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Probleme, Zielsetzung und Inhalt der Früherkennung beim Prostatakarzinom

Problems, objective, and substance of early detection of prostate cancer

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Zusammenfassung

Die aktuelle S3-Leitlinie zur Früherkennung leitet einen Paradigmenwechsel in der Früherkennung ein. Weg von der Detektion aller hin zur Identifikation der therapiebedürftigen Prostatakarzinome. Das Eintrittsalter in die jährliche Früherkennung liegt bei 40 Jahren. Die Früherkennung wird bis zu einer Restlebenserwartung von 10 Jahren fortgesetzt. Das Untersuchungsintervall wird risikoadaptiert festgesetzt. Die digital-rektale Palpation wird durch die Bestimmung des PSA-Wertes ergänzt. Vor der ersten PSA-Bestimmung ist die Aufklärung über nachfolgend notwendig werdende Maßnahmen wie Biopsie der Prostata, die Behandlung und deren Risiken notwendig. Der Schwellenwert von 4,0 ng/ml wird bei der ersten Früherkennungskonsultation als Indikation zu einer weiteren Abklärung durch Biopsie gesehen. Im weiteren Verlauf soll die PSA-Dynamik Beachtung finden. Bildgebende Verfahren spielen aufgrund der geringen Sensitivität und Spezifität keine Rolle in der Früherkennung eines Prostatakarzinoms. In der vorliegenden Arbeit wird die aktuelle Leitlinie zur Früherkennung dargestellt und vor dem Hintergrund der Literatur diskutiert.

Abstract

The current S3 guideline for early detection of prostate cancer initiates a change to the paradigm in early detection from the detection of all prostate cancers to the identification of aggressive prostate cancers. Early detection is performed annually and starts at the age of 40 years; it should be terminated at a life expectancy of less then 10 years. The choice of the frequency of early detection should be risk adapted. The digital rectal examination is supplemented by determination of PSA. Previous to the first PSA test the patient has to be informed concerning possible consequences such as biopsy recommendation and treatment options. A threshold of 4 ng/ml is defined as an indication for prostate biopsy for the first administration. In the following early detections the PSA velocity should be considered. Today imaging methods do not play a major role in early detection of prostate cancer. Early detection identifies many latent prostate cancers and patients may receive overtreatment. The recent S3 guideline for early detection is discussed against this background on the basis of the recent literature.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Uroonkologie und Kinderurologie, Universitätsklinik Essen, Essen, Deutschland

    C. Börgermann & H. Rübben

  2. Klinik und Poliklinik für Urologie, Universitätsklinik Göttingen, Göttingen, Deutschland

    H. Loertzer

  3. Urologische Klinik, Städtisches Klinikum Braunschweig, Braunschweig, Deutschland

    P. Hammerer

  4. Universitätsklinik und Poliklinik für Urologie, Halle (Saale), Deutschland

    P. Fornara

  5. Martini-Klinik, Hamburg, Deutschland

    M. Graefen

  6. Klinik für Urologie, Uroonkologie und Kinderurologie, Krankenhaus Düren gGmbH, Roonstraße 30, 52351, Düren, Deutschland

    C. Börgermann

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  1. C. Börgermann
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  2. H. Loertzer
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  3. P. Hammerer
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  4. P. Fornara
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  5. M. Graefen
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Correspondence to C. Börgermann.

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Börgermann, C., Loertzer, H., Hammerer, P. et al. Probleme, Zielsetzung und Inhalt der Früherkennung beim Prostatakarzinom. Urologe 49, 181–189 (2010). https://doi.org/10.1007/s00120-010-2234-7

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