Axel Heidenreich

Universität Heidelberg, Heidelburg, Baden-Württemberg, Germany

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Publications (732)

  • Axel Heidenreich · David Pfister
    Article · Oct 2016 · Nature Reviews Urology
  • Axel Heidenreich
    Article · Oct 2016
  • P. Paffenholz · J. Salem · D. Pfister · [...] · A. Heidenreich
    Article · Sep 2016 · Der Urologe
  • Axel Heidenreich
    [Show abstract] [Hide abstract] ABSTRACT: Die Urologie steht vor einer Vielzahl von Herausforderungen. Es bedarf strukturierter Lösungen, um unser Fach nicht nur in seiner derzeitigen Breite zu erhalten, sondern gleichzeitig auf die Bedürfnisse einzustellen, die sich aufgrund des technischen Fortschrittes, des demografischen Wandels und der Ansprüche der Nachwuchsgeneration in Bezug auf Ausbildung und Fortentwicklung ergeben. Dieses Impulsreferat soll als Gedankenanstoß dafür dienen, die zukünftigen Probleme unseres Faches zu erkennen und es soll mögliche Lösungen aufzeigen.
    Article · Sep 2016
  • Daniel Porres · Axel Heidenreich · David Pfister
    Article · Aug 2016 · European Urology
  • Source
    Dataset: S1 Table
    [Show abstract] [Hide abstract] ABSTRACT: Geolocation of users of the #KidneyStones online discussion on Twitter. (XLSX)
    File available · Dataset · Aug 2016
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    Dataset: S2 Table
    [Show abstract] [Hide abstract] ABSTRACT: Top 100 words used in the #KidneyStones online discussion on Twitter. (XLSX)
    File available · Dataset · Aug 2016
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    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Twitter is a popular microblogging platform for the rapid dissemination of information and reciprocal exchange in the urological field. We aimed to assess the activity, users and content of the online discussion, #KidneyStones, on Twitter. Methods: We investigated the Symplur Signals analytics tool for Twitter data distributed via the #KidneyStones hashtag over a one year period. Activity analysis reflected overall activity and tweet enhancements. We assessed users' geolocations and performed an influencer analysis. Content analysis included the most frequently used words, tweet sentiment and shares for top tweets. Results: 3,426 users generated over 10,333 tweets, which were frequently accompanied by links (49%), mentions (30%) and photos (13%). Users came from 106 countries across the globe and were most frequently from North America (63%) and Europe (16%). Individual and organisational healthcare professionals made up 56% of the influencers of the Twitter discussion on #KidneyStones. Besides the words 'kidney' (used 4,045 times) and 'stones' (3,335), 'pain' (1,233), 'urine' (1,158), and 'risk' (1,023) were the most frequently used words. 56% of tweets had a positive sentiment. The median (range) number of shares was 85 (62-587) for the top 10 links, 45.5 (17-94) for the top 10 photos, and 44 (22-95) for the top 10 retweets. Conclusion: The rapidly growing Twitter discussion on #KidneyStones engaged multiple stakeholders in the healthcare sector on a global scale and reached both professionals and laypeople. When used effectively and responsibly, the Twitter platform could improve prevention and medical care of kidney stone patients.
    Full-text available · Article · Aug 2016 · PLoS ONE
  • Axel Heidenreich · Simon Chowdhury · Laurence Klotz · [...] · Neal D. Shore
    [Show abstract] [Hide abstract] ABSTRACT: Improving health-related quality of life (HRQoL) is an important goal in metastatic castration-resistant prostate cancer (mCRPC).
    Article · Aug 2016 · European Urology
  • [Show abstract] [Hide abstract] ABSTRACT: Background: In the previously reported ALSYMPCA trial in patients with castration-resistant prostate cancer and symptomatic bone metastases, overall survival was significantly longer in patients treated with radium-223 dichloride (radium-223) than in patients treated with placebo. In this study, we investigated safety and overall survival in radium-223 treated patients in an early access programme done after the ALSYMPCA study and before regulatory approval of radium-223. Methods: We did an international, prospective, interventional, open-label, single-arm, phase 3b study. Enrolled patients were aged 18 years or older with histologically or cytologically confirmed progressive bone-predominant metastatic castration-resistant prostate cancer with two or more skeletal metastases on imaging (with no restriction as to whether they were symptomatic or asymptomatic; without visceral disease but lymph node metastases were allowed). Patients received intravenous injections of radium-223, 50 kBq/kg (current recommendation 55 kBq/kg after implementation of National Institute of Standards and Technology update on April 18, 2016) every 4 weeks for up to six injections. Other concomitant anticancer therapies were allowed. Primary endpoints were safety and overall survival. The safety and efficacy analyses were done on all patients who received at least one dose of the study drug. The study has been completed, and we report the final analysis here. This study is registered with, number NCT01618370, and the European Union Clinical Trials Register, EudraCT number 2012-000075-16. Findings: Between July 22, 2012, and Dec 19, 2013, 839 patients were enrolled from 113 sites in 14 countries. 696 patients received one or more doses of radium-223; 403 (58%) of these patients had all six planned injections. Any-grade treatment-emergent adverse events occurred in 523 (75%) of 696 patients; any-grade treatment-emergent adverse events deemed to be related to treatment were reported in 281 (40%) patients. The most common grade 3 or worse treatment-related treatment-emergent adverse events were anaemia in 32 (5%) patients, thrombocytopenia in 15 (2%) patients, neutropenia in ten (1%) patients, and leucopenia in nine (1%) patients. Any grade of serious adverse events were reported in 243 (35%) patients. Median follow-up was 7·5 months (IQR 5-11) and 210 deaths were reported; median overall survival was 16 months (95% CI 13-not available [NA]). In an exploratory analysis of overall survival with predefined factors, median overall survival was longer for: patients with baseline alkaline phosphatase concentration less than the upper limit of normal (ULN; median NA, 95% CI 16 months-NA) than for patients with an alkaline phosphatase concentration equal to or greater than the ULN (median 12 months, 11-15); patients with baseline haemoglobin levels 10 g/dL or greater (median 17 months, 14-NA) than for patients with haemoglobin levels less than 10 g/dL (median 10 months, 8-14); patients with a baseline Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 (median NA, 17 months-NA) than for patients with an ECOG PS of 1 (median 13 months, 11-NA) or an ECOG PS of 2 or more (median 7 months, 5-11); and for patients with no reported baseline pain (median NA, 16 months-NA) than for those with mild pain (median 14 months, 13-NA) or moderate-severe pain (median 11 months, 9-13). Median overall survival was also longer in patients who received radium-223 plus abiraterone, enzalutamide, or both (median NA, 95% CI 16 months-NA) than in those who did not receive these agents (median 13 months, 12-16), and in patients who received radium-223 plus denosumab (median NA, 15 months-NA) than in patients who received radium-223 without denosumab (median 13 months, 12-NA). Interpretation: Our findings show that radium-223 can be safely combined with abiraterone or enzalutamide, which are now both part of the standard of care for patients with metastatic castration-resistant prostate cancer. Furthermore, our findings extend to patients who were asymptomatic at baseline, unlike those enrolled in the pivotal ALSYMPCA study. The findings of prolonged survival in patients treated with concomitant abiraterone, enzalutamide, or denosumab require confirmation in prospective randomised trials. Funding: Pharmaceutical Division of Bayer.
    Article · Jul 2016 · The Lancet Oncology
  • David Pfister · Friederike Haidl · Pia Paffenholz · Axel Heidenreich
    [Show abstract] [Hide abstract] ABSTRACT: Purpose of review: In testis cancer, prognosis is excellent even in metastatic disease. Treatment and timing of patients with multiple metastatic deposits can be challenging. This review was performed to underline the current guideline recommendations. Recent findings: Depending on the primary histology, the indication of further surgical resections differ. In seminoma, resídual tumor resections are performed according to the results of a flouoro-deoxy-D-glucose-PET. Positive results must be considered critically, and to recent results it is advisable to first repeat flouoro-deoxy-D-glucose-PET to avoid overtreatment. In nonseminomatous germ cell cancer, complete remissions in good prognosis patients are followed and can be spared from surgery. All other patients still need to undergo postchemotherapy retroperitoneal lymph node dissection. In bone metastases, significant histology is found in 80% so that one should go for complete resection. In liver metastases, resections can be performed according to the histology in the retroperitoneum. Both resections, including vessel replacement, are usually performed in one session underlining the complex multidisciplinary approach. Pulmonal metastases, at least in one lobe, need to be resected. Brain metastases are rare with no standard treatment recommendation. Summary: Every patient should be presented in a multidisciplinary tumor board. Surgical interventions should be done in tertiary referral centers to achieve the best oncologic outcome and reduced morbidity.
    Article · Jul 2016 · Current Opinion in Urology
  • J. Salem · H. Borgmann · J. Bründl · [...] · A. Heidenreich
    [Show abstract] [Hide abstract] ABSTRACT: Background The increasing average age of urologists in private practice and outpatient treatment needs means that there is an increased demand for young urologists to cover outpatient care. Due to the increasing range of treatments, residents lack the mediation of those treatment methods and medical conditions which are necessary to become competent in the complete field of urology. Objectives To assess the willingness, the requirements, and the current implementation of residents training in private practice. Materials and methods A 14-item online survey was sent to 1326 urologists in private practice to measure the willingness, the requirements, and the current implementation of residents training. Results Of the 219 (17 %) respondents, 25 % have already trained residents, 41 % were authorized to provide training to residents, and 87 % have taken the appointment of a trainee into consideration. The main reason for employing a trainee was the enjoyment of the teaching experience. The main reason against employing a trainee was the lack of financial compensation. Conclusions Urologists in private practice are willing and able to participate in residents’ training. An extended integration of urological training into private practice can contribute to ensure the teaching of a wide variety of diseases/procedures and influence structural changes in the field of urology. Residents, private practitioners, and clinicians should search for solutions together with those responsible in the health care system for better integration of private practice into urology residents training.
    Article · Jun 2016 · Der Urologe
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    [Show abstract] [Hide abstract] ABSTRACT: The first St Gallen Advanced Prostate Cancer Consensus Conference (APCCC) Expert Panel identified and reviewed the available evidence for the ten most important areas of controversy in advanced prostate cancer (APC) management. The successful registration of several drugs for castration-resistant prostate cancer and the recent studies of chemo-hormonal therapy in men with castration-naïve prostate cancer have led to considerable uncertainty as to the best treatment choices, sequence of treatment options and appropriate patient selection. Management recommendations based on expert opinion, and not based on a critical review of the available evidence, are presented. The various recommendations carried differing degrees of support, as reflected in the wording of the article text and in the detailed voting results recorded in supplementary Material, available at Annals of Oncology online. Detailed decisions on treatment as always will involve consideration of disease extent and location, prior treatments, host factors, patient preferences as well as logistical and economic constraints. Inclusion of men with APC in clinical trials should be encouraged.
    Full-text available · Article · May 2016 · Annals of Oncology
  • Article · Apr 2016
  • Timur H. Kuru · Jan Herden · Vahudin Zugor · [...] · Axel Heidenreich
    Article · Apr 2016
  • Daniel Porres · Daniar Osmonov · Alexey Aksenov · [...] · Axel Heidenreich
    Article · Apr 2016
  • Article · Apr 2016
  • David Pfister · Daniel Porres · Axel Heidenreich · [...] · Frederik A. Verburg
    [Show abstract] [Hide abstract] ABSTRACT: Aim: [(68)Ga]PSMA-HBED-CC ((68)Ga-PSMA) is a novel and promising tracer for highly sensitive combined integrated positron emission tomography and X-ray computed tomography (PET/CT) diagnosis of recurrent prostate cancer (PCA). Our aim was to assess the sensitivity, specificity, positive and negative predictive value (PPV/NPV), and accuracy per lesion, as well as the positive predictive value per patient of (68)Ga-PSMA PET/CT using post-lymphadenectomy histology as a standard, and to compare these values to those obtained in a patient collective scanned using (18)F-Fluoroethylcholine ((18)FEC) PET/CT. Methods: Thirty eight patients had (18)FEC and 28 patients had (68)Ga-PSMA. We performed a pelvic and/or retroperitoneal lymphadenectomy, if necessary supplemented by resection of locally recurrent lesions in accordance with imaging results. Results: In 30/38 (18)FEC and 23/28 (68)Ga-PSMA patients ≥1 focus of PCA was identified in postsurgical histology, leading to a per-patient PPV of 78.9 % for (18)FEC and 82.1 % for (68)Ga-PSMA. In (18)FEC and (68)Ga-PSMA patients, a total of 378 and 308 lymph nodes and local lesions were removed, respectively. For (18)FEC and (68)for Ga-PSMA, the respective sensitivity (95 % confidence interval) was 71.2 % (64.5-79.6 %) and 86.9 % (75.8-94.2 %), specificity was 86.9 % (82.3-90.6 % ) and 93.1 % (89.2-95.9 %), PPV was 67.3 % (57.7-75.9 %) and 75.7 % (64.0-98.5 %), NPV was 88.8 % (84.4-92.3 %) and 96.6 % (93.5-98.5 %), and accuracy was 82.5 % (78.3-86.8 %) and 91.9 % (88.7 %-95.1 %). Conclusion: In the present series Ga-PSMA PET/CT shows a better performance than FEC PET/CT with a significantly higher NPV and accuracy for the detection of locoregional recurrent and/or metastatic lesions prior to salvage lymphadenectomy.
    Article · Mar 2016 · European journal of nuclear medicine and molecular imaging
  • A Heidenreich · D Böhmer
    [Show abstract] [Hide abstract] ABSTRACT: Locally advanced prostate cancer (LAPCA) comprises about 5-10 % of all newly diagnosed prostate cancers and is associated with the highest prostate cancer specific mortality (approximately 8-20 %). LAPCA is defined by the presence of extraprostatic extension, seminal vesicle invasion, and bladder neck infiltration of pelvic lymph node metastases. It is evident that prognosis can only be improved by interdisciplinary multimodality treatment strategies. Adequate local staging by multiparametric MRI is one of the cornerstones for an individualized, risk-adapted treatment approach. This might consist of extended radical prostatectomy with an extended pelvic lymphadenectomy or intensity-modulated radiation therapy with androgen deprivation as the primary local therapeutic approach. Both treatment strategies may be combined with neoadjuvant or adjuvant radiation therapy or salvage surgery. Combination with neoadjuvant or adjuvant chemotherapy and new androgen receptor pathway inhibitors might also be possible. This article summarizes the current treatment strategies for LAPCA.
    Article · Mar 2016 · Der Urologe
  • A. Heidenreich · D. Pfister · D. Porres
    Article · Jan 2016 · European Urology Supplements

Publication Stats

14k Citations


  • 2015
    • Universität Heidelberg
      Heidelburg, Baden-Württemberg, Germany
  • 2012-2013
    • Klinikum Weiden
      Weyden, Bavaria, Germany
    • University of Naples Federico II
      Napoli, Campania, Italy
  • 2011
    • Maria Hilf Hospital, Daun
      Daun, Rheinland-Pfalz, Germany
  • 2010
    • Technische Universität Dresden
      • Klinik und Poliklinik für Urologie
      Dresden, Saxony, Germany
  • 2005-2010
    • University Hospital RWTH Aachen
      Aachen, North Rhine-Westphalia, Germany
  • 2009
    • RWTH Aachen University
      • Department of Urology
      Aachen, North Rhine-Westphalia, Germany
    • University Medical Center Hamburg - Eppendorf
      Hamburg, Hamburg, Germany
  • 1994-2009
    • University of Cologne
      • Department of Urology
      Köln, North Rhine-Westphalia, Germany
  • 2008
    • Universitätsklinikum des Saarlandes
      Homburg, Saarland, Germany
    • Universitätsklinikum Düsseldorf
      • Urologische Klinik
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2000-2007
    • Philipps-Universität Marburg
      • Klinik für Urologie und Kinderurologie (Marburg)
      Marburg an der Lahn, Hesse, Germany