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Aktive Überwachung des Prostatakarzinoms

Active surveillance for prostate cancer

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Zusammenfassung

Die aktive Überwachung von Patienten mit einem neu diagnostizierten Prostatakarzinom (PCA) gehört zu den Therapieoptionen, die dem betroffenen Mann bei einem Niedrigrisikoprofil aufgezeigt werden sollte. Daten von Beobachtungsstudien zeigen, dass die karzinomspezifische Mortalität bei Patienten mit einem Niedrigrisikoprofil gering ist und Patienten erst nach einer Zeitspanne von 10–15 Jahren von einer aktiven Therapie in ihrer Lebenserwartung profitieren. Ältere Patienten sowie Patienten mit einer höheren Komorbidität eignen sich deshalb eher zu einer aktiven Überwachung.

Die Identifizierung histologisch bzw. klinisch insignifikanter Karzinome ist zzt. nur unzureichend möglich. Eine aktive Überwachung beinhaltet regelmäßige PSA-Kontrollen und Folgebiopsien, ein standardisiertes Nachsorgeschema existiert bislang nicht. Ein Progress in der Wiederholungsbiopsie und ein Ansteigen des PSA-Wertes im Verlauf stellen die wichtigsten Kriterien einer Intervention dar, wobei auch hier in der Literatur keine einheitlichen Kriterien bestehen.

Zur Zeit entscheidet sich nur eine Minderheit der potentiellen Kandidaten für eine aktive Überwachung und ein substantieller Anteil der Patienten verlässt nach einem relativ kurzen Zeitraum auch ohne den Nachweis einer Tumorprogression bereits wieder ein solches Programm. Hierfür wird die psychologische Belastung eines unbehandelten Tumors verantwortlich gemacht. Es wird diskutiert, dass eine aktive Überwachung auch eine Untertherapie verursachen kann, da Hinweise existieren, dass eine längere Therapieverzögerung mit einer erniedrigten Heilungsrate einer definitiven Therapie einhergehen kann.

Abstract

Active surveillance is a valuable treatment option in patients with newly diagnosed low-risk prostate cancer. Studies considering a watchful waiting approach showed favourable cancer-specific survival rates in such patients and it is assumed that patients benefit from a definitive therapy if life expectancy exceeds 10–15 years. Therefore active surveillance is especially valuable in older men and in patients with an elevated comorbidity profile.

Precise identification of histologically and clinically insignificant prostate cancers is still not possible today. Active surveillance includes regular PSA measurements combined with follow-up biopsies; however, no standardized protocol exists so far. Histological progression in the follow-up biopsy and PSA elevation are the most important criteria for initiating definitive therapy.

Today only a minority of low-risk patients join an active surveillance protocol and a substantial proportion of these men leave such a protocol early without evidence of progression. The psychological burden of living with an untreated cancer seems to be responsible for this. Active surveillance has the potential to lead to undertreatment as there is some evidence that prolonged treatment delay might adversely affect outcome of definitive therapy.

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Authors and Affiliations

  1. Martini-Klinik, Prostatazentrum an der Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    M. Graefen, G. Salomon, T. Schlomm, H. Isbarn, L. Budäus, H. Heinzer & H. Huland

  2. Klinik und Poliklinik für Urologie, Universitätsklinik Hamburg-Eppendorf, Hamburg, Deutschland

    S. Ahyai, R. Heuer & H. Huland

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  1. M. Graefen
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  2. S. Ahyai
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  3. R. Heuer
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  4. G. Salomon
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  5. T. Schlomm
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  7. L. Budäus
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Correspondence to M. Graefen.

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Graefen, M., Ahyai, S., Heuer, R. et al. Aktive Überwachung des Prostatakarzinoms. Urologe 47, 261–269 (2008). https://doi.org/10.1007/s00120-008-1638-0

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