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PSA-basierte Prostatakarzinom-Früherkennung

PSA-based early detection of prostate cancer

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Die PSA-basierte (PSA prostataspezifisches Antigen) Prostatakrebs(PCa)-Früherkennung steht trotz einer nachgewiesenen Reduktion der PCa-spezifischen Mortalität um 27 % aufgrund der noch relativ hohen Rate an Überdiagnostik und Übertherapie in der Kritik. Neuere Daten zur Wertigkeit eines frühen Basis-PSA-Werts im Alter von 45–50 Jahren, klinische Risikofaktoren und molekulare sowie neue bildgebende Verfahren haben das Potenzial, die PCa-Früherkennung zu individualisieren und damit deutlich zu verbessern.

Ziel, Material und Methoden

Es werden die aktuelle Datenlage zusammengestellt und Empfehlungen zum praktischen Vorgehen gegeben. Dazu wurde eine semiquantitative Literaturrecherche durchgeführt. Es werden insbesondere Arbeiten der letzten 2 Jahre berücksichtigt.

Ergebnisse

Es werden 4 verschiedene Modelle der risikoadaptierten Prostatakrebs-Früherkennung dargestellt. Besonders der altersadaptierte Ansatz einer PSA-Basiswert-Bestimmung hat bereits praktische Relevanz. Dies wird zurzeit im Rahmen der PROBASE-Studie prospektiv-randomisiert in Deutschland bei 50.000 Probanden getestet.

Diskussion

Die risikoadaptierte Früherkennung des Prostatakarzinoms ist bereits heute möglich und kann die Rate an unnötig diagnostizierten Männern drastisch senken. Durch die Kombination mit einer modernen Bildgebung kann unter Integration der aktiven Überwachungsstrategie auch die Rate an Patienten reduziert werden, die sich einer kurativen Therapie unterziehen müssen.

Abstract

Background

Prostate-specific antigen (PSA)-based early detection of prostate cancer has resulted in a reduction of prostate cancer-specific mortality of 27 %; however, population-based PSA screening has been critisized for a relatively high rate of overdiagnosis and overtreatment. New results on the significance of an early PSA baseline value at the age of 40–45 years, clinical risk factors, molecular and new imaging procedures have the potential to individualize and to greatly improve screening for prostate cancer.

Aim, material and methods

This review article presents the currently available data and gives recommendations for the practical approach. A semiquantitative literature search was performed with special emphasis on studies from the last 2 years.

Results

Current data confirm the prognostic value of a baseline PSA value at the age of 45–50 years. This represents one of four possible risk-adapted screening approaches. This strategy is currently being tested in a prospective randomized trial in Germany with 50,000 men (PROBASE). The other modalities of risk-adapted screening have not yet been shown to be applicable in practice but together with clinical parameters, molecular profiles and modern magnetic resonance imaging (MRI), early detection programs will be improved in the future.

Discussion

Even now, a baseline PSA-based risk-adapted screening strategy can reduce the number needed to screen. With active surveillance and modern multiparameter MRI the number needed to treat has also already been decreased.

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Literatur

  1. Ferlay J et al (2013) Cancer incidence and mortality patterns in europe: estimates for 40 countries in 2012. Eur J Cancer 49(6):1374–1403

    Article  CAS  PubMed  Google Scholar 

  2. Zentrum für Krebsregisterdaten (ZfKD) des Robert-Koch-Institutes http://www.rki.de/DE/Content/Gesundheitsmonitoring/Krebsregisterdaten/krebs_node.html. Zugriffsdatum: 9. Juni 2016

  3. Vickers AJ et al (2013) Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40–55 and long term risk of metastasis: case-control study. BMJ 2023:346

    Google Scholar 

  4. Vickers AJ et al (2014) Empirical estimates of prostate cancer overdiagnosis by age and prostate-specific antigen. BMC Med 12:26

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lilja H, Cronin AM, Dahlin A et al (2011) Prediction of significant prostate cancer diagnosed 20 to 30 years later with a single measure of prostate-specific antigen at or before age 50. Cancer 117:1210–1219

    Article  PubMed  Google Scholar 

  6. Godtman RA, Carlsson S, Holmberg E, Stranne J, Hugosson J (2016) The effect of start and stop age at screening on the risk of being diagnosed with prostate cancer. J Urol 195:1390 doi:10.1016/j.juro.2015.11.062

    Article  PubMed  Google Scholar 

  7. Arsov C, Becker N, Hadaschik BA, Hohenfellner M, Herkommer K, Gschwend JE, Imkamp F, Kuczyk MA, Antoch G, Kristiansen G, Siener R, Semjonow A, Hamdy FC, Lilja H, Vickers AJ, Schröder FH, Albers P (2013) Prospective randomized evaluation of risk-adapted prostate-specific antigen screening in young men: the PROBASE trial. Eur Urol 64(6):873–875

    Article  PubMed  Google Scholar 

  8. Lilja H et al (2007) Long-term prediction of prostate cancer up to 25 years before diagnosis of prostate cancer using prostate kallikreins measured at age 44 to 50 years. J Clin Oncol 25(4):431–436

    Article  CAS  PubMed  Google Scholar 

  9. Bryant RJ, Sjoberg DD, Vickers AJ, Robinson MC, Kumar R, Marsden L, Davis M, Scardino PT, Donovan J, Neal DE, Lilja H, Hamdy FC (2015) Predicting high-grade cancer at ten-core prostate biopsy using four kallikrein markers measured in blood in the ProtecT study. J Natl Cancer Inst 107(7)

  10. Braun K, Sjoberg DD, Vickers AJ, Lilja H, Bjartell AS (2016) A four-kallikrein panel predicts high-grade cancer on biopsy: independent validation in a community cohort. Eur Urol 69:505–511

    Article  PubMed  Google Scholar 

  11. Rotterdam Prostate Cancer Risk Calculator. http://www.prostatecancer-riskcalculator.com/seven-prostate-cancer-risk-calculators. Zugriffsdatum: 9. Juni 2016

  12. Grönberg H, Adolfsson J, Aly M, Nordström T, Wiklund P, Brandberg Y, Thompson H, Wiklund F, Lindberg J, Clements M, Egevad L, Eklund M (2015) Prostate cancer screening in men aged 50–69 years (STHLM3): a prospective population-based diagnostic study. Lancet Oncol 16:1667–1676

    Article  PubMed  Google Scholar 

  13. Arsov C, Rabenalt R, Blondin D, Quentin M, Hiester A, Godehardt E, Gabbert H, Becker N, Antoch G, Albers P, Schimmöller L (2015) Prospective randomized trial comparing magnetic resonance imaging (MRI)-guided in-bore biopsy to MRI-ultrasound fusion and transrectal ultrasound-guided prostate biopsy in patients with prior negative biopsies. Eur Urol 68:713–720

    Article  PubMed  Google Scholar 

  14. Quentin M, Blondin D, Arsov C, Schimmöller L, Hiester A, Godehardt E, Albers P, Antoch G, Rabenalt R (2014) Prospective Evaluation of Magnetic Resonance Imaging, Guided In-bore Prostate Biopsy versus Systematic Transrectal, Ultrasound Guided Prostate Biopsy in Biopsy Naıve Men with Elevated Prostate Specific Antigen. J Urol 192:1374–1379

    Article  PubMed  Google Scholar 

  15. Grenabo Bergdahl A, Wildera U, Aus G, Carlsson S, Damber J‑E, Franlund M, Geterud K, Khatami A, Socratous A, Stranne J, Hellstrom M, Hugosson J (2015) Role of magnetic resonance imaging in prostate cancer screening: a pilot study within the Göteborg randomised screening trial. Eur Urol

  16. Schröder FH et al (2014) Screening and prostate cancer mortality: results of the european randomised study of screening for prostate cancer (ERSPC) at 13 years of follow-up. Lancet 384(9959):2027–2035

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Klinik für Urologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    Peter Albers, Christian Arsov, Andreas Hiester & Robert Rabenalt

  2. Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland

    Michael Quentin, Lars Schimöller & Gerald Antoch

Authors
  1. Peter Albers
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  2. Christian Arsov
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  3. Andreas Hiester
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  4. Michael Quentin
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  5. Lars Schimöller
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  6. Gerald Antoch
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  7. Robert Rabenalt
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Corresponding author

Correspondence to Peter Albers.

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Interessenkonflikt

P. Albers, C. Arsov, A. Hiester, M. Quentin, L. Schimöller, G. Antoch und R. Rabenalt geben an, dass kein Interessenkonflikt besteht.

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

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Albers, P., Arsov, C., Hiester, A. et al. PSA-basierte Prostatakarzinom-Früherkennung. Onkologe 22, 558–561 (2016). https://doi.org/10.1007/s00761-016-0059-8

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  • DOI: https://doi.org/10.1007/s00761-016-0059-8

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