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Hein Van Poppel

Publications and source records attributed to Hein Van Poppel.

At least 19 recordsLinked to original sources
PubMed2006

What does the urologist expect from the pathologist (and what can the pathologists give) in reporting on adult kidney tumour specimens?

OBJECTIVE: To identify the parameters required by the urologist to determine the prognosis and the treatment of renal cancer in adults, and to establish the potential therapeutic targets of the new treatments that started to show clinical efficacy. METHODS: A literature search of the last 10 yr was done, paying specific attention to TNM 2002 (UICC staging) and Fuhrman's grading. Also, the main genetic characteristics of the different subtypes (according to the WHO 2004 classification) with potential therapeutic implications have been compiled. RESULTS: After the review of the literature, the opinion of the joint meeting including urologists and pathologists is that some aspects of the TNM 2002 classification must be refined. Criteria for nuclear grading should be different for the subtypes of renal cell carcinoma, and the WHO 2004 histological classification is clinically useful. CONCLUSIONS: In the workshop held in Palermo, common opinion was achieved on a number of points. The TNM 2002 classification is useful, but some adjustments should be made, particularly as referred to the tumour size cut-off, assessment of the invasion of the renal sinus fat tissue, and invasion of the ipsilateral adrenal gland. The Fuhrman's grading system is useful in clear cell renal cell carcinoma (RCC), and probably also in papillary RCC, but a redefinition for chromophobe RCC is needed. Finally, the determination of certain markers, such as VEGF and HIF, could constitute good target markers for the new therapies, but they remain under investigation.

Carcinoma, Renal Cell↗
PubMed2006

Comparing results after surgery in patients with clinical unilateral T3a prostate cancer treated with or without neoadjuvant androgen-deprivation therapy.

OBJECTIVE: To compare the results in patients with unilateral cT3 prostate cancer treated with or with no neoadjuvant androgen-deprivation therapy (nADT), as nADT might have benefit in cT2 prostate cancer, but for cT3 tumours its use remains controversial, and it is unclear whether it can prevent or delay progression after surgery. PATIENTS AND METHODS: Between 1987 and 2004, 235 patients were assessed as having unilateral cT3 disease by a digital rectal examination; before surgery, 200 patients were not treated with nADT and 35 were. The Kaplan-Meier method was used to calculate survival rates. RESULTS: With no nADT the biochemical progression-free survival (PFS) was 59.5%, the clinical PFS was 95.9%, the cancer-specific survival (CSS) was 98.7%, and overall survival was 95.9% at 5 years. With nADT, the biochemical PFS was 43.4%, clinical PFS was 77.6%, CSS was 88.7%, and overall survival was 79.8% at 5 years. The positive surgical margin rate with no nADT and with nADT was 33.5% and 57.1%, respectively, and the respective mean cancer volume was 6.6 mL and 4.0 mL. CONCLUSION: nADT can decrease tumour size but does not reduce the positive surgical margin rate, nor improve the survival rate in unilateral cT3a disease. Because of side-effects and treatment costs, we do not advise nADT in patients with unilateral cT3a prostate cancer.

Adult↗
PubMed2006

Comparison between open partial and radical nephrectomy for renal tumours: perioperative outcome and health-related quality of life.

OBJECTIVE: To compare perioperative outcome and health-related quality of life (HRQOL) after open partial and radical nephrectomy for renal tumours. METHODS: Literature search of Medline and additional references from non-Medline-indexed journals for documents concerning treatment of renal tumours, perioperative outcome, and HRQOL after radical and partial nephrectomy. RESULTS: A total of 39 references were used of which 7 discussed complications, 3 included hospital costs and length of stay, and 7 each discussed renal function and QOL. No statistical difference was found concerning perioperative complications although there seems to be a trend towards a slightly higher complication rate after partial nephrectomy. No statistical difference was reported between the two procedures concerning hospital costs and length of stay. For postoperative renal function, a higher incidence of chronic renal failure was noted after radical nephrectomy. When considering the HRQOL a benefit was found after elective partial nephrectomy. In case of mandatory partial nephrectomy the fear of recurrence and the worry about having fewer than two normal kidneys were significantly higher. CONCLUSIONS: Partial nephrectomy achieves a better HRQOL due to better preservation of renal function and overall quality of life. Considering perioperative outcome no statistical difference was found for hospital costs and length of stay. A trend towards a higher perioperative complication rate was found after partial nephrectomy.

Humans↗
PubMed2006

Prepubic urethrectomy during radical cystoprostatectomy.

OBJECTIVES: In muscle-invasive bladder cancer, the risk of developing a urethral recurrence after cystectomy varies between 4% and 18%, especially when an ileal conduit is performed. For this reason, some authors advocate a urethrectomy in these indications. At our center, we developed the technique of prepubic urethrectomy. We assessed the feasibility and implications of this technique over 20 yr of use. PATIENTS AND METHODS: We retrospectively analyzed the medical files of 180 consecutive male patients who underwent a urethrectomy simultaneously with cystectomy for invasive bladder cancer between 1985 and 2005. We describe our technique step-by-step, and present possible technical difficulties and complications of urethrectomy. RESULTS: The mean increase in operative time with the prepubic urethrectomy over cystoprostatectomy alone was 17min (range: 15-25). Postoperative complications occurred in 10 (5.5%) patients. A subcutaneous penile haematoma was noted in four (2.2%) patients, two of whom needed a circumcision later on. A scrotal haematoma was seen in five (2.7%) patients; two needed a surgical drainage and three were treated conservatively. A prepubic collection was noted in one patient who was also treated conservatively. No thromboembolic or neurologic complications were encountered. CONCLUSIONS: When a urethrectomy is indicated, it can best be performed by using the prepubic approach, because it is easier and less time-consuming than the perineal approach, and has very limited and easily manageable complications.

Aged↗
PubMed2006

Detection of clinical unilateral T3a prostate cancer - by digital rectal examination or transrectal ultrasonography?

OBJECTIVE: To assess, in a retrospective study, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of digital rectal examination (DRE), transrectal ultrasonography (TRUS) and the combination of both in unilateral clinical T3a (cT3a) prostate cancer. PATIENTS AND METHODS: The long-term outcome of surgical treatment for locally advanced prostate cancer is very good and surpasses that for radiotherapy outcomes, so it is anticipated that surgical management for cT3a disease will become more important, but staging methods for cT3a disease are not well studied. Between 1990 and 2004, 2240 patients had a radical prostatectomy at our institution; 267 were diagnosed as having clinical cT3a prostate cancer either by DRE or TRUS. The final histopathology was compared with the findings of DRE and TRUS. The sensitivity, specificity, PPV and NPV for DRE, TRUS and the combination of both were calculated. RESULTS: The sensitivity, specificity, PPV and NPV by DRE only was 90.9%, 15.8%, 47.2% and 67.7%, by TRUS only was 80.2%, 25.3%, 47.1% and 60.7%, and by both DRE and TRUS was 71.1%, 41.1%, 50.0% and 63.2%. Although the sensitivity was lower in the combined group, it had the highest specificity (41.1%) and PPV (50.0%). The combination of DRE and TRUS can detect T3a prostate cancer more accurately than either method alone. CONCLUSION: Until data on staging methods like magnetic resonance imaging become available, the combination of DRE and TRUS is advisable in selecting cT3a patients for primary radical prostatectomy.

Adult↗
PubMed2006

Impact of pathology review of stage and margin status of radical prostatectomy specimens (EORTC trial 22911).

Pathological staging and surgical margin status of radical prostatectomy specimens are next to grading the most important prognosticators for recurrence. A central review of pathological stage and surgical margin status was performed on a series of 552 radical prostatectomy specimens of patients, participating in the European Organisation for Research and Treatment of Cancer trial 22911. Inclusion criteria of the trial were pathological stage pT3 and/or positive surgical margin at local pathology. All specimens were totally embedded. Data of the central review were compared with those of local pathologists and related to clinical follow-up. Although a high concordance between review pathology and local pathologists existed for seminal vesicle invasion (94%, kappa=0.83), agreement was much less for extraprostatic extension (57.5%, kappa=0.33) and for surgical margin status (69.4%, kappa=0.45). Review pathology of surgical margin status was a stronger predictor of biochemical progression-free survival in univariate analysis [hazard ratio (HR)=2.16 and p=0.0002] than local pathology (HR=1.08 and p>0.1). The review pathology demonstrated a significant difference between those with and without extraprostatic extension (HR=1.83 and p=0.0017), while local pathology failed to do so (HR=1.05 and p>0.8). The observations suggest that review of pathological stage and surgical margin of radical prostatectomy strongly improves their prognostic impact in multi-institutional studies or trials.

Adenocarcinoma↗
PubMed2006

A pretreatment table for the prediction of final histopathology after radical prostatectomy in clinical unilateral T3a prostate cancer.

OBJECTIVES: Partin tables are the most widely used tool to predict histopathologic stage after radical prostatectomy (RP) in organ-confined tumors. Such a predictive table in clinical T3 disease is still lacking. Our objective was to create a reference table for clinical unilateral T3a prostate cancer. PATIENTS AND METHODS: Between 1987 and 2004, 200 patients with clinical unilateral T3a disease underwent a RP and bilateral pelvic lymphadenectomy at our institution. No patient had received neoadjuvant treatment. Patients were divided into three prostate-specific antigen (PSA) subgroups ( 10-20 ng/ml, and >20 ng/ml) and two biopsy Gleason sum (GS) subgroups ( or=7 [4+3]). These parameters were used in the table as predictors for final histopathology. Margin and nodal status were also recorded. The multinomial log-linear regression analysis was used to construct the table. RESULTS: The table stratifies patients into six demarcated risk groups. In the first group, consisting of patients with PSA 20 and GS >or=7 (4+3), understaging was as high as 68% (44% pT3b and 22% pT4). Receiver operating characteristic analyses showed good accurate predictive ability of the table for seminal vesicle involvement and adjacent structure involvement, with moderate predictive ability for extraprostatic extension only. CONCLUSIONS: We present a table combining preoperative serum PSA and biopsy GS to predict histopathologic results in clinical unilateral T3a prostate cancer. The table may provide a basis for decision-making and patient counseling before treating this cancer.

Adult↗
PubMed2006

Outcome of surgery for clinical unilateral T3a prostate cancer: a single-institution experience.

OBJECTIVES: The optimal management of locally advanced prostate cancer (cT3) is still a matter of debate. The objective of this study is to present 10-year outcomes of radical prostatectomy (RP) in unilateral cT3a disease. PATIENTS AND METHODS: Between 1987 and 2004, 2273 patients underwent RP at our institution. Two hundred and thirty-five (10.3%) patients were assessed as unilateral cT3a disease by digital rectal examination. Thirty-five patients who received neoadjuvant treatment before surgery were excluded from further analysis. Mean follow-up was 70.6 months. Kaplan-Meier survival analysis was used to calculate the biochemical progression-free survival (BPFS), clinical progression-free survival (CPFS), cancer-specific survival (CSS), and overall survival (OS) rates. Cox uni- and multivariate regression analyses were used to identify predictive factors in BPFS and CPFS. RESULTS: Clinical overstaging (pT2) occurred in 23.5%. One hundred and twelve (56%) patients received adjuvant or salvage therapy. OS at 5 and 10 years was 95.9% and 77.0%, respectively, and CSS was 98.7% and 91.6%. BPFS at 5 and 10 years was 59.5% and 51.1%, respectively, and CPFS was 95.9% and 85.4%. Margin status was a significant independent predictor in BPFS; cancer volume was a significant independent predictor in CPFS. CONCLUSIONS: Clinically advanced prostate cancer is still frequently overstaged. In a well-selected patient group with locally advanced prostate cancer, RP--with adjuvant or salvage treatment when needed--can yield very high long-term cancer control and survival rates. Margin status and cancer volume are significant predictors of outcome after RP.

Adult↗
PubMed2006

Percutaneous ultrasound-guided radiofrequency ablation of recurrent renal cell carcinoma in renal allograft after partial nephrectomy.

Percutaneous thermal ablation is increasingly being studied in the treatment of renal tumors. Because radiofrequency ablation is a minimally invasive and nephron-sparing procedure, it is ideally suited for patients with a single kidney, multiple tumors, or contraindications to conventional surgery. We report on a patient with recurrent renal cell carcinoma in a transplanted kidney that was successfully treated with percutaneous ultrasound-guided radiofrequency ablation.

Aged↗
PubMed2006

The indications for partial nephrectomy in the treatment of renal cell carcinoma.

Partial nephrectomy is performed more frequently for small, incidentally discovered, low-stage renal tumors. Importantly, one should distinguish the imperative indications for such surgery from the relative and elective indications, while taking contraindications to nephron-sparing surgery into account. The main advantage of partial nephrectomy over radical nephrectomy is the avoidance of renal insufficiency; the major disadvantages include the possibility of local recurrence and perioperative complications. In this article, the literature on nephron-sparing surgery was reviewed in order to put the management of renal cancer into a modern perspective.

Carcinoma, Renal Cell↗
PubMed2005

Biological variation of total prostate-specific antigen: a survey of published estimates and consequences for clinical practice.

BACKGROUND: The objectives of this study were to determine whether a single result for total prostate-specific antigen (tPSA) can be used confidently to guide the need for prostate biopsy and by how much serial tPSA measurements must differ to be significant. tPSA measurements include both analytical and biological components of variation. The European Group on Tumor Markers conducted a literature survey to determine both the magnitude and impact of biological variation on single, the mean of replicate, and serial tPSA measurements. METHODS: The survey yielded 27 studies addressing the topic, and estimates for the biological variation of tPSA could be derived from 12 of these studies. RESULTS: The mean biological variation was 20% in the concentration range 0.1-20 microg/L for men over 50 years. The biological variation means that the one-sided 95% confidence interval (CI) of the dispersion for a single tPSA result is approximately 33%. Three replicate samples with one analysis on each narrow the one-sided 95% CI for the mean concentration to approximately 20% and facilitate decisions on prostate biopsy. During monitoring of serial measurements, the change needed for significance is approximately 50% (P <0.05). CONCLUSIONS: The biological variation of tPSA has implications for screening, diagnosis, and monitoring. Single measurements may not be sufficiently precise for screening and diagnosis. Replicate samples and calculation of the mean concentration may improve precision by reducing the dispersion. Monitoring of tPSA requires an estimate of either the change needed for significance or, alternatively, of the significance of the change.

Circadian Rhythm↗
PubMed2005

High-level expression of fatty acid synthase in human prostate cancer tissues is linked to activation and nuclear localization of Akt/PKB.

Many human epithelial cancers, particularly those with a poor prognosis, express high levels of fatty acid synthase (FAS), a key metabolic enzyme linked to the synthesis of membrane phospholipids in cancer cells. In view of the recent finding that in the human prostate cancer cell line LNCaP, overexpression of FAS can be largely attributed to constitutive activation of the phosphatidylinositol-3 (PI3) kinase/Akt kinase pathway, the activation status of the Akt pathway, and whether this activation coincides with increased FAS expression, was examined in clinical prostate cancer tissues. Using well-preserved frozen prostatic needle biopsies and a sensitive Envision detection technique, S473-phosphorylated Akt (pAkt) was found in 11/23 low-grade prostatic intraepithelial neoplasia (PIN) lesions, in all (36/36) high-grade PINs, and in all (86/86) invasive carcinomas. Non-neoplastic tissues were negative. Interestingly, in low-grade PINs and low-grade carcinomas, pAkt was mainly cytoplasmic or membrane-bound and was associated with moderate elevation of FAS expression. In 24/36 high-grade PINs and 82/88 invasive carcinomas, pAkt was found at least partly in the nucleus. Greater nuclear pAkt staining, and higher FAS expression, correlated with a higher Gleason score. In the light of previous findings that pAkt plays a causative role in the overexpression of FAS in cancer cells in culture, these data strongly suggest that high-level expression of FAS in prostate cancer tissues is linked to phosphorylation and nuclear accumulation of Akt.

Cell Nucleus↗
PubMed2003

Whole bladder wall photodynamic therapy of transitional cell carcinoma rat bladder tumors using intravesically administered hypericin.

Whole-bladder wall photodynamic therapy (PDT) is a promising treatment for carcinoma in situ (CIS) and diffuse premalignant changes of the bladder. After the results of our clinical studies showing that intravesical hypericin selectively accumulates in superficial bladder tumors, we investigated the hypericin-PDT efficacy in an AY-27 orthotopic transitional cell carcinoma rat bladder tumor model. After the instillation of hypericin (30 microM, 2 hr) in the bladder, tumors were irradiated (25-50 mW/cm 6-48 J/cm(2)) using 595 nm laser light. Data demonstrate that light doses of 12-48 J/cm(2) resulted in selective PDT-induced urothelial tumor damage without damaging detrusor musculature. Histological assessment of bladder sections 2 days after PDT showed tumor destruction, with tumor cells shrinking and detaching from the bladder wall. There were tumor regrowth 1-3 weeks after treatment. The in vivo/in vitro clonogenic assay results revealed up to 98% of tumor cell kill by hypericin PDT. In conclusion, hypericin PDT can be used to safely induce a selective urothelial tumor damage without damaging detrusor musculature, when optimum hypericin concentration and light fluences are used. A small percentage (2-5%) of tumor cells that survive the photodynamic treatment resulting in tumor regrowth after a prolonged period of time is likely due to oxygen depletion during light irradiation.

Administration, Intravesical↗
PubMed2003

Idiopathic partial thrombosis of the corpus cavernosum: conservative management is effective and possible.

Three cases of spontaneous, partial, unilateral thrombosis of the corpus cavernosum are described. The patients presented with a painful mass in the perineum without priapism. Diagnosis was made through ultrasound evaluation and magnetic resonance imaging, showing unilateral, partial thrombosis of the corpus cavernosum. Treatment consisted of systemic anticoagulation. In all three cases, the thrombosis resolved spontaneously over several months without complications. The aetiology of partial thrombosis of the corpus cavernosum remains unclear, but conservative management of this rare condition appears to be effective and safe.

Adolescent↗
PubMed2003

Radical cystectomy with or without urethrectomy?

After the introduction of bladder replacement procedures, the indications for prophylactic urethrectomy have become more and more restricted. While years ago, a prophylactic urethrectomy was performed in many patients with cutaneous diversions, it has become clear that only patients with invasion by transitional cell carcinoma at the level of the prostatic urethra or bladder neck have a substantial risk of developing subsequent urethral recurrence. The pre- or intra-operative assessment of the prostatic urethra in males and of the bladder neck in females is the key to appropriate management of the urethra in patients with bladder cancer.

Cystectomy↗