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Wie soll die Hormontherapie beim kastrationsresistenten Prostatakarzinom fortgeführt werden?

How should hormone therapy for castration-resistant prostate cancer be continued?

Zusammenfassung

Nach primärer Androgendeprivation durch chirurgische Kastration, LHRH-Analoga sowie steroidale oder nichtsteroidale Antiandrogene kommt es innerhalb eines durchschnittlichen Zeitraums von 18–36 Monaten zur erneuten Progression als Zeichen des androgenunabhängigen aber noch hormonsensitiven Wachstums. Das Verständnis für die Entstehung und die Behandlung dieses als kastrationsresistentes Prostatakarzinom bezeichneten Tumorstadiums erfährt derzeit durch neue Medikamente wie Abirateron und MDV3100 grundlegende Veränderungen. Die Frage, ob eine testosteronsupprimierende Therapie mit dem Eintreten der Kastrationsresistenz fortgeführt oder beendet werden sollte, gewinnt unter Berücksichtigung der neuen Therapieansätze erneut an Bedeutung. Hier wird ein kritischer Überblick über den derzeitigen Stand der Literatur und die neuesten Leitlinien gegeben.

Abstract

After an average of 18–36 months under androgen suppression therapy by surgical castration, LHRH, and steroidal or non-steroidal antiandrogens, almost all patients with metastatic prostate cancer show PSA progression as a sign of androgen-independent but still androgen-sensitive tumor growth. Our understanding and the treatment of such castration-resistant prostate cancer has changed markedly. The introduction of new drugs like abiraterone and MDV3100 has shown that prostate cancer progression even in the“hormone-refractory” stage is driven by androgen receptor signaling. Based on this information the question of whether androgen deprivation therapy in castration-resistant prostate cancer should be continued or not is still of relevance. This review gives a critical overview of the literature and current guideline recommendations.

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Correspondence to PD Dr. M. Spahn.

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Spahn, M., Krebs, M. Wie soll die Hormontherapie beim kastrationsresistenten Prostatakarzinom fortgeführt werden?. Urologe 51, 15–19 (2012). https://doi.org/10.1007/s00120-011-2738-9

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Schlüsselwörter

  • Hormontherapie
  • Prostatakarzinom
  • Kastrationsresistenz
  • Androgendeprivation
  • Metastasenprogression

Keywords

  • Hormone therapy
  • Prostate cancer
  • Castration resistance
  • Androgen deprivation
  • Metastatic progression