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Die Lokaltherapie des Prostatakarzinoms mit thermisch ablativer Energie

Local treatment of prostate cancer using thermal-ablative energy

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Zusammenfassung

Thermische und thermisch ablative Verfahren für die Therapie des Prostatakarzinoms werden – abgesehen von historischen Vorläufern – seit ca. 1980 systematisch untersucht, es wurden zahlreiche experimentelle und klinische Arbeiten publiziert. Dabei kamen verschiedene Techniken zur Anwendung, neben der transurethralen Ablation des Prostatagewebes mit Laser- oder Mikrowellenenergie liegt der Fokus in der interstitiellen Applikation von Laser- oder Mikrowellenstrahlung sowie der induktiven Erwärmung des Gewebes im Magnetfeld nach vorheriger Implantation magnetischer Seeds oder Nanopartikel.

Mit allen genannten Verfahren wurden erste klinische Studien mit insgesamt ca. 350 Patienten behandelt, deren Ergebnisse mangels adäquater Kontrollparameter der älteren Studien und der zu kurzen Nachbeobachtungszeit aller Studien nicht beurteilt werden können. Aussagen zur therapiebedingten Morbidität scheinen möglich und sind durchweg positiv bei geringen Raten schwerwiegender unerwünschter Ereignisse, doch muss hier vor einer Verallgemeinerung die Patientenauswahl berücksichtigt werden, weiterhin der Stand der Technologie zur Zeit der jeweiligen Studien.

Die verschiedenen Publikationen werden ausführlich referiert und zusammenfassend bewertet. Nach Meinung des Autors sind die Ansätze der thermischen und thermisch ablativen Therapie des Prostatakarzinoms interessant, in Anbetracht der vorhandenen Alternativen darf die Machbarkeit jedoch nicht die Sinnhaftigkeit ersetzen.

Abstract

Thermal and thermal-ablative procedures for treating prostate cancer have been investigated systematically since approximately 1980 (apart from some historical predecessors), and numerous experimental and clinical reports have been published on this subject. Various technologies have been used, including transurethral ablation of prostatic tissue using laser or microwave energy, interstitial application of laser or microwave energy, and inductive heating of previously implanted thermoseeds or injected magnetic nanoparticles in a magnetic field.

For all of these procedures, clinical studies with a total of some 350 patients have been performed. However, the results cannot be judged correctly because of a lack of adequate control parameters for the older studies and inadequately short follow-up of all studies. Conclusions regarding treatment-related morbidity seem to be possible, with a generally positive impression and low rates of adverse effects. But before such results can be generalized, patient selection bias and the technology standards that existed when the studies were performed must be taken into consideration.

Various papers are reviewed and summarized. In the author’s opinion, the different options for thermal and thermal-ablative treatment of prostate cancer are very promising, but in light of the existing standard procedures, feasibility must not overrule reasonableness.

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  1. Klinik für Urologie und Kinderurologie, Diakoniekrankenhaus Rotenburg/Wümme, Elise-Averdieck-Straße 17, 27356, Rotenburg/Wümme, Deutschland

    R. Muschter

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Muschter, R. Die Lokaltherapie des Prostatakarzinoms mit thermisch ablativer Energie. Urologe 48, 729–739 (2009). https://doi.org/10.1007/s00120-009-1983-7

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