Der Urologe

, Volume 49, Issue 10, pp 1266–1273 | Cite as

Nodal-positives Prostatakarzinom

Stellenwert der zytoreduktiven radikalen Prostatektomie
Leitthema
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Zusammenfassung

Wir setzen uns in der vorliegenden Übersichtsarbeit kritisch mit der Indikationsstellung der zytoreduktiven radikalen Prostatektomie (RPE) und den therapeutischen Alternativen beim lokal fortgeschrittenen und metastasierten Prostatakarzinom (PCA) auf dem Boden der aktuellen Datenlage auseinander. Zielsetzung ist es, einen therapeutischen Algorithmus für eine onkologisch und funktionell möglichst optimale Therapie dieses klinisch noch immer bedeutsamen Patientenkollektivs zu entwickeln.

Die RPE bei Patienten mit lymphkotenpositivem PCA sollte aufgrund der aktuellen Datenlage unter Berücksichtigung der folgenden Parameter in ein multimodales Therapiekonzept einbezogen werden: limitierte, intrapelvine Metastasierung ohne „bulcky disease“, komplette Resektabilität des Primärtumors und der Metastasen durch extendierte RPE und extendierte pelvine Lymphadenektomie, Einbindung des Patienten in ein multimodales Therapiekonzept und eine Lebenserwartung von >10 Jahre.

Bei Patienten mit ausgedehntem Primärtumor oder einer massiven Lymphknotenmetastasierung kann die RPE zur Verbesserung der lokalen Tumorkontrolle und Prävention signifikanter lokaler sowie supravesikaler Komplikationen diskutiert werden. In diesen Fällen ist häufig die Indikation zu einer Zystoprostatektomie zu stellen. Diese sehr individuelle Entscheidung sollte zuvor in einem interdisziplinären Tumor-Board besprochen werden.

Schlüsselwörter

Prostatakarzinom Lymphknotenmetastase Radikale Prostatektomie Lymphadenektomie Überleben 

Node-positive prostate cancer

Value of radical prostatectomy

Abstract

The current review article critically discusses the potential advantages and disadvantages of radical prostatectomy in patients with locally advanced lymph node-positive prostate cancer. It is the purpose of the manuscript to develop a therapeutic algorithm for management of these patients to achieve optimal oncological and functional results.

Based on the data in the literature radical prostatectomy as part of a multimodality approach seems to be indicated in the following clinical scenario: limited intrapelvic lymph node metastasis without bulky disease; complete resectability of the primary cancer and metastases by extended radical prostatectomy and extended pelvic lymphadenectomy; inclusion of the patient in a multimodality approach; life expectancy > 10 years.

In patients with extensive locally advanced PCA or large pelvic metastases, radical prostatectomy might be indicated to improve local cancer control and to prevent significant local and supravesical complications. In these cases, the indication for extensive surgery includes radical cystoprostatectomy and should be discussed in an interdisciplinary tumour board.

Keywords

Prostate cancer Lymph nodes metastasis Radical prostatectomy Lymphadenectomy Survival 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Klinik für UrologieUniversitätsklinikum AachenAachenDeutschland
  2. 2.Klinik für UrologieUniversitätsklinikum UlmUlmDeutschland

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