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Ein neuer Goldstandard der Prostatakarzinomdiagnostik?

Bedeutung der bildgebungsgestützten gezielten Biopsien

Un nouveau standard de référence dans le diagnostic du cancer de la prostate?

Signification des biopsies ciblées guidées par imagerie

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Journal für Urologie und Urogynäkologie/Schweiz Aims and scope

Zusammenfassung

Aktuelle Studien zeigen einen Nutzen der MRT in Erst- und Rebiopsien für die Prostatakrebsdiagnostik. Eindrucksvoll wurden in mehreren Vergleichsstudien eine erhöhte Detektionsrate von klinisch signifikanten sowie anterior gelegenen Prostatakarzinomen, geringere Nebenwirkungen für den Patienten nach der Biopsie und eine niedrigere Diagnoserate von „low risk“ Prostatakarzinomen nachgewiesen. Die Qualitätsverbesserung der diagnostischen Optionen wurde nicht nur durch den Fortschritt der Technik, sondern auch die Einführung von PI-RADS v2 für die Befundstandardisierung der mpMRT-Bilder maßgeblich beeinflusst.

Dieser Artikel fasst den aktuellen Forschungsstand der PCa-Diagnostik zusammen und beschäftigt sich mit den Funktionsweisen, Opportunitäten sowie Limitationen neuer Möglichkeiten im Vergleich zur systematischen Biopsie.

Résumé

Des études récentes révèlent un avantage de l’IRM pour les biopsies diagnostiques initiales et de suivi du cancer prostatique. Différentes études comparatives ont constaté de façon impressionnante un taux accru de détection de carcinomes prostatiques cliniquement significatifs et de carcinomes prostatiques de localisation antérieure, ainsi que de plus faibles effets indésirables chez les patients après la biopsie et un plus faible taux de diagnostic de cancers prostatiques à faible risque. L’amélioration qualitative des options diagnostiques a été influencée non seulement par les progrès techniques, mais aussi par l’introduction du système PI-RADS v2 pour la standardisation de l’interprétation des images d’IRM multiparamétrique.

Cet article résume l’état actuel de la recherche dans le domaine du diagnostic du cancer de la prostate et se penche sur les modes de fonctionnement, opportunités et limitations des nouvelles options par rapport à la biopsie systématique.

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Abb. 1

Abbreviations

aPCa:

„Anterior prostate carcinoma“: anteriores Prostatakarzinom

AS:

„Active surveillance“: aktive Überwachung

csPCa:

„Clinically significant prostate cancer“: klinisch signifikanter Prostatakrebs

DCE:

„Dynamic contrast enhanced“: dynamische Kontrastmittelverstärkung

DWI:

„Diffusion-weighted imaging“: diffusionsgewichtete Bildgebung

GS:

Gleason-Score

LUTS:

„Lower urinary tract symptoms“: Symptome des unteren Harntraktes

mpMRT:

Multiparametrische Magnetresonanztomographie

NPV:

„Negative predictive value“: negativ prädikativer Wert

PCa:

„Prostate carcinoma“: Prostatakarzinom

PI-RADS v2:

„Prostate Imaging-Reporting And Data System version 2“

PRIAS:

„Prostate Cancer Research International Active Surveillance“

PPV:

„Positive predictive value“: positiv prädikativer Wert

ROI:

„Region of interest“: Region von Interesse

SB:

Systematische Biopsie

T2W:

T2-Wichtung

TB:

„Targeted biopsy“: gezielte Biopsie

TRUS:

Transrektaler Ultraschall

US:

Ultraschall

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Authors and Affiliations

  1. Martini-Klinik, Universitätsklinikum Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    Stefan Behrens, Mykyta Kachanov &  Lars Budäus

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  1. Stefan Behrens
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Correspondence to Lars Budäus.

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Interessenkonflikt

S. Behrens, M. Kachanov und L. Budäus geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

Additional information

Dieser Beitrag wird auch im Journal für Urologie und Urogynäkologie/Österreich 2018, https://doi.org/10.1007/s41972-018-0053-z veröffentlicht.

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Behrens, S., Kachanov, M. & Budäus, L. Ein neuer Goldstandard der Prostatakarzinomdiagnostik?. J. Urol. Urogynäkol. 20, 121–127 (2018). https://doi.org/10.1007/s41973-018-0037-4

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