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Fokale Therapie des Prostatakarzinoms in Deutschland – Status 2014

Focal therapy for prostate cancer in Germany – 2014 status

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An Erratum to this article was published on 17 August 2014

Zusammenfassung

Hintergrund

In der Behandlung des lokalisierten Niedrigrisikoprostatakarzinoms besteht ein Dilemma zwischen einer möglichen Übertherapie mit einem der Standardverfahren und einer potenziell ungenügenden Tumorkontrolle bei aktiver Überwachung. Die fokale Therapie (FT) bietet sich als Alternative an, da mit ihr zugleich der Organerhalt und die Beseitigung des Tumorfokus angestrebt werden.

Methode

Im vorliegenden Beitrag wird der aktuelle Status der FT in der Behandlung lokalisierter Niedrigrisikoprostatakarzinome in Deutschland beschrieben. Des Weiteren werden Kriterien vorgeschlagen, anhand derer Patienten für diese Therapie ausgewählt werden sollen.

Ergebnisse

Die Wirksamkeit der FT wird in Deutschland derzeit in zwei prospektiven Multicenterstudien überprüft: TOOKAD und HEMI. Das lokalisierte Niedrigrisikoprostatakarzinom bleibt eine diagnostische Herausforderung. Neben der transrektalen Biopsie werden die multiparametrische Magnetresonanztomographie sowie eine histopathologische Zweitmeinung als obligate Schritte angesehen.

Schlussfolgerung

Die onkologischen Ergebnisse von TOOKAD und HEMI werden für alle FT-Formen zur Behandlung des Prostatakarzinoms in Deutschland wegweisend sein. Die Akzeptanz unter den Patienten ist bereits bemerkenswert hoch.

Abstract

Background

In localized low-risk prostate cancer (PCa), there is a therapeutic dilemma between possible overtreatment by one of the standard therapies and potentially insufficient cancer control by active surveillance (AS). Focal therapy (FT) provides an alternative therapeutic option as it aims to preserve the organ and to eliminate the cancer focus at the same time.

Methods

In this article the current state of FT for localized low-risk prostate carcinoma in Germany is described. In addition, criteria that should be used to select patients for FT are proposed.

Results

Currently, the effectiveness of FT is under evaluation by two multicenter, prospective studies in Germany: TOOKAD and HEMI. However, localized low-risk prostate carcinoma remains a diagnostic challenge: Multiparametric MRI as well as histopathological second opinion are considered mandatory in addition to transrectal biospy.

Conclusion

The oncological outcome of both the TOOKAD and HEMI study will be crucial for any form of FT for prostate carcinoma in Germany in the future. However, there is a remarkably high acceptance of FT among patients.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Roosen, R. Ganzer, B. Hadaschik, J. Köllermann, A. Blana, T. Henkel, A.-B. Liehr, D. Baumunk, S. Machtens, G. Salomon, L. Sentker, U. Witsch, K.U. Köhrmann und M. Schostak geben an, dass kein Interessenkonflikt besteht. Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

Author information

Authors and Affiliations

  1. Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Klinikum Großhadern, Marchioninistraße 15, 81377, München, Deutschland

    A. Roosen

  2. Urologische Klinik und Poliklinik, Universität Leipzig, Leipzig, Deutschland

    R. Ganzer

  3. Urologische Klinik und Poliklinik, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland

    B. Hadaschik

  4. Abteilung für Allgemeinpathologie/Sektion Uropathologie, Institut für Hämatopathologie Hamburg, Hamburg, Deutschland

    J. Köllermann

  5. Klinik für Urologie und Kinderurologie, Klinikum Fürth, Fürth, Deutschland

    A. Blana

  6. Institut für ambulante Prostatatherapien, Berlin, Deutschland

    T. Henkel

  7. Klinik für Urologie, Marienkrankenhaus Bergisch-Gladbach, Bergisch-Gladbach, Deutschland

    S. Machtens

  8. Martini-Klinik am UKE GmbH, Hamburg, Deutschland

    G. Salomon & K.U. Köhrmann

  9. Urologische Gemeinschaftspraxis, Sinsheim, Deutschland

    L. Sentker & M. Schostak

  10. Klinik für Urologie und Kinderurologie, Krankenhaus Nordwest, Frankfurt am Main, Frankfurt am Main, Deutschland

    U. Witsch

  11. Klinik für Urologie und Kinderurologie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland

    A.-B. Liehr & D. Baumunk

Authors
  1. A. Roosen
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  2. R. Ganzer
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  3. B. Hadaschik
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  4. J. Köllermann
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  5. A. Blana
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  8. D. Baumunk
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  10. G. Salomon
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  11. L. Sentker
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  13. K.U. Köhrmann
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  14. M. Schostak
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Consortia

Arbeitskreis für Fokale und Mikrotherapie der Akademie der Deutschen Gesellschaft für Urologie e.V.

Corresponding author

Correspondence to A. Roosen.

Additional information

A. Roosen und R. Ganzer haben gemeinsame, gleichbeteiligte Erstautorenschaft.

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Roosen, A., Ganzer, R., Hadaschik, B. et al. Fokale Therapie des Prostatakarzinoms in Deutschland – Status 2014. Urologe 53, 1040–1045 (2014). https://doi.org/10.1007/s00120-014-3532-2

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