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Bildgebende Verfahren bei Primärdiagnose und Staging des Prostatakarzinoms

Imaging modalities for primary diagnosis and staging of prostate cancer

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Zusammenfassung

Die neue S3-Leitlinie Prostatakarzinom schließt den Einsatz bildgebender Verfahren in die Früherkennung, Primärdiagnostik und Stadieneinteilung des Prostatakarzinoms ein. Früherkennung und Primärdiagnose beruhen zunächst auf digitaler rektaler Untersuchung, PSA-Wert und Prostatabiopsie. Unter den bildgebenden Verfahren zeigt die MRT die besten Testgüteparameter. Die Magnetresonanztomographie (MRT) ersetzt zwar nicht die Biopsie zum Beweis des Prostatakarzinoms, kann aber nach vorangehender negativer Biopsie mit ihrem hohen negativen Vorhersagewert ggf. weitere Biopsien ersparen. Für die Beurteilung der T-Kategorie zeigt die MRT ebenfalls die besten Testgüteparameter; ihr klinischer Einsatz ist jedoch aufgrund begrenzter therapeutischer Konsequenzen eingeschränkt. Für das N-Staging bei Patienten mit hohem Risiko für Lymphknotenbefall kann die MRT mit hoher Spezifität ggf. eine unnötige Lymphadenektomie verhindern. Risikoadaptiert sollen Knochenszintigraphie und ggf. weitere radiologische Untersuchungen zur Beurteilung hämatogener Metastasen (M-Kategorie) durchgeführt werden.

Abstract

The new S3 guideline on prostate cancer includes imaging modalities applied for early detection, primary diagnosis, and staging of prostate cancer. Detection and primary diagnosis are based on digital rectal examination, serum PSA levels, and prostate biopsy. Among the imaging modalities, MRI shows the highest test quality parameters. Although MRI cannot replace biopsy to prove prostate cancer, its high negative predictive value can help to reduce the number of subsequent biopsies after negative prostate biopsy. For T-staging, MRI also demonstrates the highest test quality parameters. Its clinical application is limited, since therapeutic consequences are restricted. Due to its high specificity, MRI can save unnecessary pelvic lymph node dissections in patients at high risk for lymph node metastasis (N-staging). Risk-adjusted bone scans, complemented by additional radiological examinations if necessary, remain the standard to assess hematogenous metastasis (M staging).

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Danksagung

Für die angeregten Diskussionen und den wissenschaftlichen Austausch bei der Erstellung des Kapitels „Diagnostik und Stadieneinteilung“ der neuen S3-Leitlinie Prostatakarzinom danken wir unseren Kollegen PD Dr. med. Dirk Beyersdorff, Berlin, Prof. Dr. med. Markus Graefen, Hamburg, Prof. Dr. med. Holger Palmedo, Bonn, und Prof. Dr. med. Mark Schrader, Berlin.

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Authors and Affiliations

  1. Institut für klinische Radiologie, LMU München, Klinikum der Universität München, Ziemssenstraße 1, 80336, München, Deutschland

    U.G. Mueller-Lisse

  2. Urologische Klinik und Hochschulambulanz , Charité-Universitätsmedizin Berlin, Berlin, Deutschland

    K. Miller

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  1. U.G. Mueller-Lisse
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  2. K. Miller
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Correspondence to U.G. Mueller-Lisse.

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Mueller-Lisse, U., Miller, K. Bildgebende Verfahren bei Primärdiagnose und Staging des Prostatakarzinoms. Urologe 49, 190–198 (2010). https://doi.org/10.1007/s00120-010-2235-6

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  • DOI: https://doi.org/10.1007/s00120-010-2235-6

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