Zusammenfassung
Rezidive nach kurativ intendierter Therapie des lokalisierten Prostatakarzinoms mittels Radiotherapie oder radikaler Prostatektomie treten auch in Zeiten zunehmend verbesserter Patientenselektion in einem signifikanten Prozentsatz auf. Die Definition des biochemischen Rezidivs nach operativer Therapie ist ab einem Schwellenwert von 0,4 ng/ml gegeben. Nach Radiotherapie bei verbliebenem Organ und residualer PSA-Produktion ist die Definiton des Rezidivs komplizierter; der derzeit geläufigste Algorithmus geht auf den ASTRO-Konsensus aus dem Jahre 1996 zurück und definiert das Rezidiv bei Vorliegen von 3 konsekutiven PSA-Anstiegen oberhalb des posttherapeutischen Nadirs. Das biochemische Rezidiv kann Surrogat eines Lokalrezidivs, einer systemischen Metastasierung oder einer Kombination beider Entitäten sein. Die Differenzierung von Lokalrezidiv und Fernmetastasierung erfolgt, abgesehen von bildgebenden Verfahren, primär anhand von Variablen der PSA-Kinetik, wobei kurze PSA-Verdopplungszeiten und PSA-Anstieg frühzeitig nach Primärtherapie auf ein systemisches Problem hindeuten.
Abstract
Relapses after curative therapy for localised prostate cancer using radiotherapy or radical prostatectomy occur in a significant percentage of cases, even in times of continually improving patient selection. The definition of a biochemical relapse after surgery is a PSA value of ≥0.4 ng/ml. After radiotherapy with maintenance of the organ and residual PSA production the definition is more complicated. The current algorithm is based on the ASTRO consensus of 1996 and defines a relapse as three consecutive increases in PSA above the post-therapeutic low. A biochemical relapse can indicate a local relapse, systemic metastasising of the disease or a combination of both. The differentiation of these two possibilities can be made, apart from imaging modalities, primarily on the basis of variation in PSA kinetics, whereby a short PSA doubling time and early PSA increase after primary therapy indicate a systemic problem.
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Fichtner, J. Das PSA-Rezidiv nach radikaler Prostatektomie und Strahlentherapie. Urologe 45, 1255–1259 (2006). https://doi.org/10.1007/s00120-006-1208-2
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DOI: https://doi.org/10.1007/s00120-006-1208-2