Skip to main content
SpringerLink
Log in

Nachsorge urologischer Tumorbehandlungen

Follow-up of urological tumor treatment

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Die Nachsorge urologischer Tumoren ist ein wichtiger Bestandteil in der Behandlung urologischer Tumorpatienten. Ziel der Nachsorge ist es v. a., den Behandlungserfolg zur überwachen sowie Lokal- und Fernrezidive frühzeitig zu erkennen, um weitere Therapiemaßnahmen einleiten zu können. Die in der Nachsorge angewandte Diagnostik sollte dem Grundsatz „so viel wie nötig, so wenig wie möglich“ folgen. Die Frequenz und Durchführung der Nachsorgediagnostik sollte sich dabei nach dem individuellen Rezidivrisiko des Patienten richten. In den letzten Jahren ist es dabei gelungen, in einigen Bereichen (z. B. beim Hodentumor), die Nachsorgediagnostik dem individuellen Risiko besser anzupassen. Bei anderen Tumorentitäten (z. B. beim metastasierten Harnblasenkarzinom) erscheinen die Nachsorgeempfehlungen noch wenig individualisiert und ausbaufähig. Dieser Artikel gibt einen Überblick über die aktuellen Empfehlungen und Hintergründe zur Nachsorge der wichtigsten urologischen Tumorentitäten.

Abstract

Follow-up of patients after curative treatment of urological cancer is an important component of the treatment of patients. The aim of the follow-up is to monitor the success of treatment and to identify local or distant recurrences early to be able to initiate further treatment. Investigations used for the monitoring should follow the principle “as much as necessary, as little as possible”. The interval and method of follow-up investigations should be based on the risk of recurrence for the individual patient. In recent years follow-up schemes have been improved and, for example in testicular cancer, have been adjusted to the individual risk group. In contrast, for other tumors, such as metastatic bladder carcinoma, recommendations for follow-up do not seem to be individualized. This article therefore gives an overview on current recommendations and evidence for the follow-up of the most important genitourinary tumor types.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Adamy A, Yee DS, Matsushita K et al (2011) Role of prostate specific antigen and immediate confirmatory biopsy in predicting progression during active surveillance for low risk prostate cancer. J Urol 185:477–482

    Article  PubMed Central  PubMed  Google Scholar 

  2. Akin O, Gultekin DH, Vargas HA et al (2011) Incremental value of diffusion weighted and dynamic contrast enhanced MRI in the detection of locally recurrent prostate cancer after radiation treatment: preliminary results. Eur Radiol 21:1970–1978

    Article  PubMed Central  PubMed  Google Scholar 

  3. Antonarakis ES, Feng Z, Trock BJ et al (2012) The natural history of metastatic progression in men with prostate-specific antigen recurrence after radical prostatectomy: long-term follow-up. BJU Int 109:32–39

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Arumainayagam N, Kumaar S, Ahmed HU et al (2010) Accuracy of multiparametric magnetic resonance imaging in detecting recurrent prostate cancer after radiotherapy. BJU Int 106:991–997

    Article  PubMed  Google Scholar 

  5. Babjuk M, Oosterlinck W, Sylvester R et al (2011) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Eur Urol 59:997–1008

    Article  PubMed  Google Scholar 

  6. Bastian PJ, Carter BH, Bjartell A et al (2009) Insignificant prostate cancer and active surveillance: from definition to clinical implications. Eur Urol 55:1321–1330

    Article  PubMed  Google Scholar 

  7. Boorjian SA, Thompson RH, Tollefson MK et al (2011) Long-term risk of clinical progression after biochemical recurrence following radical prostatectomy: the impact of time from surgery to recurrence. Eur Urol 59:893–899

    Article  PubMed  Google Scholar 

  8. Briganti A, Karnes RJ, Joniau S et al (2014) Prediction of outcome following early salvage radiotherapy among patients with biochemical recurrence after radical prostatectomy. Eur Urol 66:479–486

    Article  CAS  PubMed  Google Scholar 

  9. Brockman JA, Alanee S, Vickers AJ et al (2014) Nomogram predicting prostate cancer-specific mortality for men with biochemical recurrence after radical prostatectomy. Eur Urol 67(6):1160–1167

    Article  PubMed  Google Scholar 

  10. Cary KC, Pedrosa JA, Kaimakliotis HZ et al (2015) The impact of bleomycin on retroperitoneal histology at post-chemotherapy retroperitoneal lymph node dissection of good risk germ cell tumors. J Urol 193:507–512

    Article  CAS  PubMed  Google Scholar 

  11. Cathomas R, Helbling D, Stenner F et al (2010) Interdisciplinary evidence-based recommendations for the follow-up of testicular cancer patients: a joint effort. Swiss Med Wkly 140:356–369

    PubMed  Google Scholar 

  12. Chaplin BJ, Wildhagen MF, Schroder FH et al (2005) Digital rectal examination is no longer necessary in the routine follow-up of men with undetectable prostate specific antigen after radical prostatectomy: the implications for follow-up. Eur Urol 48:906–910

    Article  PubMed  Google Scholar 

  13. Crook J, Malone S, Perry G et al (2000) Postradiotherapy prostate biopsies: what do they really mean? Results for 498 patients. Int J Radiat Oncol Biol Phys 48:355–367

    Article  CAS  PubMed  Google Scholar 

  14. Crook JM, O’callaghan CJ, Duncan G et al (2012) Intermittent androgen suppression for rising PSA level after radiotherapy. N Engl J Med 367:895–903

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. D’amico AV (2010) Statin use and the risk of prostate-specific antigen recurrence after radiation therapy with or without hormone therapy for prostate cancer. J Clin Oncol 28:2651–2652

    Article  Google Scholar 

  16. D’amico AV, Moul J, Carroll PR et al (2004) Prostate specific antigen doubling time as a surrogate end point for prostate cancer specific mortality following radical prostatectomy or radiation therapy. J Urol 172:S42–S46 (discussion S46–S47)

    Article  Google Scholar 

  17. Daugaard G, Gundgaard MG, Mortensen MS et al (2014) Surveillance for stage I nonseminoma testicular cancer: outcomes and long-term follow-up in a population-based cohort. J Clin Oncol 32:3817–3823

    Article  PubMed  Google Scholar 

  18. Denham JW, Steigler A, Wilcox C et al (2008) Time to biochemical failure and prostate-specific antigen doubling time as surrogates for prostate cancer-specific mortality: evidence from the TROG 96.01 randomised controlled trial. Lancet Oncol 9:1058–1068

    Article  CAS  PubMed  Google Scholar 

  19. Donati OF, Jung SI, Vargas HA et al (2013) Multiparametric prostate MR imaging with T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences: are all pulse sequences necessary to detect locally recurrent prostate cancer after radiation therapy? Radiology 268:440–450

    Article  PubMed  Google Scholar 

  20. Eggener SE, Mueller A, Berglund RK et al (2013) A multi-institutional evaluation of active surveillance for low risk prostate cancer. J Urol 189:19–25

    Article  Google Scholar 

  21. Escudier B, Porta C, Schmidinger M et al (2014) Renal cell carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 25(Suppl 3):49–56

    Article  Google Scholar 

  22. Fizazi K, Pagliaro L, Laplanche A et al (2014) Personalised chemotherapy based on tumour marker decline in poor prognosis germ-cell tumours (GETUG 13): a phase 3, multicentre, randomised trial. Lancet Oncol 15:1442–1450

    Article  CAS  PubMed  Google Scholar 

  23. Freedland SJ, Humphreys EB, Mangold LA et al (2005) Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA 294:433–439

    Article  CAS  PubMed  Google Scholar 

  24. Garcia-Albeniz X, Chan JM, Paciorek A et al (2015) Immediate versus deferred initiation of androgen deprivation therapy in prostate cancer patients with PSA-only relapse. An observational follow-up study. Eur J Cancer 51:817–824

    Article  CAS  PubMed  Google Scholar 

  25. Hakenberg OW, Comperat EM, Minhas S et al (2015) EAU guidelines on penile cancer: 2014 update. Eur Urol 67:142–150

    Article  PubMed  Google Scholar 

  26. Hanlon AL, Pinover WH, Horwitz EM et al (2001) Patterns and fate of PSA bouncing following 3D-CRT. Int J Radiat Oncol Biol Phys 50:845–849

    Article  CAS  PubMed  Google Scholar 

  27. Haugnes HS, Aass N, Fossa SD et al (2008) Predicted cardiovascular mortality and reported cardiovascular morbidity in testicular cancer survivors. J Cancer Surviv 2:128–137

    Article  CAS  PubMed  Google Scholar 

  28. Hoffmann R, Plug I, Mckee M et al (2014) Innovations in health care and mortality trends from five cancers in seven European countries between 1970 and 2005. Int J Public Health 59:341–350

    Article  PubMed  Google Scholar 

  29. Horwich A, Fossa SD, Huddart R et al (2014) Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma. Br J Cancer 110:256–263

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Howard SA, Gray KP, O’donnell EK et al (2014) Craniocaudal retroperitoneal node length as a risk factor for relapse from clinical stage I testicular germ cell tumor. AJR Am J Roentgenol 203:415–420

    Article  Google Scholar 

  31. Hussain M, Tangen CM, Higano C et al (2006) Absolute prostate-specific antigen value after androgen deprivation is a strong independent predictor of survival in new metastatic prostate cancer: data from Southwest Oncology Group Trial 9346 (INT-0162). J Clin Oncol 24:3984–3990

    Article  PubMed  Google Scholar 

  32. Iremashvili V, Manoharan M, Rosenberg DL et al (2013) Biopsy features associated with prostate cancer progression in active surveillance patients: comparison of three statistical models. BJU Int 111:574–579

    Article  PubMed  Google Scholar 

  33. Kates M, Tosoian JJ, Trock BJ et al (2015) Indications for intervention during active surveillance of prostate cancer: a comparison of the Johns Hopkins and Prostate Cancer Research International Active Surveillance (PRIAS) protocols. BJU Int 115:216–222

    Article  PubMed  Google Scholar 

  34. Klotz L, Zhang L, Lam A et al (2010) Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol 28:126–131

    Article  PubMed  Google Scholar 

  35. Kollmannsberger C, Tandstad T, Bedard PL et al (2015) Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol 33:51–57

    Article  PubMed  Google Scholar 

  36. Kroon BK, Horenblas S, Lont AP et al (2005) Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases. J Urol 173:816–819

    Article  CAS  PubMed  Google Scholar 

  37. Kundu SD, Feldman DR, Carver BS et al (2015) Rates of teratoma and viable cancer at post-chemotherapy retroperitoneal lymph node dissection after induction chemotherapy for good risk nonseminomatous germ cell tumors. J Urol 193:513–518

    Article  PubMed  Google Scholar 

  38. Lawrentschuk N, Haider MA, Daljeet N et al (2010) ‚Prostatic evasive anterior tumours’: the role of magnetic resonance imaging. BJU Int 105:1231–1236

    Article  PubMed  Google Scholar 

  39. Le Cornet C, Lortet-Tieulent J, Forman D et al (2014) Testicular cancer incidence to rise by 25 % by 2025 in Europe? Model-based predictions in 40 countries using population-based registry data. Eur J Cancer 50:831–839

    Article  Google Scholar 

  40. Leijte JA, Kirrander P, Antonini N et al (2008) Recurrence patterns of squamous cell carcinoma of the penis: recommendations for follow-up based on a two-centre analysis of 700 patients. Eur Urol 54:161–168

    Article  PubMed  Google Scholar 

  41. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft DK, AWMF), Awmf Registernummer: 034/022ol (2014) Interdisziplinäre Leitlinie der Qualität S3 zur Früherkennung, Diagnose und Therapie der verschiedenen Stadien des Prostatakarzinoms, Langversion 3.1. AWMF, Düsseldorf

  42. Ljungberg B, Bensalah K, Canfield S et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67:913–924

    Article  PubMed  Google Scholar 

  43. Mazrani W, O’malley ME, Chung PW et al (2011) Lymph node growth rate in testicular germ cell tumours: implications for computed tomography surveillance frequency. Clin Oncol 23:333–338

    Article  CAS  Google Scholar 

  44. Miller PD, Eardley I, Kirby RS (1992) Prostate specific antigen and bone scan correlation in the staging and monitoring of patients with prostatic cancer. Br J Urol 70:295–298

    Article  CAS  PubMed  Google Scholar 

  45. Morote J, Orsola A, Planas J et al (2007) Redefining clinically significant castration levels in patients with prostate cancer receiving continuous androgen deprivation therapy. J Urol 178:1290–1295

    Article  CAS  PubMed  Google Scholar 

  46. Motamedinia P, Richard JL, Mckiernan JM et al (2012) Role of immediate confirmatory prostate biopsy to ensure accurate eligibility for active surveillance. Urology 80:1070–1074

    Article  PubMed  Google Scholar 

  47. Mottet N, Bellmunt J, Briers E et al (2015) Guidelines on Prostate Cancer-update march 2015. Eur Assoc Urol 10(3):0119494

    Google Scholar 

  48. Nishiyama T (2012) Androgen deprivation therapy in combination with radiotherapy for high-risk clinically localized prostate cancer. J Steroid Biochem Mol Bio 129:179–190

    Article  CAS  Google Scholar 

  49. Perachino M, Cavalli V, Bravi F (2010) Testosterone levels in patients with metastatic prostate cancer treated with luteinizing hormone-releasing hormone therapy: prognostic significance? BJU Int 105:648–651

    Article  CAS  PubMed  Google Scholar 

  50. Philippou P, Shabbir M, Malone P et al (2012) Conservative surgery for squamous cell carcinoma of the penis: resection margins and long-term oncological control. J Urol 188:803–808

    Article  PubMed  Google Scholar 

  51. Pickles T, Hamm J, Morris WJ et al (2012) Incomplete testosterone suppression with luteinizing hormone-releasing hormone agonists: does it happen and does it matter? BJU Int 110:500–507

    Article  Google Scholar 

  52. Picozzi S, Ricci C, Gaeta M et al (2012) Upper urinary tract recurrence following radical cystectomy for bladder cancer: a meta-analysis on 13,185 patients. J Urol 188:2046–2054

    Article  PubMed  Google Scholar 

  53. Pound CR, Partin AW, Eisenberger MA et al (1999) Natural history of progression after PSA elevation following radical prostatectomy. JAMA 281:1591–1597

    Article  CAS  PubMed  Google Scholar 

  54. Rice KR, Magers MJ, Beck SD et al (2014) Management of germ cell tumors with somatic type malignancy: pathological features, prognostic factors and survival outcomes. J Urol 192:1403–1409

    Article  PubMed  Google Scholar 

  55. Roach M III, Hanks G, Thames H Jr et al (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 65:965–974

    Article  PubMed  Google Scholar 

  56. Roobol MJ, Kranse R, Bangma CH et al (2013) Screening for prostate cancer: results of the Rotterdam section of the European randomized study of screening for prostate cancer. Eur Urol 64:530–539

    Article  PubMed  Google Scholar 

  57. Ross AE, Loeb S, Landis P et al (2010) Prostate-specific antigen kinetics during follow-up are an unreliable trigger for intervention in a prostate cancer surveillance program. J Clin Oncol 28:2810–2816

    Article  CAS  PubMed  Google Scholar 

  58. Rouviere O, Vitry T, Lyonnet D (2010) Imaging of prostate cancer local recurrences: why and how? Eur Radiol 20:1254–1266

    Article  PubMed  Google Scholar 

  59. Scher HI, Halabi S, Tannock I et al (2008) Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: recommendations of the Prostate Cancer Clinical Trials Working Group. J Clin Oncol 26:1148–1159

    Article  PubMed Central  PubMed  Google Scholar 

  60. Schoots IG, Petrides N, Giganti F et al (2015) Magnetic resonance imaging in active surveillance of prostate cancer: a systematic review. Eur Urol 67:627–636

    Article  PubMed  Google Scholar 

  61. Siddiqui SA, Boorjian SA, Inman B et al (2008) Timing of androgen deprivation therapy and its impact on survival after radical prostatectomy: a matched cohort study. J Urol 179:1830–1837

    Article  PubMed  Google Scholar 

  62. Soukup V, Babjuk M, Bellmunt J et al (2012) Follow-up after surgical treatment of bladder cancer: a critical analysis of the literature. Eur Urol 62:290–302

    Article  PubMed  Google Scholar 

  63. Stewart SB, Thompson RH, Psutka SP et al (2014) Evaluation of the National Comprehensive Cancer Network and American Urological Association renal cell carcinoma surveillance guidelines. J Clin Oncol 32:4059–4065

    Article  PubMed  Google Scholar 

  64. Sylvester RJ, Van Der Meijden AP, Oosterlinck W et al (2006) Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 49:466–467

    Article  PubMed  Google Scholar 

  65. Tombal B, Miller K, Boccon-Gibod L et al (2010) Additional analysis of the secondary end point of biochemical recurrence rate in a phase 3 trial (CS21) comparing degarelix 80 mg versus leuprolide in prostate cancer patients segmented by baseline characteristics. Eur Urol 57:836–842

    Article  PubMed  Google Scholar 

  66. Trock BJ, Han M, Freedland SJ et al (2008) Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA 299:2760–2769

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  67. Umbehr MH, Platz EA, Peskoe SB et al (2014) Serum prostate-specific antigen (PSA) concentration is positively associated with rate of disease reclassification on subsequent active surveillance prostate biopsy in men with low PSA density. BJU Int 113:561–567

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  68. Van Den Bergh RC, Ahmed HU, Bangma CH et al (2014) Novel tools to improve patient selection and monitoring on active surveillance for low-risk prostate cancer: a systematic review. Eur Urol 65:1023–1031

    Article  Google Scholar 

  69. Zengerling F, Hartmann M, Heidenreich A et al (2014) German second-opinion network for testicular cancer: sealing the leaky pipe between evidence and clinical practice. Oncol Rep 31:2477–2481

    PubMed Central  PubMed  Google Scholar 

  70. Zumsteg ZS, Spratt DE, Romesser PB et al (2014) The natural history and predictors of outcome following biochemical relapse in the dose escalation era for prostate cancer patients undergoing definitive external beam radiotherapy. Eur Urol 67(6):1009–1016

    Article  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt . C.-H. Ohlmann, P. Albers, K. Boehm, M. Graefen, O. Hakenberg, M. Kuczyk, J. Graf, I. Peters und C. Protzel geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66421, Homburg/Saar, Deutschland

    C.-H. Ohlmann

  2. Martini-Klinik, Prostatakarzinom-Zentrum, Universitätsklinik Hamburg-Eppendorf, Hamburg-Eppendorf, Deutschland

    K. Boehm & M. Graefen

  3. Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    M. Kuczyk & I. Peters

  4. Urologische Klinik und Poliklinik, Universität Düsseldorf, Düsseldorf, Deutschland

    P. Albers & J. Graf

  5. Klinik und Poliklinik für Urologie, Universitätsmedizin Rostock, Rostock, Deutschland

    O.W. Hakenberg & C. Protzel

Authors
  1. C.-H. Ohlmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Albers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Boehm
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Graefen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. O.W. Hakenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Kuczyk
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Graf
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. I. Peters
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C. Protzel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C.-H. Ohlmann.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ohlmann, CH., Albers, P., Boehm, K. et al. Nachsorge urologischer Tumorbehandlungen. Urologe 54, 1223–1233 (2015). https://doi.org/10.1007/s00120-015-3936-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-015-3936-7

Schlüsselwörter

Keywords

Search

Navigation