Der Urologe

, Volume 45, Issue 6, pp 715–722

High-dose-rate-Brachytherapie beim Risikoprostatakarzinom

  • M. Schenck
  • K. Krause
  • R. Schwandtner
  • I. Haase
  • D. Fluehs
  • J. Friedrich
  • T. Jaeger
  • C. Boergermann
  • H. Ruebben
  • M. Stuschke
Leitthema

Zusammenfassung

Beim Prostatakarzinom ist zur Einschätzung des Therapieerfolgs hinsichtlich der rezidivfreien Zeit die Gruppierung in Niedrig-, Intermediär- und Hochrisikokarzinome sinnvoll. Die Trias PSA ≥10, Gleason-Score ≥7 und die klinische Tumorkategorie cT3 (extrakapsuläres Tumorwachstum) sind bei der Einteilung hilfreich und einfach.

Das Phänomen des posttherapeutischen biochemischen Rezidivs könnte eine Folge der zzt. noch zu ungenauen Bildgebung in der Erkennung von Lymphknoten- oder Knochenmetastasen sein, sodass bereits zum Diagnosezeitpunkt eine Metastasierung nicht erkannt und eine lokale Therapie eingeleitet wird. Andererseits sind Karzinome der Hochrisikogruppe durch biologische Tumoreigenschaften gekennzeichnet, die auch sekundär zu einer fortschreitenden Erkrankung führen. Hierbei ist eine risikoadaptierte Therapie von immenser Wichtigkeit. In der Strahlentherapie spielt die applizierte Strahlendosis eine wichtige Rolle. Das Auftreten des biochemischen Lokalrezidivs korreliert mit den Risikofaktoren und der Strahlendosis. Vor diesem Hintergrund kann bei einem selektionierten Patientengut eine initiale 3D-konformale perkutane Strahlentherapie und HDR-Brachytherapie einen Vorteil bringen.

Erste eigene Erfahrungen zeigen, dass die HDR-Brachytherapie in Kombination mit der Teletherapie beim Risikoprostatakarzinom eine nebenwirkungsarme Therapieform ist. Bezüglich der PSA-rezidivfreien Zeit, der Lebensqualität, Miktion und erektiler Funktion zeigt die Untersuchung bei den ersten 42 Patienten erfolgversprechende Ergebnisse.

Schlüsselwörter

HDR-Brachytherapie Hochrisikoprostatakarzinom Lebensqualität IPSS IIEF-5 

High-dose rate brachytherapy for high-risk prostate cancer

Abstract

To estimate disease-free survival it is necessary to allocate patients into tumor risk groups: locally advanced prostate carcinoma with extracapsular spread or localized prostate carcinoma of tumor stage T2c or one of the risk factors PSA >20 or Gleason ≥8 apply for the high-risk group. Intermediate-risk carcinomas are those belonging to tumor stage T2b or with PSA >10–20 or Gleason 7. Particulary for patients with intermediate and high-risk disease early PSA relapse is of major interest.

This phenomenon could be a consequence of current inadequate imaging of lymph node or bone metastasis or as a consequence subclinical metastatic spread remains undetectable during radical treatment. However, tumor biology itself could lead to the progression of the disease in the high-risk group. As a consequence, risk-adapted therapy is very important in these cases. The applied radiation dose plays an important role in radiotherapy.

Several publications have shown that the biochemical relapse correlates with the generally accepted risk factors and the radiation dose. Regarding this, high-quality treatment planning and HDR brachytherapy combined with EBRT (external beam radiation therapy) leads to good treatment results in selected groups. So far in our own experience, HDR brachytherapy in combination with EBRT is a successful form of treatment with few acute and late side effects in the first 42 patients examined. First results concerning to PSA relapse-free time, quality of life, miction, and erectile function are promising.

Keywords

High-dose rate brachytherapy High-risk prostate carcinoma Quality of life IPSS IIEF-5 

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  • M. Schenck
    • 1
    • 4
  • K. Krause
    • 2
    • 4
  • R. Schwandtner
    • 3
  • I. Haase
    • 3
  • D. Fluehs
    • 3
    • 4
  • J. Friedrich
    • 2
    • 4
  • T. Jaeger
    • 1
    • 4
  • C. Boergermann
    • 1
    • 4
  • H. Ruebben
    • 1
    • 4
  • M. Stuschke
    • 2
    • 4
  1. 1.Urologische Klinik und PoliklinikUniversitätsklinikumEssen
  2. 2.Klinik für StrahlentherapieUniversitätsklinikumEssen
  3. 3.Klinische StrahlenphysikUniversitätsklinikumEssen
  4. 4.Interdisziplinäre Radio-UroonkologieUniversitätsklinikumEssen

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