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Bildgebung des Prostatakarzinoms

Imaging of prostate cancer

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Das Prostatakarzinom (PCa) ist die häufigste lebensbedrohliche Tumorerkrankung des Mannes in der westlichen Hemisphäre. In Deutschland muss mit ca. 40.609 Erkrankungen jährlich gerechnet werden. Die Mortalität liegt bei ca. 10% der Erkrankten. Ziel der prätherapeutischen Diagnostik ist die möglichst exakte Bestimmung des lokalen Ausmaßes des Prostatakarzinoms bezüglich intraprostatischer Lokalisation, Kapseldurchbruch, Samenblaseninfiltration, Infiltration der neurovaskulären Bündel und evtl. der umgebenden Organe des kleinen Beckens, die Detektion einer lokoregionären Lymphknotenmetastasierung und ggf. einer Fernmetastasierung. Eine exakte prätherapeutische Diagnostik ist deshalb wichtig, weil die verfügbaren Behandlungsstrategien in strenger Abhängigkeit vom festgestellten klinischen Stadium der Tumorerkrankung und Risikoprofil festgelegt werden müssen. Die anatomische und funktionelle molekulare Bildgebung des Prostatakarzinoms wurde in den letzten Jahren erheblich weiterentwickelt. Der transrektale Ultraschall (TRUS) stellt in Verbindung mit der gezielten Biopsie der Prostata nach wie vor die am häufigsten eingesetzte bildgebende Methode der Prostata dar und ist die Basisbildgebung der Prostata bei der Abklärung des Prostatakarzinoms. In diagnostischen Problemfällen, z. B. bei negativer Stanzbiopsie und persistierendem Verdacht auf ein Prostatakarzinom, können die MRT/MRS- und die C-11-/F-18-Cholin-PET/CT-Bildgebung des Prostatakarzinoms häufig das Karzinom lokalisieren, die Beziehung zu den umgebenden intra- und extraprostatischen Strukturen und Organen darstellen und eine gezielte Rebiopsie ermöglichen. Das nodale Staging des Prostatakarzinoms ist ohne spezifische, derzeit klinisch noch nicht verfügbare lymphotrope Kontrastmittel wenig sensitiv und unzureichend spezifisch. Besondere Fortschritte wurden in der Bildgebung des Lokalrezidivs erzielt, das bei PSA-Werten >1 ng/ml durch die Kombination von kontrastmittelgestützter MRT und C-11-Cholin-PET/CT nachgewiesen werden kann.

Abstract

Prostatic carcinoma (PCa) is the most common life-threatening cancer in the Western world. In Germany about 40,609 new cases are expected per year. Mortality is 10%. The major goals of pretherapeutic imaging are determination of local intraprostatic tumor extent, presence of extracapsular extension (ECE), seminal vesicle invasion (SVI), invasion into neurovascular bundles and if so into surrounding tissues and organs. In addition, determination of presence and extent of nodal spread as well as distant metastases is required. Exact pretherapeutic staging is mandatory, because the choice of optimal tumor treatment is initiated in strict dependence on tumor stage and risk profile. Anatomic as well as functional molecular imaging of PCa has made significant progress in recent years. Transrectal ultrasonography (TRUS) is primarily used as the basic imaging test in PCa and to guide prostate biopsies. When prostate biopsies are negative but suspicion of PCa persists, MRI/MRS and C-11-/F-18-choline PET/CT may be helpful for localization of PCa, determining intraprostatic tumour extent – and if so – ECE, SVI, invasion into neurovascular bundles and to guide targeted biopsies. Lymphotrophic contrast agents are highly promising for accurate nodal staging of PCa, but are not yet available for clinical use. Thus, nodal staging with commonly available imaging modalities remains insufficiently sensitive and inadequately specific. Localization of local relapse of PCa with contrast-enhanced MRI and C-11-choline PET/CT has made significant progress and allows imaging of local recurrence of PCa in the majority of patients with a PSA >1 ng/ml.

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  1. Klinik für Nuklearmedizin, Universität Ulm, Robert-Koch-Straße 8, 89081, Ulm, Deutschland

    S.N. Reske

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Reske, S. Bildgebung des Prostatakarzinoms. Onkologe 13, 677–690 (2007). https://doi.org/10.1007/s00761-007-1224-x

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