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Der Urologe

, Volume 49, Issue 2, pp 181–189 | Cite as

Probleme, Zielsetzung und Inhalt der Früherkennung beim Prostatakarzinom

  • C. Börgermann
  • H. Loertzer
  • P. Hammerer
  • P. Fornara
  • M. Graefen
  • H. Rübben
Leitthema

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.

Schlüsselwörter

Prostatakarzinom Früherkennung Prostataspezifisches Antigen (PSA) Digital-rektale Untersuchung (DRU) PSA-Anstiegsgeschwindigkeit 

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

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.

Keywords

Prostate cancer Early detection Prostate-specific antigen (PSA) Digital rectal examination (DRE) PSA velocity 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Schroder FH, Hugosson J, Roobol MJ et al (2009) Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 360(13):1320–1328CrossRefPubMedGoogle Scholar
  2. 2.
    Andriole GL, Crawford ED, Grubb RL III et al (2009) Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 360(13):1310–1319CrossRefPubMedGoogle Scholar
  3. 3.
    Stamey TA, Caldwell M, McNeal JE et al (2004) The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years? J Urol 172(4 Pt 1):1297–1301CrossRefPubMedGoogle Scholar
  4. 4.
    Brawer MK, Chetner MP (1997) Campell‘s urology. Saunders, Philadelphia, pp 2506–2518Google Scholar
  5. 5.
    Catalona WJ, Loeb S (2005) The PSA era is not over for prostate cancer. Eur Urol 48(4):541–545CrossRefPubMedGoogle Scholar
  6. 6.
    Arbeitsgemeinschaft wissenschaftlich medizinischer Fachgesellschaften (2002) S3-Leitlinie: PSA-Bestimmung in der Prostatakarzinomdiagnostik (Früherkennung des Prostatakarzinoms). http://www.awmf-online.deGoogle Scholar
  7. 7.
    Bill-Axelson A, Holmberg L, Filen F et al (2008) Radical prostatectomy versus watchful waiting in localized prostate cancer: the Scandinavian prostate cancer group-4 randomized trial. J Natl Cancer Inst 100(16):1144–1154CrossRefPubMedGoogle Scholar
  8. 8.
    Morgan TO, Jacobsen SJ, McCarthy WF (1996) Age-specific reference ranges for prostate-specific antigen in black men. N Engl J Med 335(5):304–310CrossRefPubMedGoogle Scholar
  9. 9.
    Fang J, Metter EJ, Landis P et al (2001) Low levels of prostate-specific antigen predict long-term risk of prostate cancer: results from the Baltimore longitudinal study of aging. Urology 58(3):411–416CrossRefPubMedGoogle Scholar
  10. 10.
    Loeb S, Roehl KA, Antenor JA et al (2006) Baseline prostate-specific antigen compared with median prostate-specific antigen for age group as predictor of prostate cancer risk in men younger than 60 years old. Urology 67(2):316–320CrossRefPubMedGoogle Scholar
  11. 11.
    Ross KS, Carter HB, Pearson JD, Guess HA (2000) Comparative efficiency of prostate-specific antigen screening strategies for prostate cancer detection. JAMA 284(11):1399–1405CrossRefPubMedGoogle Scholar
  12. 12.
    Carter HB, Epstein JI, Partin AW (1999) Influence of age and prostate-specific antigen on the chance of curable prostate cancer among men with nonpalpable disease. Urology 53(1):126–130CrossRefPubMedGoogle Scholar
  13. 13.
    Smith CV, Bauer JJ, Connelly RR et al (2000) Prostate cancer in men age 50 years or younger: a review of the department of defense center for prostate disease research multicenter prostate cancer database. J Urol 164(6):1964–1967CrossRefPubMedGoogle Scholar
  14. 14.
    Ries LA, Melbert D, Krapcho M (2008) SEER cancer statistics review, 1975–2005, National cancer institute. Bethesda, MD, http://www.seer.cancer.gov/csr/1975_2005Google Scholar
  15. 15.
    Horan AH, McGehee M (2000) Mean time to cancer-specific death of apparently clinically localized prostate cancer: policy implications for threshold ages in prostate-specific antigen screening and ablative therapy. BJU Int 85(9):1063–1066CrossRefPubMedGoogle Scholar
  16. 16.
    Johansson JE, Andren O, Andersson SO et al (2004) Natural history of early, localized prostate cancer. JAMA 291(22):2713–2719CrossRefPubMedGoogle Scholar
  17. 17.
    Carter HB, Ferrucci L, Kettermann A et al (2006) Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability. J Natl Cancer Inst 98(21):1521–1527PubMedCrossRefGoogle Scholar
  18. 18.
    Bryant RJ, Hamdy FC (2008) Screening for prostate cancer: an update. Eur Urol 53(1):37–44CrossRefPubMedGoogle Scholar
  19. 19.
    Albertsen PC, Fryback DG, Storer BE et al (1996) The impact of co-morbidity on life expectancy among men with localized prostate cancer. J Urol 156(1):127–132CrossRefPubMedGoogle Scholar
  20. 20.
    Oberpenning F, Hetzel S, Weining C et al (2003) Semi-quantitative immunochromatographic test for prostate specific antigen in whole blood: tossing the coin to predict prostate cancer? Eur Urol 43(5):478–484CrossRefPubMedGoogle Scholar
  21. 21.
    Price CP, Allard J, Davies G et al (2001) Pre- and post-analytical factors that may influence use of serum prostate specific antigen and its isoforms in a screening programme for prostate cancer. Ann Clin Biochem 38(Pt 3):188–216CrossRefPubMedGoogle Scholar
  22. 22.
    Carter HB, Epstein JI, Chan DW et al (1997) Recommended prostate-specific antigen testing intervals for the detection of curable prostate cancer. JAMA 277(18):1456–1460CrossRefPubMedGoogle Scholar
  23. 23.
    Schroder FH, Raaijmakers R, Postma R et al (2005) 4-year prostate specific antigen progression and diagnosis of prostate cancer in the European randomized study of screening for prostate cancer, section rotterdam. J Urol 174(2):489–494CrossRefPubMedGoogle Scholar
  24. 24.
    Cruijsen-Koeter IW van der, Kwast TH van der, Schroder FH (2003) Interval carcinomas in the European Randomized Study of Screening for Prostate Cancer (ERSPC)-Rotterdam. J Natl Cancer Inst 95(19):1462–1466PubMedGoogle Scholar
  25. 25.
    Roobol MJ, Roobol DW, Schroder FH (2005) Is additional testing necessary in men with prostate-specific antigen levels of 1.0 ng/mL or less in a population-based screening setting? (ERSPC, section Rotterdam). Urology 65(2):343–346CrossRefPubMedGoogle Scholar
  26. 26.
    Bangma CH, Roemeling S, Schroder FH (2007) Overdiagnosis and overtreatment of early detected prostate cancer. World J Urol 25(1):3–9CrossRefPubMedGoogle Scholar
  27. 27.
    D’amico AV, Whittington R, Malkowicz SB et al (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280(11):969–974CrossRefGoogle Scholar
  28. 28.
    Catalona WJ, Richie JP, Ahmann FR et al (1994) Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men. J Urol 151(5):1283–1290PubMedGoogle Scholar
  29. 29.
    Loeb S, Roehl KA, Catalona WJ, Nadler RB (2007) Prostate specific antigen velocity threshold for predicting prostate cancer in young men. J Urol 177(3):899–902CrossRefPubMedGoogle Scholar
  30. 30.
    Thompson IM, Pauler DK, Goodman PJ et al (2004) Prevalence of prostate cancer among men with a prostate-specific antigen level <or =4.0 ng per milliliter. N Engl J Med 350(22):2239–2246CrossRefPubMedGoogle Scholar
  31. 31.
    Gosselaar C, Roobol MJ, Schroder FH (2005) Prevalence and characteristics of screen-detected prostate carcinomas at low prostate-specific antigen levels: aggressive or insignificant? BJU Int 95(2):231–237CrossRefPubMedGoogle Scholar
  32. 32.
    Klotz L (2004) Active surveillance with selective delayed intervention: using natural history to guide treatment in good risk prostate cancer. J Urol 172(5 Pt 2):48–50CrossRefGoogle Scholar
  33. 33.
    Djavan B, Kadesky K, Klopukh B et al (1998) Gleason scores from prostate biopsies obtained with 18-gauge biopsy needles poorly predict Gleason scores of radical prostatectomy specimens. Eur Urol 33(3):261–270CrossRefPubMedGoogle Scholar
  34. 34.
    Koksal IT, Ozcan F, Kadioglu TC et al (2000) Discrepancy between Gleason scores of biopsy and radical prostatectomy specimens. Eur Urol 37(6):670–674CrossRefPubMedGoogle Scholar
  35. 35.
    Pinthus JH, Witkos M, Fleshner NE et al (2006) Prostate cancers scored as Gleason 6 on prostate biopsy are frequently Gleason 7 tumors at radical prostatectomy: implication on outcome. J Urol 176(3):979–984CrossRefPubMedGoogle Scholar
  36. 36.
    Humphrey PA (2004) Gleason grading and prognostic factors in carcinoma of the prostate. Mod Pathol 17(3):292–306CrossRefPubMedGoogle Scholar
  37. 37.
    Carter HB, Pearson JD, Metter EJ et al (1992) Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA 267(16):2215–2220CrossRefPubMedGoogle Scholar
  38. 38.
    Berger AP, Deibl M, Strasak A et al (2007) Large-scale study of clinical impact of PSA velocity: long-term PSA kinetics as method of differentiating men with from those without prostate cancer. Urology 69(1):134–138CrossRefPubMedGoogle Scholar
  39. 39.
    Raaijmakers R, Wildhagen MF, Ito K et al (2004) Prostate-specific antigen change in the European randomized study of screening for prostate cancer, section Rotterdam. Urology 63(2):316–320CrossRefPubMedGoogle Scholar
  40. 40.
    Soletormos G, Semjonow A, Sibley PE et al (2005) Biological variation of total prostate-specific antigen: a survey of published estimates and consequences for clinical practice. Clin Chem 51(8):1342–1351CrossRefPubMedGoogle Scholar
  41. 41.
    Vickers AJ, Wolters T, Savage CJ et al (2009) Prostate-specific antigen velocity for early detection of prostate cancer: Result from a large, representative, population-based cohort. Eur Urol 56:761–762CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2010

Authors and Affiliations

  • C. Börgermann
    • 1
    • 6
  • H. Loertzer
    • 2
  • P. Hammerer
    • 3
  • P. Fornara
    • 4
  • M. Graefen
    • 5
  • H. Rübben
    • 1
  1. 1.Klinik und Poliklinik für Urologie, Uroonkologie und KinderurologieUniversitätsklinik EssenEssenDeutschland
  2. 2.Klinik und Poliklinik für UrologieUniversitätsklinik GöttingenGöttingenDeutschland
  3. 3.Urologische KlinikStädtisches Klinikum BraunschweigBraunschweigDeutschland
  4. 4.Universitätsklinik und Poliklinik für UrologieHalle (Saale)Deutschland
  5. 5.Martini-KlinikHamburgDeutschland
  6. 6.Klinik für Urologie, Uroonkologie und KinderurologieKrankenhaus Düren gGmbHDürenDeutschland

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