Der Pathologe

, Volume 29, Issue 5, pp 339–347

Active Surveillance des lokalisierten Prostatakarzinoms

Wertigkeit der Prostatastanzbiopsie
Schwerpunkt: Uropathologie

Zusammenfassung

Mehr als 80% der Männer, bei denen heutzutage ein Prostatakarzinom (PCA) durch Screening diagnostiziert wird, sterben nicht mehr an den Folgen dieser Erkrankung. Etwa 70% befinden sich in einem frühen, auf die Prostata begrenzten Stadium, nahezu die Hälfte der PCA sind klein (<5 cm3) und zeigen oft über Jahre keine Progression (insignifikantes PCA). Man geht heute davon aus, dass durch das PSA-Screening die Karzinomdiagnose um etwa 9 Jahre vorverlegt wird und eine sofortige radikale Prostatektomie oder Strahlentherapie bei etwa jedem 3. Patienten eine Übertherapie darstellt. Die aktive Überwachung („active surveillance“) solcher Patienten mit einer auf den medizinisch oder persönlich erforderlichen Zeitpunkt verschobenen Intervention könnte möglicherweise für viele Patienten eine gute Alternative zur sofortigen kurativen Therapie darstellen. Dies setzt aber die sichere Identifizierung von Patienten mit hohem Progressionsrisiko voraus. Der zuverlässigen Aufarbeitung und detaillierten, über die alleinige Karzinomdiagnose hinausgehenden Befundung von Prostatastanzbiopsien kommt dabei eine zentrale Rolle zu. Ein Gleason-Score ≤6 und eine Tumorinfiltration in weniger als 3 Stanzen sind Prädiktoren des insignifikanten PCA. Neben dem gezielten Gleason-Training ist auch das Erkennen solcher Befunde von Bedeutung, bei denen sich von vornherein ein Zuwarten verbietet.

Schlüsselwörter

Insignifikantes Prostatakarzinom Active Surveillance Gleason-Score Prostatastanzbiopsie Standardisierte Aufbereitung 

Active surveillance of localized prostate cancer

Significance of prostate core needle biopsies

Abstract

Today, more than 80% of men diagnosed with prostate cancer (PCA) by PSA screening do not die from the sequelae of their disease. About 70% present with early, organ-confined cancer and almost half of them are small (<5 cm3) without evidence of progression over years (insignificant PCA). It is assumed that screening brings the diagnosis of PCA forward by about 9 years and that in almost one third of these cases immediate radical prostatectomy or radiotherapy would result in overtreatment. Thus, the treatment strategy of “active surveillance” with selective but delayed intervention for patients with organ-confined PCA could be an attractive alternative to the known curative therapy options. However, a prerequisite of such a therapeutic approach would be a precise identification of patients at high risk for cancer progression. Careful work-up of prostate core needle biopsies including improved pre-embedding preparation and detailed interpretation are of the utmost importance. A Gleason score ≤6 and tumor in only one or two cores are considered predictive of organ-confined cancer. Pathologists should concentrate on correct Gleason scoring in core needle biopsies and identification of lesions that exclude a patient from active surveillance.

Keywords

Insignificant prostate cancer Active surveillance Gleason score Core needle biopsy Improved pre-embedding 

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Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Institut für Pathologie NordhessenKasselDeutschland
  2. 2.Klinik für UrologieKlinikum Kassel GmbH, KasselKasselDeutschland

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