Peter Albers

Heinrich-Heine-Universität Düsseldorf, Düsseldorf, North Rhine-Westphalia, Germany

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Publications (336)1045.89 Total impact

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    ABSTRACT: Purpose Magnetic resonance imaging guided biopsy is increasingly performed to diagnose prostate cancer. However, there is a lack of well controlled, prospective trials to support this treatment method. We prospectively compared magnetic resonance imaging guided in-bore biopsy with standard systematic transrectal ultrasound guided biopsy in biopsy naïve men with increased prostate specific antigen. Materials and Methods We performed a prospective study in 132 biopsy naïve men with increased prostate specific antigen (greater than 4 ng/ml). After 3 Tesla functional multiparametric magnetic resonance imaging patients were referred for magnetic resonance imaging guided in-bore biopsy of prostate lesions (maximum 3) followed by standard systematic transrectal ultrasound guided biopsy (12 cores). We analyzed the detection rates of prostate cancer and significant prostate cancer (greater than 5 mm total cancer length or any Gleason pattern greater than 3). Results A total of 128 patients with a mean ± SD age of 66.1 ± 8.1 years met all study requirements. Median prostate specific antigen was 6.7 ng/ml (IQR 5.1–9.0). Transrectal ultrasound and magnetic resonance imaging guided biopsies provided the same 53.1% detection rate, including 79.4% and 85.3%, respectively, for significant prostate cancer. Magnetic resonance imaging and transrectal ultrasound guided biopsies missed 7.8% and 9.4% of clinically significant prostate cancers, respectively. Magnetic resonance imaging biopsy required significantly fewer cores and revealed a higher percent of cancer involvement per biopsy core (each p <0.01). Combining the 2 methods provided a 60.9% detection rate with an 82.1% rate for significant prostate cancer. Conclusions Magnetic resonance imaging guided in-bore and systematic transrectal ultrasound guided biopsies achieved equally high detection rates in biopsy naïve patients with increased prostate specific antigen. Magnetic resonance imaging guided in-bore biopsies required significantly fewer cores and revealed a significantly higher percent of cancer involvement per biopsy core.
    The Journal of Urology. 11/2014; 192(5):1374–1379.
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    ABSTRACT: Purpose This study evaluates the diagnostic value of the ESUR scoring system (PI-RADS) regarding prostate cancer detection using MR-guided in-bore biopsies (IB-GB) as the reference standard. Methods 566 lesions in 235 consecutive patients (65.7 ± 7.9 years, PSA 9.9 ± 8.5 ng/ml) with a multiparametric (mp)-MRI (T2WI, DWI, DCE) of the prostate at 3 T were scored using the PI-RADS scoring system. PI-RADS single (PSsingle), summed (PSsum), and overall (PSoverall) scores were determined. All lesions were histologically verified by IB-GB. Results Lesions with a PSsum below 9 contained no prostate cancer (PCa) with Gleason score (GS) ≥ 4 + 3 = 7. A PSsum of 13-15 (PSoverall V) resulted in 87.8% (n = 108) in PCa and in 42.3% (n = 52) in GS ≥ 4 + 3 = 7. Transition zone (TZ) lesions with a PSsum of 13-15 (PSoverall V) resulted in 76.3% (n = 36) in PCa and in 26.3% (n = 10) in GS ≥ 4 + 3 = 7, whereas for peripheral zone (PZ) lesions cancer detection rate at this score was 92.9% (n = 79) and 49.4% (n = 42) for GS ≥ 4 + 3 = 7. Using a threshold of PSsum ≥ 10, sensitivity was 86.0%, and negative predictive value (NPV) was 86.2%. For higher grade PCa sensitivity was 98.6%, and NPV was 99.5%. Conclusion A PSsum below 9 excluded a higher grade PCa, whereas lesions with a PSsum ≥ 13 (PSoverall V) represented in 88% PCa, and in 42% higher grade PCa. The PSsum or PSoverall demonstrated a better diagnostic value for PZ lesions with higher detection rates for higher grade PCa compared to TZ lesions.
    European Journal of Radiology 08/2014; · 2.51 Impact Factor
  • A Lusch, M Zaum, C Winter, P Albers
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    ABSTRACT: Residual tumor resection (RTR) in patients with metastatic testicular cancer plays a pivotal role in a multimodal treatment. It can be performed unilaterally or as an extended bilateral RTR. Additional surgical procedures might be necessary, such as nephrectomy, splenectomy, partial colectomy, or vascular interventions with possible caval resection, cavotomy, or aortic resection with aortic grafting. Consequently, several complications can be seen in the intra- and postoperative course, most common of which are superficial wound infections, intestinal paralysis, lymphocele, and chylous ascites. We sought to describe complication management and how to prevent complications before they arise.
    Der Urologe. Ausg. A. 07/2014; 53(7):991-5.
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    ABSTRACT: This study evaluated the accuracy of MR sequences [T2-, diffusion-weighted, and dynamic contrast-enhanced (T2WI, DWI, and DCE) imaging] at 3T, based on the European Society of Urogenital Radiology (ESUR) scoring system [Prostate Imaging Reporting and Data System (PI-RADS)] using MR-guided in-bore prostate biopsies as reference standard.
    European Radiology 06/2014; · 4.34 Impact Factor
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    ABSTRACT: MRI-guided biopsies are increasingly used for prostate cancer (PCa) diagnosis. However, there is a lack of well controlled prospective trials to support this treatment method. The aim of this study was to prospectively compare the MRI-guided in-bore biopsy with the standard systematic TRUS-guided biopsy in biopsy naïve men with elevated PSA.
    The Journal of urology. 05/2014;
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    ABSTRACT: Background/Aim: Initial inaccurate staging is a common problem associated with active surveillance (AS) for patients detected by transrectal ultrasound-guided prostate biopsy (TRUS-GB). Subsequently, repeated biopsies are necessary to monitor such patients. Thus, in addition to the already established clinicopathological criteria, there is a considerable demand for new, objective decision criteria to more accurately select AS candidates. Recently, a novel RNA expression signature derived from 31 cell-cycle progression (CCP) genes has been shown to be a strong predictor of outcome in patients after radical prostatectomy or radiotherapy. This is a qualitative pilot study to evaluate the prognostic value of the CCP-score (CCP-S) for the first time in men managed with AS after MRI-guided prostate biopsy (MRI-GB). Nine patients previously diagnosed with prostate cancer during an ongoing, prospective trial assessing MRI-GB with additional TRUS-GB and were subsequently managed with AS. CCP-S were retrospectively derived from biopsy specimens. The CCP-S is defined as the expression level of 31 CCP genes, normalized to 15 housekeeping genes, and is clinically validated in a range between -1.3 and 4.7. To assess the estimated 10-year mortality risk (without curative treatment), the CCP-S from each patient was combined with the individual CAPRA (Cancer of the Prostate Risk Assessment) score (CAPRA-S). Median patient age was 72 (range=58-77) years. Mean pre-biopsy PSA level was 6.33±1.94 (range 4.23-9.97) ng/ml. Eight cases had Gleason score 6 (3+3) and one cancer had Gleason score 7 (3+4). Median CCP-S was -0.9 (range=-1.5 to 0.0). Combining CCP-S with CAPRA-S [CAPRA-S: 1 (n=4), 2 (n=4), 3 (n=1)] the estimated 10-year mortality risk was not calculable for three patients because their CCP-S [CCP-S -1.4 (n=2) and -1.5 (n=1)] was outside the validated range. For the other 6 patients the estimated 10-year mortality ranged from 1.0-3.0%. The CCP-S confirms accurate staging of AS patients detected by MRI-based biopsy strategies and may significantly reduce inaccurate staging of AS patients and subsequent unnecessary re-biopsies. The CCP score may help to more accurately select for active surveillance candidates.
    Anticancer research 05/2014; 34(5):2459-66. · 1.71 Impact Factor
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    Anticancer research 05/2014; · 1.71 Impact Factor
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    ABSTRACT: This position paper is intended to help to structure and to standardize therapy monitoring in patients with metastatic castration-resistant prostate cancer (mCRPC). With the treatment options available today, patients with metastatic disease can often maintain good quality of life and stable disease for several years. It is crucial that once a therapy becomes insufficiently effective that it be replaced in a timely manner by a new treatment option. From a prognostic point of view, it is important that patients receive as many as possible and in the ideal case all currently available treatment options.
    Der Urologe 05/2014; 53(5):710-4. · 0.46 Impact Factor
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    ABSTRACT: In 2006, the German Testicular Cancer Study Group initiated an extensive evidence-based national second-opinion network to improve the care of testicular cancer patients. The primary aims were to reflect the current state of testicular cancer treatment in Germany and to analyze the project's effect on the quality of care delivered to testicular cancer patients. A freely available internet-based platform was developed for the exchange of data between the urologists seeking advice and the 31 second-opinion givers. After providing all data relevant to the primary treatment decision, urologists received a second opinion on their therapy plan within <48 h. Endpoints were congruence between the first and second opinion, conformity of applied therapy with the corresponding recommendation and progression-free survival rate of the introduced patients. Significance was determined by two-sided Pearson's χ2 test. A total of 1,284 second-opinion requests were submitted from November 2006 to October 2011, and 926 of these cases were eligible for further analysis. A discrepancy was found between first and second opinion in 39.5% of the cases. Discrepant second opinions led to less extensive treatment in 28.1% and to more extensive treatment in 15.6%. Patients treated within the framework of the second-opinion project had an overall 2-year progression-free survival rate of 90.4%. Approximately every 6th second opinion led to a relevant change in therapy. Despite the lack of financial incentives, data from every 8th testicular cancer patient in Germany were submitted to second-opinion centers. Second-opinion centers can help to improve the implementation of evidence into clinical practice.
    Oncology Reports 04/2014; · 2.30 Impact Factor
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    ABSTRACT: Genetic and epigenetic changes in the mitogen activated protein kinase (MAPK) signaling render urothelial cancer a potential target for tyrosine kinase inhibitor (TKI) treatment. However, clinical trials of several TKIs failed to prove efficacy. In this context, we investigated changes in MAPK signaling activity, downstream apoptotic regulators and changes in cell cycle distribution in different urothelial cancer cell lines (UCCs) upon treatment with the multikinase inhibitor sorafenib. None of the classical sorafenib targets (vascular endothelial growth factor receptor 1/-receptor 2, VEGFR1/-R2; platelet-derived growth factor receptor α/-receptor β, PDGFR-α/-β; c-KIT) was expressed at significant levels leaving RAF proteins as its likely molecular target. Low sorafenib concentrations paradoxically increased cell viability, whereas higher concentrations induced G1 arrest and eventually apoptosis. MAPK signaling remained partly active after sorafenib treatment, especially in T24 cells with an oncogenic HRAS mutation. AKT phosphorylation was increased, suggesting compensatory activation of the phosphatidylinositol-3-kinase (PI3K) pathway. Sorafenib regularly down regulated the anti-apoptotic myeloid cell leukemia 1 (Mcl-1) protein, but combinatorial treatment with ABT-737 targeting other B-cell lymphoma 2 (Bcl-2) family proteins did not result in synergistic effects. In summary, efficacy of sorafenib in urothelial cancer cell lines appears hampered by limited effects on MAPK signaling, crosstalk with further cancer pathways and an anti-apoptotic state of UCCs. These observations may account for the lack of efficacy of sorafenib in clinical trials and should be considered more broadly in the development of signaling pathway inhibitors for drug therapy in urothelial carcinoma.
    International Journal of Molecular Sciences 01/2014; 15(11):20500-17. · 2.46 Impact Factor
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    ABSTRACT: Salvage systemic therapy for advanced urothelial carcinoma has substantial unmet needs. Small phase II trials have been conducted with varying eligibility criteria, which render cross-trials comparisons difficult. Moreover, accrual to trials is hampered by comorbidities, elderly age and poor performance status. Therefore, improvements in clinical trial design may facilitate further advances. This commentary summarizes recent data regarding prognostic factors, which allow us to recommend inclusive, yet rational, eligibility criteria and stratification factors to enhance accrual and improve interpretability of data from phase II trials: 1) allowing either prior perioperative platinum-based chemotherapy within 1 year or prior platinum-based chemotherapy for metastatic disease, 2) allowing ≤2 prior lines of therapy, 3) allow patients regardless of quality of response to prior therapy, 4) allow all sites of primary urothelial malignancy, and 5) a preplanned analysis of outcomes controlled for baseline prognostic factors.
    Clinical Genitourinary Cancer 01/2014; · 1.43 Impact Factor
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    ABSTRACT: Objectives To assess the surgical and oncological outcome of robot-assisted radical cystectomy (RARC) compared with open radical cystectomy (ORC). Patients and methods Clinical data of 64 patients undergoing RARC between August 2010 and August 2013 were prospectively documented and retrospectively compared with 79 patients undergoing ORC between August 2008 and August 2013 at a single academic institution. Perioperative results, surgical margins status, and nodal yield after RARC and ORC were compared using Mann-Whitney U test (continuous variables) and chi-square test (categorical variables). Additional age-stratified analysis was performed in elderly patients (≥75 y). To avoid inference errors by multiple testing, P-values were adjusted using Bonferroni׳s correction. Results Baseline characteristics of both cohorts were balanced. RARC patients had significantly less blood loss (RARC: 300 [interquartile range {IQR}: 200–500] ml; perioperative transfusion rate: 0 [IQR: 0–2] red packed blood cells [RPBCs]; ORC: 800 [IQR: 500–1200] ml, P<0.01; transfusion rate: 3 [IQR: 2–4] RPBCs, P<0.01), and hospital stay of RARC patients was reduced by 20% (RARC: 13 [IQR: 9–17] d, ORC: 16 [IQR: 13–21] d, P< 0.01). A total of 55 patients who underwent RARC and 59 patients who underwent ORC were eligible for analysis of oncological surrogates “surgical margin status” and “lymph-node yield” as well as for survival data. No differences between patients undergoing RARC or ORC were observed. In elderly patients (≥75 y; RARC: 17 patients, ORC: 28 patients), decreased intraoperative blood loss (RARC: 300 [IQR: 100–475] ml; ORC: 800 [IQR: 400–1300] ml, P<0.01) and lower transfusion rate (RARC: 0 [IQR: 0–1] RPBCs; ORC: 4 [IQR: 2–5] RPBCs, P<0.01) were observed in the robotic group. Major limitations of this study are the retrospective study design and a potential selection bias. Conclusions RARC provides significant advantages compared with ORC regarding blood loss and postoperative recovery, whereas surgical and oncological outcomes are not different.
    Urologic Oncology: Seminars and Original Investigations. 01/2014;
  • Lukas Esch, Wolfgang A Schulz, Peter Albers
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    ABSTRACT: Several novel therapeutic agents have demonstrated ability to improve overall survival in metastatic castration-resistant prostate cancer (mCRPC) in recent years. With as many as 5 new agents approved within the last 5 years and an ongoing lack of comparative and prospective data, strategies for patient selection and sequencing of drug treatments are urgently needed. This review will summarize current clinical evidence and relevant molecular mechanisms in mCRPC. The understanding of these mechanisms may provide valuable assistance in making therapeutic decisions, especially while robust clinical data remain sparse. © 2014 S. Karger GmbH, Freiburg.
    Oncology research and treatment. 01/2014; 37(9):492-8.
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    ABSTRACT: Background The complete remission (CR) rate with salvage systemic therapy for urothelial carcinoma (UC) is unclear and its value as an intermediate endpoint and association with survival are unknown. Materials and methods Data from Phase II trials of salvage chemotherapy and/or biologic agents were pooled. Data regarding response, overall survival (OS), progression-free survival (PFS), time from prior chemotherapy (TFPC), hemoglobin (Hb), performance status (PS) and liver metastasis (LM) status were collected. Cox proportional hazards regression was used to evaluate the association of CR and other prognostic factors with outcomes. Results 789 of 818 patients enrolled in 12 phase II trials were evaluable. CR and partial response (PR) were seen in 14 (1.8%) and 109 (13.8%) patients. Median (95% CI) OS for those with a CR was 21.5 (14.2-34.3) months, compared with 6.7 (6.0-7.0) months in those without a CR (p<0.001). Median (95% CI) PFS for those with a CR was 15.7 (8.2-27.1) months, compared with 2.6 (2.4-2.8) months for those without a CR (p<0.001). Prior cisplatin and TFPC ≥3 months were associated with CR (p<0.05). The presence of poor prognostic factors and suboptimal response to prior therapy did not preclude CR. Conclusions CR occurs in 1.8% of patients receiving salvage therapy for advanced UC, and is strongly associated with durable OS and PFS. CR warrants validation as an intermediate endpoint and may help select agents for further investigation and tumors for molecular interrogation.
    Clinical Genitourinary Cancer 01/2014; · 1.43 Impact Factor
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    ABSTRACT: Background The differential impact of number of prior lines of therapy and setting of prior therapy (perioperative, metastatic) is unclear in advanced urothelial carcinoma (UC). Patients and methods Ten phase II trials of salvage chemotherapy and/or biologic agent therapy enrolling 731 patients were available. Data on the number of prior lines of therapy and setting of prior therapy were required in addition to known previously recognized prognostic factors: time from prior chemotherapy, hemoglobin, performance status and liver metastasis status. Cox proportional hazards regression was used to evaluate the association of number of prior lines and prior perioperative therapy with overall survival (OS) as the primary clinical endpoint. Trial was a stratification factor. Results 711 patients were evaluable. The overall median PFS and OS were 2.7 and 6.8 months, respectively. The number of prior lines were 1 in 559 (78.6%), 2 in 111 (15.6%), 3 in 29 (4.1%), 4 in 10 (1.4%) and 5 in 2 (0.3%) patients. Prior perioperative chemotherapy was given to 277 (39.1%) and chemotherapy for metastatic disease to 454 (64.1%). The number of prior lines was not independently associated with OS (HR 0.99 [95% CI: 0.86-1.14]). Prior peri-operative chemotherapy was a favorable factor for OS on univariable but not multivariable analysis. Conclusions The number of prior lines of therapy and prior perioperative chemotherapy were not independently prognostic in UC patients receiving salvage therapy. Adoption of these data in salvage therapy trials should enhance accrual, the interpretability of results and drug development.
    Clinical Genitourinary Cancer 01/2014; · 1.43 Impact Factor
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    ABSTRACT: Several large randomized controlled trials have provided evidence that neoadjuvant chemotherapy (NC) improves outcomes in patients with muscle-invasive urothelial bladder cancer (MIBC) who undergo radical cystectomy (RC). We sought to analyze the study design, methods and observations in these trials to identify patient subgroups that appeared most likely to benefit and discover distinguishing features from those groups that did not obtain improved outcomes. We analyzed the initial and updated methods and results of the four main prospective trials of NC (SWOG, MRC, and Nordic I and II) and subsequent meta-analyses that have been the basis for advocating the use of NC in all patients with MIBC who undergo RC. The group that demonstrated the greatest apparent benefit were those patients who were free of cancer at the time of RC (pT0). These patients had markedly improved overall and disease-specific survivals compared to those with residual disease. However, these improvements occurred regardless of whether downstaging from MIBC to pT0 was seen with transurethral resection (TUR) alone (control group) or with TUR+NC. Thus, the major benefit from NC appeared to be the greater number of patients achieving pT0 in the chemotherapy group. In focusing on this, we explored limitations in these studies which may have influenced these outcomes. We also considered the potential for overtreatment of patients not likely to benefit from chemotherapy regimens. Finally, we employed risk stratification techniques to offer a decision tree model in the selection of patients for NC that conceivably could maximize oncologic outcomes and minimize overtreatment. In the four main NC trials and their subsequent meta-analyses, pT0 patients in each group experienced similar survival, far exceeding those in both groups that did not achieve pT0 status. The benefit from NC appeared to be the larger number of patients than in the TUR-only group that were downstaged to pT0, suggesting that variables other than NC may have influenced outcomes. Therefore, employing strategies to selectively administer NC to certain at-risk patients has the potential to maintain improved bladder cancer outcomes while reducing overtreatment and its associated toxicities.
    The Journal of urology 11/2013; · 3.75 Impact Factor
  • Peter Albers
    European Urology 11/2013; · 10.48 Impact Factor
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    ABSTRACT: To study the impact of prognostic factors (liver metastasis [LM], anemia [Hb<10 g/dl], ECOG-performance status [PS] ≥1, time from prior chemotherapy [TFPC]) on the activity of second-line therapy for advanced urothelial carcinoma (UC). Twelve phase II trials evaluating second-line chemotherapy and/or biologics (n=748) in patients with progressive disease were pooled. Progression-free survival (PFS) was defined as tumor progression or death from any cause. PFS at 6 months (PFS6) was defined from the date of registration and calculated using the Kaplan-Meier method. Response rate (RR) was defined using RECIST 1.0. A nomogram predicting PFS6 was constructed using the RMS package in R (www.r-project.org). Data regarding progression, Hb, LM, PS and TFPC were available from 570 patients in 9 phase II trials. The overall median PFS was 2.7 months (mo), PFS6 was 22.2% (95% CI: 18.8-25.9) and RR was 17.5% (95% CI: 14.5%-20.9%). For every unit increase in risk group, the hazard of progression in 6 mo increased by 41% and the odds of response decreased by 48%. A nomogram was constructed to predict PFS6 on an individual patient level. The model was internally validated and displayed acceptable calibration performance. PFS6 and RR vary as a function of baseline prognostic factors in patients receiving second-line therapy for advanced UC. A nomogram incorporating prognostic factors facilitates the evaluation of outcomes across phase II trials enrolling heterogeneous populations and helps select suitable agents for phase III testing.
    BJU International 11/2013; · 3.05 Impact Factor
  • A Lorch, P Albers
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    ABSTRACT: Germ-cell cancer (GCC) is still the most common cancer diagnosis in men between the ages of 20 and 45 years with an increasing incidence. Due to effective and standardized algorithms that have been developed to stratify patients into different risk groups, remarkable progress has been made in the medical treatment of testicular cancer with an overall cure rate of 88%. The application of surgery, radiotherapy and chemotherapy, the choice of chemotherapy agents as well as treatment duration is defined in international consensus guidelines. The guidelines are based on histology, tumor stages and presence or absence of already known and well-established risk factors. These stringent parameters guarantee the optimal curative treatment options for each GCC patient and can avoid overtreatment as well as undertreatment. For patients with early stage disease, careful consideration between possible side effects due to an adjuvant therapy and the expected relapse rate must be made, whereas in advanced tumor stages the optimal sequence of chemotherapy, surgery and radiotherapy is the focus. In patients who progress or relapse after first-line therapy, the issue of optimal treatment represents a particular challenge and is far more complex. It needs to take into account the analysis of special prognostic variables for a further risk-tailored therapy. A careful weighting between the chosen regimen and the often higher rate of treatment failure in contrast to increased toxic side-effects is mandatory.The disregard of accurate risk stratification and application of accepted treatment standards for patients with GCC at the time of initial diagnosis or at relapse is associated with developing more extensive disease and more intensive treatment. It also results in lower cure rates with the need for further therapy or leads to death of the patient without ever having had a chance for cure.
    Der Urologe 10/2013; · 0.46 Impact Factor

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4k Citations
1,045.89 Total Impact Points

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Institutions

  • 2008–2014
    • Heinrich-Heine-Universität Düsseldorf
      • • Department of Urology
      • • Institut für Diagnostische und Interventionelle Radiologie
      Düsseldorf, North Rhine-Westphalia, Germany
    • Städtisches Krankenhaus Kiel
      Kiel, Schleswig-Holstein, Germany
  • 2013
    • Maria Hilf Hospital
      Mönchengladbach, North Rhine-Westphalia, Germany
  • 2009–2013
    • University Medical Center Hamburg - Eppendorf
      • Department of Internal Medicine II. (Oncology/Haematologie with Sections Bone Marrow Transplantation and Pneumologie)
      Hamburg, Hamburg, Germany
    • University Hospital RWTH Aachen
      Aachen, North Rhine-Westphalia, Germany
  • 2008–2013
    • Universitätsklinikum Düsseldorf
      • Urologische Klinik
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2012
    • Barts Cancer Institute
      Londinium, England, United Kingdom
  • 2010–2012
    • Leibniz Research Center for Working Enviroment and Human Factors
      Dortmund, North Rhine-Westphalia, Germany
  • 2011
    • Technische Universität München
      • Urologische Klinik und Poliklinik
      München, Bavaria, Germany
  • 2008–2011
    • Maria Hilf Hospital, Daun
      Daun, Rheinland-Pfalz, Germany
  • 2003–2009
    • Klinikum Kassel
      Cassel, Hesse, Germany
    • University of Tuebingen
      Tübingen, Baden-Württemberg, Germany
  • 1995–2009
    • University of Bonn
      • • Klinik und Poliklinik für Urologie und Kinderurologie
      • • Institut für Pathologie
      Bonn, North Rhine-Westphalia, Germany
    • Ruhr-Universität Bochum
      Bochum, North Rhine-Westphalia, Germany
  • 2007–2008
    • Targos Molecular Pathology GmbH
      Cassel, Hesse, Germany
    • Universität Kassel
      • Communications Laboratory
      Kassel, Hesse, Germany
    • Institut für Pathologie und Molekularpathologie
      Gelsenkirchen, North Rhine-Westphalia, Germany
  • 1998–2008
    • University of Cologne
      • • Department of Neurology
      • • Department of Urology
      Köln, North Rhine-Westphalia, Germany
  • 1994–2006
    • Indiana University-Purdue University Indianapolis
      • Department of Urology
      Indianapolis, IN, United States
  • 2005
    • Universitätsklinikum des Saarlandes
      Homburg, Saarland, Germany
  • 2004
    • Martin Luther University of Halle-Wittenberg
      Halle-on-the-Saale, Saxony-Anhalt, Germany
  • 2002–2003
    • Universität des Saarlandes
      • Klinik für Urologie und Kinderurologie
      Saarbrücken, Saarland, Germany
  • 1995–2002
    • University of Bonn - Medical Center
      Bonn, North Rhine-Westphalia, Germany