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Neuroendokrines Prostatakarzinom

  • S. Tritschler
  • R. Erdelkamp
  • C. Stief
  • M. Hentrich
Originalien

Zusammenfassung

Neuroendokrine Prostatakarzinome (NEPC) treten zumeist in Form eines gemischt neuroendokrin-azinären Prostatakarzinoms auf, das sich unter antiandrogener Therapie entwickelt (t-NEPC). Etwa 30–40 % aller metastasierten kastrationsresistenten Prostatakarzinome weisen neuroendokrine Anteile auf. Primäre kleinzellige Prostatakarzinome sind hingegen äußerst selten. Ein t‑NEPC sollte in Betracht gezogen werden, wenn trotz rascher Progression ein disproportional niedriger PSA(prostataspezifisches Antigen)-Wert vorliegt und neuroendokrine Marker wie Chromogranin A oder neuronenspezifische Enolase erhöht sind. Hierbei korreliert das Risiko für die Entwicklung eines t‑NEPC mit dem initialen Gleason-Score. Die Therapie orientiert sich an der Behandlung kleinzelliger Bronchialkarzinome. Bei negativem PSA ist eine Chemotherapie mit Cisplatin und Etoposid Therapie der Wahl, worunter Ansprechraten von 30–60 % mit einem medianen Überleben von meist unter einem Jahr erreicht werden können. Bei deutlich erhöhtem PSA sollte eine Chemotherapie mit Carboplatin und Docetaxel erwogen werden.

Schlüsselwörter

Prostata Neuroendokrine Karzinome Antiandrogene Therapie Chromogranin A Chemotherapie 

Carcinome neuroendocrine de la prostate

Résumé

Les carcinomes neuroendocrines de la prostate (CNEP) se présentent le plus souvent sous la forme dʼun cancer mixte neuroendocrine et acinaire de la prostate, se développant sous traitement anti-androgénique (CNEP-t). Environ 30 à 40 % de tous les cancers prostatiques résistant à la castration présentent des parts neuroendocrines. Les cancers prostatiques primaires à petites cellules sont par contre extrêmement rares. Lorsque le taux de PSA (antigène spécifique de la prostate) est plus faible quʼattendu en présence dʼune progression rapide de la maladie et de taux accrus de marqueurs neuroendocrines tels que la chromogranine A ou lʼénolase spécifique des neurones, il faut songer à la possibilité dʼun CNEP-t. Le risque de développer un CNEP-t est corrélé ici au score Gleason initial. Lʼapproche thérapeutique sʼinspire du traitement des carcinomes pulmonaires à petites cellules. Lors dʼun résultat négatif du test de PSA, une chimiothérapie à base de cisplatine et dʼétoposide est le traitement de choix, permettant dʼatteindre des taux de réponse de 30 à 60 % avec une survie médiane généralement inférieure à un an. Dans le cas dʼun taux nettement accru de PSA, on envisagera une chimiothérapie à base de carboplatine et de docétaxel.

Mots clés

Prostate Carcinomes neuroendocrines Traitement anti-androgénique Chromogranine A Chimiothérapie 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

S. Tritschler, R. Erdelkamp, C. Stief und M. Hentrich geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2018

Authors and Affiliations

  • S. Tritschler
    • 1
  • R. Erdelkamp
    • 2
  • C. Stief
    • 1
  • M. Hentrich
    • 3
  1. 1.Urologische Klinik und Poliklinik, Klinikum GroßhadernLMU MünchenMünchenDeutschland
  2. 2.Pathologisches InstitutLMU MünchenMünchenDeutschland
  3. 3.Medizinische Klinik IIIRotkreuzklinikum MünchenMünchenDeutschland

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