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Prostatakarzinom

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Facharztwissen Urologie

Zusammenfassung

Das Prostatakarzinom tritt weltweit mit deutlich verschiedener Häufigkeit und Mortalität auf, grundsätzlich erkranken Männer in Industrieländern häufiger daran als Männer in Entwicklungsländern. Besonders niedrige Inzidenz gilt für China und Japan; in Deutschland stellt das Prostatakarzinom die häufigste Krebsart bei Männern dar. Unterscheiden lassen sich das inzidentelle, mainfeste, okkulte, insignifikante und latente Prostatakarzinom: Letzteres wird erst bei einer Obduktion diagnostiziert und hat zu Lebzeiten des Mannes nie Beschwerden verursacht; ein latentes Prostatakarzinom haben 60–70% aller über 80-jährigen Männer. Histologisch handelt es sich insgesamt meist um ein Adenokarzinom. Der Nutzen eines Screenings mittels PSA wird kontrovers diskutiert; für die Diagnose wird neben der digitalen rektalen Untersuchung der PSA-Wert bestimmt und daraus die Indikation für eine Stanzbiopsie abgeleitet, die zur Diagnose führt. Die histologische Differenzierung der Karzinome erfolgt mittels Gleason-Score. Zum Staging kommen neben digitaler Untersuchung, PSA v. a. der transrektale Ultraschall, aber auch MRT und Skelettszintigrafie zum Einsatz. Das therapeutische Spektrum reicht je nach Stadium von Active Surveillance über radikale Prostatektomie, Strahlentherapie (extern oder interstitiell), Hormonentzugstherapie (Androgenblockade) –auch in Kombinationen – bis zum Watchful Waiting (palliative Situationen). Beim kastrationsresistenten Prostatakarzinom kommen eine Chemotherapie oder die Behandlung mit Modulatoren der Androgenrezeptorfunktion sowie medikamentöse Therapien der Knochenmetastasen infrage.

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Authors and Affiliations

  1. Urologische Klinik und Poliklinik, Universitätsklinikum Rostock, Ernst-Heydemann-Str. 6, 18055, Rostock, Deutschland

    O. W. Hakenberg

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  1. O. W. Hakenberg
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Editors and Affiliations

  1. Klinik für Urologie, Bundeswehrzentralkrankenhaus, Koblenz, Germany

    Hans-Ulrich Schmelz

  2. Klinik für Urologie, Bundeswehrkrankenhaus, Ulm, Germany

    Christoph Sparwasser

  3. Klinik u. Polikl. f. Urologie, Kinderurol. u Andrologie, Universitätsklinikum Gießen, Gießen, Germany

    Wolfgang Weidner

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Hakenberg, O. (2014). Prostatakarzinom. In: Schmelz, HU., Sparwasser, C., Weidner, W. (eds) Facharztwissen Urologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-44942-0_23

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  • DOI: https://doi.org/10.1007/978-3-642-44942-0_23

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