Urologie最新文献

The rapid development of molecular medicine has opened up new perspectives for the diagnosis and treatment of urological tumors. Urology faces the challenge of effectively treating advanced cancer, especially in view of the genetic diversity of urological tumors. The molecular tumor board offers an innovative approach to identify targeted therapy options based on the individual genetic signatures of tumor cells or tumor microenvironment-based treatment options. In this article, the concept of the molecular tumor board in urology is presented using the example of prostate cancer. We discuss the principles, applications, and future prospects of this promising approach.

Because only patients can adequately assess symptoms, disability, and quality of life, concordance between a patient's and physician's assessment is often low. Accordingly, patient-reported outcomes (PROs) are increasingly used in research and routine clinical care. In daily practice, PROs are not only applied to measure the patient's perceived outcome of medical treatments, but also to assess their health status before intervention starts. Typically, several patient-reported outcome measures (PROMs), which are reliable and valid, are available for the assessment of the most important PROMs. In daily clinical practice, the integration of PROs can be useful for clinical assessment and treatment planning or for quality management. Currently, the most promising application is routine patient monitoring using digital PROMs (ePROMs). Systematic reviews have revealed that the routine use of PROMs in daily clinical care is associated with, among others, improved physician-patient communication, higher patient satisfaction, reduced symptom burden, higher quality of life, and improved survival. This effect is especially strong if health care professionals continuously receive the results of the PRO monitoring. Patients are usually inclined to disclose their health status, and the positive effects of routine patient monitoring are widely recognized. However, several barriers to using PROs and PROMs still exist.

Background: Digital health applications (DiGA) were included in the German healthcare system in 2020. They are available for prescription and reimbursed by public and private insurance companies. For the specialty of urology, there are currently two DiGA available: for the treatment of erectile dysfunction and benign prostatic hyperplasia/overactive bladder (BPH/OAB). The legal basis, clinical results and practical implementation are presented.

Methods: Evaluation of websites and publications to show the regulatory requirements, mode of action, results of clinical trials and prescribing practice with DiGA.

Results: Since 2020, 63 DiGA have been listed in the register of the Federal Office for Drugs and Medical Devices (BfArM), 35 of them definitively. Two urological DiGA aim to treat erectile dysfunction and BPH/OAB. Randomized, controlled studies have shown a significant and clinically relevant patient benefit for both DiGA. Further urological DiGA are in clinical development.

Conclusions: DiGAs offer multimodal therapy combinations that have not yet been used in clinical practice and show a multidimensional benefit for the patient.

Background and objectives: The human papillomavirus (HPV) is one of the most common viruses transmitted through intimate contact, causing many benign and malignant diseases. Vaccination protects against these diseases. Despite the HPV vaccination being recommended by the Standing Committee on Vaccination (STIKO), knowledge and vaccination rates in Germany are very low. Therefore, the aim of the study was to assess the HPV knowledge among German students.

Materials and methods: Between 06/2019 and 01/2024, a nationwide online survey on HPV knowledge among students in Germany was distributed via the respective student councils. The survey included two aspects: 1) basic characteristics of the participants and 2) knowledge questions about HPV (e.g., transmission routes, effectiveness, and side effects of vaccination, knowledge about the HPV subtypes). Data collection was anonymous.

Results: A total of 459 students took part in the study. Of these, 335 (72.98%) were female, 122 (26.57%) were male, and 2 (0.45%) did not specify their gender. The average age of the students was 24.02 years, and most of the participants were in their 6th (23.31%/107) semester. In all, 75.82% (348) of the participants were medical students followed by law students with 19.61% (90) participants. The most represented study location was Aachen, with 270 (58.82%) participants. Only about half (48.80%/223) of the students knew that approximately 8000 new cancer cases in Germany are HPV-associated annually. Regarding the HPV vaccination, more than a third (35.82%/163) of participants did not know that it also protects against genital warts, while 21.93% (100) did not know that boys can also benefit from the HPV vaccination and that it does not only improve HPV protection of girls against cervical cancer.

Conclusion: Despite several years of HPV vaccination recommendation by the Standing Committee on Vaccination (STIKO), knowledge about HPV among college students still remains very low. Further prevention and educational efforts are needed to address HPV knowledge gaps, with the additional goal of improving HPV vaccination rates.

Background: The aim of this study was to determine the proportion of patients with prostate cancer (PCa) who remained on primary androgen deprivation therapy (ADT) after starting treatment for castration-resistant prostate cancer (CRPC) and to describe their treatment patterns.

Materials and methods: The study comprises a retrospective analysis of 609,308 patients in urological practices in Germany from 2011 to 2020 based on anonymized secondary data from the UROscience webserver. PCa patients were eligible for inclusion if they received ADT after a 6-month prescription-free pre-index period.

Results: A total of 3,112 patients (mean age 75.5 [±8.0] years) were included. Most patients received gonadotropin-releasing hormone (GnRH) agonists (72.3%), followed by antiandrogens (24.9%). The median duration of ADT treatment was 25.9 months. The estimated probabilities of continuing ADT 3, 6, and 8 years after starting treatment were 40.7%, 20.1%, and 12.7%, respectively. Interruption across all ADTs occurred in 42.7% of patients, switching of primary ADT in 52.2% and discontinuation in 82.2% of patients. After starting ADT, 14.6% of patients received treatment for CRPC, of whom 76.4% continued primary ADT. The median duration of CRPC treatment was 11.0 months. The estimated probabilities of developing CRPC 3, 6, and 8 years after starting ADT were 11.1%, 20.1%, and 25.9%, respectively.

Conclusion: This study has shown that a relevant proportion of patients discontinued primary ADT after starting treatment for CRPC, although guidelines recommend continuing ADT if the disease progresses.

Background: The treatment landscape of metastatic hormone-sensitive prostate cancer (mHSPC) has undergone fundamental changes in recent decades, moving away from the sole use of androgen deprivation therapy (ADT) and towards intensified combination therapies.

Purpose: To what extent have the data from prospective phase III studies influenced clinical practice in the management of mHSPC over the past 5 or 10 years?

Results: A total of 1098 mHSPC patients with a median age at metastasis of 70 years and a median prostate-specific antigen (PSA) level of 43 ng/ml were included in the present study. Significant differences were observed in terms of PSA nadirs in mHSPC after stratification by year of metastatic onset. Significant differences were also observed regarding systemic therapies applied in mHSPC and metastatic castration-resistant prostate cancer (mCRPC; p < 0.001). Regarding the annual estimated percentage change (EAPC) over the past 10 years, a significant decrease in ADT monotherapy from 85% (2013) to 29% (2023; EAPC: -12%, p < 0.001) was observed. Conversely, there was a significant increase in androgen receptor signaling inhibitor (ARSI) use from 6% in 2013 to 55% in 2023 (EAPC: +21.7%, p < 0.001). Regarding docetaxel chemotherapy, a bell-shaped pattern was apparent over the past 10 years, with rates increasing from 8% in 2013 to 25% in 2019 and decreasing to 0% in 2023. The proportion of triplet therapies was 16% in 2023.

Conclusion: Over the past 10 years there has been an adaptation of intensified combination therapies for mHSPC in clinical reality, with the most frequent use of ARSI and triplet therapies.

The previous concept of self-administration as a regulatory body in healthcare in Germany has been repeatedly called into question by politicians. Different approaches can be recognized in various examples. In the author's view, healthcare provision based on legal ordinances and action geared towards legislative periods cannot replace the solutions found by self-administration-neither in terms of content, expertise nor quality. It is precisely the separation of roles and responsibilities between the state and self-administration that has so far ensured that decisions are made close to the healthcare system in order to further develop the healthcare system in Germany based on evidence and without losing sight of the costs.

The healthcare industry has long complained about an acute shortage of skilled workers. Vacancies can often only be filled by skilled workers from abroad. While rural areas are increasingly experiencing a shortage of personnel, many urban centers continue to have an oversupply and a sufficient number of young doctors. Hospitals do not expect the situation to improve in the future. Hospitals are trying to counteract the negative development of the job situation in nursing staff. Government intervention can limit the economically motivated adjustment of resource utilization. The demand for staff will not fall as a result of de-economization.