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Bagatellisierung des Prostatakarzinoms?

Stadien-Shift und mögliche Ursachen

Trivialization of prostate cancer?

Stage shift and possible causes

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Zusammenfassung

Hintergrund

Die U.S. Preventive Services Task Force hat 2012 mit einer stark negativen „Grad-D-Empfehlung“ den PSA(prostataspezifisches Antigen)-Test nicht nur nicht empfohlen, sondern sogar vor ihm gewarnt. In den USA kam es daraufhin zu einem „stage shift“ hin zu fortgeschritteneren Tumorstadien unter den neu entdeckten Prostatakarzinomen (PCA). Im Gegensatz zur höchst fragwürdigen amerikanischen PLCO-Studie zeigt die europäische ERSPC-Studie aber eine klare Senkung der PCA-bedingten Mortalität.

Ziel der Arbeit

Wir analysieren bei unseren Patienten, ob sich die Tumorstadienverteilung bei kurativ behandelten PCA signifikant veränderte, ob dies Einfluss auf die perioperativen Ergebnisse und Komplikationsraten nimmt und wodurch diese Veränderungen entstanden sein könnten.

Material und Methoden

Patientenkollektive nach radikaler Prostatektomie aus 2008 bis 2010 wurden anhand demographischer Daten, intraoperativer Verläufe, peri- und postoperativer Komplikationen und histopathologischer Ergebnisse mit denen aus 2017 verglichen.

Ergebnisse

1276 Operationen wurden analysiert. Bereits die präoperativen PSA-Werte wiesen eine deutliche Erhöhung im Jahr 2017 auf (10,5 ± 13,4 ng/ml vs. 8,4 ± 9,1 ng/ml; p = 0,032). Die pathologische Stadieneinteilung ergab eine 20%ige Zunahme der T3-Tumoren (49,4 % vs. 29,0 %; p < 0,001). Karzinome mittlerer und schlechter Differenzierung und damit hoher Aggressivität lagen um 11,2 % (p < 0,001) bzw. 10,4 % (p < 0,001) signifikant häufiger vor. Die Zahl der Patienten mit einer lymphonodalen Metastasierung war sogar 4‑fach angestiegen (4,5 % vs. 16,9 %; p < 0,001).

Schlussfolgerung

Es zeigt sich in den Prostatektomiekollektiven eine Verschiebung zu ungünstigen und metastasierten Tumorstadien. Dieser negative Trend scheint maßgeblich durch eine geringere Akzeptanz der Früherkennung mittels PSA-Bestimmung bedingt.

Abstract

Background

According to the strongly negative grade D recommendation of the U.S. Preventive Services Task Force in 2012, the prostate-specific antigen (PSA) test was not only not recommended but was also warned against. As a result in the USA there was a stage shift towards more advanced tumor stages under the newly detected prostate cancers; however, in contrast to the highly questionable American PLCO study, the European ERSPC study showed a clear reduction in prostate cancer-related mortality.

Objective

In this patient cohort it was investigated whether the tumor stage distribution in curatively treated prostate cancer has significantly changed, whether this has an influence on the perioperative results and complication rates and how these changes could have occurred.

Material and methods

Patients after radical prostatectomy from 2008 to 2010 were compared to those from 2017. Demographic data, intraoperative courses, perioperative and postoperative complications and histopathological results were compared.

Results

A total of 1276 operations were analyzed. Preoperative PSA levels showed a significant increase in 2017 (10.5 ± 13.4 ng/ml vs. 8.4 ± 9.1 ng/ml, p = 0.032). The pathological staging revealed a 20% increase in T3 tumors (49.4% versus 29.0%, p < 0.001). Correspondingly, moderately and poorly differentiated cancers and therefore those with higher aggressiveness were significantly more frequent with 11.2% (p < 0.001) and 10.4% (p < 0.001), respectively. The number of patients with lymph node metastases at prostatectomy even increased fourfold (4.5% vs. 16.9%, p < 0.001).

Conclusion

In the radical prostatectomy group, there was a shift to unfavorable and metastatic tumor stages. This negative trend seems largely to be caused by a lower acceptance of early detection by means of PSA determination.

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Author information

Correspondence to PD Dr. M. Saar.

Ethics declarations

Interessenkonflikt

M. Saar, M.S.K.M. Abdeen, C. Niklas, Z.T.F. Al-Kailani und M. Stöckle geben an, dass kein Interessenkonflikt besteht. S. Siemer ist als Proktor für die Firma Intuitive tätig.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Saar, M., Abdeen, M.S.K.M., Niklas, C. et al. Bagatellisierung des Prostatakarzinoms?. Urologe 58, 1461–1468 (2019) doi:10.1007/s00120-019-01039-1

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Schlüsselwörter

  • Lymphknotenmetastasen
  • Radikale Prostatektomie
  • Stadien-Shift
  • Active Surveillance
  • Prostataspezifisches Antigen

Keywords

  • Lymph node metastases
  • Prostatectomy
  • Stage shift
  • Active surveillance
  • Prostate specific antigen