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Aktive Überwachung beim Niedrigrisikoprostatakarzinom

Active surveillance of low risk prostate cancer

Zusammenfassung

Das Prostatakarzinom ist in Europa die häufigste Krebserkrankung des Mannes. Die Diagnostik umfasst immer die Kontrolle des Prostataspezifischen-Antigen(PSA)-Spiegels und die Biopsie einer repräsentativen Prostatagewebeprobe. Mit den so erhobenen Befunden können die Erkrankung und deren Prognose eingeschätzt werden. Als Therapieoptionen für ein lokalisiertes Prostatakarzinom geben die europäischen und die deutschen Leitlinien mehrere Varianten vor: die radikale Prostatektomie, eine perkutane Strahlentherapie oder eine Brachytherapie. Ebenso gehört die aktive Überwachung („active surveillance“, AS) zu den Therapieoptionen. Hier werden jedoch strenge Einschlusskriterien angegeben. Der Vorteil der AS liegt darin, dass nur die Patienten einer definitiven Therapie zugeführt werden, die ein Fortschreiten des Prostatakarzinoms zeigen. Patienten mit stabiler Erkrankung werden weiterüberwacht und müssen sich somit nicht mit den Nebenwirkungen der Therapien aussetzen. Allerdings sind die existierenden Einschlusskriterien für die AS aktuell noch zu unsicher. Für einige Patienten mag sich daher der Zeitpunkt einer effektiven Therapie verzögern. Die AS hat ohne Zweifel einen Stellenwert in der Behandlung des Prostatakarzinoms, jedoch fehlen derzeit noch zuverlässige Prädiktoren für die sichere Prognoseabschätzung. Daher müssen die Patienten über die jeweiligen Vor- und Nachteile der AS informiert und aufgeklärt werden.

Abstract

In Europe prostate cancer is one of the most common cancers among men. The diagnostics always include a control of the prostate-specific antigen (PSA) level and examination of a representative tissue sample from the prostate. With these findings it is possible to evaluate the degree of progression of the cancer and its prognosis. Several treatment options for localized prostate cancer are given by national and international guidelines including radical prostatectomy, percutaneous radiation therapy, or brachytherapy and surveillance of the cancer with optional treatment at a later stage. For the latter treatment option, known as active surveillance, strict criteria have to be met. The advantage of active surveillance is that only patients with progressive cancer are subjected to radical therapy. Patients with very slow or non-progressing cancer do not have to undergo therapy and thus do not have to suffer from the side effects. The basic idea behind active surveillance is that some cancers will not progress to a stage that requires treatment within the lifetime of the patient and therefore do not require treatment at all. Unfortunately the criteria for active surveillance are not definitive enough at the current time leading only to a delay in effective treatment for many patients. The surveillance strategy has without doubt a high significance among the treatment options for prostate cancer; however, at the current time it lacks reliable indicators for a certain prognosis. Therefore, patients must be informed in detail about the advantages and disadvantages of active surveillance.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. K. Lellig, B. Beyer, M. Graefen, D. Zaak und C. Stief geben an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Correspondence to K. Lellig.

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Lellig, K., Beyer, B., Graefen, M. et al. Aktive Überwachung beim Niedrigrisikoprostatakarzinom. Urologe 53, 1031–1039 (2014). https://doi.org/10.1007/s00120-014-3535-z

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Schlüsselwörter

  • Vorhersage
  • Krankheitsprogression
  • Risikoabschätzung
  • Prostataspezifisches Antigen
  • Gleason Score

Keywords

  • Forecasting
  • Disease progression
  • Risk assessment
  • Prostate-specific antigen
  • Gleason score