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Chemotherapie beim hormonrefraktären Prostatakarzinom

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Zusammenfassung

Die zunehmende Lebenserwartung und die steigende Zahl weitgehend gesunder älterer Männer führt dazu, dass vermehrt Patienten nach palliativer Hormontherapie oder kurativer Therapie nicht mehr hormonsensible Rezidive eines Prostatakarzinoms erleben. Nach 10 Jahren ohne therapeutischen Fortschritt beim hormonrefraktären Prostatakarzinom hat die Einführung neuer Substanzen zu einer Renaissance der Chemotherapie geführt. Sie kann zwar weiterhin keine Heilung versprechen, erfüllt aber neben deutlichen und längerfristigen Remissionen wesentliche Kriterien der Palliation, nämlich gute Verträglichkeit und eine Verbesserung der Lebensqualität. Hier haben sich v. a. die Taxane als Monotherapie oder in Kombination mit Estramustin bei guter Wirksamkeit und Verträglichkeit sowie Mitoxantron in Kombination mit Prednisolon bei mäßiger Wirksamkeit, aber deutlicher Symptomreduktion bewährt. Trotz Hinweisen für eine Lebensverlängerung durch die moderne Chemotherapie fehlt der eindeutige Beweis hierfür. Die deutliche Schmerzreduktion bei geringer therapiebedingter Morbidität macht die Chemotherapie des hormonrefraktären Prostatakarzinoms häufig zur besseren Alternative gegenüber dem alleinigen Schmerz- und Komplikationsmanagement.

Abstract

An increasing life expectancy and the growing number of largely healthy older men have lead to more patients with hormone insensitive relapses after palliative hormone or curative therapy for prostate cancer. After 10 years without therapeutic improvement for hormone refractory prostate cancer, the introduction of new substances has led to a revival of chemotherapy. Although a definitive cure is still not possible, such chemotherapy fulfils important palliative criteria—good toleration and an improvement in quality of life—in addition to distinct long-term remission. For example, taxane as a monotherapy or in combination with estramustine is effective and well tolerated while mitoxantrone in combination with prednisolone, although of limited effectiveness, leads to a substantial reduction in symptoms. Although evidence for increased longevity through modern chemotherapy is available, this has still not been definitively demonstrated. The substantial reduction in pain and therapy related morbidity frequently makes chemotherapy for hormone refractive prostate cancer a superior alternative to simple pain and complication management.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Universitätsklinikum „Carl Gustav Carus“ der TU Dresden, Dresden

    M. P. Wirth & J. Nippgen

  2. Klinik und Poliklinik für Urologie, Universitätsklinikum „Carl Gustav Carus“, Fetscherstraße 74, 01307, Dresden

    M. P. Wirth

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Correspondence to M. P. Wirth.

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Wirth, M.P., Nippgen, J. Chemotherapie beim hormonrefraktären Prostatakarzinom. Urologe [A] 42, 1453–1460 (2003). https://doi.org/10.1007/s00120-003-0452-y

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