterone and 17.5% darolutamide treatment. Baseline characteristics and clinical parameters during triplet therapy were documented. Mann-Whitney U test for continuous or X²-test for categorical variables was used. Variables on progression were tested using logistic regression analysis and tabulated as hazard ratios (HR), 95% confidence interval (CI). RESULTS Of 83.5% patients with synchronous and 16.5% with metachronous disease were included. 83.5% had high-volume disease diagnosed by conventional imaging (48.9%) or PSMA PET-CT (51.1%). While docetaxel and ARPI were administered consistent with pivotal trials, prednisolone, prophylactic gCSF and osteoprotective agents were not applied guideline conform in 32.5%, 37%, and 24.3% of patients, respectively. Importantly, a nonsimultaneous onset of chemotherapy and ARPI, performed in 44.3% of patients, was associated with significantly worse treatment response (P = .015, HR 0.245). Starting ARPI before chemotherapy was associated with significantly higher probability for progression (P = .023, HR 15.781) than vice versa. Strikingly, 15.6% (abiraterone) and 25.5% (darolutamide) low-volume patients as well as 14.4% (abiraterone) and 17.6% (darolutamide) metachronous patients received triplet therapy. Adverse events (AE) occurred in 61.9% with grade 3 to 5 in 15% of patient without age-related differences. All patients achieved a PSA decline of 99% and imaging response was confirmed in 88% of abiraterone and 75% of darolutamide patients. CONCLUSIONS Triplet therapy arrived in clinical practice primarily for synchronous high-volume mHSPC. Regardless of selected therapy regimen, treatment is highly effective and tolerable. Preferably therapy should be administered simultaneously, however if not possible, chemotherapy should be started first.
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Affiliation(s)
- Mona Kafka
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Giulia Giannini
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Hannes Neuwirt
- Department of Internal Medicine IV, Medical University Innsbruck, Innsbruck, Austria
| | - Heidemarie Ofner
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - Gero Kramer
- Department of Urology, Medical University Vienna, Vienna, Austria
| | | | - Ferdinand Luger
- Department of Urology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Thomas Höfner
- Department of Urology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Wolfgang Loidl
- Department of Urology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | | | | | - Antonia Bergmaier
- Department of Urology, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Andreas Berger
- Department of Urology, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Thomas Winder
- Department of Oncology, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Sarah Weiss
- Department of Urology, Kepler University Linz, Linz, Austria
| | | | - Steffen Krause
- Department of Urology, Kepler University Linz, Linz, Austria
| | - Martin Drerup
- Department of Urology, Barmherzige Brüder Salzburg, Salzburg, Austria
| | - Elmar Heinrich
- Department of Urology, Barmherzige Brüder Salzburg, Salzburg, Austria
| | | | | | - Sonia Vallet
- Division of Internal Medicine 2, Karl Landsteiner University of Health Sciences, University Hospital Krems, Krems, Austria
| | - Franz Stoiber
- Department of Urology, Salzkammergut Klinikum Vöcklabruck, Vöcklabruck, Austria
| | - Sarah Laimer
- Department of Urology, Tauernklinikum, Zell am See, Austria
| | - Stephan Hruby
- Department of Urology, Tauernklinikum, Zell am See, Austria
| | - Gert Schachtner
- Department of Urology, Landeskrankenhaus Hall, Innsbruck, Austria
| | - Udo Nagele
- Department of Urology, Landeskrankenhaus Hall, Innsbruck, Austria
| | - Sebastian Lenart
- Department of Urology, Barmherzige Brüder Vienna, Vienna, Austria
| | - Anton Ponholzer
- Department of Urology, Barmherzige Brüder Vienna, Vienna, Austria
| | - Jacob Pfuner
- Department of Urology, Klinikum Wels-Grieskirchen, Wels, Austria
| | | | - Christoph Kamhuber
- Department of Oncology, Kardinal Schwarzenberg Klinikum, Schwarzach, Austria
| | - Ecan Müldür
- Department of Oncology, Klinik Ottakring, Vienna, Austria
| | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
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Steinkellner L, Luger F, Loidl W. [Importance of genetic testing in prostate cancer]. Urologie 2022; 61:1392-1398. [PMID: 36378280 DOI: 10.1007/s00120-022-01977-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Abstract
Due to the increasing accessibility, molecular diagnostics are becoming more important in urology. There are validated predictive and prognostic biomarkers available for prostate cancer. This has clinical implications for screening diagnosis and personalized treatment options. The best known examples are mutations in the DNA damage repair genes breast cancer 1 (BRCA1) and BRCA2 for which the poly (ADP-ribose) polymerase (PARP) inhibitor olaparib has been approved in 2020. This continuous progress enables a more tumor-specific and personalized treatment for prostate cancer. In order to provide this precision medicine, it is necessary to know the most important basic principles, have a close-knit interdisciplinary cooperation and access to a molecular tumor board due to the increased complexity.
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Affiliation(s)
- Lukas Steinkellner
- Abteilung für Urologie und Andrologie, Ordensklinikum Linz Elisabethinen, Fadingerstraße 1, 4020, Linz, Österreich
| | - Ferdinand Luger
- Abteilung für Urologie und Andrologie, Ordensklinikum Linz Elisabethinen, Fadingerstraße 1, 4020, Linz, Österreich
| | - Wolfgang Loidl
- Abteilung für Urologie und Andrologie, Ordensklinikum Linz Elisabethinen, Fadingerstraße 1, 4020, Linz, Österreich.
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Hofbauer SL, Luger F, Harland N, Plage H, Reimann M, Hollenbach M, Gusenleitner A, Stenzl A, Schlomm T, Wiemer L, Cash H. A non-inferiority comparative analysis of micro-ultrasonography and MRI-targeted biopsy in men at risk of prostate cancer. BJU Int 2021; 129:648-654. [PMID: 34773679 DOI: 10.1111/bju.15635] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 09/26/2021] [Accepted: 11/08/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To compare the efficacy of multiparametric magnetic resonance imaging (mpMRI)-directed and micro-ultrasonography (micro-US)-directed biopsy for detecting clinically significant (Grade Group >1) prostate cancer (csPCa). MATERIALS AND METHODS A total of 203 patients were prospectively enrolled at three institutions across Germany and Austria in the period from January 2019 to December 2019. During each biopsy, the urologist was blinded to the mpMRI report until after the micro-US targets had been assessed. After unblinding, targets were then sampled using software-assisted fusion, followed by systematic samples. The primary outcome measure was non-inferiority of micro-US to detect csPCa, with a detection ratio of at least 80% that of mpMRI. RESULTS A total of 79 csPCa cases were detected overall (39%). Micro-US-targeted biopsy detected 58/79 cases (73%), while mpMRI-targeted biopsy detected 60/79 (76%) and non-targeted (completion sampling) samples detected 45/79 cases (57%). mpMRI-targeted samples alone detected 7/79 (9%) csPCa cases which were missed by micro-US-targeted and non-targeted samples. Three of these seven were anterior lesions with 2/7 in the transition zone. Micro-US-targeted samples alone detected 5/79 (6%) and completion sampling alone detected 4/79 cases (5%). Micro-US was non-inferior to mpMRI and detected 97% of the csPCa cases detected by mpMRI-targeted biopsy (95% CI 80-116%; P = 0.023). CONCLUSIONS This is the first multicentre prospective study comparing micro-US-targeted biopsy with mpMRI-targeted biopsy. The study provides further evidence that micro-US can reliably detect cancer lesions and suggests that micro-US biopsy might be as effective as mpMRI for detection of csPCA. This result has significant implications for increasing accessibility, reducing costs and expediting diagnosis.
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Affiliation(s)
| | - Ferdinand Luger
- Department of Urology, Ordensklinikum Linz, Elisabethinen, Austria
| | - Niklas Harland
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Henning Plage
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maximillian Reimann
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Hollenbach
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Thorsten Schlomm
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Laura Wiemer
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Prouro, Urology Berlin, Berlin, Germany.,Department of Urology, University of Magdeburg, Magdeburg, Germany
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Klotz L, Lughezzani G, Maffei D, Sánchez A, Pereira JG, Staerman F, Cash H, Luger F, Lopez L, Sanchez-Salas R, Abouassaly R, Shore ND, Eure G, Paciotti M, Astobieta A, Wiemer L, Hofbauer S, Heckmann R, Gusenleitner A, Kaar J, Mayr C, Loidl W, Rouffilange J, Gaston R, Cathelineau X, Klein E. Comparison of micro-ultrasound and multiparametric magnetic resonance imaging for prostate cancer: A multicenter, prospective analysis. Can Urol Assoc J 2020; 15:E11-E16. [PMID: 32701437 DOI: 10.5489/cuaj.6712] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION High-resolution micro-ultrasound has the capability of imaging prostate cancer based on detecting alterations in ductal anatomy, analogous to multiparametric magnetic resonance imaging (mpMRI). This technology has the potential advantages of relatively low cost, simplicity, and accessibility compared to mpMRI. This multicenter, prospective registry aims to compare the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of mpMRI with high-resolution micro-ultrasound imaging for the detection of clinically significant prostate cancer. METHODS We included 1040 subjects at 11 sites in seven countries who had prior mpMRI and underwent ExactVu micro-ultrasound-guided biopsy. Biopsies were taken from both mpMRI targets (Prostate Imaging-Reporting and Data System [PI-RADS] >3 and micro-ultrasound targets (Prostate Risk Identification using Micro-ultrasound [PRIMUS] >3). Systematic biopsies (up to 14 cores) were also performed. Various strategies were used for mpMRI target sampling, including cognitive fusion with micro-ultrasound, separate software-fusion systems, and software-fusion using the micro-ultrasound FusionVu system. Clinically significant cancer was those with Gleason grade group ≥2. RESULTS Overall, 39.5% were positive for clinically significant prostate cancer. Micro-ultrasound and mpMRI sensitivity was 94% vs. 90%, respectively (p=0.03), and NPV was 85% vs. 77%, respectively. Specificities of micro-ultrasound and MRI were both 22%, with similar PPV (44% vs. 43%). This represents the initial experience with the technology at most of the participating sites and, therefore, incorporates a learning curve. Number of cores, diagnostic strategy, blinding to MRI results, and experience varied between sites. CONCLUSIONS In this initial multicenter registry, micro-ultrasound had comparable or higher sensitivity for clinically significant prostate cancer compared to mpMRI, with similar specificity. Micro-ultrasound is a low-cost, single-session option for prostate screening and targeted biopsy. Further larger-scale studies are required for validation of these findings.
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Affiliation(s)
| | | | | | | | | | | | - Hannes Cash
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Rob Abouassaly
- Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, United States
| | - Gregg Eure
- Urology of Virginia, Virginia Beach, VA, United States
| | | | | | - Laura Wiemer
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Jasmin Kaar
- Ordensklinikum Linz, Barmherzige Schwestern Linz, Austria
| | - Clemens Mayr
- Ordensklinikum Linz, Barmherzige Schwestern Linz, Austria
| | - Wolfgang Loidl
- Ordensklinikum Linz, Barmherzige Schwestern Linz, Austria
| | | | | | | | - Eric Klein
- Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, United States
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Abstract
In merely a short period of time the comprehension of castration-resistant prostate cancer has evolved. It is now possible to clearly outline the exact definition and variance of the disease pattern. A wealth of new effective agents can be applied to extend the patient's life span and improve the quality of life. An understanding of the pharmacodynamics and side effects of each substance is of utmost importance for the practical application. In order to use these new medicines in a differentiated manner urologists require continuous education. The evaluation of response to treatment has yet to be satisfyingly verified. Molecular markers still need to be developed and evaluated.
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Affiliation(s)
- W Loidl
- Urologische Abteilung, Krankenhaus der Barmherzigen Schwestern, Seilerstätte 4, A-4010, Linz, Österreich,
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Chun F, Auprich M, Haese A, Ward J, Pummer K, Babaian R, Augustin H, Luger F, Gutschi S, Budäus L, Fisch M, Huland H, Graefen M. MP-16.12 Pre-Operative Urinary Prostate CAncer Gene 3 (PCA3) in the Prediction of Small Tumor Volume, Insignificant, Locally Advanced and Aggressive Prostate Cancer. Urology 2011. [DOI: 10.1016/j.urology.2011.07.380] [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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Auprich M, Ward JF, Babaian R, Pummer K, Augustin H, Luger F, Gutschi S, Huland H, Haese A. 187 PRE-OPERATIVE URINARY PROSTATE CANCER GENE 3 (PCA3) IS PREDICTING PATHOLOGICALLY CONFIRMED SMALL VOLUME AND INSIGNIFICANT PROSTATE CANCER. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Auprich M, Chun FKH, Ward JF, Pummer K, Babaian R, Augustin H, Luger F, Gutschi S, Budäus L, Fisch M, Huland H, Graefen M, Haese A. Critical assessment of preoperative urinary prostate cancer antigen 3 on the accuracy of prostate cancer staging. Eur Urol 2010; 59:96-105. [PMID: 20980098 DOI: 10.1016/j.eururo.2010.10.024] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 10/11/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Knowledge about the staging significance of the prostate cancer antigen 3 (PCA3) score to better identify pathologic features after radical prostatectomy (RP) is limited and controversial. OBJECTIVE Our aim was to study the clinical staging significance of PCA3 to identify pathologic favorable and/or unfavorable features in the RP specimen. DESIGN, SETTING, AND PARTICIPANTS Complete retrospective clinical and pathologic data of consecutive men who had undergone RP from three tertiary referral centers including preoperative PCA3 scores (n=305) and computer-assisted planimetrically measured tumor volume data (n=160) were available. INTERVENTION All patients were treated with RP. MEASUREMENTS PCA3 scores were assessed using the PROGENSA assay (Gen-Probe, San Diego, CA, USA). Beyond standard risk factors (age, digital rectal examination, prostate-specific antigen, prostate volume, biopsy Gleason score, percentage of positive cores), five different PCA3 codings were used in logistic regression models to identify five distinct pathologic end points: (1) low-volume disease (<0.5 ml), (2) insignificant prostate cancer (PCa) according to the Epstein criteria, (3) extracapsular extension (ECE), (4) seminal vesicle invasion (SVI), and (5) aggressive disease defined as Gleason sum ≥7. Accuracy estimates of each end point were quantified using the area under the curve (AUC) of the receiver operator characteristic analysis in models with and without PCA3. RESULTS AND LIMITATIONS PCA3 scores were significantly lower in low-volume disease and insignificant PCa (p ≤ 0.001). AUC of multivariable low-volume disease (+2.4 to +5.5%) and insignificant PCa models (+3 to +3.9%) increased when PCA3 was added to standard clinical risk factors. In contradistinction, regardless of its coding, PCA3 scores were not significantly elevated in pathologically confirmed ECE (p=0.4) or SVI (p=0.5), respectively. Higher PCA3 scores were associated with aggressive disease (p<0.001). Importantly, the addition of PCA3 to multivariable intermediate- and high-grade models did not improve prediction. Despite reporting the largest pathologic PCA3 study, the main limitation resides in its small sample size. CONCLUSIONS PCA3 was confirmed as a valuable predictor of pathologically confirmed low-volume disease and insignificant PCa. Further exploration of its role as an additional marker to select patients for active surveillance may be warranted. In contradistinction, assessment of pathologically advanced or aggressive PCa is not improved using PCA3.
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Affiliation(s)
- Marco Auprich
- Department of Urology, Medizinische Universität Graz, Graz, Austria
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