Peter Albers

Publications of Peter Albers

• Rs11892031[A] on chromosome 2q37 in an intronic region of the UGT1A locus is associated with urinary bladder cancer risk.

  Authors: Silvia Selinski, Marie-Louise Lehmann, Meinolf Blaszkewicz, Daniel Ovsiannikov, Oliver Moormann, Christoph Guballa, Alexander Kress, Michael C Truß, Holger Gerullis, Thomas Otto [......] Mark Hartel, Wobbeke Weistenhöfer, Wolfgang Schöps, S Adibul Hassan Rizvi, Muhammad Aslam, Gergely Bánfi, Imre Romics, Katja Ickstadt, Jan G Hengstler, Klaus Golka

  Archives of toxicology. 04/2012;

  Recently, rs11892031[A] has been identified in a genome-wide association study (GWAS) to confer increased risk of urinary bladder cancer (UBC). To confirm this association and additionally study aRecently, rs11892031[A] has been identified in a genome-wide association study (GWAS) to confer increased risk of urinary bladder cancer (UBC). To confirm this association and additionally study a possible relevance of exposure to urinary bladder carcinogens, we investigated the IfADo UBC study group, consisting of eight case-control series from different regions including 1,805 cases and 2,141 controls. This analysis was supplemented by a meta-analysis of all published data, including 13,395 cases and 54,876 controls. Rs11892031 A/A was significantly associated with UBC risk in the IfADo case-control series adjusted to cigarette smoking, gender, age and ethnicity (OR = 1.18; 95% CI = 1.02-1.37; P = 0.026). In the meta-analysis, a convincing association with UBC risk was obtained (OR = 1.19; 95% Cl = 1.12-1.26; P < 0.0001). Interestingly, the highest odds ratios were obtained for individual case-control series with a high degree of occupational exposure to polycyclic aromatic hydrocarbons and aromatic amines: cases with suspected occupational UBC (OR = 1.41) and cases from the highly industrialized Ruhr area (OR = 1.98) compared with Ruhr area controls (all combined OR = 1.46). Odds ratios were lower for study groups with no or a lower degree of occupational exposure to bladder carcinogens, such as the Hungary (OR = 1.02) or the ongoing West German case-control series (OR = 1.06). However, the possible association of rs11892031[A] with exposure to bladder carcinogens still should be interpreted with caution, because in contrast to the differences between the individual study groups, interview-based data on occupational exposure were not significantly associated with rs11892031. In conclusion, the association of rs11892031[A] with UBC risk could be confirmed in independent study groups.

• The Contemporary Role of Chemotherapy for Advanced Testis Cancer: A Systematic Review of the Literature.

  Authors: Fabio Calabrò, Peter Albers, Carsten Bokemeyer, Chris Martin, Lawrence H Einhorn, Alan Horwich, Susanne Krege, Hans Joachim Schmoll, Cora N Sternberg, Gedske Daugaard

  European urology. 03/2012;

  CONTEXT: Germ cell tumours (GCTs) of the testis are the most common cancer in young men; they are also one of the most curable cancers. Standard treatment of metastatic GCTs has evolved on the basisCONTEXT: Germ cell tumours (GCTs) of the testis are the most common cancer in young men; they are also one of the most curable cancers. Standard treatment of metastatic GCTs has evolved on the basis of randomised trials and prognostic factors. OBJECTIVE: This review summarises the evolving role of chemotherapy in the treatment of previously treated and untreated patients with metastatic GCTs and outlines the current standard treatment. EVIDENCE ACQUISITION: Randomised and nonrandomised trials of first-line, salvage, and palliative therapy were reviewed. EVIDENCE SYNTHESIS: Three cycles of standard bleomycin, etoposide, and platinum (BEP) can be considered the gold-standard treatment in good-risk patients, and four cycles of the same combination can result in cure in approximately 80% of intermediate-risk and 50% of poor-risk patients. The routine use of high-dose chemotherapy in patients with intermediate- or poor-prognosis GCT has not improved treatment outcome, but the role of tumour marker decline during the first cycles may provide useful prognostic information. Prognostic variables in patients who experience treatment failure after cisplatin-based chemotherapy can be used to guide salvage strategies, and many new drugs or combinations have shown activity in this setting. Patients and physicians should be aware of the risk of short- and long-term toxicity of treatments, and guidelines for screening and prevention of this risk should be established. CONCLUSIONS: A risk-based strategy offers the best chance of cure, even in patients with refractory GCT.

• Repeat Transrectal Ultrasound Biopsies with Additional Targeted Cores According to Results of Functional Prostate MRI Detects High-risk Prostate Cancer in Patients with Previous Negative Biopsy and Increased PSA - A Pilot Study.

  Authors: Christian Arsov, Michael Quentin, Robert Rabenalt, Gerald Antoch, Peter Albers, Dirk Blondin

  Anticancer research. 03/2012; 32(3):1087-92.

  Background/Aim: Patients with previous negative transrectal ultrasound-guided biopsy (TRUS-GB) and persistently increased prostate-specific antigen (PSA) value represent a great diagnostic problem.Background/Aim: Patients with previous negative transrectal ultrasound-guided biopsy (TRUS-GB) and persistently increased prostate-specific antigen (PSA) value represent a great diagnostic problem. Magnetic resonance imaging (MRI)-guided biopsy demonstrates high prostate cancer detection rates in these patients if functional MRI is suspicious for prostate cancer. However, MRI-guided biopsy is not commonly available and features considerable technical requirements. This was a pilot study to investigate if a standard repeat TRUS-GB, with additional targeted cores to suspicious lesions on functional MRI, can achieve similar detection rates as compared to MRI-guided biopsy. 3 Tesla functional MRI was performed in 58 patients with ≥1 previous negative biopsy, persistently increased PSA ≥4 ng/ml and unsuspicious digital rectal examination. Suspicious lesions were marked on a localization map to enable their finding on TRUS. Random TRUS-GB with additional targeted cores according to the functional MRI findings were performed in patients with ≥1 suspicious lesion. In 37.9% (22/58), functional MRI demonstrated suspicious findings. Out of these 22 patients, 16 underwent TRUS-GB with additional targeted cores. Prostate cancer was diagnosed in 68.8% (11/16). Eight out of these 11 patients subsequently underwent radical prostatectomy and all tumors fulfilled criteria for high-risk prostate cancer. With a median follow-up of 49.1 weeks neither significant PSA increase nor prostate cancer was detected in patients with normal functional MRI findings. Our approach enables excellent detection rates of clinically significant prostate cancer in patients with ≥1 previous negative biopsy and persistently increased PSA levels. Due to the current disadvantages of MRI-guided biopsy, our approach therefore represents an excellent alternative to MRI-guided biopsy.

• Randomized Phase III Study Comparing Paclitaxel-Bleomycin, Etoposide, and Cisplatin (BEP) to Standard BEP in Intermediate-Prognosis Germ-Cell Cancer: Intergroup Study EORTC 30983.

  Authors: Ronald de Wit, Iwona Skoneczna, Gedske Daugaard, Maria De Santis, August Garin, Nina Aass, Alfred J Witjes, Peter Albers, Jeffery D White, José R Germa-Lluch, Sandrine Marreaud, Laurence Collette

  Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 01/2012;

  PURPOSETo compare the efficacy of four cycles of paclitaxel-bleomycin, etoposide, and cisplatin (T-BEP) to four cycles of bleomycin, etoposide, and cisplatin (BEP) in previously untreated patientsPURPOSETo compare the efficacy of four cycles of paclitaxel-bleomycin, etoposide, and cisplatin (T-BEP) to four cycles of bleomycin, etoposide, and cisplatin (BEP) in previously untreated patients with intermediate-prognosis germ-cell cancer (GCC). PATIENTS AND METHODSPatients were randomly assigned to receive either T-BEP or standard BEP. Patients assigned to the T-BEP group received paclitaxel 175 mg/m(2) in a 3-hour infusion. Patients who were administered T-BEP received primary granulocyte colony-stimulating factor (G-CSF) prophylaxis. The study was designed as a randomized open-label phase II/III study. To show a 10% improvement in 3-year progression-free survival (PFS), the study aimed to recruit 498 patients but closed with 337 patients as a result of slow accrual. RESULTS: 0.37 to 0.97) and was statistically significant (P = 0.03). Overall survival was not statistically different. CONCLUSIONT-BEP administered with G-CSF seems to be a safe and effective treatment regimen for patients with intermediate-prognosis GCC. However, the study recruited a smaller-than-planned number of patients and included 7.7% ineligible patients. The primary analysis of the trial could not demonstrate statistical superiority of T-BEP for PFS. When ineligible patients were excluded, the analysis of all eligible patients demonstrated a 12% superior 3-year PFS with T-BEP, which was statistically significant.

• Residual tumor size and IGCCCG risk classification predict additional vascular procedures in patients with germ cell tumors and residual tumor resection: a multicenter analysis of the German Testicular Cancer Study Group.

  Authors: Christian Winter, David Pfister, Jonas Busch, Cigdem Bingöl, Ulrich Ranft, Mark Schrader, Klaus-Peter Dieckmann, Axel Heidenreich, Peter Albers

  European urology. 11/2011; 61(2):403-9.

  Residual tumor resection (RTR) after chemotherapy in patients with advanced germ cell tumors (GCT) is an important part of the multimodal treatment. To provide a complete resection of residual tumor,Residual tumor resection (RTR) after chemotherapy in patients with advanced germ cell tumors (GCT) is an important part of the multimodal treatment. To provide a complete resection of residual tumor, additional surgical procedures are sometimes necessary. In particular, additional vascular interventions are high-risk procedures that require multidisciplinary planning and adequate resources to optimize outcome. The aim was to identify parameters that predict additional vascular procedures during RTR in GCT patients. A retrospective analysis was performed in 402 GCT patients who underwent 414 RTRs in 9 German Testicular Cancer Study Group (GTCSG) centers. Overall, 339 of 414 RTRs were evaluable with complete perioperative data sets. The RTR database was queried for additional vascular procedures (inferior vena cava [IVC] interventions, aortic prosthesis) and correlated to International Germ Cell Cancer Collaborative Group (IGCCCG) classification and residual tumor volume. In 40 RTRs, major vascular procedures (23 IVC resections with or without prosthesis, 11 partial IVC resections, and 6 aortic prostheses) were performed. In univariate analysis, the necessity of IVC intervention was significantly correlated with IGCCCG (14.1% intermediate/poor vs 4.8% good; p=0.0047) and residual tumor size (3.7% size < 5 cm vs 17.9% size ≥ 5 cm; p < 0.0001). In multivariate analysis, IVC intervention was significantly associated with residual tumor size ≥ 5 cm (odds ratio [OR]: 4.61; p=0.0007). In a predictive model combining residual tumor size and IGCCCG classification, every fifth patient (20.4%) with a residual tumor size ≥ 5 cm and intermediate or poor prognosis needed an IVC intervention during RTR. The need for an aortic prosthesis showed no correlation to either IGCCCG (p=0.1811) or tumor size (p=0.0651). The necessity for IVC intervention during RTR is correlated to residual tumor size and initial IGCCCG classification. Patients with high-volume residual tumors and intermediate or poor risk features must initially be identified as high-risk patients for vascular procedures and therefore should be referred to specialized surgical centers with the ad hoc possibility of vascular interventions.

• Words of wisdom. Re: Conventional-dose versus high-dose chemotherapy as first salvage treatment in male patients with metastatic germ cell tumors: evidence from a large international database. Re: Prognostic factors in patients with metastatic germ cell tumors who experienced treatment failure with cisplatin-based first-line chemotherapy.

  Authors: Peter Albers

  European urology. 11/2011; 60(5):1124-5.

• Diagnosis, staging, and risk factors: SIU/ICUD Consensus Meeting on Germ Cell Tumors (GCT), Shanghai 2009.

  Authors: Peter Albers, Ferran Algaba, Gabriella Cohn-Cedermark, Maria DeSantis, Sabine Kliesch, Judd W Moul

  Urology. 10/2011; 78(4 Suppl):S427-34.

• Urinary bladder cancer risk in relation to a single nucleotide polymorphism (rs2854744) in the insulin-like growth factor-binding protein-3 (IGFBP3) gene.

  Authors: Silvia Selinski, Marie-Louise Lehmann, Meinolf Blaszkewicz, Daniel Ovsiannikov, Oliver Moormann, Christoph Guballa, Alexander Kress, Michael C Truss, Holger Gerullis, Thomas Otto [......] Mark Hartel, Wobbeke Weistenhöfer, Wolfgang Schöps, S Adibul Hassan Rizvi, Muhammad Aslam, Gergely Bánfi, Imre Romics, Katja Ickstadt, Jan G Hengstler, Klaus Golka

  Archives of toxicology. 09/2011; 86(2):195-203.

  Currently, twelve validated genetic variants have been identified that are associated with urinary bladder cancer (UBC) risk. However, those validated variants explain only 5-10% of the overallCurrently, twelve validated genetic variants have been identified that are associated with urinary bladder cancer (UBC) risk. However, those validated variants explain only 5-10% of the overall inherited risk. In addition, there are more than 100 published polymorphisms still awaiting validation or disproval. A particularly promising of the latter unconfirmed polymorphisms is rs2854744 that recently has been published to be associated with UBC risk. The [A] allele of rs2854744 has been reported to be associated with a higher promoter activity of the insulin-like growth factor-binding protein-3 (IGFBP3) gene, which may lead to increased IGFBP-3 plasma levels and cancer risk. Therefore, we investigated the association of rs2854744 with UBC in the IfADo case-control series consisting of 1,450 cases and 1,725 controls from Germany, Hungary, Venezuela and Pakistan. No significant association of rs2854744 with UBC risk was obtained (all study groups combined: unadjusted P = 0.4446; adjusted for age, gender and smoking habits P = 0.6510), besides a small effect of the [A] allele in the Pakistani study group opposed to the original findings (unadjusted P = 0.0508, odds ratio (OR) = 1.43 for the multiplicative model) that diminished after adjustment for age, gender and smoking habits (P = 0.7871; OR = 0.93). Associations of rs2854744 with occupational exposure to urinary bladder carcinogens and smoking habits were also not present. A meta-analysis of all available case-control series including the original discovery study resulted in an OR of 1.00 (P = 0.9562). In conclusion, we could not confirm the recently published hypothesis that rs2854744 in the IGFBP3 gene is associated with UBC risk.

• Which patients benefit the most from neoadjuvant chemotherapy in advanced bladder cancer?

  Authors: Günter Niegisch, Peter Albers

  Current opinion in urology. 09/2011; 21(5):434-9.

  Despite 5% advantage in 5-year overall survival, neoadjuvant chemotherapy may result in considerable overtreatment of bladder cancer patients because of the lack of response criteria. The review'sDespite 5% advantage in 5-year overall survival, neoadjuvant chemotherapy may result in considerable overtreatment of bladder cancer patients because of the lack of response criteria. The review's purpose was to identify the criteria on which the selection of bladder cancer patients for neoadjuvant chemotherapy followed by radical cystectomy should be based. About 30-40% of patients with metastatic bladder cancer are ineligible for platinum-based neoadjuvant chemotherapy because of renal impairment. Stratification based on the clinical tumor stage is likely to be biased by inappropriate preoperative staging. Differences in the response to neoadjuvant chemotherapy seem not to be predictable by histological subtype of bladder cancer. Future developments in radiological imaging, molecular cancer staging and response prediction aim to identify patients who will profit from neoadjuvant chemotherapy. Patients considered for neoadjuvant chemotherapy should be eligible for cisplatinum-based regimens. To avoid overtreatment, preferably patients with nonorgan-confined and lymph-node disease should be treated by neoadjuvant chemotherapy. However, the possibility of staging error should be taken into account. Patients with limited metastatic disease may also profit from neoadjuvant chemotherapy followed by radical cystectomy with concomitant metastasectomy.

• Prognostic factors in second-line treatment of urothelial cancers with gemcitabine and paclitaxel (German Association of Urological Oncology trial AB20/99).

  Authors: Günter Niegisch, Rolf Fimmers, Roswitha Siener, Su-In Park, Peter Albers

  European urology. 08/2011; 60(5):1087-96.

  In the treatment of urothelial cancer, identification of patients who are likely to benefit from further therapy after cisplatin failure is crucial for reasonable treatment decisions. Validate theIn the treatment of urothelial cancer, identification of patients who are likely to benefit from further therapy after cisplatin failure is crucial for reasonable treatment decisions. Validate the prognostic factor model (PFM) for survival developed by Bellmunt et al. in a different patient cohort with a different chemotherapy regimen. Baseline parameters of 102 patients treated within a randomized phase 3 trial of second-line gemcitabine and paclitaxel (GP) comparing short-term to prolonged chemotherapy (German Association of Urological Oncology trial AB20/99) were analyzed. Patients were stratified according to the PFM based on a score including performance status, presence of hepatic metastases, and hemoglobin levels. The baseline parameters of the GP cohort were compared with those of patients treated in the phase 3 trial of vinflunine versus best supportive care. Univariate and multivariate analyses of baseline parameters with respect to overall survival (OS) and treatment response were performed. OS of patients stratified according to the PFM was compared by log-rank test. The vinflunine and the GP cohorts differed, as patients after perioperative (neoadjuvant or adjuvant) treatment were included in the latter cohort. According to the PFM, prognostic subgroups with significant difference in OS (11.8 mo [95% confidence interval (CI), 6.3-17.3], 8.1 mo [95% CI, 4.8-11.4], 3.2 mo [95% CI, 0.0-7.9]; p=0.007) were identified. The PFM identified risk groups in patients with failed treatment of metastatic disease (14.1 mo [95% CI, 8.9-19.3], 7.3 mo [95% CI, 0.0-17.8], 3.8 mo [95% CI, 0.0-9.0]; p=0.006) but not in patients treated (neo)adjuvantly. Lymph node-only disease was a strong predictor of treatment response that overruled every other single predictive parameter (0.284, p=0.0266). The PFM was successfully validated in the GP and should be used to tailor second-line treatment strategy. Patients with lymph node-only disease may benefit from second-line treatment even if anemia or impaired performance status is present. German Cancer Society 01-09 (www.krebsgesellschaft.de).

• EAU guidelines on testicular cancer: 2011 update.

  Authors: Peter Albers, Walter Albrecht, Ferran Algaba, Carsten Bokemeyer, Gabriella Cohn-Cedermark, Karim Fizazi, Alan Horwich, Maria Pilar Laguna

  European urology. 08/2011; 60(2):304-19.

  On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy, and follow-up of testicular cancer were established. This article is a short version of the EAUOn behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy, and follow-up of testicular cancer were established. This article is a short version of the EAU testicular cancer guidelines and summarises the main conclusions from the guidelines on the management of testicular cancer. Guidelines were compiled by a multidisciplinary guidelines working group. A systematic review was carried out using Medline and Embase, also taking Cochrane evidence and data from the European Germ Cell Cancer Consensus Group into consideration. A panel of experts weighted the references, and a level of evidence and grade of recommendation were assigned. There is a paucity of literature especially regarding longer term follow-up, and results from a number of ongoing trials are awaited. The choice of treatment centre is of the utmost importance, and treatment in reference centres within clinical trials, especially for poor-prognosis nonseminomatous germ cell tumours, provides better outcomes. For patients with clinical stage I seminoma, based on recently published data on long-term toxicity, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment. The TNM classification 2009 is recommended. These guidelines contain information for the standardised management of patients with testicular cancer based on the latest scientific insights. Cure rates are generally excellent, but because testicular cancer mainly affects men in their third or fourth decade of life, treatment effects on fertility require careful counselling of patients, and treatment must be tailored taking individual circumstances and patient preferences into account.

• Genotyping NAT2 with only two SNPs (rs1041983 and rs1801280) outperforms the tagging SNP rs1495741 and is equivalent to the conventional 7-SNP NAT2 genotype.

  Authors: Silvia Selinski, Meinolf Blaszkewicz, Marie-Louise Lehmann, Daniel Ovsiannikov, Oliver Moormann, Christoph Guballa, Alexander Kress, Michael C Truss, Holger Gerullis, Thomas Otto [......] Muhammad Aslam, Gergely Bánfi, Imre Romics, Michael Steffens, Arif B Ekici, Andreas Winterpacht, Katja Ickstadt, Holger Schwender, Jan G Hengstler, Klaus Golka

  Pharmacogenetics and genomics. 07/2011; 21(10):673-8.

  Genotyping N-acetyltransferase 2 (NAT2) is of high relevance for individualized dosing of antituberculosis drugs and bladder cancer epidemiology. In this study we compared a recently publishedGenotyping N-acetyltransferase 2 (NAT2) is of high relevance for individualized dosing of antituberculosis drugs and bladder cancer epidemiology. In this study we compared a recently published tagging single nucleotide polymorphism (SNP) (rs1495741) to the conventional 7-SNP genotype (G191A, C282T, T341C, C481T, G590A, A803G and G857A haplotype pairs) and systematically analysed if novel SNP combinations outperform the latter. For this purpose, we studied 3177 individuals by PCR and phenotyped 344 individuals by the caffeine test. Although the tagSNP and the 7-SNP genotype showed a high degree of correlation (R=0.933, P<0.0001) the 7-SNP genotype nevertheless outperformed the tagging SNP with respect to specificity (1.0 vs. 0.9444, P=0.0065). Considering all possible SNP combinations in a receiver operating characteristic analysis we identified a 2-SNP genotype (C282T, T341C) that outperformed the tagging SNP and was equivalent to the 7-SNP genotype. The 2-SNP genotype predicted the correct phenotype with a sensitivity of 0.8643 and a specificity of 1.0. In addition, it predicted the 7-SNP genotype with sensitivity and specificity of 0.9993 and 0.9880, respectively. The prediction of the NAT2 genotype by the 2-SNP genotype performed similar in populations of Caucasian, Venezuelan and Pakistani background. A 2-SNP genotype predicts NAT2 phenotypes with similar sensitivity and specificity as the conventional 7-SNP genotype. This procedure represents a facilitation in individualized dosing of NAT2 substrates without losing sensitivity or specificity.

• Randomized, open-label phase III trial of docetaxel plus high-dose calcitriol versus docetaxel plus prednisone for patients with castration-resistant prostate cancer.

  Authors: Howard I Scher, Xiaoyu Jia, Kim Chi, Ronald de Wit, William R Berry, Peter Albers, Brian Henick, David Waterhouse, Dean J Ruether, Peter J Rosen, Anthony A Meluch, Luke T Nordquist, Peter M Venner, Axel Heidenreich, Luis Chu, Glenn Heller

  Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 06/2011; 29(16):2191-8.

  To compare the efficacy and safety of docetaxel plus high-dose calcitriol (DN-101) to docetaxel plus prednisone in an open-label phase III trial. Nine hundred fifty-three men with metastaticTo compare the efficacy and safety of docetaxel plus high-dose calcitriol (DN-101) to docetaxel plus prednisone in an open-label phase III trial. Nine hundred fifty-three men with metastatic castration-resistant prostate cancer (CRPC) were randomly assigned to Androgen-Independent Prostate Cancer Study of Calcitriol Enhancing Taxotere (ASCENT; 45 μg DN-101, 36 mg/m(2) docetaxel, and 24 mg dexamethasone weekly for 3 of every 4 weeks) or control (5 mg prednisone twice daily with 75 mg/m(2) docetaxel and 24 mg dexamethasone every 3 weeks) arms. The primary end point was overall survival (OS), assessed by the Kaplan-Meier method. At an interim analysis, more deaths were noted in the ASCENT arm, and the trial was halted. The median-follow-up for patients alive at last assessment was 11.7 months. Median OS was 17.8 months (95% CI, 16.0 to 19.5) in the ASCENT arm and 20.2 months (95% CI, 18.8 to 23.0) in the control arm (log-rank P = .002). Survival remained inferior after adjusting for baseline variables (hazard ratio, 1.33; P = .019). The two arms were similar in rates of total and serious adverse events. The most frequent adverse events were GI (reported in 75% of patients), and blood and lymphatic disorders (48%). Docetaxel toxicity leading to dose modification was more frequent in the ASCENT (31%) than in the control arm (15%). ASCENT treatment was associated with shorter survival than the control. This difference might be due to either weekly docetaxel dosing, which, in a prior study, showed a trend toward inferior survival compared with an every-3-weeks regimen, or DN-101 therapy.

• Testicular germ cell tumors: pathogenesis, diagnosis and treatment.

  Authors: Christian Winter, Peter Albers

  Nature reviews. Endocrinology. 01/2011; 7(1):43-53.

  Testicular germ cell tumors represent the most common solid malignancy of young men aged 15-40 years. Histopathologically, testicular germ cell tumors are divided into two major groups: pure seminomaTesticular germ cell tumors represent the most common solid malignancy of young men aged 15-40 years. Histopathologically, testicular germ cell tumors are divided into two major groups: pure seminoma and nonseminoma. The pathogenesis of testicular germ cell tumors remains unknown; however, cryptorchidism is the main risk factor, and molecular studies have shown strong evidence of an association between genetic alterations and testicular germ cell tumors. In cases of suspicion for testicular germ cell tumor, a surgical exploration with orchiectomy is obligatory. After completion of diagnostic procedures, levels of serum tumor markers and the clinical stage based on the International Union Against Cancer tumor-node-metastasis classification should be defined. Patients with early-stage testicular germ cell tumors are treated by individualized risk stratification within a multidisciplinary approach. The individual management (surveillance, chemotherapy or radiotherapy) has to be balanced according to clinical features and the risk of short-term and long-term toxic effects. Treatment for metastatic tumors is based on risk stratification according to International Germ Cell Cancer Collaborative Group classification and is performed with cisplatin-based chemotherapy and residual tumor resection in cases of residual tumor lesion. High-dose chemotherapy represents a curative option for patients with second or subsequent relapses.

• Rs710521[A] on chromosome 3q28 close to TP63 is associated with increased urinary bladder cancer risk.

  Authors: Marie-Louise Lehmann, Silvia Selinski, Meinolf Blaszkewicz, Michael Orlich, Daniel Ovsiannikov, Oliver Moormann, Christoph Guballa, Alexander Kress, Michael C Truss, Holger Gerullis [......] Wolfgang Schöps, Anwer E Beg, Muhammad Aslam, Gergely Bánfi, Imre Romics, Katja Ickstadt, Holger Schwender, Andreas Winterpacht, Jan G Hengstler, Klaus Golka

  Archives of toxicology. 11/2010; 84(12):967-78.

  Single nucleotide polymorphism (SNP) rs710521[A], located near TP63 on chromosome 3q28, was identified to be significantly associated with increased bladder cancer risk. To investigate theSingle nucleotide polymorphism (SNP) rs710521[A], located near TP63 on chromosome 3q28, was identified to be significantly associated with increased bladder cancer risk. To investigate the association of rs710521[A] and bladder cancer by new data and by meta-analysis including all published data, rs710521 was studied in 1,425 bladder cancer cases and 1,740 controls that had not been included in previous studies. Blood samples were collected from 1995 to 2010 in Germany (n = 948/1,258), Hungary (n = 262/65), Venezuela (n = 112/190) and Pakistan (n = 103/227) supplemented by a meta-analysis of 5,695 cases and 40,187 controls. Detection of a A/G substitution (rs710521) on chromosome 3q28, position 191128627 was done via fast real-time polymerase chain reaction (rt-PCR). Rs710521[A] is associated with increased risk in the unadjusted analysis (OR = 1.21; 95% Cl = 1.04-1.40; P = 0.011) and in the recessive model adjusted for age, gender, smoking habits and ethnicity (OR = 1.23; 95% Cl = 1.05-1.44; P = 0.010). No difference between individuals occupationally exposed versus not occupationally exposed to urinary bladder carcinogens was observed concerning the relevance of rs710521[A]. Similarly, rs710521[A] did not confer different susceptibility in smokers and non-smokers. Performing a meta-analysis of 5,695 cases and 40,187 controls including all published studies on rs710521, a convincing association with bladder cancer risk was obtained (OR = 1.18; 95% Cl = 1.12-1.25; P < 0.0001). However, the odds ratio is relatively small.

• Current second-line treatment options for patients with castration resistant prostate cancer (CRPC) resistant to docetaxel.

  Authors: Christian Arsov, Christian Winter, Robert Rabenalt, Peter Albers

  Urologic oncology. 09/2010;

  Chemotherapy with docetaxel remains the standard first-line treatment in patients with castration-resistant prostate cancer (CRPC). To date there is no recommended second-line therapy in case ofChemotherapy with docetaxel remains the standard first-line treatment in patients with castration-resistant prostate cancer (CRPC). To date there is no recommended second-line therapy in case of progression after docetaxel treatment. Knowledge of the molecular and cellular changes that occur during the transition of hormone-native to CRPC is increasing rapidly opening new therapy strategies in CRPC patients. This article will focus on recent available therapy options for patients with progressive CRPC after first-line treatment with docetaxel and highlights promising novel substances that are currently under investigation.

• Histological evidence for the existence of germ cell tumor cells showing embryonal carcinoma morphology but lacking OCT4 expression and cisplatin sensitivity.

  Authors: Thomas Mueller, Lutz Peter Mueller, Hans-Juergen Holzhausen, Ralf Witthuhn, Peter Albers, Hans-Joachim Schmoll

  Histochemistry and cell biology. 08/2010; 134(2):197-204.

  The biological basis for manifestation of chemotherapy resistance in metastatic testicular germ cell tumors (GCT) remains obscure and is of particular clinical interest. In nonseminomatous GCTThe biological basis for manifestation of chemotherapy resistance in metastatic testicular germ cell tumors (GCT) remains obscure and is of particular clinical interest. In nonseminomatous GCT (NSGCT) the pluripotent embryonal carcinoma (EC) cells are the precursors of the manifold differentiated structures but also drive the malignant growth. They are known to be hypersensitive towards DNA-damaging agents and to express the embryonal transcription factor OCT4. We recently characterized EC cells that lack OCT4 expression and show cisplatin resistance. In the present, immunohistochemical study we analyzed the composition of NSGCT with the focus on such OCT4-negative EC cells using a NSGCT xenograft model as well as patient-derived NSGCT samples. In the xenograft model, the cisplatin-sensitive cell line H12.1 gives rise to xenografts where EC structures are mainly composed of OCT4-positive cells, whereas xenografts from the resistant cell line 1411HP exclusively comprise OCT4-negative EC areas. We found that post-chemotherapy residual metastatic tumors of patients can be comprised of exclusively OCT4-negative EC, whereas the matched testicular primary tumor harbors OCT4-positive EC. Thorough histological analyses revealed a few examples of such OCT4-negative EC cells also in the testicular primary tumor as well as in xenografts from the cisplatin-sensitive NSGCT-cell line. For these cells we propose an identity as early extraembryonal progenitor cells directly derived from OCT4-expressing EC cells. This challenges the use of the term EC cell. The data also support our hypothesis that malignant growth of resistant NSGCT may be driven by this cell type.

• Organ-sparing surgery for adult testicular tumours: a systematic review of the literature.

  Authors: Gianluca Giannarini, Klaus-Peter Dieckmann, Peter Albers, Axel Heidenreich, Giorgio Pizzocaro

  European urology. 05/2010; 57(5):780-90.

  According to current guidelines, radical orchidectomy is the standard treatment for testis tumours of malignant and unknown origin. Testis-sparing surgery (TSS) has recently been proposed as anAccording to current guidelines, radical orchidectomy is the standard treatment for testis tumours of malignant and unknown origin. Testis-sparing surgery (TSS) has recently been proposed as an alternative option in selected cases. Our aim was to analyse the cumulative evidence for TSS in the treatment of adult malignant tumours of different histology, including notes on operative technique, indications, complications, and oncologic and functional outcome. A systematic literature search of the Medline/PubMed database for full-length papers reporting on TSS for adult malignant tumours was performed up to September 2009. Bibliographies of retrieved articles and review articles were also examined. Only those articles with complete data on operative technique, complications, and oncologic or functional outcome were selected. Furthermore, published abstracts at major urologic meetings in the last decade (1999-2009) and guidelines on testis cancer from major oncologic and urologic medical associations were searched and evaluated. No randomised controlled trials have compared TSS and radical orchidectomy; only retrospective outcome studies and case reports on TSS are available. In patients with small malignant germ cell tumours arising in both or in solitary testes, TSS coupled with local adjuvant radiotherapy ensures good oncologic control and is associated with a preserved endocrine function in most cases. In patients with small Leydig cell tumours, TSS can also be performed with elective indications (healthy contralateral testes), provided that pathology fails to reveal aggressive features. Finally, TSS is an option for patients with small ultrasound-detected, nonpalpable tumours even with elective indications because the incidence of benign definitive histology is high at approximately 80%. The overall complication rate is low (<6%). Data on exocrine and endocrine gonadal function, male body image, and health-related quality of life after TSS are still immature. TSS can be safely adopted for the treatment of carefully selected cases of tumours of different histology. Prospective multicentre studies are warranted to further qualify TSS as a treatment option to be recommended as an alternative to radical orchidectomy and to explore the perceived functional advantages of testis preservation.

• Canadian consensus guidelines for the management of testicular germ cell cancer.

  Authors: Lori Wood, Christian Kollmannsberger, Michael Jewett, Peter Chung, Sebastian Hotte, Martin O'Malley, Joan Sweet, Lynn Anson-Cartwright, Eric Winquist, Scott North [......] Jeremy Sturgeon, Mary Gospodarowicz, Roanne Segal, Tina Cheng, Peter Venner, Malcolm Moore, Peter Albers, Robert Huddart, Craig Nichols, Padraig Warde

  Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 04/2010; 4(2):e19-38.

• Extraperitoneal laparo-endoscopic single-site radical prostatectomy: first experience.

  Authors: Robert Rabenalt, Christian Arsov, Markus Giessing, Christian Winter, Peter Albers

  World journal of urology. 03/2010; 28(6):705-8.

  Up to now, laparo-endoscopic single-site surgery (LESS) represents the closest surgical technique to scar-free surgery. The objective of the study is to report the first clinical experience with aUp to now, laparo-endoscopic single-site surgery (LESS) represents the closest surgical technique to scar-free surgery. The objective of the study is to report the first clinical experience with a LESS endoscopic extraperitoneal radical prostatectomy. A 74-year-old man presented with a clinically localized prostate cancer (PSA 9.9, Gleason score 3 + 3 = 6). Consent was obtained for LESS radical prostatectomy. After a 2-cm midline subumbilical incision, the preperitoneal space was created using a balloon trocar. Then, the Triport™ was introduced. Using straight, as well as pre-curved instruments, the radical prostatectomy was performed in accordance with the well-described technique of endoscopic extraperitoneal radical prostatectomy. The procedure was completed successfully. Overall operation time was 290 min. The estimated blood loss was 100 mL. There were no intra-or postoperative complications. No additional ports were required. On the 6th postoperative day, a cystogram was performed. No leak was demonstrated, enabling catheter removal. Histopathology revealed bilateral adenocarcinoma with no extracapsular extension and a Gleason sum of 3 + 4 = 7. Surgical margins were negative. Two weeks postoperatively, the patient reported the use of only one safety pad for continence. An extraperitoneal laparo-endoscopic single-site radical prostatectomy is technically challenging but can be accomplished. A multi-instrument port and purpose-built equipment are mandatory. The oncologic outcome was not compromised. Additional short- and long-term studies are necessary to clarify the role of LESS in radical prostatectomy regarding the oncologic and functional outcome as well as the potential benefits like reduced tissue trauma and pain.