Michael A Gorin

University of Wuerzburg, Würzburg, Bavaria, Germany

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Publications (112)436.34 Total impact

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    ABSTRACT: We developed a new scaffold for radionuclide-based imaging and therapy of clear cell renal cell carcinoma (ccRCC) targeting carbonic anhydrase IX (CAIX). Compound XYIMSR-01, a DOTA-conjugated, bivalent, low-molecular-weight ligand, has two moieties that target two separate sites on CAIX, imparting high affinity. We synthesized [111In]XYIMSR-01 in 73.8-75.8% (n = 3) yield with specific radioactivities ranging from 118 - 1,021 GBq/μmol (3,200-27,600 Ci/mmol). Single photon emission computed tomography of [111In]XYIMSR-01 in immunocompromised mice bearing CAIX-expressing SK-RC-52 tumors revealed radiotracer uptake in tumor as early as 1 h post-injection. Biodistribution studies demonstrated 26% injected dose per gram of radioactivity within tumor at 1 h. Tumor-to-blood, muscle and kidney ratios were 178.1 ± 145.4, 68.4 ± 29.0 and 1.7 ± 1.2, respectively, at 24 h post-injection. Retention of radioactivity was exclusively observed in tumors by 48 h, the latest time point evaluated. The dual targeting strategy to engage CAIX enabled specific detection of ccRCC in this xenograft model, with pharmacokinetics surpassing those of previously described radionuclide-based probes against CAIX.
    Oncotarget 09/2015; DOI:10.18632/oncotarget.5254 · 6.36 Impact Factor
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    ABSTRACT: Renal cell carcinoma (RCC) is common with more than 60,000 new cases in the United States yearly. No curative therapies are available for metastatic RCC. Improved methods of imaging metastatic RCC would be of value in identifying sites of occult disease and potentially for judging response to therapy. A 58-year-old man with known metastatic clear cell RCC was imaged with both F-FDG and F-DCFPyL PET/CT. F-DCFPyL is a small molecule inhibitor of the prostate-specific membrane antigen (PSMA), a target known to be highly expressed on solid tumor neovasculature. Relative to F-FDG, F-DCFPyL identified more lesions and demonstrated higher tumor radiotracer uptake.
    Clinical nuclear medicine 09/2015; DOI:10.1097/RLU.0000000000000995 · 3.93 Impact Factor
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    ABSTRACT: Patient summary: We found that the imaging test (99m)Tc-sestamibi SPECT/CT can be used to accurately diagnose two types of benign kidney tumors. This test may be eventually used to help better evaluate patients diagnosed with a renal tumor.
    European Urology 09/2015; DOI:10.1016/j.eururo.2015.08.056 · 12.48 Impact Factor
  • Clinical Genitourinary Cancer 09/2015; DOI:10.1016/j.clgc.2015.09.011 · 2.32 Impact Factor
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    ABSTRACT: Molecular imaging with positron emission tomography (PET) provides a powerful means of identifying and characterizing cancerous processes, as well as providing a quantitative framework within which response to therapy can be ascertained. Unfortunately, the most commonly used PET radiotracer, (18)F-fluorodeoxyglucose (FDG), has not demonstrated a definitive role in determining response to therapy in metastatic renal cell carcinoma (RCC). As a result, new radiotracers able to reliably image RCC could be of tremendous value for this purpose. Five patients with known metastatic RCC were imaged with the low-molecular weight radiotracer (18)F-DCFPyL, an inhibitor of the prostate-specific membrane antigen at 60 min post injection. (18)F-DCFPyL PET/CT and conventional images (either contrast-enhanced computed tomography or magnetic resonance imaging) were centrally reviewed for suspected sites of disease. In all five patients imaged, sites of putative metastatic disease were readily identifiable by abnormal (18)F-DCFPyL uptake, with overall more lesions detected than on conventional imaging. These PET-detected sites included lymph nodes, pancreatic parenchymal lesions, lung parenchymal lesions, a brain parenchymal lesion, and other soft tissue sites. (18)F-DCFPyL uptake ranged from subtle to intense with maximum standardized uptake values (SUVmax) for the identified lesions of 1.6-19.3. Based upon this small patient series, limited pathology and imaging follow-up of these patients suggests a higher sensitivity for (18)F-DCFPyL compared to conventional imaging in the detection of metastatic RCC (94.7 versus 78.9 %). PSMA expression in the tumor neovasculature of RCC has been previously established and is believed to provide the basis for the imaging findings presented here. PSMA-based PET/CT with radiotracers such as (18)F-DCFPyL may allow more accurate staging of patients with RCC and conceivably the ability to predict and follow therapy in patients treated with agents targeting the neovasculature.
    Annals of Nuclear Medicine 08/2015; DOI:10.1007/s12149-015-1017-z · 1.68 Impact Factor
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    ABSTRACT: To investigate the rate of premature instrument exchange during robot assisted laparoscopic radical prostatectomy (RALRP) and robot assisted partial nephrectomy (RAPN). The majority of robotic instruments have a predetermined lifespan of 10 uses, however, it is unknown if instruments are routinely exchanged prior to 10 uses in clinical practice. We retrospectively reviewed instrument use in consecutive RALRP and RAPN cases performed by high-volume robotic surgeons at one tertiary care center between January 2011 and October 2014. The number of instruments used per case was evaluated and instances of additional instrument utilization were noted. Exchange number was compared between the first and second half of cases performed. Operative times were compared between cases with and without exchange. Student's t-test and Pearson's χ2 test were used to determine statistical significance. 3 surgeons performed 1579 RALRP procedures and 2 surgeons performed 313 RAPN procedures. During RALRP, monopolar curved scissors required exchange in 12.4% cases. Other instruments were exchanged in less than 2% of cases. Exchange rates were similar for RAPN. Only exchange of Prograsp forceps decreased with increasing surgeon experience (p=.02) and instrument exchange did not lengthen operative times (p > 0.05 for all instruments). During RALRP and RAPN, monopolar curved scissors required exchange in approximately 10% of cases, while other instruments were rarely exchanged. Robotic instrument lifetime may not uniformly be 10 uses. The pre-set lifetime of robotic instruments and/or pricing should be reevaluated. Copyright © 2015 Elsevier Inc. All rights reserved.
    Urology 08/2015; DOI:10.1016/j.urology.2015.05.047 · 2.19 Impact Factor
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    ABSTRACT: Treatment options for small renal masses include partial nephrectomy (PN), ablation and active surveillance. We sought to compare patients who met the criteria for percutaneous ablation but underwent robotic PN to the rest of our robotic PN cohort. This was done in order to detect any safety concerns and to define any risk factors that might contraindicate the use of robotic PN, an oncologically superior procedure, in patients who qualify for ablation. Our departmental renal mass registry was queried for patients who underwent robotic PN but also met criteria for percutaneous ablation. These were compared to the rest of the robotic PN cohort. Demographics, perioperative characteristics and recurrence data were compared. Overall, 321 robotic PNs were identified. Of these, 26 (8.1%) met ablation criteria. Among patient characteristics, age and BMI were similar in both groups. Among operative characteristics, estimated blood loss (EBL) and operative time were similar. Warm ischemia time was significantly less for patients who met ablation criteria (14 vs. 17 minutes, p = 0.002). Mean tumor size was smaller for patients who met ablation criteria (2.3 vs. 2.7 cm, p = 0.012). Among postoperative characteristics, complications were similar overall and when present, stratified by Clavien grade. Robotic PN is a safe, effective treatment option for small renal masses, even in patients who meet ablation criteria. There were no recurrences in our cohort and the majority of complications were Clavien grade 1.
    Central European Journal of Urology 08/2015; 68(2):132-6. DOI:10.5173/ceju.2015.528
  • Michael A Gorin · Steven P Rowe · Mohamad E Allaf · Pedram Argani
    International Journal of Urology 08/2015; DOI:10.1111/iju.12908 · 2.41 Impact Factor
  • Michael A. Gorin · Mark S. Soloway
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    ABSTRACT: Active surveillance with delayed intervention aims to minimize the discomfort, potential complications and costs associated with immediate treatment of recurrent low grade Ta tumors of the bladder. We reviewed the data supporting this management strategy for low risk bladder cancer.
  • Michael A Gorin · Steven P Rowe · Mohamad E Allaf
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    ABSTRACT: Patients presenting with a clinically localized renal mass should ideally be managed with a risk-adapted approach that incorporates data regarding the metastatic potential of a given tumour. Unfortunately, currently available anatomical imaging techniques are unable to reliably distinguish between the various types of renal tumours, which include both benign and malignant histologies. Nuclear imaging offers a potential noninvasive means to characterize clinically localized renal tumours. A number of nuclear imaging tests are currently under investigation for this purpose and might one day be incorporated into patient care.
    Nature Reviews Urology 06/2015; 12(8). DOI:10.1038/nrurol.2015.122 · 4.84 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e459. DOI:10.1016/j.juro.2015.02.763 · 4.47 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e425-e426. DOI:10.1016/j.juro.2015.02.1117 · 4.47 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e558-e559. DOI:10.1016/j.juro.2015.02.1539 · 4.47 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e1059. DOI:10.1016/j.juro.2015.02.1970 · 4.47 Impact Factor
  • Lorenzo Marconi · Michael A Gorin · Mohamad E Allaf
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    ABSTRACT: To ensure the early detection of recurrent disease, all patients should undergo routine surveillance following partial nephrectomy for renal cell carcinoma. In order to optimize resource allocation and avoid unnecessary radiation exposure, the frequency and duration of surveillance should be tailored to the individual patient's risk of cancer recurrence. The evidence for surveillance after partial nephrectomy is presented reviewing the current literature on prognostic models and proposed surveillance protocols based on the timing and patterns of renal cell carcinoma recurrence. In addition, we review recent guidelines on post partial nephrectomy surveillance as well as the literature on novel imaging techniques that may aid in early disease discovery.
    Current Urology Reports 04/2015; 16(4):489. DOI:10.1007/s11934-015-0489-7 · 1.51 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e329. DOI:10.1016/j.juro.2015.02.1328 · 4.47 Impact Factor
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    ABSTRACT: Objective To compare the safety and perioperative outcomes of robotic versus laparoscopic retroperitoneal lymph node dissection (RPLND). Patients and Methods Our institutional review board approved retrospective testicular cancer registry was queried for patients who underwent a primary unilateral robotic (R-RPLND) or laparoscopic (L-RPLND) RPLND by a single surgeon for a stage I testicular nonseminomatous germ cell tumor. Groups were compared for differences in baseline and outcomes variables. Results Between July 2006 and July 2014, a total of 16 R-RPLND and 21 L-RPLND cases were performed by a single surgeon. Intra- and perioperative outcomes including operative time, estimated blood loss, lymph node yield, complicate rate and ejaculatory status were similar between groups (all p > 0.1). Conclusions As an early checkpoint, R-RPLND appears comparable to the laparoscopic approach in terms of safety and perioperative outcomes. It remains unclear if R-RPLND offers any tangible benefits over standard laparoscopy.
    BJU International 03/2015; DOI:10.1111/bju.13121 · 3.53 Impact Factor
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    ABSTRACT: A growing body of retrospective literature is emerging regarding active surveillance (AS) for patients with small renal masses (SRMs). There are limited prospective data evaluating the effectiveness of AS compared to primary intervention (PI). To determine the characteristics and clinical outcomes of patients who chose AS for management of their SRM. From 2009 to 2014, the multi-institutional Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry prospectively enrolled 497 patients with solid renal masses ≤4.0cm who chose PI or AS. AS versus PI. The registry was designed and powered as a noninferiority study based on historic recurrence rates for PI. Analyses were performed in an intention-to-treat manner. Primary outcomes were overall survival (OS) and cancer-specific survival (CSS). Of the 497 patients enrolled, 274 (55%) chose PI and 223 (45%) chose AS, of whom 21 (9%) crossed over to delayed intervention. AS patients were older, had worse Eastern Cooperative Oncology Group scores, total comorbidities, and cardiovascular comorbidities, had smaller tumors, and more often had multiple and bilateral lesions. OS for PI and AS was 98% and 96% at 2 yr, and 92% and 75% at 5 yr, respectively (log rank, p=0.06). At 5 yr, CSS was 99% and 100% for PI and AS, respectively (p=0.3). AS was not predictive of OS or CSS in regression modeling with relatively short follow-up. In a well-selected cohort with up to 5 yr of prospective follow-up, AS was not inferior to PI. The current report is among the first prospective analyses of patients electing for active surveillance of a small renal mass. Discussion of active surveillance should become part of the standard discussion for management of small renal masses. Copyright © 2015. Published by Elsevier B.V.
    European Urology 02/2015; DOI:10.1016/j.eururo.2015.02.001 · 12.48 Impact Factor
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    ABSTRACT: To describe our technique for robot-assisted radical nephrectomy (RARN) with inferior vena cava (IVC) tumor thrombectomy and to present initial results for our first two patients. Two patients with renal masses with infrahepatic IVC extension underwent RARN with IVC tumor thrombectomy using a four-arm configuration. Both cases were right-sided tumors. Vascular control was obtained with complete cross-clamping of the vena cava with robotic bulldog clamps. Intraoperative ultrasound was used to delineate extent of tumor extension. Specimens were removed en-bloc, and the IVC was closed with 2-layers of 4-0 Prolene. The specimen is extracted through a lower midline incision. Two robotic IVC thrombectomies were successfully completed. There were no conversions, intraoperative or postoperative complications. Median operative time was 243 minutes with a median estimated blood loss of 150 mL. Both patients were able to ambulate independently free of intravenous opioids on postoperate day 1. Median length of stay was 4.5 (range 3-6) days. Final pathology revealed clear cell RCC in both cases with negative surgical margins. Robotic technology may facilitate RN and IVC thrombectomy in the well selected patient and appears to be a safe and feasible approach.
    The Canadian Journal of Urology 02/2015; 22(1). · 0.98 Impact Factor
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    ABSTRACT: The differentiation of oncocytoma from renal cell carcinoma (RCC) remains a challenge with currently available cross-sectional imaging techniques. As a result, a large number of patients harboring a benign oncocytoma undergo unnecessary surgical resection. In this study, we explored the utility of Tc-MIBI SPECT/CT for the differentiation of these tumors based on the hypothesis that the large number of mitochondria in oncocytomas would lead to increased Tc-MIBI uptake. In total, 6 patients (3 with oncocytoma and 3 with RCC) were imaged with Tc-MIBI SPECT/CT. Relative quantification was performed by measuring tumor-to-normal renal parenchyma background ratios. All 3 oncocytomas demonstrated radiotracer uptake near or above the normal renal parenchymal uptake (range of uptake ratios, 0.85-1.78). In contrast, the 3 RCCs were profoundly photopenic relative to renal background (range of uptake ratios, 0.21-0.31). Tc-MIBI SPECT/CT appears to be of value in scintigraphically distinguishing benign renal oncocytoma from RCC.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
    Clinical Nuclear Medicine 01/2015; 40(4). DOI:10.1097/RLU.0000000000000670 · 3.93 Impact Factor

Publication Stats

445 Citations
436.34 Total Impact Points


  • 2015
    • University of Wuerzburg
      • Department of Nuclear Medicine
      Würzburg, Bavaria, Germany
  • 2014–2015
    • Johns Hopkins University
      • Department of Pathology
      Baltimore, Maryland, United States
  • 2012–2015
    • Johns Hopkins Medicine
      • Department of Urology
      Baltimore, Maryland, United States
  • 2009–2013
    • University of Miami
      • Department of Microbiology & Immunology
      كورال غيبلز، فلوريدا, Florida, United States
  • 2009–2012
    • University of Miami Miller School of Medicine
      • Department of Urology
      Miami, Florida, United States
  • 2010
    • University of Michigan
      • Department of Internal Medicine
      Ann Arbor, Michigan, United States
  • 2006
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States