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Strahlentherapie des Prostatakarzinoms in der neuen S3-Leitlinie

Teil 2: Postoperative Strahlentherapie und Brachytherapie

Radiation therapy for prostate cancer in the new S3 guideline

Part 2: postoperative radiation therapy and brachytherapy


Der postoperativen adjuvanten Strahlentherapie kommt durch das Vorliegen dreier randomisierter Studien im Stadium pT3R1 besondere Bedeutung zu, da hier eine Überlebensverlängerung gegenüber der „Wait-and-see-Strategie“ nachgewiesen wurde. Als Alternative steht die Bestrahlung bei persistierendem oder ansteigendem PSA-Wert nach radikaler Prostatektomie zur Verfügung. In diesem Fall jedoch sollte die Salvagestrahlentherapie so früh wie möglich erfolgen, am besten, wenn der PSA-Wert <0,5 ng/ml ist. Die Nebenwirkungen der perkutanen Strahlentherapie mit modernen Techniken in diesem Stadium sind sehr gering, schwere Spätfolgen Grad III oder IV treten in <3% der Fälle auf. Die LDR-Brachytherapie als Monotherapie ist eine primäre Therapieoption des „Low-risk-Tumors“. Bei Patienten mit „Intermediate-risk-Tumoren“ ist die Datenlage kontrovers und noch nicht abschließend beurteilbar. Bei „High-risk-Tumoren“ sollte die LDR-Brachytherapie nicht eingesetzt werden. Auch die High-dose-rate- (HDR-)Brachytherapie“ in Verbindung mit einer perkutanen Strahlentherapie ist als Beispiel einer typischen Dosiseskalation eine primäre Option bei „Intermediate-risk-“ und „High-risk-Prostatakarzinom“. Die Notwendigkeit einer zusätzlichen Hormontherapie bei der HDR-Brachytherapie ist unklar. Eine HDR-Monotherapie kann nur in Studien empfohlen werden.


Postoperative adjuvant radiation therapy has achieved special significance based on the results of three randomized studies on stage pT3R1 prostate cancer which provided evidence for prolonged survival in comparison to the “wait and see” strategy. When PSA levels persist or increase after radical prostatectomy, irradiation represents an alternative. In this instance, salvage radiotherapy should be initiated as early as possible, most suitably when the PSA level is <0.5 ng/ml. Side effects of percutaneous radiotherapy using modern techniques are minimal in this stage; severe grade 3 or 4 late sequelae occur in <3% of cases. Low dose rate (LDR) brachytherapy as monotherapy is a primary treatment option for low-risk tumors. In patients with intermediate-risk tumors, data are controversial and cannot be assessed conclusively. LDR brachytherapy should not be administered in high-risk tumors. High dose rate (HDR) brachytherapy combined with percutaneous radiotherapy as an example of a typical dose escalation approach is a primary option for intermediate- and high-risk prostate cancer. Whether additional hormone therapy is needed with HDR brachytherapy is unclear. HDR monotherapy can only be recommended in the clinical trial setting.

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Correspondence to T. Martin.

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Martin, T., Wenz, F., Böhmer, D. et al. Strahlentherapie des Prostatakarzinoms in der neuen S3-Leitlinie. Urologe 49, 216–220 (2010).

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  • Prostatakarzinom
  • Postoperative Strahlentherapie
  • HDR-Brachytherapie
  • LDR-Brachytherapie


  • Prostate cancer
  • Postoperative radiation therapy
  • HDR brachytherapy
  • LDR brachytherapy