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Abstract
ZusammenfassungSeit nachgewiesen wurde, daß die Infarzierung von Nierenkarzinomen die Prognose unabhängig von der weiteren Therapie nicht beeinflußt, und seit die Angiographie in der Diagnostik der Nierentumoren durch die Computertomographie ersetzt wurde, hat die therapeutische Embolisierung ihr Hauptanwendungsgebiet in der Urologie verloren. Diese Entwicklung wurde verstärkt durch den Ersatz von Nierensteinoperationen mit temporärer Okklusion der Nierenarterie durch weniger invasive Methoden und die enttäuschenden Ergebnisse der Embolisierung bei Blutungen aus Blase und Prostata. Zahlenmäßig selten, bleibt sie aber Therapie der Wahl bei isolierten Läsionen des arteriellen Nierengefäßbaums, wie kongenitalen arteriovenösen Fisteln und Verletzungen durch perkutane Biopsie, Lithotripsie oder stumpfes Trauma. Kapillare Embolisationsverfahren ermöglichen die »radiologische« Nephrektomie, die bei terminaler Niereninsuffizienz mit nicht beherrschbarer Hypertonie, Proteinurie oder Hämaturie mit einer geringeren Morbidität behaftet ist als die chirurgische Nephrektomie.
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Sanghvi NT, Chen WH, Carlson R, Weis C, Seip R, Uchida T, Marberger M. Clinical validation of real-time tissue change monitoring during prostate tissue ablation with high intensity focused ultrasound. J Ther Ultrasound 2017; 5:24. [PMID: 28924476 PMCID: PMC5598037 DOI: 10.1186/s40349-017-0102-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 09/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of these clinical studies was to validate a Tissue Change Monitoring (TCM) algorithm in vivo. TCM is a quantitative tool for the real-time assessment of HIFU dose. TCM provides quantitative analysis of the backscatter pulse echo signals (pre and immediately post HIFU) for each individual ablative site, using ultrasonic tissue characterization as a surrogate for monitoring tissue temperature. Real-time analysis generates an energy difference parameter (ΔE in dB) that is proportional to tissue temperature. METHODS Post in vitro studies, two clinical studies were conducted to validate the TCM algorithm on the Sonablate® device. Studies enrolled histologically confirmed, organ confined prostate cancer patients. The first clinical study was conducted in two phases for whole gland ablation. First eight patients' data were used to measure the algorithm performance followed by 89 additional patients for long term outcome. The second clinical study enrolled five patients; four patients with focal cancer had hemi-ablation only and one had whole gland ablation. Four 3 Fr. needles containing three thermocouples each were placed transperineally in the prostate to record tissue temperatures in the focal zone, posterior to the focal zone and on the lateral gland where no HIFU was applied. Tissue temperatures from the focal zone were correlated to the ΔE parameter. RESULTS In the first clinical study, the average TCM rate was 86%. Pre and 6 months post HIFU, median PSA was 7.64 and 0.025 ng/ml respectively and 97% patients had negative biopsy. For the second clinical study, the measured prostate tissue temperatures (Average, Max, and Min) in the ablation zones were 84°, 114° and 60 °C and the corresponding ΔE (dB/10) parameters were 1.05, 2.6 and 0.4 resulting in 83% of temperatures in the range of 75°-100 °C and 17% in the 60°-74 °C range. Outside the focal zone, the average temperature was 50 °C and in the lateral lobe where no HIFU was applied, peak temperature was 40.7 °C. CONCLUSIONS The TCM algorithm is able to estimate tissue changes reliably during the HIFU procedure for prostate tissue ablation in real-time and can be used as a guide for HIFU dose delivery and tissue ablation control.
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Affiliation(s)
| | - Wo-Hsing Chen
- Ulthera Inc., Merz Device Innovation Center, 1840 S Stapley Drive, Ste. 200, Mesa, AZ 85204 USA
| | - Roy Carlson
- SonaCare Medical, LLC, 4000 Pendleton Way, Indianapolis, IN 46226 USA
| | - Clint Weis
- SonaCare Medical, LLC, 4000 Pendleton Way, Indianapolis, IN 46226 USA
| | - Ralf Seip
- SonaCare Medical, LLC, 4000 Pendleton Way, Indianapolis, IN 46226 USA
| | - Toyoaki Uchida
- Hachioji Urologic Clinic, 3-6-7, Koyasucho, Hachioji, Tokyo 192-0904 Japan
| | - Michael Marberger
- Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Mengual L, Ribal MJ, Lozano JJ, Ingelmo-Torres M, Liang J, Han CT, Palou J, Rodriguez-Faba O, Witjes F, Van der Heijden AG, Medina R, Conde JM, Marberger M, Schmidbauer J, Ye D, Ye X, Meng X, Alcaraz A. S&T-65 PROSPECTIVE, BLINDED, INTERNATIONAL AND MULTICENTER VALIDATION OF A GENE EXPRESSION TEST FOR THE NON-INVASIVE DIAGNOSIS OF BLADDER CANCER. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | | | | | | | - CT. Han
- Shanghai, China, People's Republic of
| | | | | | | | | | | | | | | | | | | | - Xun Ye
- Shanghai, China, People's Republic of
| | - Xia Meng
- Shanghai, China, People's Republic of
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Ribal MJ, Mengual L, Lozano JJ, Ingelmo-Torres M, Palou J, Rodríguez-Faba O, Witjes JA, Van der Heijden AG, Medina R, Conde JM, Marberger M, Schmidbauer J, Fernández PL, Alcaraz A. Gene expression test for the non-invasive diagnosis of bladder cancer: A prospective, blinded, international and multicenter validation study. Eur J Cancer 2016; 54:131-138. [PMID: 26761785 DOI: 10.1016/j.ejca.2015.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 05/15/2015] [Revised: 10/15/2015] [Accepted: 11/05/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study aimed to validate, in a prospective, blinded, international and multicenter cohort, our previously reported four non-invasive tests for bladder cancer (BC) diagnosis based on the gene expression patterns of urine. METHODS Consecutive voided urine samples from BC patients and controls were prospectively collected in five European centres (n=789). Finally, 525 samples were successfully analysed. Gene expression values were quantified using TaqMan Arrays and previously reported diagnostic algorithms were applied to gene expression data. Results from the most accurate gene signature for BC diagnosis were associated with clinical parameters using analysis of variance test. RESULTS High diagnostic accuracy for the four gene signatures was found in the independent validation set (area under curve [AUC]=0.903-0.918), with the signature composed of two genes (GS_D2) having the best performance (sensitivity: 81.48%; specificity: 91.26%; AUC: 0.918). The diagnostic accuracy of GS_D2 was not affected by the number of tumours (p=0.58) but was statistically associated with tumour size (p=0.008). Also, GS_D2 diagnostic accuracy increases with increasing BC tumour risk. We found no differences in the performance of the GS_D2 test among the populations and centres in detecting tumours (p=0.7) and controls (p=0.2). CONCLUSIONS Our GS_D2 test is non-invasive, non-observer dependent and non-labour-intensive, and has demonstrated diagnostic accuracy in an independent, international and multicenter study, equal or superior to the current gold standard (cystoscopy combined with cytology). Additionally, it has higher sensitivity than cytology while maintaining its specificity. Consequently, it meets the requirements for consideration as a molecular test applicable to clinical practice in the management of BC.
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Affiliation(s)
- Maria J Ribal
- Department and Laboratory of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain.
| | - Lourdes Mengual
- Department and Laboratory of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain.
| | - Juan J Lozano
- CIBERehd, Plataforma de Bioinformática, Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.
| | - Mercedes Ingelmo-Torres
- Department and Laboratory of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain.
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Barcelona, Spain.
| | | | - Johannes A Witjes
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | | | - Rafael Medina
- Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain.
| | - Jose M Conde
- Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain.
| | | | | | - Pedro L Fernández
- Pathology Department, Hospital Clínic, Universitat de Barcelona, Spain.
| | - Antonio Alcaraz
- Department and Laboratory of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain.
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Cuzick J, Thorat MA, Andriole G, Brawley OW, Brown PH, Culig Z, Eeles RA, Ford LG, Hamdy FC, Holmberg L, Ilic D, Key TJ, La Vecchia C, Lilja H, Marberger M, Meyskens FL, Minasian LM, Parker C, Parnes HL, Perner S, Rittenhouse H, Schalken J, Schmid HP, Schmitz-Dräger BJ, Schröder FH, Stenzl A, Tombal B, Wilt TJ, Wolk A. Prevention and early detection of prostate cancer. Lancet Oncol 2014; 15:e484-92. [PMID: 25281467 PMCID: PMC4203149 DOI: 10.1016/s1470-2045(14)70211-6] [Citation(s) in RCA: 310] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Prostate cancer is a common malignancy in men and the worldwide burden of this disease is rising. Lifestyle modifications such as smoking cessation, exercise, and weight control offer opportunities to reduce the risk of developing prostate cancer. Early detection of prostate cancer by prostate-specific antigen (PSA) screening is controversial, but changes in the PSA threshold, frequency of screening, and the use of other biomarkers have the potential to minimise the overdiagnosis associated with PSA screening. Several new biomarkers for individuals with raised PSA concentrations or those diagnosed with prostate cancer are likely to identify individuals who can be spared aggressive treatment. Several pharmacological agents such as 5α-reductase inhibitors and aspirin could prevent development of prostate cancer. In this Review, we discuss the present evidence and research questions regarding prevention, early detection of prostate cancer, and management of men either at high risk of prostate cancer or diagnosed with low-grade prostate cancer.
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Affiliation(s)
- Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
| | - Mangesh A Thorat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Gerald Andriole
- Division of Urologic Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO, USA
| | - Otis W Brawley
- Office of the Chief Medical Officer, American Cancer Society, Atlanta, GA, USA; Department of Hematology and Oncology, Emory University, Atlanta, GA, USA
| | - Powel H Brown
- Department of Clinical Cancer Prevention, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zoran Culig
- Molecular Pathology, Department of Urology, Innsbruck Medical University, Innsbruck, Austria
| | - Rosalind A Eeles
- Division of Cancer Genetics and Epidemiology, The Institute of Cancer Research, London, UK; Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Leslie G Ford
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | | | - Lars Holmberg
- Medical School, King's College London, London, UK; Regional Cancer Center Uppsala Orebro and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Dragan Ilic
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Hans Lilja
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Surgery (Urology), Laboratory Medicine, and Medicine (GU-Oncology), Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Laboratory Medicine, Lund University, University Hospital UMAS, Malmö, Sweden
| | - Michael Marberger
- Department of Urology, Vienna University Medical School, Vienna, Austria
| | - Frank L Meyskens
- Biological Chemistry, Public Health, and Epidemiology, School of Medicine, University of California, Irvine, CA, USA
| | - Lori M Minasian
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Chris Parker
- Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Howard L Parnes
- Prostate and Urologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Sven Perner
- Department of Prostate Cancer Research, Institute of Pathology, University Hospital of Bonn, Bonn, Germany
| | | | - Jack Schalken
- Urology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hans-Peter Schmid
- Department of Urology, Kantonsspital St Gallen, St Gallen, Switzerland
| | | | - Fritz H Schröder
- Erasmus University and Erasmus Medical Centre, Rotterdam, Netherlands
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tübingen, Tuebingen, Germany
| | - Bertrand Tombal
- Department of Urology, Université Catholique de Louvain, Brussels, Belgium
| | - Timothy J Wilt
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, and Section of General Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Alicja Wolk
- Division of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Muller BG, van den Bos W, Brausi M, Cornud F, Gontero P, Kirkham A, Pinto PA, Polascik TJ, Rastinehad AR, de Reijke TM, de la Rosette JJ, Ukimura O, Villers A, Walz J, Wijkstra H, Marberger M. Role of multiparametric magnetic resonance imaging (MRI) in focal therapy for prostate cancer: a Delphi consensus project. BJU Int 2014; 114:698-707. [PMID: 24180365 DOI: 10.1111/bju.12548] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Berrend G. Muller
- Department of Urology; AMC University Hospital; Amsterdam The Netherlands
| | | | - Maurizio Brausi
- Department of Urology; EstenseS. Agostino Hospital; Modena Italy
| | | | - Paolo Gontero
- Department of Urology; Molinette University Hospital; Turin Italy
| | | | - Peter A. Pinto
- Department of Urology; National Cancer Institute; Bethesda MD
| | - Thomas J. Polascik
- Department of Surgery/Urology; Duke University Medical Center; Durham NC
| | | | - Theo M. de Reijke
- Department of Urology; AMC University Hospital; Amsterdam The Netherlands
| | | | - Osamu Ukimura
- Department of Urology; University of Southern California; Norris Cancer Center; Los Angeles CA USA
| | | | - Jochen Walz
- Department of Urology; Institut Paoli-Calmettes Cancer Center; Marseille France
| | - Hessel Wijkstra
- Department of Urology; AMC University Hospital; Amsterdam The Netherlands
- Department of Electrical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
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Andriole GL, Bostwick DG, Gomella LG, Marberger M, Montorsi F, Tammela TL, Tindall DJ, Fowler IL, Garges HP, Wilson TH, Castro R. Modeling and Analysis of Gleason Score 8-10 Prostate Cancers in the REDUCE Study. Urology 2014; 84:393-9. [DOI: 10.1016/j.urology.2014.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 04/06/2014] [Accepted: 04/09/2014] [Indexed: 12/01/2022]
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Tsivian M, Rampersaud EN, del Pilar Laguna Pes M, Joniau S, Leveillee RJ, Shingleton WB, Aron M, Kim CY, DeMarzo AM, Desai MM, Meler JD, Donovan JF, Klingler HC, Sopko DR, Madden JF, Marberger M, Ferrandino MN, Polascik TJ. Small renal mass biopsy - how, what and when: report from an international consensus panel. BJU Int 2014; 113:854-63. [DOI: 10.1111/bju.12470] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Matvey Tsivian
- Division of Urology; Department of Surgery; Duke University Medical Center; Durham NC USA
| | - Edward N. Rampersaud
- Division of Urology; Department of Surgery; Duke University Medical Center; Durham NC USA
| | | | | | | | - William B. Shingleton
- Section of Urology; Department of Surgery; Georgia Health Sciences University; Augusta GA USA
| | - Monish Aron
- Department of Urology; University of Southern California; Los Angeles CA USA
| | - Charles Y. Kim
- Department of Radiology; Duke University Medical Center; Durham NC USA
| | - Angelo M. DeMarzo
- Department of Pathology; Johns Hopkins University Medical Center; Baltimore MD USA
| | - Mihir M. Desai
- Department of Urology; University of Southern California; Los Angeles CA USA
| | - James D. Meler
- Department of Radiology; Baylor University Medical Center; Dallas TX USA
| | - James F. Donovan
- Division of Urology; Department of Surgery; University of Cincinnati; Cincinnati OH USA
| | | | - David R. Sopko
- Department of Radiology; Duke University Medical Center; Durham NC USA
| | - John F. Madden
- Department of Pathology; Duke University Medical Center; Durham NC USA
| | | | - Michael N. Ferrandino
- Division of Urology; Department of Surgery; Duke University Medical Center; Durham NC USA
| | - Thomas J. Polascik
- Division of Urology; Department of Surgery; Duke University Medical Center; Durham NC USA
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Abstract
A high disease prevalence, the presentation in older age, a frequently slowly progressing course of disease, and high costs make diagnosis and therapy of prostate cancer a special challenge for urologists. Effective prevention of the disease may help to resolve some of the problems mentioned above. Two randomised, controlled studies prove that effective chemoprevention of prostate cancer is possible using 5-α reductase inhibitors (finasteride, dutasteride) (LoE 1) both in individuals at low and those at high risk developing prostate cancer. Furthermore, there is evidence that other compounds, e.g. selective estrogen receptor modulators (SERMs), non-steroidal anti-inflammatory drugs (NSAIDs) and statins might also be effective. This review investigates potential risks and benefits of chemoprevention including a consideration of health economic aspects. The authors conclude that chemoprevention in a high risk cohort using 5-α reductase inhibitors is a viable option and may even be cost effective. In consequence, the options of chemoprevention in prostate cancer should be further explored in an open and unbiased way.
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Affiliation(s)
- Bernd J Schmitz-Dräger
- Urologie, Schön Klinik Nürnberg/Fürth, Urologie 24, c/o Europa-Allee 1, 90763, Fürth, Germany,
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Muller BG, Fütterer JJ, Gupta RT, Katz A, Kirkham A, Kurhanewicz J, Moul JW, Pinto PA, Rastinehad AR, Robertson C, de la Rosette J, Sanchez-Salas R, Jones JS, Ukimura O, Verma S, Wijkstra H, Marberger M. The role of magnetic resonance imaging (MRI) in focal therapy for prostate cancer: recommendations from a consensus panel. BJU Int 2013; 113:218-27. [PMID: 24215670 DOI: 10.1111/bju.12243] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To establish a consensus on the utility of multiparametric magnetic resonance imaging (mpMRI) to identify patients for focal therapy. METHODS Urological surgeons, radiologists, and basic researchers, from Europe and North America participated in a consensus meeting about the use of mpMRI in focal therapy of prostate cancer. The consensus process was face-to-face and specific clinical issues were raised and discussed with agreement sought when possible. All participants are listed among the authors. Topics specifically did not include staging of prostate cancer, but rather identifying the optimal requirements for performing MRI, and the current status of optimally performed mpMRI to (i) determine focality of prostate cancer (e.g. localising small target lesions of ≥0.5 mL), (ii) to monitor and assess the outcome of focal ablation therapies, and (iii) to identify the diagnostic advantages of new MRI methods. In addition, the need for transperineal template saturation biopsies in selecting patients for focal therapy was discussed, if a high quality mpMRI is available. In other words, can mpMRI replace the role of transperineal saturation biopsies in patient selection for focal therapy? RESULTS Consensus was reached on most key aspects of the meeting; however, on definition of the optimal requirements for mpMRI, there was one dissenting voice. mpMRI is the optimum approach to achieve the objectives needed for focal therapy, if made on a high quality machine (3T with/without endorectal coil or 1.5T with endorectal coil) and judged by an experienced radiologist. Structured and standardised reporting of prostate MRI is paramount. State of the art mpMRI is capable of localising small tumours for focal therapy. State of the art mpMRI is the technique of choice for follow-up of focal ablation. CONCLUSIONS The present evidence for MRI in focal therapy is limited. mpMRI is not accurate enough to consistently grade tumour aggressiveness. Template-guided saturation biopsies are no longer necessary when a high quality state of the art mpMRI is available; however, suspicious lesions should always be confirmed by (targeted) biopsy.
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Affiliation(s)
- Berrend G Muller
- Department of Urology, AMC University Hospital, Amsterdam, the Netherlands
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Schoenthaler M, Buchholz N, Farin E, Ather H, Bach C, Bach T, Denstedt JD, Fritsche HM, Grasso M, Hakenberg OW, Herwig R, Knoll T, Kuehhas FE, Liatsikos E, Liske P, Marberger M, Osther PJS, Santos JMR, Sarica K, Seitz C, Straub M, Traxer O, Trinchieri A, Turney B, Miernik A. The Post-Ureteroscopic Lesion Scale (PULS): a multicenter video-based evaluation of inter-rater reliability. World J Urol 2013; 32:1033-40. [PMID: 24135917 DOI: 10.1007/s00345-013-1185-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 10/07/2013] [Indexed: 01/22/2023] Open
Abstract
PURPOSE The Post-Ureteroscopic Lesion Scale (PULS) offers a simple grading system for the description of ureteral lesions after ureteroscopy. In this article, we present the results of a video-based multicenter evaluation of the inter-rater reliability of clinically important PULS grades 0-3. METHODS Video sequences at the end of ureteroscopy (final passage) were recorded for 100 consecutive patients at a single institution and assessed by experienced urologists (n = 20) and senior residents (n = 17) at 19 international centers. The cohort included only patients with lesions grades 0-3 (with grades 2 and 3 subsumed as 2 + since distinction is defined by an extravasation of contrast medium in fluoroscopy). The gradings were evaluated for inter-rater reliability and in terms of simplicity, validity, comprehensibility, reproducibility, and usefulness. RESULTS Overall, inter-rater reliability was high (Kendall's W = 0.69, p < 0.001) and was comparable between specialists (Kendall's W = 0.69, p < 0.001) and residents (Kendall's W = 0.71, p < 0.001). The matched ratings showed grade 0 in 43.0 % of patients and grades 1 or 2 + in 44.0 and 13.0 % of patients, respectively. Results of the questionnaires indicated a high degree of acceptance, with an overall rating of 1.76 (1.64-1.93 for different items, scale 1-6). CONCLUSIONS Inter-rater reliability of the endoscopically assessable PULS was high among urologists with different levels of experience in different countries worldwide. The validated PULS system may be used for standardized reporting of ureteral lesions/injuries after ureteroscopy. In addition, PULS will enable more selective standardization of indications for postoperative DJ stenting based on the randomized controlled trials.
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Affiliation(s)
- Martin Schoenthaler
- Department of Urology, University Medical Center, Hugstetterstr. 55, 79106, Freiburg, Germany
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Mulders PFA, Molina A, Marberger M, Saad F, Higano CS, Chi KN, Li J, Kheoh T, Haqq CM, Fizazi K. Efficacy and safety of abiraterone acetate in an elderly patient subgroup (aged 75 and older) with metastatic castration-resistant prostate cancer after docetaxel-based chemotherapy. Eur Urol 2013; 65:875-83. [PMID: 24099659 DOI: 10.1016/j.eururo.2013.09.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [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: 06/20/2013] [Accepted: 09/04/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Metastatic castration-resistant prostate cancer (mCRPC) is a disease that primarily affects older men. Abiraterone acetate (AA), a selective androgen biosynthesis inhibitor, in combination with low-dose prednisone (P) improved overall survival (OS) in a randomised trial in mCRPC progressing after docetaxel versus placebo (PL) plus P. OBJECTIVE To examine the efficacy and safety of AA plus P versus PL plus P in subgroups of elderly (aged ≥ 75 yr) (n=331) and younger patients (<75 yr) (n=863). DESIGN, SETTING, AND PARTICIPANTS We conducted a post hoc analysis of a randomised double-blind PL-controlled study in mCRPC patients progressing after docetaxel chemotherapy. INTERVENTION Patients were randomised 2:1 to AA (1000 mg) plus low-dose P (5mg twice daily) (n=797) or PL plus P (n=398). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary end point was OS. Secondary end points were time to prostate-specific antigen (PSA) progression (TTPP), radiographic progression-free survival (rPFS), and PSA response rate. Treatment differences were compared using the stratified log-rank test. The Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI). The key limitation was the post hoc analysis. RESULTS AND LIMITATIONS Elderly patients treated with AA plus P showed improved OS (HR: 0.64; 95% CI, 0.478-0.853; p=0.0022), TTPP (HR: 0.76; 95% CI, 0.503-1.155; p=0.1995), and rPFS (HR: 0.66; 95% CI, 0.506-0.859; p=0.0019), and higher PSA response rate with relative risk (HR: 4.15; 95% CI, 2.2-8.0]; p ≤ 0.0001) compared with patients treated with PL plus P. Grade 3/4 adverse events occurred in 62% of elderly patients and in 60% of patients aged <75 yr treated with AA plus P. Incidences of hypertension and hypokalaemia, although increased in the AA plus P arm, were similar in both age subgroups and readily managed. CONCLUSIONS AA improves OS and is well tolerated in both elderly patients and younger patients with mCRPC following docetaxel, hence providing an important treatment option for elderly patients who may not tolerate alternative therapies with greater toxicity. TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT00638690.
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Affiliation(s)
- Peter F A Mulders
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Arturo Molina
- Janssen Research & Development, Los Angeles, CA, USA
| | | | - Fred Saad
- University of Montreal, Montreal, QC, Canada
| | | | - Kim N Chi
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Jinhui Li
- Janssen Research & Development, Raritan, NJ, USA
| | - Thian Kheoh
- Janssen Research & Development, Los Angeles, CA, USA
| | | | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
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Abstract
With the high prevalence of bothersome lower urinary tract symptoms (LUTS) in older men, clinical management has to be fairly simple and straightforward. In the absence of severe problems requiring immediate action, and after excluding possible other etiological factors by a simple diagnostic algorithm, the key parameter for therapeutic decisions is the severity of LUTS, in particular the degree of annoyance and irritation, and prostatic enlargement. Patients with bothersome LUTS request rapid improvement but also worry about possible deterioration, complications, and the need for surgery. With a prostate volume above 30-40 mL and/or prostate-specific antigen (PSA) serum >1.5 ng/mL, the combination of an alpha-1 blocker with a 5-alpha-reductase inhibitor (5-ARI) should be first-line treatment. With prostates <30 mL at baseline the issue whether the prostate really is the culprit becomes central. Given the rapid onset of action of alpha-1 blockers, a 4-6-week trial appears to be a logical approach. If the International Prostate Symptom Score does not improve and storage symptoms prevail, an overactive bladder appears more likely as causative factor and antimuscarinics are the next step. Based on available data this is recommended as add-on medication to the alpha-1 blocker. With no improvement, or increasing postvoid residual the diagnostic algorithm needs to be revisited and more extensive urodynamic evaluation may be needed.
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Affiliation(s)
- Michael Marberger
- Department of Urology, Medical University Vienna, Waehringer Guertel, Vienna, Austria.
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Marberger M, Chartier-Kastler E, Egerdie B, Lee KS, Grosse J, Bugarin D, Zhou J, Patel A, Haag-Molkenteller C. A Randomized Double-blind Placebo-controlled Phase 2 Dose-ranging Study of OnabotulinumtoxinA in Men with Benign Prostatic Hyperplasia. Eur Urol 2013; 63:496-503. [DOI: 10.1016/j.eururo.2012.10.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 10/05/2012] [Indexed: 11/30/2022]
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Füllhase C, Chapple C, Cornu JN, De Nunzio C, Gratzke C, Kaplan SA, Marberger M, Montorsi F, Novara G, Oelke M, Porst H, Roehrborn C, Stief C, McVary KT. Systematic review of combination drug therapy for non-neurogenic male lower urinary tract symptoms. Eur Urol 2013; 64:228-43. [PMID: 23375241 DOI: 10.1016/j.eururo.2013.01.018] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 01/15/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Several drugs are approved for the treatment of lower urinary tract symptoms (LUTS) in men, but these are mostly used by clinicians as monotherapies. The combination of different compounds, each of which targets a different aspect of LUTS, seems appealing. However, only few clinical trials have evaluated the effects of combination therapies. OBJECTIVE This systematic review analyzes the efficacy and adverse events of combination therapies for male LUTS. EVIDENCE ACQUISITION PubMed and Cochrane databases were used to identify clinical trials and meta-analyses on male LUTS combination therapy. The search was restricted to studies of level of evidence ≥ 1b. A total of 49 papers published between January 1988 and March 2012 were identified. EVIDENCE SYNTHESIS The α1-adrenoceptor antagonist (α1-blocker)/5α-reductase inhibitor (5-ARI) combination provides the most data. This combination seems to be more efficacious in terms of several outcome variables in patients whose prostate volume is between 30 ml and 40 ml when treatment is maintained for >1 yr; when given for <1 yr, α1-blockers alone are just as effective. The combination of α1-blocker/5-ARI shows a slightly increased rate of adverse events. It remains unknown whether its safety and superiority over either drug as monotherapy are sustained after >6 yr. The α1-blocker/muscarinic receptor antagonist (antimuscarinic) combination was most frequently assessed as an add-on therapy to already existing α1-blocker therapy. Inconsistent data derive from heterogeneous study populations and different study designs. Currently, the α1-blocker/antimuscarinic combination appears to be a second-line add-on for patients with insufficient symptom relief after monotherapy. The combination seems to be safe in men with postvoid residual <200 ml. However, there are no trials >4 mo concerning safety and efficacy of this combination. The α1-blocker/phosphodiesterase type 5 inhibitor combination is a new treatment option with only preliminary reports. More studies are needed before definitive conclusions can be drawn. CONCLUSIONS An α1-blocker/5-ARI combination is beneficial for patients whose prostate volume is between 30 ml and 40 ml when medical treatment is intended for >1 yr. Based on short-term follow-up studies, add-on of antimuscarinics to α1-blockers is an option when postvoid residual is <200 ml.
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Affiliation(s)
- Claudius Füllhase
- Department of Urology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
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Klingler C, Margreiter M, Marberger M. New ablative treatments for small renal masses: HIFU ablation. ARCH ESP UROL 2013; 66:79-89. [PMID: 23406803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Solid renal tumours with a diameter <4cm comprise up to half of all renal tumours coming for a therapeutic decision in tertiary care centres today. ∼80% are renal cell cancers, and nephron-sparing excision is standard therapy. The approach has considerable morbidity , and as many of these tumours are diagnosed in elderly ,infirm patients less invasive focal ablation appears attractive. This is usually achieved with radiofrequency or cryoablation, either percutaneously under image guidance or by a laparoscopic approach. The quality of reports on the outcome with this treatment is moderate, with no prospective comparative studies, and in general short follow-up. Metanalyses suggest more reliable results with cyro- than with radiofrequency ablation . Morbidity is lower than with nephron-sparing surgery, but still substantial and almost entirely due to the perforating trauma at ablation. This would be avoided by energy ablation with high-intensity focused ultrasound from an extracorporeal energy source. Phase 1 clinical studies with several prototoypes have been disappointing, as multiple acoustic interphases and target mobility obviously render adequately precise focusing unreliable. New HIFU transducers that can be approximated directly to the tumour via a laparoscopic approach circumvent these problems. A phase 1 study with this technique in 31 patients demonstrates that complete ablation of tumours can be achieved in this manner, at least for tumours <3cm and in a peripheral position in the lower and middle third of the kidney. Perforating trauma to the kidney is avoided, and morbidity is minimized. Of course patients still need long - term follow-up with sequential imaging and even biopsies, and tumour control is most likely less reliable than with standard nephron-sparing surgery.
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Hansen J, Auprich M, Ahyai SA, de la Taille A, van Poppel H, Marberger M, Stenzl A, Mulders PFA, Huland H, Fisch M, Abbou CC, Schalken JA, Fradet Y, Marks LS, Ellis W, Partin AW, Pummer K, Graefen M, Haese A, Walz J, Briganti A, Shariat SF, Chun FK. Initial prostate biopsy: development and internal validation of a biopsy-specific nomogram based on the prostate cancer antigen 3 assay. Eur Urol 2012; 63:201-9. [PMID: 22854248 DOI: 10.1016/j.eururo.2012.07.030] [Citation(s) in RCA: 94] [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] [Received: 05/07/2012] [Accepted: 07/12/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND Urinary prostate cancer antigen 3 (PCA3) assay in combination with established clinical risk factors improves the identification of men at risk of harboring prostate cancer (PCa) at initial biopsy (IBX). OBJECTIVE To develop and validate internally the first IBX-specific PCA3-based nomogram that allows an individual assessment of a man's risk of harboring any PCa and high-grade PCa (HGPCa). DESIGN, SETTING, AND PARTICIPANTS Clinical and biopsy data including urinary PCA3 score of 692 referred IBX men at risk of PCa were collected within two prospective multi-institutional studies. INTERVENTION IBX (≥ 10 biopsy cores) with standard risk factor assessment including prebiopsy urinary PCA3 measurement. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS PCA3 assay cut-off thresholds were investigated. Regression coefficients of logistic risk factor analyses were used to construct specific sets of PCA3-based nomograms to predict any PCa and HGPCa at IBX. Accuracy estimates for the presence of any PCa and HGPCa were quantified using area under the curve of the receiver operator characteristic analysis and compared with a clinical model. Bootstrap resamples were used for internal validation. Decision curve analyses quantified the clinical net benefit related to the novel PCA3-based IBX nomogram versus the clinical model. RESULTS AND LIMITATIONS Any PCa and HGPCa were diagnosed in 46% (n=318) and 20% (n=137), respectively. Age, prostate-specific antigen, digital rectal examination, prostate volume, and PCA3 were independent predictors of PCa at IBX (all p<0.001). The PCA3-based IBX nomograms significantly outperformed the clinical models without PCA3 (all p<0.001). Accuracy was increased by 4.5-7.1% related to PCA3 inclusion. When applying nomogram-derived PCa probability thresholds ≤ 30%, only a few patients with HGPCa (≤ 2%) will be missed while avoiding up to 55% of unnecessary biopsies. External validation of the PCA3-based IBX-specific nomogram is warranted. CONCLUSIONS The internally validated PCA3-based IBX-specific nomogram outperforms a clinical prediction model without PCA3 for the prediction of any PCa, leading to the avoidance of unnecessary biopsies while missing only a few cases of HGPCa. Our findings support the concepts of a combination of novel markers with established clinical risk factors and the superiority of decision tools that are specific to a clinical scenario.
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Affiliation(s)
- Jens Hansen
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Klatte T, Streubel B, Wrba F, Remzi M, Krammer B, de Martino M, Waldert M, Marberger M, Susani M, Haitel A. Renal cell carcinoma associated with transcription factor E3 expression and Xp11.2 translocation: incidence, characteristics, and prognosis. Am J Clin Pathol 2012; 137:761-8. [PMID: 22523215 DOI: 10.1309/ajcpq6llfmc4oxgc] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
We studied the characteristics and prognosis of renal cell carcinoma (RCC) associated with Xp11.2 translocation and transcription factor E3 (TFE3) expression and determined the need for genetic analysis in routine diagnostics. Of 848 consecutive cases, 75 showed microscopic features suggestive of Xp11.2 translocation RCC or occurred in patients 40 years or younger. Of these cases, 17 (23%) showed strong nuclear TFE3 immunostaining, which was associated with more advanced tumors and inverse prognosis in univariate (P = .032) but not multivariate (P = .404) analysis. With fluorescence in situ hybridization and polymerase chain reaction, only 2 cases showed alterations of the X chromosome and the ASPL-TFE3 gene fusion, respectively. In our laboratory, the predictive value of TFE3 expression for the Xp11.2 translocation was 12%. Strong nuclear TFE3 expression is associated with metastatic spread and a poor prognosis. In our laboratory, TFE3 is not diagnostic for Xp11.2 translocation RCC. Diagnosis of Xp11.2 translocation RCC may be made only genetically.
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Affiliation(s)
- Tobias Klatte
- Department of Urology, Medical University of Vienna, Austria
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Cordeiro ER, Cathelineau X, Thüroff S, Marberger M, Crouzet S, de la Rosette JJ. High-intensity focused ultrasound (HIFU) for definitive treatment of prostate cancer. BJU Int 2012; 110:1228-42. [DOI: 10.1111/j.1464-410x.2012.11262.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [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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Chun FKH, Hansen J, de la Taille A, van Poppel H, Marberger M, Stenzl A, Mulders PF, Huland H, Abbou CC, Stillebroer AB, van Gils MP, Schalken JA, Fradet Y, Marks LS, Ellis W, Partin AW, Pummer K, Haese A, Auprich M. 1210 BIOPSY-SPECIFIC PCA3- BASED PROSTATE BIOPSY NOMOGRAMS ARE HIGHLY ACCURATE. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Chun FK, Haese A, de la Taille A, van Poppel H, Marberger M, Mulders PF, Abbou CC, Stillebroer AB, Van Gils MP, Schalken JA, Stenzl A, Fradet Y, Marks LS, Ellis W, Partin AW, Walz J, Auprich M. 1216 DEVELOPMENT OF NOVEL PCA3 CUT-OFFS FOR INITIAL AND REPEAT BIOPSY USING DIFFERENT STATISTICAL APPROACHES WITHIN A US- EUROPEAN MULTI INSTITUTIONAL COHORT. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1505] [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: 10/28/2022]
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Smeenge M, Barentsz J, Cosgrove D, de la Rosette J, de Reijke T, Eggener S, Frauscher F, Kovacs G, Matin SF, Mischi M, Pinto P, Rastinehad A, Rouviere O, Salomon G, Polascik T, Walz J, Wijkstra H, Marberger M. Role of transrectal ultrasonography (TRUS) in focal therapy of prostate cancer: report from a Consensus Panel. BJU Int 2012; 110:942-8. [PMID: 22462566 DOI: 10.1111/j.1464-410x.2012.11072.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
What's known on the subject? and What does the study add? Focal therapy techniques are emerging in prostate cancer treatment. However, several key questions about patient selection, treatment and monitoring still have to be addressed. The concept of focal therapy is barely discussed in current urological guidelines. In the present manuscript, we report the results of a consensus meeting focused on ultrasonography, the most common used urological imaging method, in relation to focal therapy of prostate cancer. • To establish a consensus on the utility of ultrasonography (US) to select patients for focal therapy. Topics were the current status of US to determine focality of prostate cancer, to monitor and assess outcome of focal therapy and the diagnostic advantages of new US methods. In addition, the biopsy techniques required to identify focal lesions were discussed. • Urological surgeons, radiation oncologists, radiologists, and basic researchers from Europe and North America participated in a consensus meeting on the use of transrectal US (TRUS) in focal therapy of prostate cancer. The consensus process was face-to-face and specific clinical issues were raised and discussed with agreement sought when possible. • TRUS is commonly used and essential for diagnosing men with prostate cancer. It is particularly useful for targeting specific anatomical regions or visible lesions. However, it has several limitations and there is a need for improvement. Newer visualisation techniques, e.g. colour Doppler US, contrast-enhanced US and elastography, are being developed but currently there is no US technique that can accurately characterise a cancer suitable for focal therapy. Systematic biopsy is the only known procedure that allows the identification of prostate cancers suitable for focal therapy. Scarce data exist about the role of US for monitoring patients during or after ablative therapy. • Consensus was reached on all key aspects of the meeting. • US cannot reliably identify focal prostate cancer. New US methods show promising results in identifying prostate cancer focality. • Currently selecting appropriate candidates for focal therapy should be performed using dedicated protocols and biopsy schemes.
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Affiliation(s)
- Martijn Smeenge
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands.
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Marberger M, Barentsz J, Emberton M, Hugosson J, Loeb S, Klotz L, Koch M, Shariat SF, Vickers A. Novel approaches to improve prostate cancer diagnosis and management in early-stage disease. BJU Int 2012; 109 Suppl 2:1-7. [DOI: 10.1111/j.1464-410x.2011.10870.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [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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Aumayr K, Breitegger M, Mazal PR, Koller A, Marberger M, Susani M, Haitel A. Quantification of extraprostatic perineural spread and its prognostic value in pT3a pN0 M0 R0 prostate cancer patients. Prostate 2011; 71:1790-5. [PMID: 21563191 DOI: 10.1002/pros.21396] [Citation(s) in RCA: 10] [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: 11/26/2010] [Accepted: 03/16/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND The prognostic relevance of the amount of extraprostatic cancer spread in nerves in prostate cancer patients is not well established. METHODS Eighty-eight patients were included in our study with pT3a pN0 M0 R0 prostate cancer treated with retropubic prostatectomy. Eighty-seven of them showed perineural invasion, 54 were confined to the prostate, 33 showed cancer spread in extraprostatic nerves, which was quantified by counting each transverse section of nerves infiltrated by cancer in totally embedded specimens. Biochemical relapse was established by serum PSA levels of ≥0.2 ng/ml as well as PSA ≥ 0.4 ng/ml and higher according to the EAU guidelines. RESULTS Extraprostatic but not intraprostatic perineural infiltration was significantly more often found in tumors of higher Gleason score. Intraprostatic number of infiltrated nerves (NIN) correlated with extraprostatic NIN. There was no association between extraprostatic or intraprostatic NIN and Gleason score, lymphatic, or blood vessel invasion. Extraprostatic neural infiltration in ≤10 nerves extended relapse free survival in univariate analysis for PSA 0.2 and 0.4 ng/ml (P = 0.002 and P < 0.000001, respectively) and remained significant in multivariate analysis for PSA 0.4 ng/ml (P = 0.039). CONCLUSIONS High amount of extraprostatic NIN correlates with tumor progression and seems to be an independent prognostic parameter.
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Affiliation(s)
- Klaus Aumayr
- Department of Pathology, Medical University of Vienna, Vienna, Austria
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Marberger M. 213 INVITED Treatment of Small Renal Tumours – Surveillance Focal Treatment or Surgery? Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70428-2] [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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van Poppel H, Haese A, Graefen M, de la Taille A, Irani J, de Reijke T, Remzi M, Marberger M. The relationship between Prostate CAncer gene 3 (PCA3) and prostate cancer significance. BJU Int 2011; 109:360-6. [PMID: 21883822 DOI: 10.1111/j.1464-410x.2011.10377.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the relationship between Prostate CAncer gene 3 (PCA3) and prostate cancer significance. PATIENTS AND METHODS Clinical data from two multi-centre European open-label, prospective studies evaluating the clinical utility of the PCA3 assay in guiding initial and repeat biopsy decisions were analysed. First-catch urine was collected after digital rectal examination (three strokes per lobe) and the PCA3 score was determined using the PROGENSA(®) PCA3 assay. Transrectal ultrasound-guided biopsy (≥8 cores) and radical prostatectomy (RP) specimens were analysed by the local pathologist. The relationship between biopsy and RP outcomes with the PCA3 score was assessed. RESULTS Of the 1009 men enrolled, 348 (34%) had a positive biopsy. The median and mean PCA3 scores were statistically significantly lower in men with biopsy Gleason score <7 vs ≥7, with clinical stage T1c vs T2a-T2c, T3a cancers, with ≤33% vs >33% positive biopsy cores and with 'biopsy indolent' vs 'biopsy significant' prostate cancer (indolent prostate cancer defined by biopsy Epstein criteria). In all, 175 men with a positive biopsy had a RP: median and mean PCA3 scores were statistically significantly lower in men with pathological Gleason score <7 vs ≥7, and with pathological stage T2a-T2c vs T3a-T3b cancers. CONCLUSIONS The PCA3 score may combined with traditional tools aid in identifying men with clinically insignificant prostate cancer, as shown by biopsy and RP pathological features including biopsy Epstein criteria, who could be candidates for active surveillance. Treatment selection should be based on a combination of clinical and pathological variables. If one wants to use a threshold point to guide treatment decisions in clinical practice, a PCA3 score threshold of 20 may have the highest utility for selecting men with clinically insignificant prostate cancer in whom active surveillance may be appropriate; a PCA3 score threshold of 50 may be used to identify men at high risk of harbouring significant prostate cancer who are candidates for RP. Although the association between the PCA3 score and prostate cancer aggressiveness needs further evaluation, the inclusion of the PCA3 score into patient management strategies may provide clinicians with another tool to more accurately determine the course of treatment.
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de Martino M, Klatte T, Schatzl G, Waldert M, Remzi M, Haitel A, Kramer G, Marberger M. Insertion/deletion polymorphism of angiotensin I-converting enzyme gene is linked with chromophobe renal cell carcinoma. Urology 2011; 77:1005.e9-1005.e13. [PMID: 21477733 DOI: 10.1016/j.urology.2010.11.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Revised: 11/25/2010] [Accepted: 11/25/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To study the putative significance of angiotensin I-converting enzyme (ACE) in renal cell carcinoma (RCC). Recent evidence has suggested that a 287-base pair insertion (I)/deletion (D) polymorphism (rs4646994) of the angiotensin I-converting enzyme (ACE) might be associated with cancer risk and progression. METHODS The present case-control study accrued 383 subjects, including 210 with RCC and 173 age- and sex-matched healthy individuals without evidence or a history of cancer. Genomic DNA was extracted from the peripheral blood leukocytes. The ACE fragment containing the polymorphism was amplified using conventional polymerase chain reaction using specific primer pairs and subsequently genotyped using agarose gel electrophoresis. RESULTS Overall, a DD genotype and D allele were more frequently noted in the patients with RCC than in the controls (P = .042 and P = .045, respectively), and resulted from a greater frequency of DD and D in chromophobe RCC (P = .023 and P = .020, respectively). In contrast, the genotype and allele distribution of the controls and patients with papillary or clear cell RCC was similar. The II genotype was not observed in any patient with chromophobe RCC. On multivariate logistic regression analysis, the ACE genotype was an independent risk factor for chromophobe RCC (P = .012). Neither the ACE genotypes or alleles were associated with the tumor stage or grade. CONCLUSIONS The results of the present study have shown for the first time that the ACE insertion/deletion gene polymorphism rs4646994 might be linked with the development of chromophobe RCC. Neither the ACE genotypes nor the alleles were associated with RCC progression.
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Van Poppel H, Becker F, Cadeddu JA, Gill IS, Janetschek G, Jewett MAS, Laguna MP, Marberger M, Montorsi F, Polascik TJ, Ukimura O, Zhu G. Treatment of localised renal cell carcinoma. Eur Urol 2011; 60:662-72. [PMID: 21726933 DOI: 10.1016/j.eururo.2011.06.040] [Citation(s) in RCA: 170] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 06/20/2011] [Indexed: 02/08/2023]
Abstract
CONTEXT The increasing incidence of localised renal cell carcinoma (RCC) over the last 3 decades and controversy over mortality rates have prompted reassessment of current treatment. OBJECTIVE To critically review the recent data on the management of localised RCC to arrive at a general consensus. EVIDENCE ACQUISITION A Medline search was performed from January 1, 2004, to May 3, 2011, using renal cell carcinoma, nephrectomy (Medical Subject Heading [MeSH] major topic), surgical procedures, minimally invasive (MeSH major topic), nephron-sparing surgery, cryoablation, radiofrequency ablation, surveillance, and watchful waiting. EVIDENCE SYNTHESIS Initial active surveillance (AS) should be a first treatment option for small renal masses (SRMs) <4 cm in unfit patients or those with limited life expectancy. SRMs that show fast growth or reach 4 cm in diameter while on AS should be considered for treatment. Partial nephrectomy (PN) is the established treatment for T1a tumours (<4 cm) and an emerging standard treatment for T1b tumours (4-7 cm) provided that the operation is technically feasible and the tumour can be completely removed. Radical nephrectomy (RN) should be limited to those cases where the tumour is not amenable to nephron-sparing surgery (NSS). Laparoscopic radical nephrectomy (LRN) has benefits over open RN in terms of morbidity and should be the standard of care for T1 and T2 tumours, provided that it is performed in an advanced laparoscopic centre and NSS is not applicable. Open PN, not LRN, should be performed if minimally invasive expertise is not available. At this time, there is insufficient long-term data available to adequately compare ablative techniques with surgical options. Therefore ablative therapies should be reserved for carefully selected high surgical risk patients with SRMs <4 cm. CONCLUSIONS The choice of treatment for the patient with localised RCC needs to be individualised. Preservation of renal function without compromising the oncologic outcome should be the most important goal in the decision-making process.
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Affiliation(s)
- Hein Van Poppel
- Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium
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de Martino M, Klatte T, Haitel A, Marberger M. Serum cell-free DNA in renal cell carcinoma: a diagnostic and prognostic marker. Cancer 2011; 118:82-90. [PMID: 21713763 DOI: 10.1002/cncr.26254] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 04/10/2011] [Accepted: 04/13/2011] [Indexed: 01/21/2023]
Abstract
BACKGROUND Currently, there are no established diagnostic and prognostic serum markers for renal cell carcinoma (RCC). The objective of this study was to evaluate the putative significance of serum cell-free DNA. METHODS Preoperative serum samples from 200 consecutive patients with sporadic, solid renal tumors were analyzed (157 patients with RCC and 43 patients with benign renal tumors). Quantitative real-time polymerase chain reaction was used to assess total cell-free DNA (ring finger protein 185 [RNF185]) and CpG island methylation of Ras association domain family member 1A (RASSF1A) von Hippel-Lindau (VHL), prostaglandin-endoperoxidase synthase 2 (PTGS2), and P16 (cyclin-dependent kinase inhibitor 2A). Associations with RCC, pathologic variables, and disease-specific survival were evaluated. RESULTS Total cell-free DNA levels and CpG island methylation of RASSF1A and VHL were highly diagnostic for RCC with an area under the receiver operating characteristic curve of 0.755, 0.705, and 0.694, respectively. VHL methylation was detected more frequently in patients with clear cell RCC than in those with other subtypes (P = .007). Total cell-free DNA levels were higher in patients with metastatic RCC (P < .001) and necrotic RCC (P = .003) and were associated with poorer disease-specific survival (P < .001). In multivariate analysis, the tumor stage, size, grade, and necrosis (SSIGN) score (P < .001) and categorized total cell-free DNA levels (P = .028) were retained as independent prognostic factors. CONCLUSIONS The current results indicated that cell-free DNA represents a novel serum-based diagnostic and prognostic biomarker for RCC. Total serum cell-free DNA levels and CpG island methylation of RASSF1A and VHL may be useful diagnostic biomarkers for RCC. VHL methylation of cell-free DNA is suggestive of clear cell RCC. Total serum cell-free DNA may be a useful prognostic biomarker that may assist in tailoring postoperative surveillance and therapy. External prospective validation of these data will be required.
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Marberger M, Freedland SJ, Andriole GL, Emberton M, Pettaway C, Montorsi F, Teloken C, Rittmaster RS, Somerville MC, Castro R. Usefulness of prostate-specific antigen (PSA) rise as a marker of prostate cancer in men treated with dutasteride: lessons from the REDUCE study. BJU Int 2011; 109:1162-9. [PMID: 21699645 DOI: 10.1111/j.1464-410x.2011.10373.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine if dutasteride-treated men can be monitored safely and adequately for prostate cancer based on data from the Reduction by Dutasteride in Prostate Cancer Events (REDUCE) study. To analyse whether the use of treatment-specific criteria for repeat biopsy maintains the usefulness of prostate-specific antigen (PSA) level for detecting high grade cancers. PATIENTS AND METHODS The REDUCE study was a randomized, double-blind, placebo-controlled investigation of whether dutasteride (0.5 mg/day) reduced the risk of biopsy-detectable prostate cancer in men with a previous negative biopsy. The usefulness of PSA was evaluated using biopsy thresholds defined by National Comprehensive Cancer Network guidelines in the placebo group and any rise in PSA from nadir (the lowest PSA level achieved while in the study) in the dutasteride group. The number of cancers detected on biopsy in the absence of increased/suspicious PSA level as well as sensitivity, specificity, positive predictive value and negative predictive value for high grade prostate cancer detection were analysed by treatment group. Prostate cancer pathological characteristics were compared between men who did and did not meet biopsy thresholds. RESULTS Of 8231 men randomized, 3305 (dutasteride) and 3424 (placebo) underwent at least one prostate biopsy during the study and were included in the analysis. If only men meeting biopsy thresholds underwent biopsy, 25% (47/191) of Gleason 7 and 24% (7/29) of Gleason 8-10 cancers would have been missed in the dutasteride group, and 37% (78/209) of Gleason 7 and 22% (4/18) Gleason 8-10 cancers would have been missed in the placebo group. In both groups, the incidence of Gleason 7 and Gleason 8-10 cancers generally increased with greater rises in PSA. Sensitivity of PSA kinetics was higher and specificity was lower for the detection of Gleason 7-10 cancers in men treated with dutasteride vs placebo. Men with Gleason 7 and Gleason 8-10 cancer meeting biopsy thresholds had greater numbers of positive cores, percent core involvement, and biopsy cancer volume vs men not meeting thresholds. CONCLUSION Using treatment-specific biopsy thresholds, the present study shows that the ability of PSA kinetics to detect high grade prostate cancer is maintained with dutasteride compared with placebo in men with a previous negative biopsy. The sensitivity of PSA kinetics with dutasteride was similar to (Gleason 8-10) or higher than (Gleason 7-10) the placebo group; however, biopsy decisions based on a single increased PSA measurement from nadir in the dutasteride group resulted in a lower specificity compared with using a comparable biopsy threshold in the placebo group, indicating the importance of confirmation of PSA measurements.
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Mitteregger D, Aberle SW, Makristathis A, Walochnik J, Brozek W, Marberger M, Kramer G. High detection rate of Trichomonas vaginalis in benign hyperplastic prostatic tissue. Med Microbiol Immunol 2011; 201:113-6. [DOI: 10.1007/s00430-011-0205-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Indexed: 11/24/2022]
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De Nunzio C, Kramer G, Marberger M, Montironi R, Nelson W, Schröder F, Sciarra A, Tubaro A. The controversial relationship between benign prostatic hyperplasia and prostate cancer: the role of inflammation. Eur Urol 2011; 60:106-17. [PMID: 21497433 DOI: 10.1016/j.eururo.2011.03.055] [Citation(s) in RCA: 298] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 03/31/2011] [Indexed: 12/29/2022]
Abstract
CONTEXT Prostate cancer (PCa) is the most common cancer in the adult male, and benign prostatic hyperplasia (BPH) represents the most frequent urologic diagnosis in elderly males. Recent data suggest that prostatic inflammation is involved in the pathogenesis and progression of both conditions. OBJECTIVE This review aims to evaluate the available evidence on the role of prostatic inflammation as a possible common denominator of BPH and PCa and to discuss its possible clinical implication for the management, prevention, and treatment of both diseases. EVIDENCE ACQUISITION The National Library of Medicine Database was searched for the following Patient population, Intervention, Comparison, Outcome (PICO) terms: male, inflammation, benign prostatic hyperplasia, prostate cancer, diagnosis, progression, prognosis, treatment, and prevention. Basic and clinical studies published in the past 10 yr were reviewed. Additional references were obtained from the reference list of full-text manuscripts. EVIDENCE SYNTHESIS The histologic signature of chronic inflammation is a common finding in benign and malignant prostate tissue. The inflammatory infiltrates are mainly represented by CD3(+) T lymphocytes (70-80%, mostly CD4), CD19 or CD20 B lymphocytes (10-15%), and macrophages (15%). Bacterial infections, urine reflux, dietary factors, hormones, and autoimmune response have been considered to cause inflammation in the prostate. From a pathophysiologic standpoint, tissue damage associated with inflammatory response and subsequent chronic tissue healing may result in the development of BPH nodules and proliferative inflammatory atrophy (PIA). The loss of glutathione S-transferase P1 (GSTP1) may be responsible in patients with genetic predisposition for the transition of PIA into high-grade intraepithelial neoplasia (HGPIN) and PCa. Although there is growing evidence of the association among inflammatory response, BPH, and PCa, we can only surmise on the immunologic mechanisms involved, and further research is required to better understand the role of prostatic inflammation in the initiation of BPH and PCa. There is not yet proof that targeting prostate inflammation with a pharmacologic agent results in a lower incidence and progression or regression of either BPH or PCa. CONCLUSIONS Evidence in the peer-reviewed literature suggested that chronic prostatic inflammation may be involved in the development and progression of chronic prostatic disease, such as BPH and PCa, although there is still no evidence of a causal relation. Inflammation should be considered a new domain in basic and clinical research in patients with BPH and PCa.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy.
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Auprich M, van Poppel H, Marberger M, Stenzl A, Mulders PF, Huland H, Abbou CC, Stillebroer AB, van Gils MP, Schalken JA, Fradet Y, Marks LS, de la Taille A, Ellis W, Partin AW, Haese A. 2320 INITIAL AND REPEAT PROSTATE BIOPSY: COMPARATIVE PERFORMANCE ANALYSIS OF PSA, %FPSA, PROSTATE VOLUME AND URINARY PCA3 INCLUDING DEVELOPMENT OF NOVEL PCA3 CUT-OFF THRESHOLDS. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.2567] [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: 11/15/2022]
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Pettaway CA, Nickel JC, Marberger M, Wilson TH, Rittmaster RS. 2136 EFFICACY OF DUTASTERIDE IN MEN WITH LOW PROSTATE VOLUME IN THE REDUCTION BY DUTASTERIDE OF PROSTATE CANCER EVENTS (REDUCE) STUDY. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.2333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Auprich M, Haese A, van Poppel H, Marberger M, Stenzl A, Mulders PF, Huland H, Abbou CC, Stillebroer AB, van Gils MP, Schalken JA, Fradet Y, Marks LS, de la Taille A, Ellis W, Partin AW, Chun FKH. 987 CRITICAL ASSESSMENT OF URINARY PROSTATE CANCER GENE 3 (PCA3) IN THE PREDICTION OF AGGRESSIVE PROSTATE CANCER (GLEASON SCORE ≥ 7) AT BIOPSY. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.1019] [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: 10/18/2022]
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Marberger M, McConnell JD, Fowler I, Andriole GL, Bostwick DG, Somerville MC, Rittmaster RS. Biopsy misidentification identified by DNA profiling in a large multicenter trial. J Clin Oncol 2011; 29:1744-9. [PMID: 21444877 DOI: 10.1200/jco.2010.32.1646] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Reduction by Dutasteride of Prostate Cancer Events (REDUCE) prostate cancer risk reduction study randomly assigned 8,231 men to dutasteride or placebo for 4 years. Protocol-mandated biopsies were obtained after 2 and 4 years. After the discovery of three cases of biopsy sample misidentification in the first 2 years, all protocol-mandated biopsy samples were DNA tested to verify biopsy identity. METHODS Biopsy and blood DNA profiling was performed retrospectively for the year 2 scheduled biopsies and prospectively for the year 4 scheduled biopsies. Toward the end of year 2, multiple changes were made to improve sample handling and chain of custody. RESULTS Of the 6,458 year 2 and 4,777 year 4 biopsies, 26 biopsies reflecting 13 sample handling errors at year 2 (0.4%) and one biopsy reflecting one sample handling error at year 4 (0.02%) were confirmed to be mismatched to the patient for whom they were originally submitted. Of 6,733 reference blood samples profiled, 31 (0.5%) were found to be mismatched to the patient's verified identity profile. Sample identification errors occurred at local research sites and central laboratories. CONCLUSION Biopsy misidentification is a potential problem in clinical laboratories and clinical trials. Until now, biopsy misidentification has not been studied in the setting of a large, multinational clinical trial. In the REDUCE study, process improvement initiatives halfway through the trial dramatically reduced biopsy mismatches. The potential for biopsy mismatches in clinical trials and clinical practice is an under-recognized problem that requires rigorous attention to details of chain of custody and consideration of more widespread DNA identity testing.
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Affiliation(s)
- Michael Marberger
- Department of Urology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
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Ploussard G, Haese A, Van Poppel H, Marberger M, Stenzl A, Mulders PFA, Huland H, Bastien L, Abbou CC, Remzi M, Tinzl M, Feyerabend S, Stillebroer AB, Van Gils MPMQ, Schalken JA, de La Taille A. The prostate cancer gene 3 (PCA3) urine test in men with previous negative biopsies: does free-to-total prostate-specific antigen ratio influence the performance of the PCA3 score in predicting positive biopsies? BJU Int 2011; 106:1143-7. [PMID: 20230386 DOI: 10.1111/j.1464-410x.2010.09286.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [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
OBJECTIVE to determine the performance characteristics of the prostate cancer gene 3 (PCA3) score on the outcome of biopsy relative to different ranges of free-to-total prostate-specific antigen (PSA) ratio (f/tPSA) in men with a previous negative biopsy and a PSA level of 2.5-10 ng/mL, as urine tests like PCA3 are currently under investigation in order to improve prostate cancer diagnosis and to decrease the rate of unnecessary rebiopsies. PATIENTS AND METHODS data from the previous prospective European multicentre study were reviewed. Only patients with a PSA level of 2.5-10 ng/mL were included in the present study. In all, 301 patients had complete data. The diagnostic accuracy of the PCA3 score for predicting a positive biopsy outcome was studied using sensitivity, specificity, negative and positive predictive values. The PCA3 performance was evaluated relative to three different subgroups of f/tPSA, as follows: >20% (group 1), 10-20% (group 2) and <10% (group 3). RESULTS the prostate cancer detection rates were 18.8%, 23.9% and 34.8% in groups 1, 2 and 3, respectively. The area under the receiver operating characteristic curve of the PCA3 score, total PSA and f/tPSA was 0.688, 0.553 and 0.571, respectively. The percentage of men with positive biopsies was 30.6%, 37.0% and 44.4% in those with a PCA3 score of >30, vs 10.3%, 15.5% and 28.6% when the PCA3 score was <30, in groups 1, 2 and 3, respectively. The difference was significant only in groups 1 and 2. In men with a f/tPSA of ≤ 10% the difference in detection rates relative to the PCA3 score was not statistically significant regardless of which PCA3 threshold was used. A high PCA3 score was significantly associated with age, clinical T2 stage and positive biopsy (P < 0.001, 0.013 and <0.001, respectively). In bivariate analysis accounting for the PCA3 score and the f/tPSA, a PCA3 score of >30 was a significant independent predictor of positive biopsies (odds ratio 3.01; 95% confidence interval 1.74-5.23; P < 0.001). CONCLUSIONS PCA3 remained a better predictor of prostate cancer than f/tPSA. In men with a f/tPSA of >10%, the use of the PCA3 score was highly correlated with the risk of having cancer on re-biopsy, and could prevent unnecessary prostate biopsies if the value is low.
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Andriole GL, Bostwick D, Brawley OW, Gomella L, Marberger M, Montorsi F, Pettaway C, Tammela TL, Teloken C, Tindall D, Freedland SJ, Somerville MC, Wilson TH, Fowler I, Castro R, Rittmaster RS. The Effect of Dutasteride on the Usefulness of Prostate Specific Antigen for the Diagnosis of High Grade and Clinically Relevant Prostate Cancer in Men With a Previous Negative Biopsy: Results From the REDUCE Study. J Urol 2011; 185:126-31. [DOI: 10.1016/j.juro.2010.09.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Gerald L. Andriole
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | | | - Otis W. Brawley
- American Cancer Society and Emory University, Atlanta, Georgia
| | - Leonard Gomella
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | | | - Curtis Pettaway
- The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Claudio Teloken
- UFCSPA - Federal University of Health Sciences and Santa Casa Hospital, Porto Alegre, Brazil
| | | | | | | | | | - Ivy Fowler
- GlaxoSmithKline, Research Triangle Park, North Carolina
| | - Ramiro Castro
- GlaxoSmithKline, Research Triangle Park, North Carolina
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Kontur S, Schatzl G, Valimberti E, Marberger M. C15 DIFFERENCES IN OBJECTIVE AND SUBJECTIVE GRADE OF INCONTINENCE AFTER RADICAL PROSTATECTOMY - A LONG TERM FOLLOW UP STUDY. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1569-9056(10)61538-2] [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: 11/27/2022]
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Margreiter M, Marberger M. Focal therapy and imaging in prostate and kidney cancer: high-intensity focused ultrasound ablation of small renal tumors. J Endourol 2010; 24:745-8. [PMID: 20380511 DOI: 10.1089/end.2009.0624] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The rising incidence of small, incidentally detected renal masses in elderly, infirm patients has raised interest in minimally invasive, energy ablative techniques. High-intensity focused ultrasound (HIFU) delivers ultrasonic energy, resulting in heat and tissue destruction in the targeted tissue at a selected depth. In contrast to radiofrequency ablation and cryoablation, HIFU does not require puncturing the tumor, avoiding the high risk of hemorrhage or tumor spillage. While the extracorporeal approach shows unsatisfactory results, laparoscopic HIFU appears to be a promising alternative treatment option. Problems with respiratory movement and interphases, as seen in extracorporeal HIFU, are avoided when the transducer is brought directly to the target by laparoscopic HIFU. Potential benefits of laparoscopic HIFU are decreased morbidity, shorter hospitalization and convalescence, and preservation of renal function. Nevertheless, further prospective studies have to be performed to define the oncological success of HIFU as an alternative to open and laparoscopic surgery in small renal masses.
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Affiliation(s)
- Markus Margreiter
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Klatte T, Remzi M, Zigeuner RE, Mannweiler S, Said JW, Kabbinavar FF, Haitel A, Waldert M, de Martino M, Marberger M, Belldegrun AS, Pantuck AJ. Development and External Validation of a Nomogram Predicting Disease Specific Survival After Nephrectomy for Papillary Renal Cell Carcinoma. J Urol 2010; 184:53-8. [DOI: 10.1016/j.juro.2010.03.026] [Citation(s) in RCA: 34] [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] [Received: 11/17/2009] [Indexed: 01/20/2023]
Affiliation(s)
- Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Mesut Remzi
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | | | - Jonathan W. Said
- Department of Pathology and Laboratory Medicine, University of California-Los Angeles, Los Angeles, California
| | - Fairooz F. Kabbinavar
- Department of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Andrea Haitel
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Matthias Waldert
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | - Michael Marberger
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Arie S. Belldegrun
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Allan J. Pantuck
- Department of Urology, University of California-Los Angeles, Los Angeles, California
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Bostwick DG, Qian J, Drewnowska K, Varvel S, Bostwick KC, Marberger M, Rittmaster RS. Prostate Needle Biopsy Quality in Reduction by Dutasteride of Prostate Cancer Events Study: Worldwide Comparison of Improvement With Investigator Training and Centralized Laboratory Processing. Urology 2010; 75:1406-10. [DOI: 10.1016/j.urology.2009.07.1348] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 07/14/2009] [Accepted: 07/18/2009] [Indexed: 10/20/2022]
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Drewnowska K, Bostwick DG, Qian J, A.arvel S, Bostwick KC, Sigler M, Marberger M, Rittmaster RS. Correlation between quality of prostate biopsy and pathological diagnosis in the REDUCE study after 2 and 4 years of treatment with dutasteride. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e15056] [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: 11/20/2022] Open
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Marberger M. Editorial comment on: complications of laparoscopic and percutaneous renal cryoablation in a single tertiary referral center. Eur Urol 2010; 58:147-8. [PMID: 20363549 DOI: 10.1016/j.eururo.2010.03.040] [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]
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Auprich M, Haese A, de la Taille A, Graefen M, Kil P, Gontero P, van Poppel H, Stenzl A, de Reijke T, Marberger M, Chun F. 2156 INITIAL PROSTATE BIOPSY: PCA3 OUTPERFORMS ESTABLISHED RISK FACTORS OF PROSTATE CANCER AND INCREASES MULTIVARIATE PREDICTIVE ACCURACY. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.2258] [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: 10/19/2022]
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Andriole GL, Bostwick DG, Brawley OW, Gomella LG, Marberger M, Montorsi F, Pettaway CA, Tammela TL, Teloken C, Tindall DJ, Somerville MC, Wilson TH, Fowler IL, Rittmaster RS. Effect of dutasteride on the risk of prostate cancer. N Engl J Med 2010; 362:1192-202. [PMID: 20357281 DOI: 10.1056/nejmoa0908127] [Citation(s) in RCA: 762] [Impact Index Per Article: 54.4] [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: 01/16/2023]
Abstract
BACKGROUND We conducted a study to determine whether dutasteride reduces the risk of incident prostate cancer, as detected on biopsy, among men who are at increased risk for the disease. METHODS In this 4-year, multicenter, randomized, double-blind, placebo-controlled, parallel-group study, we compared dutasteride, at a dose of 0.5 mg daily, with placebo. Men were eligible for inclusion in the study if they were 50 to 75 years of age, had a prostate-specific antigen (PSA) level of 2.5 to 10.0 ng per milliliter, and had had one negative prostate biopsy (6 to 12 cores) within 6 months before enrollment. Subjects underwent a 10-core transrectal ultrasound-guided biopsy at 2 and 4 years. RESULTS Among 6729 men who underwent a biopsy or prostate surgery, cancer was detected in 659 of the 3305 men in the dutasteride group, as compared with 858 of the 3424 men in the placebo group, representing a relative risk reduction with dutasteride of 22.8% (95% confidence interval, 15.2 to 29.8) over the 4-year study period (P<0.001). Overall, in years 1 through 4, among the 6706 men who underwent a needle biopsy, there were 220 tumors with a Gleason score of 7 to 10 among 3299 men in the dutasteride group and 233 among 3407 men in the placebo group (P=0.81). During years 3 and 4, there were 12 tumors with a Gleason score of 8 to 10 in the dutasteride group, as compared with only 1 in the placebo group (P=0.003). Dutasteride therapy, as compared with placebo, resulted in a reduction in the rate of acute urinary retention (1.6% vs. 6.7%, a 77.3% relative reduction). The incidence of adverse events was similar to that in studies of dutasteride therapy for benign prostatic hyperplasia, except that in our study, as compared with previous studies, the relative incidence of the composite category of cardiac failure was higher in the dutasteride group than in the placebo group (0.7% [30 men] vs. 0.4% [16 men], P=0.03). CONCLUSIONS Over the course of the 4-year study period, dutasteride reduced the risk of incident prostate cancer detected on biopsy and improved the outcomes related to benign prostatic hyperplasia. (ClinicalTrials.gov number, NCT00056407.)
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Affiliation(s)
- Gerald L Andriole
- Division of Urology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA.
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Auprich M, Haese A, Graefen M, de Reijke T, van Poppel H, de la Taille A, Stenzl A, Gontero P, Kil P, Marberger M, Chun F. 2132 VALIDATION OF PCA3- BASED NOMOGRAMS FOR PREDICTING POSITIVE BIOPSY FOR PROSTATE CANCER. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.2220] [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: 10/19/2022]
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Haese A, Auprich M, de la Taille A, de Reijke T, Kil P, Gontero P, van Poppel H, Graefen M, Marberger M, Stenzl A, Chun F. 2155 THE DIAGNOSTIC PERFORMANCE OF THE PCA3-SCORE IN RELATION TO THE NUMBER OF BIOPSY (BX) SESSIONS: RESULTS OF A MULTINATIONAL ANALYSIS OF 1251 MEN. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.2257] [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: 10/19/2022]
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