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Der Urologe

, Volume 55, Issue 3, pp 333–344 | Cite as

Multimodale Therapie des lokal fortgeschrittenen Prostatakarzinoms

  • A. HeidenreichEmail author
  • D. Böhmer
Leitthema

Zusammenfassung

Das lokal fortgeschrittene Prostatakarzinom (LFPCA) macht etwa 5–10 % der neu diagnostizierten Prostatakarzinome (PCA) aus. Das LFPCA ist definiert durch das Vorliegen von extraprostatischer Extension, Samenblaseninvasion, Blasenhalsinvasion oder lokoregionärer Lymphknotenmetastasen. Nur durch eine multimodale Therapiestrategie kann die hohe Mortalitätsrate von 10–15 % verbessert werden. Voraussetzung für eine individuelle multimodale Therapie ist eine adäquate lokale Stagingdiagnostik durch eine multiparametrische Magnetresonanztomografie. Als lokale Primärtherapie kommen die extendierte radikale Prostatektomie mit extendierter pelviner Lymphadenektomie (pLAD) bzw. die intensitätsmodulierte Strahlentherapie in Kombination mit einer begleitenden Androgendeprivation in Betracht. Beide Therapieverfahren können durch die Addition einer adjuvanten Strahlentherapie bzw. einer Salvage-Operation bzw. die Integration neoadjuvanter und adjuvanter medikamentöser Behandlungsmaßnahmen wie Chemotherapie oder Androgenrezeptorinhibitortherapie optimiert werden. Der Beitrag diskutiert die aktuellen Konzepte der multimodalen Diagnostik und Therapie.

Schlüsselwörter

Prostatektomie Strahlentherapie Androgenantagonisten Lymphadenektomie 

Multimodal therapy of locally advanced prostate cancer

Abstract

Locally advanced prostate cancer (LAPCA) comprises about 5–10 % of all newly diagnosed prostate cancers and is associated with the highest prostate cancer specific mortality (approximately 8–20 %). LAPCA is defined by the presence of extraprostatic extension, seminal vesicle invasion, and bladder neck infiltration of pelvic lymph node metastases. It is evident that prognosis can only be improved by interdisciplinary multimodality treatment strategies. Adequate local staging by multiparametric MRI is one of the cornerstones for an individualized, risk-adapted treatment approach. This might consist of extended radical prostatectomy with an extended pelvic lymphadenectomy or intensity-modulated radiation therapy with androgen deprivation as the primary local therapeutic approach. Both treatment strategies may be combined with neoadjuvant or adjuvant radiation therapy or salvage surgery. Combination with neoadjuvant or adjuvant chemotherapy and new androgen receptor pathway inhibitors might also be possible. This article summarizes the current treatment strategies for LAPCA.

Keywords

Prostatectomy Radiation therapy Androgen antagonists Lymphadenectomy 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

Axel Heidenreich und Dirk Böhme geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Klinik für UrologieUniversitätsklinikum KölnKölnDeutschland
  2. 2.Klinik für Radioonkologie und StrahlentherapieCharité Campus Benjamin FranklinBerlinDeutschland

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