Skip to main content

R. Pelger

Followers

23

Following

15

Co-authors

14

Public Views

Interests

Uploads

Papers by R. Pelger

Needle placement and position of electro stimulation inside sacral foramen determines pelvic floor EMG response – implications for sacral neuromodulation

Neurourology and Urodynamics, 2017

Hypothesis / aims of study Sacral neuromodulation is a well-accepted treatment for overactive bla... more Hypothesis / aims of study Sacral neuromodulation is a well-accepted treatment for overactive bladder, non-obstructive urinary retention and faecal incontinence. A lead is placed through the 3 or 4 sacral foramen to stimulation the sacral nerve roots, and position is determined based upon clinical observation of an inward movement of the bellows (e.g. pelvic floor contraction). However for urological indications, intention to treat results varies between 50 and 60% (1). One of the reasons may be inadequate lead location, e.g. not close to the target nerve. The aims of the study are to determine the pelvic floor (PF) EMG responses upon electro-stimulation at different locations within the same foramen (e.g. S3 or S4); hypothesizing that different locations inside the foramen will lead to different EMG responses.

The effect of EMG biofeedback assisted pelvic floor muscle therapy on symptoms of the overactive bladder syndrome in women: A randomized controlled trial

Neurourology and urodynamics, Jan 21, 2016

The overactive bladder syndrome (OAB) is defined as urinary urgency, usually accompanied by frequ... more The overactive bladder syndrome (OAB) is defined as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence. Biofeedback-assisted pelvic muscle therapy (BAPFMT) is a first-line treatment option for OAB. The aims of this study were to determine the efficacy and effectiveness of BAPFMT on symptoms of OAB after 9 weeks of treatment and to detect changes EMG activity of individual pelvic floor muscles (PFM) with the MAPLe. Patients were randomly divided into an intervention group that received BAPFMT with the MAPLe or into a control group which received only toilet behavior and lifestyle instructions. The Pelvic Floor Inventories (PeLFIs), the King's Health Questionnaire (KHQ), a voiding dairy, a 24 h pad-test, and vaginal EMG registration of the pelvic floor with the MAPLe were used at inclusion and after 9 weeks follow-up to determine the effect of BAPFMT on complaints of OAB and Quality of Life (QoL). Fifty-eight patients were ...

The Multiple Array Probe (Maple): A New Tool Capable of Measuring Emg of and Differentiate Between Individual Pelvic Floor Muscles

Neuro-urology: functional disorders in male and female urogenital trac

The surgical anatomy of the renal pyelocaliceal system studied by volume rendering of CTU

European Urology Supplements, 2017

886PEfficacy of enzalutamide in hormone-sensitive metastatic prostate cancer: Clinical utility of 18F-choline PET and whole body MRI

Annals of Oncology, 2019

Background AR-inhibition with Enzalutamide may be an attractive alternative for 1L treatment of m... more Background AR-inhibition with Enzalutamide may be an attractive alternative for 1L treatment of men with hormone-sensitive prostate cancer compared to androgen deprivation therapy (ADT). There is an unmet need for robust, reproducible imaging technology allowing accurate quantification and qualification of bone plus soft tissue metastases and assessment of early tumour responses to novel agents. PET/CT or WB MRI imaging offer advantage over traditional bone and CT scans. Methods Sixty patients with metastatic hormone-sensitive PC were included in this prospective cohort study. Patients received Enzalutamide 160 mg once daily until progression of disease. Imaging tests were performed at baseline and bone scintigraphy and CT repeated at 3 month intervals, 18F-choline PET/CT at 2 weeks, 2, 6, 9 and 12 months and WB-MRI at 6 and 12 months. Enumeration of circulating tumor cells and quality of life assessments were secondary outcomes. Results Sixty patients with a median age of 72 yrs (r...

Indwelling Urinary Catheter-Related Problems After Laparoscopic Radical Prostatectomy

Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society / WOCN

The purpose of this study was to determine occurrence rates of catheter-related problems and thei... more The purpose of this study was to determine occurrence rates of catheter-related problems and their association to pertinent clinical characteristics in men with indwelling urinary catheters following laparoscopic radical prostatectomy. Descriptive, correlational study. One hundred twelve men who underwent laparoscopic radical prostatectomy between December 2010 and December 2012 at the Leiden University Medical Centre in the Netherlands were included in this study. After surgery, a Charriere 20 (20F) silicone catheter was left indwelling for 1 week. Data were gathered from 2 sources; we reviewed participants' medical records, and participants completed a questionnaire designed for this study. Pearson χ tests were used to analyze associations between dichotomous and ordinal variables and catheter-related problems. Univariate logistic regression analyses were used to analyze the relationships between continuous factors and catheter-related problems. Seventy-five percent of partici...

$Research paper thumbnail of 614 A randomised clinical trial of 89 strontium and the aminobisphosphonate olpadronate in the palliative management of hormone refractory metastatic prostate cancer: Comparative efficacy and cost analysis$

614 A randomised clinical trial of 89 strontium and the aminobisphosphonate olpadronate in the palliative management of hormone refractory metastatic prostate cancer: Comparative efficacy and cost analysis

European Urology Supplements, 2004

The flare in alkaline phosphatase activity post-orchidectomy predicts which patient may benefit from early chemotherapy in metastatic prostate cancer

The Prostate, 2002

A flare in serum alkaline phosphatase (ALP) activity post-orchidectomy has been shown to be of ne... more A flare in serum alkaline phosphatase (ALP) activity post-orchidectomy has been shown to be of negative prognostic value for progression-free survival (PFS) in patients with prostate cancer. The aim of this study was to investigate whether a flare in ALP may help identify patients in whom prognosis could be positively influenced by early chemotherapy. A retrospective analysis of the database of a Dutch multicenter study was conducted to evaluate the prognostic value of the flare in ALP post-orchidectomy for survival and PFS in 112 patients treated with orchidectomy (previously reported) compared to 121 age- and stage-matched patients additionally treated with estramustine-phosphate (EMP) as first line therapy. There was no overall difference in PFS and survival between the two treatment regimen. Subgroup analysis of patients demonstrating a greater than 50% increase in ALP post-orchidectomy showed, however, a significant increase in PFS in patients additionally treated with EMP. Our data suggest that the simple measurement of ALP activity within 4 weeks of castration represents a useful adjunct in assessing which patients with prostate cancer undergoing androgen ablation may benefit from additional early chemotherapy.

$Research paper thumbnail of Bone scintigraphy predicts the risk of spinal cord compression in hormone-refractory prostate cancer$

Bone scintigraphy predicts the risk of spinal cord compression in hormone-refractory prostate cancer

European Journal of Nuclear Medicine and Molecular Imaging, 2004

In prostate cancer, confirmation of metastatic involvement of the skeleton has traditionally been... more In prostate cancer, confirmation of metastatic involvement of the skeleton has traditionally been achieved by bone scintigraphy, although the widespread availability of prostate-specific antigen (PSA) measurements has tended to eliminate the need for this investigation. The potential of bone scintigraphy to predict skeletal-related events, particularly spinal cord compression, after the onset of hormone refractoriness has never been investigated. The aim of this study was to establish whether a new method of evaluating bone scintigraphy would offer a better predictive value for this complication of the metastatic process than is achieved with currently available grading methods. We studied 84 patients with hormone-refractory prostate cancer who had undergone bone scintigraphy at the time of hormone escape. Tumour grading and parameters of tumour load (PSA and alkaline phosphatase activity) were available in all patients. The incidence of spinal cord compression was documented and all patients were followed up until death. Bone scintigraphy was evaluated by the conventional Soloway grading and by an additional analysis determining total or partial involvement of individual vertebrae. In contrast to the Soloway method, the new method was able to predict spinal cord compression at various spinal levels. Our data suggest that there is still a place for bone scintigraphy in the management of hormone-refractory prostate cancer.

Strategies for Management of Prostate Cancer-Related Bone Pain

Drugs & Aging, 2001

Prostate cancer is one of the most common malignancies and a leading cause of cancer-related deat... more Prostate cancer is one of the most common malignancies and a leading cause of cancer-related death in men worldwide. In the majority of cases, prostate cancer metastasises to the skeleton, in which case cancer-related bone pain becomes a major cause of morbidity. Androgen ablation is the treatment of choice for securing regression of skeletal metastases in the majority of cases. Intermittent androgen ablation is an attractive alternative, aimed at minimising adverse effects of hormone deprivation but also potentially delaying hormone-refractoriness. The development of hormone-refractoriness is heralded by a significant increase in morbidity largely because of escalating bone pain caused by the progression of the metastatic process. Skilful use of analgesics is initially successful but eventually fails to control symptoms. Localised metastases are best treated with local radiotherapy that is rapidly effective. Over the last few years, it has become clear that therapeutic modalities using bone-seeking radionuclides or bisphosphonates have been effective in the palliation of prostate cancer-related bone pain, although not affecting survival. The main limiting factor with the use of radionuclides is bone marrow suppression, also a feature of the very late stages of prostate cancer. Bisphosphonates do not carry this disadvantage. Results of large double-blind, placebo-controlled studies should be awaited, however, before advocating the widespread use of these agents in the management of patients with prostate cancer and skeletal metastases.

$Research paper thumbnail of Severe hypophosphatemic osteomalacia in hormone-refractory prostate cancer metastatic to the skeleton: natural history and pitfalls in management$

Severe hypophosphatemic osteomalacia in hormone-refractory prostate cancer metastatic to the skeleton: natural history and pitfalls in management

Bone, 2005

We report the case of a severe symptomatic hypophosphatemic osteomalacia in a 66-year-old patient... more We report the case of a severe symptomatic hypophosphatemic osteomalacia in a 66-year-old patient with hormone-refractory prostate cancer metastatic to the skeleton. A follow-up of 2 years from diagnosis to development of hormone refractoriness and death allowed us to study the natural history of this uncommon disturbance of mineral homeostasis in this common malignancy. Relevant to the difficult management of the late stages of prostate cancer is the failure of hypophosphatemia to respond to conventional therapeutic approaches and the favorable outcome of antitumor therapy suggesting that this group of patients, although having a poor prognosis, could still benefit from aggressive second line therapy. In this malignancy in which metastases have a predilection for bone, failure to recognize osteomalacia can only result in significantly increasing the burden of skeletal complications.

BMP7, a Putative Regulator of Epithelial Homeostasis in the Human Prostate, Is a Potent Inhibitor of Prostate Cancer Bone Metastasis in Vivo

The American Journal of Pathology, 2007

Bone morphogenic protein 7 (BMP7) counteracts physiological epithelial-to-mesenchymal transition,... more Bone morphogenic protein 7 (BMP7) counteracts physiological epithelial-to-mesenchymal transition, a process that is indicative of epithelial plasticity. Because epithelial-to-mesenchymal transition is involved in cancer, we investigated whether BMP7 plays a role in prostate cancer growth and metastasis. BMP7 expression in laser-microdissected primary human prostate cancer tissue was strongly down-regulated compared with normal prostate luminal epithelium. Furthermore, BMP7 expression in prostate cancer cell lines was inversely related to tumorigenic and metastatic potential in vivo and significantly correlated to E-cadherin/vimentin ratios. Exogenous addition of BMP7 to human prostate cancer cells dose-dependently inhibited transforming growth factor ␤-induced activation of nuclear Smad3/4 complexes via ALK5 and induced E-cadherin expression. Moreover, BMP7-induced activation of nuclear Smad1/4/5 signaling transduced via BMP type I receptors was synergistically stimulated in the presence of transforming growth factor ␤, a growth factor that is enriched in the bone microenvironment. Daily BMP7 administration to nude mice inhibited the growth of cancer cells in bone. In contrast, no significant growth inhibitory effect of BMP7 was observed in intraprostatic xenografts. Collectively, our observations suggest that BMP7 controls and preserves the epithelial phenotype in the human prostate and underscore a decisive role of the tumor microenvironment in mediating the therapeutic response of BMP7. Thus, BMP7 can still counteract the epithelial-to-mesenchymal transition process in the metastatic tumor, positioning BMP7 as a novel therapeutic molecule for treatment of metastatic bone disease.

The Flare in Serum Alkaline Phosphatase Activity After Orchiectomy: A Valuable Negative Prognostic Index for Progression-Free Survival in Prostatic Carcinoma

Journal of Urology, 1996

Purpose: We determined whether a n early flare in serum alkaline phosphatase activity after orchi... more Purpose: We determined whether a n early flare in serum alkaline phosphatase activity after orchiectomy was of prognostic value for progression-free survival in patients with advanced prostatic carcinoma. Materials and Methods: A retrospective analysis of a data base from a Dutch multicenter study on prostatic carcinoma was done to determine the prognostic value of a flare in alkaline phosphatase activity after orchiectomy in 112 patients with metastatic (75%) or locally advanced (25%) disease. Cox's proportional hazards models and Kaplan-Meier survival curves were used. Results: Of the patients 50% had initially increased alkaline phosphatase levels and a flare in activity was demonstrated in 87% 2 to 4 weeks after orchiectomy. The prostate specific antigen nadir (cutoff 4 ng./ml.) 6 months after orchiectomy was of significant prognostic value for progression-free survival. A flare in alkaline phosphatase activity after orchiectomy demonstrated a n early significant prognostic value for progression-free survival, independent of the serum alkaline phosphatase activity. Conclusions: The simplicity, ready availability and cost-effectiveness of serum alkaline phosphatase activity as a prognostic index render it attractive to the clinician, particularly early in the course of prostatic carcinoma. Measuring the flare in alkaline phosphatase activity within 1 month of orchiectomy may permit early identification of patients in whom the disease is likely to progress rapidly and who would potentially benefit from aggressive treatment. KEY WORDS: orchiectomy, prostatic neoplasms, alkaline phosphatase, survival 15 24 (1 7 3 0) 28 (2&35) Less than 50 49 29 (24-34) 34 (30-38) 50-100 19 13 (8-19) 27 (19-34) More than 100 29 11 (7-15) 20 (11-26) PSA nadir (pg.11.) Less than 4 72 29 (24-35) 36 (3141) No. pts. More than 4 40 17 (13-20) 24 (21-28)

The influence of pain on the outcome of ESWL

European Urology Supplements, 2017

Malignant Fibrous Histiocytoma of the Spermatic Cord

American Journal of Clinical Oncology, 2002

ABSTRACT

“Primum non nocere”: ασχειυ περι τα υοσηματα δυο, ωφελειυ η μηβλαπτειυ

The Moment of ‘Enlightment

European Urology Supplements, 2006

Is het zinvol om bij een klinisch typische niersteenkoliek (flankpijn + erythrocyturie) een echo te laten maken om hydronefrose uit te sluiten?

Vademecum permanente nascholing huisartsen, 2006

Short-Term Metabolic Effects of Pamidronate in Patients With Prostatic Carcinoma and Bone Metastases

The Lancet, 1989

Evaluation of a multi-colour fluorescence in situ hybridisation assay for the detection of bladder cancer-results from three European laboratories

European Urology Supplements, 2003

Needle placement and position of electro stimulation inside sacral foramen determines pelvic floor EMG response – implications for sacral neuromodulation

Neurourology and Urodynamics, 2017

Hypothesis / aims of study Sacral neuromodulation is a well-accepted treatment for overactive bla... more Hypothesis / aims of study Sacral neuromodulation is a well-accepted treatment for overactive bladder, non-obstructive urinary retention and faecal incontinence. A lead is placed through the 3 or 4 sacral foramen to stimulation the sacral nerve roots, and position is determined based upon clinical observation of an inward movement of the bellows (e.g. pelvic floor contraction). However for urological indications, intention to treat results varies between 50 and 60% (1). One of the reasons may be inadequate lead location, e.g. not close to the target nerve. The aims of the study are to determine the pelvic floor (PF) EMG responses upon electro-stimulation at different locations within the same foramen (e.g. S3 or S4); hypothesizing that different locations inside the foramen will lead to different EMG responses.

The effect of EMG biofeedback assisted pelvic floor muscle therapy on symptoms of the overactive bladder syndrome in women: A randomized controlled trial

Neurourology and urodynamics, Jan 21, 2016

The overactive bladder syndrome (OAB) is defined as urinary urgency, usually accompanied by frequ... more The overactive bladder syndrome (OAB) is defined as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence. Biofeedback-assisted pelvic muscle therapy (BAPFMT) is a first-line treatment option for OAB. The aims of this study were to determine the efficacy and effectiveness of BAPFMT on symptoms of OAB after 9 weeks of treatment and to detect changes EMG activity of individual pelvic floor muscles (PFM) with the MAPLe. Patients were randomly divided into an intervention group that received BAPFMT with the MAPLe or into a control group which received only toilet behavior and lifestyle instructions. The Pelvic Floor Inventories (PeLFIs), the King's Health Questionnaire (KHQ), a voiding dairy, a 24 h pad-test, and vaginal EMG registration of the pelvic floor with the MAPLe were used at inclusion and after 9 weeks follow-up to determine the effect of BAPFMT on complaints of OAB and Quality of Life (QoL). Fifty-eight patients were ...

The Multiple Array Probe (Maple): A New Tool Capable of Measuring Emg of and Differentiate Between Individual Pelvic Floor Muscles

Neuro-urology: functional disorders in male and female urogenital trac

The surgical anatomy of the renal pyelocaliceal system studied by volume rendering of CTU

European Urology Supplements, 2017

886PEfficacy of enzalutamide in hormone-sensitive metastatic prostate cancer: Clinical utility of 18F-choline PET and whole body MRI

Annals of Oncology, 2019

Background AR-inhibition with Enzalutamide may be an attractive alternative for 1L treatment of m... more Background AR-inhibition with Enzalutamide may be an attractive alternative for 1L treatment of men with hormone-sensitive prostate cancer compared to androgen deprivation therapy (ADT). There is an unmet need for robust, reproducible imaging technology allowing accurate quantification and qualification of bone plus soft tissue metastases and assessment of early tumour responses to novel agents. PET/CT or WB MRI imaging offer advantage over traditional bone and CT scans. Methods Sixty patients with metastatic hormone-sensitive PC were included in this prospective cohort study. Patients received Enzalutamide 160 mg once daily until progression of disease. Imaging tests were performed at baseline and bone scintigraphy and CT repeated at 3 month intervals, 18F-choline PET/CT at 2 weeks, 2, 6, 9 and 12 months and WB-MRI at 6 and 12 months. Enumeration of circulating tumor cells and quality of life assessments were secondary outcomes. Results Sixty patients with a median age of 72 yrs (r...

Indwelling Urinary Catheter-Related Problems After Laparoscopic Radical Prostatectomy

Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society / WOCN

The purpose of this study was to determine occurrence rates of catheter-related problems and thei... more The purpose of this study was to determine occurrence rates of catheter-related problems and their association to pertinent clinical characteristics in men with indwelling urinary catheters following laparoscopic radical prostatectomy. Descriptive, correlational study. One hundred twelve men who underwent laparoscopic radical prostatectomy between December 2010 and December 2012 at the Leiden University Medical Centre in the Netherlands were included in this study. After surgery, a Charriere 20 (20F) silicone catheter was left indwelling for 1 week. Data were gathered from 2 sources; we reviewed participants' medical records, and participants completed a questionnaire designed for this study. Pearson χ tests were used to analyze associations between dichotomous and ordinal variables and catheter-related problems. Univariate logistic regression analyses were used to analyze the relationships between continuous factors and catheter-related problems. Seventy-five percent of partici...

$Research paper thumbnail of 614 A randomised clinical trial of 89 strontium and the aminobisphosphonate olpadronate in the palliative management of hormone refractory metastatic prostate cancer: Comparative efficacy and cost analysis$

614 A randomised clinical trial of 89 strontium and the aminobisphosphonate olpadronate in the palliative management of hormone refractory metastatic prostate cancer: Comparative efficacy and cost analysis

European Urology Supplements, 2004

The flare in alkaline phosphatase activity post-orchidectomy predicts which patient may benefit from early chemotherapy in metastatic prostate cancer

The Prostate, 2002

A flare in serum alkaline phosphatase (ALP) activity post-orchidectomy has been shown to be of ne... more A flare in serum alkaline phosphatase (ALP) activity post-orchidectomy has been shown to be of negative prognostic value for progression-free survival (PFS) in patients with prostate cancer. The aim of this study was to investigate whether a flare in ALP may help identify patients in whom prognosis could be positively influenced by early chemotherapy. A retrospective analysis of the database of a Dutch multicenter study was conducted to evaluate the prognostic value of the flare in ALP post-orchidectomy for survival and PFS in 112 patients treated with orchidectomy (previously reported) compared to 121 age- and stage-matched patients additionally treated with estramustine-phosphate (EMP) as first line therapy. There was no overall difference in PFS and survival between the two treatment regimen. Subgroup analysis of patients demonstrating a greater than 50% increase in ALP post-orchidectomy showed, however, a significant increase in PFS in patients additionally treated with EMP. Our data suggest that the simple measurement of ALP activity within 4 weeks of castration represents a useful adjunct in assessing which patients with prostate cancer undergoing androgen ablation may benefit from additional early chemotherapy.

$Research paper thumbnail of Bone scintigraphy predicts the risk of spinal cord compression in hormone-refractory prostate cancer$

Bone scintigraphy predicts the risk of spinal cord compression in hormone-refractory prostate cancer

European Journal of Nuclear Medicine and Molecular Imaging, 2004

In prostate cancer, confirmation of metastatic involvement of the skeleton has traditionally been... more In prostate cancer, confirmation of metastatic involvement of the skeleton has traditionally been achieved by bone scintigraphy, although the widespread availability of prostate-specific antigen (PSA) measurements has tended to eliminate the need for this investigation. The potential of bone scintigraphy to predict skeletal-related events, particularly spinal cord compression, after the onset of hormone refractoriness has never been investigated. The aim of this study was to establish whether a new method of evaluating bone scintigraphy would offer a better predictive value for this complication of the metastatic process than is achieved with currently available grading methods. We studied 84 patients with hormone-refractory prostate cancer who had undergone bone scintigraphy at the time of hormone escape. Tumour grading and parameters of tumour load (PSA and alkaline phosphatase activity) were available in all patients. The incidence of spinal cord compression was documented and all patients were followed up until death. Bone scintigraphy was evaluated by the conventional Soloway grading and by an additional analysis determining total or partial involvement of individual vertebrae. In contrast to the Soloway method, the new method was able to predict spinal cord compression at various spinal levels. Our data suggest that there is still a place for bone scintigraphy in the management of hormone-refractory prostate cancer.

Strategies for Management of Prostate Cancer-Related Bone Pain

Drugs & Aging, 2001

Prostate cancer is one of the most common malignancies and a leading cause of cancer-related deat... more Prostate cancer is one of the most common malignancies and a leading cause of cancer-related death in men worldwide. In the majority of cases, prostate cancer metastasises to the skeleton, in which case cancer-related bone pain becomes a major cause of morbidity. Androgen ablation is the treatment of choice for securing regression of skeletal metastases in the majority of cases. Intermittent androgen ablation is an attractive alternative, aimed at minimising adverse effects of hormone deprivation but also potentially delaying hormone-refractoriness. The development of hormone-refractoriness is heralded by a significant increase in morbidity largely because of escalating bone pain caused by the progression of the metastatic process. Skilful use of analgesics is initially successful but eventually fails to control symptoms. Localised metastases are best treated with local radiotherapy that is rapidly effective. Over the last few years, it has become clear that therapeutic modalities using bone-seeking radionuclides or bisphosphonates have been effective in the palliation of prostate cancer-related bone pain, although not affecting survival. The main limiting factor with the use of radionuclides is bone marrow suppression, also a feature of the very late stages of prostate cancer. Bisphosphonates do not carry this disadvantage. Results of large double-blind, placebo-controlled studies should be awaited, however, before advocating the widespread use of these agents in the management of patients with prostate cancer and skeletal metastases.

$Research paper thumbnail of Severe hypophosphatemic osteomalacia in hormone-refractory prostate cancer metastatic to the skeleton: natural history and pitfalls in management$

Severe hypophosphatemic osteomalacia in hormone-refractory prostate cancer metastatic to the skeleton: natural history and pitfalls in management

Bone, 2005

We report the case of a severe symptomatic hypophosphatemic osteomalacia in a 66-year-old patient... more We report the case of a severe symptomatic hypophosphatemic osteomalacia in a 66-year-old patient with hormone-refractory prostate cancer metastatic to the skeleton. A follow-up of 2 years from diagnosis to development of hormone refractoriness and death allowed us to study the natural history of this uncommon disturbance of mineral homeostasis in this common malignancy. Relevant to the difficult management of the late stages of prostate cancer is the failure of hypophosphatemia to respond to conventional therapeutic approaches and the favorable outcome of antitumor therapy suggesting that this group of patients, although having a poor prognosis, could still benefit from aggressive second line therapy. In this malignancy in which metastases have a predilection for bone, failure to recognize osteomalacia can only result in significantly increasing the burden of skeletal complications.

BMP7, a Putative Regulator of Epithelial Homeostasis in the Human Prostate, Is a Potent Inhibitor of Prostate Cancer Bone Metastasis in Vivo

The American Journal of Pathology, 2007

Bone morphogenic protein 7 (BMP7) counteracts physiological epithelial-to-mesenchymal transition,... more Bone morphogenic protein 7 (BMP7) counteracts physiological epithelial-to-mesenchymal transition, a process that is indicative of epithelial plasticity. Because epithelial-to-mesenchymal transition is involved in cancer, we investigated whether BMP7 plays a role in prostate cancer growth and metastasis. BMP7 expression in laser-microdissected primary human prostate cancer tissue was strongly down-regulated compared with normal prostate luminal epithelium. Furthermore, BMP7 expression in prostate cancer cell lines was inversely related to tumorigenic and metastatic potential in vivo and significantly correlated to E-cadherin/vimentin ratios. Exogenous addition of BMP7 to human prostate cancer cells dose-dependently inhibited transforming growth factor ␤-induced activation of nuclear Smad3/4 complexes via ALK5 and induced E-cadherin expression. Moreover, BMP7-induced activation of nuclear Smad1/4/5 signaling transduced via BMP type I receptors was synergistically stimulated in the presence of transforming growth factor ␤, a growth factor that is enriched in the bone microenvironment. Daily BMP7 administration to nude mice inhibited the growth of cancer cells in bone. In contrast, no significant growth inhibitory effect of BMP7 was observed in intraprostatic xenografts. Collectively, our observations suggest that BMP7 controls and preserves the epithelial phenotype in the human prostate and underscore a decisive role of the tumor microenvironment in mediating the therapeutic response of BMP7. Thus, BMP7 can still counteract the epithelial-to-mesenchymal transition process in the metastatic tumor, positioning BMP7 as a novel therapeutic molecule for treatment of metastatic bone disease.

The Flare in Serum Alkaline Phosphatase Activity After Orchiectomy: A Valuable Negative Prognostic Index for Progression-Free Survival in Prostatic Carcinoma

Journal of Urology, 1996

Purpose: We determined whether a n early flare in serum alkaline phosphatase activity after orchi... more Purpose: We determined whether a n early flare in serum alkaline phosphatase activity after orchiectomy was of prognostic value for progression-free survival in patients with advanced prostatic carcinoma. Materials and Methods: A retrospective analysis of a data base from a Dutch multicenter study on prostatic carcinoma was done to determine the prognostic value of a flare in alkaline phosphatase activity after orchiectomy in 112 patients with metastatic (75%) or locally advanced (25%) disease. Cox's proportional hazards models and Kaplan-Meier survival curves were used. Results: Of the patients 50% had initially increased alkaline phosphatase levels and a flare in activity was demonstrated in 87% 2 to 4 weeks after orchiectomy. The prostate specific antigen nadir (cutoff 4 ng./ml.) 6 months after orchiectomy was of significant prognostic value for progression-free survival. A flare in alkaline phosphatase activity after orchiectomy demonstrated a n early significant prognostic value for progression-free survival, independent of the serum alkaline phosphatase activity. Conclusions: The simplicity, ready availability and cost-effectiveness of serum alkaline phosphatase activity as a prognostic index render it attractive to the clinician, particularly early in the course of prostatic carcinoma. Measuring the flare in alkaline phosphatase activity within 1 month of orchiectomy may permit early identification of patients in whom the disease is likely to progress rapidly and who would potentially benefit from aggressive treatment. KEY WORDS: orchiectomy, prostatic neoplasms, alkaline phosphatase, survival 15 24 (1 7 3 0) 28 (2&35) Less than 50 49 29 (24-34) 34 (30-38) 50-100 19 13 (8-19) 27 (19-34) More than 100 29 11 (7-15) 20 (11-26) PSA nadir (pg.11.) Less than 4 72 29 (24-35) 36 (3141) No. pts. More than 4 40 17 (13-20) 24 (21-28)

The influence of pain on the outcome of ESWL

European Urology Supplements, 2017

Malignant Fibrous Histiocytoma of the Spermatic Cord

American Journal of Clinical Oncology, 2002

ABSTRACT

“Primum non nocere”: ασχειυ περι τα υοσηματα δυο, ωφελειυ η μηβλαπτειυ

The Moment of ‘Enlightment

European Urology Supplements, 2006

Is het zinvol om bij een klinisch typische niersteenkoliek (flankpijn + erythrocyturie) een echo te laten maken om hydronefrose uit te sluiten?

Vademecum permanente nascholing huisartsen, 2006

Short-Term Metabolic Effects of Pamidronate in Patients With Prostatic Carcinoma and Bone Metastases

The Lancet, 1989

Evaluation of a multi-colour fluorescence in situ hybridisation assay for the detection of bladder cancer-results from three European laboratories

European Urology Supplements, 2003