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Die Fusionsbiopsie in der Primärdiagnostik des Prostatakarzinoms

Durchführung, Nutzen und klinische Aspekte

Fusion biopsies for primary diagnosis of prostate cancer

Implementation, benefits, and clinical aspects

Zusammenfassung

Das Prostatakarzinom zählt zu den häufigsten Tumoren weltweit. Die histologische Befundsicherung mittels Biopsie ist obligater Bestandteil der Diagnostik. Problem der bislang als Goldstandard angesehenen 10- bis 12-fach-Biopsie ist primär die erhebliche Unterdiagnostik klinisch signifikanter Karzinome. Magnetresonanztomographie(MRT)-basierte Verfahren, sog. Fusionsbiopsien, konnten hier eine signifikante Verbesserung erzielen. Es existieren 3 verschiedene Herangehensweisen (kognitive und softwaregestützte MRT/TRUS[transrektaler Ultraschall]-Fusion sowie In-bore-Biopsie) mit ähnlich guten Detektionsraten jedoch Unterschieden im technischen und zeitlichen Aufwand der Durchführung. Um Fusionsfehler zu reduzieren, sollten MRT-suspekte Areale mehrmals biopsiert werden. Für die möglichen Zugangswege (transrektal oder transperineal) gibt es derzeit keine eindeutige Präferenz, klinische Parameter wie Infektionsrisiko oder Lage des Tumors können die Entscheidung allerdings beeinflussen. Während die Deutsche S3-Leitlinie eine MRT vor der Primärbiopsie als optional ansieht, wird diese in den EAU-Leitlinien 2019 (European Association of Urology) bereits für alle Patienten empfohlen. Die Kombination aus MRT-gezielter und systematischer Biopsie bietet die höchsten Detektionsraten mit dem Nachteil, dass vermehrt Niedrigrisikotumoren diagnostiziert werden. Sowohl bei der Entscheidung zur Active Surveillance als auch bei der Planung invasiver Therapien sowie experimenteller fokaler Therapien, profitieren Patient und Behandler von einer verbesserten Aussagekraft der Biopsie.

Abstract

Prostate carcinoma is one of the most common tumors worldwide. Histological confirmation by biopsy is an obligatory part of the diagnostic approach. The main problem of the 10–12-fold transrectal ultrasound-guided (TRUS) biopsy, which has so far been regarded as the gold standard, is the underdiagnosis of clinically significant cancer. MRI-based procedures, so-called fusion biopsies, have shown superior results when compared to conventional biopsies. There are three different approaches (cognitive and software-based MRI/TRUS fusion and in-bore biopsy) with comparable detection rates but differences in the technical aspects and time involvement. In order to reduce fusion errors, targeted biopsies should consist of multiple cores. There is currently no clear preference for the access pathway (transrectal or transperineal), but clinical parameters such as infection risk or location of the tumor can influence the decision. While the German S3 guideline considers MRI prior to primary biopsy to be optional, the 2019 European Association of Urology guidelines already recommend MRI prior to biopsy for all patients. The combination of MRI-targeted and systematic biopsy offers the highest detection rates with the disadvantage that more low-risk tumors are diagnosed. Both the patient and the urologist benefit from an improved informative value of the biopsy when deciding on active surveillance as well as when planning invasive therapies.

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Author information

Correspondence to Dr. med. L. Püllen.

Ethics declarations

Interessenkonflikt

B. Hadaschik: Beratertätigkeit AstraZeneca, BMS, Janssen, Lightpoint Medical, Sanofi, Uromed; Referententätigkeit Astellas, Bayer, BMS, Curagita, Janssen, MedCom, Pfizer. T.H. Kuru: Beratertätigkeit Uromed, Referententätigkeit Guerbet, MedCom. L. Püllen und D. Eberli geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Püllen, L., Hadaschik, B., Eberli, D. et al. Die Fusionsbiopsie in der Primärdiagnostik des Prostatakarzinoms. Urologe 58, 504–510 (2019). https://doi.org/10.1007/s00120-019-0889-2

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Schlüsselwörter

  • Transrektaler Ultraschall
  • Magnetresonanztomographie
  • Prophylaxe
  • Active surveillance
  • Rebiopsie

Keywords

  • Transrectal ultrasound
  • Magnetic resonance imaging
  • Prophylaxis
  • Active surveillance
  • Rebiopsy