Zusammenfassung
Durch die PSA-gestützte Früherkennung werden immer mehr Karzinome entdeckt, die ohne Screening unerkannt geblieben wären. Vor diesem Hintergrund gewinnen defensive Strategien an Bedeutung. Die aktuelle S3-Leitlinie trägt dieser Entwicklung Rechnung, indem sie „active surveillance“ (AS) und „watchful waiting“ (WW) als gleichberechtigte Therapieoptionen beim lokal begrenzten Prostatakarzinom empfiehlt. Die verfügbaren Daten zu AS, auf denen die Leitlinienempfehlungen beruhen, weisen darauf hin, dass es sich für eine definierte Patientenklientel mit Tumoren geringen Risikoprofils um eine sichere Therapieoption handelt. Dennoch sind in der Praxis die Vorbehalte gegen defensive Strategien hoch, obwohl eine kurative Maßnahme bei Patienten mit Low-risk-Tumoren von geringem therapeutischem Nutzen ist.
Abstract
Early detection based on measurement of the prostate-specific antigen (PSA) has resulted in more cases of prostate cancer being discovered that would have remained unnoticed without screening. Against this background, defensive strategies gain in importance. The current S3 guideline takes this development into account by recommending “active surveillance” (AS) and “watchful waiting” (WW) as equally accepted treatment options for localized prostate cancer. The available data concerning AS, on which the guideline recommendations rely, indicate that it is a safe treatment option for a well-defined patient cohort with low-risk tumors. Nevertheless, defensive strategies are regarded with considerable reservation in clinical practice, although curative measures in patients with low-risk tumors are of little therapeutic value.
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Interessenkonflikt
Der korrespondierende Autor weist auf folgende Beziehungen hin: Er ist Mitglied des Advisory Boards der Fa. Astra-Zeneca und der Fa. Novartis und Mitglied der Steuergruppe zur Erstellung der S3-PCA-Leitlinie. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.
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Weißbach, L., Schaefer, C. & Heidenreich, A. Ein Paradigmenwechsel. Urologe 49, 199–205 (2010). https://doi.org/10.1007/s00120-010-2236-5
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DOI: https://doi.org/10.1007/s00120-010-2236-5