S A Loening

Humboldt-Universität zu Berlin, Berlín, Berlin, Germany

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Publications (354)909.09 Total impact

  • M. Lein, C. Stephan, K. Jung, D. Schnorr, S. A. Loening
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    ABSTRACT: Das prostataspezifische Antigen (PSA) ist die wichtigste Kenngröße in der Diagnostik und Therapieüberwachung des Prostatakarzinoms. Zur besseren Abgrenzung zwischen benigner Prostatahyperplasie (BPH) und Prostatakarzinom, aber auch zur Früherkennung des Prostatakarzinoms haben sich die molekularen Formen des PSA und neuerdings auch das humane Kallikrein 2 (hK2) als wertvolle Entscheidungshilfen erwiesen. Es wird eine Literaturübersicht über bisher vorliegende Informationen zur Aussagekraft des freien PSA (fPSA) in Relation zum Gesamt-PSA (tPSA), des an α1-Antichymotrypsin gebundenen PSA (ACT-PSA) und des komplexierten PSA (cPSA) zusammen mit eigenen Resultaten gegeben. Der Quotient fPSA/tPSA (fPSA%) hat sich bereits als eine wichtige Entscheidungsgröße in der urologischen Praxis etabliert, mit der Sensitivität und Spezifität der Prostatakarzinomdiagnostik verbessert werden. Die Zahl von Prostatastanzbiopsien im tPSA-Bereich 4–10 μg/l kann damit reduziert und bei tPSA-Werten <4 μg/l können zusätzlich unerkannte Karzinompatienten identifiziert werden. Ein diagnostischer Vorteil der alleinigen Bestimmung des gebundenen PSA bzw. der entsprechenden Quotienten (ACT-PSA/tPSA oder cPSA/tPSA) im Vergleich zum fPSA% konnte bisher nicht sicher nachgewiesen werden. Die Bestimmungen der anderen molekularen PSA-Formen und des hK2 sind noch weitgehend Gegenstand der Forschung bzw. erfordern noch entsprechende klinische Evaluierungen. Prostate-specific antigen (PSA) is the most useful marker in the early detection of prostate cancer and in the monitoring of patients with this diagnosis. Molecular forms of PSA and human kallikrein 2 (hK2) have been used to discriminate between benign prostatic hyperplasia and prostate cancer, as well as for the detection of prostate cancer within the gray zone of PSA. In this respect, a literature survey on the diagnostic validity of free PSA (fPSA) related to total PSA (tPSA), PSA bound to α1-antichymotrypsin (ACT-PSA), and complexed PSA (cPSA) is given together with our own results. The ratio of fPSA/tPSA has been shown to improve both sensitivity and specificity of prostate cancer diagnosis based on tPSA measurements. The number of biopsies can be reduced in the total PSA range of 4–10 μg/l. Furthermore, carcinomas can be detected in patients with PSA values less than 4 μg/l. ACT-PSA or cPSA alone and the calculated derivatives are not superior in their discriminatory power compared with tPSA and the fPSA% value. The other molecular PSA forms and hK2 are still objects of research and their diagnostic significance needs to be evaluated in more extensive clinical trials.
    Der Urologe 05/2012; 39(4):313-323. · 0.46 Impact Factor
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    ABSTRACT: In the early 1950s, Rubin H. Flocks of the University of Iowa began to treat prostate cancer patients with colloidal gold (Au(198)) therapy, evolving his technique over nearly 25 years in 1515 patients. We reviewed the long-term outcomes of Flocks' prostate cancer patients as compared to those patients treated by other methods at the University of Iowa before Flocks' chairmanship. We reviewed archived patient records, Flocks' published data, and long-term survival data from the Iowa Tumor Registry to determine short- and long-term outcomes of Flocks' work with colloidal gold. We also reviewed the literature of Flocks' time to compare his outcomes against those of his contemporaries. The use of colloidal gold, either as primary or adjunctive therapy, provided short- and long-term survival benefit for the majority of Flocks' patients as compared to historical treatment options (p < 0.001). Flocks' use of colloidal gold for the treatment of locally advanced prostate cancer offered short- and long-term survival benefits compared to other contemporary treatments.
    The Scientific World Journal 01/2011; 11:1560-7. · 1.73 Impact Factor
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    ABSTRACT: Patients with metastatic papillary renal cell carcinoma (RCC) show special clinical behavior compared to patients with other histologic subtypes of RCC. This study aimed to assess the relevance of surgical and systemic options used in treatment of these patients prior to the recent era of targeted therapies. Retrospectively, we assessed clinical data of 61 patients with metastatic papillary RCC who were treated at eight centers in Germany. Median follow-up was 20 (range 1-114) months and median age at time of diagnosis was 62 (range 24-85) years. Men were affected predominantly (50/61; 82%). Twenty-one patients (34%) showed metastases at time of diagnosis. In the remaining 40 patients, median time to development of metastases was 30.4 (range 3-143; mean 16.5) months. Sites of metastases were lung (37; 61%), bone (24; 38%), liver (20; 33%), lymph nodes (24; 38%), and local recurrence (17; 28%). Others sites of disease were brain metastases (6 patients/10%), peritoneal carcinosis (5 patients/8%), and others. A surgical approach with potentially curative intention was performed primarily in 11 patients (18%). 31 patients received an immuno- (interferon-alpha +/- interleukin-2) or immunochemotherapy as first line treatment for metastatic disease. Overall, 42/61 patients (69%) received systemic therapy. Supportive care only was performed in 12 patients (20%) because of poor performance status. Median overall survival after diagnosis of metastatic disease was longer than 48 months in patients with tumor resection (n = 11) compared to 13.0 +/- 4.3 months 95% CI 4.5-21.5 (n = 42) months in patients without surgical approach. Complete resection of metastases represents a valid option in management of patients with relapsing or metastatic papillary RCC.
    Journal of Cancer Research and Clinical Oncology 12/2009; 136(6):905-10. · 2.91 Impact Factor
  • European Urology Supplements - EUR UROL SUPPL. 01/2008; 7(3):257-257.
  • European Urology Supplements - EUR UROL SUPPL. 01/2008; 7(3):137-137.
  • Der Urologe 10/2007; 46(9):1087-8. · 0.46 Impact Factor
  • Der Urologe 10/2007; 46(9):1081-2. · 0.46 Impact Factor
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    ABSTRACT: Worldwide, specific pediatric allocation schemes successfully try to minimize waiting time for children with end-stage renal disease (ESRD). The article is a review of current issues in pediatric kidney transplantation. The procedure is the treatment of choice for children and adolescents with ESRD, with 1- and 3-year graft survival rates of 95% and 90% and recipient survival after 5 and 10 years of 95% and 90%. Preoperative surgery is often necessary to minimize negative effects of congenital anomalies. No minimum age exists for pediatric transplantation, but most often the recipient body weight is ideally above 10 to 15 kg. Technical concepts should include extravesical anastomosis, stenting of the ureter, and potentially intraperitoneal placement of the graft. Immunosuppression has constantly improved. The aim is a tailored regimen to reduce side effects and improve compliance, which necessitates intense counseling of the child and the parents prior to, during, and after transplantation as many adolescents lose their graft due to noncompliance. Intense follow-up must also exclude infections, especially with herpes and polyoma viruses. For the future, age matching may be only one promising concept to improve results. As only a small number of children require the procedure in each country, multinational studies should be initiated to optimize outcomes in children and adolescents.
    Transplantation Proceedings 10/2007; 39(7):2197-201. · 0.95 Impact Factor
  • Der Urologe 10/2007; 46(9):1084-6. · 0.46 Impact Factor
  • Der Urologe 10/2007; 46(9):1083-4. · 0.46 Impact Factor
  • Der Urologe 08/2007; 46(9):1084-1086. · 0.46 Impact Factor
  • Der Urologe 08/2007; 46(9):1087-1088. · 0.46 Impact Factor
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    ABSTRACT: To investigate the treatment-related morbidity and quality of life (QoL) during thermotherapy using superparamagnetic nanoparticles in patients with locally recurrent prostate cancer. Ten patients with biopsy-proven locally recurrent prostate cancer following primary therapy with curative intent and no detectable metastases were entered on a prospective phase I trial. Endpoints were feasibility, toxicity and QoL. Following intraprostatic injection of a nanoparticle dispersion, six thermal therapy sessions of 60 min duration were delivered at weekly intervals using an alternating magnetic field. National Cancer Institute (NCI) common toxicity criteria (CTC) and the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-PR25 questionnaires were used to evaluate toxicity and QoL, respectively. In addition, prostate specific antigen (PSA) measurements were carried out. Maximum temperatures up to 55 degrees C were achieved in the prostates at 25-30% of the available magnetic field strength. Nanoparticle deposits were detectable in the prostates one year after thermal therapy. At a median follow-up of 17.5 months (3-24), no systemic toxicity was observed. Acute urinary retention occurred in four patients with previous history of urethral stricture. Treatment-related morbidity was moderate and QoL was only temporarily impaired. Prostate-specific antigen (PSA) declines were observed in eight patients. Interstitial heating using magnetic nanoparticles was feasible and well tolerated in patients with locally recurrent prostate cancer. Deposition of nanoparticles in the prostate was highly durable. Further refinement of the technique is necessary to allow application of higher magnetic field strengths.
    International Journal of Hyperthermia 06/2007; 23(3):315-23. · 2.59 Impact Factor
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    ABSTRACT: En recientes ensayos clínicos, se ha evaluado en tumores malignos humanos, un nuevo método de dispensación de calor en pequeños espacios (intersticios) utilizando nanopartículas magnéticas y una técnica de inyección directa. En el cáncer de próstata, este procedimiento se ha investigado en dos estudios fase I separados empleando en uno solamente termoterapia de nanopartículas magnéticas y en otro en combinación con braquiterapia (implantes permanentes). En ambos estudios se demostró viabilidad y buena tolerancia, usando el primer prototipo de un aplicador de campo magnético. Como con cualquier otra técnica por calor, este nuevo procedimiento requiere herramientas específicas para su planificación, control de calidad y monitorización térmica, basado en una imagen apropiada y en técnicas de planificación. En estos primeros estudios, se evalúa un nuevo método que permite una planificación y distribución tridimensional no invasiva de la temperatura basado en la tomografía computerizada (TC). En la actualidad, los factores limitantes de este procedimiento son el malestar del paciente a altas intensidades de campos magnéticos y la distribución intratumoral subóptima de las nanopartículas. Hasta que estas limitaciones sean superadas y la termoablación pueda ser aplicada con seguridad como monoterapia, esta modalidad de tratamiento está siendo evaluada en combinación con la irradiación en pacientes con cáncer de próstata localizado.
    Actas urologicas españolas 06/2007; 31(6):660-667. · 1.14 Impact Factor
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    ABSTRACT: Fast-track surgery describes innovative treatment concepts ensuring a faster convalescence phase. The aim of this study was to allow hospital discharge 3 days after surgery without additional complications in patients receiving LRPE for localized prostate cancer. Twenty-five patients each were randomized in the study groups to verify if a fast-track regimen could be transferred into clinical routine. The perioperative data, early complications, hospital stay as well as readmission rate were analyzed. The mean postoperative stay was 3.6 days in the fast-track group versus 6.7 days in the conventional group. The overall complications were significantly less in the fast-track procedure. The readmission rate was low and not significant. Patients receiving an LRPE benefit from a suitable fast-track concept. The postoperative hospital stay could be shortened nearly by half with a significantly decreased overall complication rate. Thus, fast-track concepts might contribute to saving resources in the long term. However, more evidence based on larger prospective trials is needed to achieve optimal quality of life for patients perioperatively.
    World Journal of Urology 05/2007; 25(2):185-91. · 2.89 Impact Factor
  • European Urology Supplements 03/2007; 6(2):49-49. · 3.37 Impact Factor
  • European Urology Supplements 03/2007; 6(2):201-201. · 3.37 Impact Factor
  • European Urology Supplements 03/2007; 6(2):223-223. · 3.37 Impact Factor
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    ABSTRACT: The systemic treatment of renal cell cancer represents a challenge for uro-oncologists. Although no internationally recognised treatment regime has been defined, cytokine therapy has been the standard of care for metastatic disease. The growing understanding of the relevant mechanisms in the molecular biology of renal cell carcinoma has led to the development of targeted therapies. Novel tyrosine kinase and angiogenesis inhibitors have had a beneficial effect on progression-free and overall survival in patients with advanced renal cell cancer and represented a significant progress. Even though several important aspects regarding treatments and combinations of these drugs with each other as well as with cytokines still remain unclear, cytokine therapy will probably become less important as a first-line treatment. With increasing therapeutic options becoming available as potential new standards and with the old standards being poorly defined, a critical analysis of the role of different systemic therapies for renal cell carcinoma is warranted. A better knowledge of molecular markers and their prognostic relevance could allow the rational use of different targeted therapies in individual patients in the future. Until such therapies become available, the systemic treatment options should be selected carefully in individual patients.
    Aktuelle Urologie 02/2007; 38(1):38-45. · 0.47 Impact Factor
  • European Urology Supplements - EUR UROL SUPPL. 01/2007; 6(2):179-179.

Publication Stats

5k Citations
909.09 Total Impact Points

Institutions

  • 1993–2012
    • Humboldt-Universität zu Berlin
      • • Department of Psychology
      • • Department of Biology
      Berlín, Berlin, Germany
  • 1997–2007
    • Charité Universitätsmedizin Berlin
      • • Department of Urology
      • • Institute of Radiology
      Berlin, Land Berlin, Germany
  • 2001
    • St.-Antonius-Hospital Eschweiler
      Eschweiler, North Rhine-Westphalia, Germany
  • 2000
    • University of Innsbruck
      Innsbruck, Tyrol, Austria
  • 1999
    • Ruppiner Kliniken GmbH
      Berlín, Berlin, Germany
  • 1998
    • Harvard Medical School
      Boston, Massachusetts, United States
    • Massachusetts General Hospital
      • Department of Urology
      Boston, MA, United States
    • Humboldt State University
      Arcata, California, United States
  • 1978–1996
    • University of Iowa
      • • Department of Urology
      • • Department of Biomedical Engineering
      • • Department of Pathology
      Iowa City, IA, United States
  • 1983
    • Roswell Park Cancer Institute
      Buffalo, New York, United States
  • 1980
    • University of Iowa Children's Hospital
      Iowa City, Iowa, United States